Obama Faces a Critical Moment for His Presidency

WASHINGTON — President Obama returned to the White House from his summer break on Sunday determined to jump-start his struggling presidency by reasserting command of the health care debate and recalibrating expectations that some advisers believe got away from him.

With his honeymoon seemingly over and his White House on the defensive, Mr. Obama faces what friends and foes alike call a make-or-break moment in his young administration. Because he has elevated health care to such a singular priority, advisers said he must force through a credible plan or risk crippling his presidency.

“It goes without saying that a lot is riding now on his ability to re-energize the health care debate and bring it home to a successful conclusion,” said John D. Podesta, who ran Mr. Obama’s transition and still advises him on health care, energy and other issues. “Nothing will influence the perception of the presidency more than whether he can be successful in getting a health care bill through the Congress.”

Recognizing the stakes, Mr. Obama has worked on a strategy for autumn to regain the initiative. He talked on Thursday from Camp David with Nancy Pelosi, the House speaker, and Harry M. Reid, the Senate majority leader. He spent part of Sunday working on this week’s speech to the nation and dispatched top surrogates to the talk shows to try to reframe the health care debate. And he has two meetings scheduled for Monday with his health policy and political advisers planned around a trip to Cincinnati to observe Labor Day.

As much as health care has consumed the president, other vexing issues await him in the fall. In the coming weeks, he will decide whether to order thousands more troops to Afghanistan and pursue new sanctions against Iran. He will host a meeting of the Group of 20 nations to spur the world economy and push forward with arms control negotiations with Russia.

Now, as he prepares for Wednesday’s address before a joint session of Congress, Mr. Obama and his team are simultaneously trying to figure out how they got into this dilemma and how to get out of it. An administration that swept into office just seven months ago on a wave of hope and optimism has burned through good will and public patience in swift fashion and now finds itself under fire from both the left and the right.

He faces a crisis of expectations tough to manage. Can he form a health care compromise that satisfies both his liberal base and fiscal conservatives in his own party, much less the other one? Can he stanch the slide in support for the war in Afghanistan even as he considers sending more troops? Can he soothe discontent with an economy that appears to have bottomed out but remains moribund? Can he change the tenor of debate in a capital that seems as polarized as ever?

“To govern is to make choices, and to make choices is to make some unhappy,” David Axelrod, the president’s senior adviser, said in an interview. “He made some very tough decisions that pulled us away” from a new Great Depression. “But he had to expend some political capital to do that. He’s expending some capital to do something that’s very important, which is to bring security and health care to people who don’t have it.”

Some Republicans said Mr. Obama’s fundamental mistake was believing his election presaged a larger ideological shift in the country. “If they thought that his popularity and the good will he had would support liberal policies, they were wrong,” said Charles R. Black, a Republican strategist who worked last year for Senator John McCain of Arizona, Mr. Obama’s Republican presidential opponent.

White House officials have signaled that they are prepared to scale back their aspirations for the health care legislation. In private conversations, some said they would be happy even if they end up with a pared-back program that can serve as a basis for future efforts.

One element clearly on the table is a proposed government-backed health insurance plan to compete with private insurers. Just as they have in recent weeks, White House officials indicated Sunday that Mr. Obama would continue to push for the so-called public option but they did not make it a condition of signing whatever bill lands on his desk.

Mr. Axelrod, appearing on NBC’s “Meet the Press,” said the public option “is a valuable tool” but added that “it shouldn’t define the whole health care debate.” Robert Gibbs, the White House press secretary, said on ABC’s “This Week With George Stephanopoulos” that Mr. Obama would “draw some lines in the sand” on Wednesday but “I doubt we’re going to get into heavy veto threats.”

The conundrum for the president, though, was on display during a roundtable discussion later on the same program. Robert Dole, the former Republican senator from Kansas and onetime presidential nominee, said a public option would never pass the Senate. Representative Maxine Waters, Democrat of California and a leader of Congressional liberals, said no plan could pass with House without a public option.

Mr. Obama is hardly the first president to run into trouble after the bunting and balloons have vanished, but his slipping support has fueled a narrative about a young and relatively inexperienced president who overinterpreted his mandate and overreached in his policies. His job approval rating has fallen to 56 percent from 62 percent since February in polls taken by The New York Times and CBS News. Other surveys register an even sharper drop.

But his overall standing with the public is still healthy, and his first seven months have not been as rocky as those of Bill Clinton or Gerald R. Ford. Mr. Clinton, at least, later recovered enough to win re-election. And Mr. Obama showed during last year’s campaign that he has the capacity to ride out rough moments. If he ultimately gets some form of health care program passed that he can call a victory, this turbulence may ultimately be forgotten.

Vin Weber, a former Republican congressman from Minnesota, said the backlash to Mr. Obama’s spending and health care proposals had eroded his support but not fundamentally shifted the nation’s politics. “The American people are sort of returning to where they were,” he said. “I don’t think they’ve made a big swing to the right. They’re returning to their centrist moorings.”

Of all the challenges Mr. Obama faces this fall, health care has come to dominate so much that the fate of the rest of his domestic program, particularly climate change legislation and new regulations on the financial industry, may depend in part on whether he wins this fight.

“He’s gone all in,” said Matt Bennett, vice president of Third Way, a Democratic-oriented advocacy organization, using a poker term. “Everyone’s watching. The bets are all on the table. And we’re just waiting to see what the cards say.”