Howard Dean has become the talisman for a bundle of anxieties (the bank bailouts, Afghanistan surging, card check, state secrets, gay rights, civil liberties) -- this was HIS party before it was Obama's, remember -- but now, figures like Andy Stern, the White House's most powerful labor ally, are voicing doubts about Obama's willingness to fight for progressive causes.
The White House is clearly worried -- not so much about final passage of health care, but about how Democrats perceive the health care victory. It would be a disaster for them if Democrats, taking their cues from the liberal activists
in Washington, don't come around to the view that health care is a major accomplishment. It is clear that this ventilation process has already cost the health care plan support among rank-and-file Democrats.
The White House and Congress need a win, for the sake of winning something, but also to demonstrate to voters that Democrats can govern. The policy consequences of the Senate health care bill will determine whether people support it, but the politics of the moment will influence how people perceive the policy outcomes. (As Bill Clinton, in a very rare public statement, put it, "Allowing this effort to fall short now would be a colossal blunder...") It is especially important to achieve a win, the White House believes, at a time when Americans are growing even more skeptical of big institutions (and government) to do anything. And it should be a satisfying win in the face of such opposition. The country is moving right, policy-wise. Obama's folks contend that it's because government needs to do a better job. Liberal activists locate this trend in Obama's having failed to lead the progressive majority he built.
The two arguments are these: the White House contends that the bill is a foundation -- and will meaningfully improve the lives of 30 million people without insurance -- and represents the greatest advance for American health care since LBJ and Medicare. The activist left, broadly, has come to the view that the Senate (and the White House) are held hostage by the forces to whom we've outsourced our health care: the insurance industry, who've just received a massive subsidy in exchange for minimal sacrifices.
The truth, of course, is that both of these arguments are valid. Which one you accept is a matter of taste, preference, mental furniture, ideological commitment, geography.
Beyond this, though, it's a matter of respect: liberals aren't feeling the love. They feel taken for granted. They feel as if the president hasn't done enough to bring them into his coalition. They projected a lot onto candidate Obama, and -- for a variety of reasons, some valid -- don't see the same guy. It is as if Obama's approach to governing assumes that the only influential audiences are the ones he has to court. The White House is looking for ways to palliate the anxiety.