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Obama Bets Big on Sweeping Health Care Reform in 2009

Last night, Nate concluded that, based on what is likeliest to happen to his approval ratings in the coming 18 months, Barack Obama’s optimal window for aggressive agenda-setting is 2009 (“it makes a lot of sense for Obama to be pursuing a very ambitious agenda right now”).

Today marks the beginning of the White House Health Reform Summit. In an ambitious East Room speech beginning now (1pm Eastern), Obama states definitively, “[O]ur goal will be to enact comprehensive health care reform by the end of this year.” He’s all-in.

“Health care is no longer just a moral imperative, it is a fiscal imperative,” Obama says.

By so clearly delineating his intention to sign legislation in the next 10 months, the White House is ignoring the “cable chatter” and the vogue-of-the-week “overload” buzzword. It surely knows that a major benchmark tied to those approval ratings will be Obama’s effectiveness in shepherding the process forward. It’s doubtful that voters would penalize him for a slop factor of a couple extra months, particularly if there are unexpected signs of economic turnaround, but there isn’t much more room based on the clarity in this speech.

This means Obama has two choices: (1) accomplish the sweeping goal he’s laying out; or (2) make it clear through an aggressive use of the bully pulpit that he’s doggedly on the job, in the event Congress balks and thwarts the effort. If he can’t do either one of these things, with (1) clearly being preferable to (2), voters will hold him accountable.

Significantly, the reform must be ambitious for him to get credit. He’s referencing Teddy Roosevelt, 100 years of health buildup, and deriding “tinkering.” Voters will know the difference between a tinker and change you can believe in, and Obama seems to understand that.

The speech is clearly one the White House feels good about. Calling the exploding cost of health care, “one of the greatest threats… to the very foundation of our economy,” Obama blames “failures of will, or Washington politics, or industry lobbying” as the culprit for the current crisis.

As has become a recent trademark, Obama cites an election mandate to justify the aggressive goal. While he will listen to many viewpoints and insists “[t]here will be no sacred cows,” Obama strongly warns that this effort will not be hijacked by oppositional will. “The status quo,” he says, “is the one option that is not on the table.”

“I am here today because I believe that this time is different.”

His chips, now pushed forward on the clean green felt, tell us he knows this hand is make-or-break.