In the last week and a half, Obama has rediscovered his voice on health care--telling audiences he is determined to achieve comprehensive reform, not some piecemeal version, and that he is willing to fight for it. And, administration officials say, the sentiments are genuine. Obama has instructed his staff not to abandon the pursuit of a full reform package, even though, it seems, that's what some advisers would prefer--and even though the Democrats no longer have the sixty votes necessary to break Republican filibusters in the Senate.

But rhetoric alone won't get the job done. House Speaker Nancy Pelosi has said her chamber won't vote for the Senate bill, as written, until the Senate passes modifications to that bill--something the Senate would have to do through the budget reconciliation process, in which Republicans couldn't block a vote from taking place. The modifications the House has in mind include more money for affordability protections and the elimination of a tax on expensive health benefits.

Senate Majority Leader Harry Reid, naturally, wants the House to vote for the full Senate bill first. And while he's said he thinks amending the bill in reconciliation makes sense, he wants the bill to be as small--and easy to pass--as possible. He also wants to keep the benefits tax, or some version of it.

In both cases, the leaders are basing their positions in part on what their caucus members are saying to them. Most progressives don't like the benefits tax. Most moderates don't like the alternatives--some combination of taxes on the rich and cuts to industry--and don't like the high price tag in general. Members of all ideologies are worried that passing a bill in reconciliation would drag out this politically debilitating debate longer--while giving critics more reason to think the bill is full of unsavory backroom deals.

The position of the two leadership groups isn't surprising. It's exactly the sort of posturing you’d expect in a House-Senate negotiation--and, if it were happening four or five months ago, the Democrats could afford to let it play out on its own. But there’s no time for that now. While giving health reform a small break from the spotlight is probably healthy, just letting the negotiations drag out will only disappoint supporters while antagonizing the opposition--all while the attention of members begins to wander.

Nor is it clear the two houses are even capable of reaching an agreement on their own. If members of the House were rational, they would pass the Senate bill, as written, simply because it'd be such a huge achievement--one that would make life better for literally tens of millions of Americans. And, if members of the Senate were rational, they would sign off on at least some of the House’s requested fixes without a fuss, because they were about to agree on them anyway--after the last round of negotiations, before Massachusetts--and because most of the changes make the bill better.

Indeed, there's a pretty obvious deal that ought to work for both sides, even now:

  1. Further reducing the benefits tax, either by further delaying its implementation or raising the threshold at which it begins
  2. Replacing that money by increasing the Medicare tax on unearned income and bigger reductions in subsidies to private insurers that serve Medicare patients
  3. Slightly improving the affordability protections and filling in part of the Medicare drug benefit gap, by further reducing payments to the drug industry
  4. Eliminating special deals like the government's agreement to cover Nebraska's expansion.

All of this is doable in a reconciliation bill. But, as far as I know, neither House nor Senate leaders have said they'd support such an agreement. And that reluctance is doubtless based, at least in part, on bitterness between the two houses as much as it's based on actual policy outcomes. In other words, it's not just lack of common vision. It's lack of trust and respect, too.

That’s why congressional Democrats increasingly think the president has to broker a deal--and why some, at least, are upset the White House isn’t move involved already. Senator Sherrod Brown told Huffington Post's Sam Stein that White House engagement had actually “dried up” in the last ten days, notwithstanding the president's public rhetoric. Stein also reported that, at Wednesday's meeting of the Senate Democratic caucus, Al Franken and Bernie Sanders confronted White House senior counselor David Axelrod to complain about the lack of White House leadership. (Politico now has more details of what was said there.)

I’m hearing the same thing from many insiders. Responding to Obama's recent speeches--and, among other things, my own article praising them--one source plugged into the negotiations e-mailed

Obama's rhetoric is helpful, but he has not yet taken the lead in getting Pelosi and Reid to agree either on final substance or on strategy. This can only be resolved with Obama's strong leadership--and it hasn't occurred yet. He needs to move from cheer-leading to real leading. 

Another source, who's also involved in discussions, was even more blunt:

Democrats need a leader to bolster their courage and determination and they don’t have one at the moment.

And what exactly would this "real leading" entail? I honestly don’t know--this is new territory for me. But when I asked these same sources what, precisely, the president could be doing, here’s how one explained it:

It means hammering out an agreement with the congressional leaders--especially Pelosi and Reid--that results in a specific, final legislative package as well as working out the strategic details (the two-step process, including sequencing) so that there is a game plan for moving forward. Right now, there appears to be a difference between the House and Senate leadership about sequencing--i.e., what comes first, reconciliation or passing the Senate bill.

Leadership means getting an actual agreement on these things and not allowing the discussion to continue endlessly with a resolution. It probably means that the President has to state how he believes this must go forward and pushing his congressional colleagues to follow his suggestions.

To be clear--and to state what should be obvious--I’m not on the inside so I surely don’t know everything that’s going on. My information is only as good as my sources, which are diverse and informed but, inevitably, have limits and biases of their own.

And the White House has some reasons for wielding its influence carefully. Among other things, bullying legislators--even House members--can backfire, convincing wavering lawmakers to turn against what's a bill the public tells pollsters it opposes.

What's more, while the relatively hands-off strategy seems ill-advised now, it’s also the strategy that got the administration farther on health care reform than any before it. If not for a historically awful candidate in the Massachusetts Senate race, the Democrats would still have 60 votes, health care reform would be law, and everybody would be celebrating the administration’s strategic genius.

Still, giving Congress so much leeway now could invite a replay of the summer spectacle--when negotiators in the Senate Finance committee dithered and dithered, slowly but surely eroding reform’s support. Obama eventually ended those negotiations, saving reform in the process, by threatening to introduce his own bill. That move jolted Finance Committee Max Baucus into action, propelling the process forward.

The time may be right for yet another intervention along those lines. If not, reform could really be dead.

Update: I should probably reiterate what I've said before. Nobody--not the president and not the members of Congress--are going to move if progressives don't push for it. That's where the real shove has to start.