WASHINGTON_President Barack Obama is doing everything he can to push through his health care overhaul, a struggle that might demand deep concessions.

He has summoned Republicans and Democrats to the White House. He has used public forums to bypass Congress and make a direct pitch to the people. He has turned to his political operation to air campaign-like TV ads.

But it has not squelched congressional concerns about the high cost of extending health insurance coverage to millions of uninsured Americans.

So the president soon must decide how hard to press contentious cost-saving plans such as limiting reimbursements under Medicare, the government program which provides health care coverage to the elderly.

Obama also must choose, at some point, whether to make concessions on his top domestic priority that could attract a few Senate Republican votes _ and anger liberal supporters. The alternative is a bare-knuckled parliamentary tactic that would inflame partisan tensions and probably kill some of the items he wants in the legislation.

In a week that presented plenty of good and bad news for Obama, the White House took a stay-the-course approach. The president promoted his proposals daily. There was a last-minute White House statement Friday and a health-focused radio and Internet address Saturday.

"This is what the debate in Congress is all about: whether we'll keep talking and tinkering and letting this problem fester as more families and businesses go under and more Americans lose their coverage," Obama said Saturday in his weekly address. "Or whether we'll seize this opportunity _ one we might not have again for generations _ and finally pass health insurance reform this year, in 2009."


In public at least, Obama has embraced a general message and left the specifics to Congress. He hasn't backed away from major parts of the plan or the fast-approaching deadline he has sought for weeks, despite requests from various Democrats to do so.

That was true even when the nonpartisan Congressional Budget Office stunned Obama's supporters by saying the bills moving through Congress would add to the nation's long-term health care costs rather than reduce them.

Critics reveled in the news.

Several Democrats said they could not support the bills without significant changes. Their threats could doom the legislation because Republican lawmakers are nearly unanimous in their opposition.

For the most part, Obama exuded optimism and emphasized the week's positive developments. "Those who are betting against this happening this year are badly mistaken," he said Friday.

Two House committees and one Senate committee endorsed bills containing many of Obama's priorities: subsidizing insurance for the poor, limiting insurers' ability to deny coverage, providing a government-run option for insurance. Major groups representing doctors and nurses became the latest to endorse the efforts.

Still, some of Obama's tactics left people scratching their heads.

On Wednesday he invited four Republican senators to the White House to discuss health care. Three _ Sens. Saxby Chambliss of Georgia, Bob Corker of Tennessee and Lisa Murkowski of Alaska _ are seen by colleagues as highly unlikely to vote for an Obama-backed plan.

The fourth, Sen. Susan Collins of Maine, is a moderate Republican viewed as a possible supporter, even though she has demanded changes in the Democratic-drafted bills.

Even those who accepted White House invitations said it's hard to imagine that Obama thinks such chats with conservatives will win him any votes.

"I think he's just trying to get a sense as to what the prognosis might be in the Senate," Murkowski said in an interview.

As for Obama's push to get the House and Senate to pass separate bills by August, she said, "I just don't see how it comes together."

Murkowski said the White House is sending a "mixed message" by coupling its Republican outreach with thinly veiled threats to use strong-arm tactics to ram home a health care bill if Republicans insist on too many changes.

Obama adviser David Axelrod is walking that line.

"We want to work with everyone who will work with us, and we want to do it in the spirit of bipartisanship," he said in an interview Thursday. But, he added, "We can't defer reform and we want to move forward. Those who don't, they need to address those Americans struggling with higher premiums and losing their insurance."

Senate Democrats could resort to a parliamentary procedure, known as "reconciliation," that essentially would bar Republicans from using stalling tactics to block a health care bill. But Senate rules would allow opponents to knock some nonbudgetary items from the bill. Those might include the "public option" for insurance, which is dear to many liberals.

"It's obviously better to have it bipartisan," said John Podesta, who headed Obama's transition team and advises on health care. "But there is a considerable amount that could be done, and will be done, with reconciliation" if Republicans don't come on board, he said.


With high cost projections posing the greatest political threat to Obama's plans, the White House gently promoted two ideas last week that would give the executive branch greater control over medical costs.

One would allow a panel of medical experts to endorse certain treatments that would be eligible for federal payments under Medicare and Medicaid, the government health insurance programs which provide coverage to the elderly, disabled and poor. The second would empower a different board to set Medicare reimbursement rates, which now vary considerably from state to state. Congress could vote to reject the rates, but the plan would substantially reduce lawmakers' direct role in the politically tinged process of running Medicare.

Outside Washington, people are seeing dueling TV ads from groups favoring and opposing Obama's health care proposals.

Families USA and a major pharmaceutical group are airing ads supporting the president's agenda on three major national cable networks.

Organizing for America, the Democratic Party organization that is closely tied to Obama, is running a nationwide campaign that includes thousands of house parties and other grass-roots activities. It is airing ads in Arkansas, Indiana, Florida, Louisiana, Maine, North Dakota, Nebraska and Ohio to get moderate centrist senators to back the health care effort.

On the other side, a coalition of health insurance groups is readying TV ads opposing a public option for insurance. Other conservative groups are airing ads suggesting that Obama would push the United States into a Canada-like system that would require long waits for important medical treatments.