President Obama, in the Rose Garden with the American Nurses Association that endorsed his campaign in September, said downcast Democrats slogging through legislative thickets on the path to health care reform need a pep talk.

"We need to buck up people here," Obama said. "That's what nurses do. It's time for us to buck up the Congress. We need to get this done. These nurses are on board. The American people are on board. It's up to us now."

The is the second health care pep talk Obama's delivered in three days. The first came in all-Democrats meeting at the White House on Monday. The president told Democrats leading the relevant health committees to pick up the pace and pass bills out of the House and Senate before they leave for the August recess.

The problem for the White House runs deeper than typical legislative depression and self-doubt, even for the biggest combined Democratic congressional majorities since Lyndon Johnson's presidency.

Democrats can't agree on how to pay for health care reform. The House bill seeks $540 billion in taxes on couples earning more than $350,000 a year. But Speaker Pelosi conceded yesterday she doesn't have the votes -- yet -- to pass the House bill, calling it a draft proposal (the second so far).

There's another potential problem for the House bill. A preliminary Congressional Budget Office analysis says the number of uninsured will rise by one million each in the bill's first three years. The CBO also says full implementation will leave 17 million uninsured -- this at a projected cost of at least $1 trillion over 10 years. Also, 85 percent of those costs are compressed in the last five years as Democrats seek a gradual implementation of their public option, health care exchange and other system-wide alterations. These heavy costs on the second five years will inevitably raise fears the program should (some will argue likely) be more expensive than currently projected.

See full CBO preliminary analysis here. Click on the pdf: http://www.cbo.gov/ftpdocs/103xx/doc10310/06-15-HealthChoicesAct.pdf

In the Senate, the House bill is a dead letter. There is zero (or nearly zero) support for a surtax on the wealthy. Obama has had two opportunities to endorse it and passed both times. The Senate Finance Committee is scheduled to vote next week on taxes to pay for the Health, Education, Labor and Pension Committee's health reform bill (which passed on a party-line 13-10 vote today). But Finance does not have a taxation method politically palatable enough to survive a committee vote. Not yet at least.

These problems have led the White House to step up the rhetorical fire against "cynics" and "naysayers" who it says oppose reform. Today, that meant criticizing insurance industry profits.

"Deferring reform is nothing more than defending the status quo," Obama said. "And those who would oppose our efforts should take a hard look at just what it is they're defending. Over the last decade, health insurance premiums have risen three times faster than wages."

White House ally, Sen. Charles Schumer of New York, held a parallel press conference to denounce health insurance industry profits. Schumer said the industry feeds off a lack of competition and pockets profits "that would be enough to make big oil executives blush."

Meanwhile, the Democratic National Committee began airing TV spots today - nationally and in the states of numerous Senate Democrats - that urge health care action (see early blog post for links).

Here are the Senate Democrats now being urged by the White House to get off the dime: Blanche Lincoln and Mark Pryor of Arkansas; Evan Bayh of Indiana; Bill Nelson of Florida; Mary Landrieu of Louisiana; Kent Conrad and Byron Dorgan of North Dakota; and Ben Nelson of Nebraksa.

The DNC ads are also running in Ohio, but that targeting appears aimed at Republican George Voinovich (the Buckeye state's junior senator, Sherrod Brown is already on board). The ad's presence in Maine is clearly directed at the two Republicans, Susan Collins and Olympia Snowe, both on the White House list of potential converts.

"This progress should make us hopeful," Obama said of the introduction of the House bill and the one-committee passage of health reform in the Seante. " But it shouldn't make us complacent."

Democrats are not so much complacent as they are conflicted about the range of benefits, the method of creating a so-called public option (pure government financed vs. private cooperative), the depth of proposed cost savings (Medicare vs. Medicaid vs. doctors), and how to pay for it (surtax on wealth vs. taxing health care benefits vs. reducing itemized deductions for the wealthy).

When Sen. Chris Dodd, Connecticut Democrat, opened up the committee's final vote on the health reform bill, he mentioned the historic proceedings that had occurred before in the Russell Caucus Room.

"I mentioned, in fact, the hearings on the examination of what happened to the Titanic, which is not maybe the best example to use considering the effort we're undertaking," Dodd said.

The cheap joke is obvious. The better and more balanced observation is the Titanic metaphor applies currently to the massive size of the legislative task before congressional Democrats. But unlike those who built the Titanic, the legislative engineers and designers are not working off the same blueprints. They're also trying to move much faster.

What this will do to the final product is unclear. What is certain is Democrats face weeks of confusion, frustration and political angst between now and the August recess.

That's why they needed to be "bucked up."