WASHINGTON -- President Barack Obama's furious, final push to get a health care bill passed threatens to shove aside the message he promised would top his list this year: creating jobs.
Even as the White House juggles several enormous issues at once, the public takes its cues about the president's chief concern from how he spends his time, energy and capital. As Obama himself put it on Wednesday, from now until Congress takes a final vote on a health care overhaul, "I will do everything in my power to make the case for reform."
That kind of now-or-never campaign means America can expect a debate consumed by health care, again, for weeks.
The White House is trying mightily to focus it on real people and the human cost of inaction. But there will be no escaping the same slog that turned off so many people in 2009 -- congressional process, arm-twisting and doomsday rhetoric.
So what unfolds over the next few weeks will affect millions of Americans and alter the course of Obama's presidency. He has a shrinking window in which to find enough votes within his party to pass health care legislation so he can free himself to spend more bully pulpit time on the single issue that has stoked the public ire since he became president -- disappearing jobs.
Polling shows the economy remains a bigger personal worry to people than the cost, access and coverage problems endemic to the health care system.
There is a huge economic element to health care as people struggle to pay premiums or keep their insurance. Yet to many, the astounding loss of jobs is a singular issue that demands constant, bold attention.
It is just this competition -- the economy versus health care -- that helped define Obama's grueling first year in office and prompted howls within his own party for a recalibrated jobs-first agenda.
Obama responded with a State of the Union speech on Jan. 27 that was remarkably focused on the economy, dwarfing all other issues. "Creating jobs has to be our number one priority in 2010," Obama emphasized the next day at a stop in Tampa, Florida.
Yet it was always the reality that Obama would consolidate his attention on health care again, at least for one last blitz. Beyond all the policy implications, Obama has spent a year on it and never intended to let that effort go to waste.
The White House's political calculation is that the next few weeks are their last chance to push through an overhaul of health coverage. But aides also know it cannot drag on, as every day focused on process overshadows their message.
There is no expectation within the West Wing that voters' moods will change until they see their lives improving. Senior Obama adviser David Axelrod said the plan is to keep plugging away on an agenda to shore up the economy for the long haul.
"We're going to still be out there on jobs," Axelrod said, dismissing any worry that the economy-first message will be obscured. "We're going to be focused on health care for the next few weeks, but we're still going to be doing jobs."
To get votes, Obama is lobbying lawmakers, many of whom are teetering in this election year. He's calling on his 2008 campaign supporters to push Congress for a vote. He's staging health care events in Philadelphia and St. Louis this coming week.
"They are looking at the election in November, and they need to have one big victory that they can claim," said Michael Lind, policy director of the economic growth program at the New America Foundation, a Washington think tank. "This is not the victory they would have chosen, because even if it does help the economy, it won't help most people for years to come. The problem is, there just doesn't seem to be the ability to do anything significant about jobs this year."
The House and Senate have passed versions of a $35 billion bill that offers a tax break to companies that hire workers and extends federal highway programs, but even supporters doubt it will create many jobs. By comparison, the economic stimulus bill enacted last year -- and not nearly spent out yet -- was an $862 billion measure.
Lawmakers plan more steps this year. But there is less political will to keep spending on big jolts to the economy.
Obama has always argued that overhauling health care is not just about health, but also an economic imperative for families who will suffer "if we let this opportunity pass for another year or another decade or another generation" -- a message he conveyed Saturday in his weekly radio and Internet address.
Part of Obama's final argument to Democratic lawmakers is that getting health care done will give them momentum on other issues. It's possible that the opposite is true, and a defeat now could undermine him on other fronts.
Maryland's Democratic Gov. Martin O'Malley said Obama understands that the rising costs of health care are hurting U.S. economic interests long term. Still, he urged Obama to finish up this priority and pivot back to a heavier jobs message.
"If we wrap this up, if we get this passed, it will become clear that health care was always about jobs," he said.