It's his top domestic priority and arguably his most challenging political fight yet as president, in no small part because of the vast number of diverse stake-holders involved.
Familiar tools from the Obama candidacy are being used in the struggle, adapted to his office: among them the town hall meetings with his sleeves rolled up, a quick-response Web site to douse critics' claims, chain e-mails and a populist pitch against the entrenched powers in Washington.
Plus he's now got the bully pulpit, which he used Saturday.
"I know there's plenty of real concern and skepticism out there," he said in his weekly radio and Internet address. "I know that in a time of economic upheaval, the idea of change can be unsettling, and I know that there are folks who believe that government should have no role at all in solving our problems."
Carefully trying not to alienate opponents even while taking them on, he cited "legitimate differences worthy of the real discussion that America deserves." But as Democratic allies face taunts and insults at town hall style gatherings, Obama asked his audience to "lower our voices, listen to one another and talk about differences that really exist."
In the GOP's address, Utah Sen. Orrin Hatch pressed for a bipartisan solution.
"Ensuring access to affordable and quality health care for every American is not a Republican or Democrat issue - it is an American issue," he said.
He said he also encourages a respectful debate, but "there is nothing un-American about disagreements. In fact, our great nation was founded on speaking our minds."
Obama seeks legislation that would provide coverage for millions of uninsured people while controlling costs. Critics say proposals in Congress would spend too much and give government too big a role.
Conservative activists and Obama opponents have stepped up their attacks in recent weeks - and may be outmaneuvering a White House known for its organizational abilities.
In campaign mode, Obama is hosting question-and-answer sessions that proved valuable during the presidential race. The Democratic National Committee and Obama's allies are spending millions on advertising campaigns to influence public opinion, much like they did last year. Associates are going out to make the case. The White House is using Internet tools honed during his groundbreaking bid to rally supporters.
Obama is trying to energize his estimated 13 million grass-roots supporters through his campaign apparatus, called Organizing for America. But there are indications that those who turned out in to help elect Obama aren't doing the same to get a policy passed - evidence of the difficulty in the transition from campaigning to governing.
In Pittsburgh, Obama adviser Valerie Jarrett told liberal bloggers Saturday at a conference that the president can't accomplish his goal without them. "I cannot say to you how strongly we depend upon you and your outreach and your network to energize people who are on the ground, not just for health care, but for all the tough issues that are lying ahead," she said.
Earlier in the week, White House senior adviser David Axelrod asked supporters to forward a chain e-mail to counter criticism circulating online. The White House also began a "Reality Check" Web site "to help Americans clear up health care lies and misinformation."
Those efforts were reminiscent of the Obama team's attempts during the 2008 campaign to debunk Internet rumors about his faith and upbringing.
The DNC has created a Web video - "What You Won't See on National Cable News" - to highlight civil town hall meetings, and Obama also plans to speak to backers by telephone during a health care event Wednesday.
Over the past week, he's fielded questions from audiences in Portsmouth, N.H., and Belgrade, Mont., as well as in Grand Junction. Thus far, he's faced polite crowds, a stark contrast to the taunts and jeers that Democratic lawmakers have endured at similar sessions during their August break.
Much like in the campaign, Obama's using people's stories to illustrate his points, railing against interest groups and asking supporters to "rise to this moment."
In Grand Junction, he sounded much like a candidate again as he adapted a campaign theme.
He likened the health care effort to policy fights that led to Social Security and Medicare system. "These struggles have always boiled down to a contest between hope and fear," Obama said - a talking point of his candidacy. "So if you want a different future, if you want a brighter future. I need your help."
Associated Press writer Dan Nephin in Pittsburgh contributed to this report.
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