"Look,” the President said. "Even if we hadn’t tackled health care, this was going to be a tough year.” We were in the Oval Office, talking about how health care reform had become such a mess.

It was the Friday before his first anniversary in office, the Friday before a Republican named Scott Brown demolished the assumptions of Barack Obama’s presidency by winning Ted Kennedy’s Senate seat and ending the Democrats’ filibuster-proof dominance.

It was a Friday when the President’s decision to go all in on health care was beginning to seem like a disastrous gamble.
I asked Obama how he thought his Administration was perceived by someone in the Boston suburbs who had supported him a year ago, looking for "change” — and now saw the President making deals with everyone from Joe Lieberman to the labor unions to Senator Ben Nelson of Nebraska (whose special Medicaid deal was a public embarrassment) to the pro-life forces, not to mention the drug and insurance companies.

"When I promised change, I didn’t promise that somehow members of Congress weren’t going to be looking to try to get a project in their district or help a hospital in their neighborhood,” the President said halfheartedly.

But later he acknowledged, "There’s a culture in this town, which is an insider culture. That’s what I think people outside of Washington legitimately can’t stand — a sense that they’re not being heard.

I think we’ve done actually a pretty good job of working in this town without being completely consumed by it. But from the outside, if you’re just watching TV, and all you’re hearing about is the reports, people may get the false impression that somehow [the insiders] are the folks we’re spending more time listening to.”

But how false an impression is it? The President insisted, lamely, that he spends plenty of time hearing from average Americans. But he seemed to spend as much time overseas during his first year as he did traveling the country, experiencing the economic anguish firsthand.

And he seems to have fallen headlong into the muck and madness of Washington, pursuing a historic goal — universal health care — that is certainly worthy, and central to his party’s unfinished legacy, and crucial to the country’s long-term economic future, but peripheral to most Americans, who have relentlessly told pollsters, by huge majorities, that they are happy with the health care they currently receive and far more worried about other things. On this defining issue, the President and his party have lost touch with the country.

Which was unfortunate, because he has done a great many other things very well. Obama was right, of course, about the troubles he faced when he took the oath on Jan. 20, 2009.

He came to the presidency at a moment of crisis, in the midst of a financial collapse and two wars. He acted with purposeful restraint to help stabilize a juddering economy. Overseas, he quickly restored diplomacy to its rightful place at the center of U.S. foreign policy while moving aggressively to combat al-Qaeda and its allies in Afghanistan and the borderlands of Pakistan.

Almost all his choices were controversial — an economic-stimulus package that was called too small by some and too large by others, the Afghan escalation, an effort to address climate change that was also called too weak by some and too radical by others — but none of them were dishonorable.

His has been a serious and substantive presidency. But the question, a year in, is whether it has been politically tone-deaf — and why the best presidential orator in a generation finds it so hard to explain himself to the American people.
Health care reform has clearly been at the heart of the Administration’s troubles.

The President cited three problems that bedeviled the process. The first was context: his plan would cost nearly $100 billion a year — in fairness, he was also proposing ways to pay for it — and regulate one-sixth of the economy just after he had spent $787 billion on a stimulus package that most Americans didn’t really understand, and hundreds of billions more to bail out predator banks, which most Americans didn’t understand, either.

It seemed profligate, even though Obama could argue, rightly, that the bailouts and stimulus were needed to stanch the economic hemorrhage, and that in the long run, his health care reform was the first step toward containing costs and getting the national debt back under control after the Bush Administration had blown apart the Clinton Administration’s admirable budget discipline.

The second problem was the Republican Party. Obama came to office attempting bipartisanship. The Republicans weren’t buying.

"The classic example being me heading over to meet with the House Republican caucus to discuss the stimulus,” the President said, "and finding out that [minority leader John] Boehner had already released a statement saying, We’re going to vote against the bill before we’ve even had a chance to exchange ideas.”

Instead of recalibrating right then and there, Obama decided to push ahead with health care. There were a handful of Republicans, led by the two Senators from Maine, who seemed committed to voting for a reasonable plan.

But the atmosphere deteriorated over the summer as the Republicans took a turn toward nihilism. They demagogued nonexistent provisions of the bill, like "death panels.”

By August, the President was saying privately that he didn’t know if bipartisanship was possible when the polls said that a third of the opposition party didn’t even think he was an American citizen.

The few Republicans pretending to discuss health care reform, especially those on the Senate Finance Committee, stalled. "The whole thing went on too long,” says Senator Sherrod Brown, a liberal from Ohio. "[Finance Committee chairman] Max Baucus wasted three months trying to negotiate with six Republican Senators.”

The longer the process went on, the more the guts and fat of the bill were exposed to public scrutiny. The historic reforms — the fact that insurance companies would no longer be able to deny coverage to anyone, the fact that individuals and small businesses would be able to shop for insurance and pay less in health care superstores, the fact that the poor would have their coverage subsidized — took a backseat.

"There is no doubt,” the President told me, "that ... having this intense a focus on the sausage-making process in Congress is never helpful.”

And that was the third problem: the focus on sausage making was unavoidable, given that health care aroused almost every special interest extant in Washington.

The President insisted to me that, despite the compromises, the bill was sound. He even insisted that it still would pass. But that was before Massachusetts.

Now it seems likely that the heroes on Capitol Hill will head for the hills rather than take a risky vote in an election year. "It’s going to get very ugly for a while,” says a close aide to the President. Obama will have to transform himself — but will he be a more cautious politician, or a bolder one to meet the populist anger of the times?

TIME