Matthew Ygelsias has a ‘Think Progress‘ post, “What’s the Point of These Health Care Town Halls?,” which can be read as a continuation of the topic Ed raised earlier today in his TDS post “Should Town Hall Meetings Matter?”
Yglesias riffs on Michael Crowley’s post commending Sen. Claire McCaskill’s handling of a town hall meeting earlier today. Yglesias agrees with Crowley about McCaskill:

She was pitch-perfect: polite and responsive without being a pushover, armed with clear and compelling facts (emphasis on things any health reform bill will *not* do) and firm when necessary. She shamed one of the loudest hecklers by reminding him that “we have good manners in Missouri,” but without losing her own temper. I know the mid-day MSNBC audience is small, but I feel like almost any open-minded person who saw this performance would come away trusting McCaskill over the protesters.

Sounds like it might make a good training video on how to handle the GOP goon squads that have been showing up at some of these forums, but Yglesias provides no link. Looking at the big picture, Yglesias wonders whether the town hall meetings are worth the trouble:

…Watching McCaskill on TV what I mostly thought of was that I don’t understand why members of congress are holding these town halls. There’s been so much focus on the spectacle of the whole thing that nobody’s really stepped back and explained what the purpose of these events are other than to give us pundits something to chat about. Obviously this is not a good way of acquiring statistically valid information about your constituents’ opinions. And it doesn’t seem like a mode of endeavor likely to increase the popularity of the politician holding the town hall. The upside is extremely limited, and you’re mostly just exposing yourself to the chance that something could go wrong.

Yglesias gets an earful of answers in the comments. Nothing earth-shaking, but some thoughtful insights, such as ‘Dan’s take:

The point is to establish anti-Washington credentials. Remember when McCain was begging for Obama to do a series of town halls together last summer? Something about the format seems to jive well with the angry-white-guy populist shtick.

Adds ‘Henry B.’:

I think the reason for doing them is primarily custom and secondarily the need to generate favorable local media coverage. If you’re a member of Congress and you do a couple town-halls and don’t screw up too badly, you can count on some nice pictures on the front of the local papers. It gives people back home proof that you’re making an effort to stay in touch with your constituents.
There is, of course, an unusually large downside risk this year, and I think that’s why a lot of members of Congress have canceled their town-halls this year. Obviously the members who are going forward with their town-halls are getting more attention, but I work on the Hill and have heard of several members who aren’t doing any town-halls.

‘Ted’ shares Ygelsias’s view:

Everyone’s making good points about the value of town halls in the past. But if these things are going to be regularly astroturfed, I agree with MY that it’s hard to see the upside right now, for individual candidates.
I’m not sure what the overall effect has been on health care reform. Ambinder is saying that the right has blown it by letting their crazies run with the ball. But I haven’t seen a whole lot of effective messaging from our side, either. The net effect may be that people are convinced that the teabaggers are nuts, but remain confused & apprehensive about health policy.

A commenter named ‘Midland” explains:

…Most politicians get their start talking to people one on one and get to the top doing the same. That’s why so many of them seem so inarticulate on television: they didn’t get to where they are going to acting school, they got there by talking to a whole lot of people in small groups. About politics, about themselves, about things they believed in, for good or ill.
The saddest thing about this latest blast of meanness from the right is that town halls, for most of the last two decades, have been a refuge of intelligent, adult political debate. No matter how stupid, bombastic, trivial, or dishonest the network coverage, a politician in a honest town hall meeting usually got sincere questions from thoughtful citizens. It was always a welome contrast to the Beltway gasbags.

‘Njorl’ suggests an interesting idea:

…The Democrats best strategy would have been to hold simultaneous town halls all over the country. You’d get fewer shipped-in crazies that way.

The bottom line, simple as it sounds, may be that, with major electronic media so unwilling to give fair coverage to the case FOR Democratic health care reform proposals, proponents simply have to take every messaging opportunity available.

In his Robert Reich’s Blog, via TomPaine.com, the former Secretary of Labor has a richly-deserved smackdown for the “astroturfer” protests dogging health care meetings now being held in congressional districts. As Reich describes the protests:

This isn’t grass roots. It’s Astroturf. The vans carry the logo “Americans for Prosperity,” one of the Washington front groups orchestrating the fight against universal health. They’re using Congress’s August recess to heckle Democratic representatives when they meet with their constituents, stage erszatz local anti-universal health rallies, and fill home-town media with carefully-crafted, market-tested messages demonizing healthcare reform.
The Republican party’s fingerprints are all over this. FreedomWorks, another group now Astroturfing its way around America, is chaired by former House Republican Leader Dick Armey. Texas Republican Pete Sessions, who chairs the National Republican Campaign Committee, says the days of civil town halls are “now over.” Key Republican funders are forking out big bucks. The U.S. Chamber of Commerce, whose ties to the GOP are legion, announced in June it would “develop a sweeping national advocacy campaign encompassing advertising, education, political activities, new media and grassroots organizing” to battle universal health and other Democratic initiatives.

Reich says the protests are more about political opportunism than genuine convictions about health care policy:

Republicans have no other strategy. They can’t attack Obama personally because he’s just too popular. They’ve been incapable of coming up with their own plan for healthcare reform. The biggest healthcare interest groups — the AMA, private insurers, and Big Pharma — have publicly backed the major healthcare initiatives coming from congressional Democrats (although, I suspect, are quietly supporting the Republicans’ Astroturf blitz). Their “tea parties” in April were a flop. Their poll numbers are awful. Their major loudmouths — Rush Limbaugh, Sean Hannnity, and Dick Cheney — are not exactly attractive to most Americans. Their biggest nightmare, Sarah Pallin, is already on the campaign trail for 2012.

Despite all the bluster and publicity, Reich believes the astroturfers are doomed insofar as stopping health care reform altogether. But there is cause for concern about their effect on weaker-willed Democratic members of congress:

But this Republican strategy will fail. 2010 will not be 1994. There’s too much momentum behind universal health care right now to stop it. Yet the Republicans’ fake grass-roots campaign may cause some Democratic lawmakers to become even more nervous about universal health care than they already are, or at least give them an excuse to duck when it comes time to vote in September. The result will be a watered-down set of reforms that still leave millions of Americans uninsured and don’t slow healthcare costs. This is why Obama has to fight for this so hard over the August recess, why he has to be far more specific about what he wants in the bill, and why he can’t afford any more diversions — like the beer summit, or economic advisors who seem to open the door to middle-class tax increases.

if President Obama can stay on point, find more ways to tap his speechmaking skills in service to health care reform and mobilize the network of activists that helped to elect him, the astroturfers will find their rightful place as a minor footnote in the story of the successful struggle to bring genuine health security to America.

With the House of Reps already ajourned for the August recess, The DCCC has hit the ground running with a “Major Advertising and Grassroots Offensive” called “Health Care ER.” DCCC Chairman Chris Van Hollen has said that the campaign is targeting more than two-dozen Republicans throughout August, explaining:

Time and again, Republicans protect a broken system of skyrocketing costs, insurance companies making health care decisions, and record setting insurance company profits instead of working with President Obama to bring real health insurance reform. President Obama and Democrats are working for health insurance reform that lowers costs and protects patient’s choice of doctors and plans, while Republican are fighting for insurance companies. This August we are going district-by-district to hold Republicans accountable for trying to obstruct health insurance reform through their scare tactics and just-say-no protection of big insurance companies.

Some of the actions being conducted by the DCCC include:

Radio ads in seven (7) Republican Members districts;
Volunteer live calls, automated calls to 25 targeted Republican Members;
Volunteer live calls to talk radio stations in their districts;
Three (3) million e-mails;
Letter writing drive in their districts;
Letters to the editors of newspapers in the targeted districts;
An on-line petition campaign;
Fact check Republicans’ lies about health insurance reform;
Tele-town halls in the districts

You can hear the radio ads at the DCCC Stakeholder Weblog, which also has an ad script and a complete list of the targted Republicans.
Brian Beutler of TPM reports that the targeted Republicans fall into three categories “vulnerable, moderate, and high-profile.” Eight Reps, including Michelle Bachman (R-MN); Joseph Cao (R-LA), Charlie Dent (R-PA), Dan Lungren (R-CA), Thaddeus McCotter (R-MI), Erik Paulsen (R-MN), Dave Reichert (R-WA), and Pat Tiberi (R-OH) will be the focus of attack ads in their districts.
Volunteers who want to get involved in the health care reform struggle are encouraged to contact the DCCC here.

HHS Secretary Kathleen Sebelius has an op-ed, “Lifting A Burden Of Worry” in today’s WaPo, with simple, elegantly-stated message points that health care reform advocates can tap to both challenge reform obstructionists and help win support from those who have concerns. It’s not hard to imagine Sebelius’s op-ed being re-worked into multiple formats — persuasive ad spots for traditional and new media, as well as speeches by and media interviews with reform supporters. As Sebelius defines the central problem in simple terms:

The current health-care system gives insurance companies all the power. They get to pick and choose who gets a policy. They can deny coverage because of a preexisting condition. They can offer coverage only at exorbitant rates — or offer coverage so thin that it’s no coverage at all. Americans are left to worry about whether they’ll get laid off and lose their insurance or wake up from surgery with a $10,000 bill because they didn’t read the fine print on their policy.

That concern is shared by millions of Americans, even those who have some skepticism about the way reform legislation is shaping up. Sebelius also highlights a huge “hidden” expense of the current system:

…Right now, many entrepreneurs are paralyzed by our fractured health insurance system. They know that if they leave their job, they might not be able to get insurance for their families. So they, and their innovations, stay put. Health reform means unleashing America’s entrepreneurs to chase their big ideas.

It’s a hidden cost which cripples American entrepreneurs in competition with their counterparts in nations that have portable health security for all. Sebelius also does a nice, succinct job of calling out the fear-mongers:

…We’ve learned over the past 20 years that “socialized medicine” and “government-run health care” are code words for “don’t change anything.” With some insurers raising premiums by more than 25 percent and 14,000 people losing their health insurance every day, Americans want to hear something more from their leaders than “wait and see” and “more of the same.”

She then provides one of the best short statements that encapsulates what Americans want:

Health insurance is fundamentally about peace of mind. If you have good insurance, you don’t have to worry about an accident or sudden illness. You know that whatever happens, you and your family will be taken care of.

The public option provides a reasonable alternative to unbridled domination of our health care by the insurance industry, explains Sebelius:

By giving Americans choices, health reform will switch the roles. Americans will get peace of mind and insurance companies will start getting nervous. They will know that if they don’t deliver a great value, their customers will flee. So they will start offering better coverage.

And the vision:

…We have a huge, once-in-a-lifetime opportunity to improve the lives of all Americans, insured and uninsured alike….We can make investments in prevention, wellness and health information technology that will allow the health-care system to deliver incredible results at prices we can all afford. Imagine a system in which your doctor spends as much time trying to keep you healthy as treating you when you’re sick, in which you and your doctor have all the information you need to choose the treatments that work best for you, in which you never have to fill out the same paperwork twice. Health reform is the first step in that direction.

Secretary Sebelius has done an outstanding job of simplifying the message that can help cut through the obstructionist fog and bring health security to millions. The August recess provides the opportunity for Dems and reform advocates to spread it far and wide.

Oscar Wilde said that “the best thing to do with advice is to pass it on; it is never of any use to oneself.” And pass it on we do, hoping that it will be of some use in the struggle for health care reform. And, judging by the surfeit of health care reform strategy advice from all points of the political spectrum, few advocates can fairly complain that their views are not being heard. Here follows some of the more interesting nuggets from recent editorials, articles and blogs:
The Editors of The New York Times forum on”Selling Health Care Reform to Voters” included contributions from seven diverse opinion leaders. In one article, Julian E. Zelizer, a professor of history and public affairs at Princeton University, voices an oft-heard concern these days:

President Obama has allowed Congress to work out the details of the legislation…The problem is that he has neglected to keep working on the message. As Congress deliberates, reports inevitably emerged about the potential costs of the program and the limitations of the expected impact. Opponents of reform have steadily gained ground by warning of a government takeover. Support for reform has diminished. A coalition of centrist Democrats and Republicans are pushing legislation that falls far short of President Obama’s promise.
During the most successful struggle for health care reform — the passage of Medicare and Medicaid — Presidents Kennedy and Johnson were never shy in talking to the public about what they hoped to accomplish…Both of these presidents delivered speeches about what health care reform could accomplish. This was an era when liberals were comfortable talking to Americans about why government worked. At a rally at Madison Square Garden in May 1962, Kennedy rebutted every argument of his opponents and said, “This bill serves the public interest. It involves the Government because it involves the public welfare. The Constitution of the United States did not make the President or the Congress powerless. It gave them definite responsibilities to advance the general welfare, and that is what we are attempting to do.”

Most Dems will disagree with the forum contribution of GOP strategist Michael Murphy, but he may have a point or two worth mulling over nestled in his predictably partisan screed:

…When you do anything in Washington of such size that it directly touches the lives of most Americans, you had better be authentically bipartisan. Big changes are scary and difficult. Their fragile nature can only survive politics if both parties are chained together in a lifeboat of mutual survival. Otherwise one party will certainly torpedo the other.
True bipartisanship is difficult. It demands real compromise, an anathema to the drunk with victory ideological partisans who lead the Democrats in the House and Senate. Unfortunately, these are the people that President Obama has outsourced his health care plan to…Measures that only make broken things bigger and more complicated, without fixing or reforming core problems are an easy kill in Washington.

Harold Pollack, faculty chairman of the Center for Health Administration Studies at the University of Chicago, says of President Obama

…He should puncture complacency about an unsustainable status quo. You may believe that you have good insurance. Absent effective regulation, you have no real way to know. You certainly can’t know that it will remain affordable for you or your employer. As costs escalate and financial insecurity moves up the economic ladder, this really matters.

Robert Blendon, professor of health policy and political analysis at the Harvard University JFK School of Government and the School of Public Health, adds

…For about half of Americans, the critical issue is ensuring that their health premiums go down, not up. At the moment, people are worried that the trend is up. The president has to stop talking about the national problem of “bending the curve” — and instead talk specifically about how he will lower insurance premiums for average families.
…The president has continually talked about cutting back on Medicare to save money for health reform. He has to reassure seniors that the cutbacks won’t affect the benefits they are currently getting. Some of the problem is how people absorb the message. When they hear President Obama talking about “cutting back Medicare,” they think “benefits” when he means to aim his savings at paying physician, hospitals, and nursing homes less money.

Also in the New York Times, Carl Hulse has a revealing article about the difficulties involved in Dems using the ‘reconciliation’ process to pass health care reform by a simple majority vote. Hulse sees a possibility of a sort of hybrid strategy for Dems:

…Democrats are envisioning an unusual two-track approach. Under this strategy, some of the most contentious elements of the health plan — new taxes and fees as well as savings from Medicare, Medicaid and other federal programs — would be packaged in one bill that could be passed by a simple majority.
A second measure would contain the policy changes and program expansions and would be treated like an ordinary bill, subject to filibuster and amendment. But the thinking is that this legislative sidecar would contain enough popular programs to attract the 60 votes needed to overcome a filibuster. Voilà — a health care bill.

In the Sunday L.A. Times, Doyle McManus joins the chorus of pundits decrying President Obama’s “bend the curve” (slow the rate of increase) on health care spending as a yawner unlikely to excite popular support. McManus offers an alternative strategy:

Obama and his aides know they need to win this debate; they’ve known that all along. So what can they do?
First, reframe the issue — not as an arid fiscal question of “bending the curve” but as a moral and economic imperative to provide reliable coverage to those who have insurance as well as those who don’t. Obama began to do this last week when he unveiled an eight-point “bill of rights” for health insurance consumers and promised “stability and security.”
Second, endorse a specific plan — even though that means making someone unhappy. Obama hamstrung himself by allowing centrists in the Senate to attempt to fashion a genuinely bipartisan proposal… The goal was to see whether an earnest show of bipartisanship could win a few Republican votes. As long as Montana Democrat Max Baucus and Iowa Republican Chuck Grassley were negotiating — and it has been a very long time — Obama didn’t want to get too specific with his own “red lines,” lest he drive Grassley away. The time to jettison Grassley is near.
Third, mobilize Obama’s Democratic supporters. That won’t be as easy as it sounds. Many liberal Democrats would prefer the single-payer model that was never seriously debated in Congress this year. Many more will find fault with parts of whatever plan Obama finally settles on — for example, if he accedes to the Senate centrists’ proposal for health cooperatives instead of a single federally administered “public option” insurance plan. But the president can explain to the faithful that the Republicans would love to “break him” and that liberals shouldn’t make the perfect the enemy of the good.

Read more…

DemFromCt has a pair of good posts at the Daily Kos trying to sort out the latest public opinion on health care reform. In the first link-rich post, “NBC/WSJ and CBS/NYT Polls: Americans Are Divided On Health Care, Down On The Economy,” he analyzes recent polling data on support for President Obama, approval of the job congress is doing and support for health care refom and suggests a strategy:

The bottom line from both polls: Americans are persuadable but are not sold on what they hear on the news. Specific plans sell, but the opposition is well financed and quite skilled at obstruction. Still, the odds are that reform will pass and a bill will emerge from each chamber, and nothing drives polls like success. Depending on the public to drive the process is fraught with difficulty. This will take White House salesmanship to get the job done.
As for regaining momentum, that’s easy and takes two steps. First, bring it down to ordinary people’s level over the August break about what it means to them (affordable medical care you don’t have to worry about losing), and second, have an actual bill to debate rather than Mike Enzi’s version of how to stop whatever is emerging. Nothing succeeds like success.

In his second post, “TIME Poll: Americans Back Reform but Worry About Details,” DemFromCT reviews numbers showing a strong mandate for comprehensive coverage for “all Americans” and for the public option, and he concludes:

Bottom line here, when looking at all the polls: critics in the GOP have raised doubts about Obama’s plan, but he remains 15-20 points ahead of Congressional GOP in terms of public preference. And though doubts are there, especially about cost, people are anxious, fear losing what they have, and crave stability. They want details, and they want Obama to explain and reassure.

Mark Blumenthal’s Pollster.com post “Health Care: ‘Losing the Message War?‘” cites Kaiser Foundation data indicating strong support for fundamental reforms, despite persistent anxieties about cost and coverage:

…The Kaiser Foundation surveys are typically the most comprehensive on the subject of health care and this latest tracker is no exception. The found a majority of Americans continuing to support the goal of reform and large majorities expressing support for a “variety of methods of expanding health insurance coverage, including Medicaid expansion (74 percent), an individual mandate (68 percent), an employer mandate (64 percent) and a public plan (59 percent).”..

Both DemFromCT and Blumenthal cite the effectiveness of anti-reform messaging in keeping public anxieties high. But Democrats do have a strong tailwind in the public’s recognition that substantial reform is urgently needed, and recognition that Republican obstructionists have failed to deliver even a semblance of meaningful reform. The challenge is now for the President, congress and reform advocates to refine and simplify their messaging and raise the confidence level of the insured that their health security will benefit from the Democratic reforms.

In his current ‘Public Opinion Snapshot‘ at the Center for American Progress web pages, TDS Co-Editor Ruy Teixeira spotlights a new 25-nation ‘Global Attitudes Survey” by Pew, which clearly indicates that President Obama’s foreign policy has been a stunning success. Described by Teixeira as “heavy on consultation and diplomacy and notably light on the unilateral use of U.S. power,” Obama’s foreign policy has produced a dramatic turn around in America’s image abroad, as Teixeira explains:

…From 2008 to 2009, favorability toward the United States increased in 21 of 24 nations, excluding the United States. This increase in favorability included double- digit rises in 11 nations: France (up 33 points), Germany (+33), Indonesia (+26), Spain (+25), Mexico (+22), Britain (+16), Argentina (+16), Nigeria (+15), Brazil (+14), Canada (+13), and India (+10).

The survey credits President Obama with leading the remarkable transformation, notes Teixeira, who cites:

…An enormous increase in the number of people internationally with a lot or some confidence that the U.S. president will do the right thing in world affairs. The median level of confidence in the U.S. president among the 21 countries surveyed in both 2008 and 2009 shifted from just 17 percent for Bush in 2008 to 71 percent for Obama in 2009.

Teixeira explains that the extraordinary transformation is attributable to two factors — Bush’s dismal performance in foreign affairs and President Obama’s exceptional credibility as a world leader. Says Teixeira: “It’s good to know that a progressive foreign policy has been able to repair some of this damage so quickly.”

Businessweek, via MSN Money has an article, “What’s most likely to bankrupt you” that ought to be required reading for every Democrat. And, as President Obama takes the campaign for health care reform on the road, it wouldn’t hurt to include this graph from the article as selling point #1 for those who think their health insurance is adequate and reform may not be so necessary:

Medical problems caused 62% of all personal bankruptcies filed in the U.S. in 2007, according to a study by Harvard researchers. And in a finding that surprised even the researchers, 78% of those filers had medical insurance at the start of their illnesses, including 60.3% who had private coverage, not Medicare or Medicaid.

If anyone can find a better short paragraph that explains why we need a public option, please share. Wondering if health security has been getting better or worse? Here’s the next graph:

Medically related bankruptcies have been rising steadily for decades. In 1981, only 8% of families filing for bankruptcy cited a serious medical problem as the reason, while a 2001 study of bankruptcies in five states by the same researchers found that illness or medical bills contributed to 50% of all filings.

The article goes on to add that the bankruptsy filers were “for the most part solidly middle class before medical disaster hit. Two-thirds owned their homes, and three-fifths had gone to college.”
In other words, those poll respondents we’ve been reading aboout who feel secure about their health insurance may be marinating in self-delusion. As the authors of the cited study, which is being published in the American Journal of Medicine, Drs. David Himmelstein and Steffie Woolhandler of Harvard Medical School, Elizabeth Warren of Harvard Law School and Deborah Thorne, a sociology professor at Ohio University, conclude:

“For middle-class Americans, health insurance offers little protection. Most of us have policies with so many loopholes, co-payments and deductibles that illness can put you in the poorhouse,” said lead author Himmelstein. “Unless you’re Warren Buffett, your family is just one serious illness away from bankruptcy.”

Woolhandler adds,

Covering the uninsured isn’t enough,” she said. “Reform also needs to help families who already have insurance by upgrading their coverage and assuring that they never lose it.”

As President Obama takes his case on the road, this is the kind of information that can help him persuade middle-class, insured Americans why they need health care reform. It’s important that all Democrats — office holders, rank and file and others use it as well. The uninsured know why we need health care reform. It’s time to educate the insured as well, and that’s a worthy challenge for all progressive journalists at this critical moment.

It’s a little early for high fives over at the Democratic Congressional Campaign Committee, but 15 months out, the DCCC ought to be encouraged by a new CQPolitics report indicating House Dems are in solid position for the 2010 elections. The report, by Greg Giroux and Bob Benenson, analyzes “100 congressional districts with races where either major party stands a chance of winning the seat” and concludes that the Dems House majority appears “secure.” Further,

The only three contests in which CQ Politics rates an advantage to the challenging party are all for seats now held by the Republicans and targeted by the Democrats…The Democrats’ two most vulnerable seats, currently rated Tossup, are in districts where McCain outran Obama by wide margins

The only other seat rated “tossup” in the report (NY 23) is now held by a Republican. CQPolitics provides updated ratings for all 435 House districts here, with links offering electoral and demographic data for each district and personal information about its representative.
Benenson and Giroux caution that “the party holding the White House often loses seats during a president’s first mid-terms” and a DCCC report in early June noted turnout concerns regarding two key constituencies:

African-Americans and college-age students turned out in considerable numbers for Obama, and it is far from clear whether they will do so again in the midterms. In fact, exit polls over the past few elections have shown that turnout for both groups has dropped in nonpresidential years.
For example, African-Americans made up 11 percent of all voters in 2004 and 13 percent of all voters in 2008, but only 10 percent of the 2006 midterm electorate. For younger voters, the drop-off is even more stark. Voters 18-29 years old constituted 18 percent of all voters in 2008 and 17 percent of all voters in 2004. But in the intervening 2006 midterm, they accounted for only 12 percent of all voters.

Mid-term turnout concerns notwithstanding, Giroux and Benenson conclude:

While at least some net gain is a very plausible possibility for the Republicans, it would take a huge reversal of political fortune for the party to reclaim a House majority. Of the 335 contests that CQ Politics’ election analysts rate as Safe for the incumbent party, 198 are currently Democratic (including that one vacant seat) and just 137 are Republican.
In addition, the Democrats are solidly favored in 31 of the 59 competitive contests for seats they currently hold, plus the Republican seat in Louisiana’s 2nd District. So if the Democrats were to win only their Safe seats and those rated Democrat Favored, they would have a total of 230 — well above the majority threshold of 218 seats.

It’s unclear at this juncture, what impact, if any, the current health care reform struggle in the House will have on Dems’ prospects, although it is hard to imagine it not helping if they pass a good bill.

Regarding the concerns in Dem circles about President Obama’s recent approval ratings, Brendan Nyhan has a calm-headed analysis. As Nyhan explains:

…Coverage of presidential approval suffers from a bizarre ahistoricism. Reporters typically have almost no understanding of the forces that drive presidential approval or the patterns it tends to follow during the course of a president’s time in office…That’s why it’s amusing to see so many people acting like it’s news that approval of President Obama’s handling of health care and overall job performance numbers are trending downward (particularly among independents and Republicans). Of course his numbers are going down! It’s been a virtual certainty that this transition would take place since the day Obama took office. The only question was when it would happen and how far down they would go.
The reason is simple. Presidential approval tends to decline after the honeymoon period as the opposition party begins to be more critical of the president…This decline was likely to be especially significant in Obama’s case because his initial Gallup approval levels were the highest for any president since JFK.

Regarding approval of Obama’s handling of health care, Nyhan notes:

…At first, Obama benefitted from what the political scientist John Zaller calls a one-message environment in which Congressional Republicans offered platitudes about their desire to work with him on health care. However, as the legislative process has moved forward, the GOP and its allies in the press have begun to aggressively attack his approach to the issue. As such, Republicans and sympathetic independents in the electorate are now more likely to tell pollsters that they don’t approve of Obama’s handling of the issue.
The upside for Obama is that these numbers don’t seem to indicate anything specific about the prospects for his health care plan. It would be surprising if the public didn’t start to split along partisan lines at this point given the nature of the proposal. There isn’t much information here that the two parties couldn’t have anticipated (though it would be helpful to put the numbers in context — how do Obama’s health care approval numbers compare to, say, Clinton’s in July 1993?)

Nyhan believes that we are not likely to see much of an uptick in Obama’s approval numbers in the near future as a result of his efforts in behalf of health reform, given the intensity of the approaching battle, even though it’s rarely the case that one factor trumps all others in swaying presidential approval ratings. In addition, as chart data Nyhan provides indicates, “the aggregate preference of the electorate for more or less government — what the political scientist James Stimson calls public mood — tends to move in the opposite direction of a dominant governing party.”
So we can give the hand-wringing about approval ratings a rest. It would be more surprising if Obama’s approval numbers didn’t go down. Let the opposition do the chicken little dance, while Dems keep our eyes on the big prize, which is enacting meaningful health care reform. When that historic struggle is won, we can expect an uptick in the president’s approval ratings — and Democratic fortunes in general.