"However well he may be dealing with it, a bad economy will always harm a president," agreed Matthew Continetti, an associate editor at the Weekly Standard. "But the town hall meetings, the tea parties, national polls and the Republican electoral victories indicate that the American people have rejected the substance of the President's agenda — particularly his stance on healthcare."

Certainly, Obama's dogged pursuit of a comprehensive healthcare Bill seems to have been the tipping point for voters increasingly alarmed by the expansion of government, increase in federal spending and the visible proliferation of Chicago-style wheeler-dealing. At 2,409 pages long (at the time of writing), the Patient Protection and Affordable Care Act is a collection of mandates, price controls, entitlements, regulations, taxes and barely-concealed political kickbacks. The Congressional Budget Office has projected it will cause individual insurance premiums (ie, insurance plans not obtained through an employer) to rise by up to 13 per cent and will cost an estimated $4.9 trillion over the next 20 years. According to a recent CNN poll, only 25 per cent of Americans support the current comprehensive Bill, while a staggering 73 per cent want it abandoned.

While liberal observers dispute that the healthcare reform saga amounts to a rejection of Obama's agenda, many do feel that it may have been strategically unwise to pursue it so early in his presidency. "He should have focused on jobs and the economy from the beginning — that's what he ran on, and that's what he won on," Juan Williams reasoned. "By pursuing healthcare, he made it look as if that was not his top priority, and he inadvertently appeared to be out of touch with the concerns of ordinary Americans." 

William Galston exlained:, "He has been compelled by circumstance to inject billions into the economy through the stimulus Bill. While I think that was completely necessary, I think a lot of Americans were shocked by that level of spending, and following it up with the healthcare Bill may have increased that sense of unease."

There are also profound cultural reasons for public opposition to the Bill. In contrast to British voters, who consider nationalised healthcare a positive right, the American public is generally suspicious of any assertion of government control over individual decisions. It's an essentially libertarian ethos dating back to the American Revolution — which may be another reason why Obama's current struggle confuses many of his admirers across the pond.Peter Beinart, the author and former editor of the New Republic, believes the President should use his authority to build a society closer to a social-democratic model. "The central question of Obama's presidency will be whether we have transitioned from Reagan's America to one in which major progressive change can be achieved," Beinart remarked. "I am personally hopeful that this will be the case, but it's certainly a pretty big task." 

Beinart's position seemed quite tenable to me. Yet the resurgence of small-government rhetoric among the tea party movement and in recent elections indicates that the pendulum may have swung the other way. As Caldwell observed, "There is a difference between principles and the culture as it exists on the ground. So Obama's agenda may very well make sense as an argument, but it does not make political sense if you consider the wishes and habits of the American people."