Rarely does a president bet everything on a single card, but Barack Obama did it on health care. Almost from the beginning, the White House was guided by one priority: Nothing must get in the way of health care. Everything else would have to wait.

Sunday night, the president who was criticized for winning a Nobel Prize without much of a record finally won a signature achievement – victory on the kind of massive health care overhaul that Democrats had failed to achieve for nearly half a century.

In the months ahead, Obama will face the question of whether his health care victory is a high-water mark for a now-exhausted administration, or instead becomes the leaping-off point for victories on other big issues, such as energy, immigration and financial regulation.

But what became clear in the health care debate is that Obama is a president with a combative stubbornness, one that was not often visible in his cool, above-the-fray public demeanor. And he has demonstrated that a president who picks a goal, adopts a battle plan and sticks with it, come what may, is not easy to knock out.

In the 14 months of the health care fight, Obama saw his popularity plunge 20 points. Voters, whipsawed by high unemployment, lost savings and the other ravages of a devastating recession, boiled over in anger at a president seeming obsessed with his own priorities.

From the beginning, GOP strategists saw the health care debate as a chance to cripple Obama’s presidency. Sen. Jim DeMint, R-S.C., cast the stakes in military terms, predicting that a defeat on health care would be Obama’s “Waterloo.”

In perhaps the White House’s darkest hour, Obama suffered a stinging rebuke – and lost the Democrats’ filibuster-proof Senate majority – when Massachusetts spurned a last-minute presidential appeal and gave the late Sen. Edward M. Kennedy’s seat to a Republican in a special election dominated by health care.

Yet if Obama wavered, it was only briefly. Even some Democrats counseled him to drop the attempt at massive change and settle for smaller health care goals. Although he toyed with the idea at least once, in the end he held fast.

And while he was criticized even within his own party for delegating to Congress the early shaping of the health care bill, Obama mobilized in the weeks after Republican Scott Brown won the special election in Massachusetts.

From that day, it was clear that the endgame for Obama would come in the House of Representatives. He then fought with a combination of tactics that played to his strength – campaigning – but also required a skill that was less tested – negotiating.

On both fronts, he showed a level of pragmatism that frustrated some of his most liberal and idealistic supporters – a willingness to trade a perfect bill for a somewhat less ambitious one that could pass.

Exploiting the bully pulpit, he made a series of trips to places like St. Charles, Mo., and Cleveland and exhorted rank-and-file supporters with the rhetoric he honed during his 2008 campaign. He invited both Democrats and Republicans to a televised health care “summit” – notable not for any breakthrough accomplishment but for underscoring just how far apart the Democrats and Republicans were on the issue.

As late as Saturday, he traveled to Capitol Hill to lead a rally of House Democrats.

In between such events, he and his aides tirelessly lobbied fence-sitting members of the House.

Obama bluntly told skeptical members that for his presidency to be strong, he needed them to pass the bill.

Rep. Raul M. Grijalva, D-Ariz., said Obama spoke to members of the House Progressive caucus and laid out the stakes.

In the audience was Rep. Dennis J. Kucinich, D-Ohio, and other liberals who were upset the bill did not include a public option.

Obama told the group, “For us to move on other issues of importance we’re going to need a strong presidency. And if I lose this one it’s going to be a weakened presidency and it will be very difficult to move on other items,” Grijalva recounted.

In his personal lobbying, the president showed a knack for finding the right chord. He persuaded Rep. Dan Maffei, D-N.Y., with the argument that health care issue would not be addressed for years to come if this effort collapsed.

And Obama laid on a little flattery and told Maffei, a freshman who was formerly spokesman for the House Ways and Means committee, that his commitment to the bill could help win support from other wavering lawmakers. Maffei agreed on the phone to support the bill.

“We only have one president at a time,” Maffei said he told the president. “We need you to succeed.”

Obama thanked him.

Even Sunday was filled with presidential strategizing and phone calls. Obama popped into an 11 a.m. senior staff meeting in Chief of Staff Rahm Emanuel’s office, and then spent the afternoon making calls to House members and watching the NCAA basketball tournament.

In the late afternoon, he made the final decision to take one more chance. He agreed to issue an executive order declaring that the health care measure would not change the existing ban on federal funding for abortions.

That brought over Rep. Bart Stupak, D-Mich., leader of the last Democratic holdouts, even though the order risked infuriating some of Obama’s most important supporters.

Looking forward, the question is whether Obama can build on the momentum of his health care victory.

As Rep. Brad Sherman, D-Calif., said Sunday, the obstacles to other legislative goals won’t disappear with passage of health care.

“Financial reform is just around the corner. But it’s not like the American Bankers Association is going to endorse an independent consumer protection agency just because the health care bill passes,” Sherman said. “That doesn’t mean the immigration bill is going to pass.

“Everything else is a very heavy lift,” he said.


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