Mr. Obama laughed about it afterward. “I generally wouldn’t take advice about what’s good for Democrats” from Mr. McConnell, he told an audience in Pennsylvania. But he conceded that “that’s what members of Congress are hearing right now on the cable shows and in sort of the gossip columns in Washington.” He went on to argue that the issue should be what’s right, not the politics.  But this is Washington and politics are never far from the surface, especially at a decisive moment like this. If the schedule being mapped last week holds – and Mr. Obama’s senior adviser, David Axelrod, said on Sunday that it would — the fate of the president’s health care plan should be decided within the week. “I believe we will have” the votes, Mr. Axelrod said on ABC’s “This Week,” though Republicans and even some Democrats have questioned whether the votes are there now.  But the plan’s fate could depend on how a couple dozen Democratic congressmen answer the questions Mr. McConnell and Mr. Obama raised: Would passing health care devastate Democratic chances in the fall? Would rejecting it devastate a Democratic presidency?  Washington is already debating how pivotal the vote will be to his presidency. Mr. Obama has devoted vast energy and political capital over the last 14 months to get to this point, the presidential equivalent of an all-in bet on the poker table. Should he fail to push his plan through a Congress with strong Democratic majorities, it would certainly damage his credibility as a leader for months, and maybe years. Already the fight has scarred Washington, leaving behind a polarized and angry political elite and questions about whether the system is broken.  If Mr. Obama falls short on health care, his hopes of passing other ambitious legislation like an overhaul of immigration and a market-based cap on carbon emissions to curb climate change would seem out of reach, at least for the rest of this year. Much of Washington would question whether he is weak, some Democratic candidates would run away from him and Mr. Obama would be forced to consider a narrower agenda like that pursued by Bill Clinton after his own health care drive collapsed.  At the same time, passing it has its risks too. While a bill-signing ceremony in the Rose Garden would provide at least a short-term boost to a beleaguered president, Republicans have made clear that the legislative procedure Democrats are using to avoid another filibuster would so anger them that they would not cooperate on other major initiatives this year.  “If they jam through health care,” said Senator Lindsey Graham of South Carolina, then Democrats will have “poisoned the well” on other issues. He was interviewed Sunday on ABC’s “This Week.”  An immigration proposal he has been working on with Senator Charles Schumer, Democrat of New York, would likely fall victim to the worsened environment, he said.  If Mr. Obama and the Democrats succeed, the challenge over the next eight months will be to convince the public that the program is better than polls suggest they think it is. And while some of its features would take effect right away, particularly popular limits on abuses by insurance companies, much of its impact in terms of coverage for the uninsured would not kick in until long after the fall election.  “If and when this is passed, Democrats will run aggressively on this,” said Dan Pfeiffer, the White House communications director. “We relish the idea of Republicans running on the Tea Party mantle of repeal.”  But Karl Rove, the former senior adviser to President George W. Bush, said Republicans relish the fight as well. “If they pass it,” he said about the Democrats, “they’re dead in the polls.”  Past presidents have suffered the consequences of big initiatives. Mr. Bush failed to get a Republican Congress to approve his overhaul of Social Security in 2005, undercutting his ability to pass other major proposals for the rest of his term. In hindsight, Mr. Rove said he wished the Bush White House had led off the second term with immigration and chalked up a bipartisan victory before moving on to Social Security.  The more salient precedent remains Mr. Clinton’s health care drive, which ran aground in a Democratic Congress in his first term. The debacle fueled the electoral sweep that handed Congress to the Republicans in 1994. Democrats have bitter memories. “A lot of them have P.T.S.D. from 1994,” said a White House official, referring to post-traumatic stress disorder.  Among those who lost reelection that year was Marjorie Margolies Mezvinsky, a freshman Democrat from Pennsylvania who cast the deciding vote on Mr. Clinton’s budget package, which cut the deficit through spending cuts and a tax increase on the wealthy.  The former congresswoman, who now goes by Marjorie Margolies, recalled last week that she had boiled down her explanation of her vote to four minutes. The problem was that her opponents had boiled down their criticism of her to a 30-second advertisement. “It’s very hard to push back on that 30 seconds and that’s what these members are going to face and that’s what these members are scared about,” she said.  Rahm Emanuel, a former top adviser to Mr. Clinton who now serves as White House chief of staff, has often said Mr. Clinton’s problem was not taking on health care but losing on health care. Unlike Mr. Rove, Mr. McConnell and other Repubicans, Thomas M. Davis III, a former congressman who served in the Republican leadership, said failure to pass health care would be worse for Democrats than passing it.
Win or lose on health care, President Obama will face a vastly different political landscape after the fate of his plan is decided.