Matt Yglesias sums up a plausible healthcare strategy:
if I were a member of congress in addition to the polling I’d be thinking about how things will actually look to people when a bill passes. If you think Medicare recipients will continue to be happy with the quality of the health care services they receive, then you should assume that Medicare recipients will continue to be happy with the quality of the health care services they receive. Conversely, if you promise younger people that your bill will improve their health care, you’d better deliver something that actually improves their health care. Whether or not you sell them on it in advance seems less important than whether or not what you did looks good in retrospect. [emphasis added)
I suspect that the main reason Obama wants healthcare reform passed quickly is not so much that he felt he had momentum, but that he needs a little time after it passes for people to calm down, get familiar with the new environment and see that they won’t be hurt but may be helped by reform. Seniors especially need time to realize that Medicare won’t be changed.
I suspect it will be years before the impact of the bill becomes fully realized. But if not much changes in a negative way come November 2010, the electoral prospects for Dems will not be as grim as they might be if no reform was passed.