Barack Obama moved to end the paralysis gripping Washington today when he embarked on a final effort to push his troubled healthcare bill through Congress.
Faced with a growing wave of public discontent with his administration, Obama set out an 11-page heath reform plan aimed at reviving his fortunes and dispelling predictions he would end up as only a one-term president
Obama desperately needs the health bill to fulfil his top election campaign promise, especially as he is struggling to secure any other major pieces of legislation in the present toxic political atmosphere.
His heath plan, the first time he has set out in detail what kind of reform he would like, offered multimillion dollar sweeteners aimed at winning over voters.
His plan would cost an estimated total of $950bn (£613bn) over 10 years and would extend health coverage to an extra 31 million people.
Washington is being described as ungovernable by US commentators after more than a month of stalemate, with Obama accused of failing to provide leadership and the Democrats still in the shock after the loss of the Massachusetts Senate seat to the Republicans last month.
Obama posted his plan on the White House website yesterday, setting out health proposals that are heavily populist, promising to curb excessive rises in insurance costs and to give tax cuts for the working class.
The president is to hold a summit in Washington with the Republicans on Thursday supposedly aimed at encouraging a bipartisan approach to health reform, but the plan posted today was an almost total rejection of Republican calls for Obama to start from scratch.
In his response to the president's plan, John Boehner, the Republican leader in the House, suggested the summit was unlikely win over his party. "The president has crippled the credibility of this week's summit by proposing the same massive government takeover of health care based on a partisan bill the American people have already rejected," he said.
An Obama spokesman, Dan Pfeiffer, briefed reporters on the new health proposals, saying: "We view this as the opening bid for the health meeting. We took our best shot at bridging the differences."
Pfeiffer challenged the Republicans to post their alternative version of health reform on the web.
The Senate and the House have passed different versions of the bill and were preparing to negotiate a compromise in January when the Massachusetts result threw that into disarray. A plan shaping up in the White House and Congress is to push the bill through with no Republican support.
Obama's plan is close to a version passed by the Senate on Christmas Eve and the course now being charted would see the House pass the same version too, avoiding a need to return to the Senate where the Republicans could obstruct it.
The biggest sweetener in Obama's plan is to create a body that will decide whether rises by insurance companies are unreasonable. That is in response to angry public protests in California after the Anthem insurance company raised costs by 39%.
Another sweetener is to make insurance more affordable for tens of millions by offering what the White House described as the biggest tax cut in healthcare in history. The measure is aimed primarily at left-leaning Democrats in the House to secure their backing for the Senate version of the bill, which is more conservative than the version passed by the House.
But getting House approval is far from being a given. Although the Democrats enjoy a majority of more than 70 in the House, their version of the bill only passed by 220 to 215 in November.
The House Speaker, Nancy Pelosi, gave a guarded welcome to Obama's plan today, saying: "I look forward to reviewing it with House members and then joining the president and the Republican leadership at the Blair House [the summit location] meeting on Thursday."
In another nod to public opinion, Obama put forward a proposal aimed at eliminating a piece of pork-barrel spending put into the Senate version to help win the support of Nebraska Democrat Ben Nelson. The senator had secured funding for his state but Obama is now proposing the spending be applied to all states.