They are not worried about his policy choices. Their concerns are more fundamental. They are worried about his determination.

But they do not know if he possesses the trait that is more important than intellectual sophistication and, in fact, stands in tension with it. They do not know if he possesses tenacity, the ability to fixate on a simple conviction and grip it, viscerally and unflinchingly, through complexity and confusion. They do not know if he possesses the obstinacy that guided Lincoln and Churchill, and which must guide all war presidents to some degree.

Most of them, like most people who have spent a lot of time in Afghanistan, believe this war is winnable. They do not think it will be easy or quick. But they do have a bedrock conviction that the Taliban can be stymied and that the governments in Afghanistan and Pakistan can be strengthened.

I know about 50 really smart people on Afghanistan with lots of time on the ground there, and no two have the same opinion about what U.S. policy should be.

...if these experts do not know the state of President Obama's resolve, neither do the Afghan villagers. They are now hedging their bets, refusing to inform on Taliban force movements because they are aware that these Taliban fighters would be their masters if the U.S. withdraws. Nor does President Hamid Karzai know. He's cutting deals with the Afghan warlords he would need if NATO leaves his country.

The Obama adminstration has, I believe, some leverage at the moment, which it could use to affect the composition and behavior of the next Afghan government. As long as Afghanistan's ruling politicians--Hamid Karzai especially--think the United States might reduce its commitment to Afghanistan, they could be willing to accede to U.S. demands on key ministerial and provincial-level appointments....

while countless memoranda and manuals exist instructing U.S. servicemen on how to wage counterinsurgency campaigns at the operational and tactical levels, there is currently little guidance for how U.S. policymakers should use leverage over its Afghan partners. The Obama administration, if it's clever, will try to figure out the best way to use its leverage over Karzai and other Afghan politicians. And in that effort, they deserve time to succeed.

1. He spelled out how reform would make those who already have insurance more secure, and reassured seniors that he was strengthening rather than hollowing out Medicare.
2. He directly spelled out, denounced and debunked the lies and distortions that have dominated coverage of the issue all summer
   
3. He positioned himself in the center between "those on the left" who would a) prefer a single payer system and b) insist on a public option or bust, and "those on the right" who would a) end employer-based health care and completely individualize or b) simply try to kill any reform bill that has a chance of passing.
4. Returning to the theme that gave his rhetoric wings in the campaign, having carved out that center space for himself, he moved the center left by defining provision for the common weal as a central theme in American history albeit (balancing individualism and a healthy skepticism about government).

a) But the problem that plagues the health care system is not just a problem of the uninsured. Those who do have insurance have never had less security and stability than they do today. More and more Americans worry that if you move, lose your job, or change your job, you'll lose your health insurance too. More and more Americans pay their premiums, only to discover that their insurance company has dropped their coverage when they get sick, or won't pay the full cost of care. It happens every day....

b) Here are the details that every American needs to know about this plan:

First, if you are among the hundreds of millions of Americans who already have health insurance through your job, Medicare, Medicaid, or the VA, nothing in this plan will require you or your employer to change the coverage or the doctor you have. Let me repeat this: nothing in our plan requires you to change what you have.

What this plan will do is to make the insurance you have work better for you. Under this plan, it will be against the law for insurance companies to deny you coverage because of a pre-existing condition. As soon as I sign this bill, it will be against the law for insurance companies to drop your coverage when you get sick or water it down when you need it most. They will no longer be able to place some arbitrary cap on the amount of coverage you can receive in a given year or a lifetime. We will place a limit on how much you can be charged for out-of-pocket expenses, because in the United States of America, no one should go broke because they get sick. And insurance companies will be required to cover, with no extra charge, routine checkups and preventive care, like mammograms and colonoscopies - because there's no reason we shouldn't be catching diseases like breast cancer and colon cancer before they get worse. That makes sense, it saves money, and it saves lives.

That's what Americans who have health insurance can expect from this plan - more security and stability.

And on Medicare:

More than four decades ago, this nation stood up for the principle that after a lifetime of hard work, our seniors should not be left to struggle with a pile of medical bills in their later years. That is how Medicare was born. And it remains a sacred trust that must be passed down from one generation to the next. That is why not a dollar of the Medicare trust fund will be used to pay for this plan.

The only thing this plan would eliminate is the hundreds of billions of dollars in waste and fraud, as well as unwarranted subsidies in Medicare that go to insurance companies - subsidies that do everything to pad their profits and nothing to improve your care. And we will also create an independent commission of doctors and medical experts charged with identifying more waste in the years ahead.

These steps will ensure that you - America's seniors - get the benefits you've been promised. They will ensure that Medicare is there for future generations. And we can use some of the savings to fill the gap in coverage that forces too many seniors to pay thousands of dollars a year out of their own pocket for prescription drugs. That's what this plan will do for you. So don't pay attention to those scary stories about how your benefits will be cut - especially since some of the same folks who are spreading these tall tales have fought against Medicare in the past, and just this year supported a budget that would have essentially turned Medicare into a privatized voucher program. That will never happen on my watch. I will protect Medicare.

2. Giving the lie to Palin and her ilk:

Still, given all the misinformation that's been spread over the past few months, I realize that many Americans have grown nervous about reform. So tonight I'd like to address some of the key controversies that are still out there.

Some of people's concerns have grown out of bogus claims spread by those whose only agenda is to kill reform at any cost. The best example is the claim, made not just by radio and cable talk show hosts, but prominent politicians, that we plan to set up panels of bureaucrats with the power to kill off senior citizens. Such a charge would be laughable if it weren't so cynical and irresponsible. It is a lie, plain and simple.

There are also those who claim that our reform effort will insure illegal immigrants. This, too, is false - the reforms I'm proposing would not apply to those who are here illegally. And one more misunderstanding I want to clear up - under our plan, no federal dollars will be used to fund abortions, and federal conscience laws will remain in place.

My health care proposal has also been attacked by some who oppose reform as a "government takeover" of the entire health care system. As proof, critics point to a provision in our plan that allows the uninsured and small businesses to choose a publicly-sponsored insurance option, administered by the government just like Medicaid or Medicare.

So let me set the record straight. My guiding principle is, and always has been, that consumers do better when there is choice and competition. Unfortunately, in 34 states, 75% of the insurance market is controlled by five or fewer companies. In Alabama, almost 90% is controlled by just one company. Without competition, the price of insurance goes up and the quality goes down....[defense of the public option follows]

3. Carving out the center:

There are those on the left who believe that the only way to fix the system is through a single-payer system like Canada's, where we would severely restrict the private insurance market and have the government provide coverage for everyone. On the right, there are those who argue that we should end the employer-based system and leave individuals to buy health insurance on their own.

I have to say that there are arguments to be made for both approaches. But either one would represent a radical shift that would disrupt the health care most people currently have. Since health care represents one-sixth of our economy, I believe it makes more sense to build on what works and fix what doesn't, rather than try to build an entirely new system from scratch. And that is precisely what those of you in Congress have tried to do over the past several months....

It's worth noting that a strong majority of Americans still favor a public insurance option of the sort I've proposed tonight. But its impact shouldn't be exaggerated - by the left, the right, or the media. It is only one part of my plan, and should not be used as a handy excuse for the usual Washington ideological battles. To my progressive friends, I would remind you that for decades, the driving idea behind reform has been to end insurance company abuses and make coverage affordable for those without it. The public option is only a means to that end - and we should remain open to other ideas that accomplish our ultimate goal. And to my Republican friends, I say that rather than making wild claims about a government takeover of health care, we should work together to address any legitimate concerns you may have.

4) Moving the center left and positioning government action for the common good as a core element of American identity: For this, Obama deployed the ghost of Teddy Kennedy:

He [Kennedy] repeated the truth that health care is decisive for our future prosperity, but he also reminded me that "it concerns more than material things." "What we face," he wrote, "is above all a moral issue; at stake are not just the details of policy, but fundamental principles of social justice and the character of our country."

I've thought about that phrase quite a bit in recent days - the character of our country. One of the unique and wonderful things about America has always been our self-reliance, our rugged individualism, our fierce defense of freedom and our healthy skepticism of government. And figuring out the appropriate size and role of government has always been a source of rigorous and sometimes angry debate.

For some of Ted Kennedy's critics, his brand of liberalism represented an affront to American liberty. In their mind, his passion for universal health care was nothing more than a passion for big government.

But those of us who knew Teddy and worked with him here - people of both parties - know that what drove him was something more. His friend, Orrin Hatch, knows that. They worked together to provide children with health insurance. His friend John McCain knows that. They worked together on a Patient's Bill of Rights. His friend Chuck Grassley knows that. They worked together to provide health care to children with disabilities.

On issues like these, Ted Kennedy's passion was born not of some rigid ideology, but of his own experience. It was the experience of having two children stricken with cancer. He never forgot the sheer terror and helplessness that any parent feels when a child is badly sick; and he was able to imagine what it must be like for those without insurance; what it would be like to have to say to a wife or a child or an aging parent - there is something that could make you better, but I just can't afford it.

That large-heartedness - that concern and regard for the plight of others - is not a partisan feeling. It is not a Republican or a Democratic feeling. It, too, is part of the American character. Our ability to stand in other people's shoes. A recognition that we are all in this together; that when fortune turns against one of us, others are there to lend a helping hand. A belief that in this country, hard work and responsibility should be rewarded by some measure of security and fair play; and an acknowledgement that sometimes government has to step in to help deliver on that promise.

This has always been the history of our progress. In 1933, when over half of our seniors could not support themselves and millions had seen their savings wiped away, there were those who argued that Social Security would lead to socialism. But the men and women of Congress stood fast, and we are all the better for it. In 1965, when some argued that Medicare represented a government takeover of health care, members of Congress, Democrats and Republicans, did not back down. They joined together so that all of us could enter our golden years with some basic peace of mind.

You see, our predecessors understood that government could not, and should not, solve every problem. They understood that there are instances when the gains in security from government action are not worth the added constraints on our freedom. But they also understood that the danger of too much government is matched by the perils of too little; that without the leavening hand of wise policy, markets can crash, monopolies can stifle competition, and the vulnerable can be exploited. And they knew that when any government measure, no matter how carefully crafted or beneficial, is subject to scorn; when any efforts to help people in need are attacked as un-American; when facts and reason are thrown overboard and only timidity passes for wisdom, and we can no longer even engage in a civil conversation with each other over the things that truly matter - that at that point we don't merely lose our capacity to solve big challenges. We lose something essential about ourselves.

Al Qaeda terrorists are trained to resist torture. As shocking as these techniques are to us, the al Qaeda training prepares them for much worse - the torture they would expect to receive if caught by dictatorships for example. This is why, as we see from the recently released Department of Justice memos on interrogation, the contractors had to keep getting authorization to use harsher and harsher methods, until they reached waterboarding and then there was nothing they could do but use that technique again and again. Abu Zubaydah had to be waterboarded 83 times and Khalid Shaikh Mohammed 183 times. In a democracy there is a glass ceiling of harsh techniques the interrogator cannot breach, and a detainee can eventually call the interrogator's bluff.

A third major problem with this technique is that it is slow. It takes place over a long period of time, for example preventing the detainee from sleeping for 180 hours as the memos detail, or waterboarding 183 times in the case of KSM. When we have an alleged "ticking timebomb" scenario and need to get information quickly, we can't afford to wait that long.

Another disastrous consequence of the use of the harsh techniques was that it reintroduced the "Chinese Wall" between the CIA and FBI - similar to the wall that prevented us from working together to stop 9/11. In addition, the FBI and the CIA officers on the ground during the Abu Zubaydah interrogation were working together closely and effectively, until the contractors' interferences. Because we in the FBI would not be a part of the harsh techniques, the agents who knew the most about the terrorists could have no part in the investigation. An FBI colleague of mine, for example, who had tracked KSM and knew more about him than anyone in the government, was not allowed to speak to him.

Furthermore, the CIA specializes in collecting, analyzing, and interpreting intelligence. The FBI, on the other hand, has a trained investigative branch. Until that point, we were complimenting each other's expertise, until the imposition of the "enhanced methods." As a result people ended doing what they were not trained to do.

It is also important to realize that those behind this technique are outside contractors with no expertise in intelligence operations, investigations, terrorism, or al Qaeda. Nor did the contractors have any experience in the art of interview and interrogation. One of the contractors told me this at the time, and this lack of experience has also now been recently reported on by sources familiar with their backgrounds.

It was a mistake to abandon it [Soufan's noncoercive "Informed Interrogation Approach"] in favor of harsh interrogation methods that are harmful, shameful, slower, unreliable, ineffective, and play directly into the enemy's handbook. It was a mistake to abandon an approach that was working and naively replace it with an untested method. It was a mistake to abandon an approach that is based on the cumulative wisdom and successful tradition of our military, intelligence, and law enforcement community, in favor of techniques advocated by contractors with no relevant experience.

The mistake was so costly precisely because the situation was, and remains, too risky to allow someone to experiment with amateurish, Hollywood style interrogation methods- that in reality- taints sources, risks outcomes, ignores the end game, and diminishes our moral high ground in a battle that is impossible to win without first capturing the hearts and minds around the world. It was one of the worst and most harmful decisions made in our efforts against al Qaeda.

Q You've heard a lot of Republican criticism that he's going around the world apologizing about America. Do you accept that?

SEC. GATES: Well, I like to remind people that when President George W. Bush came into office, he talked about a more humble America. And, you know, you go back to Theodore Roosevelt and his line about speaking softly but carrying a big stick. I think that acknowledging that we have made mistakes is not only factually accurate - I think that it is unusual because so few other governments in the world are willing to admit that, although they make them all the time, and some of them make catastrophic mistakes.

And in speeches myself, I have said that at times we have acted too arrogantly. And I didn't feel that I was being apologetic for America. I just was saying because - I was just saying that that's the way we are in terms of being willing to recognize our own limitations, and when we make a mistake, to correct it, because I think the next line that I always use is, no other country in the world is so self-critical and is so willing to change course when we feel that we've strayed from our values or when we feel like we've been too arrogant.

So I think - I have not seen it as an apology tour at all, but rather a change of tone, a more humble America. But everybody knows we still have the big stick.

Q But you do think that the [Pakistani] leadership gets it? Because I look at what's happened, Mr. Secretary. They have these Taliban forces, insurgency, 60 miles from the capital, 100 miles from the capital. And what they've done so far is move 6,000 troops from the eastern border to the western border out of an army of about a half-million.

This does not strike one as a full-throated response at every level that mobilizes the nation and its defense forces. Do you think that there is still a way to go for the Pakistani military in terms of focusing on this threat?

SEC. GATES: Well, I think what you have to do is look at it in some historical context. For 60 years Pakistan has regarded India as its existential threat, as the main enemy. And its forces are trained to deal with that threat. That's where it has the bulk of its army and the bulk of its military capability.

And historically, the far western part of Pakistan has generally been ungoverned. And the Pakistani governments going back decades would do deals with the tribes and the Pashtuns and would play the tribes against one another, and occasionally, when necessary, use the army to put down a serious challenge.

I think that - and partly it's because the Punjabis so outnumber the Pashtuns that they've always felt that if it really got serious, it was a problem they could take care of. I think the - that's why I think the movement of the Taliban so close to Islamabad was a real wake-up call for them.

Now, how long it takes them to build the capabilities, the additional military capabilities and the training that goes into counterinsurgency and so on and to develop the civilian programs that begins to push back in that part of the country, I think, is still a period ahead of us.

But I would just remind that, you know, the first al Qaeda attack on the United States was in 1993. We really didn't change much of anything we did until after we were hit on September 11th, 2001. So al Qaeda was at war with us for eight years, at least eight years, before we acknowledged that we were at war with them as well. And I think a little bit of the same denial has been going on in Pakistan. But I think that the recent developments have certainly got their attention.

Q Do you think they have the counterinsurgency capacity? Because at some level armies don't like to fight these kind of wars, as you well know. What armies like to do is have a big enemy so they can have a big budget and never have to fight a war. And that is, in effect, what has happened with Pakistan with India, which is they have this big enemy. It justifies a very large budget for the Pakistani military. But they don't actually have to fight, whereas this one, the insurgency, is one which they have to fight. They could lose. And so they worry, I think, that they even have the capacity. Do they have the capacity for real counterinsurgency?

SEC. GATES: Well, I think that they are at the beginning of the process of developing that capacity. But again, to provide some perspective, in 2003, when we went into Iraq, or even in 2001 and '02, when we went into Afghanistan, our Army didn't have that capacity either. We had forgotten everything we learned about counterinsurgency in Vietnam. And it took us several years to change our tactics and to get ourselves into a position where we could effectively fight a counterinsurgency.

So institutions are slow to change even in the face of a real threat. And I think that the Pakistanis are beginning to open up to others, to get additional help. I certainly hope that's the case. But I don't - it's not something where I would sort of blame the Pakistani army, because we went through the same process ourselves as we confronted a building insurgency in Iraq.

We had to learn all over again how to do this, and we had to acquire the equipment to do it effectively, completely outside the normal Pentagon bureaucracy, for the most part. So perhaps I have a little more understanding of the challenges that our Pakistani counterparts face than perhaps others.

Q You once said that the chief lesson you learned from 40 years in government was the limits of power. So apply that lesson to Afghanistan today. What do you think of - what are the limits to what America can do in Afghanistan?

SEC. GATES: Well, I have been quoted as accurately as saying I have real reservations about significant further commitments of American military - of the American military to Afghanistan, beyond what the president has already approved. The Soviets were in there with 110,000, 120,000 troops. They didn't care about civilian casualties. And they couldn't win. If there's ever an example that military power alone cannot be successful in Afghanistan, I think it was the Soviet experience. And I think there's a lot we can learn from that. And so I worry - it is
absolutely critical that the Afghans believe that this is their war. It is their war against people who are trying to overthrow their government that they democratically elected.

For all of its flaws and shortcomings, it is theirs. And they - we must be their partner and their ally. If we get to the point where the Afghan people see us as occupiers, then we will have lost. So the way we treat the Afghans, the importance of keeping the Afghans in the lead in many of these activities, the military as well as the civilian, I think is absolutely critical, so that they know - so that these villagers know that it's their people who are leading this fight. This isn't some foreign army coming in there, like all the previous foreign armies, to just occupy them.

Q But that means that a year from now, six months from now, you are unlikely to approve a request for additional troops in Afghanistan.

SEC. GATES: I would be a hard sell; there's no question about it. And I have not made a secret of that, either publicly or in government meetings. I think we will have - between the American military commitment and our coalition partners, the ISAF partners, we will have about 100,000 troops in Afghanistan. That's only about 10,000 shy of what the Russians had. And I think we need to think about that.

My view is it would be a far better investment to focus on building the strength of the Afghan army and the Afghan police, making sure that of the numbers of people we have there, there are adequate trainers so that we can accelerate the growth of those forces.

It's that combination of a certain level of international support for the Afghan military effort and the growing of the Afghan security forces themselves. It's that partnership that I think eventually will be successful in Afghanistan. As long as - if we try to do it all ourselves, I think it won't work.

The three Cox children have a rare disease called Shwachman Diamond Syndrome, which curtails the production of bacteria-fighting blood cells and digestive enzymes needed to absorb nutrients properly. It can lead to life-threatening infection, bone-marrow failure or a deadly form of leukemia.

After Samuel, 7, Grace, 12, and Jake, 15, were diagnosed with the genetic disease earlier this decade, landing a job with good health benefits became the biggest priority for Mr. Cox. He gave up plans to run his own home respiratory-care business to work as a salaried medical-equipment salesman. In 2006, the family moved to North Carolina from Kansas City to be closer to specialists at Duke University.

But the Coxes' insurance covered only part of the children's care, which includes regular gamma globulin injections to boost their immune systems. At times, the children have seen specialists outside their insurer's network, requiring the Coxes to pay 30% of the bills. The companies that have insured the Cox children deemed some of their treatments experimental, which they don't tend to cover.

Until recently, the Coxes stayed afloat on a patchwork of Good Samaritan efforts and rising home prices. The parish of their former church, Abundant Life Baptist of Lee's Summit, Mo., rallied around them, even after they moved from the Kansas City suburb to North Carolina. A medical fund set up by the church raised tens of thousands of dollars. A separate annual fund-raiser organized by neighbors has generated more than $50,000. And the Coxes tapped more than $100,000 of equity from their former Kansas City home to finance travel to far-flung hospitals before selling it in 2006.

But the economic crisis is rattling their makeshift network of assistance...The Coxes face more than $40,000 in unpaid medical bills as the commissions that Mr. Cox makes on top of his $47,000 base salary dwindle. At the same time, the family's medical and dental premiums at Fisher & Paykel Healthcare, the respiratory-device maker that employs Mr. Cox, jumped about 13% to $876 a month for 2009.

Like most journalists, I do my best to operate in a comfort zone of detachment. But the subject of my cover story in the upcoming edition of TIME is one about which I won't claim the slightest bit of objectivity. It is about my brother Patrick. Last summer, he found out his kidneys were failing; a few weeks later, he found out his health insurance wasn't going to pay for his treatment.

I used to think I was something of an authority on health care; I've covered its policy and its politics for 15 years. But when my family took its own trip through the frustrating maze that is this country's health care system, I discovered how much I had to learn. Health problems are behind half the bankruptcies in this country, and three-quarters of those bankrupt people had health insurance when they got sick. Just about anyone could be one diagnosis away from catastrophe. My editors decided to put this story on the cover not because it is so extraordinary, but because it is so common, and becoming more so every day.

So please read this story. And after you do, go find your health insurance policy and read it, too.

UPDATE: A number of Swampland commenters have suggested that we give our readers a chance to share their own stories. That's a terrific idea. There's now a link in the third paragraph of the story where Facebook users can share their own experiences. (You then scroll to the bottom of the page.) It's not perfect, technologically, but it does give us a way to gather feedback. Please give it a try.

Whitehouse.gov should try that "share your experience" exercise. As Jonathan Chait notes on his healthcare blog The Treatment, Obama, as he seeks to marshall the country in support of health care reform, is avoiding focusing solely or primarily on the plight of the uninsured. Not only is he spotlighting health care costs -- a matter of the country's long-term fiscal viability -- but he's also speaking in terms of Jacob Hacker's great risk shift:

But Obama also presented the cost problem as a problem for individuals--one that was crushing the insured as well as the uninsured, and in many cases transforming the insured into the uninsured:

In the last eight years, premiums have grown four times faster than wages. An addition 9 million Americans have joined the ranks of the uninsured. The cost of health care now causes a bankruptcy in America every 30 seconds. By the end of the year, it could cause 1.5 million Americans to lose their homes. Even for folks who are weathering this economic storm, and have health care right now, all it takes is one stroke of bad luck--an accident or an illness, a divorce, a lost job--to become one of the nearly 46 million uninsured or the millions who have health care, but really can't afford what they've got."

The emphasis is mine [Chait's], because that's the argument Obama and other reformers need to make. Pollsters will tell you, accurately, that the phrase "universal health care" does not play that well with the voters. That's because, when it's phrased that way, middle-class voters thinks that simply means paying more taxes so that people without insurance now can get it. What Obama is trying to do here is to suggest that everybody--the uninsured and insured--are vulnerable today, and that neither will be totally secure until we do something to guarantee coverage and make health care less expensive.