If  Barack Obama has an Achille’s Heel (if? who doesn’t…) it is almost certainly his arrogance. Most of the time he keeps it in check, or at least does a reasonably good job of masking it. When it peeks through he is generally quick to recognize the potential damage (“You’re nice enough, Hillary”). But this time his arrogance may once again cost Americans the chance at having the health care system as good as every other industrialized country in the world.

The arguments about the relative merits of various plans, the depth of the problem, and even who is most to blame are almost beside the point. Certainly Atul Gawande’s take in the New Yorker’s June 1 issue in which he explained why McAllen, Texas is the nation’s second most expensive health care market is very persuasive in arguing that who pays is much less in important than in how medical care is coordinated. And in a follow-up this past week the New York Times front-paged a story about how McAllen, Texas is — shockers! — among a handful of much larger cities whose “citizens” have donated the most money to Congress in order to influence the health care debate. The story goes on to explain how the very things that Gawande identified as the reasons McAllen’s health care is so expensive have been preserved in the latest version of the House bill. Those doctors are getting a good ROI apparently. So much for reform.

Should we be surprised? Hell no. Harry and Louise may be on the side of reform this time around but the fact that they are back at all is a vivid reminder how incredibly difficult fixing our ridiculous system is. Which is where Obama’s arrogance has made things worse.

We didn’t need Hillary Clinton to tell us that if the U.S. health care system was to really be changed (and it is f*cked up: highest cost in the world producing middling results) a President had to have a war plan. The arguments from doctors, health insurance companies, free-market conservatives, Blue Dog Democrats, and Big Pharma were predictable. Their combined ability to drive the debate should have been worry #1 for the Obama team. ClintonCare was KO’d by a combination of White House hubris and a masterful public relations campaign from opponents. How could Obama not avoid following the same path?

The President apparently believed his mandate and his popularity ratings big enough to magnify his bully pulpit in such a way that he alone could counter the other side. He mistakenly thought that (as did the last Democratic President in the months after he was elected) and having a Democratic Congress was enough. But that was just silly from the start. As multiple reporters have pointed out over the past few months most Americans desperately want the health care system changed — just not in any way that will effect the way it currently works for them. I know that sounds absurd but it’s true.

Americans who have health insurance may complain about the costs but flash a little “socialized medicine” snake oil in front of them and see how fast they switch sides. That’s because even with their co-pays and premiums they don’t really pay anything like the full cost of their health care. Their employers pay a sizable chunk and then that’s subsidized by you and me through an outdated tax credit for health premiums. So Americans are paying twice as much as anyone else — it’s just hidden.

Americans without health insurance — as large and growing a group as that might be — are unfortunately less likely to vote and therefore have less political clout than those with care. So even if they buy into ObamaCare and aren’t persuaded by the RedsCare crowd, they don’t really have the juice to make a difference in the debate.

And look at all those talking heads. Last time around CNN was the only 24/7 cable news network and they actually did news. Now three networks (five if you count CNBC and FBC) spend all day talking about the news instead of the more expensive task of reporting it. Of course all of these fine people who gather to impart their wisdom have generous employer-funded taxpayer-subsidized health plans. In fact the on-air folks at NBC left their union several years back because some rebelled when the union health plan instituted premiums. Yep before 2006 they paid no premiums and they thought that was normal. That’s how out-to-lunch some of these all-day bloviators are.

So in the face of all this readily apparent information what does Obama do? Not a whole lot. His personal appeals and working with Congress aside, the President has done virtually nothing to successfully prepare for, or more importantly, preempt the predictable onslaught. His last minute prime time seminar was too lame too little too late. And so Congress slinks away for the rest of the summer having passed nothing, Obama is left to lick his wounds, and We the People are no closer to having a rational health care system.

Nice going O. The only hope we have is that he seems to learn from his mistakes. Let’s hope the horse hasn’t left the barn.