Some of Karl Rove:

Given the Democratic congressional margins, Mr. Obama has the votes to do it, but at huge costs to him and his party. Legislation that looks anything like the bill moving through the House will contain deeply unpopular provisions—including massive deficit spending, tax hikes and Medicare cuts—and create enormous ill will on Capitol Hill. This will be especially true if Democrats rely on parliamentary tricks to pass a bill in the Senate with 51 votes. The public’s reaction in August showed that the president is creating the conditions for a revolt against his party in the 2010 elections.
On the other hand, if Mr. Obama jettisons the public option, he may spark a revolt within his party. The Democratic base is already grumbling and could block a bill if it doesn’t include a public option.
Presidents always encounter rough patches. What is unusual is how soon Mr. Obama has hit his. He has used up almost all his goodwill in less than nine months, with the hardest work still ahead. At the year’s start, Democrats were cocky. At summer’s end, concern is giving way to despair. A perfect political storm is amassing, and heading straight for Democrats.