In her research, Scott found that Ann Dunham did not lack health insurance when she was dying of cancer, as her son would claim in pressing for his health care overhaul. Instead, she lacked disability insurance that would have paid other expenses.

"I don't see these things as an indictable offense," Scott says, chalking it up to a "failure of memory."

It is instructive that Obama, now 51, brought his own personal narrative — his most powerful weapon — to the health care fight. It is the signal achievement of his first term, but it came at great cost: time and energy and political capital in the midst of a raging recession.

"The president is an intellectually ambitious man who is temperamentally cautious," says Sean Wilentz, a professor of history at Princeton.

For health care, he was all in.

"I don't think a system is working when small businesses are gouged and 15,000 Americans are losing coverage every single day; when premiums have doubled and out-of-pocket costs have exploded and they're poised to do so again," Obama told a gathering of Republican lawmakers in 2010. "I mean, to be fair, the status quo is working for the insurance industry, but it's not working for the American people. It's not working for our federal budget. It needs to change."