WASHINGTON - August is do-or-die month for both President Barack Obama and his hopes of overhauling U.S. healthcare, and the battle will be fought not in Washington, but across the country.

With lawmakers gone from Washington for a month and much of the reform plan still to be written when they return, the rancorous battle spreads to lawmakers' town meetings, television and radio, and grass-roots campaigns.

Obama's own tactics have contributed to the free-flowing, -- and expensive -- exchange of ideas.

Although he has set an overall goal of expanding insurance coverage to the nearly 46 million uninsured and vowed to hold down skyrocketing medical costs, he has left the details to lawmakers in the Democratic-controlled House and Senate.

Democrats will make their case to the public with stories of patients bankrupted by costs that insurers would not cover, hundreds lining up for charity, and people in need forced to delay life-saving treatments.

Republicans and others will try to stop Obama from achieving his No. 1 domestic goal with a counter-argument: Why should Americans think that any plan conceived in Washington will in any way improve the medical attention they get now?

Outspoken in their support of free enterprise, Republicans accuse the Democrats of trying to socialize medicine -- anathema to the many Americans who oppose government intervention in their lives.

Obama vowed on Wednesday to get a reform bill through Congress this year even without Republicans on board.

FEVER PITCH

The debate will likely reach a fever pitch, with millions of dollars being spent by political parties as well as the drug, medical and insurance industries. E-mails and the Internet will take the drive nationwide.

Seeking to influence the landmark debate, healthcare companies have become the biggest-spending lobbying force in Washington, with nearly $1 million spent a day.

Democrats in turn are targeting insurance companies.

House of Representatives Speaker Nancy Pelosi branded them villains for blocking a public insurance option. Obama assailed a system he said worked for insurance companies, not their customers.

Angered by what she called the demonizing of health insurers, Karen Ignagni of the trade group America's Health Insurance Plans, said that while open to the insurance market reforms envisioned by Congress, the group opposed a government-run insurance system that might send their industry into a death spiral.

August will be the month when the country decides whether it supports reform and what shape it should take, Ignagni said.

DUELING POLLS
Most Americans receive health insurance that is at least partially paid for by their employers, and a CNN/Opinion Research Corporation poll in early August confirmed what AHIP has been saying -- most Americans are satisfied.

The conservative National Center for Policy Analysis, engaged in what its president John Goodman calls trench warfare, has garnered a million signatures for a petition to stop what it fears is nationalization of healthcare.

NCPA supports individually owned health insurance. Public opinion is tending our way, Goodman said.

Other opinion polls bolster the case of the other side.

A Quinnipiac University poll released on Wednesday showed that while a majority of voters disapproved of Obama's handling of healthcare, and did not want it to add to the federal deficit, some 62 percent still supported a key element in the House of Representatives' version -- a government health insurance option to compete with private insurers.

A video of boos directed at Health and Human Services Secretary Kathleen Sibelius and Democratic Senator Arlen Specter on Sunday in Philadelphia scored over 500,000 hits on YouTube.

Crowds chanting Just say no, shouted down Democratic Representative Lloyd Doggett's attempt to hold a healthcare meeting in Austin, Texas, over the weekend.

White House spokesman Robert Gibbs called the disruptive groups manufactured anger.

I hope people will take a jaundiced eye to what is clearly the AstroTurf nature of so-called grass-roots lobbying, he said, referring to a brand of artificial turf.

The White House and the Democratic National Committee are responding with equal vehemence, unveiling a YouTube ad that links those same protest videos to desperate Republicans and their well-funded allies organizing angry mobs.

(Editing by Howard Goller)

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