How does healthcare play out politically?

WASHINGTON (Reuters) - By pushing Congress for final passage of U.S. healthcare reform, President Barack Obama is gambling voters will reward Democrats for the accomplishment rather than punish them in November congressional elections.

In declaring it was time for Congress to "finish its work" on healthcare, Obama said on Wednesday, "I don't know how this plays politically, but I know it's right."

Other Democrats see it this way: They have little choice but to push ahead on the legislation because after devoting a year to healthcare, they can ill afford to come away with nothing.

Democratic political consultant Bob Shrum said Democrats "absolutely need to pass this because they're going to have to run with it this fall."

"The one suicidal thing Democrats can do is run away from this," he said.

That kind of thinking is driving the White House and Democratic leaders on Capitol Hill to try to muster the votes necessary to approve comprehensive legislation. "Whatever it takes" was how White House spokesman Robert Gibbs described what Obama was prepared to do to get it passed.

House of Representatives Speaker Nancy Pelosi may have the toughest task. The House passed its version last November by a narrow 220-215 margin and since then some Democrats who voted for it are balking.

Democratic strategist Steve Elmendorf said the Democratic calculation is that "whatever the downside to this bill, they already own it and the only way to get an upside is to actually pass it and let people see" that the U.S. healthcare system improves.

"They're in the tunnel and I don't think they can back up," he said.

CONVENTIONAL WISDOM

The conventional wisdom in Washington is that Democrats should brace for big losses in November and that Republicans stand to make deep inroads into Democrats' strong majorities in the House of Representatives and the Senate.

Republicans picked up governor's seats in Virginia and New Jersey last November and a key Senate seat in Massachusetts in January and have little desire to join in handing Obama a legislative victory ahead of this November.

Republicans are gambling that Americans will reward them for opposing what they say is a broad and costly government intrusion into how U.S. healthcare is delivered.

Senate Republican leader Mitch McConnell said if Democrats use a muscle tactic called "reconciliation" to approve healthcare legislation, "Every election in America this fall will be a referendum on this issue."

"To ignore public opinion is not going to put the issue behind them, it's going to put the issue before them," McConnell said.

Polls offer a mixed picture on healthcare, so much so that both sides have used opinion surveys to argue their case. For example, Americans tell pollsters they oppose the Democrats' healthcare legislation, but like some of its elements.

"It's kind of ambiguous," said Andrew Kohut, director of the Pew Research Center for the People & The Press.

"Largely, people say they oppose the proposals they've heard about. But when we ask them what do they want Congress and the president to do, most say don't give up, they want something," he said.

Andy Smith, a political science professor at the University of New Hampshire, said Obama may have a tough time convincing his own Democrats to stick together because they fear voters more concerned about the economy could toss them out in November.

"What Democrats are going to have to do is try to portray this bill as a necessary way to improve the economy, an economic measure," he said.

(Additional reporting by Patricia Zengerle; editing by David Alexander and Vicki Allen)