Top White House advisers, especially chief of staff Rahm Emanuel, are still privately predicting massive changes to the health care system in 2009. But for the first time, Democrats on Capitol Hill and in the administration are expressing frank worries about stronger-than-expected opposition from moderate Democrats and worse-than-expected estimates for how much the plan could cost.

Business groups, which had embraced the idea of reform and have been meeting quietly with Democrats for months in an effort to shape the legislation, now talk of spending millions of dollars to oppose the latest proposals out of Capitol Hill. And Democrats themselves are not united, with leading party figures making contradictory declarations about how far they should go to overhaul the system when deficits are soaring and prospects for an economic recovery remain cloudy.

And top Democratic officials tell POLITICO they are increasingly pessimistic about getting any more Republican votes than they did on the stimulus package, with some aides referring to the idea of a bipartisan bill as “fool’s gold” — an unattainable waste of time.