But the health care effort and its expansion of government involvement in the private sector proved politically toxic and generated deep internal division within the White House. Mr. Magaziner was seen as dismissive and few were willing to confront the president’s wife. “There were a lot of people who were intimidated,” said Leon E. Panetta, the chief of staff.

Ms. Shalala, who had been named secretary of health and human services, was one of the few who tried. “I told Hillary that this thing is just headed for disaster, and she told me I was just jealous that I wasn’t in charge and that was why I was complaining,” Mr. Edelman, who served as Ms. Shalala’s assistant secretary, remembered Ms. Shalala telling him.

Some of the White House economists were dubious and privately called Mrs. Clinton’s health care team “the Bolsheviks.” In return, according to Ms. Rivlin, the economists were “sometimes treated like the enemy.” Their suggested changes were ignored. “We could have beaten Ira alone,” said Mr. Blinder. “But we couldn’t beat Hillary.”

Indeed, the conflict left the president in a bind. “You can’t fire your wife,” Mr. Kantor observed.