WATCHING President Barack Obama deliver his stirring speech on healthcare to a joint session of Congress on Wednesday, Hillary Clinton, the secretary of state, may have experienced a powerful sense of déjà vu.

In 1993 her husband, President Bill Clinton, stood at the same podium beneath the US Capitol dome and issued a spirited defence of his own sweeping proposals — much influenced by her ideas — for a new system of national health insurance.

Within a year the reform effort that became known as “HillaryCare” was dead, killed by endless party wrangling over who should pay for what.

The ghost of Clinton failures past returned to haunt the White House last week, despite acclaim for a brilliant attempt by a new president to reassert his diminished authority after a summer of mishaps.

Obama’s return to the dazzling rhetorical form that mesmerised voters during last year’s presidential elections earned him glowing reviews from all but a sullen rump of conservative Republican diehards who were left muttering angrily about “lies, pontifications and platitudes”.

For Democrats who had grown increasingly nervous about popular mistrust of the reform proposals, the president’s compelling account of the urgent need for a new system of health insurance inspired raptures of excitement and relief. “The president’s speech breathed new life into what we are doing,” said Senator Max Baucus, the Montana Democrat who is leading negotiations on the Senate healthcare bill. The New York Daily News called the president “Battling Bam”.

Yet memories of the Clintons and the crushing collapse of their healthcare effort were far from extinguished, as many who admired Obama’s performance questioned his ability to keep his promises on expensive health-related issues when a host of other economic and foreign policy challenges are pressing for White House attention.

“It was a terrific political speech,” said Arnold Relman, professor emeritus of medicine at Harvard medical school. “But eloquence, clarity and passion do not by themselves provide the means to achieve [his] ends.”

Mary Matalin, a leading Republican strategist, noted that Obama’s conciliatory bipartisan message was “getting through loud and clear. It’s just that the dogs won’t eat the dog food”.

Even as the president was departing for Minnesota yesterday for yet another speech on healthcare — to be followed by an appearance this evening on 60 Minutes, the CBS news programme — his aides were worrying about a flood of bad news. New economic data show poverty is continuing to spread, average household income is falling and a new wave of home repossessions may be looming as mortgage payers face sharp increases in their monthly repayments.

Nor has the enthusiasm the Democrats have shown for healthcare spread to Obama’s foreign policies, where divisions among his supporters on the Afghanistan war are beginning to threaten his military strategy. Several prominent Democrats warned last week they would not support increasing troop levels for an Afghan “surge” that General Stanley McChrystal, the senior US commander in Kabul, is expected to request this month.

Obama’s advisers appear to have concluded their strongest weapon in any policy dispute is the president’s still potent ability to electrify his audience with a firework-filled speech. He will turn to the economy in an address tomorrow and is expected to outline US goals in Afghanistan later this month.

Stung by Obama’s triumphant rebound after months on the healthcare ropes, Republicans last week attempted to depict the silver-tongued president as a “snake-oil salesman” who had carefully avoided the small print that will explain how he intends to pay for a $900 billion new system without “adding a dime” to the US budget deficit.

Even though Obama paid tribute in his speech to Senator John McCain, his Republican election rival, for some helpful ideas on reform, McCain dismissed the president’s plan, which he described as “an egregiously expensive and expansive form of government-run healthcare”.

Some of the president’s admirers were equally concerned that details had been left vague. “He should have been clearer about how he intends to pay for the coverage of Americans who can’t otherwise afford it and how he’ll contain future costs,” said Robert Reich, a former secretary of labour in the Clinton administration.

Richard Huber, a former chairman of Aetna, one of America’s biggest insurance companies, added: “Obviously, the devil is in the details.”

Obama aides argue that the Clinton approach was different from the Obama one, putting Congress, and not Hillary, in the driving seat while early proposals are hatched.

Obama enjoys a larger majority in Congress than Bill Clinton and has a better prospect of wringing concessions from right and left. Clinton himself has predicted that this year’s healthcare initiative “is going to have a different ending”.

Yet veterans of both campaigns warn that Obama’s speech was the easy part. Once Congress starts negotiating the details, “then you hit the rapids”, said a former insurance industry lobbyist.

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