As President Barack Obama dons his flip-flops and contemplates a blissfully blank page in his public diary, rumbles of resentment over his holiday destination choice and discord over his health reform plan threaten to spoil the mood.

The Obama family arrived on Sunday at a 28-acre farm retreat on Martha’s Vineyard, the east coast island retreat popular with America’s rich and famous. When they switch on the television they may see a prickly advert from the advocacy group Conservatives for Patients’ Rights.