The Obama administration was grappling on Thursday with a growing revolt from liberals over its $848bn (€592bn, £525bn) healthcare bill with one standard-bearer of the Democratic party’s left calling on the White House to scrap it and start again.

“If I were a senator I would not vote for the current healthcare bill,” Howard Dean, the former presidential candidate, wrote in Thursday’s Washington Post. Mr Dean, whose visceral opposition has turned him into a spokesman for the disenchanted left, accused the White House of doing the bidding of the private insurance industry by caving in to demands to drop a public insurance option from the Senate version of the bill.

The White House, which briefly considered Mr Dean as a potential health secretary in January, hit back, saying criticisms from the former Vermont governor were “predicated on . . . erroneous conclusions”.

David Axelrod, Mr Obama’s senior adviser, told MSNBC it would be “very very tragic” if eleventh hour liberal opposition were to scupper the biggest expansion of healthcare in more than a generation.

Privately, officials said they suspected Mr Dean was partly motivated by a long-running feud with Rahm Emanuel, Mr Obama’s chief of staff, who has made clear the White House’s overriding aim is to pass healthcare reform and signalled much less concern about the precise contours of the bill.

But supporters of the administration said Mr Obama faced a backlash from progressives that could damage him in next year’s mid-term congressional elections. “Every political party needs to energise its base as well as appeal to independents to win elections,” said Simon Rosenberg, president of NDN, the liberal think-tank. “The White House should be concerned about how disaffected the base is becoming.”

Thursday’s escalation of the dispute between liberals and the White House coincided with opinion polls showing sharply declining support for healthcare reform. A poll by the Wall Street Journal and NBC also showed that Mr Obama’s personal approval ratings had dropped below 50 per cent for the first time since he took office.

The descent by the Democratic party this week into a form of civil war was prompted on Monday by the Senate leadership’s decision to remove a measure from the bill that would have give people aged between 55 and 64 the option to buy into Medicare – the government programme for retirees.

The climbdown was precipitated by Joe Lieberman, the independent Democrat from Connecticut, who said the measure would promote a government takeover of the healthcare industry and had said he would vote against the bill. Harry Reid, the Democratic majority leader in the Senate, had little choice but to accede to Mr Lieberman’s demands since he needs all 60 votes from the Democratic caucus to prevent a crippling opposition filibuster.

Many believe that Mr Lieberman, whose state is home to the headquarters of many insurance companies, and who backed John McCain in last year’s presidential election, was trying to take revenge on liberals who tried and failed to unseat him in 2006.

Senate liberals, such as Sherrod Brown of Ohio and Jay Rockefeller of West Virginia, have pointedly declined to join Mr Dean’s rebellion. Both said they would vote for the bill in spite of misgivings. They also pointed out that it would bring 30m uninsured Americans into the net and debar insurance companies from excluding customers with pre-existing conditions. The pair also said that the insurance industry continued to lobby heavily against the bill.

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