The sign on the wall of the Clinton campaign “war room” in Little Rock had three short messages on it, generally attributed to flamboyant political strategist James Carville:

Change vs. more of the same.

The economy, stupid.

Don’t forget health care.

Time for the midterm exam, Mr. President.

Don’t forget health care. Well, forget health care. The administration had two choices on health care reform. The Clintonites could have turned matters over to the Democratic leadership in Congress, allowing the appropriate committees to take charge and forge some kind of consensus bill. Or they could take matters into their own hands and craft a package for presentation to Congress.

The first approach would have played to Congress’ strengths. There would have been many opportunities for backroom deals to grease the legislative process. The really important work could have been done in secret. The minority could have been shut out of the process by clever use of the rules. And so on.

The result would not have been pretty. I have no doubt that the enterprising Robert Byrd, a Democrat from West Virginia, and the all-time pork champion of the Senate, would somehow have arranged for $250 million to establish the Robert Byrd Center for Advanced Tongue Depressor Research just outside of Wheeling, for example. And if you are the sort of person who, like me, thinks enhancing the role of government in health care delivery would be roughly equivalent to enhancing the role of Jack Kevorkian in health care delivery, then the result would have been disastrous as well.

But there probably would have been legislation. Even nominally conservative Republicans were suffering chronic testosterone deficiency and going along with the idea that something had to be done, on the courageous grounds that if they did nothing, voters would be unhappy with them and that would be the end of the world. But no. The Clintonites decided to pursue Option B, and “ClintonCare” was born.

I think the problem ultimately came down to this: Bill Clinton won 43 percent of the vote but acted as if he had won 53 or maybe 73 percent of the vote. Being anything but ego-deficient, the president interpreted his victory as a mass repudiation of 12 years of Republicans in the White House and as a mandate for sweeping social change led by a dynamic, revitalized federal government. Unfortunately, a more accurate assessment would be that Clinton happened to be the last Democrat standing when the time came for George Bush to be put out of his misery.

I think we also must face up to one other reason for the president’s decision to craft a Clinton plan: Mrs. Clinton. We will have to wait for the memoir literature coming out of this administration to find out the whole story, of course, but I think it is quite possible that the first lady is a figure accorded Lorena Bobbitt-like respect in the Clinton White House.

The economy, stupid. When the Clinton budget plan was under consideration on Capitol Hill, Republicans denounced it as the largest tax increase in history and said it was sure to send the economy into the tank, and that Clinton would be blamed, taking the heat from an angry electorate.  The good news and bad news for the president: The Republicans were wrong. The economy has not tanked. Rather, it has been growing smartly. But Clinton is being blamed, taking the heat from an angry electorate.  When Ronald Reagan’s approval ratings hit the skids on the eve of the 1982 midterm election, it was because the economy truly was in the tank – a serious recession was under way, people were unemployed or nervous about their jobs and so on. Bill Clinton has hit the skids despite the growing economy, millions of new jobs created and so on. This is no small achievement.

Change vs. more of the same. The president, however, is feeling better about himself these days. In fact, he is hitting the campaign trail for the midterm elections. By some accounts, he is fired up, eager to turn the election into a referendum on himself and his administration.

Now, it is true that the president is having a hard time finding Democratic candidates to join him on the campaign trail, which may seem unusual in that they are the ones running for office, not he. In fact, some reports show the candidates to be conspicuously absent when Clinton comes to town. Democratic candidates wake up in a cold sweat from nightmares in which they are trapped alone on a podium with Bill Clinton and he is hugging them.

Meanwhile, in Republicans’ private fantasy lives – where they dream of things so outrageous they couldn’t tell Oprah, or even the people doing the research for the big sex survey – Republicans envision Bill Clinton turning the midterm election into a referendum on himself. (Yes, yes, oh please baby, yes.)

But the president is charged up indeed – especially after his foreign policy success in Iraq, standing up to Saddam Hussein, for which he has won widespread acclaim.

In short, the president’s greatest achievement, the one thing lately for which he has garnered broad popular support – to the point that people actually approve of something he has done – is his successful continuation of the Bush administration policy whereby the vicious Iraqi dictator would be kept in check.

In other words, the only thing that has worked for Clinton is more of the same.