You'll all want to read the New Republic article on David Axelrod's struggles since arriving at the White House.
In a nutshell, here is the problem. Axelrod believes in the reform message of the campaign. But to get things done, you have to operate in the system as it exists -- which means catering to interest groups, placating big business, and providing political benefits for individual members of Congress. When you do this, however, you turn off a chunk of your base that was vested in the message of "changing Washington" -- even if you only engaged in these practices to accomplish the agenda you ran on - such as health care reform.
These same themes are developed in a piece by Peter Baker in the New York Times Magazine. Baker comments:
But it is possible to win the inside game and lose the outside game. In
their darkest moments, White House aides wonder aloud whether it is even
possible for a modern president to succeed, no matter how many bills he
signs. Everything seems to conspire against the idea: an implacable
opposition with little if any real interest in collaboration, a news media
saturated with triviality and conflict, a culture that demands solutions
yesterday, a societal cynicism that holds leadership in low regard.
Good question to ask David Brooks?