Suddenly you know they've been around too long. When the temperature edges into the 90s, and the political debate becomes as stifling, enervating and unpleasant as the weather. When a poster depicting the 44th president as a red lipstick-daubed Batman-style Joker alongside the word 'Socialism' becomes a major political talking point.

When cable TV shows resurrect, for the umpteenth time, the canard that Barack Obama was not born in the US, even though his Hawaii birth certificate is available on the internet. And, it should also be said, when the president injudiciously wades into the arrest of a Harvard professor, elevating a minor incident in a Boston suburb into a national drama.

In short, even politicians need a break. So what more perfect moment for that mightiest of commanders – 'Generale Agosto' (General August) as he is called by the Italians, who know a thing or two about legislative logjams – to take matters in hand and march those weary, quarrelsome legislators off to the beaches for some overdue R&R. And, in a sense, precisely that has happened. The 'triple-H' days (hazy, hot and humid) are arriving in Washington and, on Thursday evening, the Senate, like the House of Representatives a week earlier, wrapped up and, with a deep sigh of relief, disappeared until September.

But matters are not so simple. 'General August' has indeed marched his men out of town. But extra manoeuvres rather than sweet days of repose await them. The 2009 summer recess may be the most important in years, and for America's politicians this will be a working holiday with a vengeance. Everything hangs in the balance: an economy struggling to regain its footing, critical and hugely important legislation, even – some would say – the very fate of a presidency.

In spring all still seemed possible. But in the US (if not yet in the rest of a world still in quiet euphoria that George W Bush is no longer in the White House) the long Obama honeymoon is over. In America, there is a creeping realisation that the mammoth expectations were unreal. This president remains the epitome of cool, but even a rockstar politician is a politician nonetheless.

Every would-be occupant of the White House campaigns for office vowing "to change the way Washington works", but Obama's remarkable life story and stunning political ascent seemed to make that promise credible. In reality, the dazzle of a new dawn is fading, obscured by the quiet fog of business as usual – of a political system in which lobbyists and special interests as ever reign supreme.

Optimism abroad

Abroad, optimism is still the order of the day. The style, and in some ways the substance, of US foreign policy has been transformed. America's image in the world is vastly improved. This administration, unlike its predecessor, is serious about climate change. It is making a real, and more even-handed, push for peace in the Middle East. If it is deepening its involvement in Afghanistan, it is finally beginning to disengage from Iraq. The national security team, starring Hillary Clinton and featuring such big beasts as the vice-president Joe Biden, Robert Gates at the Pentagon and special envoys like Richard Holbrooke and George Mitchell, seems to be working smoothly with none of the rows that splintered the Bush team.

But, for US voters, foreign policy is a sideshow. Domestic issues, and the most daunting array of economic and social problems in modern times, will make or break this president. And the hiss of air escaping from the Obama balloon is audible. His approval ratings have slipped from the mid-70s to the mid-50s, no better than those of George W Bush in the doldrums of August eight years ago, before the cataclysm of 9/11 changed everything.

Ordinarily, the decline would be no disaster. It is not as if Americans are flocking to an intellectually bankrupt, leaderless Republican party. The difference lies in the growing disenchantment of independents who went massively for the Democratic candidate last November, and a feeling of let-down among left-wingers who allowed themselves to believe in a liberal utopia that was never on the cards.

In a way, it is surprising Obama's ratings have not fallen further. The $787bn (€550bn) economic stimulus package, the greatest legislative achievement of the first 100 days, has not proved the instant miracle cure. He may have inherited the biggest financial mess in generations but, increasingly, in the public mind this is now Obama's economy, not George W Bush's.

Soon the Great Recession will be declared over by those who measure such things. The prospect, however, is of a "jobless recovery". While last week's monthly employment figures showed a slight improvement, with a decline in the unemployment rate to 9.4%, economists said that was only because 400,000 people gave up the search for work permanently – and another 247,000 still lost their jobs in July.

In the meantime, trillion-dollar deficits stretch as far as the eye can see. For fiscal conservatives and many other voters, America's debt is now as big a worry as America's recession. However deftly the Obama administration handled the car company bankruptcies, critics from both right and left feel the Obama team has been too soft on the banks and credit card companies, which are as rapacious as ever towards consumers and once more doling out huge bonuses to executives, despite the huge commitment of taxpayers' money that rescued them from disaster.

Nothing, though, is as contentious as the project for healthcare reform – the desperately needed overhaul of a sector that consumes some 17% of the national economy. At the best of times reform would be difficult; Obama is not starting from scratch, but seeking to adjust a $2.3 trillion industry, courting conflict with some of the most entrenched vested interests in the land.

The last effort to impose comprehensive reform, by the Clintons in 1993/1994, ended in humiliating failure. That bill was cooked up behind closed doors at the White House, stoking resentment on Capitol Hill. Anxious to avoid that mistake, the Obama team has taken the opposite tack, setting out broad aims and letting Congress work out the details.

But that is no less tortuous a process. Three very different measures – two from Senate committees, one from the House – are currently circulating. Assuming final versions are approved by each chamber, those two bills will have to be reconciled into a final measure that must be approved before Obama can sign it into law. Until then, the enterprise will be at the mercy of lobbyists and interest groups including hospitals, drug companies and privately owned, for-profit insurers, all with billions of dollars on the line.

Obama's original goal was a vote in the full House, if not the Senate, before the recess. He will now have to wait until autumn.

Difficult battle

It is a fiendishly difficult battle to wage. The subject is desperately complicated, and the majority is perfectly happy with the status quo. Opposition at that point becomes an easy job of scaring the contented majority of voters into believing change means disaster, and that big government will wreck a system that works perfectly well for them – even though that system is simultaneously failing to cover a sixth of the population and driving the country towards bankruptcy.

The S-word emblazoned on the Joker poster is but one example of the scaremongering. The 'Tea Party' squads of hecklers who have already disrupted several meetings are another. Yet another is a 2003 clip of candidate Obama circulating on the internet, in which he seems to call for a single-payer healthcare system – akin to those of Canada or Britain, and of course the ultimate Socialist nightmare for right-thinking, freedom-loving Americans.

The delay will provide more time for opponents of reform to marshal resistance. In the meantime, it has already become clear that some of the more radical changes originally sought by Obama will be jettisoned to win the support of conservative Democrats.

For, however strident their opposition, the Republicans are a sideshow in the argument. With a filibuster-proof 60 votes in the Senate and a more than comfortable majority in the House, a united Democratic party could drive health reform through on its own. But American politics no longer works like that, if it ever did. A Democratic president has more to worry about from his friends than his enemies.

The health debate, moreover, brings out both the best and the worst of Obama. No one can make the case for reform more powerfully than this most eloquent and clear-minded of politicians. But, at times, he sounds too didactic, too professorial – if anything, too reasonable. In his desire to please everyone, he may end up pleasing no one.

Thus far, none of the really tough decisions on reform have been taken. Will people be forced to buy insurance? Will those who receive healthcare through an employer (over 50% of people) be taxed on this hitherto tax-free perk? Will other taxes have to rise to help cover the $1 trillion cost of reform? Obama has said nothing – other than to repeat his campaign vow that "middle-class" taxes will not rise, closing off one important option in advance. In short, for all the lofty rhetoric, healthcare reform sounds ever more like politics as usual.

Some complain, furthermore, that the president is too deferential to the Congress where he briefly served. The White House insists otherwise, saying Obama spends hours on the phone with key lawmakers. But what is surely needed now is another Lyndon Johnson, the last president to achieve major healthcare reform – a force of nature who would wheedle, bully, bribe and threaten lawmakers to bend them to his will. But even LBJ had it easy when he drove through Medicaid and Medi­care, the programmes for the poor and the elderly. In 1965, he was starting from scratch.

Ambitious reforms

And, if healthcare is Obama's prime objective, it is not the only one. He is simultaneously trying to push through an ambitious green energy bill and tough new regulation of the financial markets that last year brought the US and the world to the brink of calamity. All this – and the overhaul of foreign policy too – when America must extract itself from the worst economic slump since the Great Depression. No wonder he is accused of trying to do too much, too quickly.

The reality, however, is that a president's power is never as great as in his first year in office, fresh with the mandate granted by electoral victory. If these things are not done now, team Obama argues, when will they ever be?

And though the waters are choppier with 200 days gone, everything is still to play for. For one thing, some form of health reform will surely be passed by Congress, if only because it is inconceivable that Democrats would deal a potentially mortal blow to their own leader by failing to deliver. What emerges may be only a tinkering with the status quo – but even tinkering can be hailed as triumph. The same goes for the energy bill and the financial regulation bill that includes a new watchdog agency to protect consumers' financial interests.

Second, there is the man himself. Politics, it is said, is the art of the possible, and this president may have set his sights extraordinarily, perhaps impossibly, high. But Obama treats politics like chess. As few in his trade, he likes to play the long game. He remains the "no-drama Obama" of the campaign.

Even in his case, the laws of political gravity were bound to kick in sooner or later – and in this dire economy, probably sooner. By the same token, however, the gloomy prognostications of the chattering classes in the steamy height of summer should not be taken at face value either. Destiny still beckons. If the first 200 days of Barack Obama's term are over, there are still 1,261 days to go.

The presidential in-tray: So much to do

The Economy

The signal achievement of Obama's first 100 days was the $787bn (€550bn) stimulus package, and while the vastly expensive package has not been the panacea some hoped, economists say that it has had a real impact on growth. The next challenge will be finding a way to pay off that debt without too many unpopular cuts in services – or still more unpopular tax rises.

Foreign Policy

Bill Clinton's recent foray into North Korea aside, there have been few surprises: a shift of focus from Iraq to Afghanistan, a more conciliatory attitude to long-standing foes, progress on Guantanamo and a subtle change of direction on Israel. After the neocons, all that was a breath of fresh air to many observers – but the proof will be in the pudding. The $64m question, still to be answered: will the new approach ever make Iran unclench its fist?

Climate Change

That Obama takes carbon emissions more seriously than his predecessor in the Oval Office is undisputed. What is less clear is whether those good intentions will be enough to enact meaningful change. The environment is well below healthcare and the economy on the agenda, and efforts to pass an emissions bill (an ambitious one, it should be noted) have so far stalled. If that can be pushed through by the end of the year, it will be deemed a qualified success.

Healthcare

The subject that so vexed the Clinton administration is proving similarly challenging for Obama: had it not been for the economy, it certainly would have been his top legislative priority, but now he seems to be losing momentum. There is little doubt that some reform will be enacted eventually: the danger is that it will be so watered down to appease Republicans – and even conservative 'blue dog' Democrats – as to be meaningless.

Washington culture

That Obama would run as a Washington outsider was a given – these days, everyone does. In fact, he is the consummate compromising politician.

It was never likely that he would be able to make big changes to how the Capitol works. But it's not all smoke and mirrors. The administration has tried to be more inclusive when it shapes legislation and has put ethics rules in place that mark a sharp change in tone from the previous regime.