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One message President Obama has pressed upon congressional Democrats is that the top priority in health care reform is establishing the principle that all Americans are entitled to decent coverage.

His point is that advocates shouldn't obsess about shoehorning every idea they favor into the legislation; once the basic framework is built, Congress will adjust the details over time, as it has with all other major social-policy innovations.

That's an accurate reading of American history. But it's also true that it's easier to renovate a house that has a sturdy foundation. And Obama now faces the risk that in the final maneuvering, his allies will chisel two dangerous cracks into the plan's base.

One threat revolves around an amendment adopted by the Senate Finance Committee from Sens. Charles Schumer, D-N.Y., and Olympia Snowe, R-Maine, that eroded the bill's cornerstone provision: the mandate that individuals buy health insurance, with help from government subsidies if necessary. Under the amendment, Americans would be exempt from the mandate if they cannot find insurance costing 8 percent or less of their income; the bill originally set the cutoff at 10 percent. The amendment also slashed the penalties for those who simply ignore the mandate: Fines would start at zero and rise to only $750 by 2017.

That sounds consumer-friendly. But in the complex world of risk sharing, the amendment, perversely, could make insurance costlier for those who need it most.

Here's why. If the plan exempts too many people from the individual mandate -- or sets insufficient penalties for those who flout it -- then it might be that only those with the greatest need for coverage will sign up when the government-sponsored insurance exchanges open in 2013. Too many younger people with lower health costs (and generally lower incomes) might either be exempt from the mandate or choose to pay the token penalty rather than buy insurance. That would tilt the exchanges' customer base (or "risk pool") toward the old and sick, which would cause premiums to soar. And that could quickly undermine support for the new system.

Because the insurance industry raised this alarm in its much-criticized report on the Finance bill, reform supporters are inclined to dismiss it. But many prominent health care thinkers share this concern. (In Democratic circles, that might amount to sympathy for the devil.) One worried expert is Jonathan Gruber, a Massachusetts Institute of Technology health economist frequently consulted by Democrats. Gruber has calculated that the Schumer-Snowe approach will reduce the number of uninsured people the bill covers by about 3 million -- and raise premiums for those it does cover by 10 percent. "You'll lose the 35-year-old who doesn't go to the doctor," Gruber frets.

Equally concerned is Sarah Bianchi, the chief domestic policy adviser for both the 2004 John Kerry and the 2000 Al Gore presidential campaigns. "Insurance works only when the healthy and the sick pay premiums," Bianchi sensibly reminded in a recent Democratic Leadership Council paper. Rather than excusing more people from the mandate, she says, Congress should spend more on subsidies to help uninsured families buy the coverage they would be required to purchase. "Because they have an affordability problem, they let more people out of the mandate," she says. "But because they let more people out, they will make premiums go up." The House, more reasonably, would allow the administration to decide whom to exempt from the mandate.

The second potential crack in the bill's foundation would threaten Obama's ability to fund the subsidies necessary for an effective mandate. One of Finance's key provisions would tax the costliest "Cadillac" health insurance plans. That could help slow the rise in health spending by encouraging workers to choose thriftier plans. Also, revenue from the tax, according to the Congressional Budget Office, would grow faster than reform's costs -- thus helping it remain affordable over time. For both reasons, the liberal Center on Budget and Policy Priorities this week called the tax a "sound element" of reform.

But 180 House Democrats, under pressure from unions worried about protecting benefits, are insisting that the final bill drop the Cadillac tax. They prefer a surtax on high earners. A surtax, however, wouldn't discourage health care spending or generate revenue that grows as fast as costs. Like the Senate's weakening of the mandate, that approach would leave reform on shaky ground.

To provide his plan a firm foundation, Obama will need to stare down his friends on both fronts.