As President Obama seeks to revive his moribund healthcare initiative -- and arrest the precipitous drop in his political fortunes -- he is struggling with the consequences of one of his most important early decisions: letting Congress take the lead in designing his signature policy proposal.

Leaving it to Congress put an unusually glaring spotlight on how Capitol Hill does business. The spectacle of Congress’ horse-trading, secrecy and gridlock has fueled today’s virulent anti-Washington mood. The public’s reaction was all the greater because Obama had campaigned on a promise to change the way Washington did business, and because healthcare reform engendered such personal high hopes and anxiety.

The way voters saw it, the smoke-filled room was back -- and they did not like it.

“It’s an ugly process, and it looks like there are a bunch of backroom deals,” Obama conceded in a January television interview. “The process didn’t run the way I ideally would like it to.”

But Obama himself helped bring on the backlash.

“In 2006 and 2008, voters threw out Republicans and thought things would change,” said Frank Luntz, a Republican pollster. “Now they see it’s even worse. Because of YouTube and Facebook, and you can watch TV on your cellphone, we know these deals are happening. We assumed they happened 20 years ago, but we know it today.”

That’s one reason Obama has called a healthcare summit this week -- to try to renew the debate on more pristine terms. Even if nothing comes of the talks, they are designed to spotlight on national television precisely the bipartisan, high-minded debate that Congress’ year-long process was not.

From the outset of his presidency, Obama invited Congress to devise the details of healthcare legislation and other major initiatives -- an apparent bid to avoid what happened when President Clinton tried to overhaul healthcare 17 years ago.

Clinton delivered a detailed proposal drafted in private administration talks, and it fell flat with a Democratic Congress; Obama set only broad outlines of his initiatives and declined to state preferences on central provisions.

Critics fault Obama and Congress for taking so long with the task, pointing to the standard set by President Lyndon B. Johnson, when such landmark measures as Medicare and the Voting Rights Act were passed seven months into 1965.

But Johnson had the advantage of a landslide election behind him and enormous congressional majorities: He had 68 Democrats in the Senate and 295 in the House.

Now, Congress has 57 Democratic senators and 255 Democrats in the House. And it’s one of the least respected institutions in government. The latest Gallup poll found that Congress’ approval rating is 18%, as low as it was in 1992 and down from 39% since the beginning of the Obama administration.

Tapping into that disaffection, Republicans have denounced Democrats for making major decisions about the healthcare bill in closed-door sessions -- such as when Senate Majority Leader Harry Reid (D-Nev.) crafted a 383-page amendment rewriting the Senate bill as he brought it to the floor.

Democrats also suffered black eyes from special legislative provisions written into the bills to win support from particular lawmakers -- especially Medicaid funding breaks sought by Sens. Mary L. Landrieu (D-La.) and Ben Nelson (D-Neb.), moves that were dubbed the “Louisiana Purchase” and “Cornhusker Kickback.”

Even if such practices are common on Capitol Hill, they were easily exploited by GOP critics at a time of economic hardship and mistrust of large institutions.

“The forces unleashed by the financial collapse created in the minds of people the sense that there are demonic forces at work in banking, real estate and, not surprisingly, in Congress as well,” said Ross K. Baker, a political scientist at Rutgers University who is an expert on Congress.

The firestorm helped elect Republican Scott Brown of Massachusetts to the Senate. Healthcare action on Capitol Hill was an easy target for his populist message as he denounced “those backroom deals for Nebraska and others.” His campaign momentum surged.

The effects on Democratic strategy have been lasting.

Party leaders have been very cautious about moving the healthcare bill through a fast-track procedure, fearing that will be tarred as a strong-arm maneuver. House Democrats are also insisting that the Nebraska deal and other parochial provisions be stripped from the House-Senate compromise.

On another key priority -- a jobs bill -- Reid has whittled down a bipartisan proposal in part because it included some special-interest provisions.

At the healthcare summit Thursday, Democrats hope to neutralize complaints that the process so far has been too partisan and secretive.

But hardly anyone in Washington expects major decisions or compromises to be made on camera.

“Obama probably made a mistake by over-hyping the notion of transparency,” said Norman J. Ornstein, an expert on Congress at the American Enterprise Institute.

Compromising means giving up something -- and that’s harder to do in a public setting.

“The idea that in public you’re going to say, ‘I’m going to have to abandon this position,’ -- it doesn’t happen,” Ornstein said.

janet.hook@latimes.com