As President Barack Obama plays Robin Hood with health-care reform, more than just his other domestic priorities are at stake. With his presidential approval rating going south-according to the most recent Rasmussen poll, 40 percent of Americans strongly disapprove of his performance in office and only 31 percent strongly approve-Mr. Obama is increasingly pressed to put foreign policy on the back burner.

The president and his advisers would likely disagree with such criticism, pointing to Mr. Obama's well-received speech in Cairo, hours of talks with Russian leaders in Moscow, and the recent "Three Amigos" summit in Mexico, as well as Vice President Joe Biden's high-profile visits to Ukraine and Georgia and Secretary of State Hillary Clinton's long trip to Africa.

But speeches, even when well reasoned and delivered in style, are not a substitute for making those hard choices that often require a president to use his bully pulpit at home, spend personal political capital, and even, perhaps, anger important domestic constituencies. And such heavy lifting has been sadly absent. His insistence that Israel freeze settlements on the West Bank seemed to symbolize a new, more evenhanded approach to the Arab-Israeli dispute. But Prime Minister Benjamin Netanyahu has refused to budge, standing his ground on the cheap and making himself more popular at home. President Obama has opted to claim progress simply because the Israelis are not starting new settlements. That falls quite short of what the president demanded originally, and yet there is no evidence that the administration has put any meaningful pressure on Israel as the impressive new Israeli ambassador to the United States, Michael Oren, pointed out recently on Fareed Zakaria's GPS. Contrary to media reports, Oren "wasn't summoned at all" to the State Department over the settlements disagreement and as he emphasized, "these issues are being worked out in a very constructive, very friendly atmosphere." But such sweet talk is not the way to get Netanyahu to make meaningful concessions on settlements against the opposition of his own coalition partners.

The Obama administration also promised a reset with Russia, but it wouldn't even initiate a repeal of the Jackson-Vanik amendment-which withheld trade benefits in an effort to force the Soviet Union to allow freer emigration-that has long outlived its usefulness and now serves only one purpose; namely, to demonstrate to Moscow that the administration is not prepared to take even the easiest and most obvious steps to achieve a new beginning with Russia.

Another priority for the United States is to reestablish control of its borders and to reduce illegal immigration. Yet at a recent news conference in Guadalajara with Mexican President Felipe Calderón and Canadian Prime Minister Stephen Harper, rather than demanding that Mexico do more to police its side of the border, President Obama instead expressed concern that, until the United States offers illegal immigrants a path to citizenship, "we will continue to have people crossing the borders in a way that is dangerous for them." In all three instances, Mr. Obama clearly has not been able to bring himself to do anything that might rub influential domestic constituencies-whether supporters of Israel, neo-cold warriors or powerful Hispanic groups-the wrong way.

In contrast to the Bush administration, the Obama team has not launched futile crusades, nor has it generated a powerful backlash against America. So far its sins are primarily those of omission-but these can still be quite costly. Indeed, the administration is not responsible for the difficulty it has encountered in engaging Iran, where the clerical regime is torn apart by post-election infighting. Still, Iran continues to march toward nuclear-weapons capability and, as Obama has said himself, the clock is ticking. If engagement with Tehran does not deliver by early fall, Washington will have to change course and proceed with highly punitive sanctions. And if sanctions do not bring results, no option is off the table, including a military strike against Iranian nuclear facilities. But with growing skepticism in Moscow about the seriousness of Obama's "reset" policy, meaningful Russian cooperation on Iran is increasingly unlikely, and the lack of progress on the Arab-Israeli dispute would assure that a military strike against Iran would create massive indignation in the Muslim world. With the Maliki government in Iraq already demonstrating pro-Iranian sympathies and, according the latest Gallup poll, 59 percent of Pakistanis believing that the greatest threat to their country comes from the United States, it doesn't require excessive imagination to contemplate how an American attack on Iran could explode the whole region, greatly complicating U.S. tasks in both Iraq and Afghanistan and potentially bringing the price of oil to several hundred dollars a barrel. If that happens, Mr. Obama will have to forget about his costly health-care plans and, probably, accept that he would be a one-term president.

Neglecting necessary foreign-policy decisions in the name of optional domestic priorities would make these very goals totally unattainable.

Dimitri K. Simes is the publisher of The National Interest.