Determining the trajectory of health care in the House depends on your vantage point. The view from the top is apparently rosy, as House Democratic leaders gathered Friday at a rah-rah news conference to boast that the measure was picking up steam after clearing two of three committees.

“We are in very excellent shape,— Speaker Nancy Pelosi (D-Calif.) said.

From ground level, however, things looked considerably darker.

Even as the bill marches forward, Democratic leaders are facing revolts on multiple fronts. The most serious threat remains from moderates in the Blue Dog Coalition, who, varyingly, want deeper cost cuts, a more limited public option and a fix for regional disparities under Medicare.

The package passed the Ways and Means and Education and Labor committees early Friday after long markups that stretched through the night and into the morning. The bill grew even more liberal in the Education and Labor markup when Rep. Dennis Kucinich (D-Ohio) succeeded in attaching an amendment allowing states to opt in to a federally funded single-payer health care system.

But Blue Dogs are planning to make their stand this week in the Energy and Commerce Committee.

The group has seven members on the panel, enough to bring down the bill if their concerns aren’t addressed. And at least one other disaffected Democrat on the panel pledged Friday to block the bill on the floor if leaders decide to bypass the committee altogether. “They can’t continue to ignore us,— Rep. Bart Stupak (D-Mich.) said.

Stupak joined six Blue Dogs who broke ranks in the Friday markup to put a Republican amendment over the top despite the objections of Energy and Commerce Chairman Henry Waxman (D-Calif.). The early defeat for Waxman signaled trouble ahead.

Behind objections to how the package would expand coverage is a more fundamental concern over whether it will bring down costs. Douglas Elmendorf, the director of the Congressional Budget Office, sent shock waves through House Democratic ranks when he testified before the Senate on Thursday that the House bill would actually increase federal health care costs rather than cut them.

Blue Dogs, business-friendly moderates in the New Democrat Coalition and others have said reining in health care spending should be the first priority in the reform drive. “We’ve got to fix the system before we throw more money at it,— Rep. Martin Heinrich (D-N.M.) said.

And if the draft bill does nothing to achieve that, some said, lawmakers need to go back to the drawing board.

“Nobody is giving it very good marks right now,— said Rep. Allen Boyd (D-Fla.), a senior Blue Dog. “Many of us think we should scrap it and start over.—

Leaders are facing trouble on other fronts, as well. Led by Rep. Jared Polis (Colo.), 22 Democrats, mostly freshmen, on Friday sent Pelosi a letter expressing strong objections to the surcharge tax on the wealthy that would raise $544 billion to pay for expanded coverage. The freshmen, who huddled with Pelosi twice last week, argued that the tax increase would hurt small businesses. They made the case for a smaller tax — and the need to cut spending — directly to President Barack Obama and Chief of Staff Rahm Emanuel in a meeting at the White House on Friday. The session was cut short by House votes, but Rep. Gerry Connolly (D-Va.), the freshman class president, said he expected the conversation to pick up again this week.

On top of their substantive concerns, the new lawmakers are worried they will have to take a tough vote on the tax on the rich only to see it significantly rejiggered in negotiations with the Senate.

“We’re skeptical this will be the ultimate financing mechanism,— Polis said. “It’s probably a vote to no avail.—

It’s a common concern for Democrats from swing districts, who are aiming to avoid a vote on a liberal House bill that would get moderated — after a long, bruising August break — in talks with the Senate.

The freshmen made that point to Pelosi in their meeting with her last week, suggesting she allow the House more time to complete its version so it will track more closely with what the Senate produces. And on Friday, she left wiggle room for delaying a vote before lawmakers leave town for the summer recess. After reasserting that her plan is to “move forward to have a bill on the floor,— she added, “We have to see what the Senate is going to do.—

Steven T. Dennis contributed to this report.