Public option: Obama’s changing positions

The Obama administration is sending mixed signals on its commitment to publicly funded, government-run health insurance as a supposedly indispensable component of health-care reform.

Over the weekend, President Obama said that the public option was not "the entirety" of health-care reform, and his secretary of Health and Human Services said that the public option was not the "essential element" of reform and suggested that instead the administration might be open to health-care cooperatives as an alternative. And Obama press secretary Robert Gibbs indicated that the public option might be only one way of achieving the administration’s overriding goal of choice and competition.

On Monday, the White House was trying to stuff the toothpaste back in the tube, especially after several key Senate Democrats rebelled at the possible loss of a public option and a drafter of the House bill said that dropping the option could lose as many as 100 votes.

Speaking in Colorado, Obama seemed to minimize the significance of a public option to health-care overhaul, calling it "just one sliver of it, one aspect of it." Hardly. A public option would significantly expand the government’s role, from insuring the old and the poor, as it does now, to covering the rest of the population.

The idea is that publicly funded insurance, sold through an exchange in competition with private insurance plans, would help keep costs down. The private companies fear that a government plan, susceptible to political pressures to increase benefits and have the taxpayers pay for them, would drive them out of business.

It is a legitimate objection and one that the Obama administration, if it is truly committed to the public option, must address.

As an alternative, the idea of health-care cooperatives has been floated. Non-profit, member-owned co-ops, initially established with federal funds, would use their size and buying power to obtain quality health insurance for their members on the private market. While appealing, the concept of health-care cooperatives is largely untested.

Obama may have been tactically smart to let congressional Democrats take the lead in drawing up the plan, and the White House has been cagey about the specifics of the reform it wants. A recent public opinion poll shows that support for a public option, never terribly strong, may be dropping.

If the public option is what Obama genuinely wants, he is going to have to give up his role of detached referee over the squabbling Democrats and the intransigent Republicans and get his hands dirty cajoling and browbeating Congress into line.