While President Barack Obama's concession on a health care "government option" continues to draw complaints from liberals, it is failing to gain interest from his conservative critics — another sign of the daunting challenge to find middle ground in an increasingly partisan struggle.
Officially, the White House continues to maintain that there’s been no shift in position. On Tuesday, presidential spokesman Robert Gibbs said the Obama administration has not altered its goals on health care reform or distanced itself from a government-run public insurance option.
The rash of reports began after Health and Human Services Secretary Kathleen Sebelius appeared to signal the president was open to health care cooperatives as an alternative.
Gibbs said there was no intention to indicate a change in policy. He said, "If it was a signal, it was a dog whistle we started blowing weeks ago."
Meantime, public support for a public health care option appears to be waning.
In a new NBC News poll set for release Tuesday afternoon, a plurality of Americans now oppose a government-run plan — 47 percent to 43 percent. That’s a shift from last month’s poll (released in conjunction with The Wall Street Journal) when 46 percent said they supported it, compared to 44 percent who did not.
In another sign of discontent with the looming overhaul, some 60,000 senior citizens have severed ties with the AARP since July 1. The membership loss suggests dissatisfaction on the part of AARP members at a time when many senior citizens are concerned about proposed cuts to Medicare providers to help pay for making health care available for all.
A separate survey of consumer sentiment on health care, compiled by the nonpartisan Robert Wood Johnson Foundation, showed that Americans' confidence in insurance coverage, affordability and access dropped more than 5 points in July.
Among seniors eligible for Medicare the drop was even more striking — 10.4 points — suggesting the health care debate is raising alarm bells for older people.
Enthusiasm for public option
But in the face of these numbers, several political heavyweights remain enthusiastic about the possibility of a public option.
"You really can't do health reform" without allowing the government to compete with private insurers, said Howard Dean, a former Democratic Party chairman. "Let's not say we're doing health reform without a public option," he added in a slap at the administration's latest move.
His remarks were echoed by lawmakers as well as AFL-CIO President John Sweeney, who said the option was the only way to force "real competition" on the insurance industry.
Obama and his top aides signaled retreat over the weekend on proposals for a provision under which consumers could choose from health insurance policies sold by the federal government as well as those marketed by private companies.
"All I'm saying is, though, that the public option, whether we have it or we don't have it, is not the entirety of health care reform," the president told a town hall-style audience in Grand Junction, Colo., on Saturday. "This is just one sliver of it, one aspect of it."
The government option has emerged as one of the most contentious elements of legislation taking shape in Congress, with critics saying it is a step toward a federal takeover of health care and supporters arguing it is essential to create competition with private firms.
Proposals for creation of nonprofit cooperative ventures have emerged as an alternative, but so far, neither liberals nor conservatives have shown great interest.
GOP opposition
Obama made his remarks as he struggled to regain momentum for a health care overhaul that has generated controversy among Democrats and near unanimous opposition among Republicans.
Republicans have ratcheted up the attacks in recent days. Rep. John Boehner of Ohio, the House GOP leader, likened the administration to a school yard bully intent on stealing lunch money, and accused the nation's drug makers of "cutting a deal with the bully."
In a letter to Billy Tauzin, the head of the Pharmaceutical Research and Manufacturers of America (PhRMA), Boehner said the industry had agreed to a deal with the White House "in hopes of securing favorable treatment and future profits."
PhRMA agreed to pick up no more than $80 billion in costs for health care overhaul over the next decade, under a deal with the White House. It also will spend as much as $150 million in the next few months on television ads to promote health care legislation.
Ken Johnson, senior vice president at PhRMA, said in response to Boehner's letter: "We have been working diligently for more than a year to advance bipartisan health care reform. We're proud of those efforts, and they are completely consistent with our core principals."
The bill faces numerous obstacles when lawmakers return to the Capitol after Labor Day.
In the House, where Democrats hold a 256-178 majority, passage of legislation will hinge on the ability of the administration and Democratic leaders to satisfy liberals who favor a robust government option and centrists who prefer the co-op approach.
Because they cannot realistically count on any Republican votes, the margin for error is reduced. At the same time, House leaders want to protect their rank-and-file centrists, who tend to come from swing districts, and whose victories in 2006 and 2008 helped give the party its large majority.
In a statement, Speaker Nancy Pelosi said, "There is strong support in the House for a public option," adding it is the best way "to lower costs, improve the quality of health care, ensure choice and expand coverage."
But the statement did not rule out legislation that lacks a government option.
There are similar Democratic divisions in the Senate, where the party controls 60 seats to 40 for the Republicans. A bipartisan group of six senators has been meeting for weeks on a possible compromise that would not include a government option. It is not clear whether they will be successful in reaching a final agreement.
Public option to be added later?
On MSNBC Monday, Dean said he believes the public option might be added to the legislation during the Senate's budget reconciliation process between the two chambers, when it would need only 51 votes to pass, instead of the 60 usually required for contentious bills.
Reconciliation is really part of the budget process and provisions in the bill that are not relevant to spending or to tax revenue could be deleted from it.
"But I think we will have a public option at the end," Dean said.
However, Sen. Kent Conrad, D- N.D., a member of the Senate Finance Committee, has repeatedly said that it will not be possible to use the reconciliation process to enact the health insurance overhaul —partly because too much of the bill is not directly related to the budget.
While the president says he favors a bipartisan approach, he has also said it may ultimately be necessary for Democrats to produce a bill more to their own liking.
Jim Manley, spokesman for Senate Majority Leader Harry Reid, said the Nevada lawmaker "supports a public option" because it could keep insurance companies in check. "But he also knows that 60 votes will be needed to get anything done. Senator Reid recognizes there are different proposals on the table that could accomplish this goal," the spokesman said, a clear reference to the co-op alternative.
'Single payer' approach
"Leaving private insurance companies the job of controlling the costs of health care is like making a pyromaniac the fire chief," said Rep., Anthony Weiner, D-N.Y. Weiner is one of dozens of Democrats who favor creation of a so-called "single payer" approach under which the government would take over the health care system. For many of them, the government option represents a significant retreat.
Rep. Barbara Lee, D-Calif., who chairs the Congressional Black Caucus, issued a statement that called the weekend administration statements deeply troubling. "The Congressional Black Caucus remains committed to ensuring that health reform is meaningful, and that means making sure that a public option is part of the package," she said.
The Senate Republican leader, Mitch McConnell of Kentucky, issued a statement that emphasized other complaints about Obama's proposals.
"While both political parties believe we need to reform our health care system, particularly in the areas of cost and access, Americans are rightly skeptical about the administration's approach to overhauling everyone's health care and about the more than $1 trillion price tag. Moreover, Americans are concerned about funding new government programs through massive cuts to Medicare and taxes on small business," he said.