Obama on healthcare reform: Mr. Flexible

His idea of a public insurance plan to compete with private ones is meeting resistance. Will the alternative of health insurance 'cooperatives' suffice?

Gerald Herbert/AP
President Barack Obama conducts a town hall meeting on health care reform, Thursday at Southwest High School in Green Bay, Wis.

It's crunch time on healthcare reform, and a clear theme is emerging from the White House: flexibility.

President Obama has launched an aggressive public effort for reform, laying out in broad terms what he would like in legislation – but no ultimatums on specifics. He has framed the debate as reform versus no reform, with a goal of lowered costs and a reduction in the ranks of the uninsured, now at 46 million Americans. Indeed, Mr. Obama's only requirement, say senators from both parties, is that Congress pass something.

In a town hall meeting in Green Bay, Wis., Thursday, Obama promoted creation of a new public insurance plan, designed to compete with private insurers and bring down costs. But that "public option" is on the ropes. Republicans object vehemently to the idea, arguing it could drive private insurers out of business and lead to a government-run health insurance system. The powerful American Medical Association, which Obama addresses on Monday in Chicago, also opposes the public insurance option.

GOP signals hope for 'cooperatives'

Already, key Senate Democrats are in flexibility mode, looking at an alternative: creation of nonprofit national, state, and regional health insurance "cooperatives." These entities would be run by their members, not the government, and designed to provide affordable coverage to small businesses and individuals. They would be subject to the same regulations as private insurers. The idea of cooperatives, proposed by Sen. Kent Conrad (D) of North Dakota, has gotten an early thumbs-up from key Republicans, such as Sen. Charles Grassley of Iowa, the ranking Republican on the Senate Finance Committee.

In a closed-door bipartisan session with senators on Wednesday, Obama reportedly expressed interest in the idea of cooperatives. But the next day, in his town hall meeting in Green Bay, he still pushed hard for a new government-run insurance plan. Obama insists the public option isn't a harbinger of "single-payer" healthcare, a fully government run system and a concept anathema to conservatives. But some on the left want it to be, and chances are, Obama's continued push for a public plan is aimed at satisfying his left flank – many of whom are members of Congress and the public who want a single-payer system.

Some Democrats, too, wary of 'public option'

Opposition to the public insurance option isn't limited to Republicans. Some moderate Democrats, mostly from swing and red states, have also expressed strong reservations about anything that looks like the camel's nose under the tent in the direction of government-run healthcare.

For now, Democratic Senate leaders in the health reform effort are trying to attract as much Republican support as they can. The broader the support on Capitol Hill, the more likely the public is to support the plan. In particular, Max Baucus, Democratic chair of the Senate Finance Committee, one of two key Senate committees handling reform, has singled a willingness to ditch the public insurance option in favor of insurance cooperatives.

But ultimately, it's Obama's reform effort. In his remarks in Green Bay, the president spoke of bringing down healthcare costs and insuring the uninsured as a "moral imperative." And he said he welcomed ideas and debate. "But what I will not welcome," he added, "is endless delay or a denial that reform needs to happen."

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