President Barack Obama has learned the lessons of Bill Clinton's failed bid to overhaul the nation's health care system. Too well, in fact, say fellow Democrats angry over his refusal to intervene while a conservative proposal advances in the Senate.
Obama says he supports a government-run health insurance program to compete with private insurers, a proposal that is popular with many Americans, especially Democrats. But he is standing by as a watered-down, bipartisan version appears likely to be included in a Senate package.
The president's allies hope it can be strengthened later, or at least accepted by liberals who want a tougher measure. Compromise is essential to every tough political battle, they say, and Obama may prove wise by keeping his options open in a health care debate certain to last for months.
Frustrated liberal activists, however, point to polls showing strong public support for a government-run option that is more robust than the one apparently favored by the Senate Finance Committee. They ask why Democrats, who control the House, Senate and White House, are pushing a version backed by many Republicans.
White House aides say Obama wants to avoid issuing nonnegotiable demands early in the legislative process. He feels Clinton made such a mistake in a failed 1993 bid to revamp the health care system. Obama has made clear that he supports a bona fide public option for health insurance, which critics say is missing from the Senate Finance package, at least for now.
But Obama "wants comprehensive health reform even more," said former Sen. Tom Daschle, who has advised the administration on health care. "He will do all he can to get a public option," Daschle said, "but at the end of the day, the only thing nonnegotiable is success."
Some Democrats, however, feel Obama has over-learned the lessons of 1993 and is bending over too far to attract GOP support in the Senate. Unless he and congressional Democratic leaders agree to strengthen the public insurance provision later in the legislative process, they say, he may regret his hands-off approach.
"No one in this building wants health care reform as much as we do," California Democratic Rep. Lynn Woolsey, co-chair of the Congressional Progressive Caucus, told reporters in the Capitol this week. However, she said, if a bill "does not include a real and robust public option that lives up to our criteria, then we will fight it with everything that we have."
The legislative focus is on the 100-member Senate, where the rules make it difficult to pass contested bills without 60 votes; there are 57 Democrats, plus two independents who usually vote with Democrats. The House is moving a Democratic-crafted bill virtually certain to include a publicly run health insurance provider with the clout to compete with private insurers.
In the Senate, Finance Committee Chairman Max Baucus, D-Mont., is determined to win some Republican support for a far-reaching health care bill, which eventually must be reconciled with the House version to become law. GOP members oppose a public option similar to the House's plan, saying it would have unfair advantages that would drive private insurers out of business.
Many Democrats dispute that claim, but Baucus is leaning toward a compromise version involving nonprofit cooperatives. Critics say co-ops would not be genuine public options for health insurance.
Proposed by Sen. Kent Conrad, D-N.D., the co-ops would receive federal startup money, but then would operate independently of the government. They would have to maintain the same financial reserves that private companies are required to keep in case of unexpectedly high claims.
With the administration declining to publicly criticize the co-op proposal, other Democrats have stepped in.
Sen. Chuck Schumer of New York says the co-ops would lack sufficient startup funding, and they would be too decentralized to bargain for the best values for insurance buyers nationwide. An acceptable public option must have a presidentially appointed board to make rules without interference from the insurance industry, he says.
"Right now, this co-op idea doesn't come close to satisfying anyone who wants a public plan," Schumer said this week.
In an interview Thursday, he said Baucus was weighing his request to bulk up Conrad's proposal.
If that fails, critics of the co-op compromise will have other chances to change it, and Obama can weigh in if he likes. The Senate Finance Committee bill could be amended on the Senate floor. The bill could be rewritten in House-Senate negotiations. Or Senate Democrats could use a strong-arm measure, called reconciliation, to pass a version with little or no GOP support.
All those options carry political risks and uncertainty.
Obama repeatedly promotes a public insurance option that sounds similar to the robust program the House wants.
"The public plan, I think, is an important tool to discipline insurance companies," he said in a news conference Tuesday. But he said he would draw no "lines in the sand," leaving proponents to wonder whether he might eventually drop the public program in exchange for something else.
Insurance companies oppose the public option proposal. Their cause was hurt this week when congressional investigators said two-thirds of the U.S. health insurance industry used a faulty database that overcharged patients for seeing doctors outside their insurance network, costing Americans billions of dollars in inflated medical bills.
The investigation was headed by Sen. Jay Rockefeller, D-W.Va. He is among those who will press Obama to back a potent government-run health insurance program.
"Health care reform cannot succeed without a strong public plan option that works for the American people," Rockefeller's office said this week.