Critical Condition

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New York Times on the public option:

PHOENIX — The White House, facing increasing skepticism over President Obama’s call for a public insurance plan to compete with the private sector, signaled Sunday that it was willing to compromise and would consider a proposal for a nonprofit health cooperative being developed in the Senate.

The “public option,” a new government insurance program akin to Medicare, has been a central component of Mr. Obama’s agenda for overhauling the health care system, but it has also emerged as a flashpoint for anger and opposition. Kathleen Sebelius, the health and human services secretary, said the public option was “not the essential element” for reform and raised the idea of the co-op during an interview on CNN.

Mr. Obama himself sought to play down the significance of the public option at a town-hall-style meeting on Saturday in Grand Junction, Colo., when a university student challenged him on how private insurers could compete with the government.

After strongly defending the public plan, the president suggested that he, too, viewed it as only a small piece of a broader initiative intended to control costs, expand coverage, protect consumers and make the delivery of health care more efficient.

“The public option, whether we have it or we don’t have it, is not the entirety of health care reform,” the president said. “This is just one sliver of it, one aspect of it.”

For Mr. Obama, giving up on the public plan would have risks and rewards. The reward is that he could punch a hole in Republican arguments that he wants a “government takeover” of health care and possibly win some Republican votes. The risk is that he could alienate liberal Democrats, whose support he will also need to pass a bill.

On Sunday, Senator John D. Rockefeller IV, Democrat of West Virginia, affirmed his support for the public option. “I believe the inclusion of a strong public plan option in health reform legislation is a must,” Mr. Rockefeller said in a statement. “It is the only proven way to guarantee that all consumers have affordable, meaningful and accountable options available in the health insurancemarketplace.”

White House officials say the president has not abandoned the idea of a pure government plan, a central feature of the legislation moving through the House. But Ms. Sebelius’s comments did seem to open the door, and at least one Democrat close to the White House said the administration was well aware that, with moderate Senate Democrats opposed to the idea of a public plan, Mr. Obama might have to give up on the notion to get a bill through.

“The president is going to continue to try to persuade everyone of the great value of having a true public plan,” said this Democrat, who spoke on condition of anonymity to avoid discussing strategy publicly. ”But at the end of the day, I believe he recognizes that there are other, arguably less effective, ways to achieve greater coverage, more choice, better quality and lower cost in our system.”

In an interview on Sunday, Mr. Obama’s senior adviser, David Axelrod, said the president remained convinced that a public plan was “the best way to go.” But Mr. Axelrod said the nuances of how to develop a nonprofit competitor to private industry had never been “carved in stone.”

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