Compromise gives White House a health option

Sunday, June 14, 2009 | 3:14 p.m. CDT; updated 11:20 a.m. CDT, Thursday, September 3, 2009

WASHINGTON — As Congress begins work on putting President Barack Obama's goal of universal health coverage into law, administration officials and allies sought to sidestep Republican objection to letting the government compete with private plans.

Cabinet officials and Obama allies on Sunday sought to rein in lawmakers, who were expected this week to introduce specific plans that run counter to Obama's political promises. Many urged lawmakers to consider a cooperative program that would expand coverage to the 50 million uninsured Americans with taxpayer support without direct governmental control.

America is the only developed nation that does not have a comprehensive national health care plan for all its citizens. Many private U.S. health insurance plans are largely employer-funded and based on specific workplaces, so Americans who lose their jobs often also lose health insurance coverage for their family.

The concessions Obama wants could be the smoothest way to deliver the bipartisan health care legislation the administration seeks by its self-imposed August deadline, officials said.

"There is no one-size-fits-all idea," Health and Human Services Secretary Kathleen Sebelius said. "The president has said, 'These are the kinds of goals I'm after: lowering costs, covering all Americans, higher-quality care.' And around those goals, there are lots of ways to get there."

Some of those ways, though, run counter to the White House's earlier positions and Obama's own political base. While Democratic supporters from Obama's left have advocated a government-run option — championed by an ailing Sen. Edward M. Kennedy and Sen. Chris Dodd — presidential aides and congressional leaders in both parties have sought a speedy compromise.

Leading that pack: the cooperative approach, similar to rural utilities that have government financial support but operate independently. Sen. Kent Conrad, the North Dakota Democrat who chairs the Budget Committee, has offered the co-op idea as a way to avoid a bruising and protracted political wrangle on Capitol Hill.

"This really isn't, to me, a matter of right or wrong," Conrad said. "This is a matter of: Where are the votes in the United States Senate?"

That political situation has guided most of the talks. While Democrats control both chambers of Congress, they have only 59 senators — one short of the number needed to end a Republican filibuster to block the bill.

"I think you are in a 60-vote environment. And that means you have got to attract some Republicans, as well as holding virtually all the Democrats together," Conrad said. "And that, I don't believe, is possible with the pure public option. I don't think the votes are there."

To offset the numeric challenge, Conrad proposed a compromise that drew interest from moderate Republicans, including one who helped Obama pass his economic stimulus plan.

"It's far preferable to the government-run plan that has been discussed by the administration," Republican Sen. Susan Collins said. "We need to better understand how it would work. But it's certainly better than a Washington-run plan."

Obama's political team at the White House has seen such a compromise as an option, although publicly the administration remains in support of a government competitor to private insurance. But during appearances on Sunday news programs, the support seemed to waver.

Sebelius said "having these ideas on the table is exactly where we need to be right now." And Vice President Joe Biden indicated the White House was ready to accept that "a public plan is on a continuum."

The answer for Republicans: Unacceptable.

"I think that, for virtually every Republican, a government plan is a nonstarter," said Senate Minority Leader Mitch McConnell. "There are a whole lot of other things we can agree to do on a bipartisan basis that will dramatically improve our system."

To reach that bipartisan solution — something the White House has emphasized — Democrats were likely to make concessions to find the $1 trillion the plan would cost over the next decade.


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