Why Obama wants to be as vague as possible about health care reform.

How to fix health policy.
July 7 2009 7:37 PM

Going Public, Quietly

Why Obama wants to be as vague as possible about health care reform.

President Obama is in Russia, but he's still holding hands in Washington. Advocates of a public option as a part of health care reform got spooked he was going to abandon them, so between press releases heralding the U.S./Russian agreement on reducing strategic weapons, the White House released an out-of-the-blue two-sentence statement reiterating Obama's pledge to seek a public option as a part of health care reform. "As I've said before," it read, "one of the best ways to bring down costs, provide more choices, and assure quality is a public option that will force the insurance companies to compete and keep them honest."

Why does the president have to issue a statement from several time zones away reiterating something he's already said? Because his supporters worry that in order to achieve comprehensive health care reform, and to win support from some Republicans, Obama will trade away his support for a public option. Alternatively, they worry that he will redefine public option beyond recognition.

John Dickerson John Dickerson

John Dickerson is Slate's chief political correspondent and author of On Her Trail. Read his series on the presidency and on risk.

The irony is that this most recent statement is unlikely to make anyone less nervous: It merely reflects the strategic ambiguity Obama has been trying to achieve throughout this process. Yes, he's for a public plan—but he's not specific, which means his support can mean all things to all people. This ambiguity gives the president room to make deals, and it doesn't impinge on Congress' prerogatives. But it also creates explosive moments of confusion.

Because of strategic ambiguity, any drop of specificity from the White House rings like a foghorn signal. That's what happened this time. Chief of Staff Rahm Emanuel was quoted expressing flexibility on the details of a public plan in the Wall Street Journal. "The goal is to have a means and a mechanism to keep the private insurers honest," he said in an interview. "The goal is non-negotiable; the path is [negotiable]."

So far, so ambiguous. But Emanuel went further. He said one of several ways to meet Obama's goals could be a mechanism that implements a public plan only if the current insurance marketplace fails to provide sufficient competition. Because the White House has stayed away from details, this was interpreted as an endorsement for the idea of a "trigger."

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Advocates of a public plan don't like the idea of a "trigger," because it makes a public plan conditional. On Tuesday, Sen. Charles Schumer, emerging from the lunch where Democratic senators welcomed Al Franken (with three standing ovations), said Emanuel's remarks were a surprise. "I had never heard that they were for the trigger. That came as a surprise to me," he said. "Maybe in year three there might be a public plan? Not good enough." Moveon.org e-mailed its members Tuesday asking them to tell the White House they're "disappointed in Chief of Staff Emanuel's comments."

This Obama/Emanuel two-step is not new. During discussions over whether to prosecute Bush administration Justice Department lawyers for condoning torture, Emanuel said there should be no prosecutions—only to have Obama say shortly thereafter that there might be. In this case, Emanuel's comments confirm the worst fears of public-option advocates: that the administration is prepared to compromise on their issue. A comment from a Democratic aide in the Senate—"We'll take anything called a public plan as long as it gets us [bi-partisan] agreement"—didn't help much, either.

But Schumer has been working to bridge the gap between those who want a pure public option (a Medicare-for-all-type plan that would be separate from Medicare) and those who support a patient-owned cooperative that would be free from government control. A cooperative, favored by Republican senators like Chuck Grassley and conservative Democratic senators like Ben Nelson, could meet the criteria the president laid out. But true believers in a public plan say a co-op would be too weak to lower costs or compete with private insurance companies.

Schumer has declared the idea dead previously but sounded more positive Tuesday. "If we can come to some kind of compromise on some kind of co-op situation that really keeps the insurance companies honest, I'm open to it. It can't be two little co-ops in two little places." Schumer even seemed to have compromised on a key sticking point in his negotiations with conservative Democrats. He had previously advocated that the co-op board be linked to the government. Now he says that while "there would be a role for the federal government in setting it up, then it would become independent."

Liberal Democrats and their allies were concerned enough about Emanuel's remarks to seek clarification from the White House. But the president's statement, while aimed at reiterating his commitment, doesn't actually contradict anything Emanuel said. If, in the end, Obama decides that a trigger or a cooperative plan keeps insurance companies honest, then he will say he's kept his word on the goals of the public option. So Obama's statement today can be read as both a walk-back of Emanuel's remarks and support of them. When I pointed this out to a White House adviser, the response was succinct: "Mission accomplished."

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