The debate over whether or not a health-care bill should include a public plan — a government-run health insurance option much loved by liberal health-care reformers — is often portrayed as a difference of policy, fought over questions like: Is the public plan just a single-payer Trojan horse? Will it actually lower the cost of insurance premiums? Might it put private insurers out of business? But these days, the president's stance on the issue seems to hinge less on these questions and, instead, on pure political calculation.
The health-care question of the week amongst anxious reformers has been whether or not Obama actually supports a public plan, and if so, how much. The president has spent a fair amount of time selling the virtues of a public option. But in a recent press conference, Obama refused say that a public plan was a must-have, and earlier this week, White House Chief of Staff Rahm Emmanuel irked public-plan supporters when he said that the administration might be open to some kind of compromise — perhaps including an Olympia Snowe-style "trigger" mechanism that would significantly delay the implementation of the program — on the public plan.
But now Emmanuel is trying to walk back his waffling. And the Congressional Progressive Caucus, whose members believe that a strong public plan is the only effective check on private insurers, are being vocal about their displeasure with the short shrift they feel has been given to the public plan. This puts the White House, which has signaled that a desire to make health-care reform a bipartisan affair, in a tough spot: Centrist Republicans like Sen. Chuck Grassley and some conservative Democrats like Sen. Mary Landrieu are opposed to a public plan on the grounds that it would shift too many people off of private insurance.
So for the president, at least, what's at stake here isn't a matter of policy, but personal political capital. Obama supports a public plan, probably in its strongest form, but he's more than willing to water it down or perhaps even scrap it altogether if that's what it takes to pass a health-care bill. Right now, health-care reform is the single biggest item on Obama's legislative agenda, and if it fails, he'll take a huge hit politically. His top priority is protecting his own political future, and he isn't going to let legislative details, regardless of their importance, get in the way.