White House Political Honcho Goes Mealy-Mouthed on Public Option

Just days before President Barack Obama is scheduled to deliver a major prime-time speech on health care reform, David Axelrod, the president's senior adviser, seemed to signal a willingness on the president's part to drop the public plan from legislation under discussion in Congress, in order to get a bill.

Yet even as Axelrod did so, White House Press Secretary Robert Gibbs indicated that the president would use the speech to make a case for including a publicly funded insurance option in any health care reform.

Axelrod downplayed the significance of a public health reform plan in his appearance this Sunday on NBC's Meet the Press, hosted by David Gregory. (Full transcript here; video and more from Axelrod's exchange with Gregory on the public option at the end of this story.)

Meanwhile, Gibbs, appearing on ABC's This Week, indicated that in the president's speech on Wednesday, he would state his support for a public health insurance plan.

David Gregory: This is what the House speaker says, Nancy Pelosi. She draws a line in the sand. She says the following, "Any real change requires the inclusion of a strong public option to promote competition and bring down costs. If a vigorous public option is not included, it would be a major victory for the health insurance industry. A bill without a strong public option will not pass the House. Eliminating the public option would be a major victory for the insurance companies. We have rationed care, increased premiums and denied coverage." Does the president agree with the House speaker?

David Axelrod: Well, he certainly agrees that we have to have competition and choice to hold the insurance companies honest. We have to have insurance protections for folks who have insurance, so they can't do the kinds of things that they've done in the past, arbitrarily throwing people off their insurance if they have a pre-existing condition or if they get seriously ill. He agrees with all of that.

The idea here is to bring more security and stability to people who have insurance and to help those who don't have insurance get it at a price they can afford. The public option within that exchange is certainly a valuable tool.

DG: The reality is as a political matter, you cannot get Republicans to sign on, nor can you get moderate Democrats, maybe 10 or 12 of them to sign on if the president fights for the public option. True or false?

DA: Look, why don't we let the president speak and make his case, and then we can have this discussion. I believe that there's enormous consensus around a broad number of issues that would make a great difference for people who have insurance and people who need insurance, and we have to build on that.

And I think the president will be able to do that on Wednesday night and we'll go from there.

One irony in this (and there are many when it comes to the current consternation over health care reform) is that in the districts of many of those conservative Democrats who oppose the public plan, either public sentiment remains in favor of the public option, or it appears to have little bearing on how constituents will vote in the upcoming midterm elections.

Take, for instance, the district of Rep. Mike Ross, D-Ark., spokesman for the conservative Blue Dog coalition in the House of Representatives. At 538.com, Nate Silver pointed out several months ago that the number of uninsured in Ross's district far exceeds the mean for uninsured in all congressional districts.

More than one-fifth of Ross' constituents lack health care coverage altogether -- and that doesn't even account for the underinsured.

Then there's the Senate, where Finance Committee Chairman Sen. Max Baucus, D-Mont., a recipient of oddles of campaign dollars from the health care industry, has held up the works by insisting on crafting a "bipartisan" health care reform bill (that may get one Republican vote, if he's lucky) that will contain no public option.

Silver, posting last week, notes a Daily Kos poll of Baucus's state, where respondents were asked this question:

If Max Baucus opposed a public health insurance option would that make you more or less likely to vote for him or would it have no real effect on your vote?

A clear majority -- 61 percent -- said Baucus' opposition to the public plan would not affect their votes. The poll does not parse out how the votes of the remaining 39 percent would be affected by the senator's opposition to a public option.

Answering another question, 47 percent said that the $4 million Baucus has received from health and insurance interests " hurts his judgment when voting on health care issues."

Despite this data, it seems, the White House is willing to cave on the public plan. NBC reported that on the conference call Obama conducted with members of the Congressional Progressive, Black, Asian Pacific American and Hispanic caucuses -- who have been insisting that a public option remain in the bill -- Obama reminded the caucus members that they have "safe" Democratic seats, while those who oppose the public option may not.

Public opinion polls continue to show broad public support for a public health care plan, although the margins range wildly, according to how the question is asked.

Last week's CNN poll shows 55 percent support (PDF -- Page 7) for "a public health insurance option administered by the federal government," while an AARP poll from several weeks ago shows 79 percent in support of" a federal government health insurance option should be available for people to buy."

Axelrod seemed to indicate that the president is more swayed by the balking of conservative Dems than by the confounding polls. (To be fair, who knows what the administration's internal polling is telling them.)

Video of Axelrod's complete exchange with Gregory regarding the public health insurance option appears below:


DG: Let's talk about ideas on the table. The big one is the so-called public option, a government plan that would be alongside private insurance plans to try to create competition and drive down costs. This is what the president said back in July about the public option.

(Videotape, July 18, 2009)

Obama: That's why any plan I sign must include an insurance exchange, a one-stop shopping marketplace where you can compare the benefits, costs and track records of a variety of plans, including a public option to increase competition and keep insurance companies honest and choose what's best for your family.

(End videotape)

DG: Does the president stand by that statement?

DA: You know, he certainly believes that a public option within this exchange would be important. Let's, let's, let's focus on what the issue is. There are 10 ...

DG: He said it must be included, David. He said it must be included.

DA: He said there must -- he said there must be a, an exchange where people can get insurance at a competitive price. He believes in competition and choice. The public option is a, is an important tool to help promote that where there is no competition. He still believes that.

But here's the problem, David. If you don't have insurance today, if don't have insurance through your employer, and you need to get a policy, it costs you three times as much, on the average, as it would if you had employer coverage. People simply can't afford it.

One of the ways -- so we want to create a pool in which people who don't have insurance, and small businesses, can go and get insurance at a competitive price. And a public option would be a valuable tool within that group, that package of plans that would be offered, private and public.

DG: I just want to be clear here because in his statement, he was unequivocal. He said it must be included. A public plan must be included.

Is he now signaling that he would compromise on that if you could still have some measure of competition?

DA: Well, first of all, you'd have to take the whole statement. He believes that a health insurance exchange where people can go, small businesses, people who don't have insurance can get insurance at an affordable price, is still essential to any health reform, and he believes a public option would be an important part of that package. He hasn't changed his view.

DG: This is what the House speaker says, Nancy Pelosi. She draws a line in the sand. She says the following, "Any real change requires the inclusion of a strong public option to promote competition and bring down costs. If a vigorous public option is not included, it would be a major victory for the health insurance industry. A bill without a strong public option will not pass the House. Eliminating the public option would be a major victory for the insurance companies. We have rationed care, increased premiums and denied coverage." Does the president agree with the House speaker?

DA: Well, he certainly agrees that we have to have competition and choice to hold the insurance companies honest. We have to have insurance protections for folks who have insurance, so they can't do the kinds of things that they've done in the past, arbitrarily throwing people off their insurance if they have a pre-existing condition or if they get seriously ill. He agrees with all of that.

The idea here is to bring more security and stability to people who have insurance and to help those who don't have insurance get it at a price they can afford. The public option within that exchange is certainly a valuable tool.

DG: The reality is as a political matter, you cannot get Republicans to sign on, nor can you get moderate Democrats, maybe 10 or 12 of them to sign on if the president fights for the public option. True or false?

DA: Look, why don't we let the president speak and make his case and then we can have this discussion. I believe that there's enormous consensus around a broad number of issues that would make a great difference for people who have insurance and people who need insurance, and we have to build on that. And I think the president will be able to do that on Wednesday night, and we'll go from there.

DG: What about the idea of a trigger, which is to say that you can introduce a government plan into states if the private insurance market doesn't succeed at driving down prices? Does the president think that's an idea worth considering?

DA: Well, I'll let the president address the specifics on Wednesday, David. But again, the goal here is to create competition and choice.

There are markets where there are insurance companies that, that have 90 percent of the business, states in this country. So it's very difficult to discipline the insurance companies on price and on the quality of care.

Competition would do that and give the consumers a better break. He's for promoting competition and choice.

DG: So a trigger is still possible?

DA: Well, again, I'll let him address this. He believes the public option is a, is a good tool.

Now, it shouldn't define the whole health care debate, however. There are, you know, the insurance guarantees that are in there for the 160 million people who have employer-based coverage are absolutely essential so that they have, you know, the ability to hang on to their insurance if they get seriously ill and not get thrown off. If they have someone in their family with a pre-existing condition, they can get them covered and so on.

We have to -- that there's a cap on out-of-pocket expenses so if you get sick, you don't go broke. These are the things that health reform would bring to people who have insurance today as they hold on to the policies that they have.