By Noam N. Levey , Tribune Washington Bureau|September 10, 2009
WASHINGTON - — WASHINGTON - - On a night reserved for laying out his vision of health care, President Barack Obama offered a spirited defense of his broad goals but continued to avoid making concrete commitments on some of the most contentious issues, including the so-called "public option."
The president's reluctance to draw lines in the sand came even as lawmakers in his party have pleaded for clearer signals. But it reflected a guiding principle of the administration's health care strategy: to put off the most controversial decisions until the last moment.
And so, while some liberal Democrats have threatened to revolt if Obama does not insist on a new government insurance plan, the president told the joint session of Congress Wednesday night that he will consider other approaches to making coverage affordable for the uninsured.
"The public plan is only a means to that end," the president said, "and we should be open to other ideas that accomplish our ultimate goal."
That flexibility may rankle liberals, but it reflects a basic political reality. At this stage of the legislative process, when neither the House nor the Senate has begun floor debate, the House will not pass a health care bill that does not include the public plan. And the Senate will not pass a bill that does.
A final decision on the public plan will probably come only after each house has acted on its own bill and a conference committee has begun negotiations to resolve the differences. It is in those negotiations, carried out behind closed doors, that a final compromise may be hammered out.
Much the same is true for other key issues in the health care fight, including the details of individual and employer insurance mandates, trimming federal payments to Medicare Advantage plans, and levying new fees and taxes to pay for the overhaul.
Obama's careful combination of specific goals and less-specific prescriptions for achieving them was designed to retain his freedom to compromise when the decision point is reached, perhaps months from now.
"It's not critical that the president lock down every single outstanding question right now," said Chris Jennings, a senior health care adviser in the Clinton administration. "In fact, going too far in one way or the other might actually mess things up."
Today, just 42 percent of Americans surveyed approve of the way Obama is handling health care, while 52 percent disapprove, according to the latest Associated Press-GfK poll. That is a major shift from April, when 53 percent approved of the president's health care policy and 28 percent disapproved.
