Giving up public option may be expedient, but it's unnecessary

WASHINGTON — It's true that politics is the art of the possible, but it's also true that great leaders expand the scope of possibility. Barack Obama took office pledging to be a transformational president. The fate of a government-run public health-insurance option will be an early test of his ability to end the way Washington's big-money, special-interest politics suffocates true reform.

Without that option, what Obama now calls "health-insurance reform" still would be better than no reform at all, I think. But frankly, it's becoming hard to tell. So many genuine reforms have already been taken off the table — fully universal coverage, the ability to negotiate prices with the drug companies — that expectations are ratcheted down almost daily.

Giving up the public option would send many of Obama's progressive supporters into apoplexy, yet the administration has sent clear signals that this is the path-of-less-resistance it's prepared to take.

"The public option, whether we have it or we don't have it, is not the entirety of health-care reform. This is just one sliver of it, one aspect of it," Obama said Saturday at a town hall in Grand Junction, Colo. Kathleen Sebelius, the secretary of health and human services, told CNN that a public option is "not the essential element" of comprehensive reform.

But what is the "essential element"? Where, if anywhere, does Obama draw a line in the sand? For reform to be meaningful, there must be some components that a final package absolutely should include. What on earth might they be?

Obama was wise to avoid the central mistake of Bill Clinton's failed attempt at health reform, which was to hand Congress a fully elaborated package and say "take it or leave it." Instead, Obama set broad — and, frankly, awfully fuzzy — policy outlines and let Congress fill in the details. But he followed this strategy to a fault, allowing the effort to be hijacked by special-interest lobbies determined to thwart genuine reform.

The let-Congress-do-it approach meant that multiple bills would be written in committees on both sides of the Capitol, which gave the health-insurance and drug-company lobbyists a target-rich environment. They could nibble a little here, gnaw a little there, find the weak points and exploit them. Republicans could find opportunities for demagoguery — the proposal to have Medicare pay for end-of-life counseling, for example, which was twisted into euthanizing the elderly and infirm. Opponents could write a script for chaos at town-hall meetings, designed to create the impression that Americans love their health care system just the way it is.