PHOENIX — The White House, facing increasing skepticism over President Obama’s call for a public insurance plan to compete with the private sector, signaled Sunday that it was willing to compromise and would consider a proposal for a nonprofit health cooperative being developed in the Senate.The “public option,” a new government insurance program akin to Medicare, has been a central component of Mr. Obama’s agenda for overhauling the health care system, but it has also emerged as a flashpoint for anger and opposition. Kathleen Sebelius, the health and human services secretary, said the public option was “not the essential element” for reform and raised the idea of the co-op during an interview on CNN.
Word that the public option might be dropped angered many liberals. One prominent Democrat, former Governor Howard Dean of Vermont, said on Monday that he saw a public plan as inextricably linked to a health overhaul. “I don’t think it can pass without the public option,” Mr. Dean, who is a physician and a former chairman of the Democratic National Committee, said on “The Early Show” on CBS.
“There are too many people who understand, including the president himself, the public option is absolutely linked to reform,” he said. “You can’t have reform without a public option. If you really want to fix the health-care system, you’ve got to give the public the choice of having such an option.”
Mr. Obama himself sought to play down the significance of the public option at a town-hall-style meeting on Saturday in Grand Junction, Colo., when a university student challenged him on how private insurers could compete with the government.
After strongly defending the public plan, the president suggested that he, too, viewed it as only a small piece of a broader initiative intended to control costs, expand coverage, protect consumers and make the delivery of health care more efficient.
“The public option, whether we have it or we don’t have it, is not the entirety of health care reform,” Mr. Obama said. “This is just one sliver of it, one aspect of it.”
The president is scheduled to speak on Monday at a Veterans of Foreign Wars convention in Phoenix, where the health care issue is expected once again to be front and center.
For Mr. Obama, giving up on the public plan would have risks and rewards. The reward is that he could punch a hole in Republican arguments that he wants a “government takeover” of health care and possibly win some Republican votes. The risk is that he could alienate liberal Democrats, whose support he will also need to pass a bill.
On Sunday, Senator John D. Rockefeller IV, Democrat of West Virginia, affirmed his support for the public option. “I believe the inclusion of a strong public plan option in health reform legislation is a must,” Mr. Rockefeller said in a statement. “It is the only proven way to guarantee that all consumers have affordable, meaningful and accountable options available in the health insurance marketplace.”
White House officials say the president has not abandoned the idea of a pure government plan, a central feature of the legislation moving through the House. But Ms. Sebelius’s comments did seem to open the door, and at least one Democrat close to the White House said the administration was well aware that, with moderate Senate Democrats opposed to the idea of a public plan, Mr. Obama might have to give up on the notion to get a bill through.
“The president is going to continue to try to persuade everyone of the great value of having a true public plan,” said this Democrat, who spoke on condition of anonymity to avoid discussing strategy publicly. “But at the end of the day, I believe he recognizes that there are other, arguably less effective, ways to achieve greater coverage, more choice, better quality and lower cost in our system.”
In an interview on Sunday, Mr. Obama’s senior adviser, David Axelrod, said the president remained convinced that a public plan was “the best way to go.” But Mr. Axelrod said the nuances of how to develop a nonprofit competitor to private industry had never been “carved in stone.”
On Capitol Hill, the Senate Finance Committee is expected to produce a bill that features a nonprofit co-op. The author of the idea, Senator Kent Conrad, Democrat of North Dakota and chairman of the Budget Committee, predicted Sunday that Mr. Obama would have no choice but to drop the public option.
“The fact of the matter is, there are not the votes in the United States Senate for the public option,” Mr. Conrad said on “Fox News Sunday.” “There never have been. So to continue to chase that rabbit, I think, is just a wasted effort.”
The co-op, modeled after rural electric and agricultural cooperatives in Mr. Conrad’s home state, would offer insurance through a nonprofit, nongovernmental consumer entity run by its members. Mr. Axelrod said one downside of a co-op, from Mr. Obama’s point of view, was that it might be unable to “scale up in such a way that would create a robust” competitor to private insurers.
And whether a co-operative would actually bring Republicans on board with Mr. Obama is unclear. Senator Richard C. Shelby, the Alabama Republican who appeared alongside Mr. Conrad on “Fox News Sunday,” called the co-op idea “a step in the right direction,” adding: “I don’t know if it will do everything people want, but we ought to look at it. I think it’s a far cry from the original proposals.”
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