The reversals, hints of concessions and politically-dicey proposals on health care are piling up for President Barack Obama, whose appeal for bipartisan legislation carries risk with no guarantee of reward. By one definition, that's called presidential leadership, flexibility first, meant to embolden others to do the same. By another, it's political inconsistency that risks offending seniors who are covered by the government-funded Medicare program, liberals who favor government-run health care and union families with coverage negotiated by contract with employers. “Many of us are prepared to accept changes that maybe wouldn't be our first choice,” says Sen. Richard Durbin, an Illinois Democrat. He meant it as a challenge to Republicans, few of whom have seem interested in seeking common ground on health care with the White House and Democrats who control Congress. But so far, Obama has been anything but uninterested. “He is flexible when it comes to methods,” his chief of staff, Rahm Emanuel, said recently. “But when it comes to outcomes, he is not,” referring to the president's goal of curtailing health care costs while spreading coverage to millions who lack it. Beginning last winter, Obama has called for $600 billion in savings over the next 10 years from Medicare and Medicaid – the government health care programs for the elderly, poor and disabled. More than a decade ago, when then House Speaker Newt Gingrich and the Republicans wanted to save about $270 billion from Medicare over seven years, Democrats accused them of seeking to cut essential programs. Obama did some attacking of his own in last year's presidential campaign, criticizing Republican nominee John McCain over the Arizona senator's proposal to tax health insurance benefits. Obama now has opened the door to just that idea. “I don't want to prejudge what they're doing,” the president said recently about Senate supporters of a plan to tax workers with expensive insurance through their jobs. Gerald W. McEntee, president of the 1.6 million-member American Federation of State, County and Municipal Employees, said members of the union “are not going to tolerate that.” Obama is “a person of his word,” he added pointedly, referring to the campaign promises. Any tax on health care benefits would violate two campaign pledges. Obama campaigned against that specific proposal and pledged often not to raise taxes on people earning less than $250,000. Pressed last April on the subject, White House press secretary Robert Gibbs said there were no caveats, health benefits or otherwise. The president also is a convert to the cause of requiring people to purchase insurance, with waivers in cases of financial hardship. He opposed these mandates last year when his main Democratic presidential rival, Hillary Rodham Clinton, backed them. Now, he says, “my thinking on the issue of mandates has evolved. And I think that that is typical of most people who study this problem deeper.” That's not all. Obama has left the door open to legislation that does not give individuals the ability to purchase insurance from a government-run plan. Many congressional Democrats want the federal involvement, saying it will help people by creating competition for private insurers. Polls show this public option enjoys widespread backing, and Obama sometimes cites those surveys. “Why would it drive private insurance out of business? If private insurers say that the marketplace provides the best quality health care, if they tell us that they're offering a good deal, then why is it that the government, which they say can't run anything, suddenly is going to drive them out of business? That's not logical,” he said at a news conference this past week. But nowhere did he say he would veto any bill that lacked a government insurance option. In fact, the president has drawn few lines in the sand. Any legislation must not add to the deficit, he says. And he told ABC television's “Good Morning America” that “if any reform that we get is not driving down costs in a serious way ... if people say, `We're just going add more people onto a hugely inefficient system,' then I will say no. Because we can't afford it.” In Congress, there's not much support for adding to the deficit, and none for making an inefficient health care system more inefficient. Instead, the prospects for success in health care hinge on a few big issues, as well as dozens if not hundreds of smaller ones. Obama has shown flexibility on most, if not all of them.
