WASHINGTON - Even as liberals urge President Barack Obama to demand bold, far-reaching changes to the nation's health care system, the White House signaled openness Thursday to compromises that might attract moderate congressional Democrats as well as some Republicans.
Obama believes in "fundamental principles" about overhauling health care, top presidential adviser David Axelrod told The Associated Press, but "he's not dogmatic about how we get there."
Axelrod's comments did not definitively answer how hard Obama will push for the most ambitious parts of his proposal, including health insurance for virtually all Americans and a government-run plan to compete with private insurers. But his diplomatic tone was in keeping with the administration's approach of refusing to flatly demand several parts that are dear to Democratic activists who helped elect him.
Those are the type of conciliatory hints that frustrate many liberals. They fear Obama will dilute the bold health care proposals he campaigned for, even though Democrats control the House, Senate and White House. One group, the Progressive Change Campaign Committee, sent a mass-distributed e-mail quoting a Texas man saying he is "dropping out of political activism" because of his disillusionment with Obama over health care.
Also, former President Bill Clinton told Esquire Magazine that Obama should forge ahead with his health care proposals. "I wouldn't even worry about the Republicans," Clinton said. Obama is doing the right thing, he said, "even though he's jamming a lot of change down the system."
But many Democrats wonder if Obama really will jam a robust plan past overwhelming GOP opposition and the reservations of many centrist congressional Democrats eyeing their next election. Those Democrats will listen carefully for clues when Obama addresses a joint session of Congress next Wednesday night.
Axelrod's cautious answers Thursday might offer little comfort to those seeking forceful signs from the administration.
Asked if Obama might accept a Republican senator's idea for creating a public health insurance option only if private insurers prove unwilling or unable to meet certain affordability targets, Axelrod replied: "We need choice and competition within the pool that's created."
The plan has been floated by Republican Sen. Olympia Snowe of Maine. She often is seen as the most likely GOP lawmaker to support a primarily Democratic-crafted health bill. She would have nonprofit agencies offer health insurance only if private insurers could not cover 95 percent of the people in their regions with plans costing no more than about 15 percent of the person's or household's annual income.
Many Democrats want prompt creation of a government-run program to compete with private insurers, who stand to gain millions more customers if Congress mandates coverage of the nation's uninsured. Obama has often said he favors such a "public option." But he and his aides have repeatedly stopped short of saying he would sign no bill without it.
Obama's pollster Joel Benenson sent new survey findings to Democratic lawmakers Thursday in an apparent bid to reassure them that support for health care changes can be politically popular. The somewhat lukewarm support for Obama's initiatives, his memo said, is "based in large part on a lack of awareness of the details of the plan."
"When voters learn about the composition of the plan, support grows considerably," the memo said.
Liberals hope the administration's conciliatory words will eventually give way to a forceful move to enact a far-reaching bill, even if it draws no GOP votes. Some are warning Obama not to take them for granted.
The Congressional Progressive Caucus, comprised of 83 liberal lawmakers, sent Obama a letter Thursday saying a health bill "without a robust public option will not achieve the health reform this country so desperately needs. We cannot vote for anything less."
But some moderate Democrats in the House and Senate are wary of a government-run insurance plan. It might amass enough leverage over doctors, drug companies and others to eventually drive private insurers out of business, they say.
The Congressional Black Caucus called on Obama Thursday to show "unwavering support" for "a strong public health option" and the full funding of health care expansions included in a pending House bill.
Vice President Joe Biden said Thursday the administration is fiercely determined to get a health care overhaul, although he conceded it probably won't happen without "an awful lot of screaming and hollering."
Appearing at a Brookings Institution gathering, Biden said it will be difficult to find a consensus on remaking the health care system. But he also predicted that "we're going to get something substantial." He declared that "we're going to get there."
Meanwhile, a top Republican player in the health care debate said Americans should expect a rather modest bill from Congress this fall. Sen. Charles Grassley of Iowa, one of three GOP negotiators seeking a bipartisan bill in the Senate Finance Committee, told Iowa radio station KMCH, "It may be a scaled-own bill. It may be kind of miniature to what we're talking about."
