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Correction to This Article
Earlier versions of this article, including in the print edition of The Washington Post, incorrectly attributed a quote to Len Nichols, health policy director at the New America Foundation, instead of to Ron Pollack, vice president of Families USA. It was Pollack who said: "This issue has become so vituperative, a serious conversation about how to structure a public plan has gotten secondary attention."

Health-Care Dialogue Alarms Obama's Allies

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By Ceci Connolly
Washington Post Staff Writer
Tuesday, April 21, 2009

As Congress returns to begin an intense debate over reshaping the nation's $2.2 trillion health-care system, prominent left-leaning organizations and liberal House members are issuing a warning to their Democratic allies: Don't cave on us.

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The early skirmishing -- essentially amounting to friendly fire -- is perhaps the clearest indication yet of the uphill battle President Obama faces in delivering on his promise to make affordable, high-quality care available to every American.

Disputes over whether to create a new government-sponsored insurance program to compete with private companies shine a light on the intraparty fissures that may prove more problematic than any partisan brawl.

More than 70 House Democrats recently warned party leaders that they will not support a broad health reform bill that does not offer consumers a government-sponsored policy, and two unions withdrew from a high-profile health coalition because it would not endorse a public plan.

"It's way too early" to abandon what it considers a central plank in health reform, said Andy Stern, president of the Service Employees International Union. He said the organization pulled out of the bipartisan Health Reform Dialogue because it feared its friends in the coalition were sacrificing core principles too soon. "You don't make compromises with your allies."

Last week, two top administration officials suggested that Obama is open to compromise on the public plan, comments that set off alarm bells in some corners of his party.

"That's what got the left nervous. I took that as a signal to Senator Grassley" that Obama is willing to negotiate around an issue Grassley has vehemently opposed, said Len Nichols, health policy director at the New America Foundation, a nonprofit think tank, referring to Sen. Charles E. Grassley (R-Iowa). "It was the first time the president indicated he could live without it."

During last year's campaign, Obama proposed offering a government-sponsored plan as a low-cost alternative for Americans who are having trouble purchasing insurance in the private market. Proponents say it would reduce costs because it would not need to make a profit or pay large executive salaries.

Many Republicans and industry executives say that any program modeled after Medicare -- with its power to set prices -- would have an unfair advantage over private-sector competitors and eventually force some companies out of business.

"The sacred cow on the left and the right is the public plan," said former senator Thomas A. Daschle, who was Obama's first choice to oversee the reform effort.

In comments last week, Nancy-Ann DeParle, head of the White House Office of Health Reform, said the ultimate solution may rest in how a public plan is defined.

"There are different breeds of public plans that could be part of this," she said, explaining that the Medicare model is not the only approach.


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