The Trail: A Daily Diary of Campaign 2008


Dan Balz's Take

On Iran and Health Care, Obama Careful to Keep His Options Open

By Dan Balz
President Obama used his press conference Tuesday to sharpen his rhetoric on Iran and vigorously defend the most controversial provision of his health care proposal. But in addressing two of the biggest challenges before his administration, he also carefully left himself room to maneuver as events unfold.

Obama's opening statement on Iran represented a notable escalation in his rhetoric, after a week of criticism from Republicans that he was not standing strongly enough with the demonstrators in the streets.

He said the United States and the international community were "appalled and outraged by the threats, the beatings and imprisonments of the last few days," adding for emphasis, "I strong condemn these unjust actions." At the close of the press conference, he described as "heartbreaking" the video that showed the death of Neda Agha-Soltan on the streets of Tehran Saturday.

Though he laughed off a question as to whether he had been influenced to toughen his language by criticism from Sens. John McCain and Lindsey Graham, he was clearly anxious to send a revised message to the Iranian regime and to the protesters who have come under sometimes deadly assault in the past five days. Though he insisted his statements have been consistent since the protests began after the obviously corrupted election, Obama was far more pointed and emphatic in his opening statement than he has been earlier.

Still, he resisted closing off his options, even when pressed by reporters to give a hint as to the limits of his patience or to the consequences for the Iranian regime if they failed to heed the warnings from the United States and other governments.

"Only I'm the president of the United States," he said at one point. That was a barbed reminder that, while others may express their outrage freely at the Iranian leadership, he alone has a responsibility to advance the interests of the United States no matter how the current events in Iran turn out. On this, he was as firm as ever in resisting the impulse to close off his options.

"I know everybody here is on a 24-hour news cycle," he said. "I'm not."

Pressed by NBC's Chuck Todd about consequences for the regime, he curtly held his ground. "I answered your question, which is that we don't yet know how this is going to play out. Okay?" he said.

Obama was similarly insistent on both sending a message and keeping open his options on health care. The most spirited exchange came when USA Today's David Jackson raised the question of whether a reform package must include a public insurance plan as an option to private insurance.

Shortly before Obama entered the White House briefing room, two key health industry groups -- the America's Health Insurance Plans and Blue Cross and Blue Shield Association -- sent a letter to the Senate Health, Education, Labor and Pensions Committee outlining their opposition to the inclusion of a public option in the legislation.

"A government plan option -- in any form -- is unnecessary to achieve comprehensive reform and would have devastating consequences on the health insurance coverage that employers and individuals currently have, the federal budget deficit and existing provider systems," the groups said.

Up to now, what has been remarkable about the health care debate is the degree of cooperation and calm rhetoric between the health industry and the administration. Obama has managed, so far, to keep everyone at the table, and in some instances to wrest concessions out of the industry.

The letter from AHIP and Blue Cross therefore represented one of the most significant confrontations to date between the two sides. But Obama was as forceful in defending the public option as the industry groups were in condemning it. He called the inclusion of a public plan "an important tool to discipline insurance companies." By which he meant a public plan would act as a competitor with private insurers in ways that he insisted would keep all prices lower.

He also was strongly dismissive of the industry's alarms about the consequences of including a public plan in a reform package, which they say could force some private insurance companies out of business.

"Why would it drive private insurance out of business?" he asked. "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."

But when ABC's Jake Tapper pressed Obama to answer Jackson's final question -- is the inclusion of a public plan non-negotiable? -- Obama carefully modulated his language. He acknowledged the industry's concerns about a public plan as legitimate and said that, properly structured, this option could meet his and the industry's interests.

"We are still early in this process," he said. "So you know, we have not drawn lines in the sand, other than that reform has to control costs and that it has to provide relief to people who don't have health insurance or are under-insured."

Obama may have bottom lines in mind, for both Iran and health care. But he was not prepared on Tuesday to signal to publicly what they may be. He has told advisers that the current talk that health care reform is in trouble is a predictable moment in a battle as complex as this one, but not something that requires a major course correction. On Iran, Tuesday may have been as close to that kind of correction as Obama makes, but he resisted going farther than he wanted.

He may move from his current positions on both challenges, but, seemingly, only after events have played out more definitively. For now, despite pressure, the president is moving both to keep his critics at bay and to preserve as much room as possible for whatever comes next.

Posted at 3:54 PM ET on Jun 23, 2009  | Category:  Dan Balz's Take
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The republican'ts are idiots. Their best efforts got us a quagmire in Iraq and let Bin Laden slip through their fingers in Afghanistan. 2 wars they were not able to manage correctly nor win. Thank god they are now limited to the peanut gallery where fools saying idiotic things belong. Just because you screwed up the entire country in the last eight years doesn't mean you have to screw up Iran's green rebellion. You are the Republican't party, bad ideas, even worse execution.

Posted by: motodude | June 24, 2009 2:10 AM

God, he's so cool, isn't he! Just like Cohen said in his piece yesterday, the O is the coolest! Keeping his options OPEN, baby! Not meddlin', not jivin' just playin' it cool. Cool Hand O! Options scattered all OVER the table, man!

Posted by: chatard | June 23, 2009 10:04 PM

David Letterman jokes cause Obama to sharpen his rhetoric on Iran!

Posted by: ryan_heart | June 23, 2009 7:10 PM


It’s official. America and the World are now in a GLOBAL PANDEMIC. A World EPIDEMIC with potential catastrophic consequences for ALL of the American people. The first PANDEMIC in 41 years. And WE THE PEOPLE OF THE UNITED STATES will have to face this PANDEMIC with the 37th worst quality of healthcare in the developed World.


We spend over twice as much of our GDP on healthcare as any other country in the World. And Individual American spend about ten times as much out of pocket on healthcare as any other people in the World. All because of GREED! And the PRIVATE FOR PROFIT healthcare system in America.

And while all this is going on, some members of congress seem mostly concern about how to protect the corporate PROFITS! of our GREED DRIVEN, PRIVATE FOR PROFIT NATIONAL DISGRACE. A PRIVATE FOR PROFIT DISGRACE that is in fact, totally valueless to the public health. And a detriment to national security, public safety, and the public health.

Progressive democrats and others should stand firm in their demand for a robust public option for all Americans, with all of the minimum requirements progressive democrats demanded. If congress can not pass a robust public option with at least 51 votes and all robust minimum requirements, congress should immediately move to scrap healthcare reform and demand that President Obama declare a state of NATIONAL HEALTHCARE EMERGENCY! Seizing and replacing all PRIVATE FOR PROFIT health insurance plans with the immediate implementation of National Healthcare for all Americans under the provisions of HR676 (A Single-payer National Healthcare Plan For All).

Coverage can begin immediately through our current medicare system. With immediate expansion through recruitment of displaced workers from the canceled private sector insurance industry. Funding can also begin immediately by substitution of payroll deductions for private insurance plans with payroll deductions for the national healthcare plan. This is what the vast majority of the American people want. And this is what all objective experts unanimously agree would be the best, and most cost effective for the American people and our economy.

In Mexico on average people who received medical care for A-H1N1 (Swine Flu) with in 3 days survived. People who did not receive medical care until 7 days or more died. This has been the same results in the US. But 50 million Americans don’t even have any healthcare coverage. And at least 200 million of you with insurance could not get in to see your private insurance plans doctors in 2 or 3 days, even if your life depended on it. WHICH IT DOES!

Contact congress and your representatives NOW! AND SPREAD THE WORD!

God Bless You


Posted by: JackSmith1 | June 23, 2009 6:21 PM

Aprogressiveindependent said:

"Prince Hamlet of the Potomac certainly has strong tendencies to vacillate"

Give me one example.

The only Vaseline here is between the Republicans screaming that meeting your needs will destroy America and the Media story of the week crying that Obama hasn't already sealed the deal on his entire agenda already.

Aren't you even curious to know why private health insurance companies admit that their "free market" monopoly can't compete with government care?

Posted by: JohnQuimby | June 23, 2009 6:15 PM

The Republicans simply cannot have it bothways in their arguments. On the one hand, they argue big government is inefficient, on the other hand they are saying the health insurance industry cannot compete with the government's public option health care. I guess that make the private industry even less efficient than the government, so all the more reasons for getting rid of the bloated private health insurance industry.

Posted by: pspox | June 23, 2009 6:11 PM

The Republicans simply cannot have it bothways in their arguments. On the one hand, they argue big government is inefficient, on the other hand they are saying the health insurance industry cannot compete with the government's public option health care. I guess that make the private industry even less efficient than the government, so all the more reasons for getting rid of the bloated private health insurance industry.

Posted by: pspox | June 23, 2009 6:09 PM

Obama is making it clear that we suppport actual democracy, not the sham that Iran had in the last election. He can't go too far in the rhetoric, or he'll provide additional ammunition to the hard-liners in Iran. I'm glad we have a president who appreciates the requirements of the office, instead of a gucci cowboy looking for an excuse to start another unnecessary was for the benefit of his corporate masters.

On health care, he is finally showing the public that the choice is not between your doctor and government, but between insurance companies, who make their profits by denying care, and a government safety net.

Posted by: bizecology | June 23, 2009 5:44 PM



World leaders, including Pakistan and Afghanistan hail Ahmadinejad win amid Israel fury

Posted by: evergreen2so | June 23, 2009 5:38 PM

I am glad today President Obama reminded people that their fear that they will lose their insurance plan or their doctor if the government offers an alternative plan, is an outcome that is not as scary as the reality of not changing our healthcare system and of not opening up a different model for taking care of our healthcare costs, with a focus as well onc cost reduction that can only be realized if something that drives the substantial cost of healthcare up to the detriment of every insuree and user of the healthcare system. Insurance companies will push insurance. They are in business for that. Insurance companies do not promote health. They promote profit. Someone else pointed out that patients have not lost their choice of doctor w/Medicare. I strongly doubt that I would lose my access to my family physician if we had a government plan even if I participated in that plan. It's time to sort truth from fiction. It is true that healthcare costs are out of control. I had the personal experience of having to pay for insurance from my own plan, a situation that is now mandatoryin my state were I not on my employer's plan and I know how many extra hours I had to work beyond a 40 hour work week to keep that insurance. Health insurance and healthcare have become too expensive for individuals and they are becoming too expensive for employers. I fear losing my coverage due to the excessive costs that are driven in part by the cost of health insurance, even though I currently have an insurance plan through my employer. 30% of my healthcare and everyone else's supports insurance. That will only go up if nothing is done. That can only have the possibility of going down if a single payer plan or at the very least a government option enters the healthcare scene. I am hopeful that our Senators and Representatives who have their coverage paid for by us the taxpayers and whose extended families and friends are as vulnerable as we are, will rise above their past loyalty to the insurance industry and mindfully choose to protect others' healthcare in the same way, we the American taxpayers take care of their health care costs.

Posted by: nkelly1 | June 23, 2009 5:21 PM

Prince Hamlet of the Potomac certainly has strong tendencies to vacillate, be indecisive and often flip flop from his previous rhetoric, especially when he was a candidate. This is quite disappointing, as many of us when we supported and voted for Barack Obama believed he would be a president who would assert strong leadership, reflecting strong principles.

One can understand why Obama wants to keep his options open about Iran, since we do not know exactly how events there will proceed. However, Obama, if he truly seeks major health care reform as opposed to a health care bill that is basically a sell-out to private health care insurance companies, needs to declare what is acceptable and unacceptable to him in a health care bill. Otherwise, those in Congress seeking a relatively weak health care "reform" bill are more likely to prevail.

Obama and his key domestic advisors are misreading the "lessons" of the failed health care initiative during the Clinton administration, when the Clintons basically tried to impose their health care bill on Congress. Obama is being excessively deferential toward several "centrist," arguably conservative, Democrats and a few Republican Senators, whereas he should be using a balanced approach, which necessitates stronger presidential leadership.

Posted by: Aprogressiveindependent | June 23, 2009 5:20 PM


Posted by: imellee23 | June 23, 2009 5:19 PM

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