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.
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