Does President Obama have the guts?

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And we are now going to see how he governs when it comes to meaningful health care reform. In his heart and in his head he knows what it takes for such reform. He knows that a public option — a government-run health care program like Medicare — has the best chance of competing with the insurance industry.

In Grand Junction, Colo., last week Obama said that if the public option “could keep its costs lower and provide a good-quality service and good benefits, then that would help keep the insurance companies
honest.”

The public option would do so by creating not socialism but competition. In order to compete with the huge health care industry, you have to be huge yourself or you get steamrollered. That’s why a public option would work and a system of smaller health care “co-ops” almost certainly would not.

In general, the health care industry wants health care reform and for a very simple reason: It would mean 47 million new customers, many of them young and healthy.
But the industry does not want a public option as a part of that reform, because a public option would be large enough to negotiate with private insurers, pharmaceutical companies, hospitals and doctors for lower costs.

“A public option would cut deeply into their current profits,” writes Robert Reich, former secretary of labor under Bill Clinton. “That’s why they’ve been willing to spend a fortune on lobbyists, threaten and intimidate legislators and ordinary Americans, and even rattle Obama’s cage to the point where the administration is about to give up on it.”

We don’t know for sure that Obama is about to give up on the public option. I think, in the end, he will not. I think he may be tougher than some think and stronger than the polls show. But I admit there are troubling signs.

“The public option, whether we have it or we don’t have it, is not the entirety of health care reform,” Obama said at Grand Junction. “This is just one sliver of it, one aspect of it.”
But it is a very important sliver, a critical aspect. And how Obama acts right now on health care reform could tell us how he will act for the rest of his presidency.

Sometimes it is not enough to have just your heart and your head in the right place. You have to have your guts there, too.

Senator Charles E. Grassley, Republican of Iowa, called President Obama and Speaker Nancy Pelosi “intellectually dishonest” on Tuesday, saying that Democrats were using the flap over end-of-life consultations to divert attention away from health care legislation currently being considered in the House.

The Iowa Republican, while not explicitly mentioning euthanasia or rationing of care, also said that he did not want government policy to “treat life at age 85 different than we do life at 35.” (At a town hall meeting last week in Adel, Iowa, the senator said, “We should not have a government plan that will pull the plug on grandma.”)

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