WASHINGTON (AP) — The reversals, hints of concessions
and politically dicey proposals on health care are piling up for
President Barack Obama, whose appeal for bipartisan legislation carries
risk with no guarantee of reward.

By one definition, that’s called presidential leadership, flexibility first, meant to embolden others to do the same.

By
another, it’s political inconsistency that risks offending people on
Medicare, liberals who favor government-run health care and union
families with coverage negotiated by contract with employers.

“Many
of us are prepared to accept changes that maybe wouldn’t be our first
choice,” says Sen. Richard Durbin, D-Ill. He meant it as a challenge to
Republicans, few of whom have seem interested in seeking common ground
on health care with the White House and Democrats who control Congress.

But so far, Obama has been anything but uninterested.

“He
is flexible when it comes to methods,” his chief of staff, Rahm
Emanuel, said recently. “But when it comes to outcomes, he is not,”
referring to the president’s goal of curtailing health care costs while
spreading coverage to millions who lack it.

Beginning last
winter, Obama has called for $600 billion in savings over the next 10
years from Medicare and Medicaid. More than a decade ago, when then
House Speaker Newt Gingrich, R-Ga., and the GOP wanted to save about
$270 billion from Medicare over seven years, Democrats accused them of
seeking to cut essential programs.

Obama did some attacking of
his own in last year’s presidential campaign, criticizing Republican
nominee John McCain over the Arizona senator’s proposal to tax health
insurance benefits. Obama now has opened the door to just that idea.

“I
don’t want to prejudge what they’re doing,” the president said recently
about Senate supporters of a plan to tax workers with expensive
insurance through their jobs.

Gerald W. McEntee, president of the
1.6 million-member American Federation of State, County and Municipal
Employees, said members of the union “are not going to tolerate that.”
Obama is “a person of his word,” he added pointedly, referring to the
campaign promises.

Any tax on health care benefits would violate two campaign pledges.

Obama
campaigned against that specific proposal and pledged often not to
raise taxes on people earning less than $250,000. Pressed last April on
the subject, White House press secretary Robert Gibbs said there were
no caveats, health benefits or otherwise.

The president also is a
convert to the cause of requiring people to purchase insurance, with
waivers in cases of financial hardship. He opposed these mandates last
year when his main Democratic presidential rival, Hillary Rodham
Clinton, backed them.

Now, he says, “my thinking on the issue of
mandates has evolved. And I think that that is typical of most people
who study this problem deeper.”

That’s not all.

Obama has
left the door open to legislation that does not give individuals the
ability to purchase insurance from a government-run plan. Many
congressional Democrats want the federal involvement, saying it will
help people by creating competition for private insurers. Polls show
this public option enjoys widespread backing, and Obama sometimes cites
those surveys.

“Why would it drive private insurance out of
business? 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,” he said at a news conference this past week.

But nowhere did he say he would veto any bill that lacked a government insurance option.

In fact, the president has drawn few lines in the sand.

Any legislation must not add to the deficit, he says.

And
he told ABC’s “Good Morning America” that “if any reform that we get is
not driving down costs in a serious way … if people say, ‘We’re just
going add more people onto a hugely inefficient system,’ then I will
say no. Because we can’t afford it.”

In Congress, there’s not
much support for adding to the deficit, and none for making an
inefficient health care system more inefficient.

Instead, the
prospects for success in health care hinge on a few big issues, as well
as dozens if not hundreds of smaller ones. Obama has shown flexibility
on most, if not all of them.

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EDITOR’S NOTE — David Espo is AP’s chief congressional correspondent.