Reviewing the Record: Obama Stance on Government-Run Health Care Has Shifted Over Time

The White House is fighting tooth-and-nail to assure Americans that under President Obama's health care reform plan, anyone who wants to keep their private insurance will be able to do so.

On Thursday, White House spokesman Robert Gibbs repeated that the president is not wedded to a single-payer, or government-only, system.

"The president's preference on a health care plan, he had an opportunity to outline, debate and discuss in an almost two-year campaign for president, from 2007 to 2008," Gibbs said. "The president is open to a bill that increases choice and competition."

For months, Obama has been shooting down charges that Washington is weighing a government takeover of health care, saying the feds are "not gonna mess with" anyone's private plans.

But a close look at Obama's health care comments over the course of his public career shows he wasn't always so clear-cut about the issue.

As recently as 2008, then-Sen. Obama suggested that more government control than advertised could be in the cards someday.

As recently as 2007, he suggested that employer coverage could be eliminated in the long-term.

And in 2003, he said a single-payer system was his ultimate goal.

Since the health care debate reached a fever pitch this summer, Obama has all but eliminated talk of a long-term overhaul of the private system. It would be too "disruptive," he has said, adding that the country should just build on the "free-market system" in effect.

But Republicans continue to warn that the so-called "public option" in the Democrats' health care reform package is the first step toward a single-payer system. They refer to Obama's own words to make the argument.

"The president himself back in 2003 in video that's on the net openly advocated a single-payer system," Rep. Mike Pence, R-Ind., told FOX News Thursday. "(Constituents) know it's going to cause millions of people to lose their health insurance and really put us on a pathway toward single-payer socialized medicine."

Though the White House is calling such talk "disinformation," Pence disputed that, referring to a video dated June 2003 that shows Obama speaking at what is identified as an AFL-CIO conference. The video was shot while Obama was campaigning for U.S. Senate.

"I happen to be a proponent of a single-payer universal health care program," Obama said at the time, arguing that the current system is basically a bad investment, yielding too little in return for what Americans pay. "A single-payer health care plan, a universal health care plan -- and that's what I'd like to see. But as all of you know, we may not get there immediately. Because first we've got to take back the White House, and we've got to take back the Senate, and we've got to take back the House."

Obama won election a year later. Democrats took control of Congress two years after that. But still no movement toward a single-payer system, as Obama had foreshadowed in 2003.

By 2007, Obama was tempering his comments significantly yet still leaving the door open to a new health care paradigm in America.

At a Jan. 25, 2007, conference where he addressed Families USA, Obama was asked whether he is considering a single-payer system to replace the employer-based one.

He said he wasn't. But then he suggested that could be a long-term goal.

"I don't think we immediately replace the employer-based system, but I think that setting up pools that provide a capacity for more and more people to not be dependent on an employer for their health care important," he said.

At a March 24, 2007, forum for the Service Employees International Union Forum, Obama reiterated that stance.

"But I don't think we're going to be able to eliminate employer coverage immediately," he said. "There's going to be potentially some transition process. I can envision a decade out or 15 years out or 20 years out where we've got a much more portable system."

He described this as a system where employers can provide coverage but many employees would be able to get "better coverage" outside that system. He talked about facilitating an environment where individuals can "make that choice to transition out of employer coverage."

At the time, Obama seemed to still be talking about a long-term, voluntary and natural transition away from private coverage that the government could facilitate.

As the presidential campaign heated up, his comments again started to take on a new nuance.

At a Jan. 21, 2008, debate Obama wholeheartedly endorsed a single-payer system -- but only in an ideal world, not reality.

"I never said that we should try to go ahead and get single-payer," he said. "What I said was that if I were starting from scratch, if we didn't have a system in which employers had typically provided health care, I would probably go with a single-payer system."

He said the same thing at a New Mexico town hall meeting on Aug. 18, 2008, adding that the problem is: "We're not starting from scratch."

"We're starting from an existing system ... and so what I've said is we can't afford to wait for some abstract, theoretical system. We've got to deal with what we have right now and fix it," he said.

Still, at another New Mexico event that same day he left the door open when asked why the government couldn't start a single-payer system.

"People don't have time to wait," Obama said, according to an account from The Wall Street Journal. "They need relief now. So my attitude is let's build up the system we got, let's make it more efficient. We maybe over time -- as we make the system more efficient and everybody's covered -- decide that there are other ways for us to provide care more effectively."

Discussion of those "other ways" is out of the debate by mid-2009, with Congress hunkering down to hammer out a comprehensive health care reform package that blends a public option with other regulated private plans all offered to consumers as part of a new health care exchange.

Obama repeated in May 2009 that he would have liked to use a single-payer system if starting from scratch. But he said then, and since then, that such a move could never work given the infrastructure in place. His argument against a single-payer system has become much more concrete since Congress began writing the reform legislation.

"For us to completely change our system, root and branch, would be hugely disruptive ... in a way that I'm not prepared to go," he said at his June 24 televised town hall on health care.

At his July 1 online town hall, he added that he wants a system that "preserves the innovation that is introduced in part with a free-market system."

"We're not suddenly just going to completely upend the system," Obama said. "We want to build on what works about the system and fix what's broken about the system."

Today, Obama insists that a public option is not a "Trojan horse" for a single-payer system.

The White House has pushed this more recent commentary to the front, as it battles online campaigns to portray him as a secret backer of government-run health care.  On Thursday Gibbs urged people to look at the breadth of Obama's statements, and not select snippets.

"If you look at the statements that have been put up on other Internet sites that splice a bunch of stuff together and I think that if you look at the answers that state senator, U.S. senator, President Barack Obama have given on that, we hope to provide people with a full and accurate picture and not something that only the words' opponents might want to see," he said.