In a recent interview with the New York Times, White House Chief of Staff Rahm Emanuel made note of the politics at play in the health care debate.
"Let's be honest. The goal isn't to see whether I can pass this through the executive board of the Brookings Institution," Emanuel said. "I'm passing it through the United States Congress with people who represent constituents."
He added, "I'm sure there are a lot of people sitting in the shade at the Aspen Institute — my brother being one of them — who will tell you what the ideal plan is. Great, fascinating. You have the art of the possible measured against the ideal."
Indeed, for all the lofty ideals thrown about in the dialogue surrounding health care reform, the Democratic votes tallied against the House's health care bill can be largely chalked up to politics: As noted in our latest CBSNews.com Health Care Progress Report, nearly all of the Democrats who voted against the bill represent districts that favored Republican presidential candidate John McCain over Barack Obama in the 2008 election.
Democrats who support abortion rights are struggling with how to hold their ground on the issue without foiling the entire health care overhaul. More than 40 House Democrats are signaling they will oppose any final health care bill that includes the amendment added to the House bill by Democratic Rep. Bart Stupak, which restricts which health insurance plans can offer coverage for abortions. Yet moderate Sen. Ben Nelson (D-Neb.) -- whose hesitancy about health care reform has given him special leverage -- says he would like to see a version of the Stupak amendment in the Senate bill.
President Obama in a recent ABC interview sounded uncomfortable with the Stupak amendment.
"This is a health care bill, not an abortion bill," he said. "And we're not looking to change what is the principle that has been in place for a very long time, which is federal dollars are not used to subsidize abortions. And I want to make sure that the provision that emerges meets that test -- that we are not in some way sneaking in funding for abortions, but, on the other hand, that we're not restricting women's insurance choices."
At times, advocates of health care reform in Congress have clashed with the White House -- Emanuel in particular -- for the concessions made to conservatives and moderates so far. Sen. Chuck Schumer (D-N.Y.) butted heads with Emanuel over the Senate's approach to a government-run health insurance plan, Politico reported. Schumer was a proponent of including a "public option" that gives the states the ability to opt out -- which Senate Majority Leader Harry Reid has chosen to include in the bill -- while Emanuel reportedly favored "triggering" a public option after a number of years, as suggested by Republican Sen. Olympia Snowe (Maine).
"This isn't a big ideological division; neither one could care less which public option mechanism is used," an unnamed Democrat told Politico. "It's a strategic difference, a political difference, but it's a big one."
The question of how much to concede has certainly created a rift between politicos and policy wonks, as Emanuel suggested to the Times.
Jacob Hacker, a Yale political science professor and strong proponent of the public option, has quite a different view than Emanuel. "We shouldn't let the terrible be the ally of the expedient, " he said earlier this year.