“Do you realize how it will look if I have an executive from the second largest health insurance giant in the country write the new health care law?”  

“It’s not as if the chairman of the committee who is tasked with crafting the law has clean hands either. Max Baucus took almost $5,000,000 in campaign money from that industry in the last five years, Mr. President.   He’s a Democrat, that’s bona fide enough for your average supporter.  He’s one of the good guys in this partisan knife fight, as far as they know.”  

“But a staffer who was an executive at Wellpoint until a couple of weeks ago?” asks the president, “how will having her as the primary author of the law, the architect of Obamacare, look to my supporters?”  

“Believe me, you’ll be as safe as an octopus in a cloud of ink on a dark night, sir,” says one of the president’s closest advisers.  “Only a few Americans will ever even hear the name Elizabeth Fowler and, of that few, even less will care.”

“But the bill before me is plainly a gift to the insurance and pharmaceutical industries.  We get a  concession on ‘pre-existing condition’ because we’re delivering potentially 40,000,000 new customers to them, mandating the purchase of insurance while agreeing to very gently regulate how much they can gouge patients.  Increasing deductibles to almost $2,000 out of pocket for people 150% above the poverty line.  Pay an insurance premium every month to a private company and then reach into your pocket to pay the first $2,000 of your medical bills before insurance kicks in?  Is this the Hope and Change I campaigned on?”

“Whatever law you pass will be put up for repeal dozens of times, they’ll drag it through every court in the country, shut down the government over it.  The opposition, you may have noticed, is truly rabid.  You can pass Romneycare, or Nixon’s plan.. well, no, not Nixon’s plan, you’d look like a Socialist… but you can pass the Republicans’ own plan, Mr. President, and they’d come after you with torches and pitchforks.  Your supporters will realize you were in no position not to compromise.”  

“Even though we have the Senate and the House, I have to take the only plan that truly makes sense, a buy-in to Medicare, off the table right at the start, ensure that insurance company and pharmaceutical industry profits will be as robust as before, in fact, make purchase of private health care mandatory, in legislation that still leaves millions of Americans uninsured?  Is that what you’re telling me, Phyllis?”  

“Yes, sir,” she says.  

“I realize I’m arguing with myself.  I’m a charismatic campaigner, I’m accomplished, my ideals are beyond question.  I was voted into office on a wave of hope.  Is this really the best I can do as president of a country longing for real change, desperate for hope they can believe in?”  

“At least you weren’t a governor, sir, when you were running.  You were spared going back to your home state to execute a brain damaged murderer on the eve of the primary.”  

“I suppose I’ll have to make do with that,” the president says, closing the folder on his desk.  “What’s next?”