Barack Obama delivers an emotive speech on reform – and his grandmother’s death – in Colorado

US healthcare reform could proceed without a government-run insurance scheme, the Obama administration is ever more frequently acknowledging. It is a position that would win over some conservatives but disappoint many ­liberals.

Kathleen Sebelius, the secretary of health and human services, told CNN on Sunday that the public option, mooted as providing competition to private insurers and forcing down costs, was “not an essential ­element”.

“I think there will be a competition to private insurers,” she said. “That really is the essential part, that you don’t turn over the whole new marketplace to private insurance companies and trust them to do the right thing.”

Both President Barack Obama and Ms Sebelius stressed that there needed to be a mechanism to compete with private insurers, which could usher in a rival co-operative scheme if a public plan were ­abandoned.

Kent Conrad, a Democratic member of the Senate finance committee, has championed the co-op, which would see small businesses and individuals banding together to bargain for better deals with ­insurers.

Richard Shelby, a Republican senator and critic of the reform effort, said it would be “a step in the right direction”.

“I think the Democratic administration – President Obama and his cabinet – have read the tea leaves of America right now,” he told Fox News.

The administration has sought to recapture the initiative on healthcare and calm the atmosphere around a debate that has become marked by angry protests against reform.

Writing in the New York Times on Sunday, Mr Obama emphasised to Americans happy with their healthcare that reform would bring more protection and lower costs, which would affect them as well as the 46m uninsured.

“If you like your doctor, you can keep your doctor,” he wrote. “If you like your healthcare plan, you can keep your healthcare plan. You will not be waiting in any lines. This is not about putting the government in charge of your health­ insurance.”

Mr Obama said on Saturday in Grand Junction, Colorado, that the public option was “not the entirety” of reform, even though it remained his preferred means of pushing down insurance costs.

“I believe that we should [have it], on balance,” he said. “It’s not perfect. It’s not going to solve every problem, but I think it . . . would keep the insurance companies more honest.”

Striking a more emotional tone than before during his meeting, Mr Obama recalled the death of his grandmother last year and hit out at the suggestion of some Republicans that he wanted to introduce government-run “death panels”.

“I know what it’s like to watch somebody you love, who’s ageing, deteriorate, and have to struggle with that,” he said. “So the notion that somehow I ran for public office or members of Congress are in this so that they can go around pulling the plug on grandma? I mean, when you start making arguments like that, that’s simply ­dishonest.”