US healthcare reform could proceed without a government-run insurance scheme, the Obama administration is increasingly acknowledging; a decision that would win over some conservatives – but would disappoint many liberals.

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

The administration has tried to recapture the healthcare initiative and to calm a debate marked by angry protests.

In the New York Times yesterday, President Barack Obama emphasised to Americans happy with their healthcare that reform would bring more protection and lower costs, affecting them as well as 46m uninsured.

“If you like your healthcare plan, you can keep your healthcare plan,” he wrote. “This is not about putting the government in charge of your health insurance.”

Mr Obama said on Saturday in Grand Junction, Colorado, the public option was “not the entirety” of reform, even though it remained his preferred means to push down insurance costs. “It's not perfect. It's not going to solve every problem, but I think it . . . would keep the insurance companies more honest.”

Mr Obama and Ms Sebelius emphasised 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 to be abandoned.