The spectacle of the president of the United States turning into a pitchman for multibillion-dollar publicly traded insurance companies is jarring. It also represents quite a journey for Obama, who once described himself as a “proponent” of single-payer health care, which largely eliminates for-profit insurers.

But Obama finds himself in this situation due to a combination of his own choices and political constraints. He rejected market-based reforms of the health care system (such as allowing the purchase of insurance across state lines and ending the discrimination in the tax code against individuals buying insurance on their own) that would have increased competition for insurance and brought down premiums.

At the same time, he wasn’t willing to take on the insurance industry and support a much more disruptive single-payer system. His olive branch to the left — a government-run health insurance option to be sold on the exchanges along with privately administered plans — couldn’t pass through the Senate even with Democrats controlling 60 votes.