The opt-out portion of the health care bill isn't ideal in my view (any bill that leaves people uncovered isn't great), but it does leave a huge opening to prove that a public option is a good idea. And as Andrew Sullivan points out, that's enough to put the fear of God into the Republicans, and quell the paranoia that government is trying to takeover healthcare. And from a political point of view, it has the potential to be devastating:
The genius of the opt-out is that it coopts the states' rights argument (just as ending the prohibition on marijuana does); it has the potential to make "liberalism' popular again; it has easily demonized opponents - the health insurance industry; and it forces Republicans not to rail against socialism in the abstract but to oppose actual benefits for the working poor in reality.
It's a brutal, Chicago-style political maneuver. And Obama appears not to be the person really pushing it.