By Jeffrey Young - 06/25/09 12:34 AM EDT
The televised town-hall-style event, recorded at the White House and aired exclusively by ABC News, provided Obama with an opportunity to persuade middle-class voters, most of whom are insured, that his plans would not destroy what they like about the healthcare system.
Obama returned time and again to his mantra: “If you are happy with your plan and you are happy with your doctor, then we don’t want you to have to change.”
But, Obama contended, the coverage and services people currently enjoy are on track to be disrupted without healthcare reform. Indeed, Obama focused as much on what will happen without reform as on what his reform plan would do.
“The problem is, 10 years from now you’re not going to be happy because it’s going to cost twice as much or three times as much as it does right now,” Obama said. “If we don’t do anything, if there’s inaction, I think that’s where the great danger that you lose your healthcare exists, because [of] the cost problems.”
Obama responded to questions about whether the government would ration care or interfere with the relationships between doctors and patients, whether a new government-run insurance plan is necessary and how he would pay for the more than $1 trillion healthcare reform is expected to cost.
The Obama administration and its allies in Congress have proposed sweeping reforms to the American healthcare system.
The features of their plans include establishing a national exchange where people can buy insurance, including a government-run “public option”; subsidies for people who cannot afford coverage; expansions of Medicaid for low-income people; and a plethora of other reforms designed to cut costs and improve medical care.
Anxiety about greater government involvement in the healthcare system was a common theme of the questions.
In response to American Medical Association President J. James Rohack, Obama said, “Doctors are not going to be working for the government. They’re still going to be working for themselves. They’re still going to be focused on patient care.”
Obama acknowledged that the healthcare reform plans being written in Congress would require new government spending between $1 trillion and $2 trillion over the next 10 years. That new spending will be fully offset by cuts and tax increases and will not add to the budget deficit, Obama promised.
The administration has proposed more than $600 billion in Medicare and Medicaid cuts to partially pay for healthcare reform. In addition, Obama touted his proposal to raise more than $300 billion in tax revenue by limiting itemized deductions for people earning more than $250,000 a year.
But Obama also argued that the nation would spend even more on healthcare in the coming decades were reform not enacted.
“In terms of cost, understand that the system is already out of whack in terms of costs as it is,” Obama said. “So if we do nothing, costs are going to keep on going up 6 percent, 7 percent, 8 percent per year, and government, businesses and families are all going to find themselves either losing their healthcare or paying a lot more out of pocket.”
Obama also defended his support for the public option and indicated some openness to new taxes on workplace health benefits, a policy he has strongly criticized in the past.
Asked by ABC News’s Charles Gibson to respond to criticisms by Senate Republicans that the public option would unfairly compete with private insurance companies, increase government spending and add to the deficit, Obama said: “They’re wrong.”
Obama rebutted claims that the public option would drive insurers out of business, thus forcing people to sign up for government coverage because private plans would not be available.
“We can set up a public option in which they’re collecting premiums, just like any private insurer, that doctors are reimbursed at a fair rate, but, because administrative costs are lower, we are able to keep private insurers honest in terms of the growth of costs of premiums and deductibles and so forth.
Insurance companies that offer good plans will attract customers and get even more business if more people are able to afford insurance, Obama said.
“I think that the insurance companies will still thrive,” Obama said in response to a question from Ronald Williams, chairman and CEO of the insurance company Aetna. “They’ve got terrific leadership. Aetna is a well-managed company, and I’m confident that your shareholders are going to do well.”
Obama also conceded that some lawmakers are considering levying taxes on some workers’ healthcare benefits. While not endorsing the notion, Obama did not rule it out.
“I’m pushing my idea, other folks are pushing their ideas. There is going to have to be some compromise at the end of the day,” Obama said.
“I continue to believe that it would be the wrong way to go” to do away with the currently unlimited tax exclusion for workplace health insurance, Obama said. “That’s not what is being discussed right now in Congress,” he added.
Instead, lawmakers are looking to tax health benefits for people above a certain income threshold or whose benefits are worth more than $13,000 to $17,000 a year, Obama said. “That’s a debate that is taking place in Congress right now.”