No new overtures on healthcare

President Obama made clear in his State of the Union address Tuesday that healthcare costs are the biggest driver of U.S. debt, but offered no new proposals for reining in those costs.

"Those of us who care deeply about programs like Medicare must embrace the need for modest reforms – otherwise, our retirement programs will crowd out the investments we need for our children, and jeopardize the promise of a secure retirement for future generations," Obama said.

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His proposals to reduce entitlement spending hewed to ideas he has already proposed in all or nearly all of his budget proposals as president. Obama called for reducing Medicare's payments for prescription drugs, charging seniors a higher premium for their Medicare benefits, and changing the way healthcare services are delivered.

The pharmaceutical industry has strongly — and successfully — opposed cuts to its Medicare reimbursements, and so far Republican lawmakers haven't broken with industry under the pressure of deficit reduction.

Obama's signature healthcare law is already shifting the way Medicare wields its enormous purchasing power. The law includes a major new program to shift Medicare payments toward rewarding quality and efficiency, rather than the quantity of services provided.

In adhering to familiar proposals, Obama reiterated his opposition to significant entitlement changes — such as raising the eligibility age for Medicare, or GOP proposals to partially privatize the program.

"I am open to additional reforms from both parties, so long as they don’t violate the guarantee of a secure retirement," Obama said. "Our government shouldn’t make promises we cannot keep – but we must keep the promises we’ve already made."

He hit a similar theme in his inaugural address, arguing that entitlement programs like Medicare and Medicaid represent a sacred commitment to older generations.

Obama had endorsed raising the Medicare age in earlier deficit talks with House Speaker John Boehner (R-Ohio) but has since taken the idea off the table. He has also rescinded his support for Medicaid reforms the White House previously proposed.