By Ceci Connolly and Michael D. Shear
Washington Post Staff Writers
Thursday, July 23, 2009; A01
President Obama confronted increasing doubts about the impact of widespread changes to the health-care system, seeking to assure middle-class Americans on Wednesday that the landmark legislation he envisions would improve their quality of life and is essential to curing the nation's economic ills.
"This is not just about 47 million Americans who have no health insurance," he said in a prime-time televised news conference, the fourth of his presidency. "Reform is about every American who has ever feared that they may lose their coverage."
Six months after his inauguration, Obama finds his signature domestic issue stalled on Capitol Hill, where House Democratic leaders are working to quell dissension and the second-ranking Democrat in the Senate acknowledged that action probably will be delayed until September.
Addressing what he called "entirely legitimate" skepticism, the president vowed that health-care reform would drive down costs, eventually saving families thousands of dollars. But he struggled to explain how any of the measures under consideration would fulfill that promise.
For the past week, Obama has engaged in a two-pronged campaign to woo recalcitrant lawmakers and sell nervous voters from the bully pulpit. The news conference seemed to be intended less to stake out new ground than to calm a nation still reeling from the economic meltdown. "The American people are understandably queasy about the huge deficits and debt that we're facing right now," he said.
The president has been under pressure to explain how far-reaching legislation would translate into eventual savings for families, businesses and the government. He said the plans would squeeze "waste" out of a system that is dominated by insurance companies making large gains.
"Right now, at the time when everybody's getting hammered, they're making record profits and premiums are going up," he said.
Over the long term, Obama said, he anticipates slowing the rate of health-care spending by digitizing medical records, eliminating duplication and waste, and revolutionizing the way doctors are paid. He rejected the idea that reform would require sacrifice for most, and dismissed suggestions that Medicare spending might decrease, raising costs for seniors.
"No. No," he said. "It's not going to reduce Medicare benefits. What it's going to do is to change how those benefits are delivered so that they're more efficient."
Doctors and hospitals would order fewer repetitive tests under his ideal system, Obama said. And he added that providers would turn to less expensive drugs that work as well as their costly alternatives, though he did not explain how that would be encouraged or enforced.
"Our proposals would change incentives so that doctors and nurses are free to give patients the best care, just not the most expensive care," he said.
Polls show that most Americans think there is a need to improve a system that is among the costliest and least effective in the world, but there is widespread unease about how the changes might affect those who are generally satisfied with their care. Obama attempted to shift the discussion Wednesday from legislative haggling to an appeal aimed at Americans' everyday lives.
"I realize that with all the charges and criticisms being thrown around in Washington, many Americans may be wondering, 'What's in this for me? How does my family stand to benefit from health insurance reform?' " he said in setting the theme of his remarks. "Tonight I want to answer those questions."
He promised that virtually every American would benefit from a system that provides "more security and more stability." He pledged insurance market changes that would enable all to obtain coverage, regardless of health status, and suggested that everyone would be guaranteed preventive care, such as checkups and mammograms.
In an interview with The Washington Post's editorial page editor earlier in the day, he also said that meaningful reform must tackle the twin challenges of covering the uninsured and containing skyrocketing medical costs.
"I think that it's important to do both," he said. "I think it's important for us to make sure that 46 million people who don't have health insurance get it. And I think it's important for us to bend the cost curve, separate and apart from coverage issues."
Obama said he is open to a proposal in the House that would increase taxes on couples earning more than $1 million a year, saying "that meets my principles."
As his fellow Democrats on Capitol Hill wrestled with intraparty divisions over the legislative details, the president took up the partisan battle with Republicans who have battered the legislation's costs and have suggested that Democrats are attempting to rush its passage.
"I understand how easy it is for this town to become consumed in the game of politics, to turn every issue into a running tally of who's up and who's down," he said.
The battle, he argued, is not about politics, but about the people who write him letters and show up at town hall meetings fretting about their medical care.
"This debate is not a game for these Americans, and they cannot afford to wait for reform any longer," he said. "They are counting on us to get this done."
From the outset of his presidency, Obama has pressed for quick action on legislation that extends health insurance to the vast majority of Americans, raises the quality of care nationwide and clamps down on cost increases that he has described as "unsustainable." He has demanded votes on the House and Senate floor before the August recess.
On Capitol Hill, House Speaker Nancy Pelosi (D-Calif.) expressed confidence she will have the votes to pass a health bill. But she declined to commit to meeting Obama's timetable as she attempts to tamp down a series of brush fires within her own diverse Democratic caucus.
On the Senate side, progress slowed in the bipartisan talks convened by Finance Committee Chairman Max Baucus (D-Mont.) when Sen. Orrin G. Hatch (R-Utah) withdrew from the negotiations. And Senate Majority Whip Richard J. Durbin (D-Ill.) told the Hill newspaper that the measure would not reach the Senate floor until after Labor Day.
In recent days, the House has become bogged down in negotiations, with several factions inside the Democratic caucus unhappy with the 1,000-page bill drafted by three committee chairmen.
"I think the speaker was well intentioned because she was hearing optimistic things, but I don't believe there are the votes on the floor as of right now," said Rep. Baron P. Hill (Ind.), a centrist Democrat.
Two House panels approved the legislation in little more than a day, but action in the Energy and Commerce Committee came to an abrupt halt when conservative Democrats said they had the votes to defeat it.
Obama said Wednesday that he is pushing for an Independent Medicare Advisory Council that would set Medicare reimbursement rates based on physician performance rather than the number of procedures performed.
Beyond health care, Obama made clear that he believes the banking and financial systems will return to risky behavior unless the government takes steps to prevent them. And he seemed to favor fees on banks that continue risky practices. In the Post interview, Obama used stark language to describe how dire he thinks the situation was earlier this year.
"I walked in when we were about to slip into the Great Depression -- or the next Great Depression," he said.
Staff writer Perry Bacon Jr. and staff researcher Madonna Lebling contributed to this report.