When it came to Medicare, Obama reiterated his determination to accept only limited cost-cutting proposals.

Among the ideas he appeared to reference was requiring pharmaceutical companies to charge Medicare the lower rates they currently receive from Medicaid, the federal-state health insurance program for the poor.

Obama also mentioned asking “more from our wealthiest seniors”—presumably a proposal to increase the Medicare premiums that higher income seniors pay. And he noted that his 2010 health-care law already contains measures aimed at slowing the growth of Medicare spending.

These include penalizing hospitals for unnecessary re-admissions of Medicare patients they treat, as well as payment incentives to provide more efficient care. However, as he did in his inaugural address, Obama suggested he would stand firm against cuts that would require a more fundamental restructuring of the program. “Yes, the the biggest driver of our long-term debt is the rising cost of health care for an aging population,” he said. “But we can’t ask senior citizens and working families to shoulder the entire burden of deficit reduction.”   a