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Primetime pitch seeks to ease fears, intensify pressure for healthcare plan

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By Lisa Wangsness
Globe Staff / July 23, 2009

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WASHINGTON - President Obama sought to calm middle-class fears about a major healthcare overhaul last night, telling Americans in a prime-time news conference that people who already have insurance would benefit as much as those who do not.

Obama said that all Americans would gain “more stability and more security’’ from the overhaul and that the legislation is about changing the way medical care is delivered in America, not just about covering the uninsured. He said reforming the system would lower premiums and rein in escalating costs.

“It will prevent insurance companies from dropping your coverage if you get too sick,’’ Obama said. “It will give you the security of knowing that if you lose your job, move, or change your job, you will still be able to have coverage. It will limit the amount your insurance company can force you to pay for your medical costs out of your own pocket. And it will cover preventive care like check-ups and mammograms that save lives and money.’’

It is economically untenable, he said, to leave intact a healthcare system that is brimming with dysfunctional incentives that are driving the costs of care through the roof. Premiums are already heavily inflated by inefficient care, he said.

“Why would we want to pay for things that don’t work?’’ Obama said. “We just can’t afford what we’re doing right now.’’

Despite the urgency of the moment, the president’s tone last night was characteristically low-key and his rhetorical style coolly logical. Obama’s job last night was to rally Americans to the cause of the overhaul by convincing them that they have a stake in its outcome at a time when negotiations have become bogged down in Congress and public support has wavered.

The political problem Obama faces is that five out of six Americans already have health insurance. They have seen premiums double in the last 10 years, but the debate over healthcare in Washington is dominated by headlines about which taxes Democrats might raise to pay the $1 trillion bill for covering the uninsured. One June poll found that fewer than 30 percent of Americans thought the overhaul would benefit people like them.

Last night Obama reiterated his promise that middle-class families would not bear the brunt of those costs, but he edged away from repeating his campaign promise that he would not raise taxes on families making under $250,000 a year. He even used language suggesting middle income earners might wind up contributing something.

“The one commitment I’ve been clear about is I don’t want that final one-third of the cost of healthcare to be completely shouldered on the backs of middle-class families already struggling in a difficult economy,’’ he said. “If I see a proposal primarily funded on the backs of middle-class families, I will be opposed to it.’’

He said a modified version of a House plan to impose a surtax on the wealthy - families making more than $1 million - would be acceptable, though he added he preferred his own proposal to limit itemized deductions for wealthy families.

Obama said voters were “understandably queasy’’ about the debt and the deficit, but he promised he would not sign a bill unless it did not add to the deficit and would lower health costs over the long term. He also acknowledged that early drafts of legislation had not gone far enough toward doing that.

The president tried repeatedly to underscore that one of the most important goals is to reorganize the delivery of healthcare to cut waste and inefficiency and to end incentives that encourage doctors to prescribe extra tests or procedures to make more money.

Right now, he said, Americans pay for every duplicate test they get because one specialist doesn’t bother sending the first one to the patient’s other doctors. They also pay when doctors pick the most expensive treatments in order to maximize earnings, he said.

“That’s raising your premiums, it’s raising everybody’s premiums, and that money right now is coming out of your pocket,’’ he said. “I want to change that. Every American should want to change that.’’

If nothing does change, he said, healthcare premiums will continue to rise.

They shot up three times faster than wages over the last decade, he said, depriving families, businesses, and government budgets of money needed for other things.

But Obama sidestepped a question about whether Americans would have to sacrifice some kinds of care - doing everything possible to save the lives of terminally ill elderly patients, for example - for the sake of efficiency.

“They’re going to have to give up paying for things that don’t make them healthier,’’ he said. “I think that’s the kind of change you want.’’

Lawmakers appear to be unlikely to meet their deadline for passing healthcare legislation in both houses of Congress before the monthlong August recess, but Obama said he was still determined to sign a bill before the end of the year. Deadlines, he said, are essential in a town where “inertia is the default position’’ because so many interests are invested in the status quo. He said he is “in a rush’’ because families are “getting clobbered by healthcare costs.’’

But he added that he would not put speed ahead of sound policy. “I do think it’s important to get this right.’’

Obama painted himself as an earnest reformer up against Republican battleaxes seeking to “break’’ him - even though moderate Democrats are as much responsible for the delays as Republicans.

Regular people, he said, need help.

“This debate is not a game for these Americans, and they cannot afford to wait for reform any longer,’’ Obama said.

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