Obama ramps up again on health care

OBAMA'S RADIO INTERVIEW

MR. SMERCONISH: Hi, everybody. Welcome back to the program. I'm Michael Smerconish. What an honor for me to say I'm live at the White House and I'm joined by the President of the United States.

Mr. President, what an honor for me, and thank you, sir, for this privilege, and thank you for coming back to my radio program.

THE PRESIDENT: Michael, it's great to be on the show again. Every time we've been on it's been a great time. So I appreciate the opportunity.

MR. SMERCONISH: Folks are stacked up, as you might imagine. They're anxious to pose some questions about health care to the President of the United States. More than 5,000 e-mail suggestions have flowed through my Web site in just the last 24 hours alone.

If it's all right, I'll start by posing a couple of questions and some of the things that I continue to hear from folks, and we'll welcome phone callers, as well.

Allow me, sir, to begin with this. Did Secretary Sebelius misspeak last weekend? You know, a great deal has been made as to what she said pertaining to the so-called public option.

THE PRESIDENT: She really didn't misspeak. The surprising thing is she'd been saying this all along. She said the same thing a month ago. And let me just describe what the issue is here. We have consistently talked about the need for health care reform because family premiums are going up three times faster than inflation and wages. The costs of Medicare and Medicaid will bankrupt this country if we don't reduce the cost inflation of health care. You've got families who can't get health care because of preexisting conditions or they bump up against some lifetime cap if a family member gets really ill.

So what we've said is there are a number of components of health care. One is that for people who already have health insurance, they can keep their health insurance, but we're going to have some consumer protections to regulate how insurers operate. For example, they can't prohibit people from getting it, health insurance, because of a preexisting condition. They can't have lifetime caps or yearly caps that prevent people from getting the care that they need.

We're also going -- for people who don't have health insurance -- to set up a system similar to what Congress has, where you can buy into a bigger pool, get better rates, have better protections around you. You would be buying that insurance from private insurers.

But one of the options we talked about was a public option where there wouldn't be a profit motive involved. It would be non-for-profit, and that public option would give you affordable health insurance.

Now, what we've said is we think that's a good idea. But we haven't said that that's the only aspect of health insurance. And what she essentially said was, is that all these other insurance reforms are just as important as the public option. The press got a little excited and some folks on the left got a little excited about this. Our position hasn't changed. We think that the key is cost control, competition, making sure that people have good, quality options. If we're able to achieve that, that's the end that we're seeking. And the means -- you know, we can have some good arguments about what the best way to achieve it is, but we've got to change because the status quo is unsustainable.

MR. SMERCONISH: Mr. President, there's a mindset among many folks in many audience who say that the endgame, it's all about single-payer; that it's a public option or it's a co-operative. And sir, you know that there's a perception out there that you want it all -- you know, you want to be in the banks, you want to be in the automotive industry, and now you want to be in health care. Can you address that mindset?

THE PRESIDENT: I absolutely can. First of all, look, the intervention in the banks wasn't started by me, it was started by a conservative Republican administration -- and rightly so, because our banks were on the verge of meltdown. The only thing that we've done is said, let's put in place some financial regulations to make sure that this doesn't happen again.

The auto interventions weren't started by me -- they were started by a conservative Republican administration. The only thing that we did was rather than just write GM and Chrysler a blank check, we said, you know what, if you're going to get any more taxpayer money, you've got to be accountable. They went through a record bankruptcy, and now GM for the first time is actually hiring folks back.

So I know that there's this perception that somehow we have engaged in these extraordinary interventions. Part of it had to do with the worst financial crisis in history. And the fact that both the auto bailout and the bank bailout were started under a previous, conservative Republican administration indicates the fact that this wasn't ideological; this was a matter of necessity.

Now, as far as health care goes, I've consistently said I would love the private marketplace to be handling this without any government intervention. The problem is it's not working. What we're seeing is about 14,000 folks lose their health insurance every single day. We are seeing health care inflation go up about twice as fast as regular inflation. Businesses are being crippled by it. Small businesses especially have almost no access to the marketplace because they've got no leverage with insurance companies.

So all we've said is let's keep the private system intact, but let's make sure that people who right now can't get health insurance -- about 46 million -- that they're able to buy into the market. And number two, let's have some consumer protections to make sure that those of us who have health insurance don't end up getting a bad deal because we didn't read the fine print and we think that we have coverage; when we finally get sick and we need it, it turns out that we're vulnerable because insurance companies aren't operating in the interests of their customers.

MR. SMERCONISH: I like to drive an MDX and an F-150, and I've communicated by e-mail in the last 24 hours with the woman who sold me the MDX and the guy who sold me the F-150, and each of them, Mr. President, are saying that Cash for Clunkers has been a great idea and a wonderful initiative and they closed a lot of deals, but the payments are late. And I'm hearing from a number of folks who say, come on, if the federal government can't get it together relative to Cash for Clunkers, I don't want to entrust my health care to the federal government.

THE PRESIDENT: Well, let me first address Cash for Clunkers. It has been successful beyond anybody's imagination. And we're now slightly victims of success because the thing happened so quick, there was so much more demand than anybody expected, that dealers were overwhelmed with applications.

Now, this program has only been going on for a few weeks, and we have hired three times as many people to process this stuff as we originally had. There has not been extraordinary delays on the U.S. government's part -- I understand dealers want to get their money back as soon as possible, but the fact of the matter is this is a good-news story; they are seeing sales that they have not seen in years.

And they will get their money, but we've got to process it properly, because if we were careless about it, if we were just sending out checks where applications were incomplete and so on, first of all, we'd be breaking the law because there are statutes set up in terms of how this is supposed to go; and secondly, there'd probably be some story -- you'd be asking me about scandals where there were a whole bunch of checks of taxpayer money being wasted, going out to people who hadn't actually bought cars.

So I think this is actually a high-class problem to have -- that we're selling too many cars too quickly and there's some backlog in the application process. It is getting fixed.

MR. SMERCONISH: Mr. President, Ernie is a listener of mine on WTKK in Boston and wishes to pose the following question. Ernie, go ahead for the President of the United States.

Q Thank you, Michael. Mr. President --

THE PRESIDENT: How are you, Ernie?

Q I'm good. Thank you for taking this call.

THE PRESIDENT: Great to talk to you.

Q I understand you've said that the federal health care plan for government employees is a pretty good plan.

THE PRESIDENT: It is.

Q And Congress has voted, to my understanding, not to join the public plan once it passes because they want to keep their good federal plan. Would you be willing to either urge Congress to have the federal employees join the public plan, or would you be willing to urge Congress to somehow open up the federal health plan to all Americans?

MR. SMERCONISH: Thank you, Ernie. I hear this all the time, Mr. President.

THE PRESIDENT: Well, it's a great question, Ernie. First of all, understand that currently federal employees have a very good health care plan because they're able to leverage the insurance companies. There are so many members of their -- of the federal workforce that they can get the best rates possible. Every insurance company wants to do business with the federal government. So premiums are lower and it's a better deal overall.

The same concept is what we're trying to do in setting up what's called a health insurance exchange. Essentially it'd be a marketplace where people who currently don't have health insurance or small businesses could pool their numbers so they have leverage over the insurance companies and they could go on a Web site and look at the various options, the types of various private health insurance plans that are being offered, and choose the one that's best for their families. So we're actually trying to duplicate what exists for federal employees. We want to make that available to everybody else.

Now, what we have said is, let's make a public option one choice of many choices that are available to people who are joining the exchange. And I see nothing wrong with potentially having that public option as one option for federal employees, as well.

But the important thing that I think I have to make absolutely clear: Nobody would be obligated to choose the public option. If you went on that Web site and you said, you know what, Aetna or Blue Cross Blue Shield are offering a good deal and I would rather choose that plan than the public plan, you'd be perfectly free to do so. Nobody would be saying you are obligated to go into a public plan.

MR. SMERCONISH: I think what folks are saying is that they'd love it if you'd stand up and say, whatever it is that we're creating, be it a co-op, be it a public option, whatever name ultimately might be ascribed to it, we in the executive branch, we in the Congress, we will live with exactly these parameters.

THE PRESIDENT: I think there would be -- I think it would make perfect sense for us to make the public option available to federal employees, as well. But keep in mind it would just be a choice.

MR. SMERCONISH: Understood. Let me keep moving, if I may. Tracy listens on WXNT News Talk 1430 in Indianapolis. Tracy, your question for the President.

Q Mr. President, thanks for taking my call.

THE PRESIDENT: Hi, Tracy.

Q Hi. Until I heard you say that a private option is just a sliver of your health care proposal recently, I think myself and many Americans thought that pretty much was your proposal.

THE PRESIDENT: I know.

Q So my question is, could you please quickly list five or six bullet points of what legislation must include for you to be willing to sign it? For instance, employer mandates, tort reform, illegal immigrants -- what about them? Must it include a public option?

THE PRESIDENT: I'd be happy to. First of all, you mentioned illegal immigrants. This has been an example of just pure misinformation out there. None of the bills that have been voted on in Congress, and none of the proposals coming out of the White House propose giving coverage to illegal immigrants -- none of them. That has never been on the table; nobody has discussed it. So everybody who is listening out there, when you start hearing that somehow this is all designed to provide health insurance to illegal immigrants, that is simply not true and has never been the case.

MR. SMERCONISH: What is their fate, if I might ask? Because there's a 1986 law on the book that says if you show up at an ER, you've got to be treated.

THE PRESIDENT: Well, that will continue because we don't want a situation in which some child, even if they're an illegal immigrant, shows up in an emergency room with tuberculosis and nobody is giving them treatment, and then they're going back to the playground and playing next to our kids.

So I think there is a basic standard of decency where if somebody is in a death situation or a severe illness, that we're going to provide them emergency care. But nobody has talked about providing health insurance to illegal immigrants. I want to make that absolutely clear.

Now, Tracy, you had a good point about what are the bullet points that I want. Number one, it's got to be deficit-neutral. This has to be paid for, because in the past, some of the health care plans that we've put forward have not been paid for. A good example of this was the prescription drug benefit for seniors. That was a important thing to do, but we never actually figured out how to pay for it. That just went directly into the deficit and the national debt. We can't afford to do that. So that would be point number one.

Point number two, it has to bend the cost curve. What that means is that we've got to create a plan that experts credibly say will reduce health care inflation, because if all we're doing is adding more people, but we're not controlling costs, that will blow up the deficit over the long term and it will blow up the burdens on individual families and businesses. We've got to get control of our costs. We spend $6,000 more than any other advanced country per person on health care. That's number two.

Number three, we've got to have the insurance reforms I talked about for people who already have health insurance. And that means making sure you can get health insurance even if you've got a preexisting condition; making sure that you're not burdened by lifetime caps; making sure that insurance companies can't drop you just because you get sick or because you're older or because you're not as healthy -- so making sure that there are basic insurance protections, that's very important.

Number four is I want to make sure that we have a health exchange, as I just described, that is similar to what members of Congress have where you will have a set of options. If you're a small business, if you're an individual, self-employed, you have trouble getting health insurance right now, you can go and look at a bunch of options. And we've got to make it affordable for middle-class families, so part of the plan has to be that if you can't afford a market-based premium, that we're giving you a little bit of help and you're able to get health insurance.

Choice, competition, reducing costs -- those are the things that I want to see accomplished in this health reform bill.

MR. SMERCONISH: Where, Mr. President, does personal responsibility factor into all this? There was a front-page story in USA Today recently that talked about obesity being the single most significant factor -- I mean, you're a fit guy. How about rewarding those who get on a StairMaster every day?

THE PRESIDENT: Well, the interesting thing is you're already starting to see this happen among a lot of private companies. Safeway, for example, is a company that has done a great job in helping encourage its employees to get fit, and they actually give them an incentive. They say, look, you're going to save X amount on your insurance premiums; you'll see that in your paycheck if you are taking steps to take care of yourself. And I think that creating incentives like that for prevention, for wellness, creating cash incentives for people where it shows up they're saving money on their health insurance because of it, I think that's something that should be part of this.

MR. SMERCONISH: Mr. President, Joe listens to me at Home Base, which is the Big Talker 1210 in Philadelphia.

Joseph, go ahead for the President of the United States.

Q Thank you for taking my call, Mr. President.

THE PRESIDENT: Hey, Joe, how are you?

Q Oh, I'm scared out of my mind talking to you here. (Laughter.) I'm a supporter, worked hard for you last year.

THE PRESIDENT: I appreciate you.

Q I'm getting a little ticked off that it feels like the knees are buckling a little bit. You have an overwhelming majority in both the House and the Senate, and you own the whole shooting match. And I'm just not getting -- it's very frustrating to watch you try and compromise with a lot of these people who aren't willing to compromise with you.

MR. SMERCONISH: Are your knees buckling? That's his question.

THE PRESIDENT: Well, look, I guarantee you, Joe, we are going to get health care reform done. And I know that there are a lot of people out there who have been hand-wringing, and folks in the press are following every little twist and turn of the legislative process. You know, passing a big bill like this is always messy. FDR was called a socialist when he passed Social Security. JFK and Lyndon Johnson, they were both accused of a government takeover of health care when they passed Medicare. This is the process that we go through -- because, understandably, the American people have a long tradition of being suspicious of government, until the government actually does something that helps them, and then they don't want anybody messing with whatever gets set up.

And I'm confident we're going to get it done, and as far as negotiations with Republicans, my attitude has always been let's see if we can get this done with some consensus. I would love to have more Republicans engaged and involved in this process. I think early on a decision was made by the Republican leadership that said, look, let's not give them a victory and maybe we can have a replay of 1993-94 when Clinton came in; he failed on health care and then we won in the midterm elections and we got the majority. And I think there's some folks who are taking a page out of that playbook.

But this shouldn't be a political issue. This is a issue for the American people. There are a bunch of Republicans out there who have been working very constructively. One of them, Olympia Snowe in Maine, she's been dedicated on this. Chuck Grassley, Mike Enzi, others -- they've been meeting in the Senate Finance Committee. I want to give them a chance to work through these processes.

And we're happy to make sensible compromises. What we're not willing to do is give up on the core principle that Americans who don't have health insurance should get it; that Americans who do have health insurance should get a better deal from insurance companies and have consumer protections. We've got to reduce health care inflation so that everybody can keep the health care that they have. That's going to be my priorities, and I think we can get it done.

MR. SMERCONISH: A bit off message. Today the Scots released the Lockerbie bomber due to -- actually maybe it is health care-related. He's got terminal cancer. Your take on this. A lot of folks very offended over a perceived lack of justice.

THE PRESIDENT: We have been in contact with the Scottish government, indicating that we objected to this. And we thought it was a mistake. We're now in contact with the Libyan government, and want to make sure that if in fact this transfer has taken place, that he's not welcomed back in some way, but instead should be under house arrest. We've also obviously been in contact with the families of the Pan Am victims, and indicated to them that we don't think this was appropriate.

MR. SMERCONISH: Mr. President, in each of our prior three conversations, I spoke with you extensively about the need for closure, and we agreed relative to bin Laden and Ayman al Zawahiri. And as a matter of fact, and this is well documented -- I've written and spoken about it extensively -- things that you said during the course of the campaign played a critical role in my personal decision-making pertaining to the 2008 election. So I feel I'd be derelict in my duty if I didn't come here today and say, where are we? I know we had a major victory recently with the number-one individual for the Taliban in those tribal regions. But pertaining to bin Laden and Ayman al Zawahiri, where is it?

THE PRESIDENT: Well, here's where we're at. We are continuing to ramp up the pressure in Afghanistan. And we had a -- what appears to be a successful election in Afghanistan despite the Taliban's effort to disrupt it. You've got General McChrystal now over there and more troops who are putting pressure on the eastern and southern portions of Afghanistan.

On the other hand, you've got the Pakistani army for the first time actually fighting in a very aggressive way, and that's how we took out Baitullah Mehsud --

MR. SMERCONISH: Right.

THE PRESIDENT: -- the top Taliban leader in Pakistan, who was also one of bin Laden's key allies. So the goal here is essentially to have a pincher where we are squeezing them on both sides, we're eliminating their allies, it's making it more difficult for them to communicate, making it more difficult for them to operate safe havens, and over time what we hope to do is to flush them out. We are going to keep on putting pressure on them, and I know that it's at great cost. I have to sign letters to family members who have fallen and a lot more are falling in Afghanistan than in Iraq. And as a consequence, we've got to make sure that we are really focused on finishing the job in Afghanistan, but it's going to take some time.

MR. SMERCONISH: Mr. President, Susan listens to WOR News Radio 710 in New York City. Susan, go ahead for the President of the United States.

Q Yes, thank you very much, Mr. President, for talking to us directly about this important issue.

THE PRESIDENT: Thank you, Susan.

Q We all want reform. I guess it's really a matter of what the best solution is. And a lot of us feel that the federal government is just not equipped for or it's their role to be getting involved in delivering health care services. And we're very concerned that most of the money will actually go -- instead of taking care of people, it will go to, you know, the cost of administering a huge government bureaucracy. Why not do something more like giving incentives to the states? Like here in New York we already have free health care for people who can't afford it. And, you know, it should only be for people who can't afford it, not for the 20- and 30-somethings that choose to spend their money on SUVs and the latest electronic gadgets. And it's not free because we all know that we're going to be paying for it, and it should be only for the people who can't really afford it. And we want to have our own health care decisions locally, and we don't want the federal government making those decisions for us.

MR. SMERCONISH: Is there a state solution here, Mr. President?

THE PRESIDENT: Well, look, first of all, Susan, I think that it's important to understand that part of the health reform proposal that we've put forward would involve the states. The states in some cases would be empowered to expand Medicaid to cover more people, the same way that they've been able to cover more children under the Children's Health Insurance Program. So a sizable portion of the people who are currently uninsured would in fact be getting their insurance through the states. That's how the current Medicaid program is able to allow states to cover more people.

Keep in mind that nobody is talking about the government administering all of health care. What we're talking about here is a public option that people could sign up for, but in that situation they'd have to operate like any private insurer. They'd have to be collecting premiums and so forth.

The track record for government administering health care actually is surprisingly good. Medicare, for example, a government program, has much lower administrative costs than private insurers do. Now, part of it is, is because they don't have -- either somebody is qualified or they're not, and so signing them up is a lot more automatic.

But that points to one of the big problems that we have. In private insurance, huge amounts of insurance companies are spending a lot of money and a lot of effort and a lot of staff just trying to cherry pick people who are healthy, and sign them up, and then eliminate people who are sick. And part of what we want to do here is just reform the system so that insurance companies are operating more fairly to all people.

If you're young, actually, it's easier to get health insurance these days. The really tough population are folks who are from 50 to 64. Maybe they just got laid off. Maybe they're self-employed. They have a whale of a time trying to buy health insurance, and we want to make sure that there is a market for them.

Last point that I would make is that -- you mention the fact that a lot of young people opt out. One of the things that we would do under reform is to say, if you want, you can stay on your health insurance or your parents' health insurance up to the age of 26. That would cover a lot of young people who they fall in that gap. Their first job doesn't necessarily offer them insurance. It gives them a way of having coverage until they get that job that has a little bit more security.

MR. SMERCONISH: You're needed across town. I appreciate very much the privilege of coming to the White House. Mr. President, thank you so much for being on the Michael Smerconish program.

THE PRESIDENT: Mike, it's always a pleasure. And I want to thank all your listeners. Terrific questions. There's a great dialogue that takes place on this show, and I just hope that we can continue that dialogue in the same spirit to solve some of America's big problems.

MR. SMERCONISH: Thank you, sir. I'll be back in just a moment from the White House.

OBAMA'S REMARKS AT ORGANIZING FOR AMERICA

THE PRESIDENT: Thank you, everybody. Hey! Thank you.

AUDIENCE: Yes we can! Yes we can! Yes we can! Yes we can!

THE PRESIDENT: Thank you. Thank you, everybody. Please have a seat. This looks like a casual crowd; I'm going to -- (laughter) -- take off my jacket here. Let me begin by thanking Beth not just for the great introduction, but for the unbelievable dedication that she showed throughout the campaign, but more importantly almost now trying to actually get some things done.

I want to thank Congresswoman Debbie Wasserman. Where'd Debbie go? (Applause.) I hear you were on a scooter. I want to see that at some point. (Laughter.) That's pretty cool -- always stylish. (Laughter.)

I want to acknowledge my great friend Tim Kaine, who joined us earlier by phone, and is doing just a great job on behalf of not only the people of Virginia but also on behalf of Democrats all across the country.

And to all of my Organizing for America volunteers, thank you so much for your unbelievable dedication. It is good to be here. (Applause.)

It's great to be here with all of you because it reminds me of how we got here in the first place. We're here because you believed that after an era of selfishness and greed, that we could reclaim a sense of responsibility and a sense that we have obligations to each other not just here in Washington but all across the country. You believed that instead of growing inequality, we could restore a sense of fairness and balance to our economic life and create lasting growth and prosperity. You believed that at a time of war and turmoil, we could stand strong against our enemies, but also stand firmly for our ideals, and reach out to the rest of the world and describe to them what America is about and how we can forge together a world of common interests and common concerns.

That's the change that you believed in. That's why you worked so hard, knocking on doors and making phone calls and hot sun and -- (laughter) -- cold winds and sometimes having doors slammed in your faces -- (laughter) -- and your family members all saying, why are you doing this, because this guy has no chance. (Laughter.) That's something I'll never forget.

But we all know that winning the election was just the beginning. I said this election night, I said it at the inauguration, and somehow I think maybe some people thought I was just fooling. I was serious. Winning the election was just the start. Victory in an election wasn't the change that we sought -- it had to manifest itself in the real day-to-day lives of ordinary Americans all across the country. And I know that folks like Beth and all of you at OFA have been working to make that change, doing the same things you were doing during the campaign -- going block by block, neighbor by neighbor, having doors slammed in your faces, people telling you, why are you doing this; it doesn't make any chance.

But just so you don't lose heart as we enter into probably our toughest fight, let's just recall what we've already gotten done. Not one month into this administration, we responded to the worst financial crisis since the Great Depression by putting in place a sweeping economic recovery program that has already made an enormous difference in people's lives. You've got millions of people who have unemployment insurance and got COBRA so they could keep their health insurance, and states who've been able to avoid layoffs of teachers and firefighters; a tax cut for 95 percent of working families, a commitment we made during the campaign that we have already fulfilled; thousands of people being put back to work all across the country rebuilding our roads and our bridges and our hospitals.

As a consequence of everything that we did, just in that first month, we've been able to see a stabilization of the financial system where a lot of economists thought that we were going to be dipping into a Great Depression. Obviously we're not out of the woods yet, but we've taken steps to address the housing crisis and keep people in their homes. We made some tough choices to keep the financial and the automotive sectors from collapsing, which would have further shocked our economy.

That's on the economic side. In the meantime, we lifted the ban on stem cell research; we expanded health insurance programs to 11 million more children across the country. (Applause.) We passed a national service bill that will give thousands of Americans opportunities to serve. (Applause.) (Coughing.) I get all choked up just talking about it. (Laughter.)

We passed the Lilly Ledbetter Fair Pay Act -- (applause) -- to make sure that women are treated the same way as men. We passed legislation to protect consumers from unfair rate hikes and abusive fees for credit card companies, and some of those rules went into effect today. (Applause.) We passed laws to protect our children from marketing by tobacco manufacturers. We've prohibited torture. We've begun to leave Iraq to its people. We've taken the fight to al Qaeda in Afghanistan and Pakistan. We've rebuilt our military and we're restoring our alliances and our standing the world. So not a bad track record. (Applause.)

Not a bad track record. We should be proud of what we've accomplished. But we're not satisfied. And we should be confident but not complacent. We've got more work to do, and we've got more promises to keep. And one of those promises is to achieve quality, affordable health care for every single American, and that is what we intend to do -- (applause.)

Now, we all know this has been an emotional debate. We've seen tempers flare. Accusations have been hurled. And sometimes it seems like one loud voice can drown out all the civil, sensible voices out there. But remember one thing: Nothing is more powerful than millions of voices calling for change. That's how we won this election. You know this and that's why since OFA launched its health reform campaign in June you've hosted 11,000 events in more than 2,500 towns in every single state and every single congressional district, which is remarkable. (Applause.)

And of course, the TV cameras aren't there when you're doing all this. (Laughter.) And when you notice that nobody is paying attention to what you're doing, just remember we've been through this before. Some of you were involved when we were in Iowa, 30 points down, and all of Washington said, oh, it's over -- hand-wringing and angst and teeth-gnashing. (Laughter.) And then last year just about this time, you'll recall that the Republicans had just nominated their Vice Presidential candidate, and everybody was -- the media was obsessed with it, and cable was 24 hours a day, and "Obama's lost his mojo." (Laughter.) You remember all that? (Laughter.) There's something about August going into September -- (laughter) -- where everybody in Washington gets all wee-weed up. (Laughter.) I don't know what it is. (Laughter.) But that's what happens.

But instead of being preoccupied with the polls and with the pundits and with the cable chatter, what you guys consistently did was you just kept on working steadily, deliberately, sensibly, knocking on doors, talking to people, talking to your co-workers, just giving people the facts, explaining to them a vision of how we're going to move forward. And that's what we're going to have to do today, because we're going to have to cut through a lot of nonsense out there, a lot of absurd claims that have been made about health insurance reform.

There was a poll done -- some of you may have seen -- Wall Street Journal/NBC poll. It turns out that a huge proportion of the American people are convinced, A, that somehow health reform means illegal immigrants are going to get health care; B, that it's a government takeover of health care; C, that all the money is going to be funding abortions; D, that -- what's the other one? Death panels, that we're all going to be, you know, pulling the plug on Grandma.

Now, come on. (Laughter and applause.) We can have a -- we can have a real debate because health care is hard, and there are some legitimate issues out there that have to be sorted through and worked on, as Debbie talked about. But what we're going to have to do is to cut through the noise and the misinformation, and the best ambassadors for true information, factual information, is all of you. You have more credibility than anybody on television when it comes to your family members and your friends and your neighbors. And that's why you being involved is so important.

Now, I don't have to explain to you why it's so important to pass health reform for the 46 million people who don't have health insurance. But it's just as important that Americans who do have health insurance, which are the majority of Americans, that they understand what health reform means for them. So let me just make sure I try to give you some bullet points here, because right now the system works very well for the insurance companies but it doesn't work so well for the American people.

First, no matter what you've heard, if you like your doctor, you can keep your doctor under the reform proposals that we've put forward. If you like your private health insurance plan, you can keep it. If your employer provides you health insurance on the job, nobody is talking about messing with that.

If you don't have health insurance, we do intend to provide you high-quality, affordable options. And that, by the way, is not just poor people who don't have health insurance -- in fact, a lot of poor Americans have health insurance under Medicaid. Mostly it's working Americans who don't have health insurance on the job, or it's self-employed Americans, or it's small business owners, or people who work for small businesses who don't have health insurance. And what we want to do is to give them a menu of options that they can choose from, and then a little bit of help in terms of making their premiums more affordable.

So that is absolutely critical. Now, one of the options we want to provide them is a public option, and there's been -- this has been a confusion around this -- (applause) -- there's been a lot of confusion about this, so let me just clarify. I think a public option is important. And let me explain why.

We're going to have a marketplace where people can select the options that work best for them, the insurance plan that works best for them. A lot of those choices, the overwhelming majority of those choices, will be private insurance options, just like members of Congress have -- they're allowed to choose from various proposals or various plans that are part of the federal employees' health plan.

But what we do think is if we have a public option in there, that can help keep insurers honest; it can provide a benchmark for what an affordable basic plan should look like. And so even though we've got a whole bunch of insurance regulations that ensure that any private insurer that's participating in the exchange is giving you a fair deal, this is sort of like the belt-and-suspenders concept -- it means that not only do they have to abide by these regulations, but they also have to compete with somebody whose interest is not just profit but instead is interested in making sure that the American people get decent care.

Now, having said that -- (applause) -- having said that, I want everybody to be clear that the public option is just one option. It will be voluntary. Nobody is talking about you having to be in the public option. Only -- the only thing that we're talking about is this being available to you as a choice, expanding consumer choice. And we think that's a good idea.

Now, there are a whole bunch of other aspects to health insurance reform, though, that people have to understand. We want to make sure that, for example, insurance companies can't prevent you from getting health insurance because of a preexisting condition. That will be the law whether you're in the health insurance exchange or you're just keeping the insurance that you already have. You should be able to keep it regardless of preexisting condition. You should be able to purchase it. There shouldn't be lifetime caps or yearly caps where you bump up against it and suddenly you've got huge out-of-pocket costs that drive you into bankruptcy. We've got to make sure that there are basic consumer protections on that.

You should be able to keep your health insurance if you get sick or you lose your job or you change jobs. And all too often what happens is when you need insurance most, that's when the insurers decide to drop you. And we've got to make sure that that is against the law. And that's part of what health insurance reform is all about.

So it's going to bring down skyrocketing costs, it's going to save families money, it's going to save businesses money, and it's going to save government money. We are going to make Medicare more efficient, guaranteeing today's seniors better benefits than they have right now. We're going to make sure that that doughnut hole in the middle of their prescription drug plan, that that doughnut hole is closed, because we want to make sure that seniors who are already living on fixed incomes during difficult times aren't having to dig even deeper to increase drug company profits.

So I just want everybody to understand that in addition to providing health insurance for people who don't have it, even if you have health insurance, you've got a stake in this debate. Fourteen thousand people are losing their health insurance every single day. Millions of people all across the country are vulnerable to exclusions because of things like preexisting conditions. Millions of Americans have experienced the fact that premiums have gone up three times faster than inflation and faster than incomes.

And if we go at the pace that we're going right now, there are going to be a whole lot of families who make the decision that they can't afford health insurance because the costs are simply unsustainable.

And if you're a deficit hawk, then you should be especially concerned about passing health care reform, because at the pace we're on right now, Medicare is going to run out of money in eight years. It won't be totally broke, but it will be in the red, because the costs are going up a lot faster than the money that's coming in.

So when you're talking to seniors out there, tell them, number one, nobody is talking about cutting their benefits. Talk to them about the fact that, by the way, Medicare is already a government program -- (laughter and applause) -- so when people say, "Keep government out of our health care," make sure they know that Medicare is a government program. But also explain to them that part of what we want to do is strengthen the program so that it's going to be there over the long haul. We don't want a situation in which Medicare runs short of money because we did not make the changes that were needed early on.

I am absolutely confident that we can get this done, but I want everybody to remember, this has never been easy -- never been easy. When FDR proposed Social Security, all across what was I guess the equivalent of today's Internet, right -- (laughter) -- all the newspapers and the radio shows and all that -- he was accused of being a socialist. He was going to bring socialism to America. How dare he.

When JFK and then Lyndon Johnson proposed Medicare, everybody suggested, this is going to be a government takeover of health care; it's going to destroy your relationship with your doctor. The same arguments that are being made now have been made every time we've tried to propose a significant change that ultimately made people more secure, improved our health care, improved our quality of life.

So we cannot be intimidated by some of these scare tactics. We have to understand that there a lot of people who are invested in the status quo and make a lot of money out of it. We've got to also understand that people are understandably nervous and worried about any significant changes when it comes to something as important as health care, because it touches on your lives, it's very personal -- and so they're more vulnerable to misinformation.

And that's why what all of you do is so important, because people trust you -- your neighbors, your friends, fellow community members -- they trust you. They know you. And if you are presenting the facts clearly and fairly, I'm absolutely confident that we're going to win this debate. But we're going to have a lot of work to do and I'm grateful that you're willing to do it. Let's go get 'em. Thank you very much, everybody. (Applause.)

All right. Thank you. All right.

MR. STEWART: Thank you, Mr. President. Thank you for taking time out of your very busy schedule to talk to all of us, your supporters, about this critical issue. I would just like to add, for folks who are interested, either watching this at home or at work, you can sign up to participate -- (laughter) -- or host a health care event right now by entering your zip code. And for folks who are listening on the phone, please go to BarackObama.com and sign up to participate or host an event near you.

Sir, we've collected thousands of questions from across the country, and we're going to take three -- one from e-mail, one from the telephone, and another one from Twitter -- and then we're going to open it up to your volunteers here -- these are your best volunteers in the area -- to have you call on them and ask questions there.

So with the first question, Cindy.

Q Good afternoon, Mr. President. Our first question comes from Julia in Colorado Springs, Colorado. Julia writes: I am a volunteer community organizer in Colorado. This summer our volunteers have called 4,800 members of the community and gathered declarations of support from over 2,600 people. The debate is really heating up. What do you think is the most compelling argument we can make for health reform?

THE PRESIDENT: Well, thank you, Cindy, if you're listening. I appreciate the question and the great work that you're doing.

The first thing that you have to explain to folks when we're having a discussion about health care is that the status quo is unsustainable. Or another way of putting it, if you like what you have now, unless we make some changes, you're not going to have exactly what it is that you like.

And the reason is because health care costs are going up so fast -- as I said, three times faster than wages; much faster than inflation in every other area of life -- that it's going to gobble up a higher and higher percentage of your income in terms of premiums and out-of-pocket costs. More and more employers are going to say, we just can't afford to provide you health insurance, or if we do, we're going to push more and more costs onto you.

You're going to lose more and more of your paycheck, even if you don't know it. It turns out in the 1990s, wages and incomes flatlined. And part of the reason was because a lot of the company profits that normally would have gone to salary increases or wage increases ended up being gobbled up by health care.

So if you've got a private plan, you have something to worry about. If you are on a public program like Medicare, you have something to worry about because we're going to be running out of money. And so the status quo is unsustainable. You've got to make sure that you explain that to folks. It's not as if if we just stand still, everything is going to be okay.

Point number two is that if you don't have health insurance, we're not forcing you to go into a government plan. We in fact just want to set up a system similar to what members of Congress enjoy where you'd have a menu of private insurance options, and we're just going to give you a little bit of help so that you could afford the premiums. That's all we're talking about.

Now, one of the options will be a public option because we think that potentially could be a better deal for consumers. But nobody is going to force you into that option. It will, however, help keep the private insurers honest because if they're charging a lot more -- higher profits, higher overhead, worst deal in terms of insurance -- then a lot of people will say, well, I might as well take advantage of the public option. But it will be the choice of the individual. That's the second thing to emphasize.

The third thing to emphasize and probably the most important thing to emphasize when you're talking to people about this -- because most people have insurance, remember that. The people who don't have health insurance, they're already in favor of reform. But most Americans have health insurance.

So the most important thing to describe to them is this will be a set of consumer protections that provide you more safety and security. You know that you will be provided for if you get sick, because what we're going to do is we're going to say to insurance companies, you've got to do certain things like admit people even if they've got preexisting conditions. You can't hide under the fine print a lot of terms that allow you to drop people when they get sick or exclude them from care.

In fact, the House bill actually has a provision that says insurance companies, if they want to participate in the exchange, they can only -- they can only charge 15 percent in profits and administrative costs. The rest of the care has to go to actually making people well. So that'll be a cost-control element.

But the point is, is that all these forces taken together will help people know that when they pay their premiums and they've got health insurance, that in fact it's there when they need it, and that they can count on it, and they're not going to be jerked around.

And over time, because of the cost-savings measures that we're putting in place -- for example, making sure that prevention and wellness is covered -- we're actually going to reduce the costs of health care overall over the long term. And that's going to be equally important because eventually that's going to show up in your paychecks in lower premiums, because right now Americans are paying $5,000 to $6,000 more per person in health care costs than any other advanced nation. So not only do these other countries have universal care, but they're paying $5,000 to $6,000 less per person. We're not getting a good deal. (Laughter.)

And so nobody is talking about a government takeover of health care. We are talking about making sure that people are getting a good deal for the premiums that they're already paying.

And I think that argument, most of the time, will win the day. I was just on a conservative talk show this morning -- or this afternoon, and a woman called in and she said, you know, I have to admit that I'm glad you explained how this public option works because I thought your whole plan was just the public option.

A lot of people just have a lot of misinformation, partly because, let's face it, health care is complicated and, you know, it's subject then to a lot of misinformation out there. And that's why your efforts are so important.

So thank you, Cindy, wherever you are.

MR. STEWART: All right. Thank you, Mr. President. We have our second question. And our second question comes from the telephone.

Q Our second question comes from a caller over the phone. Connie Lind (ph) is a volunteer leader from Florida. Go ahead, Connie.

THE PRESIDENT: Connie, can you hear me?

Q Good afternoon, Mr. President.

THE PRESIDENT: Hi, Connie.

Q Hi, Mr. President. Good afternoon. I'd like to thank you for taking my question. My name is Connie Lind (ph) and I live in Florida. I live in Congresswoman Debbie Wasserman Schultz's district. (Laughter and applause.) I'm a retired health care administrator. I was a neighborhood team leader during your campaign. And now I'm the new OFA community organizer. My question, sir: Are we winning support from members of Congress? Do you think we're making a difference, sir?

THE PRESIDENT: Well, look, the fact is, you've already got one of the best members of Congress, so if you talk to her you're kind of preaching to the choir -- especially since she's sitting here right now. (Laughter.) But can I just say that even if you live in a strongly Democratic district where there's a strong progressive member of Congress who's already in favor of health care reform, convincing people more broadly about the need for reform still makes a difference, because, unfortunately, Washington is obsessed with the snap poll; they are obsessed with what is played on talk radio or what's said at a town hall meeting. You can have 20 really civil, sensible town hall meetings, but if there's one where somebody is screaming, you know which one is going to get on television.

And so every single person that you talk to whose mind is changed is going to make a difference. And in your congressional district, I think Debbie would confirm there are a lot of senior citizens. Seniors right now are the most worried of any population group about health reform. They are the ones who are most nervous. And it's understandable, A, because seniors need more health care than anybody else, and they already have good health care under Medicare. And so their general attitude is, I don't want change; I just want to make sure that you're not taking away what I already have.

And that's why it's so important to emphasize to seniors, Connie, that you're talking to that we are not reducing benefits under Medicare; that we think Medicare is a sacred trust. In fact, part of what we want to do is strengthen Medicare by closing the doughnut hole that is making prescription drugs really costly for those who need prescription drugs most, and by extending the life of the Medicare trust fund over time, because right now we are spending money on things like subsidies to profitable insurance companies. About $17 billion a year is taken out of Medicare to pay to insurance companies who are already making a big profit without any competitive bidding whatsoever because they're running a portion of Medicare called Medicare Advantage.

Now, if we just have them compete, have them bid for participation, even if you still included them as a potential provider, that alone would save us $17 billion a year. And that would extend the life of the Medicare trust fund.

So you've really got to emphasize, I think, to seniors that, number one, nobody is talking about messing with your Medicare benefits; and number two, reminding seniors that, at the same time, you've got kids or you've got grandkids -- they need to make sure that they've got the same security that Medicare provides seniors. There are a lot of people who are 50, don't yet -- in their mid-50s right now, don't qualify for Medicare, may have lost their job that used to provide health care. It is almost impossible for some of them to get health care because they've already had maybe a heart attack, maybe they've had an incident of cancer, maybe they've had some sort of other preexisting condition that makes insurers want to shy away from them. Their attitude is, no, we'll take the young, healthy ones, and that way we never have to pay out and we make more profit. And that's part of what we want to change, as well, and you've just got to remind seniors that there are a lot of their family members who deserve the same kind of security that they have. Nobody is talking about taking away their security. We just want to expand that security to more people.

Okay, great question, Connie. Next question.

MR. STEWART: Cindy.

Q Our third question comes from Brandy, an OFA summer organizer in Phoenix, Arizona, who submitted her question over Twitter. She writes: There are too many lies about health insurance reform -- death panels, rationing, you name it. Where are these lies from? I want people to know the truth.

THE PRESIDENT: Well, look, we know where these lies are coming from, I mean -- (laughter.) I mean, I don't think it's any secret. If you just flick channels and then stop on certain ones -- (laughter and applause) -- then you'll see -- you know, you'll see who's propagating this stuff.

I said during the campaign that the best offense against lies is the truth. And so all we can do is just keep on pushing the truth. The truth is, there's no plan that has ever been considered under health care reform in Congress that covers illegal immigrants. Nobody has proposed that. And yet, a huge percentage believe that that's the case. So, anybody listening right now, let's dispel that myth.

There are no plans under health reform to revoke the existing prohibition on using federal taxpayer dollars for abortions. Nobody is talking about changing that existing provision, the Hyde Amendment. Let's be clear about that. It's just not true.

Let's be clear about the fact that nobody has proposed anything remotely close to a government takeover of health care. None of the plans that are out there, the most liberal, progressive plans that have come forward and come out of committee -- all of them presume that if you've got private health insurance, you can keep your health insurance. Nobody is talking about getting between you and your doctor and interfering with that relationship.

What we have said is we don't want government bureaucrats interfering in that relationship. We also don't want insurance company bureaucrats interfering with that relationship. (Applause.)

The death panel idea -- the genesis of this -- I mean, this is an interesting example of sort of tracing how misinformation spreads. There was a provision in the House bill that very sensibly said, you know, a lot of people towards the end of their life, they haven't prepared with things like a living will, they don't understand what their options are in terms of hospice, and we should reimburse people if they want that counseling. Voluntarily. If they want it, that's something that Medicare should reimburse for. It shouldn't just be wealthy people who get good counseling and information about how to handle their affairs during a very difficult time.

So that voluntary provision that permits reimbursement, which, by the way, Republicans had supported previously -- this was previously considered a bipartisan concept -- a Republican senator, former Republican House member, introduced a even -- a much more aggressive bill on this issue in the prescription drug bill passed by the Republican members of Congress; they had a similar provision for terminally ill patients. So this used to be just a sensible thing that everybody could agree to -- suddenly became death panels, and scared -- scared Grandma. (Laughter.) And it's just irresponsible.

And I have to say, part of the reason it spreads is the way reporting is done today. If somebody puts out misinformation, "Obama's Creating Death Panels," then the way the news report comes across is: "Today such-and-such accused President Obama of putting forward death panels. The White House responded that that wasn't true." And then they go on to the next story. And what they don't say is, in fact it isn't true. (Laughter and applause.)

I mean, there's never any -- I just -- you know, it's fine to have a debate back and forth -- he said, she said -- except when somebody else is just not even telling remotely the truth. Then you should say in your reports, oh, and by the way, that's just not true. (Laughter.)

But that doesn't happen often enough. And that's why it's so important that all of you deliver that message, and you've got to be able to back it up. And all of you are receiving materials where it's not just us saying this. I mean, these are third-party validators who are out there and can set the facts straight. And when people get the facts and you show them, then most people will end up being persuaded.

Not everybody. There are going to be some people who -- look, there are some people who, for partisan reasons, just want to see this go down because they see this -- they see a replay of 1993 -- you know, if we can beat a health care bill like we did with Bill Clinton, then we'll be able to take over the House, you know, next year. There's some of that.

And then there are some people who just ideologically, they just don't believe in government getting involved in anything. And that's a respectable position. I mean, there's a long American tradition of saying, government, just leave me alone and get off my back. And those folks are consistent and they were critical of Bush when he got involved in government, and they're critical of me, in terms of being -- believing that government can do some good. And I think there you can have a honest, philosophical debate, and they're just not going to agree with it.

But the majority of Americans understand we don't want government in all our business, but there are certain sensible reforms that we can pass so that consumers are protected, so that the market is working the way it should, so that the American people are getting a fair deal. Those are the people that we're trying to persuade. And I think if the majority of the people have the facts, then in fact they will be on our side. Okay?

All right. Next question. Now we can just go to the audience members here, and we'll start with this gentleman right here.

Q Mr. President, I'm Charles Cuttle (ph), I'm from North Carolina, and thank you for turning North Carolina blue. (Applause.) It's been a long time. I have two wonderful children and I have four beautiful grandchildren. And so I'm working for them and I'm working for people who, unlike me, don't have health insurance -- it's unconscionable.

Now, you've been outrageously good -- (laughter) -- let me be clear -- in trying to get a bipartisan bill through this Congress and you've got three wonderful Republicans willing to stand with you. But America needs this to happen and you know that. So where are we going to go from here?

THE PRESIDENT: Well, let me -- we don't know yet whether we've got any Republican support. We've got three Republicans who've been working very diligently. Charles Grassley, Mike Enzi, and Olympia Snowe have been working in the Senate Finance Committee with Max Baucus, the Senate Finance Chairman, a Democrat, to see if we can craft a bipartisan bill coming out of the Senate Finance Committee. I give those three Republicans a lot of credit because they're under enormous pressure not to engage in any kind of negotiations at all. And in the current political climate, they are showing some significant resolve.

I don't know if in the end they can get there. I hope they can. And we're going to just continue to wait to see if they can get a product done. But at some point in the process, there's going to have to be a conclusion that either they can get a bill done or they can't get a bill done. And my commitment to the American people is to get a good product -- which will include Republican ideas -- but I have no control over what the other side decides is their political strategy. And my obligation to the American people says we're going to get this done one way or another. (Applause.)

All right. I'm going to -- you guys have been to my town hall meetings so you know I always go boy, girl, boy, girl. (Laughter.)
Q Good afternoon, Mr. President. My name is Teresa McRae (ph), and I am from Virginia, another state that flipped from red to blue. (Applause.) I live in Spotsylvania County and it's a rural county, but when I talk to people as a community organizer for OFA, it all comes down to money. And I may suggest, well, there's long-term benefits and quality health care, but they come back to me and say, well, what's going to stop people from being in their employer-based health care and just quickly move over into the government health care, and who's going to pay for it? What do I say?

THE PRESIDENT: Okay. Well, it's a great question. There are a couple of issues involved here. The first issue is, how are we paying for health care reform generally? Now, one thing that's very important to remind people, because you notice there's been a talking point from opponents -- "trillion-dollar health care bill" -- they love repeating that -- "trillion-dollar health care bill."

First of all, it's important to remind people that when they say "trillion dollars," they're talking about over 10 years. So this -- we're talking about $100 billion a year -- which is still a significant amount of money -- but just to give you a sense of perspective, I mean, the amount of money that we're spending in Iraq and Afghanistan is -- what's the latest figure, Debbie? You figure nine -- $8 billion to $9 billion a month, right? So for about the same cost per year as we've been spending over the last five to six years, we could have funded this health care reform proposal -- just to give you a sense of perspective. That's point number one.

Point number two. About two-thirds of the costs are actually going to be paid for from money that's already in the health care system, that taxpayers are already paying for, but is not a good deal. So it's reallocating money that's being wasted right now -- taxpayer money that's being wasted right now, and using it in a way that actually makes people healthier. That's point number two.

So remember I told you about those subsidies that we're providing to insurance companies? That's an example.

Another example is, the way we reimburse hospitals right now, we don't incentivize hospitals to get their patients the best treatment the first time out, because if a patient is immediately readmitted, well, we just pay them the same rate as they were the first time.

Now, think about if your car needed repairs, and you sent it in and got it fixed -- you thought. A week later the same thing breaks down. When you went back to the auto shop, you'd probably want them to give you a little discount on fixing it the second time.

But we don't do that right now with respect to hospitals. And those are the kinds of changes that we can make that would pay for about two-thirds of the cost of health reform.

That leaves one-third -- and we do have to pay for that. I actually think that we're going to get even more savings with prevention and wellness, but unfortunately we can't c