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MS. SAWYER: And it is a big night. This conversation tonight will take place right there, inside the East Room at the White House.
And this morning more than 140 Americans from all walks of life -- and we are talking businesspeople as well as doctors and patients are getting up and getting ready for their date with the president -- what we hope will be a searching conversation about what really works and does not work in keeping Americans healthy.
But as I said, we had a chance to get the conversation started yesterday. The president and I sat there on the south balcony of the White House.
He is trying to enlist Americans to put some pressure on, send a message to Congress, because he says health care is the ticking time bomb inside the American economy.
(To President Obama.) Thank you, Mr. President.
PRESIDENT OBAMA: Thank you so much for having me.
MS. SAWYER: Do you still expect to get health care by the end of the year?
PRESIDENT OBAMA: Yes.
MS. SAWYER: Absolutely?
PRESIDENT OBAMA: Absolutely.
MS. SAWYER: If you don't is it over for four years?
PRESIDENT OBAMA: We're going to get it done, so I won't engage in hypotheticals in which we don't.
And the reason it's going to get done is because the American people understand it has to get done. Every town I visit, every city I go, people ask me, you know, why is it that my premiums have gone up two, three times in the last nine, 10 years?
So whether it's families, businesses or government, we know that we're going to have to reform this system. And I'm confident that if everybody puts their minds to it, we can get it done.
MS. SAWYER: On cost --
PRESIDENT OBAMA: Yeah.
MS. SAWYER: And I've been out with my pen and pencil all weekend.
PRESIDENT OBAMA: Right.
MS. SAWYER: Please tell me some of this is complicated for you, too.
PRESIDENT OBAMA: It is very complicated.
MS. SAWYER: The short version? To start covering the estimated $1 trillion cost or more, the president's proposed $300 billion in cuts and another 300 billion (dollars) or so in revenues -- taxes on higher-income people.
But senators have already said they're not going to do it.
PRESIDENT OBAMA: We've identified $600 billion that will be re- allocated from existing health care expenditures by the government.
To do that, we've suggested that we should take the deductions that currently wealthy people like myself or you take, drive them back down to 28 percent. If we did that, that affects 2 (percent) to 3 percent of the population and we would raise enough money to actually make sure this thing is paid for.
Now, members of Congress may have other ideas about how best to do this. I'm happy to listen to them; I still think that's the best way to go about it.
MS. SAWYER: You know about the vast skepticism out there that these numbers are going to add up, that this is going to be sufficient to cover an ever-escalating health care --
PRESIDENT OBAMA: I think the -- in this debate, the burden should be on those who say we do nothing. Because there's -- there tends to be the attitude of we've got a great system -- (chuckles) -- and if we just don't mess with it and the, you know, Obama folks aren't trying to do too much, that somehow we'll be okay. That's just not the case.
Doing nothing means more people losing their coverage, higher costs for families, higher costs for businesses, and Medicare and Medicaid will go bankrupt.
MS. SAWYER: But if you don't get the --
PRESIDENT OBAMA: So -- so if we -- if we don't make these decisions, we'll be worse off.
MS. SAWYER: Are you open to taxing benefits?
PRESIDENT OBAMA: I have identified the ways that I think we should finance this. I think Congress should adopt them. I'm going to wait and see what ideas, ultimately, they come up with.
I suspect when they start seeing what the options are, they might end up concluding that actually the options we're presenting are the best ones.
MS. SAWYER: So you're not going to say one way or the other at this point?
PRESIDENT OBAMA: I don't want to prejudge what they're doing.
MS. SAWYER: The president also seemed willing to negotiate on his much-debated public, government-funded insurance plan.
And on his most-often repeated promise to Americans, included a new variable: employers.
(To President Obama.) People have been hearing you say these words about if you like your doctor, you'll keep your doctor, period.
PRESIDENT OBAMA: Yeah.
MS. SAWYER: If you like your health plan, you'll keep your health plan, period.
Yet I though today in the press conference I heard you amend it to say if your employer decides to change it, we don't have control over that. So --
PRESIDENT OBAMA: (Whoa/Well) -- but of course that -- I mean, that's the case whether we pass health care or not. I can't pass a law that says I'm sorry, employers, you can never make changes to the health care plans that you provide your employees.
What I can say is that the government is not going to force you to -- your employer or you to join a government plan, for example. If you're happy with it and your employer's happy with it, keep it.
If your employer is not providing you the health care that you need, then we're going to give you a set of options to make sure that you continue to have health care.
MS. SAWYER: Is there a point at which you will say I will wait; I will not accept it at this cost?
PRESIDENT OBAMA: Yes. I think that if any reform that we get is not driving down costs in a serious way --
MS. SAWYER: You won't do it.
PRESIDENT OBAMA: -- if people say we're just going to add more people onto a hugely inefficient system, then I will say no, because we can't afford it.
If there aren't some basic game-changers in the system -- additional incentives for prevention, encouraging family care physicians, if we're not looking at what systems work best and trying to duplicate that, all those things that drive down costs -- if those aren't in there, then I'm not for the bill.
MS. SAWYER: And when we talked yesterday I asked the president about our visits to the doctors. How many scans are we entitled to? How many x-rays? Who's going to make that decision? And that'll be in our next half-hour.
But before we leave now, a footnote to the health care conversation.
The pesky press corps is always asking the president about his struggle with smoking. They did it in the press conference yesterday. I tried to follow up and, as you'll see, got shot down.
PRESIDENT OBAMA: (From videotape.) Have I fallen off the wagon sometimes? Yes. The -- am I a daily smoker, a constant smoker? No.
I don't do it in front of my kids; I don't do it in front of my family. And I would say that I am 95 percent cured.
MS. SAWYER: (To President Obama.) Ninety-five percent, huh? You said today -- (laughs). See, I'm shameless on asking the human- interest -- (word inaudible) -- question.
PRESIDENT OBAMA: Yeah. Yeah, and I know -- well, this is a favorite for every reporter. So the --
You know, I've answered it as often as I can. I'm sure I will continue to answer it.
MS. SAWYER: What -- is there a time of day that's the hardest? Most people have --
PRESIDENT OBAMA: Diane, you know, I think I've answered that one.
MS. SAWYER: Uh-huh. I guess it's one thing to have your friends and family nagging you. It's another thing to have the entire country nagging you about smoking.
MS. SAWYER: More of my conversation. This time we're going to turn to the experience you and I all have when we walk into our doctor's office.
How many tests, scans, procedures are we entitled to? You know, people on all sides of this debate -- Republicans, Democrats, Independents -- have said that the most expensive piece of equipment is the doctor's pen, as someone put it.
Because Americans are, in a sense, in a vicious circle inside the health care debate. Patients expect more procedures. Doctors are paid per procedures; they don't want to lose patients, and they also don't want opt be sued.
And what results is a kind of runaway train, the administration would argue, including a lot of over-treatment.
Listen to Dr. Sandeep Juahar.
DR. SANDEEP JUAHAR: (From videotape.) We as doctors are working in a system that is deeply flawed.
MS. SAWYER: He's just one of the doctors saying --
DR. JUAHAR: (From videotape.) It should be no surprise that many doctors are over-testing and over-utilizing health care.
MS. SAWYER: As the procedures snowball, the cost snowballs. Patients expect more and more. The White House says a central tenet of reform is this over-treatment must stop.
(To President Obama.) Is it time for Americans to recognize they're going to get fewer scans, fewer tests?
PRESIDENT OBAMA: I think what's important is to say to the American people that you should get the best possible care to make you well. And that the measure of the quality of care is not quantity, but whether or not it is making you better.
The Mayo Clinic, a classic example, in Rochester, Minnesota. People go there, they spend about 20 (percent), 30 percent less than some other parts of the country, and yet have better outcomes.
So what we've said is let's put out the research; let's study and figure out what works and what doesn't.
MS. SAWYER: Will there be a board making Solomonic decisions --
PRESIDENT OBAMA: Well, what I've -- what I --
MS. SAWYER: -- about best practices?
PRESIDENT OBAMA: Yeah. What I've suggested is that we have a commission that helps -- made up of doctors, made up of experts -- that helps set best practices.
MS. SAWYER: By law?
PRESIDENT OBAMA: Well, what it does is that if we know what those best practices are, then I'm confident that doctors are going to want to engage in best practices, but I'm also confident patients are going to insist on it.
MS. SAWYER: But a lot of people, when you read through the polling, say they're very concerned. They are very concerned that there's going to be a reduction in treatment some place in all of this.
Will it have the weight of law? Will it have the weight of regulation?
PRESIDENT OBAMA: Well, first of all, Diane, I think that we're still early in the process. All these issues are getting worked through.
I would dispute that their biggest concern right now is simply that their doctor is going to say, you know what? You don't actually need this test; this is the better way to go. They general trust their doctors.
I think that the biggest threat that families are concerned about is the cost of health care that eventually is going to mean they don't have any coverage.
MS. SAWYER: And there will be another big cost when the 46 million uninsured are brought onto the rolls through government pressure, even fines if they don't do it.
(To President Obama.) Will you accept mandates with fines for individuals if they don't sign up?
PRESIDENT OBAMA: The mandates are an example of something that I was resistant to during the campaign.
MS. SAWYER: Against it during the campaign.
PRESIDENT OBAMA: Yeah.
MS. SAWYER: Candidate Obama criticized Senator Hillary Clinton for these so-called mandates.
PRESIDENT OBAMA: (From videotape.) You can mandate it, but there're still going to be people who can't afford it. And if they cannot afford it, then the question is what are you going to do about it.
(To Ms. Sawyer.) I have to tell you that this is an area where people have made some pretty compelling arguments to me that if we want to have a system that drives down costs for everybody, then we've got to have healthier people not opt out of the system.
And I think that you have to be careful to make sure that there's a waiver so that if we haven't made health care affordable yet, you're not punishing people not only because they can't afford health care, but now giving them an additional fine.
But I think my thinking on the issue of mandates has evolved, and I think that that is typical of most people who study this problem deeply.
MS. SAWYER: Early in the broadcast, you saw how the president pushed back at me when I asked about smoking.
PRESIDENT OBAMA: (From videotape.) No, I think it -- I've answered that one.
MS. SAWYER: But we wondered, under Obama heath reform, should smokers, overeaters, non-exercisers, have to pay more for unhealthy practices?
(To President Obama.) I think people wonder, should there in fact be some cost to all of us if we don't take care of ourselves in this new we're-all-in-it-together world.
PRESIDENT OBAMA: Well, I think everybody does have responsibilities.
One of the things that Michelle and I are working diligently on is how can we engage kids to start healthy habits. And I think everybody understands that perfection is not the goal, but moving in the right direction is.
MS. SAWYER: Thank you so much.
PRESIDENT OBAMA: Thank you. Great to talk to you.