Did President Obama Make His Case on Health Care?

Views on Government-Funded Health Insurance

According to the latest ABC News/Washington Post poll, 62 percent of Americans support creating a government-funded entity to offer health insurance to those who don't get it elsewhere. But if that caused many private insurers to go out of business because they couldn't compete, support plummets to 37 percent.

The White House has shown some flexibility about a government-run plan. In a meeting with a bipartisan group of governors Wednesday, the possibility was raised of states offering public plans of their own instead of just one federally administered plan, according to a source with knowledge of the meeting. And White House chief of staff Rahm Emanuel told Democratic senators Tuesday night that the president was open to "alternatives" to the public plan.

Sawyer asked Ron Williams, the CEO of Aetna Insurance, "Is the president right that you need to be kept honest?"

Williams said he disagreed with the notion of a public plan.

"It's difficult to compete against a player who's also the person refereeing the game," Williams said. He proposed working to "solve the problem as opposed to introduce a new competitor who has rule-making ability."

Gibson pointed out that the president constantly makes the argument that if you like your insurance you won't have to change it. And yet from the audience, John Sheils, senior vice president of The Lewin Group, a health care policy research and management consulting firm, estimated that up to 70 percent of those with private insurance would end up on the public plan.

"There are a whole series of ways that we could design this," the president said, arguing that employers would be given a "disincentive" to shift their employees to the public plan.

Another neurologist, Dr. John Corboy of the University of Colorado Health Science Center, asked the president, "What can you do to convince the American public that there actually are limits to what we can pay for with our American health care system and if there are going to be limits, who's going to design the system and who's going to enforce the rules for a system like that?"

Obama, however, didn't directly answer the question.

"If we are smart, we should be able to design a system in which people still have choices of doctors and choices of plans that make sure that necessary treatment is provided but we don't have a huge amount of waste in the system," he said.

He said he had "great confidence" that physicians "are going to always want to do right thing" if they have the right information and a payment structure that focuses on evidence and results and not tests and referrals.

"We should change those incentive structures," the president said. "Our job this summer and this fall," he said, is to "identify the best ways to achieve the best possible care."

The president cited the Mayo Clinic as an example of a medical center where experts had figured out the most effective treatments and eliminated waste and unnecessary procedures.

Sawyer said that e-mails ABC News had received argued that "the Mayo Clinic is exactly the point," indicating that private companies are solving this problem, and raising the question as to why the government needs to get involved.

"And, unfortunately, government, whether you like it or not, is going to already be involved," Obama said, citing Medicare and Medicaid.

One questioner -- Marisa Milton, vice president of health care policy for the HR Policy Association, a public policy advocate for human resource executives -- said that "other industrialized nations provide coverage for all their residents" with "high quality care" without spending more money.

"A lot of those countries employ a different system than we do," the president said. "Almost all of them have what would be considered a single-payer system in which the government operates what is essentially a Medicare for all."

The president said he didn't think it wise to attempt to "completely change our system root and branch" since health care is one-sixth of the U.S. economy. It "would be hugely disruptive," he said, arguing that citizens would be forced to change their doctors and insurance plans "in a way I'm not prepared to go."

End-of-life issues were raised as well; right now it is estimated that nearly 30 percent of Medicare's annual $327 billion budget is spent on patients in their final year of life.

Jane Sturm told the story of her nearly 100-year-old mother, who was originally denied a pacemaker because of her age. She eventually got one, but only after seeking out another doctor.

"Outside the medical criteria," Sturm asked, "is there a consideration that can be given for a certain spirit ... and quality of life?"

"I don't think that we can make judgments based on peoples' spirit," Obama said. "That would be a pretty subjective decision to be making. I think we have to have rules that say that we are going to provide good, quality care for all people.

"We're not going to solve every single one of these very difficult decisions at end of life," he said. "Ultimately that's going to be between physicians and patients."