But I think the big problem is, is that -- and I mentioned this in the town hall meeting. We'll have a situation in which we take five tests when we know one test would be sufficient, as long as that one test would have been forwarded to the other doctors, and specialists, and nurses who needed it to help treat the patient. That doesn't happen right now. But, we're paying for five tests.
So if we could get a system where that one test is properly distributed, we all save money. And there are examples of that kind of breakdown in the system across the board. We don't spend enough money on prevention and wellness. We know that. So, as I've mentioned again in the town hall meeting, that a hospital or a medical system may not get reimbursed for a nutritionist who's helping somebody control their diet, but, they will reimburse for a $30,000 foot amputation.
So the real issue is, are we getting the best value for the money that we are already spending? And the answer is no.
MORAN: And under your plan, it's the government that will put real muscle ... into rationalizing or structuring the health care system so that we use less, use it more efficiently, or we use less. It's the government that will play that major role.
OBAMA: The government would play that role with respect to money that the government is spending. Right? Which it always -- it currently plays that role. That's not a change.
So Medicare and Medicaid -- those programs in which the government is involved and honing up dollars, I think taxpayers would expect that we spend that money wisely. We don't want to see that money wasted on weapons systems that aren't needed. We don't want it spent on welfare programs that don't work. And we shouldn't want that spent on tests that aren't making people better.
So that's true of the public dollars that are going to be used. With respect to the private sector, what we're hoping is, is that by advertising what best practices are that doctors and patients are going to have better information and they're going to start saying, hey, you know what, it turns out that this treatment, which is cheaper, leads to better results than that treatment. And they will start making changes in how they practice.
And we also do want to reform the insurance industry so that, as I mentioned before, practices like excluding people for pre-existing conditions, or dropping people for coverage unfairly, that those reforms are put in place. That will affect the private marketplace.
MORAN: When you were campaigning for president you said, if you were starting from scratch you would want the single-payer, government-run national health care system.
But, we are starting from scratch.
OBAMA: That's not exactly what I said, Terry.
What I said was, if I am starting from scratch I think that the single-payer system could make a lot of sense. But that's not the tradition that we've inherited over the last 50 years. We have an employer-based system. And so as a consequence, for us to simply transition and scrap the old system would be extraordinarily disruptive and I don't want to disrupt people's care. I don't want to add to their insecurities right now. I want to add to their securities.
And that's why what we're trying to do is in a very steady way, build onto the existing system. Make it work better and give people more security and make sure that more people have coverage at the same time as we're making it more cost efficient.
MORAN: But you also said that this public option, this government program that you're proposing for health care, could be, you said, a transition to a single-payer national health care system.
In your heart of hearts, is that what you would like to see, that gradually we would transition to national health care?
OBAMA: No. I think that what I want is an American system that works well for the American people. And I think it is possible, and there are examples out there, of private systems, a free market in health care. But a situation in which we assure that everybody has coverage.
That there are certain rules of the road and certain practices that are observed by insurance companies so that people are getting a fair deal. And I would like to make sure that all the families that I'm hearing from day in and day out who are getting battered by rising health care costs or no health care at all, that they get some relief.
And I'm also, you know, looking at the federal budget projections for the next 10, 20 and 30 years. And I feel a responsibility that if we don't do something about it then we are going to have some really bad choices down the road. And that's the irony of this thing.
What's been fascinating to me is the degree to which some of the same folks who are responsible for handing me trillions of dollars worth of deficits over the next decade because they didn't pay for tax cuts or initiatives that they had put forward, are now suggesting somehow that this is another big government spending plan, when in fact, they know, you know, and for some reason this doesn't get hammered home as much I'd like to see in the press, that if we don't reform the system that is the absolute worst thing we could do in terms of our fiscal situation. That's not disputed.
And so the only way that we're going to get control of this thing is if we reduce health care inflation to manageable levels. And I think that can be done.
MORAN: I want to shift gears here. Afghanistan -- this has been the deadliest month for American and NATO troops in Afghanistan ever.
Define victory in Afghanistan, or maybe that's not the right word.
OBAMA: I'm always worried about using the word "victory" because, you know, it invokes this notion of Emperor Hirohito coming down and signing a surrender to MacArthur.
You know, we're not dealing with nation states at this point. We're concerned with al-Qaeda and the Taliban, al-Qaeda's allies. So when you have a non-state actor, a shadowy operation like al-Qaeda, our goal is to make sure they can't attack the United States.
Now I think that's going to require constant vigilance. But with respect to Afghanistan, what that means is -- or Pakistan, for that matter. What that means is that they cannot set up permanent bases and train people from which to launch attacks. And we are confident that if we are assisting the Afghan people and improving their security situation, stabilizing their government, providing help on economic development so they have alternatives to the heroin trade that is now flourishing.
If on the Pakistani side, we are helping to stabilize the northwest provinces and giving them assistance and providing people a good livelihood. Those things will continue to contract the ability of al-Qaeda to operate. And that is absolutely critical.
MORAN: Is Pakistan helping or hurting American efforts in Afghanistan, or both?
OBAMA: Well, I think that at this point what you've seen is the Pakistani military step up in a way that we have not seen. I mean, they are engaged in serious fighting of al-Qaeda allies in that region and are trying to reassert control into areas that have become lawless.
There are downsides to that. You're seeing the displacement of a lot of people in those battle zones. And I'm very worried that we, as an international community, are helping Pakistan to deal with those people who've been displaced because we don't want that to be a new recruitment tool for radicals saying that, you know, you've been chased out of your home because of Pakistan, which that kind of propaganda I think is something that we have to be careful about.
I think that the Pakistani government in the past has been -- has tried to take the tiger by the tail and use in some cases, you know, militants to their advantage strategically. And I think they now realize that that was a mistake and my hope is that we're going to see them continue to take seriously the threat not simply to us, but, probably more acutely, the threat to Pakistan.
MORAN: Last question.
As you know there's a lot of curiosity about you and what you do, what you wear, all these things. And where you worship. If I may ask, how has -- how have the responsibilities of the presidency affected your spiritual life, if at all?
OBAMA: Well, I had a habit of praying every night before I go to bed. I pray all the time now (laughter).
Because I've got a lot of stuff on my plate and I need guidance all the time. We haven't selected a permanent church home in D.C. I mentioned earlier that with all the transitions for the girls, but also, still trying to figure out how to move this big apparatus called the presidency without being hugely disruptive to congregations. How do we time that, how do we think about that? That's something we're still sorting out.
You know, we've been attending church -- there's a little chapel up in Camp David when we go up there. There's a wonderful young pastor up there -- chaplain -- who does just wonderful work. And the Camp David families attend.
And I get -- this is one use of my BlackBerry. My Faith and Neighborhood Initiatives Director Joshua DuBois, he has a devotional that he sends to me on my BlackBerry each day. That's how I start my morning. You know, he's got a passage, scripture, in some cases quotes from other faiths to reflect on.
But, look, you know, when you're in this job I think that every president whose had it is constantly humbled by the degree to which there are a lot of issues out there and the notion that one person alone can solve all these problems I think you're cured of that illusion very quickly. This is something where you just hope that you are aligning your work with His purposes and that you're attuned to the needs of the people you're there to serve.
MORAN: Well, good luck.
OBAMA: All right. Thank you.
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