Did President Obama Make His Case on Health Care?

June 25, 2009— -- For the first time last night President Obama expressed frustration at the way Congressional Budget Office makes its analyses, leading some to question whether the president is preparing to dismiss whatever price tag the CBO places on the final draft of the congressional Democrats' health care reform proposal.

In recent weeks as the CBO -- long regarded as a fair and non-partisan arbiter -- has provided estimates of $1 trillion to $1.6 trillion for two drafts of health care reform bills, and some Democrats have claimed the CBO analyses aren't fair.

On Wednesday night Obama added his voice to the chorus of frustrated Congressional Democrats such as House Speaker Nancy Pelosi, D-Calif.

The president yesterday added his voice to the chorus of frustrated Congressional Democrats such as House Speaker Nancy Pelosi, D-Calif.

Responding to a question of: "how and who will pay for the national health care system," the president said, "What my administration has said, what I've said, is that whatever it is that we do, we pay for. So it doesn't add to our deficit."

"We will have some up-front costs," he acknowledged. "And the estimates ... have been anywhere from a trillion to $2 trillion. But what I have said is whatever it is we do, we pay for."

The president said the CBO "doesn't count all of the savings that may come from prevention, may come from eliminating all of the paperwork and bureaucracy because we have put forward health IT. It doesn't come from the evidence-based care and changes in reimbursement ... they're not willing to credit us with those savings. They say, 'That may be nice, that may save a lot of money, but we can't be certain.'"

"We spend $177 billion over 10 years in providing subsidies for insurers," the president said.

Obama made a push Wednesday for evidence-based medicine and a reduction in health care costs in the United States, but skeptics and many Republicans remain unconvinced his plans will work.

The president faced questions about the rising cost of health care, his proposed "public option" plan and taxing benefits during an ABC News' special on health care reform, "Questions for the President: Prescription for America," anchored from the White House by Diane Sawyer and Charles Gibson.

Republicans do not believe the president made his case.

"We believe we should fix our problem in the health care system," Rep. Paul Ryan, R-Wis., said on "Good Morning America" today. Ryan said he believes Congress will meet the president's deadline of achieving reform by the end of the year, but added that the reform could move forward without Republican support.

"Unfortunately, it doesn't look like it will be bipartisan health care reform," he said. "Democrats have the votes, and they've told us they're not interested in sincere bipartisanship."

Obama struggled Wednesday to explain whether his health care reform proposals would force normal Americans to make sacrifices that wealthier, more powerful people -- like the president himself -- wouldn't face.

The probing questions came from two skeptical neurologists.

Dr. Orrin Devinsky, a neurologist and researcher at the New York University Langone Medical Center, said that elites often propose health care solutions that limit options for the general public, secure in the knowledge that if they or their loves ones get sick, they will be able to afford the best care available, even if it's not provided by insurance.

Devinsky asked the president pointedly if he would be willing to promise that he wouldn't seek such extraordinary help for his wife or daughters if they became sick and the public plan he's proposing limited the tests or treatment they can get.

The president refused to make such a pledge, though he allowed that if "it's my family member, if it's my wife, if it's my children, if it's my grandmother, I always want them to get the very best care.

"There's a whole bunch of care that's being provided that every study, that every bit of evidence that we have indicates may not be making us healthier," he said.

Gibson interjected that often patients don't know what will work until they get every test they can.

"Oftentimes we know what makes sense and what doesn't," the president responded, making a push for evidence-based medicine.

Gibson asked the president if it doesn't make sense to decide what the limitations will be on options in any health care reform proposal before voting on it.

"That's what people are afraid of," Gibson said.

The president said he understood the American people "know they're living with the devil, but the devil they know instead of the devil they don't."

Doctors agree with the president that they need to cut costs and eliminate unnecessary testing, but they also want protection from malpractice lawsuits, which the president hasn't promised.

Ryan said Congressional Republicans proposed tort reform, changes in personal injury lawsuits, but "that's one thing president has taken off the table."

Senate Minority Leader, Mitch McConnell, R-Ky., and Republican National Committee Chairman Michael Steele declined interviews by "GMA."

On the "Nightline" edition of the health care forum, Gibson read the president a letter from Republicans on the Senate Finance Committee expressing concern about the creation of a government-run health care plan.

"At a time when major government programs like Medicare and Medicaid are already on a path to fiscal insolvency, creating a brand new government program will not only worsen our long-term financial outlook but also negatively impact American families who enjoy the private coverage of their choice," the senators wrote.

"The end result would be a federal government takeover of our health care system, taking decisions out of the hands of doctors and patients and placing them in the hands of a Washington bureaucracy."

"They're wrong," the president said, arguing that in a Health Insurance Exchange, the public plan would be "one option among multiple options."

The concern, Gibson articulated, is that such a plan wouldn't be offered on a level playing field.

The president rebuffed that, arguing that "we can set up a public option where they're collecting premiums just like any private insurer and doctors can collect rates," but because the public plan will have lower administrative costs "we can keep them [private insurance companies] honest."

Obama said he didn't understand those advocates of the free market who constantly say the private sector can do things better and are yet worried about this plan.

"If that's the case, no one will choose the public option," the president said. He also suggested, however, that the private sector might not necessarily be better, point out that users of Medicare and Veterans Administration hospitals constantly rate "pretty high satisfaction."

Ryan, like other Republicans, argued that the public option plan is a "non starter" and will become a "government monopoly."

"The public plan option is a stacked deck," Ryan said on "GMA." "It's absolutely the government being a referee and player in the same game."