Obama Talks Health Care With Post's Hiatt

In case you missed this yesterday --

In a telephone interview with editorial page editor Fred Hiatt Wednesday afternoon, President Obama said he will not accept a health-care reform bill, even one that is deficit-neutral, if it does not also begin to reduce the cost of care. He also indicated openness to a cap on the deductibility of employer-provided health insurance, as long as it does not kick in at current levels; such a future cap could help restrain health-care inflation, he said. And he warned that, if the nation does not soon grapple with its larger fiscal deficit problem, the government may have a harder time borrowing, and interest rates could start to rise. The best way to deal with the deficit, he said, may be through a commission for which "everything is going to have to be on the table." The commission would report back after the 2010 election, with the prospect of "locking in a pledge for action." The conversation follows. And for the Post editorial board's response, read: Mr. Obama on Health Care.

President Obama: Hello.

Fred Hiatt: Hi.

Obama: Fred.

Hiatt: This is Fred Hiatt.

Obama: How are you?

Hiatt: Fine. How are you, Mr. President?

Obama: I'm doing fine.

Hiatt: Thank you for taking this time.

Obama: Absolutely. Let's talk health care.

Hiatt: Okay. What in your mind are the most important things Congress could do to bend the [cost] curve in health care?

Obama: Well, you know, I had a meeting not just with [Congressional Budget Office Director Doug] Elmendorf, but also with a number of other health economists this week, and they confirmed what I had been hearing and reading about and studying over the last several months -- there are a wide range of delivery system reforms that we can put in place that can make a difference.

We know that if the Mayo Clinic or Geisinger are doing things smarter for less money that there should be ways to incentivize other health systems, applying these models. So that's one set of major reforms. And what we think is the most powerful lever to achieve those reforms is this MedPAC idea that we provided a very detailed proposal to Congress on.

At this point, I am confident that both the House and the Senate bills will contain what we've been calling MedPAC on steroids, the idea that you continually present new ideas to change incentives, change the delivery system, understanding that because this is such a complex system we're not always going to get it exactly right the first time, and that there have to be a series of modifications over the course of a series of years, and we have to take that out of politics and make sure that an independent board of medical experts and health economists are providing packages that are continually improving the system. So I think there's general consensus that that is one of two very powerful levers to bend the cost curve.

Now, the second idea, which is the one that got more attention, even though Elmendorf, I think, has emphasized the benefits of a MedPAC board, as well, was the elimination of the tax exclusion [on employer-provided health insurance]. And I've been very clear on my position that I think to add additional costs to families right now when they're already seeing their premiums doubled is not the kind of health reform that I'd like to see, but I believe that there may be ways of getting at the same principle.

For example, you could conceivably set up an index of some sort that makes sure that health care inflation -- or to make sure that the exclusion only accommodates a certain amount of health care inflation -- as opposed to 8 percent or 9 percent, or what have you -- without burdening current plans, but over time assuming -- if we're assuming that health care inflation is going to continue to be a problem, that you could get at the problem in that way.

Continue reading their conversation here.