TIME's Exclusive Interview with President Obama

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Brooks Kraft / Corbis for TIME

President Barack Obama

TIME senior writer Karen Tumulty sat down with President Barack Obama on Tuesday afternoon to talk about his work both in public and behind the scenes to push a health-care-reform measure through Congress. Here's the full transcript.

TIME: I thought I'd talk to you a little bit about just sort of the whole degree to which this is really a test of leadership, health care is, as much as anything. And last year at the news conference, when somebody asked you — it was almost a flip question — whose job is this, you said, "It's my job, I'm the President." But the fact is that no President has been able to pull off anything of this order of magnitude in 44 years.
President Obama:

And I understand that you've thought a lot and studied a lot, and that a few weeks ago, in fact, even Nancy-Ann [DeParle, the White House health czar] brought you a memo as to sort of just how LBJ pulled this off — not just making the case for it publicly, but really making the gears of government run. What of that experience speaks to this experience?
Well, as you point out, the last time we did something of this magnitude was 1965. And the circumstances in some cases were similar, in some cases were profoundly different. Obviously LBJ had just won a landslide reelection and had huge majorities in the Senate and the House. We have the largest Democratic majorities since LBJ. But the way that Congress works is a little bit different today than it was then. LBJ had to negotiate with Wilbur Mills and a handful of other folks. I think that Congress is more splintered. I think each member of Congress is a little more independent from party than they might have been in the past. I think the nature of the Republican opposition has changed. Today it's much more concentrated on the conservative end. And Medicare and Medicaid had been ideas first introduced by JFK, and his assassination obviously provided enormous emotional push that is different from today.

Having said that, I think in both circumstances, as President, you have to help make — help to make the case publicly, but then you also have to work through a wide range of divergent interests — geographical, ideological — and that involves combining firmness of purpose with some flexibility to get the job done. Whether we've struck that right balance we'll find out in the next couple of months.

So how much of your day are you spending on this?
Well, I think over the last two, three weeks I'd say I'm spending at least a third of my day focused on it. Now, that can manifest itself in different ways. Certainly we spend a lot of time with our health care team talking both policy and politics. I'm reaching out to members of Congress, meeting with them or talking to them on the phone to get their perspectives. Speaking to the public is absolutely critical, and so today, for example, I was over at AARP trying to answer questions of the public.

So whenever we're in the middle of a big legislative effort like this, it's going to attract a lot of my attention, as well as my team's attention.

Well, of all the big decisions that you've made strategically, one of the most important was really to lay out the broad principles and let Congress figure out how to get there. Could you talk to me a little bit about how and when you made that decision, and why you decided — because there are a lot of people right now on Capitol Hill who are saying, we need more from him; he's got to tell us what — where his bright red lines are on this.
The truth is we've actually, I think, provided more guidance than has been advertised. I mean, if you think about how we've moved this forward, we didn't simply put out some broad principles; we were fairly specific. We said we need to have insurance reform, and that's going to include things like preventing insurers from dropping people because of preexisting conditions. We said that we are going to need to expand coverage; that an insurance exchange that would provide people a menu of options was an important mechanism to expand choice and help to deliver help to people who didn't have health insurance or were underinsured. We talked about the need for a public option as part of that health care exchange.

Although you didn't define what a public option really is.
I would say, Karen, actually we defined it fairly clearly in terms of what we thought would work best. What I said was, is that it shouldn't be something that's simply a taxpayer-subsidized system that wasn't accountable, but rather had to be self-sustaining through premiums and that had to compete with private insurers.

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