TIME's Exclusive Interview with President Obama

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Brooks Kraft / Corbis for TIME

President Barack Obama

(5 of 6)

I've noticed that you're lately referring to it as health insurance reform.
Well, I think partly because we're just trying to provide some additional definition. Now, I do think that some of the insurance reform proposals are easier for people to understand. So if you just say insurance companies can't block you from getting insurance because of a preexisting condition, people I think are familiar enough with those issues that it immediately resonates with them personally.

Some of these other issues, when it comes to the discussion we just had about delivery systems, get more complicated.

And how do you think the fact that you're trying — on the one hand I thought trying to do this in a middle of a recession, when everybody is looking at people around them losing their jobs would sort of make people more anxious for something to grab onto that would seem secure. The polling would suggest that people —
It's not true.

Why is that? Or is that the case? Or is it because of the bailout or —
Here's what I think has happened. I think that we came in and had to take a series of emergency measures to stabilize the economy, and that meant a recovery package that was $800 billion. As circumstances had it, President Bush and the previous Congress hadn't dealt with their budget so we had an omnibus that had earmarks in it which got publicized. Then you had our budget that we had to introduce, that even though it actually reduced long-term budget projections, we had still inherited a $9 trillion deficit — so that number gets put out there. Then you add the supplemental, which even though the majority of the American people certainly still support making sure that our troops are safe and well-equipped, that was a big chunk of money.

So you have — and then obviously the TARP bank bailout money — didn't happen under our watch, but we had to administer it. We then took on making sure that GM and Chrysler didn't collapse, because that would have potentially created additional fear in the marketplace at a time when the economy was most vulnerable. But that got advertised.

So you add that all together and I think the American people's feeling for six months was, gosh, that's just a lot of stuff; that's a big load to take on — which then gives traction to this notion that we are interested in expanding government; which then feeds into suspicions that somehow health care is another big government project that we can't afford. And it's very hard, particularly when the figures get thrown out there — "This is going to cost $1 trillion" — even though it's $1 trillion over 10 years, even though we've identified $600 billion of the trillion dollars so that we're really talking about raising somewhere between $300 and $400 billion over 10 years, or $30 or $40 billion a year, which with very modest changes to the tax code could be easily paid for and would pay significant dividends. It's still — in people's minds it's just a big expensive thing that may end up resulting in me paying more taxes.

So ideally if — you know, you asked earlier about tactics. Had we not been in the worst financial crisis since the Great Depression I would have led with health care reform, made the case, and potentially we might have had it done by now.

But I disagree with this idea that because of the financial crisis somehow we can afford to put this off. In some ways I think it's just made it more urgent for some of the reasons you just said: A lot more people are losing their jobs, are vulnerable to losing their health care; our deficits are even bigger, which means the load on Medicare and Medicaid is just going to get worse. If we don't do this now we are going to be in a world of hurt later.

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