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 an excerpt of the full transcript, which will be published on TIME.com on July 30.
TIME: So how much of your day are you spending on this?
President Obama: 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 pre-existing 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.
And would a co-op fit that definition?
Well, I think in theory you can imagine a cooperative meeting that definition. Obviously sort of the legal structure of it is less important than practically how can it operate. There are concerns that in the past, attempts at setting up co-ops have not been successful because they just haven't been able to get off the ground; sort of the start-up energy involved may not exist if you're doing a state-by-state co-op effort as opposed to a broad national plan.
But to go to your earlier question, I guess — and I also said at the beginning that it was very important for us to alter delivery systems so that we could reduce costs. And as the process has moved forward, we have further refined those aspects of the system that can be changed to deliver more bang for the buck.
Well, you know, a few months ago, when you brought up your own grandmother's situation [she decided to get an expensive hip replacement operation, even though she was terminally ill], I mean, it was, I think, painful and personal because every family, if they haven't hit some wrenching decision like this, is going to. As you think back on that, I mean, was that the right [medical] decision? Is this the — for your family, for her? Is this the kind of thing that a reformed system, as you see it, would change the dynamic of that decision?
You know, first of all, unlike my mother, who had a difficult time with her cancer in part because her insurance was a little bit unreliable and she had just taken a new job, my grandmother had been signed up under Kaiser Permanente for years. And it's actually one of the models of high-quality, cost-efficient care that's out there right now, partly because they maintain such a stable base of patients and they construct a whole team approach that has proven to be very effective.
So my grandmother was generally very happy with her care, and if we could actually get our health-care system across the board to hit the efficiency levels of a Kaiser Permanente or a Cleveland Clinic or a Mayo or a Geisinger, we actually would have solved our problems.
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