Mr. Obama said he doesn’t support a plan to set up Medicaid reimbursement for end-of-life counseling that has stirred widespread controversy.
The president said provisions in one version of the plan in Congress led to false criticisms that Congress was going to set up “death panels that would basically pull the plug on grandma because we have decided it’s too expensive to let her live anymore.”
Arguing that “the status quo is not working for you,” Mr. Obama said the United States is spending more per capita by thousands each year than any other country and “we are not healthier for it.”
He told the crowd that, under his plan, “insurance companies would be prohibited from denying coverage because of a person’s medical history. Period.
“They will not be able to drop your coverage if you get sick. They will not be able to water down your coverage when you need it,” the president said.
He said he is not calling for a single-payer plan favored by some because a transition to such a system before it is properly set up would be “too disruptive” and potentially destructive by forcing people to give up current coverage for an entirely new system.
“I am promoting a plan that will ensure that every single person is able to get health insurance at an affordable price and that if they have health insurance, they are getting a good deal from the insurance company,” he said. “That’s what I am fighting for.”
The president called for a rational debate on “things that are real.” He argued that the plan would help small businesses and their employees get cheaper insurance by putting them into large insurance coverage pools. He said many have heard the plan could cost $800 billion to $1 trillion, and that is the cost over 10 years, not each year.
He said the plan would cost $80 billion to $100 billion annually, and he would not sign a bill that added to the national debt or budget deficit.
Mr. Obama said he would generate $177 billion by eliminating insurance company subsidies, and rely on $500 billion to $600 billion in savings from more efficient medical care and by eliminating things such as redundant medical tests. He said conversion to electronic medical records would allow doctors to easily share medical records and test results so each doctor, specialist and then the hospital treating a patient would not repeat the same tests at each step of the care.
He said that leaves a cost of $30 billion to $40 billion annually to cover those who are uninsured, “and we will need new sources of revenue to pay for it.” He has proposed limiting charitable and other itemized income tax deductions for those earning more than $250,000 to cover those costs. He said there is no agreement yet in Congress and they are “still exploring” how to pay for it.
Recalling a pledge that he would not raise taxes on middle class families, made during the New Hampshire primary last year, the president said he is not backing off that commitment. “I don’t want anybody saying somehow that I am pulling a bait and switch here,” he told a young man who had asked how the plan would be funded without middle class tax hikes.
Outside, meanwhile, hundreds of demonstrators on both sides of the issue lined the entrance road to the school, standing for hours in the sun, waving signs and loudly chanting slogans.
Confirming the president’s concerns about the “death panel,” one young blonde woman carried a sign stating, “Obama lies. Grandma dies. Stop nationalized health care.” Across the street, another carried a sign supporting the president’s plan that said: “Insurance companies are enemies of change.”
Some opponents said they wanted to keep government out of health insurance. “Reform yes. Government takeover, no way,” touted another signboard. When the president’s motorcade arrived via a rear access road, opponents frustrated that he didn’t drive past their demonstrations chanted, “Back Door Obama.”
Nancy Wright and her husband, Jim Leiterman, formerly of Spencer, Mass., who have retired to North Conway, said they believe the government is moving too fast, especially on the heels of the unprecedented economic bailout and economic stimulus programs.
“He’s moving too quickly. He is spending our money too quickly,” said Ms. Wright, adding she believes the president should tackle the immigration problem before health care. She said health care reforms are needed. “But I don’t want the government involved in my health care,” she said, sporting a bright yellow N.H. Tea Party Coalition T-shirt.
Terry Wright, who drove to the event from Maine, said she would like to see universal coverage and thinks the nation can afford it. “If we stop spending billions on advertising and lobbyists, we would have more money for health care,” she said.
The president criticized some congressional opponents of the plan, saying they approved a drug coverage bill last year without finding a way to pay for it first and that it has worsened the budget crisis in Washington.
Asked about government panels that could restrict medical treatments, Mr. Obama said a panel of doctors and health experts would set guidelines for the most appropriate methods of care, and that is needed to eliminate wasteful practices.
He used the example of diabetes patients, saying currently insurers will only pay a “pittance” for a family doctor to monitor medication and diet of diabetes patients that can prevent costly problems later. But he said the insurance companies do not hesitate to pay $30,000 for a foot amputation for a diabetic who does not get good preventive care.
“Why not make sure we are reimbursing the care that can prevent the amputation?” he asked, saying changes are needed in medical reimbursement policies.
Mr. Obama also voiced objections to media distortions driving opposition to the reforms. When a man told him he had “turned myself in” by identifying himself on the White House Web site for health care questions as a “skeptic,” the president interrupted him to explain the White House was asking people to send e-mails with criticisms of the plan so they could be answered.
“Suddenly, on some of these news outlets, this is being portrayed as Obama is collecting an enemies list. Now come on, guys, here I am trying to be responsive to questions being raised out there,” the president said.
The president said he liked the man’s question about why he doesn’t criticize Congress for their plush health plan, while others suffer with lesser insurance programs. The president added that he agreed with the man’s point.
Mr. Obama said without health care reform, the gap will widen between plans like those that federal workers have and those of others.