Obama on Health Care Bill: "I Own It"

This past week was a crucial one in the young presidency of Barack Obama. With public support for health care reform and his administration in decline, he decided to regain control over the debate with a speech before a joint session of Congress.

With concessions to intransigent Republicans, reinforcement for wavering Democrats, and even a few specifics for skeptical citizens, the president hoped to resuscitate plans for an overhaul of the medical system.

And when 60 Minutes correspondent Steve Kroft spoke with him Friday at the White House he seemed confident he had succeeded.

PRESIDENT BARACK OBAMA: Right.

KROFT: That the healthcare reform…

OBAMA: Right.

KROFT: …healthcare reform was in trouble.

OBAMA: Right.

KROFT: Do you think you changed some minds? Do you think you picked up some votes this week?

OBAMA: Well, here's a conversation I had with one of my advisors early on in this process: he said, 'I've been in this town a long time. I think this is the year we're gonna get healthcare done. But I guarantee you this will be pronounced dead at least four or five times before we finally get a bill passed.'"

KROFT: You're not getting much support from the Republicans and you've got some problems with people in your own party. Do you have enough votes to get a healthcare bill passed right now?

OBAMA: I believe that we will have enough votes to pass not just any healthcare bill, but a good healthcare bill that helps the American people, reduces costs, actually over the long-term controls our deficit. I'm confident that we've got that. Now, you're right.

So far we haven't gotten much cooperation from Republicans. And I think there're some who see this as a replay of 1993-94. You know, young president comes in, proposes healthcare. It crashes and burns and then the Republicans use that to win back the House in the subsequent election. And I think there are some people who are dusting off that playbook. In terms of the Democratic Party, they all understand we have to make this happen. We're not gonna get a better opportunity to solve our healthcare issues than we have right now. And that's why I'm confident that in the end we will get this done.

KROFT: One of the things that you said when you ran for president was that one of your talents was to be able to get people in a room with divergent opinions who were…yelling and screaming at each other. Get them to sit down and come to an agreement. Have you tried that on healthcare?

OBAMA: Yeah. Well, we tried very early on.

KROFT: Why hasn't it worked?

OBAMA: Well, I think right now, you've got just a political environment where there are those in the Republican Party who think the best thing to do is just to kill reform. That that will be good politics. And then there are some people who sincerely wanna see somethin' done, but have very different views and what I've tried to do is to make sure those in the latter category who don't just wanna kill something but actually wanna get somethin' done, that we are bringing them in and as open to their ideas as possible.

So for example, you know, tort reform. That's not something that historically has been popular in my party. But on Wednesday I specifically said that I think we can work together on a bipartisan basis to do something to reduce defensive medicine. Where doctors are worrying about lawsuits instead of worrying about patient care.

KROFT: If it came down to getting this plan passed would you be willing to do more in the area of tort reform and malpractice insurance? Would you be willing to agree to caps, for example, on malpractice judgments?

OBAMA: You know what I would be willing to do is to consider any ideas out there that would actually work in terms of reducing costs, improving the quality of patient care. So far the evidence I've seen is that caps will not do that. But there are a range of ideas that are out there, offered by doctors' organizations like the AMA, that I think we can explore.

You know, I intend to be president for a while and once bill passes, I own it. And if people look and say, 'You know what? This hasn't reduced my costs. My premiums are still going up 25 percent, insurance companies are still jerking me around,' I'm the one who's going to be held responsible."

KROFT: And the conventional wisdom has been that the reason that the House has always voted against any kind of malpractice reform or tort reform was because of the heavy contributions from the trial lawyers.

OBAMA: That is the conventional wisdom. And I think there's also been philosophical issues and differences about whether or not patients who really have been subject to negligence, whether it's fair to just say to them, "You know what? You can only get a certain amount, no matter how egregious it is."

KROFT: There is still a great deal of skepticism about how this plan is going to be paid for. What you promised is essentially you promised not to affect anybody who has coverage now at all. You have promised to add another 30 million people into the system. And you're saying that you can do all of this or want to do all this without impacting or increasing the deficit by a dime.

OBAMA: By a dime.

KROFT: How do you do that?

Obama: Well, here's how we do it. We spend over $2 trillion on healthcare every year. So we spend more per person on healthcare in this country than any other country by far.

So if we can just make some small changes that make the system more efficient, the waste and abuse, the money that's already being spent that's not making people healthier, that money can go to provide a better deal for those without insurance. And, over time, can actually reduce the cost for those who already have health insurance.

But there are thousands of details to be worked out, not to mention dozens of political deals, making it nearly impossible to accurately predict how much all of this might cost.

KROFT: You ran for this job saying that you were not a big spending liberal, and that you were definitely under no circumstances a socialist. (LAUGHTER) And I know that you inherited a unique set of circumstances. But in nine months, you've in effect nationalized two automobile companies, sections of the banking industry.

OBAMA: Ah, wait a minute.

KROFT: The country's largest…

OBAMA: Hold on, time out a second, Steve. Come on, now. Let's think about it. On the banking issue, when I walked in the banking system, the financial system was under the verge of collapse. And what have I done. I've essentially taken the program that was voted on by the previous Congress, supported by the previous Republican president, and we've made it work. So, that didn't originate under my watch.

With the auto companies, before I took office, Uncle Sam was writing them billions of dollars worth of checks without holding them accountable. And what we've said was, if you're going to get taxpayer money, then you've got to be accountable to taxpayers by restructuring.

What I think is a legitimate concern, because this did happen under my watch, is that we initiated a big recovery act. Eight hundred billion dollars. And the reason we did so was that every credible Democratic and Republican economist at the time when we came in said, "If we don't have a stimulus of some sort, then this is potentially gonna get a lot worse."

KROFT: But after doing all this, and continuing the policies, and spending incredible amounts of money, now, you're changing the health care system. I get the sense out there politically that some people are just sort of worn out. I mean, there's been so much change. And so much that people have sort of, that people are fatigued. And that you have to do all of this.

Obama: I think you are absolutely right. That this is a very difficult economic environment. People are feeling anxious. And we had to take a series of steps in circumstances obviously not of my choosing. And I think it is absolutely fair to say that people started feeling some sticker shock.

So there is an argument to be made out there that maybe health care can just wait. Because, you know, we've had to absorb a lot. The system's gone through a shock. Maybe we should just hold off until some other time.

KROFT: You were - people ask you this question - "Do we need to do all of this? Can't we scale some of this back?" And you could've said, "Yeah, Let's scale it back." But you didn't.

OBAMA: The problem I've got is that the only way I can get medium and long-term federal spending under control is if we do something about health care. Ironically, health care reform is critical to deficit reduction. I know it seems counterintuitive, 'cause people say, "Well, if we're spending more money on people who currently don't have health insurance, and we're giving credits to small businesses, and we're doing all these things, that's costing money. How can this be good for us?"

The biggest problem we have in our budget, as much as we've spent this year on crisis response, the biggest long-term problem we have - and everybody agrees with this - is the rising cost of Medicare and Medicaid.

The president says there is a broad consensus on what needs to be done, but there are also still serious disagreements over how to do it, and as he found out this past week they are not necessarily polite disagreements.

KROFT: I was talking to my CBS colleague, Bob Schieffer this morning. And we were talking about 9/11 and he was talking about the sense of unity he felt in the country on that day, and was comparing that to the situation we have now. When you were, I mean, you were heckled. Not at a town meeting. Not on the campaign trail, but in the joint session of Congress.

OBAMA: Actually, my town meetings, people were extraordinarily courteous. (LAUGHTER) Yeah.

KROFT: Were you surprised?

Obama: Well, Congressman Wilson, shouting out during my joint sessions speech was a surprise not just to me, but I think to a lot of his Republican colleagues. You know, said that it wasn't appropriate. He apologized afterwards, which I appreciated. I've said so.

Truth of the matter is that there has been I think a coarsening of our political dialogue. That I've been running against since I got into politics.

KROFT: Do you think that Congressman Wilson should be rebuked? There was talk about that today, and now he's claiming that he is a victim. That he's being attacked.

OBAMA: (LAUGHS) But see, this is part of what happens. I mean, it becomes a big circus instead of us focusing on health care.

KROFT: I think Bob Schieffer's point was that, I think he thought that…in some ways, this debate has brought out the worst in us.

OBAMA: Well…

KROFT: Not the best.

OBAMA: …well, I think you've got a convergence of things. Look, worst recession since the Great Depression. People feeling anxious. I think we're debating something that has always been a source of controversy, and that's not just health care, but also the structure, and the size, and the role of government. That's something that basically defines the left and the right in this country. And so, extremes on both sides get very agitated about that issue.

I will also say that in the era of 24-hour cable news cycles that the loudest, shrillest voices get the most attention. And so, one of the things I'm trying to figure out is, how can we make sure that civility is interesting. And, you know, hopefully, I will be a good model for the fact that, you know, you don't have to yell and holler to make your point, and to be passionate about your position.

KROFT: So, your goal to bring civility back to Washington is still a work in progress?

OBAMA: It's still a work in progress. No doubt about it.

Produced by Frank Devine and Michael Radutzky