Transcript: President Obama
On Friday, Sept. 11, 2009, 60 Minutes correspondent Steve Kroft interviewed President Barack Obama in the Blue Room of the White House. The interview took place just days after the president addressed a joint session of Congress about his health-care plan and at a crucial moment in Obama's young presidency. Below is a transcript of much of that interview.
STEVE KROFT: What were you specifically hoping to accomplish with the speech this week?
PRESIDENT BARACK OBAMA: Well, I think the most important thing was to make sure that American people understood the nature of the problem, what exactly I was proposing, to debunk some of the myths that had been floating around out there, and then to remind people that America can still do big things when we have to. When we've got big challenges ahead of us. So on the problem side of it, just making sure that people understand this is not just a problem of the 30 million American citizens without health insurance. It's also a problem for the hundreds of millions of folks who have insurance, because their costs are skyrocketing, their employers are undergoing enormous strain. It's a huge problem for our deficit. In fact it is the primary problem for our deficit. And it's making our businesses less competitive. So that was important.
The second I wanted to do was to make sure the people understood exactly what my plan does, which is to say, "If you've got insurance, we're not gonna legislate anything that would force you to change your doctor or change your plan." We are going to improve the stability and security of your plan by making sure that insurance companies can't eliminate you from a plan because of a preexisting condition. Can't impose arbitrary caps on the amount of costs of your care. Making sure that they are not using fine print to somehow increase your out-of-pocket expenses.
I want to make sure people understood that if you don't have health insurance or if you're a small business that wants to provide insurance to your employees, but just can't afford it right now -- because if you go into the market it costs you three times as much as big companies -- then you are going to be able to buy into an exchange, basically a marketplace, that gives you a range of options. And you will be able, because you're part of a bigger group, to get a better deal and save money. And for people who still can't afford it, we're going to provide you with a tax credit to give you some help so you can afford to buy it.
The third thing I wanted to do was to just disabuse some people of some crazy ideas. The notion that we've got death panels that would pull the plug on grandma. As I said before, that's a simple lie. The notion that we intend to cover illegal immigrants. I have said consistently that would be against the law, and so I'm going to repeat it here tonight. We are not going to be covering illegal immigrants. This notion that's been out there trying to scare seniors by saying somehow we're talking about cutting Medicare benefits. In fact this plan would strengthen Medicare and would help reduce the cost of prescription drugs for seniors by significant amounts.
And then the last thing I wanted to do was just remind people that, you know, anytime you try to do something big in Washington, there's gonna be controversy. Healthcare we've been debating since Theodore Roosevelt. But every time we've made progress, it's been because we've realized that the status quo was unsustainable, and somehow people of goodwill have come together after vigorous debate, sometimes angry debate, and gotten something done. And that's what happened in Social Security. You know, people said Social Security was a socialist program. Yet now it's the most important social program that we have to make sure that seniors are secure.
Said the same thing about Medicare. That this is going to be a government takeover of Medicare. Well, it turns out that if it weren't for Medicare, a lot of seniors out there would be completely out of luck. And so I wanted to provide a context to explain to people: it's always hard for us to make progress, but this is the right thing to do. Now is the time to do it.
KROFT: Before you made this speech, there was a sense clearly in the press and among people in Washington that this program was in trouble.
PRESIDENT OBAMA: Right.
KROFT: That the healthcare reform was in trouble.
PRESIDENT OBAMA: Right.
KROFT: Do you think that you do you think you changed some minds? Do you think you picked up some votes this week?
PRESIDENT 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 going to 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." And so in some ways we anticipated this was just going to be difficult. Look, you're talking about one-sixth of the economy. You've got a whole range of special interests out there that are profiting from the current system and don't want to see it change. You've got a continuing habit of polarization inside of Washington that's hard to break.
And so we knew this was going to be hard. And I think what is true is that as Congress moves forward with all its legislation, the sausage making process got a lot of people confused. They didn't know which bill was which and what the program was. It was important for me to provide some clarity. And as a consequence of the speech that I gave, I think now more people understand what the bill's about. I think there's still going to be some vigorous debate. I think there's still a lot of hard work to get to get done. But I think at least it focused people's attention on why this is so important and what exactly we're trying to do.
KROFT: You said that there were some cockamamie ideas out there about this plan that bore no resemblance to the truth.
PRESIDENT OBAMA: Right.
KROFT: Some people have faulted you for not being out there ahead of time talking more about what this plan did. That you let other people define it. That you, by turning the details over to Congress, let other people define the plan for you, and the opposition jumped in with some outlandish claims.
PRESIDENT OBAMA: Well, I think that our constitutional structure says I am head of the Executive Branch. Congress has a little bit to do with how (LAUGHS) we pass legislation. We're not going to get something done without Congress moving. And so it was important for all those committee to work through their processes.
We have seen unprecedented movement by Congress. We've got four out of the five committees have already done something. The fifth one is about to move. Just announced it. So we're further along than we ever have been.
The other thing that we've be able to achieve is we really have 80 percent of this package has some broad support across the spectrum in some very substantial areas. I think a lot of people, including Republicans, have said they believe in insurance reform, that it's not fair for somebody who's willing to pay premiums and get health insurance not to be able to get it. For example, one woman, you know, was in the middle of a double mastectomy and the insurance company said, "You didn't declare that you had acne so we're gonna cut you off." Well, I think people understand that's just not right.
I think there's broad agreement on the idea of setting up an exchange. So essentially people who don't have insurance right now -- they can't get it through the job, they don't have a big employer who can leverage a better price from the insurance companies -- they should be able to band together to essentially get a better deal. And that there should be some guidelines restricting what insurance companies do in that exchange. So I think there's broad agreement there.
And I think there's broad agreement that we have to reduce the cost of healthcare generally. And there're some ways of doing that. If we can improve the delivery systems so that, for example, doctors aren't providing five tests where one test would be sufficient if they just did a little coordination. Or if we made sure that hospitals are provided some incentives so that they get reimbursed more from Medicare if they don't have such high readmission rates. If they get it right the first time. Those are things that, across the spectrum, conservatives and liberals, agree to. So we've got that done. Now of course there is always gonna be some arguments remaining. And I welcome ideas from all sources. And I want a good debate about this.
What I don't want us to do is debate about things that aren't real because we have enough tough debates around things that are real. I don't want us to spend time debating you know, ridiculous notions that somehow there's going be some panel of government bureaucrats who are going to be determining whether or not grandma is able to get her medicine. I don't want government bureaucrats intervening in those decisions. I also don't want insurance bureaucrats intervening in those decisions. And that's what we're really pushing towards in this in this bill.
KROFT: You said there was some bipartisan support for 80 percent of what you want. You seem to be having some problems with people in your own party. Well, first of all, 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?
PRESIDENT 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, but, frankly, I haven't gotten the kind of cooperation I'd like from Republicans generally on a whole range of issues. And I think there're some who see this as a replay of 1993-1994. 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 play book.
But I also think that there're some people who sincerely want to solve this problem. They may not agree with every idea that I've put forward, but they're being constructive and they're engaging, and I really appreciate that, because it's not easy for them to do in the current political environment that they're in.
In terms of the Democratic Party, I think there is a unity about wanting to get this done. And there there's 98 percent agreement. There are some areas where there are some differences. But, you know, one of the interesting things that happens when you're a majority party, almost by definition, you've got a broader spectrum of views because you got folks who were elected from liberal states of liberal districts; you've got people who were elected from conservative states and conservative districts. They're all Democrats. They all understand we have to make this happen. We're not going to 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're gonna 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.
PRESIDENT OBAMA: Right.
KROFT: Get them to sit down and come to an agreement. Have you tried that on healthcare?
PRESIDENT OBAMA: Yeah. Well, I we tried very early on, in fact right here in the White House. That's how we kicked off our healthcare agenda was to bring all the stakeholders together and say, "Let's try to get something done."
KROFT: Why hasn't it worked?
PRESIDENT 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 will be good politics. And then there are some people who sincerely want to see something 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 want to kill something, but actually want to get something done -- that we are bringing them in and as open to their ideas as possible.
So, for example, 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. I don't think that's a silver bullet for our healthcare problem, but it is important to doctors. And it could have some impact on costs.
KROFT: What you suggested and put into effect was a pilot program George W. Bush had been working on and had suggested.
PRESIDENT OBAMA: Right.
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?
PRESIDENT OBAMA: 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 doctor's organizations like the AMA, that I think we can explore. And if somebody comes to me with a serious proposal on that front, or on any front, we want to incorporate.
Look, I have tried as much as possible in the plan that we've designed to make sure that the best ideas are out there. I have no interest in having a bill get passed that fails. That doesn't work. You know, I intend to be President for a while, and once this 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. So I have every incentive to get this right. And to the extent that I can find partners on the other side of the aisle who also want to get it right, they're going to have me right there beside them.
KROFT: 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.
PRESIDENT OBAMA: That's 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." So there's been a philosophical difference within the parties.
I think if you look at some of the ideas that are out there right now. For example, having medical experts who look at the case ahead of time so that there's some threshold that has to be met before the case goes to court. Getting essentially arbitration or mediation, where doctors and hospitals come forward early and talk to the patient in an honest way, not fearing a lawsuit and get it resolved. Which, by the way, can potentially help reduce medical errors.
You know, those are the kinds of things that I think we should be exploring, and I think we can get support both from Democrats and Republicans.
KROFT: There were just a couple of factual things that I wanted to talk to you about. You said in the speech -- this plan won't require you or your employer to change coverage or the doctor you've been seeing. The Boston Globe, for one, or pointed out that there's no guarantee that they won't have to change their plan or change their doctor either, because their employer could decide that they're going to change the plan.
PRESIDENT OBAMA: Well, let's be clear. Employers right now are changing plans with different networks all the time.
KROFT: Right.
PRESIDENT OBAMA: And that has nothing to do with my plan. That decisions that they're making about what's the best deal out there in the insurance market. What I said specifically on Wednesday in the speech is that there is nothing in the plan that I'm proposing -- no government action that's being taken -- that somehow forces people into different plans.
And the reason it was so important to make that point is there were a lot of people out there with the perception that somehow we were going to be setting up a government-run system for everybody, and people who got insurance from their employer that they were very happy with, that somehow they'd have to shift. When that is absolutely not true. It's something that we never proposed. I've been crystal clear about this from the start. Even before I had laid out my own plan, I had always said, as a principle, that we should not be forcing people who are happy with their health insurance to switch. But this is an example of the rhetoric that's been out there about government takeovers of healthcare that really had to be dispelled.
KROFT: But there will be no guarantee, what happens to the plan, that people are going to be able to keep their coverage or their doctor . . . .
PRESIDENT OBAMA: Well, here's the guarantee. The guarantee is that if you lose your job or you change jobs or you want to start your own business, you'll be able to get coverage. You know, Steve, your doctor could be elderly and decide he wants to retire to Florida, and I can't force him to keep on treating you. So there're going to be changes that would have been taking place anyway.
But the security we're providing is to say that if you've got health insurance on the job, you're a lot more likely to keep it if we can control costs and your employer is not seeing a 48 percent increase in premiums, like a small business owner wrote to me just three days ago. He said his premiums for his employees had jumped 48 percent. He said, "I don't know what to do. At some point I'm just gonna have to stop providing insurance for my employees." Now that's happening more and more.
The census data shows that six million more people lost healthcare last year. It's about 17,000 people a day on average lost their healthcare. Some of those folks may be 55. Pre-retirement. They can't yet qualify for Medicare. They're having trouble in this economic environment potentially finding a job. They probably have a few pre-existing conditions that make them expensive to cover. And in this environment right now, they can be out of luck.
And the thing that I'm trying to make sure people understand is that the vulnerability that we have to not being covered is higher than it has been in the past. And the best chance we have of making sure that you don't have to change your doctor or change your plan, that you can keep your employer-based insurance, is if we reform the system. 'Cause if we do nothing, I guarantee you more employers are going to be thinking the same way that small business owner's thinking, which is: "I want to do right by my employees, but there is no economic way that I can do it. The costs here are just goin' up too fast."
Now what he may do is he may just push more of those costs onto the employee and say, "You know what? You got to pay a much higher premium. You got much higher out of pocket costs." But families are already feeling a crunch in this recession. And they're going to say to themselves, "Maybe I we can't afford coverage after all." Those are the choices we want to avoid people having to make, and that's why reform is so important.
KROFT: There is still a great deal of skepticism about how this plan is going to be paid for. And 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.
PRESIDENT OBAMA: By a dime.
KROFT: How do you do that?
PRESIDENT 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. Over one-and-a-half times more. Thousands of dollars more per person.
KROFT: Right.
PRESIDENT OBAMA: So if we can just make some small changes that make the system more efficient -- the waste and abuse, this 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 to those who already have health insurance.
So let me give you a specific example. And that's our Medicare system. Now this is an area where there's been a lot of demagoguery and distortion, so I want to be clear exactly what we're doing here. If you are on Medicare your benefits will not be cut at all by this plan. Nobody's talking about cutting benefits. So I just want to repeat that. We're not going to take a single dollar out of the Medicare trust fund.
KROFT: But you are taking about cutting like a half a trillion dollars over a 10 year period, right?
PRESIDENT OBAMA: Let me give you some examples of what we're talking about. We've got subsidies to insurance companies that are profitable because we don't make them compete for essentially the Medicare HMOs that they operate. Just competitive bidding on that front would save us tens of billions of dollars. Just doing that, which is common sense. Making sure that in how we reimburse hospitals, that they are treating their patients well the first time so that they're not forcing seniors who have gotten sick to go back for multiple visits for the same ailment when that wasn't necessary. That could save us huge amounts of money.
You yourself are aware of the amount of fraud and abuse that is taking place in the Medicare system right now. Those are billions of dollars that don't improve patient care, that don't have to do with Medicare benefits, that we could take and make sure not only are seniors getting a better deal on their prescription drugs, but that we're also making the overall system healthier. And that will actually stabilize the cost of Medicare over the long-term.
One of the things I'm worried about is Medicare is slated right now to go into the red in eight years because, frankly, we are just not spending that money as wisely as we should. There are examples of that in Medicare. There are examples of that in Medicaid. And there are huge examples of that in the private system. And that's what's driving so may so much of this cost.
Now I just want to be clear: approximately two-thirds of the plan that I'm proposing will be paid for from those savings. We are going to also then charge a fee on insurance companies who have these gold-plated Cadillac plans that aren't actually improving people's healthcare significantly.
KROFT: That's part of the Senate finance committee's . . . .
PRESIDENT OBAMA: That's part of the Senate's finance committee bill. That will add substantially. We've put a whole menu of things that don't involve middle class tax hikes that that are primarily coming from within the healthcare system as it is and it will be paid for.
Let me just point this out, 'cause I think you know, there's been a lot of talk about how, you know, we are not thinking about the deficit here. Number one, when I say that this plan is paid for, that is contrary to what's been done for the last eight years. The last time we had a big healthcare program coming out of Congress under the previous administration was a prescription drug bill that was not paid for. That's part of the reason I inherited the kind of deficit that I inherited. So we are going to not make that same mistake on healthcare. We're going to make sure that it's paid for.
The second point I'd make, and I said this on Wednesday in the speech, we spend so much on Medicare and Medicaid that if we just reduced the cost of healthcare inflation, by one-tenth of one percent -- if we just made sure that it wasn't going up as fast, reduced it by one-tenth of one percent -- that would alone would save us $4 trillion in our deficit.
Now nobody disputes this. There are some questions about, "Well, how exactly are you going to reduce healthcare costs? You know, can you get all these doctors and hospitals to adopt some of the new systems that are out there to make sure that they're more efficient and that they're giving a better deal to patients. And it's going to take time, which is why this program wouldn't start immediately. It would start in four years' time. It's gonna take time to develop that. But I'm absolute confident that we can do it. And if we don't do, we're guaranteed to bankrupt the federal government along with families and businesses.
That's one of the functions of the independent commission. Because the medical experts tell me, you know, you're not going get this all on the first try. We know the Mayo Clinic or the Cleveland Clinic do all this great work. Great care, lower cost. But the question is, how do you distribute that across the system? And [what] kinds of incentives can you give to different hospitals, and different doctors, and different providers to make sure that they're emulating some of those best practices. That's gonna be something that you do on a year-by-year basis. You try some things, you see how that works.
And so, this medical commission that we've talked about setting about -- which has support from Republican-leaning health experts as well as Democratic-leaning health experts -- would basically look at best practices, best models, systems that are providing the best care to patients for the lowest cost. And then, making recommendations as to how we can start duplicating some of those best practices.
KROFT: Is the commission part of this bill?
PRESIDENT OBAMA: Yes.
KROFT: My impression and I think the impression of a lot of people is that this bill is very much concentrated on expanding coverage to people that don't have it. And less specific when it comes to actually reducing costs. Now, you've spoken very forcefully on the on the need to reduce costs.
PRESIDENT OBAMA: Right.
KROFT: Why did you decide not to tackle the question of cost first? And the question of universal coverage and expanding coverage later on?
PRESIDENT OBAMA: Well keep in mind that there are three different components to this. We had talked about making sure the people who don't have coverage are able to access coverage. We've also talked about making sure the people who do have coverage are getting good deal. Essentially, consumer protections for you or I, if we've got insurance already. And we've been very specific about that. So, for example, making sure that people with quote/unquote "preexisting conditions" can get care. That's something that we've been talking about for months now.
It turns out that you can't get some of these insurance reforms done unless those people who currently don't have coverage get coverage. Because insurance companies right now, what they'll argue is, "You know what, if I have to take any comers who buy insurance, but there are a whole bunch of people out there who might be very expensive to cover, that's gonna be a real problem for us unless we've got all these new customers." And so, some of these things have to be done at the same time.
Now, when it comes to reducing costs, we have said from the start that any good idea out there -- in terms of improving quality of care, making sure that patients are uppermost on the minds of providers, and doing so, by the way, not by rationing, as has been accused, but simply making sure that people are getting a better bang for their health care dollar. That's been something that we've emphasized from the start. And we've been very specific in terms of a number of ways of doing it.
We were the ones who suggested this idea of an independent commission made up of doctors and medical experts, who could provide recommendations about taking best practices and making sure that everybody benefitted from those things. And a whole range of different ideas about cost savings that have been put forward, we have said, have to be in the bill. We've embraced them.
Nobody's got a bigger stake in making sure that we are actually seeing cost reductions, because, you know, if in three years or four years or five years time, should I be reelected, and people say, "Gosh, you know, my health care cost has still gone up 50 percent, Mister President." I'm the one who's going to be responsible.
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. 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.
PRESIDENT OBAMA: Ah, wait a minute.
KROFT: The country's largest . . . .
PRESIDENT 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 his Treasury Secretary, and we've made it work. So, that didn't originate under my watch.
KROFT: And neither did the nationalization of the country's largest insurance agent.
PRESIDENT OBAMA: Exactly. When AIG happened, that didn't happen on my watch. We tried to make it work. 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, "You know what, this is not gonna be a good deal for consumers if every six months, we have to write you a $10 billion or $5 billion dollar check to keep you operating. So, if you're going to get taxpayer money, then you've got to be accountable to taxpayers by a restructuring."
The fact is that I inherited the worst economy since the Great Depression. And I inherited programs that had been initiated before I took office. The ones that are most unpopular had started under the previous administration. And what we've done is try to make sure that they work effectively. And as a consequence of the steps that we've taken, what we've seen is that a year after Lehman's collapsed, and this economic crisis started, it's fair to say that every economist out there is saying we have pulled back from the brink, and that we might even actually go into positive growth sometime in the next few months.
What I think is a legitimate concern, because this did happen under my watch, is that we initiated a big recovery act. That was a lot of money. 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 going to get a lot worse."
And now, eight months afterwards, the vast majority of economists out there are saying, "You know what, as a consequence of the stimulus, that probably helped to cushion the blow, and we probably got an additional two percent or so of growth because of it." Not to mention the fact that you had a whole bunch of people out there who got unemployment insurance after they were laid off from their jobs. A whole bunch of people were able to keep their health care after they lost their jobs. A whole bunch of states got the kind of revenues that prevented them from having to lay off teachers and cops.
So, I am happy to defend the choices that we made in a very difficult environment. And the proof is that right now, the economy, after a very trying time, has stabilized. We're not out of the woods yet. And everybody out there who's still having a tough time knows it. But we are moving in a direction where I think we can actually start seeing some positive growth.
KROFT: As I said, there was an unusual set of set of circumstances. But after doing all this, and continuing the policies, and spending incredible amounts of money I mean, amounts of money that people couldn't even get their mind around a few years ago. 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, it's there's been so much change.
PRESIDENT OBAMA: Look . . . .
KROFT: 02:08:57:00 And so much that people have -- people are fatigued. And yet, you have to do all of this.
PRESIDENT 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 not in circumstances, obviously, not of my choosing. And in a situation where we weren't very well prepared for it, because we already had a $1.3 trillion deficit that I inherited.
And I think it is absolutely fair to say that people started feeling some sticker shock. After a while, they just sort of felt like, "Gosh, you got the banks, you got the autos, you got AIG, you got, you know, two wars that we're still paying for. And it just seems like an awful lot." And so, there is an argument to be made out there that that maybe health care can just wait. Because, you know, we 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: People ask you this question. And I probably asked you this question when you first came in. Look, things are things are really difficult. We don't have as much money as we had. Do we need to do all of this? Can't we scale some of this back? And you could've said, "Let's scale it back." But you didn't.
PRESIDENT 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, because 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.
Now, if I can't control that in some way, or future Presidents can't control that in a serious way, then it doesn't matter that we did the Recovery Act. It doesn't matter there Congress is still trying to get earmarks in bills. Those are all tiny compared to the amount of outlays for health care. And so, what we've got to do is try to bring down health care inflation. And make some serious choices about deficit reduction outside of the health care system.
It is important to understand that if we start, for example, cutting support to states right now when they are in crisis, that could potentially plunge us back into a double-dip recession. So, you know, we're trying to thread the needle, get through this very difficult time, make sure that individuals and states get the support they need to bounce back and grow again. Once we get economic growth, that will improve the deficit picture. And what I also have to keep my eye on is medium- and long-term, how do we start controlling health care cost. And if we don't start now, then it could end up being too late.
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. I mean, you were heckled. Not at a town meeting. Not on the campaign trail, but on in the joint session of Congress.
PRESIDENT OBAMA: Actually, my town meetings, people were extraordinarily courteous. (LAUGHTER) Yeah.
KROFT: Were you surprised?
PRESIDENT OBAMA: Well, Congressman [Joe] Wilson shouting out during my joint sessions speech was a surprise not just to me, but I think a lot of his Republican colleagues who, you know, said that it wasn't appropriate. He apologized afterwards, which I think I appreciated, and I I've said so.
The truth of the matter is that there has been, I think, a coarsening of our political dialog that I've been running against since I got into politics. I mean, I still remember in the speech that I gave announcing that I was running for President. I said, "We can disagree without being disagreeable." And I think that the vast majority of the American people, that's exactly what they want. You know, they want people to be polite; they want people to listen to each other. They want people to engage in serious, vigorous debate, and passionate debate. But they want to make sure that it doesn't get personal. That people's motives aren't questioned.
I think that over time, I'm confident that because that's what the American people want, our politics will return to that tone. And I'm going keep on trying to set the tone as President, even if sometimes I get hollered at.
KROFT: I think Bob Schieffer's point was that he thought that in some ways, this debate has brought out the worst in us. Not the best.
PRESIDENT 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, as I pointed out on my speech on Wednesday, 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. I mean, let's take these town halls. As I've said, I had four of them. And there were people in there who disagreed with me. But all of them were courteous. All of them listened to each other.
I kept on looking for somebody to yell at me, so that I could sort of sort of engage in these folks that you were seeing on TV. That wasn't our experience. And if you go to a lot of members of Congress, and you ask them, "What was going on at some of these town hall meetings?" They'd say, "Eighty percent of the folks who were there were there to listen, to try to figure out how we can solve this problem." But you never saw those folks on TV, because it was boring.
And so, one of the things I'm trying to figure out is, how can we make sure that civility is interesting. (LAUGHTER) 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?
PRESIDENT OBAMA: It's still a work in progress. No doubt about it.
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.
PRESIDENT OBAMA: Well, see, this is part of what happens. I mean, it becomes a big circus instead of us focusing on health care. You know, this is a story that people will run with for a week. In the meantime, we stopped having a serious debate about how are we going to make sure that insurance companies who don't treat their customers right are checked. That's the conversation I want to have.
KROFT: There are people that think the most difficult problems about our health care system -- which in many respects is a complete mess -- that the real problems are not really being dealt with in this bill. Some of them are not being dealt with. And you acknowledged the other night, when you said, "I decided that we're gonna deal with the system that with the system that is in place." I want to talk a little bit about end-of-life care, because that's where a huge percentage of our health care dollars are spent. We have the ability now as a country to keep anybody alive for a long period of time, with very little prospect of ever getting better. At huge cost to the American taxpayer. Can that go on indefinitely?
PRESIDENT OBAMA: Well I just went through this. My grandmother -- who helped raise me and was as responsible as anybody for my success in life -- she passed away, as you know, last year. Right before the election. She already had terminal cancer. She was still struggling to deal with a range of health problems.
But one thing that she had done is she had put together a living will so that she was in control of these decisions. It wasn't something that either me or my sister had to guess about. And that allowed her to handle the end of her life with the kind of dignity that she had lived her life.
And, you know, I think that to the extent that there are voluntary tools available for people to think ahead, even when they're in their 30s, and their 40s, about how do I want to handle this, that gives the power to individuals. And it makes sure that nobody else is making decisions for you.
Now, ironically, it was a provision in one of the House bills, not in my plan, but one of the House bills that called for Medicare to reimburse people for counseling on how to set up things like a living will that the rumor of death panels came up. Which I think points out how sensitive this particular issue is, and it's understandable that it's sensitive. Because, you know, nobody wants to think that some bureaucrat somewhere, whether it's an insurance company bureaucrat or a government bureaucrat, is making decisions about our loved ones when they get sick.
That's why the more we can give power to people ahead of time to make decisions, the better off we're going to be. This, by the way, used to be a bipartisan idea. Republicans had actually promoted this, you know, counseling for living wills or decision making for terminally ill patients. It became politicized during the course of the debate over the last few months. What I'd like to see is just makings sure that people have control over their own situation.
KROFT: But that provision has been pulled from the bill. Why?
PRESIDENT OBAMA: Frankly, I think the manner in which this got so distorted I think scared folks off. And that's why it was so important for me on Wednesday to call people out, and say this idea that somehow, you know, government bureaucrats somewhere are going be making life and death decisions about who lives and who dies particularly effecting seniors is offensive. And when I think about those kinds of blatant lies being introduced into the political discourse, particularly when I've just gone through something as painful as the loss of my grandmother, it's upsetting, and I think it's something that that we've got to squarely address.
KROFT: You had your grandmother also had hip replacement surgery.
PRESIDENT OBAMA: Right.
KROFT: Was that paid for by Medicare or paid for by . . .
PRESIDENT OBAMA: You know, she had a combination of Medicare, but she also had a very good health plan from her retirement from her from her job. So, she was covered across the board. And that was a decision that she made and I think needed to be respected. And as I said before, the key is to make sure that people are in a position to make these decisions ahead of time.
Unfortunately, all too often you know, people aren't given the information that they need to be able to make these good decisions ahead of time, and that's something that I think as a society, would be smart to do. What I don't want is anybody to get some idea that somehow this is something that either government or insurance bureaucrats should be deciding on, because I think one aspect of the American character that I have a lot of confidence in is [that] when you empower people to make these choices, they'll make the choices.