"That's right. I'm talking to you liberal bleeding hearts out there," he told his forum on health reform. "Don't think that we can solve this problem without tackling costs. And that may make some in the progressive community uncomfortable, but it's got to be dealt with."
Without question, he supports expanding health care coverage to the 46-million Americans who lack it. He calls it a "moral imperative." But he warned that the upfront costs of such a program could doom it to failure.
"If people think that we can simply take everybody who's not insured and load them up in a system where costs are out of control, it's not going to happen. We will run out of money. The federal government will be bankrupt. State governments will be bankrupt."
In the long run, he said, universal coverage will bring down health care costs in America. But priming the pump won't be easy.
"Nothing is harder in politics than doing something now that costs money – in order to gain benefits 20 years from now," he said. "It's the single hardest thing to do in politics and that's part of the reason why health care reform has consistently broken down."
Above all else, President Obama wants to avoid the missteps and pitfalls that killed the health care reform plan put forward early in Bill Clinton's presidency. That effort of 16 years ago, led by then-First Lady Hillary Clinton, still casts a long, dark shadow.
And though Mr. Obama was stern about the fiscal factors involved, he made it clear his own heart bleeds for those without health care. Of the 40,000 letters he gets each day, he said ten make it to his desk. And on average, he said, three come from people telling him about a health care crisis in their lives. "Heartbreaking stories," he called them.
"Having said that, if we don't address costs, I don't care how heartfelt our efforts are, we will not get this done."
In the federal budget plan he unveiled last week, President Obama is making a down payment of $634-billion dollars to help implement his health care plan over the next ten years.
"I don't think that we can expand coverage on the front end without some money," he told the forum. "By definition, we will not have changed the system sufficiently to drive down costs, in order to pay for new people being part of the system."
What he's trying to do in this debate, he said, "is make sure that we're focused not just on year one and year two, but on year 10, year 20, year 30 and year 50, and making sure that our children are not bankrupted."
Participants in today's forum praised the president for his passion in pursuit of health care reform. The point Mr. Obama repeatedly tried to make today was that passion won't be enough.
That same budget with the set-aside for health care, already calls for $4.4-trillion in deficits over the next four years.