CHICAGO AND WASHINGTON — President Obama on Monday made his most detailed pitch yet for a $1-trillion overhaul of the nation's burdened healthcare system, calling it a "ticking time bomb" that threatens the nation's prosperity.
Throughout his speech to the nation's largest doctors group, Obama sought to inoculate himself against opponents who have suggested his proposal would amount to a government takeover of healthcare.
"We are spending over $2 trillion a year on healthcare, almost 50% more per person than the next most costly nation," he told 2,200 people, including more than 1,200 physicians, at the American Medical Assn.'s annual meeting in Chicago. "For all this spending, more of our citizens are uninsured, the quality of our care is often lower, and we aren't any healthier."
Obama tried to preserve an emerging consensus that the time might be right to overhaul the nation's healthcare system. But that has become increasingly challenging as he and his congressional allies begin to outline more specific policy prescriptions that may expand the private insurer's role.
"Let me also address an illegitimate concern that's being put forward by those who are claiming that a public option is somehow a Trojan horse for a single-payer system," Obama said. "But I believe, and I've taken some flak from members of my own party for this belief, that it's important for our reform efforts to build on our traditions here in the United States."
The challenges of advancing major healthcare legislation were underscored Monday by a preliminary report from the nonpartisan Congressional Budget Office, which estimated that the first major Democratic health bill -- prepared by Sen. Edward M. Kennedy (D-Mass.) -- could cost about $1 trillion over the next decade, while covering only about 16 million more people.
There are more than 46 million people in America without health coverage.
The office also estimated, in a six-page letter to Kennedy, that the number of people getting healthcare from their employer would decline by about 10%, or 15 million individuals, as people switched to a new insurance exchange.
Those numbers will almost certainly change as the legislation is adjusted by lawmakers in coming months. But the letter is already fueling GOP charges that the changes being pushed by Democrats would undermine the existing employer-based healthcare system.
Over the weekend, Obama proposed more than $300 billion in cuts in spending on the Medicare health insurance program for the elderly and Medicaid for the poor.
But the president told the AMA that the cuts would lead to better care and lower costs because they would reflect increased efficiencies in the system. And once the uninsured had coverage, he said, fewer patients would show up at emergency rooms, so hospitals would need less funding for such patients.
The talk of cuts came on top of Obama's increasingly vocal support for a yet-to-be-defined "public option" that would preserve patients' choice of doctors and work like private plans that cover federal employees.
On Monday, Obama did not retreat from those provocative proposals. But he was careful to express understanding of the challenges doctors face with malpractice lawsuits and the mind-numbing paperwork required of providers by insurance companies.
"I'm not advocating caps on malpractice awards, which I personally believe can be unfair to people who've been wrongfully harmed," Obama said, adding that he wants to scale back "defensive medicine."
Obama said he would sit down with doctors to address liability reform, encouraging "evidence-based medicine" so physicians would not see the need to order unnecessary tests they say are only needed to prevent lawsuits.
After Obama's speech, several doctors were happy that the president said he would address liability reforms. "He wants to work with the AMA on the liability issue," said the AMA president-elect, Dr. James Rohack, a Texas cardiologist. "President Obama said he understands the costs of practicing defensive medicine."
Obama was booed once, when he told AMA members he would not change his stance on malpractice-award caps. But he was greeted with several standing ovations, particularly after stating his willingness to work with the AMA.