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Obama Says Health Care Overhaul Must Be Enacted This Year

By Alex Wayne, CQ Staff

 March 5, 2009 -- President Obama said Thursday that he wants an overhaul of the nation's health care system completed by the end of the year, calling it a "fiscal imperative" vital to restoring the economy.

In opening remarks to a "Forum on Health Reform" that he hosted at the White House, Obama told an audience of about 150 lawmakers, health care industry lobbyists, labor union leaders, consumer advocates, policy experts and journalists that his administration and Congress must overcome "special interests" that have prevented sweeping health care overhauls in the past. Many of those same special interests had representatives at the forum.

Obama said that circumstances are different from the last time a full-scale health care overhaul was attempted in 1993-94 by President Bill Clinton. That effort failed, done in by fierce lobbying against it by insurers and businesses, and a lack of commitment within Congress, including among members of Clinton's own party.

"This time, the call for reform is coming from the bottom up, from all across the spectrum—from doctors, nurses and patients; unions and businesses; hospitals, health care providers and community groups," Obama said. "It's coming from mayors, governors and legislatures—Democrats and Republicans—who are racing ahead of Washington to pass bold health care initiatives on their own. This time, there is no debate about whether all Americans should have quality, affordable health care—the only question is, how?"

Obama has proposed spending $634 billion over the next 10 years as a "down payment" on a health care overhaul. He has left the details of such legislation to Congress, where Democratic leaders say they hope to move a bill to the House floor, at a minimum, before the August recess.

Broad Goals

In his fiscal 2010 budget outline, Obama said an overhaul plan should reduce in the health care system as a whole while improving the quality of care and expanding insurance coverage to most or all Americans.

In his fiscal 2010 budget outline, Obama said an overhaul plan should reduce costs in the health care system as a whole while improving the quality of care and expanding insurance coverage to most or all Americans.

Democratic lawmakers are drawing up plans that generally would expand public programs like Medicaid to cover more low-income Americans while providing subsidies for people with higher incomes to buy health insurance if they lack it.

Many Democrats would like to mandate that individuals buy insurance and employers provide it. Republicans generally would prefer to provide tax credits or other tax incentives to individuals to encourage them to purchase health insurance. Many Republicans oppose mandating coverage. Some Democrats want to create a new insurance program run by the government to compete with private insurance; many Republicans and private insurers oppose such a plan.

"Not all of the Democrats' ideas are objectionable. Just nearly all," said a skeptical Rep. Joe L. Barton of Texas, the ranking Republican on the Energy and Commerce Committee, which will write part of any overhaul.

Obama has been careful not express a position on any of those issues.

"He's been very good about not drawing lines in the sand," said Chris Jennings, a health care policy expert who was Clinton's top adviser on the subject. "He's not going to send any 'my way or no way' signals."

There is certain to be long and emotional debate about any proposals to reduce costs in the health care system. Already, some Republicans have criticized proposals for the government to underwrite studies to determine which drugs, medical procedures and devices are most effective, research that would produce winners and losers.

Obama supports such "comparative effectiveness research" and has proposed in his budget to change the way hospitals, drug companies, home health care agencies and others are paid under Medicare and Medicaid, in ways that would reduce costs in those programs by tens of billions of dollars. He has also proposed sharply reducing payments to managed care plans in Medicare run by private insurers, which his budget projects would save $177 billion over 10 years.

Participants at the health care forum, according to background information provided by the White House, "will be asked to work together and offer up ideas to bring down costs and increase coverage for all Americans.

The forum was scheduled to run from 1 p.m. until 4 p.m.

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