TIME: I thought I’d talk to you a little bit about the whole degree to which this is really a test of leadership. The fact is that no President has been able to pull off anything on this order of magnitude in 44 years [since Congress passed Medicare and Medicaid].President Obama: Well, as you point out, the last time we did something of this magnitude was 1965. And the circumstances in some cases were similar — in some cases were profoundly different. Obviously LBJ had just won a landslide re-election and had huge majorities in the Senate and the House. We have the largest Democratic majorities since LBJ. But the way that Congress works is a little bit different today than it was then … I think that Congress is more splintered. I think each member of Congress is a little more independent from party than they might have been in the past. I think the nature of the Republican opposition has changed. Today it’s much more concentrated on the conservative end … Whether we’ve struck that right balance, we’ll find out in the next couple of months.
There are a lot of people right now on Capitol Hill who are saying, “We need more from him. He’s got to tell us where his bright red lines are on this.” The truth is, we’ve actually, I think, provided more guidance than has been advertised. I mean, if you think about how we’ve moved this forward, we didn’t simply put out some broad principles. We were fairly specific. We said we need to have insurance reform, and that’s going to include things like preventing insurers from dropping people because of pre-existing conditions. We said that we are going to need to expand coverage, that an insurance exchange that would provide people a menu of options was an important mechanism to expand choice and help to deliver help to people who didn’t have health insurance or were underinsured. We talked about the need for a public option as part of that health-care exchange. Although you didn’t define what a public option really is. I would say, actually, we defined it fairly clearly in terms of what we thought would work best. What I said was, is that it shouldn’t be something that’s simply a taxpayer-subsidized system that wasn’t accountable but rather had to be self-sustaining through premiums and that had to compete with private insurers … Now, if you look at the results, the 80% of all the various bills that are out there that people have agreed to reflect our — most of our ideas from the start of this process … But the 20% that right now is still the holdup would have been a holdup if we had put forward a plan, hadn’t put forward a plan, had left it to Congress, had written it ourselves — because it represents some long-standing ideological divisions in our Congress and, frankly, in our society … We’ve put forward what I continue to believe is the most sensible way of financing [a portion of covering the cost of the uninsured], and that is simply to lower the deductions, the itemized deductions that wealthy individuals can take. That would have covered it … The fact that that has not yet been adopted I don’t think is reflective of me not giving clarity to Congress. It has to do with the fact that members of Congress are skittish about anything involving taxes, even though these are taxes that would not be imposed on anybody making less than $250,000 a year … And when you have a system this large, with this many players involved, it was inevitable that not only would that be contentious but that, again, the public would be suspicious of the possibilities that somehow this means that my doctor is not going to be able to give me what he or she thinks I need. But isn’t that going to happen occasionally or at least that I’m not going to be able to get what I want Here’s how I’ve described it, and this is the truth as I see it: there is nothing that would make you healthier that health reform would prevent you from getting. See 10 key players in health care reform.
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