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Newsmaker: Obama on Health Reform Politics, Copenhagen Climate Outcome

December 23, 2009 at 12:00 AM EDT
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In an exclusive interview with Jim Lehrer, President Obama says despite Republican opposition and backlash from some members of his own party, he is '95 percent' satisfied with the Senate's health care reform bill set for another vote on Thursday.
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JIM LEHRER: Mr. President, welcome.

PRESIDENT BARACK OBAMA: Thank you so much for having me.

JIM LEHRER: So you are completely satisfied with the health-reform bill that the Senate’s about to pass?

PRESIDENT OBAMA: You know, I am never completely satisfied. But I am very satisfied. Look, when I made that speech in the joint session of Congress, I set out some criteria for what in my mind would qualify as reform, based on the conversations that I had with families all across the country and the letters that I was receiving about people really going through a tough time in the health-care system.

I said that we wanted to make sure that people who didn’t have health insurance could get health insurance. And this bill covers 30 million people who don’t have it.

I said that for people who have health insurance, we’ve got to end insurance-company abuses, where they ban you from getting health insurance because of preexisting conditions, or they’ve got fine print – print that sets up lifetime limits on what you can spend, so if you really get sick, suddenly you may lose your house, even though you think you’ve got health insurance.

We’ve got the strongest health-insurance reforms that we’ve ever seen in this bill. I mean, all that – that whole argument about patients’ bill of rights back in the 1990s: this is the patients’ bill of rights on steroids.

I said it had to be deficit-neutral. It doesn’t just meet that criteria; it actually reduces the deficit. I said that we had to make sure that we were bending the cost curve, meaning that we were starting to get a better bang for our buck so that doctors, hospitals, nurses, providers all were focused on what provides quality care, and not just more expensive care. And we have all of those game-changers inside the bill.

So when you look at the criteria that I’ve set forth, this is a good deal. Now, are there provisions here, provisions there, that I would love to have in the bill? Of course. But overall, I think that I’ve seen 95 percent of what will work for the American people, for small businesses and for the government budget that I was seeking from the beginning.

JIM LEHRER: Ninety-five percent of what you wanted?

PRESIDENT OBAMA: Absolutely.

JIM LEHRER: Now, do you feel the same way about the House version that passed a few weeks ago?

PRESIDENT OBAMA: You know, what’s interesting is, the House version and the Senate version are almost identical. There are some differences in terms of how they pay for particular provisions. But the same principles about setting up an exchange where small businesses and individuals can buy in, pool their purchasing power to get a better deal from insurance companies, that’s in both bills. The insurance reforms are both in the House and the Senate versions.

One of the things that I think is important to remember is that, even though the exchange – the pooling that I’m talking about doesn’t start for several years, a lot of the insurance reforms start right away. Children, for example, won’t be able to be barred from getting health insurance, even if they have a preexisting condition, as soon as I sign that bill and we get that reform in place.

So there are a lot of provisions that are both in the Senate and the House bill. I actually think that reconciling them is not going to be as difficult as some people may anticipate.

JIM LEHRER: Are you going to be involved in the reconciliation?

PRESIDENT OBAMA: Absolutely.

JIM LEHRER: I mean, on a hands-on way?

PRESIDENT OBAMA: Absolutely.

JIM LEHRER: Are you going to actually participate with -

PRESIDENT OBAMA: We are – we are – we hope to have a whole bunch of folks over here in the West Wing, and I’ll be rolling up my sleeves and spending some time before the full Congress even gets into session, because the American people need it now. I mean, something that’s gotten lost, Jim, during the course of this debate – because this is how Washington works – it ends up being, well, did the president win on that one or did he lose on that one? What’s Joe Lieberman doing today, and what’s Mitch McConnell doing tomorrow?

Right now there are families who don’t have health insurance and, as a consequence of somebody getting sick in their family, have been bankrupt. Right now there are small businesses who’ve been doing the right thing by their employees and just got a notice from their insurance companies that their premiums went up 25, 30, 40 percent; and that business owner’s having to make a decision, do I start dropping coverage for my employees or do I have to lay off one employee to keep coverage for everybody else?

Those kinds of decisions are happening right now. And so, you know, I intend to work as hard as I have to work, especially after coming this far over the course of the year, to make sure that we finally close the deal.

JIM LEHRER: But you’re not – you’re not going to sit down at that table with the conferees with a list, spoken or unspoken, of your own kinds of killer provisions that you can’t – you got to get them out of there, or a favorite provision that you want in there? I mean -

PRESIDENT OBAMA: Look. Look, I mean, the -

JIM LEHRER: – any of your own preferences?

PRESIDENT OBAMA: Obviously, I’ve got some very smart people who are here working day to day on these issues. I am, though, consulting very closely with health-care economists, for example, to make sure that – for example, the provisions that will change how doctors, hospitals, other providers provide care so that it’s more patient-centered and it’s not focused on how many tests can we do, but rather what’s going to produce the best-quality outcomes; how can we reduce, for example, medical errors in hospitals, which cost us hundreds of billions of dollars and thousands of lives every single year, and we know what will prevent them. Simple checklists of things that hospitals can do.

You know, those are the kinds of things that I have enough interest in that I’m going to say to the conferees, you guys have to make sure that that’s included, because part of the deal here is not just providing more coverage or more subsidies but we keep on spending twice as much as every other advanced country and we have worse outcomes. Part of our goal is to spend our money more wisely, because if we don’t do that, then it doesn’t matter how many subsidies we have in there, how many taxes we impose. Sooner or later we start running out of money; it gobbles more and more of our overall federal budget and families’ budgets.

JIM LEHRER: And let’s say, for instance, the public-option plan: It’s in the House version; it’s not in the Senate version.

PRESIDENT OBAMA: Right.

JIM LEHRER: All right. What’s going to be your position when you sit down and talk about this?

PRESIDENT OBAMA: You know, look, I’ve been in favor of the public option. I think the more choice, the more competition we have, the better.

On the other hand, I think that the exchange itself, the system that we’re setting up that forces insurance companies to essentially bid for three million or four million or five million people’s business, that in and of itself is going to have a disciplining effect.

Would I like one of those options to be the public option? Yes. Do I think that it makes sense, as some have argued, that, without the public option, we dump all these other extraordinary reforms and we say to the 30 million people who don’t have coverage, “You know, sorry. We didn’t get exactly what we wanted?” I don’t think that makes sense.

JIM LEHRER: So it is not – that’s not a deal-breaker for you in any – any way, either way.

PRESIDENT OBAMA: I think – I think, right now, that the Senate and the House bills – if you look at their overlap, the 95 percent that they agree on – if that bill was presented to me -

JIM LEHRER: You’d sign it?

PRESIDENT OBAMA: – I would sign it.

JIM LEHRER: Mr. President, as you know, in this context, health care – and other things, too – some people are suggesting that maybe you back up too quickly on some of the positions, like whether it’s in health-care reform, the public option, some of these other things. What do you think of – what do you – how do you respond to that?

PRESIDENT OBAMA: I think people who say that aren’t paying attention. As I said before, if you compare where we are now on health care to where I started at the beginning of the year, what would’ve I said during my campaign? I’m getting 95 percent of what I want.

Now, I might not be getting 95 percent of what some other folks want.

JIM LEHRER: Okay.

PRESIDENT OBAMA: But – and oftentimes what happens is, people who are frustrated because they haven’t gotten what they want then suddenly say, “Well, he’s compromising.” Well, no, I – I’ve been very consistent throughout this process in terms of what I think is achievable and what would be – be good for American families.

And so the – you know, this notion that somehow the health-care bill that is emerging should be grudgingly accepted by Democrats as a half-a-loaf is simply incorrect. This is nine-tenths of a loaf. And for a family out there that right now doesn’t have health insurance, it is a great deal.

It is a full loaf for a lot of families out there who right now have nothing to fall back on, if they get into a medical emergency. And for people who have health-care right now, this is a good deal, because right now you’re getting less insurance than you think.

You’re getting less security than you think you’re getting because at any point, an insurance company bureaucrat can say, “You know what? Actually we think that you did not inform us of that gallbladder – that gallstone that you had removed a while back. Maybe you forgot, but we consider that a pre-existing condition. So we’re not going to cover you for the leukemia that you were just diagnosed with.”

Those are stories that happen all the time. And what we’re saying is, patients have rights. People who are buying the insurance should get what they pay for. And this is going to give them a level of security that they have not seen before and frankly we’ve been fighting for, for years, on a bipartisan basis.

A whole bunch of Republicans were very supportive of that Patients’ Bill of Rights back in the ’90s. And unfortunately I think that what’s happened is that, you know, you’ve seen greater polarization. And you know, a lot of the debate this year has been more about scoring points than actually getting something done.

JIM LEHRER: How do you feel about the way the 60-vote filibuster rule has been employed on the health-care debate?

PRESIDENT OBAMA: I am very frustrated.

I think that right now that’s the way things are operating. And we’ve had to make sure that we fight through those issues. I think Harry Reid has done a very good job grinding it out.

But as somebody who served in the Senate, who values the traditions of the Senate, who thinks that institution has been the world’s greatest deliberative body, to see the filibuster rule, which imposes a 60-vote supermajority on legislation – to see that invoked on every single piece of legislation, during the course of this year, is unheard of.

I mean, if you look historically back in the ’50s, the ’60s, the ’70s, the ’80s – even when there was sharp political disagreements, when the Democrats were in control for example and Ronald Reagan was president – you didn’t see even routine items subject to the 60-vote rule.

So I think that if this pattern continues, you’re going to see an inability on the part of America to deal with big problems in a very competitive world, and other countries are going to start running circles around us. We’re going to have to return to some sense that governance is more important than politics inside the Senate. We’re not there right now.

JIM LEHRER: Is there anything you can do about this as president of the United States? Isn’t it a Senate situation?

PRESIDENT OBAMA: It is a – it is a matter of Senate rules. Look, the fact of the matter is, is that if used prudently, then I don’t think it’s harmful for our democracy. It’s not being used prudently right now. And my hope would be that whether a senator is in the majority or is in the minority, that they’re starting to get a sense, after looking at this year, that this can’t be the way that government runs.

And one of the things that I think Democrats and Republicans have to constantly do is try to put themselves in the other person’s shoes. If we had a Republican president right now and a Republican-controlled Senate, and Democrats were doing some of these things, they’d be screaming bloody murder. And at some point, you know, I think the American people want to see government solve problems, not just engage in the gamesmanship that has become so customary in Washington.

JIM LEHRER: Back to the loaves situation. Copenhagen.

PRESIDENT OBAMA: Yes.

JIM LEHRER: Here was a situation where there were many things that you and others wanted done.

PRESIDENT OBAMA: Right.

JIM LEHRER: None of them got done -

PRESIDENT OBAMA: Yeah.

JIM LEHRER: – and yet you’ve said, well, it was a success anyhow. Is that a loaf? Did you get …

PRESIDENT OBAMA: Well, -

JIM LEHRER: You didn’t get any loaf there, did you?

PRESIDENT OBAMA: Well, – well, no – I think Copenhagen’s entirely different from health care. I mean, I think that people are justified in being disappointed about the outcome in Copenhagen. What I said was essentially that rather than see a complete collapse in Copenhagen, in which nothing at all got done and would have been a huge backward step, at least we kind of held ground and there wasn’t too much backsliding from where we were.

It didn’t move us the way we need to. The science says that we’ve got to significantly reduce emissions over the next – over the next 40 years. There’s nothing in the Copenhagen agreement that ensures that that happens.

What did occur was that at a point where there was about to be complete breakdown, and the prime minister of India was heading to the airport and the Chinese representatives were essentially skipping negotiations, and everybody’s screaming, what did happen was, cooler heads prevailed.

And we were able to at least agree on non-legally binding targets for all countries – not just the United States, not just Europe, but also for China and India, which, projecting forward, are going to be the world’s largest emitters.

So that – that was an important principle, that everybody’s got to do something in order to solve this problem. But I make no claims, and didn’t make any claims going in, that somehow that was going to be everything that we needed to do to solve climate change. And – and my main responsibility here is to convince the American people that it is smart economics and it is going to be the engine of our economic growth for us to be a leader in clean energy.

And if we pass a bill in the Senate, reconcile it with the House, that says we are going to invest in wind energy and solar energy and we’re going to be the guys who are producing wind turbines, and we’re going to be the folks who are producing solar panels on rooftops, and we’re going to be the country that is retrofitting all its homes and businesses so that we are 30 percent more energy-efficient than we are right now, that produces jobs that can’t be exported; it reduces our dependence on foreign oil; it is good economics; it will increase our exports – oh, and by the way, it also solves the climate problem. And that is, I think, an argument that I’m going to be making not just next year but for several years to come.

JIM LEHRER: Mr. President, on Afghanistan, how much of what you said in words and in theme in your Nobel Peace acceptance speech was driven by the experience of the last year, being president of the United States, particularly having to make rough decisions on Afghanistan?

PRESIDENT OBAMA: There’s no doubt that the experience of this year, meeting with our troops, looking at intelligence, going to Dover to watch caskets coming in, had a profound impact on how I think about my responsibilities.

The general theme of the Nobel speech, which says that this is a dangerous world where real evil exists out there and that compels us to occasionally make very difficult decisions about using force; that we shouldn’t glorify war, but we should accept that there are times where we have to defend our nation, protect our values: That theme is actually pretty consistent.

One of the interesting things that people forget, probably the first speech of mine that actually got noticed in my political career was back when I was a state Sen. and the run-up to the Iraq war was occurring, and I stood in the plaza, Daley Plaza, in – at a anti-war rally.

JIM LEHRER: It’s in Chicago.

PRESIDENT OBAMA: In Chicago. And there were all these signs that says, “War is not an option.” And I actually started my speech by saying, “I disagree with those signs.” Sometimes war is an option. World War II had to be fought. The Civil War is part of the reason why I can stand here on this podium. The question is, are we fighting the right wars, in the right ways?

And so in that sense, even in my opposition to Iraq, for example, I was always very clear about the fact that us going after Osama bin Laden, us dismantling al-Qaida, us making sure that, you know, people who are willingly – willing to slaughter innocents have to be stopped; my position on something like Rwanda, where, as difficult as some of these decisions may be, it makes sense for us to intervene in genocide or humanitarian efforts: Those are views that are actually fairly consistent. Obviously, the experience of the last year being president deepens and enriches that general philosophy, but it’s one that I’ve held for some time.

JIM LEHRER: You brought those into the presidency.

PRESIDENT OBAMA: Yeah.

JIM LEHRER: They didn’t – they were just honed by this experience.

PRESIDENT OBAMA: Right. Absolutely. And if – I think if you look at my previous speeches and writings, they’re fairly consistent. It is very important for I think those of us who desperately want peace, who see war as, at some level, a break-down, a manifestation of human weakness, to understand that sometimes it’s also necessary – and you know, to be able to balance two ideas at the same time; that we are constantly striving for peace, we are doubling up on our diplomacy, we are going to actively engage, we are going to try to see the world through other people’s eyes and not just our own; that we are going to invest in things like preventing climate change, so that you’re not seeing more drought and famine that creates more conflict; that we’re going to invest in development aid, not because it’s charity, but because it’s in our self-interest.

We’re going to do all those things. And then, there are going to be times where there is a Hitler, there are going to be moments like 9/11 where, despite our best efforts, things have still – things have still emerged that are of such danger not only to us, but our ideals and those things that we care for, that we’ve got to apply force. And that is a tough set of decisions to make.

That doesn’t negate our constant pursuit of peace and our constant preference for a non-violent resolution of problems.

JIM LEHRER: And Mr. President, finally, a year in – almost a year into your presidency, your – what’s your comfort level in dealing with all of these things, all these things you’ve just been talk – we’ve just been talking about – you’ve been dealing with, for this last year?

PRESIDENT OBAMA: You know, I have to tell you that, you know, I’ve spoken to some historians and I think they will agree – regardless of, you know, your political preferences – that we had as much on our plate this year as any president has ever had in their first year, maybe since FDR.

I think that we have managed an economic crisis of monumental proportions, two wars, a whole host of other challenges, very well.

I am entirely dissatisfied with where we are right now in terms of jobs, and the fact that families out there on the eve of Christmas are still really worried about being able to pay the bills or send their kids to college or have health care for themselves. And so I don’t pat myself on the back at the end of this year.

But what I do have confidence in is that we’ve made good decisions, that we’ve applied sound judgment to some very difficult situations, and that if we stay on a path where we are working hard, maintaining a sense of possibility for the future – we’re willing not to defer tough decisions around health care or energy or education, so that somebody else deals with them – that America will be strong again.

And I think that – I think I’ve shown this year that I can make hard decisions, even when they’re not popular, and that I take a long view on these problems. And I frankly think that that’s what America needs right now.

JIM LEHRER: Mr. President, merry Christmas. Happy New Year. And thank you, sir.

PRESIDENT OBAMA: Thank you. To you as well.