WASHINGTON — President Barack Obama's assertion Wednesday that government will stay out of health care decisions in an overhauled system is hard to square with the proposals coming out of Congress and with his own rhetoric.
Even now, nearly half the costs of health care in the U.S. are paid for by government at all levels. Federal authority would only grow under any proposal in play.
A look at some of Obama's claims in his prime-time news conference:
OBAMA: "We already have rough agreement" on some aspects of what a health care overhaul should involve, and one is: "It will keep government out of health care decisions, giving you the option to keep your insurance if you're happy with it."
THE FACTS: In House legislation, a commission appointed by the government would determine what is and isn't covered by insurance plans offered in a new purchasing pool, including a plan sponsored by the government. The bill also holds out the possibility that, over time, those standards could be imposed on all private insurance plans, not just the ones in the pool.
Indeed, Obama went on to lay out other principles of reform that plainly show the government making key decisions in health care. He said insurance companies would be barred from dropping coverage when someone gets too sick, limits would be set on out-of-pocket expenses, and preventive care such as checkups and mammograms would be covered.
It's true that people would not be forced to give up a private plan and go with a public one. The question is whether all of those private plans would still be in place if the government entered the marketplace in a bigger way.
He addressed some of the nuances under questioning. "Can I guarantee that there are going to be no changes in the health care delivery system?" he said. "No. The whole point of this is to try to encourage changes that work for the American people and make them healthier."
He acknowledged then that the "government already is making some of these decisions."
OBAMA: "I have also pledged that health insurance reform will not add to our deficit over the next decade, and I mean it."
THE FACTS: The president has said repeatedly that he wants "deficit-neutral" health care legislation, meaning that every dollar increase in cost is met with a dollar of new revenue or a dollar of savings. But some things are more neutral than others. White House Budget Director Peter Orszag told reporters this week that the promise does not apply to proposed spending of about $245 billion over the next decade to increase fees for doctors serving Medicare patients. Democrats and the Obama administration argue that the extra payment, designed to prevent a scheduled cut of about 21 percent in doctor fees, already was part of the administration's policy, with or without a health care overhaul.
Beyond that, budget experts have warned about various accounting gimmicks that can mask true burdens on the deficit. The bipartisan Committee for a Responsible Federal Budget lists a variety of them, including back-loading the heaviest costs at the end of the 10-year period and beyond.
OBAMA: "You haven't seen me out there blaming the Republicans."
THE FACTS: Obama did so in his opening statement, saying, "I've heard that one Republican strategist told his party that even though they may want to compromise, it's better politics to 'go for the kill.' Another Republican senator said that defeating health reform is about 'breaking' me."
OBAMA: "If we had done nothing, if you had the same old budget as opposed to the changes we made in our budget, you'd have a $9.3 trillion deficit over the next 10 years. Because of the changes we've made, it's going to be $7.1 trillion."
THE FACTS: Obama's numbers are based on figures compiled by his own budget office. But they rely on assumptions about economic growth that some economists find too optimistic. The nonpartisan Congressional Budget Office, in its own analysis of the president's budget numbers, concluded that the cumulative deficit over the next decade would be $9.1 trillion.