Obama ups ante on debt deal

President Barack Obama said Monday he continues to push congressional leaders for the “largest possible deal” in the ongoing deficit-reduction negotiations, and that it is possible to construct a package that would involve shared sacrifice from both sides—as well as some “meaningful changes to Medicare, Social Security and Medicaid” that would still maintain the integrity of those entitlement programs.

“We have agreed to a series of spending cuts that will make the government leaner, meaner, more effective, more efficient, and give taxpayers a greater bang for their buck,” Obama said, according to a transcript of a news conference he hosted at the White House late Monday morning. “That includes defense spending. That includes health spending,” he said, adding that it includes some programs he likes very much and would be nice to have “but that we can't afford right now.”

Obama also said he's asked leaders to bring him their ideas on how they can get the necessary number of votes in both congressional chambers for a deal to happen. “I'm happy to consider all options, all alternatives that they're looking at,” Obama said. “The things that I will not consider are a 30-day or 60-day or a 90-day or a 180-day temporary stopgap resolution to this problem,” he added. “This is the United States of America, and we don't manage our affairs in three-month increments.

When asked if House Speaker John Boehner—who this weekend said a smaller deal is more likely—would return to the prospect of a larger agreement that calls for $4 trillion in savings, the president said he thought the Ohio Republican has been “very sincere about trying to do something big.” But he acknowledged that the politics within Boehner's caucus is difficult right now and that it is going to take some work—on both Boehner's side and his own.

“I mean, the vast majority of Democrats on Capitol Hill would prefer not to do anything on entitlements; would prefer, frankly, not to have to do anything on some of these debt and deficit problems, the president said, adding that he is sympathetic to those concerns because those leaders are looking out for vulnerable citizens who rely on those programs.

“And what I've tried to explain to them is, No. 1, if you look at the numbers, then Medicare in particular will run out of money and we will not be able to sustain that program no matter how much taxes go up. I mean, it's not an option for us to sit by and do nothing,” he added. “And if you're a progressive who cares about the integrity of Social Security and Medicare and Medicaid, and believes that it is part of what makes our country great that we look after our seniors and we look after the most vulnerable, then we have an obligation to make sure that we make those changes that are required to make it sustainable over the long term.”

The question remains of how the entitlement changes would affect the nation's healthcare providers, including hospitals—who have launched a television campaign this summer highlighting how reimbursement cuts would lead to problems such as crowded emergency rooms and reduced access for patients.

“I think the president is pushing hard to say we need to look at long-term sustainability for our critical entitlement programs—Medicare and Medicaid. And we need to look at our long-term debt and it has to be a balanced approach and I believe that very strongly,” HHS Secretary Kathleen Sebelius told Modern Healthcare after an HHS news conference announcing a proposed regulation on state health insurance exchanges. Sebelius did comment on reimbursement cuts when asked what message she had for the nation's providers.

“We started down the road of entitlement reform with the Affordable Care Act and have put forward a notion that you can either cut benefits or improve care and lower costs,” she said. “And we're very much committed to that and we're under way on that, and I think that's a direction we'll accelerate if we're given the opportunity.”

And when asked a similar question Monday, CMS Administrator Dr. Donald Berwick responded that his agency is relying on help from the provider community.

“I think it's possible to improve care and lower costs by making things better for patients,” Berwick said. “I think providers know how to do it, can learn how to do it, and I'm very interested in partnering with them on that trajectory.”