Update: How the July 22nd press conference presaged the health insurance, not public option approach.

Dear Friend,

If you’re like most Americans, there’s nothing more important to you about health care than peace of mind.

Given the status quo, that’s understandable. The current system often denies insurance due to pre-existing conditions, charges steep out-of-pocket fees – and sometimes isn’t there at all if you become seriously ill.

It’s time to fix our unsustainable insurance system and create a new foundation for health care security. That means guaranteeing your health care security and stability with eight basic consumer protections:

1. No discrimination for pre-existing conditions
2. No exorbitant out-of-pocket expenses, deductibles or co-pays
3. No cost-sharing for preventive care
4. No dropping of coverage if you become seriously ill
5. No gender discrimination
6. No annual or lifetime caps on coverage
7. Extended coverage for young adults
8. Guaranteed insurance renewal so long as premiums are paid

Learn more about these consumer protections at Whitehouse.gov.

Over the next month there is going to be an avalanche of misinformation and scare tactics from those seeking to perpetuate the status quo. But we know the cost of doing nothing is too high. Health care costs will double over the next decade, millions more will become uninsured, and state and local governments will go bankrupt.

It’s time to act and reform health insurance, drive down costs and guarantee the health care security and stability of every American family. You can help by putting these core principles of reform in the hands of your friends, your family, and the rest of your social network.

Thank you,
Barack Obama

Note all the references to reforming insurance. Just what people thought they were voting for, right? NOT.

My emphasis and editing to add numbering to 8 Basic Consumer Protections

Update: Lynn Sweet, who has followed Obama a long time, did note in her article the day after the press conference that Obama had seemed very open to compromise and did not emphasize the public plan very much. I recall it stood out to me that he did not mention the public plan at all when listing his requirements for legislation.

Also, Obama left the impression he did not seem wedded to having Congress create a "public option" system to compete with private insurance companies -- a plank in his health care overhaul platform.

While pragmatic, Obama threatened to veto bills if they came to him with what he considered fatal flaws.

"If, at the end of the day, I do not yet see that we have it right, then I'm not going to sign a bill that, for example, adds to our deficit," Obama said.

"I won't sign a bill that doesn't reduce health-care inflation so that families as well as government are saving money. I'm not going to sign a bill that I don't think will work."

But he did not say he won't sign a bill that does not have a public option.

She also noted Obama's replies about sacrifices people must make:

Most intriguing were two questions about sacrifices people may have to make: in treatment options and payments. Obama reframed the question to a way that fits more with his view that keeping down health costs is key to helping the nation's economic recovery.

Said Obama, "They're going to have to give up paying for things that don't make them healthier. And I -- speaking as an American, I think that's the kind of change you want."

And Obama did say he was for "health insurance reform" -- in his prepared, thus carefully vetted, opening remarks. The very first opening remarks, his first sentence:

Before I take your questions, I want to talk for a few minutes about the progress we're making on health insurance reform and where it fits into our broader economic strategy.

Sixth paragraph (about a sentence or so each):

And health-insurance reform is central to that effort.

Paragraph 11:

...a lot of Americans may be wondering: What's in this for me? How does my family stand to benefit from health-insurance reform?

Paragraph 16:

I've also pledged that health-insurance reform will not add to our deficit over the next decade, and I mean it.

Paragraph 18:

That will not happen with health-insurance reform. It will be paid for.

Wow, how could I have missed that messaging?? It's right there. Insurance reform.

Public plan or public option? Obama did not mention it until the second to last questioner used the phrase in his question:

Steve Koff, the Cleveland Plain Dealer.

Q Thank you. Just to follow up on Jake's question earlier, sir: So many Americans are concerned that this plan, particularly the government insurance, the public option, would lead to reduced benefits or reduced coverage. Two questions.

One, can you guarantee that this legislation will lock in and say the government will never deny any services, that that's going to be decided by the doctor and the patient, and the government will not deny any coverage? And secondarily, can you, as a symbolic gesture, say that you and the Congress will abide by the same benefits in that public option?

PRESIDENT OBAMA: Well, number one, not only the public option, but the insurance regulation that we want to put in place will largely match up with what members of Congress are getting through the federal employee plan. That's a good example of what we're trying to build for the American people, the same thing that Congress enjoys, which is they go, there's a marketplace of different plans that they can access depending on what's best for their families.

Now one of the plans that we've talked about is a public option, and part of the reason we want to have a public option is just to help keep the insurance companies honest. If the insurance companies are providing good care -- and as it is, they're going to be more regulated so that they can't deny you care because of a pre-existing condition or because you change jobs or because they've decided you're too sick and not a good risk. You know, if -- with regulation, there's20already going to be some improvement in the insurance industry.

But having a public plan out there that also shows that maybe if you take some of the profit motive out, maybe if you are reducing some of the administrative costs, that you can get an even better deal, that's going to incentivize the private sector to do even better. And that's a good thing. That's a good thing.

Now, you know, there have been reports just over the last couple of days of insurance companies making record profits, right now. At a time when everybody's getting hammered, they're making record profits, and premiums are going up. What's the constraint on that? How can -- how can you ensure that those costs aren't being passed on to employers or passed on to employees, the American people, ordinary middle-class families, in a way that over time is going to make them broke? Well, part of the way is to make sure that there's some competition out there.

So -- so that's the idea.

Now, to get to your -- your original question, can I guarantee that there are going to be no changes in the health-care delivery system? No. The whole point of this is to try to encourage changes that work for the American people and make them healthier.

And the government already is making=2 0some of these decisions. More importantly, insurance companies right now are making those decisions. And part of what we want to do is to make sure that those decisions are being made by doctors and medical experts based on evidence, based on what works. Because that's not how it's working right now. That's not -- that's not how it's working right now.
Right now, doctors, a lot of times, are forced to make decisions based on the fee payment schedule that's out there. So if they're looking and -- and you come in and you've got a bad sore throat, or your child has a bad sore throat, or has repeated sore throats, the doctor may look at the reimbursement system and say to himself, "You know what? I make a lot more money if I take this kid's tonsils out."

Now, that may be the right thing to do. But I'd rather have that doctor making those decisions just based on whether you really need your kid's tonsils out or whether it might make more sense just to change -- maybe they have allergies. Maybe they have something else that would make a difference.

So part of what we want to do is to free doctors, patients, hospitals to make decisions based on what's best for patient care. And that's the whole idea behind Mayo. That's the whole idea behind the Cleveland Clinic.

You know, I'm going to be visiting your home town tomorrow to go to the Cleveland Clinic, to show -- to show why their system works so well. And part of the reason it works well is because they've -- they've set up a system where patient care is the number-one concern, not bureaucracy, what forms have to be filled out, what do we get reimbursed for. Those are changes that I think the American people want to see.

Q And what about yourself and Congress? Would you abide by the same benefit package?

PRESIDENT OBAMA: You know, I would be happy to abide by the same benefit package. I will just be honest with you. I'm the president of the United States, so I've got a doctor following me every minute -- (laughter) -- which is why I say, this is not about me.

I've got the best health care in the world. I'm trying to make sure that everybody has good health care, and they don't right now.

STAFF: Last question --

See also a litle night musing's comment today on Sebelius saying the administration plan would not lead to single payer. As in hell no, it won't.

Email via commenter PPCDS at FDL, hat tip to mass here at Corrente.