President Obama held a much anticipated news conference Wednesday night and opened with remarks on health care reform. Tellingly, he called the topic "health insurance reform," reflecting a view that both public and private sector insurers contribute to the nation's explosive health care costs.

The president's focus was on the economic implications of health care reform. He opened by recapitulating the recent financial collapse, which the new administration is working to reverse. "As a result of the action we took those first weeks, we were able to pull the economy back from the brink," he said.

In the context of economic concerns over paying for health care he expressed confidence that health insurance reform can be accomplished without contributing to the deficit. He acknowledged support for a tax on wealthy Americans and opposed one for the middle class. He noted that the pharmaceutical industry has promised to cut costs and that inefficiencies and redundancies in health care delivery would be eliminated to contribute to expansion of coverage to uninsured populations. He said that doctors and not bureaucracies should determine coverages, a popular refrain.
"We spend much more on health care than any other nation, but aren't any healthier for it," he said while again noting that health insurance reform is central to the effort of rebuilding the economy.

"This is not just about the 47 million Americans who have no health insurance at all. Reform is about every American who has ever feared they may lose their coverage if they become too sick or lose their job. It's about every small business that has been forced to lay off employees or cut back on their coverage because it became too expensive. And it's about the fact that the biggest driving force behind our federal deficit is the skyrocketing cost of Medicare and Medicaid."

"If we do not control these costs, we will not be able to control our deficit," the president said, later adding, "we just can't afford what we're doing right now."

However, he did not promise that a public plan would absolutely be part of the solution as he has in the past. Instead, listing some of the areas of agreement so far forged in Congress, he said, "If you don't have health insurance you will be able to choose a quality, affordable health plan through a health insurance exchange, a marketplace that promotes choice and competition."

Other general principles mentioned include: no pre-existing condition limits, an option to keep current insurance, disallowance of dropped coverage for sickness, coverage despite job loss, limits on out-of-pocket costs, and coverage for preventive care.

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