Obama's healthcare: Iowa then and now

by Mark Silva

President Barack Obama returned to Iowa City, Iowa, today to tout the healthcare legislation that he signed into law today. It was Iowa City, on May 29, 2007, where candidate Obama first proposed his vision of a healthcare overhaul for millions of uninsured Americans.

"We can do this,'' candidate Obama said that day on the campaign trail.

"Yes, we did,'' a celebrant called out at the bill-signing this week.

Back then, Republican Mitt Romney's pledge to forgo the presidential salary if he were elected president was gaining as much press attention in newspapers around the nation as Obama's healthcare plan was.

Back then, Obama's advisers were talking about a somewhat different price tag: An estimated $50 billion to $65 billion a year to finance the plan, according to a memo written by three outside experts and distributed by the Obama campaign. The CBO-estimated cost of the plan winning congressional approval is $940 billion over 10 years.
Yet back then, Obama also was talking about helping to pay for the plan by repealing then-President George W. Bush's tax cuts for households earning more than $250,000 year - a tax increase now envisioned in Obama's budget plans for 2011.

Obama also promised that he would sign a universal healthcare plan into law by the end of his first term. The bill signed this week, a little more than a year into his term, offers coverage to an estimated 32 million of the nation's 47 million uninsured - illegal immigrants, who account for much of the gap, are barred from coverage.

The candidate's promise also included cost-savings to help pay for the plan. Savings in Medicare expenses are part of the plan that Congress has approved.

That promise also included a projection that the average consumer could save $2,500 a year in insurance premium prices with the reforms proposed. The White House is offering a more general prediction now of savings that could result from changes in the law signed this week: "You will likely pay less --- perhaps much less. If you buy coverage like you have today on your own, premiums are expected to drop by 14 to 20 percent. If you get coverage through your job, premiums could decline by up to 3 percent. ''

"The senator came across with a large plan, but in Democratic presidential terms it's a centrist plan," Robert Blendon, a professor of health policy at the Harvard School of Public Health, said at the time, reading from the Tribune's account from the campaign trail in Iowa City that day. "He's talking about something that takes the existing system and makes it work."

"To help pay for this, we will ask all but the smallest businesses who don't make a meaningful contribution today to the health coverage of their employees to do so," the candidate said. Companies that do not provide health insurance would be charged a payroll tax to help fund subsidized insurance. The plan passed by Congress requires larger employers that don't provide insurance for employees to pay fines.

The candidate's proposal would have supplemented the private insurance market with a government-run National Health Insurance Exchange for those who needed to buy coverage. The so-called "public option'' fell off the table as House leaders acceded to more conservative Democrats in the Senate who refused to buy into it.

There have been a lot of white coats around healthcare events during the president's campaign for congressional passage of a healthcare plan. There were some white coats around at the University of Iowa's medical research center in May of 2007, too, when Obama proposed his plan. (See the picture below by Charlie Neibergall / AP:)