In last night's State of the Union address, President Obama noted again that "the biggest driver of our long-term debt is the rising cost of health care for an aging population" and said that "those of us who care deeply about programs like Medicare must embrace the need for modest reforms."
Keeping this in mind, it's worth noting that in recent days, the White House has been busy rejecting modest reforms: Earlier this month, White House economic adviser Gene Sperling declared flatly that "Medicaid savings, Medicaid cuts, for this administration, are not on the table." Not big cuts, not modest ones, and not even cuts it had already said it might accept. Sperling noted that his statement specifically rules out Medicaid savings and cuts that the administration had previously indicated it would consider.
And earlier this week, Obama rejected another idea for reducing the cost of Medicare that he'd previously said he would consider: raising Medicare's eligibility age.
Tonight's State of the Union also contained the following bit about the health and economic promise of drug development:
Today, our scientists are mapping the human brain to unlock the answers to Alzheimer's; developing drugs to regenerate damaged organs; devising new material to make batteries ten times more powerful. Now is not the time to gut these job-creating investments in science and innovation.
Yet Obama has repeatedly proposed changing the way Medicare pays for prescription drugs for seniors who are also eligible for Medicaid. And he made reference to changing the way the government pays for drugs in the speech, saying: "We'll reduce taxpayer subsidies to prescription drug companies and ask more from the wealthiest seniors." Putting aside the question of whether those cuts are a good idea, they would almost certainly have a dampening effect on pharmaceutical research and development spending.
He also said he would "bring down costs by changing the way our government pays for Medicare," but that's proven tricky as well. The Obama administration delayed cuts to Medicare Advantage that it stumped for, and the Government Accountability Office says that its justification for doing so is bunk.
All of which is to say that any kind of changes to Medicare or Medicaid are going to be hard—and that Obama doesn't seem too keen on making even the sort of modest reforms he says are necessary.