msnbc.com news services
updated 5/11/2009 2:15:39 PM ET 2009-05-11T18:15:39

Health care providers are promising President Barack Obama $2 trillion in savings to help cover the uninsured. It may sound like a huge windfall, but don't line up yet for those health insurance cards.

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How about a reality check instead?

Heading to the White House on Monday to pledge restraint were groups that represent hospitals, doctors, drug makers, insurers and others. But they can't actually dictate what their members charge. A doctor in New York or a hospital in Los Angeles would be free to ignore their advice.

Also, medical providers have a long track record of avoiding fiscal constraints, as witnessed by the government's efforts to tamp down Medicare costs.

And then there's one more catch: Even if every penny of the promised savings shows up, not all of it would be used to help cover an estimated 50 million uninsured Americans.

Actual savings to the government are all that can be counted as Congress tries to figure how to cover the cost of subsidies that will be needed to help make health insurance affordable for everyone.

The medical groups' pledge is "a very hopeful sign," said economist Robert Reischauer, head of the Urban Institute. "But when we get down to hammering out the details, health care reform remains both complex and philosophically and politically difficult to accomplish."

Those details will be key to whether the health providers' pledge actually results in meaningful savings, said Jonathan B. Oberlander, a health care policy analyst at the University of North Carolina at Chapel Hill. On the surface, the coalition appears to be focusing on increasing prevention, implementing electronic medical records and other methods that have not been proven to control costs very well.

"If that's all this is, this incremental reform, the health care system isn't sacrificing that much," Oberlander said. "If they want to put their money where their mouth is, they should put a cap on insurance premiums."

Costs could still turn out to be the greatest obstacle to Obama's health care plan.

Outside experts estimate the taxpayers' tab could total between $1.2 trillion and $1.5 trillion over 10 years. Obama's budget proposal includes a down payment that may cover less than half the bill.

The president wants to build on the current system in which most people get coverage through private insurers. But he wants to change the rules so the sick can't be denied insurance. And he wants to provide taxpayer subsidies to help low-wage workers and even some in the middle class afford their premiums.

"No matter how great this might sound, the reality is the administration still does not know how to pay for its massive health care plan," said Antonia Ferrier, press secretary for House Republican Leader John Boehner of Ohio.

Still, a new coalition for a health care overhaul seems to have formed, with the White House and most of the health care industry and consumer interest groups holding the political center.

"Both symbolically and politically, it is very important," Oberlander said. "It is a testament to the Obama administration's success. Whether it proves to be truly historic we can see in the long run."

Left out, for now, are conservative Republicans, who oppose Obama's direction but have yet to articulate their own vision, and Democratic liberals who have been hoping to move toward a nationalized system of Medicare for all.

Copyright 2009 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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