By Adriel Bettelheim, CQ Staff

The scope of the economic crisis will prevent him from fulfilling some of his campaign promises, President-elect Obama said Sunday, but he reiterated his desire to eliminate privately run alternatives to Medicare in order to squeeze efficiencies out of the health care system.

In an interview on ABC’s “This Week,” Obama singled out Medicare Advantage plans as an example of government initiatives that don’t work, adding that eliminating the plans and other cost-cutting could free up $200 billion to spend on expanding health care.

“What our challenge is going to be is identifying what works and putting more money into that, eliminating things that don’t work, and making things that we have more efficient,” Obama said.

The privately run, government-funded Medicare Advantage program has rapidly accumulated enrollees since it was created in 2003 (PL 108-173). It is a legacy of the Bush administration and congressional Republicans’ efforts to inject free-market forces into the entitlement program. Under the initiative, private insurers sell plans directly to seniors and are paid by the federal government for each beneficiary. The average payments are higher than the per-patient cost of traditional Medicare. In return, insurers are supposed to charge seniors lower premiums and provide enhanced benefits.

Obama and other Democrats say the payments are too generous and represent a giveaway to the insurance industry.

“We are spending a lot of money subsidizing the insurance companies around something called Medicare Advantage, a program that gives them subsidies to accept Medicare recipients, but doesn’t necessarily make people on Medicare healthier,” Obama said.

Obama hedged when asked by host George Stephanopolous whether he would follow through on a campaign pledge to repeal President Bush’s tax cuts on the wealthy (PL 107-16, PL 108-27) to pay for a broader overhaul of the U.S. health care system. He said efforts to promote health-care information technology as part of an economic stimulus package would eliminate some waste and duplication in the system.

“I want to be realistic here — not everything that we talked about during the campaign are we going to be able to do on the pace that we had hoped,” Obama said.

Foreign Policy

On national security matters, Obama acknowledged that a showdown with Iran over its nuclear program is all but inevitable and repeated his desire to engage in diplomacy. He characterized the incoming administration’s posture as respecting “the aspirations of the Iranian people, but that we also have certain expectations in terms of how a international actor behaves.”

On another sensitive issue, Obama said he intends to follow through on campaign pledged to close the military detention facility at Guantanamo Bay, Cuba, but warned it would take some time to establish a new system to evaluate charges against suspected terrorists.

“It is more difficult than I think a lot of people realize, and we are going to get it done,” Obama said. “Part of the challenge that you have is that you have got a bunch of folks that have been detained, many of whom may be very dangerous, who have not been put on trial or have not gone through some adjudication. And some of the evidence against them may be tainted, even though it’s true. And so, how to balance creating a process that adheres to rule of law, habeas corpus, basic principles of Anglo-American legal system, but doing it in a way that doesn’t result in releasing people who are intent on blowing us up.”