Karen Tumulty got a lengthy, one-on-one interview with President Obama this week. They spent most of their time discussing health care--a topic, clearly, they both know well.

Not necessarily, Obama replied:

It's still going to be a decision that the family has to make. I guess--this is my point, I think that there's this perception that you either have rationing that is very stringent and sort of makes you wait for months before you can get your cancer treated or you can never get your knee replaced, right, all the horror stories you hear from the British model or the Canadian system that people who are opposed to reform always trot out. Or, alternatively, you just have this bloated system in which we don't even try to make it rational, we just sort of live with what we have. And what I'm trying to suggest is, is that there's this huge space in between where we could make the system much more efficient, much more cost-effective, make people much healthier, and still not have to resort to some of the rationing that people are fearful of. But that--it does require changes in how we approach things.

Let's just take one example, and that is testing. It turns out that we pay 10 times what Japan pays, for example, for CAT scans and MRIs. Well, why is that? And it turns out, by the way, that we are having those tests five, six, eight times as often as folks in other countries who have just as good outcomes.

Now, some of that may have to do with reimbursement models. There may be differences that have to do with the approach that hospitals here take in recovering costs for expensive equipment. There are a whole range of reasons why that might be true, but the point is, is that it's not like people out there are--would automatically be prevented from getting CAT scans if we just tried to think when is a CAT scan or an MRI working and appropriate in improving care and when it's not.

And what we've said is that if doctors and patients had that information, and you start changing some of these delivery systems, you will see significant changes in the cost of health care and you will see improved outcomes and improved convenience, because if people are going through a battery of tests when one test would be sufficient, every time they're going to the doctor, that's gas, babysitting, sitting around for two hours, a day off work. We're not even factoring in those costs.

The one benefit of having a health care system full of waste is that you can get rid of a lot of that waste without missing it. We spend around 16 percent of our GDP on health care, the British spend around 8. That's an enormous gap.

You could argue that the approach Obama outlines above is a soft one--that merely putting information in the hands of doctors and patients isn't likely to change behavior all that much. But when we're spending as much as we are, and that spending is going up as fast as is, you don't have to change behavior all that much to generate serious financial savings--enough, surely, to pay for making sure everybody has quality insurance.

And that brings me to the other exchange I noticed. Given Obama's repeated pledge not to sign a bill that doesn't control costs, it's reasonable to wonder whether that's more of a priority than expanding coverage. But in the course of discussing a requirement that everybody get insurance, Obama went out of his way to say this:

I in no way want to suggest that cost is more important than coverage. My point has been that those two things go hand in hand. If we can't control costs, then we simply can't afford to expand coverage the way we need to. In turn, if we can expand coverage, that actually gives us some leverage with insurers or pharmaceutical industry or others to do more to help make the health care system more cost-effective.

One more thing. Obama in the interview states that he "basically changed his mind" on the question of whether to require that all people get insurance, a position he (basically) rejected duirng the campaign. He's hinted as much before, but this is a stronger, more explicit statement than I recall.

In any event, Tumulty's interview is worth reading in full. And props to her for conducting a substantive interview, one that shed light on both how Obama thinks about health care and what his policies would actually mean for average Americans. If only all media interviews with the president were this way...

--Jonathan Cohn