Obama told a largely supportive Montana audience at his second of three town hall meetings this week that fixing the health care system requires improving health insurance practices and reducing the costs of treatment. He sought questions from skeptics of his proposed health care overhaul, seeking to confront some misconceptions fueled by opponents Democrats say are undermining the debate.

One man who identified himself as a proud National Rifle Association supporter and believer in the Constitution asked how the government would pay to expand health insurance coverage to 46 million uninsured people.

"You can't tell us how you're going to pay for this," said the questioner, Randy Rathie, a welder from Ekalaka, Montana. "The only way you're going to get the money is to raise our taxes. That's the only way you can do that."

Obama responded with his oft-repeated explanation that two-thirds of the cost of overhauling health care -- estimated at about $900 billion over 10 years -- would come from eliminating waste and improving efficiency in the current system, which includes the government-run Medicare and Medicaid programs for the elderly and impoverished.

The rest would have to come from new revenue, he agreed with the questioner, and he called for reducing the amount of deductions that people making more than $250,000 a year can make on their income taxes.

"If we did that alone, just that change alone ... that would raise enough to pay for health care reform," Obama said, noting that would meet his election campaign pledge to avoid any tax increase on people earning less than $250,000 a year.

However, Obama said some taxes would have to be raised, and the crowd applauded when he said he believes people with more money, like himself, ought to pay a heavier burden.

"We've got to get over this notion that we can have something for nothing," Obama said. "That's how we got into this deficit and this debt in the first place."

In reference to emotional and heated debate at some other town hall meetings across the country in recent weeks, Obama told Rathie, "I appreciate your question, the respectful way you asked it, and by the way, I also believe in the Constitution."

Afterward, Rathie said he was impressed by Obama's performance but remained skeptical.

"I don't think he knows where that money's going to come from," he said. "If he does, he's not saying."

Obama noted there is more work to be done, with Congress seeking to merge at least four bills, along with a possible compromise agreement being negotiated by Democratic Sen. Max Baucus and five other members of his Senate Finance Committee, into a single bill in September.

Another questioner chosen when Obama asked for a skeptic identified himself as an insurance provider who wanted to know why Obama and Democrats are vilifying the insurance industry in the health care debate. Earlier in the meeting, Obama described what he called discriminatory practices by insurance companies that dropped coverage of people who became sick or refused to cover those with pre-existing medical conditions.

Obama noted some insurance companies are contributing to the reform debate, but said others are spending millions of dollars to try to defeat any health care legislation. For a health care overhaul to work for everyone, he said, it has to ensure all Americans are covered so that insurance companies have incentive to participate.

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