The president’s remarks about health care last night were, well, short and to the point, and that’s pretty much what the press reported. Less than 300 words, Politico said, noting that Obama made clear that the health reform law was here to stay and that thoughts of repealing it were off the table. “Anything can be improved,” the president said. “If you have any ideas about how to improve this law by making care better or more affordable, I am eager to work with you. “Improve” was the operative word. It’s one of those different-strokes-for-different-folks kind of words, and Obama seemed to be soliciting suggestions. He did that a year ago when Republicans were on the verge of blocking the reform law and brought up their ideas for malpractice reform.

This time, though, the president seemed to take that idea seriously, and the malpractice story line was the one the press zoomed in on, noting that the president and the Republicans are miles apart on this one. Said The Washington Post:

Even though the president said in his speech that he wants to work with Republicans, he has never supported one step the GOP has long said would control malpractice costs: creating federal limits on the size of damage awards.

NPR told listeners:

The White House fact sheet on the speech mentioned support for state reforms of medical malpractice systems rather than the federal damage award caps that Republicans want and most Democrats oppose.

A Fact Check piece sent out by the AP reported that Obama had been open to tort liability reform last year, but nothing came of it. Politico noted that malpractice reform was hardly a big money saver. The Congressional Budget Office estimates that medical liability proposals would save anywhere from $54 billion to $60 billion over ten years. That represents about one half of one percent of the nation’s health care spending.

The real cost culprits—prices charged for medical services by doctors and hospitals—-were not mentioned, except obliquely. One conclusion of his deficit commission, he said, was the necessity to wring out “excessive spending wherever we find it.”

“This means,” he said, “further reducing health care costs, including programs like Medicare and Medicaid, which are the single biggest contributor to our long-term deficit.” But what did he mean by that?

The health care cognoscenti know that one of the law’s “improvements” floating around Washington is the elimination of the Independent Payment Advisory Board, whose fifteen members are supposed to come up with ways to reduce the growth of Medicare spending. Some experts believe that board is the country’s best shot for slowing Medicare’s cost spiral. But the board is opposed by important stakeholders like the drug companies, medical device makers, hospitals, doctors, and even patients’ rights groups.

The president’s lack of clarity on this subject could also mean he may embrace a voucher system for Medicare beneficiaries, which could require them to pay more for their benefits, and could eventually end Medicare as a social insurance program. That’s a solution embraced by House budget chairman Paul Ryan, who is now in a position to make more than noise about it. What about Medicaid? Did the President have in mind cutting the funds the feds now contribute to the program? How does that square with a provision in the law that calls for expanding Medicaid eligibility to more poor Americans? A contradiction, no?

If the media didn’t pick up on the nuanced message about Medicare and Medicaid, the AARP did. In a statement, the group’s CEO, A. Barry Rand, worried that any attempt to control Medicare and Medicaid spending without addressing the underlying costs in the entire health care system will simply shift them to people of all ages and generations. How to tackle the cost of Medicare and Medicaid is SOTU’s health care takeaway.

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Trudy Lieberman is a fellow at the Center for Advancing Health and a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR’s healthcare desk, which is part of our United States Project on the coverage of politics and policy. Follow her on Twitter @Trudy_Lieberman.