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Obama's 50th Birthday Wish

The President discusses Medicare and the gift he wants for you

En español | Give him this: President Obama is a cool operator. When we met with him in April, he was secretly planning what would become a defining moment of his presidency: the deadly assault on Osama bin Laden. On this day, however, our conversation focused on domestic battles — including the war over entitlements for seniors — and, yes, how he deals with stress.

See also: JFK, Obama: Parallel challenges.

You're hitting the Big 5-0 on August 4. What's the best and worst thing you can say about that?

The worst thing is, I don't feel I'm as fast as I used to be. And I heal up slower on the basketball court. The wonderful thing is, I've been able to maintain my health pretty well. Also, I'm old enough where hopefully I've made enough mistakes I'm not going to repeat. And I'm still young enough that I can appreciate that wisdom.

Is a big celebration in the works?

Last year, on my 49th, LeBron James, Dwyane Wade, and all these other All-Star players came and played a pickup game with a bunch of my friends and me. Had a wonderful time. It'll be hard to top that. But I suspect the girls may have something planned.

Speaking of your daughters, do you hope their generation will experience aging differently than yours or your grandparents'?

It's already changed for my generation. When my grandparents were in their 50s, they were already "older." They drank, they smoked, they didn't exercise, they ate all kinds of stuff. And so they were already slowing down pretty good. Now I have friends who are 65 and 70 who are in better shape than my grandparents were when I was a kid. Americans want to be judged by their capacities, their interests, their curiosity, their imaginations, and not just by a number. I do want to make sure that when Malia and Sasha are entering their 50s, we still have the security of Social Security. Of Medicare. That we have maintained our commitment to people having basic security if things don't go well in their later years.

Yet in the debate over the deficit, people criticize "greedy geezers" for caring only about their entitlements. Is there any truth to that?

Well, seniors have paid into Social Security. They've paid into Medicare over a lifetime of hard work. And the notion that somehow they are asking for something that they don't deserve makes no sense to me. They're also under severe stress from the rise in things like gas prices, food prices, and home heating-oil prices. And if you're on a fixed income and the inflation rates on things like that are going up faster than your income, you have reason to worry. But I also think that older Americans don't want to leave huge debts to their kids and their grandkids in the form of massive deficits. That's why it's been important to reform the health care system, which is different from simply lopping off benefits under Medicare.

Can you slow the growth of Medicare costs without hurting access or quality?

What we did in the Affordable Care Act was to say there are ways we can get better bang for our health care dollars. The reforms ensured seniors can get preventive care, which could lead to less-expensive care down the road. Routine mammograms and colonoscopies are covered, there are 50 percent discounts on brand-name prescription drugs, and ultimately there's a close in the doughnut hole.

At the same time, we've said to hospitals and doctors: "Let's do things smart." Let's make sure we're not subsidizing the insurance industry for services that Medicare provides perfectly adequately. And that's in contrast to some proposals you've seen that say, "We're going to give you this set amount of money. You go into the open marketplace to try to buy health insurance," and lo and behold, you may not be able to buy it because the insurance companies are charging a lot more than what your voucher's worth. That's a way of shifting costs onto seniors. But we actually want to reduce costs.

What about Social Security?

I think we can make progress. We're ahead of the game in the sense that we're already having a vigorous debate now, and there's no danger of Social Security going bankrupt.

The issue is, can we make these tweaks to ensure that everybody who's expecting a dollar in Social Security payments gets a dollar instead of 75 cents? And the sooner we do it, the better off we're going to be. I think that if we can make some progress first on Medicare and Medicaid, because those are the entitlement programs that are really driving the long-term debt, we'll have a framework of negotiations to actually do something on Social Security as well.

Back to your birthday: Have you asked for anything special?

A much lower unemployment rate. And lower gas prices. [Laughs.] Those would be perfect gifts for my birthday.

Let's talk about the economic recovery. You've said all along it will take time. But how long do you think you can counsel patience?

Well, keep in mind that the economy is growing and has been growing for a year and a half, two years now. We've seen enormous job growth — 2 million private-sector jobs created. The question is, can we get it moving faster so that more people feel the impact? Because if you're out of a job, the only improvement you want to hear is that you're going to have a job.

So to the unemployed, those who are underwater on their homes, folks who are supporting their adult kids and aging parents, too — what can you say to offer hope?

What I can say to them is that things are getting better. Traditionally it takes a little longer to come out of a financial crisis than out of a normal recession. The tax cut that we passed in December on a bipartisan basis — helping people with their payroll tax — is putting more money in people's pockets. Yet a lot of jobs that traditionally used to be there — not just in manufacturing, but jobs like a bank teller or a travel agent — aren't as available now as they used to be. And so we have to get not just our young people, but people who are midcareer, retrained for jobs that exist now, as opposed to the jobs that existed yesterday. And as we get a handle on our deficit, we've got to make investments in education, in basic research, in clean energy, and in infrastructure.

Those are formidable challenges. What do you do to relieve stress?

Exercise is important. But the most important thing is spending time with family. And when I think about those people who continue to thrive into their 70s and their 80s, usually what distinguishes them is that they exercise and have good habits. They laugh a lot and keep their sense of humor. They're involved with their family. And they're connected to work or causes that they care about.

I'm surprised you didn't mention music as a stress reliever. You're a big music listener.

I am a big music listener, and I can tell you that my iPod is well stocked.

Marilyn Milloy is deputy editor of AARP The Magazine.