(Bloomberg) -- President Barack Obama has written a game plan onhealth care for the next president, including a crackdown onprescription drug prices that may cutpharmaceutical manufacturers’ profitsif adopted.

In a first for a sitting president, the Journal of the American Medical Associationpublished a scholarly article on Monday by "Barack Obama, J.D."that examines the passage of his landmark health law, theAffordable Care Act, and proposesfuture improvements to the U.S. health care system.

Obama wrote that a government-run insurance plan, the so-called“public option,” should be made available to Americans buyingcoverage in parts of the country where competition is limited, andthat subsidies to reduce insurance premiums in Obamacare should bemore generous.

Despite the ACA, "too many Americans still strain to pay fortheir physician visits and prescriptions, cover their deductibles,or pay their monthly insurance bills; struggle to navigate acomplex, sometimes bewildering system; and remain uninsured," Obamawrote. "More work to reform the health care system isnecessary."

The article previews themes Obama will sound in the comingmonths, as he tries to shape the next phase of the long-runningpolitical battle over the appropriate role for government in theU.S. health-care system, administration officials said.

The priorities Obama set in his article have strong supportwithin his party. Presumptive Democratic presidential nomineeHillary Clinton and her rival in thepresidential primaries, Senator Bernie Sanders of Vermont, bothcalled for the federal government to leverage its buying power toforce lower prices from drug companies. Clinton also backs a publicoption for Obamacare in all states, and Sanders would go further,favoring a government-run universal health insurance program hecalls "Medicare for all."

Defense of Obamacare

In the article, Obama vigorously defended the ACA’s expansion ofinsurance coverage and said that "trends in health care costs andquality" under the law "have been promising." About 20 millionAmericans have gained coverage since the law was enacted in 2010,he wrote, and average growth in spending per person in the Medicareprogram for the elderly and disabled "has actually been negative"from 2010 to 2014.

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Since the law took effect, the portion of nonelderly Americansunable to afford health care dropped 5.5 percentage points and theshare describing themselves as in poor or fair health dropped 3.4points, he wrote.

The article includes 68 citations and endnotes, though it wasnot formally peer-reviewed and JAMA published it as a "specialcommunication." It grew out of an appraisal of Obamacare’simplementation that Obama ordered late last year, said KristieCanegallo, a deputy White House chief of staff. She said the goalwas to "point future policy makers in the right direction" onhealth care.

Obama chose JAMA as a “serious” and “fact-driven” forum,Canegallo said.

‘High standards’

A group of senior editors at JAMA reviewed and critiqued thearticle and its factual claims, said Howard Bauchner, the journal’seditor-in chief. The article went through two formal revisions andadditional editing over two months, he said.

"While we of course recognized the author is the president ofthe United States, JAMA has enormously high standards and wecertainly expected the president to meet those standards," Bauchnersaid in an interview.

The journal also published four editorials accompanying Obama’sarticle, including one by Obama’s first director of the Office ofManagement and Budget, Peter Orszag. "Fundamentally, the ACA isworking," he wrote.

Stuart Butler, a former official at the conservative HeritageFoundation who is now a researcher at the Brookings Institution,wrote that "some troubling trends in the ACA" had not been"adequately discussed" in Obama’s article.

One of the chief problems with the law, he said, is thatpremiums and out-of-pocket costs for insurance plans sold ingovernment-run insurance exchanges are too costly, which hasdiscouraged enrollment by people who earn too much money to qualifyfor subsidies.

“For many households, the president’s promise of affordablecoverage rings hollow and has not been realized,” Butler wrote.

Drug prices

Describing work needed to improve the health law, Obama wrotethat drug costs “remain a concern,” citing a 12 percent increase inprescription drug spending in 2014. He called for legislation toincrease rebates drug manufacturers are required to provide toMedicaid and Medicare and to grant more authority to the federalgovernment to negotiate prices on high-cost drugs.

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The pharmaceutical industry has long fought any such proposals,and the 2003 law that created Medicare’s prescription drug benefitforbids the government from negotiating prices with drugmakers. TheWhite House scaled back demands for concessions on drug prices innegotiations with the pharmaceutical industry when the AffordableCare Act was developed in 2009, in order to win drugmakers’ supportfor the law.

“President Obama also uses misleading figures to lament the costof prescription drugs, while saying little about insurancecompanies actively pushing sick patients off their plans byincreasing cost-sharing to unfathomable levels or refusing to coverdrugs that patients need until it’s almost too late," JimGreenwood, chief executive officer of Biotechnology InnovationOrganization, an industry lobbying group, said in an e-mailedstatement.

BIO has sought to shift the blame for health-care costs toinsurers, and has highlighted the value of new medications.Greenwood is a former Republican member of the House ofRepresentatives.

Obama called for a “public option” insurance plan in his 2008presidential campaign and in his initial health plan as presidentbut abandoned the idea as part of a compromise to buildcongressional support for the Affordable Care Act.

The health insurance industry opposed the creation of a publicoption that would compete with their plans, and Obamacare customerstoday are limited to buying coverage from private insurers such asAnthem Inc., Aetna Inc. and Blue Cross Blue Shield companies.

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Instead of a public option, the Affordable Care Act providedfinancing for 23 startup insurers called "co-ops." More than halfof them have failed.

Obama wrote that a public plan would provide consumers "moreaffordable options" on Obamacare’s insurance marketplaces,particularly for the 12 percent of customers who live in regionswith only one or two participating insurers.

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