Obama Says Only Doctors & Patients Should Decide Health Treatments

Printer-friendly

Email article

Related subjects: Healthcare Policy, In the Loop, Legislation, Obama administration, Presidential Addresses, U.S. Economy, U.S. Law, U.S. news, U.S. Politics Comments (1)

11 August 2009 :: staff

Pres. Obama held a major healthcare town hall meeting in Portsmouth, New Hampshire, this afternoon. He used the forum to explain how closely the proposed reforms do actually address the demands of many critics across the country. He said reforms would be patient-centered, saying “I don’t think government bureaucrats should be meddling, but I also don’t think insurance company bureaucrats should be meddling.”

He warned that failing to achieve comprehensive reform that expands the pool of people covered by some sort of health insurance, public or private, would mean the current system would continue to push costs ever higher, threatening individuals, businesses and the government with bankruptcy. He also chided insurers for practices that cut off care, saying ”Insurance companies will continue to profit by discriminating against people for the simple crime of being sick. Now, that’s not a future I want for my kids.”

Obama reiterated his much-spoken admonition that change is not just a vote, not just an idea, that it requires work and persistence, that it is difficult. ”I never said change would be easy; if it were easy, it would’ve already been done”, he told the Portsmouth crowd. ”If you want a healthcare system that works for the American people as well as it works for the insurance companies, I need your help.” He urged supporters of reform to “knock on doors” and to get the facts out to the people.

The first questioner explained that he has “a wonderful government-run plan called Medicare”, adding that he likes the plan, calling it “affordable” and “reasonable”, and noting that no one tells him what kind of care he can receive. Obama answered saying ”If we can get something like Medicare right, there ought to be a little more confidence that the government can have a role, not the dominant role, but a role, in making sure people are treated fairly”.

Pres. Obama named Chuck Grassley, Mike Enzi, and Olympia Snowe as three Republican senators who he believes are honestly working to try to find a good bill that Democrats and Republicans can support. He added that if we don’t achieve bold reform that brings down costs, “there is no way to bring down the budget deficit”. His implication appeared to be that some elected officials need to do more to achieve consensus, instead of just spreading rumors or trying to “kill” reform.

A young girl then asked the president why people outside the town hall meeting had so many “signs saying mean things about reform” and why people don’t want reform that would help people who need help. The White House reportedly did not pre-select questioners, and the girl’s wording underscored the concerning amount of hostility some people see to what are really practical solutions to an urgent problem.

Pres. Obama answered by noting the rumor spread by some Republicans that one of the bills in the House mandated euthanasia for the elderly and infirm. Obama explained there are no “death panels” and that the proposal to allow Medicare to fund “advanced care” options for end of life planning was actually proposed by Republican senator (when he was still a House member) Johnny Isakson, because it would allow people to have more options and more choice in terms of needed care.

Obama also noted that aside from wild fabrications, the issue of cost has some people upset and concerned. He noted that Medicare Advantage, a system of public subsidies for private insurers that pays them over $170 billion over ten years to provide coverage Medicare already provides, while they take a profit on that care and don’t have to bid competitively for the subsidies.

The third question came from a man who had a bad experience being put on a generic medication when he had better results with the brand name. He complained that efforts to cut costs had put him in that situation, but the brand name drug was restored for his treatment, once it was determined the generic was not as effective. Pres. Obama said the case is a good example of a system working, where the better treatment was provided, as per patient need.

“Ultimately, you’ve got to get the best care, based on what the doctor says”, Obama added. He said that perhaps the process experienced by this one man was “not as efficient as it could’ve been”, but that ultimately it was a good outcome. He noted that current reform proposals would aim to make such processes as efficient as possible in order to get both the lowest costs and the best treatments available in the marketplace, for every patient.

A woman from Maine asked the next question: she said she’s on Medicare and has a supplement, but that the supplement will be lost if “something happens to my husband”. She asked how Medicare will be affected under proposed reforms, given that in her case, there’s a supplement from private insurance linked to her husband.

Pres. Obama said it’s important to note, first of all, that no Medicare benefits will be cut. This does not explain whether Medicare will cover the supplement she currently has, but in theory, Medicare is already designed to do so. Pres. Obama also noted that hospitals are not incentivized to get care right the first time, and drug costs are so excessive they are a bigger drain on seniors’ finances than any other area of healthcare.

He noted that AARP supports the proposed reforms, because they believe the outcome will be good for Medicare and for seniors. AARP is specifically focused on making sure that Medicare does not run out of money and that seniors are better able to deal with the costs of chronic health problems and/or deteriorating terminal illnesses, but also to have primary care that extends good health as far as possible into old age.

A man from Maine, who led off saying “I’m a Republican and I don’t know what I’m doing here” —prompting laughter— asked Pres. Obama about whether he supports a single “universal plan” or maintaining the private insurance system. He said he saw that Obama appeared to be more in favor of something that maintains the existing system than he once was.

Pres. Obama said it’s important to distinguish between “univeral” and “single-payer” healthcare plans. He said he does not support a single-payer plan, which he compared to “Medicare for all”, because it would be “too disruptive” and because the American system is traditionally employer-based. He explained that he does not want anyone who is satisfied with their care to lose it, so they will be able to keep it, but it’s vitally important to achieve “universal” coverage, i.e. getting everyone into some sort of insurance or reimbursement plan.

He specified that the “public option” as currently under consideration would be only one option in the whole “menu” of health insurance options that would be part of a broad “exchange” in which consumers and small businesses could shop for best priced, best quality plans, choosing freely among them.

A woman who teaches at the high school where the town hall meeting was held asked Pres. Obama what he felt would be the effect on society at large if every American who needed it had good quality mental healthcare coverage. The president said mental health has long been “undervalued” in the American health insurance system and that he favors “mental health parity”, where mental health conditions are covered by insurance plans, public or private.

A college student asked Pres. Obama how such major reforms could be implemented without 1) raising taxes on the middle class or 2) causing rampant inflation. Obama said first of all he would not sign a bill that increases the federal budget deficit or the national debt, which means that there will be no need to raise taxes.

He pointed out that the “same folks” who voted for Pres. Bush’s Medicare Prescription Drug plan, which had no such provision and vastly expanded spending now claim it’s Obama who wants “big spending”. He noted that the entire package of proposed reforms would be funded, also noting that the total proposed costs are not $1 trillion, but $100 billion per year, or $1 trillion over 10 years.

He explained how existing revenues would already cover 67% of those expenses, but that the remainder would “need to be funded” by “new sources of revenue”. He explained that instead of new taxes, a provision that would “limit the itemized deductions” available to those who earn more than $250,000 per year to the same level (about 28%) available to the average middle class family.

A woman asked what about current planned reforms would allow for expansion of coverage to the roughly 50 million uninsured. Pres. Obama cited 46 million uninsured, while other sources say the 46 million uninsured in 2007 has swelled to 52 million uninsured at present.

Pres. Obama said the application of non-optimized care is essentially a subsidy to wasteful health services, which inflates Medicare spending and effectively limits the amount of treatment available at the same costs per patient.

Pres. Obama explained that an “effectiveness” panel of experts would help to craft the best solutions for interactivity among distinct treatment centers, to avoid having to repeat costly testing that in no way contributes to healing patients and may impede quality care by wasting valuable time during courses of treatment for patients competing for doctors’ time.

He said there is a critical shortage of highly skilled nurses, nursing professors to educate them and primary care physicians, who are the effective “front lines” of healthcare. Pres. Obama said on this point that part of the necessary reforms must be funding incentives for people who want to teach nursing, study nursing or study to become primary care physicians.

The last question was from a New Hampshire resident who described himself as a “skeptic” on healthcare reform. He said he “turned himself in” on the White House website for being a skeptic, which prompted Obama to explain there is no “enemies list”, only a sincere effort to answer questions with facts and to inform the public about what is really being proposed.

The questioner asked Obama why he has not used the “bully pulpit” of the presidency to chastise Congress for maintaining “two systems, one for everybody else and one for them”. Obama took the opportunity to explain that in fact, he would like to make the choices available to most people more like the choices elected officials have.

He said that when his wife worked at the University of Chicago Hospital, she liked the plan she had, so he did not have to use the government employees plan; it was an option and they chose what was better for them. He proposed that this is exactly the reasoning behind the healthcare exchange and the public option as part of that menu: that ordinary people be able to choose between what is available to them now and something that might be better for them.

“If we can set up a system that gives you some security, then that’s a lot, and this is our best chance to do it, but I’m going to need your help.” Pres. Obama’s message was clear and was well received. Major media reports said the White House had not pre-screened the audience for pro-reform positions and the president himself said he would make sure there were skeptical views heard, and answered.

It is the first high-profile town hall meeting on healthcare in recent days that has not been marred by angry outbursts, insults or threats, from the audience. Pres. Obama addressed most of the main false rumors being spread about the proposed healthcare reforms, and clearly sought to illustrate how the reforms as proposed would: reduce costs, insure (nearly) everyone, retain the market system, expand choice for patients and privilege the doctor-patient relationship above all other considerations.

   Send article as PDF   

Printer-friendly

Email article