June 25th, 2009 – Yesterday President Barrack Obama appeared on ABC’s Primetime and Nightline to discuss his Health Reform proposals in a “Town Hall” type format where he responded to questions from the public, industry insiders and the head of the American Medical Association.
While some opponents feared this would be a 1 hour infomercial for the Democrats health reform plans, there were several tough and probing questions about how he would pay for an overhaul, how the government might interfere with medical decisions, and whether average Americans would have the same access to health care as wealthy individuals. President Obama responded to the skeptical audience with mixed results.
President Obama was asked by Dr. Orrin Devinsky, a New York neurologist, whether he would go outside a new government insurance program to get the best care for his wife or daughters if they fell ill. “If it’s my family member, if it’s my wife, if it’s my children, if it’s my grandmother, I always want them to get the very best care,” Obama said.
President Obama praised the Medicare system as a model of government run health care. That was an odd choice as if Medicare continues on its current trajectory, it is expected to be bankrupt in 10 years. Medicare has suffered from mis-management, fraud, abuse and large rate increases since its inception. The low rates that the government pays for Medicare services result in about 30% of the costs for private insurance, as the doctors must shift those low ball costs somewhere.
This exchange was eye opening to me and exposes the risks of what will happen when we put the government between patients and their doctors:
JANE STURM: Hazel Homer is over 105 now. But at 100 the doctor had said to her, I can’t do anything more unless you have a pacemaker. I said, go for it. She said, go for it. But the arrhythmia specialist said, no, it’s too old.
Her doctor said, I’m going to make an appointment, because a picture is worth a thousand words. And when the other arrhythmia specialist saw her, saw her joy of life and so on, he said, I’m going for it. So that was over five years ago. My question to you is, outside the medical criteria for prolonging life for somebody elderly, is there any consideration that can be given for a certain spirit, a certain joy of living, quality of life? Or is it just a medical cutoff at a certain age?
OBAMA: Well, first of all, I want to meet your mom. And I want to find out what’s she’s eating.
OBAMA: But, look, the first thing for all of us to understand is that we actually have some — some choices to make about how we want to
deal with our own end-of-life care. And that’s one of the things I think that we can all promote, and this is not a big government program. This is something that each of us individually can do, is to draft and sign a living will so that we’re very clear with our doctors about how we want to approach the end of life.
I don’t think that we can make judgments based on peoples’ spirit. That would be a pretty subjective decision to be making. I think we have to have rules that say that we are going to provide good, quality care for all people.
CHARLIE GIBSON: But the money may not have been there for her pacemaker or for your grandmother’s hip replacement.
OBAMA: Well, and — and that’s absolutely true. And end-of-life care is one of the most difficult sets of decisions that we’re going to have to make.
JANE STURM: What I wanted to say was, that the arrhythmia specialist who put the pacemaker in said that it cost Medicare $30,000 at the time. She had been in the hospital two or three times a month before that, so let’s say 20, 30 times being in the hospital, maybe going to rehab, the cost was so much more. And that’s what would have happened had she not had the pacemaker.
DIANE SAWYER: We have a question from Dr. Gail Wilensky, who ran Medicare in the Bush administration. Your question?
GAIL WILINSKY, Senior Fellow, Project HOPE: I want to go back to how we pay for the expansions. Estimates, as you indicated, probably $1.5 trillion to cover everyone. You mentioned savings in Medicare and Medicaid, $500 billion to $600 billion, from the numbers you’ve provided. Another $300 billion from additional revenue. That leaves about $300 billion to $600 billion more. What do we do in ways that CBO will count so that we can actually get everybody covered?
OBAMA: Look, that’s the challenge. And, obviously, there’s a vigorous debate taking place. There are a whole host of ideas, some that cut across parties. There are people who think that we should tax benefits — health care benefits at a certain level, cap the deduction. There are others who proposed a surcharge on high-income individuals. There are other cuts that may be obtained that ultimately we could find scorable.
Here’s my general point, because I know that we’re starting to wrap up. This is not an easy problem, and it’s especially not an easy problem when the economy is going through a difficult phase. You know, we’ve taken a body blow to the economy, and families were oftentimes hurting even before then.
But the one thing I’m absolutely confident about is that, whenever this country has met a significant challenge to our long-term well-being, that we ultimately rise up and meet it. And this is one of those moments where the stars are aligned. We’ve got insurers who are interested, doctors who are interested, nurses, patients. AARP is here, and they’ve seen some of the potential benefits. We’re actually going to be filling the donut hole. Drug companies have said that they’d be willing to reduce the cost for seniors for prescription drugs as part of health care reform.