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My Interview with President Obama on Health Care Reform
I met President Obama yesterday. I interviewed him at the White House about his proposals for health care reform. But naturally, as we greeted each other, I asked about his throwing out the first ball at the All Star Game the night before.
"Were you nervous about bouncing the ball?" I asked. He grinned. "I will say it's actually nerve-wracking," he said. "When they hand you the ball, there are just a lot of things that can go wrong." I found that to be a perfect metaphor for his assuming the presidency of the United States and attempting to overhaul the health care system.
The biggest news from yesterday's interview: President Obama has changed his position from the campaign trail and now believes that health care insurance should be mandated for all Americans, with a hardship exemption.
Dr. LaPook: Ultimately, philosophically, do you believe that each individual American should be required to have health insurance?
President Obama: I have come to that conclusion. During the campaign, I was opposed to this idea because my general attitude was the reason people don't have health insurance is not because they don't want it, but because they can't afford it. And if you make it affordable, then they will come. I've been persuaded that there are enough young uninsured people who are cheap to cover, but are opting out. To make sure that those folks are part of the overall pool is the best way to make sure that all of our premiums go down. I am now in favor of some sort of individual mandate as long as there's a hardship exemption. If somebody truly just can't afford health insurance even with the subsidies that the government is now providing, we don't want to double penalize them. We want to phase this in, in a way that we have time to make sure that coverage is actually affordable before we're saying to people "go out and get it."
The interview went very smoothly and fairly predictably until we reached the following exchange:
Dr. LaPook: You've said that if doctors have the information, they'll do the right thing. And generally, I like to -- I'm a physician and practicing -- I think that's true. But actually, there are a lot of times when that's not the case. For example, angioplasties -- elective angioplasties, where you open up a clogged artery in the heart. It turns out that about 30 percent of them are unnecessary, that they're done and you try to open up an artery of the heart, but really it's no better than medication, and doctors know this, but they still order them.
President Obama: Why are they still ordering them, do you think?
I will admit that he took me by surprise by turning the question on me. Suddenly I was not in a one-way interview, I was in a conversation. Politics aside, it was clear to me that he was listening and he was curious.
Dr. LaPook: I think that because they believe -- there's this thing about -- if an artery's closed. It's got to be better if it's open, and it turns out that's not true. So they have on the one side their intuition as a physician, in their bellies, and then there's the evidence-based medicine that we talk about, and they clash a lot at times, so how do you make that doctor do the right thing or give him the right incentives?
President Obama: I have enormous faith in doctors. I think they always want to do the right thing for patients. But I also think, if we're honest, doctors, right now, have disincentives to making the better choices in the situations you talked about. If you are getting paid more for the angioplasty, then that subconsciously even might make you think the angioplasty is the better route to take. And so if we're reimbursing the physician not on the basis of how many procedures you're performing but rather how are you caring for the patient overall - what are the outcomes - then I think you start seeing some different choices. And at the very least, you're not taking money out of physicians' pockets for making the better choice. So it's a combination of better information and then, I think, a different system of reimbursement that says, "let's look at the overall quality of the care of the patient."
My conversation with President Obama illustrates a crucial focus of the current health care debate: figuring out if the American people are getting their bang for the buck when doctors order tests, perform procedures, and prescribe medications. The current buzzwords among doctors and politicians are "evidence-based medicine" (is there proof that something works?) and "comparative effectiveness" (if there's more than one way to do something, what works best?). An
Institute of Medicine workshop about evidence-based medicine began today in Washington, with the following listed as "issues prompting the discussion":
- "Health costs in the United States this year will be about $2.5 trillion-nearly 17 percent of the economy.
- The United States spends far more on health care than any other nation, 50 percent more than the second highest spender and about twice as high as the average for other developed countries.
- Overall health outcomes in the United States lag behind those achieved in other countries.
- Consistent with the per capita figures, many researchers studying the nature of U.S. health expenditures feel that 20 percent of our expenditures do not contribute to better health.
Expert groups are currently trying to establish guidelines for reimbursing health expenses based on clear results from well-designed clinical studies. The problem is that for many medical issues, there is no definitive, evidence-based approach. Clinical medicine is often based on inexact, immeasurable tools such as intuition and experience. As doctors, we don't have the luxury of waiting for the twenty-year study to be completed. We have to treat the patient now, as best we can, without perfect information.
In the absence of definitive data, we will need to account for clinical judgment in an overhauled health care system. What will happen when the doctor suggests something the insurance company says is not indicated? Opponents of a public option for insurance warn about the danger of having a bureaucrat in between the patient and the physician. But that threat already exists in the current system every time an insurance company decides whether to approve a claim. Wendell Potter, former head of Public Relations for Cigna, recently told Bill Moyers about Cigna's decision to deny a liver transplant to a 17-year-old girl, Nataline Sarkisyan, even though her doctors at UCLA had recommended the procedure.
A public-relations uproar forced Cigna to reverse its decision; the company subsequently explained its reversal as an exception, saying the surgery was approved "despite the lack of medical evidence regarding the effectiveness of such treatment."
Ms. Sarkisyan died hours after Cigna's decision, without having received the transplant.
A critical flaw in the current system -- and one that must be addressed in any overhaul -- is that the same people who refuse to pay for a recommended course of action are the ones who consider the appeal of that decision. And, lo and behold, they usually end up agreeing with themselves! In more than two decades of medical practice, I have spent countless hours trying to get various services covered by payers. One encounter -- when I tried unsuccessfully to get a stomach-acid lowering pill approved for a patient who needed it -- ended up as an example of twentieth-century frustration in Letters of the Century.
Yes, our current health care system is not sustainable and we do need an overhaul. But there is no "exactly how" and we cannot afford to wait for one. There are so many nuances to the moving target of health care and so many unknowns that it is impossible to create a perfect solution on paper. I'll settle for an imperfect solution that addresses the most important problems first and represents the best efforts of our most thoughtful experts. But it should not be set in stone. It must include provisions to mature gracefully into versions 2.0 and beyond.
WATCH A CLIP OF MY INTERVIEW:
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Watch the full 12-minute clip of my interview with President Obama here.
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The President has made clear why federalized health care will fail miserable. He believes - sincerely - that physicians must be reimbursed (paid) on the basis of outcome. Now, just think about that for a minute. What is the "outcome" of most patient care? Well, the patient is "better" than before. So, if a patient is not "better" the doctor does not get paid? What does "better" mean.
This approach is literally crazy because the actual metrics are not quantifiable. How, for example, would one reimburse a physician for easing pain?
The real and only goal here is to limit the number of "unnecessary" tests and procedures. And who will decide this?
pr
I believe in universal Health Care, but at what cost? If we can find ways not to increase the deficit in an enormous way, then it should be implemented. Obama, has the the peoples' best interest, and there is no doubt about that...however, he can't do it alone, for one, Congress is still bent on doing things the same way they have been doing things for years with little or no change. Obama however, is trying to change the ways of how things are done in Congress, so that is the reason why, we need the peoples' intervention to make this change be recognizable/noticeable...perhaps then, they will start to listen.
Universal Health Care should be at the forefront with other priorities at hand, therefore, there is no need to delay this. Let's face this, Congress has been trying to pass Universal Heath Care for years now. It was defeated in the Senate during Clinton's reign, because of self preservation and the power of the Medical industry. Congress must start putting the peoples' interest first, and set aside their own self perservation.
By delaying for 60 years or so we are very late in the game compared to the rest of industrialized countries. This makes it a lot more difficult, but not impossible.
I lived in Ireland during the most recent “troubles” and saw how the ordinary working and middle class Nationalists and Unionists were so bitterly opposed yet they shared so many common problems. I see the same thing here; people being radicalized by politicians, vested interests and the media and, as a result, acting against their own best interests.
Obama is half-right when he says it has to be bi-partisan but he’s talking about congress. In fact, it has to be non-partisan at the grass roots. But when you see the animosity from both sides in Huffington Post about the issue you see where the real problem lies.
Single payer will come when the majority has a single purpose, not before.
Until then the special interests win every time.
A really good solution would be everyone being taxed 50 bucks a month. Put it towards Medicare for all. It would be freedom from an employer, from the gay unions who cannot get coverage as a couple, and rotten marriages where one spouse may not be able to afford coverage. It would illminate the need for liability on auto and home insurance bringing down that cost. It would extend the health care of all Americans, with the regulations that Medicare has it would be cost effective because there would be approx 198,000,000,000. going towards medical care. It would not be a charity given to anyone. Medicare does not discriminate on pre existing conditions and I have seen that it works very well with the highest risk.
People that feel they need special privilage health care let them get their expensive insurance coverage at their own expense.
"To me this plainly means that if the choice is between generating revenue or providing health-care, collecting revenue wins."
"Collecting revenue" should win. That is the only way to share the cost-burden and reduce the overall individual cost of care. The other option is to merely print money.
Those who elect to have no insurance run the risk and on occasion do get ill. Who pays for their care then?
Medicare for all would solve all those issues.
No collecting revenue should not win. We already have that, and that's why we're in the mess we're in. Did you even read the article?? "The United States spends far more on health care than any other nation, 50 percent more than the second highest spender and about twice as high as the average for other developed countries. Overall health outcomes in the United States lag behind those achieved in other countries. Consistent with the per capita figures, many researchers studying the nature of U.S. health expenditures feel that 20 percent of our expenditures do not contribute to better health." HELLO, we're paying far more and getting worse outcomes!
And I'm sick and tired of hearing about all those people "who elect to have no insurance". Really? Name them. My self employed father, who at 73 is STILL WORKING PROBABLY HARDER AND LONGER THAN YOU? My daughter who "aged off" her dad's health insurance and couldn't qualify for it at her work? My sister with a progressive disease who is uninsurable?? If you have an argument to make provide the facts to support it, otherwise it's completely irrelevant. And, stop relying on FAUX News for your "information"
"Ask your doctor" advertisements that benefit Big Pharma have gotta go, for a start.
Very true statement.
Yup. I couldn't agree more. Every time I see a commercial for a prescription I know the cost of that ad is added into the cost of the medication, and all the other medications made by the same company!
Not only could that save some money, but they are disturbing, and I think they contribute to people being overmedicated.
The responses from the President that stopped me in my tracks were, "I am now in favor of some sort of individual mandate as long as there's a hardship exemption.” Adding “If somebody truly just can't afford health insurance even with the subsidies that the government is now providing, we don't want to double penalize them.”
To me this plainly means that if the choice is between generating revenue or providing healthcare, collecting revenue wins.
Surely that’s the problem we started with, not the position we want to end up at,
Single Payer Now.
It's the only solution
http://www.fair.org/index.php?page=3834
Thanks for highlighting the complexities of medical decision making. Most of your commenters think single payer would eliminate any decisions by doctors, or anyone else for that matter, that might restrict the treatments a patient receives. But other countries with single payer systems have centralized technology assessment programs that make "population based" decisions about what to pay for - and YES, they turn treatments down! There isn't enough money anywhere to give everyone what they think they need, so I wish the single payer folks would stop acting as if everything can be paid for, and it's only the evil insurance companies that keep us from getting what we need.
I'm sure you struggle with insurance companies, but you are wrong about one thing -- most of these companies have appeals mechanisms that use outside experts. Medicare certainly does.
I guess you've never tried to get "prior authorization" for a medication your doctor prescribed and isn't on your HMO formulary. Believe me, if it isn't on the formulary.......good luck.
One of the biggest problems with this whole thing is that there is little incentive for med students to go into primary care...which is preventative. After graduating from their astronomically priced education, they almost HAVE to go into a specialty. All of this is a result of many complex factors..mostly the way everything has been deregulated and the banks allowed to lend for education.
I think what's going to happen is that we'll have to import doctors as we simply do not have the medical infrastructure to take of of so many more people.
BUT, if the gov wants to "mandate" insurance buying, they'd better give folks an alternative or the big insurance corporations are going to continue to bleed US dry. A few regulations which the gov will spend more $$$ trying to enforce than they would spend on single payer are not going to make the insurance industry honest.
Yes, basic care is covered in countries with single payer systems. Non essential care is covered by supplemental (out of pocket) care. If you don't agree with your doctor's decision you can pay for it , or if you want a private room, etc. But BASIC CARE is covered. This is addressed by the single payer plan being proposed here. The private insurance concerns will still have a place along side single payer. They just won't be the only arbiters of LIFE and DEATH.
http://www.pnhp.org
You're only kidding yourself. If you've ever had to appeal a decision you'd know it goes before a board of their own employees. No outside experts or even opinions.
"Biggest Bang for the Buck" is Single Payer but Obama is against it because it will drastically reduce costs along with obscene immoral profits...
So much for change...!
Just a thought.. remember when doctors, drug companies, medical insurers, and attorneys weren't permitted to advertise? It seems like absolutely every basic human need that is turned over to "private enterprise" and operated with profit as the greatest motive ends up serving only the few, leaving the "commoners" to do the bidding of the "great" corporate oligarchs, i.e., this idea that everyone "must" buy health insurance. Can it be any more obvious that this reform is brought to us by the insurance industry?
How about single payer health care and outlawing the marketing and advertising of doctors, hospitals, insurance, pharmaceuticals, and ambulance chasing attorneys? Imagine the cost savings from reductions in hypochondriasis alone, let alone that from our collective support of the high cost of marketing and advertising! Members of the "Over-the-top-greed-club" along Madison Avenue and Wall St. may have to pursue new careers, ones more supportive of the common good.
Don't just listen to someone's spin. Be empowered. Or, at least, better informed:
The evolving House health bill, HR 3200, "America's Affordable Health Choices Act" is posted here. (Scroll down to Learn more for summary and full bill text, as it is now): http://www.speaker.gov/blog/?p=1864
Help HuffPo investigate and report on the evolving House bill: http://www.huffingtonpost.com/matthew-palevsky/hundreds-join-together-to_b_237999.html
The only way to solve problems with the medical system, while improving the economy, is providing full choice/access to health care for all. But that's not enough. There's no way that I'd pay for health insurance without knowing that I'd get something of quality in return. I don't want to be marketed diseases to line the pockets of Big Pharma and ensure that I need more care to deal with the effects of poisons dispensed for non-existent disease. The insurance companies must be completely dismantled. No employer should pay for health care of employees; this harms employees and cripples business. Employees cannot pay employees as they should if they're throwing money at a partnership between the insurance companies/Big Pharma - not for quality care/physical science, but for capitalism gone wrong and marketing science.
Requiring young people to purchase insurance on the assumption they won't need care is taking money from people to pay for nothing. However, that "nothing" is better than what others will pay to be peddled drugs for a make-believe condition, while their illness remains undiagnosed during the intentional distraction.
This current plan will keep emergency rooms the main choice for people who need care out of medical necessity. And those pushed into doing such a thing ought to consciously decide never to pay, in order to force real, intelligent change that will save lives, increase quality of life for all, and improve the economy by greatly reducing waste and fortification of the problem.
Only in America do we reward incompentence. The post office is going broke, Medicade and Meicare are going into bankruptcy. Amtrak has run in the red since the government took over with no competition. Our government has almost always run a deficit an can't run itself. What makes you think they can run health care.
You want real health care reform have tort reform. Doctors currently pay on the average of $200,000 a year on mal-practice insurance. The perform more test than needed because they always worry about missing something and getting sued.
The Federal Government currently takes $1,000 per health policy per year to suppor Emergency Room visits where people have no money. A very abused system.
Both of these combined would drop health care cost drastically. But of course you wouldn't have someone else paying for your doctor visit when you have a cold
Wilson -- The Post Office, Amtrak, Medicare, Medicaid fulfill the common good. Paid for with our widely shared taxes. Meaning that your having your mail delivered, your cousin hopping on the train to visit you from Philadelphia, your aunt receiving health care that YOU don't have to pay for out of pocket, contribute to the public good. YOUR public good, funded by OUR taxes. A little goes a long way when taxes are fairly applied.
Where the common good ideal broke down, in this country, was on health care. Where it was decided that health was a commodity that could be traded on the stock market. How immoral is THAT, Wilson.
Other countries NEVER thought of health as something that could be "marketed". They saw it as a human right.
With a Single Payer system (Medicare for All), tort reform becomes moot, your automobile and homeowners' insurance will go down (no more liability clauses).
Please think it over and join us on July 30th at a rally in Washington, D.C.
http://www.Healthcare-Now.org
http://www.pnhp.org
http://PDAmerica.org
http://www.Health-Justice.org
and read Senator Sanders' platform
http://Sanders.Senate.org
and Gov. Howard Dean's prescription
http://standwithdrdean.com
If you think it's easy to sue a doctor who's harmed you, think again. And they know it. You have to go before a board of doctors and lawyers to get PERMISSION to sue now. Good luck
Funny, I hear a lot of folks badmouthing the Post Office, but I've never been able to get one of them to take a letter across the country for me for 44 cents.
LOL
rant cont'd
Please I thought that with the balance of power swinging to a liberal progressive government there could be quality lasting reform. Please someone help me understand how this is a good plan to require all people to pay into a for profit system for healthcare. What happened to "IT'S A RIGHT NOT A PRIVILEGE"
The way the president describes this bill with a mandate to require health insurance along with the heavy inclusion of industry experts and lobbyists in the legislation crafting process leads me to believe that the final bill will definitely be written for the medical industrial complex. It is ridiculous to require people to purchase health insurance, supposed access to affordable care, from a corrupt for profit industry that has a track record of working for its interests first and patients second. In the presidents own words "I've been persuaded that there are enough young uninsured people who are cheap to cover, but are opting out. To make sure that those folks are part of the overall pool is the best way to make sure that all of our premiums go down." THIS BILL WILL BE A SHAM FOR THE MEDICAL INDUSTRIAL COMPLEX, SINGLE PAYER NOW! Perhaps I'm wrong, if someone could please explain to me how a cash strapped yet still relatively healthy generation must be trapped into a terrible system that will most surely be abandoning them by the time they will need care later in life. At such a point costs will be so astronomical at the current rate of increase, every for profit insurance company will be working double time to avoid taking care of people who have been paying them for years. THIS A JOKE, IF EVERYONE MUST PAY IN THEN LEAST EXPAND GOVERNMENT INSURANCE IE MEDICARE TO ALL AND JUST RAISE THE TAX RATE!
THOBZILLA -- you have seen the light. Health "insurance" as it is structured in this country today is a racket. Why the administration wants to INCREASE our dependence on this "insurance" racket (mandates! fines!!) baffles me. Unless they are in the pocket of the health "insurance" racketeers. And that would be very disheartening, as we thought we were voting for CHANGE!
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