Health Care Reform: SPECIAL EDITION
Editor’s Note:
President Barack Obama delivered a speech June 15 at the American
Medical Association’s annual House of Delegates meeting in Chicago
outlining his administration’s plans for health care reform. We
decided to dedicate this issue to that speech and its aftermath as
the health care reform debate heats up. The text of that speech
appears below, along with commentaries from WCMSSM physicians and
position statements on health care reform from the AMA and the
National Medical Association.
Obama Speech To
AMA June 15
From the moment I
took office as President, the central challenge we have confronted
as a nation has been the need to lift ourselves out of the worst
recession since World War II. In recent months, we have taken a
series of extraordinary steps, not just to repair the immediate
damage to our economy, but to build a new foundation for lasting and
sustained growth. We are creating new jobs. We are unfreezing our
credit markets. And we are stemming the loss of homes and the
decline of home values.
But even as we
have made progress, we know that the road to prosperity remains long
and difficult. We also know that one essential step on our journey
is to control the spiraling cost of health care in America.
Today, we are
spending over $2 trillion a year on health care – almost 50 percent
more per person than the next most costly nation. And yet, for all
this spending, more of our citizens are uninsured; the quality of
our care is often lower; and we aren't any healthier. In fact,
citizens in some countries that spend less than we do are actually
living longer than we do.
Make no mistake:
the cost of our health care is a threat to our economy. It is an
escalating burden on our families and businesses. It is a ticking
time-bomb for the federal budget. And it is unsustainable for the
United States of America.
It is
unsustainable for Americans like Laura Klitzka, a young mother I met
in Wisconsin last week, who has learned that the breast cancer she
thought she'd beaten had spread to her bones; who is now being
forced to spend time worrying about how to cover the $50,000 in
medical debts she has already accumulated, when all she wants to do
is spend time with her two children and focus on getting well. These
are not worries a woman like Laura should have to face in a nation
as wealthy as ours.
Stories like
Laura's are being told by women and men all across this country – by
families who have seen out-of-pocket costs soar, and premiums double
over the last decade at a rate three times faster than wages. This
is forcing Americans of all ages to go without the checkups or
prescriptions they need. It's creating a situation where a single
illness can wipe out a lifetime of savings.
Our costly health
care system is unsustainable for doctors like Michael Kahn in New
Hampshire, who, as he puts it, spends 20 percent of each day
supervising a staff explaining insurance problems to patients,
completing authorization forms, and writing appeal letters; a
routine that he calls disruptive and distracting, giving him less
time to do what he became a doctor to do and actually care for his
patients.
Small business
owners like Chris and Becky Link in Nashville are also struggling.
They've always wanted to do right by the workers at their family-run
marketing firm, but have recently had to do the unthinkable and lay
off a number of employees – layoffs that could have been deferred,
they say, if health care costs weren't so high. Across the country,
over one third of small businesses have reduced benefits in recent
years and one third have dropped their workers' coverage altogether
since the early 90's.
Our largest
companies are suffering as well. A big part of what led General
Motors and Chrysler into trouble in recent decades were the huge
costs they racked up providing health care for their workers; costs
that made them less profitable, and less competitive with automakers
around the world. If we do not fix our health care system, America
may go the way of GM; paying more, getting less, and going broke.
When it comes to
the cost of our health care, then, the status quo is unsustainable.
Reform is not a luxury, but a necessity. I know there has been much
discussion about what reform would cost, and rightly so. This is a
test of whether we – Democrats and Republicans alike – are serious
about holding the line on new spending and restoring fiscal
discipline.
But let there be
no doubt – the cost of inaction is greater. If we fail to act,
premiums will climb higher, benefits will erode further, and the
rolls of uninsured will swell to include millions more Americans.
If we fail to
act, one out of every five dollars we earn will be spent on health
care within a decade. In thirty years, it will be about one out of
every three – a trend that will mean lost jobs, lower take-home pay,
shuttered businesses, and a lower standard of living for all
Americans.
And if we fail to
act, federal spending on Medicaid and Medicare will grow over the
coming decades by an amount almost equal to the amount our
government currently spends on our nation's defense. In fact, it
will eventually grow larger than what our government spends on
anything else today. It's a scenario that will swamp our federal and
state budgets, and impose a vicious choice of either unprecedented
tax hikes, overwhelming deficits, or drastic cuts in our federal and
state budgets.
To say it as
plainly as I can, health care reform is the single most important
thing we can do for America's long-term fiscal health. That is a
fact.
And yet, as clear
as it is that our system badly needs reform, reform is not
inevitable. There's a sense out there among some that, as bad as our
current system may be, the devil we know is better than the devil we
don't. There is a fear of change – a worry that we may lose what
works about our health care system while trying to fix what doesn't.
I understand that
fear. I understand that cynicism. They are scars left over from past
efforts at reform. Presidents have called for health care reform for
nearly a century. Teddy Roosevelt called for it. Harry Truman called
for it. Richard Nixon called for it. Jimmy Carter called for it.
Bill Clinton called for it. But while significant individual reforms
have been made – such as Medicare, Medicaid, and the children's
health insurance program – efforts at comprehensive reform that
covers everyone and brings down costs have largely failed.
Part of the
reason is because the different groups involved – physicians,
insurance companies, businesses, workers, and others – simply
couldn't agree on the need for reform or what shape it would take.
And another part of the reason has been the fierce opposition fueled
by some interest groups and lobbyists – opposition that has used
fear tactics to paint any effort to achieve reform as an attempt to
socialize medicine.
Despite this long
history of failure, I am standing here today because I think we are
in a different time. One sign that things are different is that just
this past week, the Senate passed a bill that will protect children
from the dangers of smoking – a reform the AMA has long championed –
and one that went nowhere when it was proposed a decade ago. What
makes this moment different is that this time – for the first time –
key stakeholders are aligning not against, but in favor of reform.
They are coming together out of a recognition that while reform will
take everyone in our health care community doing their part,
ultimately, everyone will benefit.
And I want to
commend the AMA, in particular, for offering to do your part to curb
costs and achieve reform. A few weeks ago, you joined together with
hospitals, labor unions, insurers, medical device manufacturers and
drug companies to do something that would've been unthinkable just a
few years ago – you promised to work together to cut national health
care spending by two trillion dollars over the next decade, relative
to what it would otherwise have been. That will bring down costs,
that will bring down premiums, and that's exactly the kind of
cooperation we need.
The question now
is, how do we finish the job? How do we permanently bring down costs
and make quality, affordable health care available to every
American?
That's what I've
come to talk about today. We know the moment is right for health
care reform. We know this is an historic opportunity we've never
seen before and may not see again. But we also know that there are
those who will try and scuttle this opportunity no matter what – who
will use the same scare tactics and fear-mongering that's worked in
the past. They'll give dire warnings about socialized medicine and
government takeovers; long lines and rationed care; decisions made
by bureaucrats and not doctors. We've heard it all before – and
because these fear tactics have worked, things have kept getting
worse.
So let me begin
by saying this: I know that there are millions of Americans who are
content with their health care coverage – they like their plan and
they value their relationship with their doctor. And that means that
no matter how we reform health care, we will keep this promise: If
you like your doctor, you will be able to keep your doctor. Period.
If you like your health care plan, you will be able to keep your
health care plan. Period. No one will take it away. No matter what.
My view is that health care reform should be guided by a simple
principle: fix what's broken and build on what works.
If we do that, we
can build a health care system that allows you to be physicians
instead of administrators and accountants; a system that gives
Americans the best care at the lowest cost; a system that eases up
the pressure on businesses and unleashes the promise of our economy,
creating hundreds of thousands of jobs, making take-home wages
thousands of dollars higher, and growing our economy by tens of
billions more every year. That's how we will stop spending tax
dollars to prop up an unsustainable system, and start investing
those dollars in innovations and advances that will make our health
care system and our economy stronger.
That's what we
can do with this opportunity. That's what we must do with this
moment.
Now, the good
news is that in some instances, there is already widespread
agreement on the steps necessary to make our health care system work
better.
First, we need to
upgrade our medical records by switching from a paper to an
electronic system of record keeping. And we have already begun to do
this with an investment we made as part of our Recovery Act.
It simply doesn't
make sense that patients in the 21st century are still filling out
forms with pens on papers that have to be stored away somewhere. As
Newt Gingrich has rightly pointed out, we do a better job tracking a
FedEx package in this country than we do tracking a patient's health
records. You shouldn't have to tell every new doctor you see about
your medical history, or what prescriptions you're taking. You
should not have to repeat costly tests. All of that information
should be stored securely in a private medical record so that your
information can be tracked from one doctor to another – even if you
change jobs, even if you move, and even if you have to see a number
of different specialists.
That will not
only mean less paper pushing and lower administrative costs, saving
taxpayers billions of dollars. It will also make it easier for
physicians to do their jobs. It will tell you, the doctors, what
drugs a patient is taking so you can avoid prescribing a medication
that could cause a harmful interaction. It will help prevent the
wrong dosages from going to a patient. And it will reduce medical
errors that lead to 100,000 lives lost unnecessarily in our
hospitals every year.
The second step
that we can all agree on is to invest more in preventive care so
that we can avoid illness and disease in the first place. That
starts with each of us taking more responsibility for our health and
the health of our children. It means quitting smoking, going in for
that mammogram or colon cancer screening. It means going for a run
or hitting the gym, and raising our children to step away from the
video games and spend more time playing outside.
It also means
cutting down on all the junk food that is fueling an epidemic of
obesity, putting far too many Americans, young and old, at greater
risk of costly, chronic conditions. That's a lesson Michelle and I
have tried to instill in our daughters with the White House
vegetable garden that Michelle planted. And that's a lesson that we
should work with local school districts to incorporate into their
school lunch programs.
Building a health
care system that promotes prevention rather than just managing
diseases will require all of us to do our part. It will take doctors
telling us what risk factors we should avoid and what preventive
measures we should pursue. And it will take employers following the
example of places like Safeway that is rewarding workers for taking
better care of their health while reducing health care costs in the
process. If you're one of the three quarters of Safeway workers
enrolled in their “Healthy Measures” program, you can get screened
for problems like high cholesterol or high blood pressure. And if
you score well, you can pay lower premiums. It's a program that has
helped Safeway cut health care spending by 13 percent and workers
save over 20 percent on their premiums. And we are open to doing
more to help employers adopt and expand programs like this one.
Our federal
government also has to step up its efforts to advance the cause of
healthy living. Five of the costliest illnesses and conditions –
cancer, cardiovascular disease, diabetes, lung disease, and strokes
– can be prevented. And yet only a fraction of every health care
dollar goes to prevention or public health. That is starting to
change with an investment we are making in prevention and wellness
programs that can help us avoid diseases that harm our health and
the health of our economy.
But as important
as they are, investments in electronic records and preventive care
are just preliminary steps. They will only make a dent in the
epidemic of rising costs in this country.
Despite what some
have suggested, the reason we have these costs is not simply because
we have an aging population. Demographics do account for part of
rising costs because older, sicker societies pay more on health care
than younger, healthier ones. But what accounts for the bulk of our
costs is the nature of our health care system itself – a system
where we spend vast amounts of money on things that aren't making
our people any healthier; a system that automatically equates more
expensive care with better care.
A recent article
in the New Yorker, for example, showed how McAllen, Texas is
spending twice as much as El Paso County – not because people in
McAllen are sicker and not because they are getting better care.
They are simply using more treatments – treatments they don't really
need; treatments that, in some cases, can actually do people harm by
raising the risk of infection or medical error. And the problem is,
this pattern is repeating itself across America. One Dartmouth study
showed that you're no less likely to die from a heart attack and
other ailments in a higher spending area than in a lower spending
one.
There are two
main reasons for this. The first is a system of incentives where the
more tests and services are provided, the more money we pay. And a
lot of people in this room know what I'm talking about. It is a
model that rewards the quantity of care rather than the quality of
care; that pushes you, the doctor, to see more and more patients
even if you can't spend much time with each; and gives you every
incentive to order that extra MRI or EKG, even if it's not truly
necessary. It is a model that has taken the pursuit of medicine from
a profession – a calling – to a business.
That is not why
you became doctors. That is not why you put in all those hours in
the Anatomy Suite or the O.R. That is not what brings you back to a
patient's bedside to check in or makes you call a loved one to say
it'll be fine. You did not enter this profession to be bean-counters
and paper-pushers. You entered this profession to be healers – and
that's what our health care system should let you be.
That starts with
reforming the way we compensate our doctors and hospitals. We need
to bundle payments so you aren't paid for every single treatment you
offer a patient with a chronic condition like diabetes, but instead
are paid for how you treat the overall disease. We need to create
incentives for physicians to team up – because we know that when
that happens, it results in a healthier patient. We need to give
doctors bonuses for good health outcomes – so that we are not
promoting just more treatment, but better care.
And we need to
rethink the cost of a medical education, and do more to reward
medical students who choose a career as a primary care physicians
and who choose to work in underserved areas instead of a more
lucrative path. That's why we are making a substantial investment in
the National Health Service Corps that will make medical training
more affordable for primary care doctors and nurse practitioners so
they aren't drowning in debt when they enter the workforce.
The second
structural reform we need to make is to improve the quality of
medical information making its way to doctors and patients. We have
the best medical schools, the most sophisticated labs, and the most
advanced training of any nation on the globe. Yet we are not doing a
very good job harnessing our collective knowledge and experience on
behalf of better medicine. Less than one percent of our health care
spending goes to examining what treatments are most effective. And
even when that information finds its way into journals, it can take
up to 17 years to find its way to an exam room or operating table.
As a result, too
many doctors and patients are making decisions without the benefit
of the latest research. A recent study, for example, found that only
half of all cardiac guidelines are based on scientific evidence.
Half. That means doctors may be doing a bypass operation when
placing a stent is equally effective, or placing a stent when
adjusting a patient's drugs and medical management is equally
effective – driving up costs without improving a patient's health.
So, one thing we
need to do is figure out what works, and encourage rapid
implementation of what works into your practices. That's why we are
making a major investment in research to identify the best
treatments for a variety of ailments and conditions.
Let me be clear:
identifying what works is not about dictating what kind of care
should be provided. It's about providing patients and doctors with
the information they need to make the best medical decisions.
Still, even when
we do know what works, we are often not making the most of it.
That's why we need to build on the examples of outstanding medicine
at places like the Cincinnati Children's Hospital, where the quality
of care for cystic fibrosis patients shot up after the hospital
began incorporating suggestions from parents. And places like
Tallahassee Memorial Health Care, where deaths were dramatically
reduced with rapid response teams that monitored patients'
conditions and “multidisciplinary rounds” with everyone from
physicians to pharmacists. And places like the Geisinger Health
system in rural Pennsylvania and the Intermountain Health in Salt
Lake City, where high-quality care is being provided at a cost well
below average. These are islands of excellence that we need to make
the standard in our health care system.
Replicating best
practices. Incentivizing excellence. Closing cost disparities. Any
legislation sent to my desk that does not achieve these goals does
not earn the title of reform. But my signature on a bill is not
enough. I need your help, doctors. To most Americans, you are the
health care system. Americans – me included – just do what you
recommend. That is why I will listen to you and work with you to
pursue reform that works for you. And together, if we take all these
steps, we can bring spending down, bring quality up, and save
hundreds of billions of dollars on health care costs while making
our health care system work better for patients and doctors alike.
Now, I recognize
that it will be hard to make some of these changes if doctors feel
like they are constantly looking over their shoulder for fear of
lawsuits. Some doctors may feel the need to order more tests and
treatments to avoid being legally vulnerable. That's a real
issue.And while I'm not advocating caps on malpractice awards which
I believe can be unfair to people who've been wrongfully harmed, I
do think we need to explore a range of ideas about how to put
patient safety first, let doctors focus on practicing medicine, and
encourage broader use of evidence-based guidelines. That's how we
can scale back the excessive defensive medicine reinforcing our
current system of more treatment rather than better care.
These changes
need to go hand-in-hand with other reforms. Because our health care
system is so complex and medicine is always evolving, we need a way
to continually evaluate how we can eliminate waste, reduce costs,
and improve quality. That is why I am open to expanding the role of
a commission created by a Republican Congress called the Medicare
Payment Advisory Commission – which happens to include a number of
physicians. In recent years, this commission proposed roughly $200
billion in savings that never made it into law. These
recommendations have now been incorporated into our broader reform
agenda, but we need to fast-track their proposals in the future so
that we don't miss another opportunity to save billions of dollars,
as we gain more information about what works and what doesn't in our
health care system.
As we seek to
contain the cost of health care, we must also ensure that every
American can get coverage they can afford. We must do so in part
because it is in all of our economic interests. Each time an
uninsured American steps foot into an emergency room with no way to
reimburse the hospital for care, the cost is handed over to every
American family as a bill of about $1,000 that is reflected in
higher taxes, higher premiums, and higher health care costs; a
hidden tax that will be cut as we insure all Americans. And as we
insure every young and healthy American, it will spread out risk for
insurance companies, further reducing costs for everyone.
But alongside
these economic arguments, there is another, more powerful one. It is
simply this: We are not a nation that accepts nearly 46 million
uninsured men, women, and children. We are not a nation that lets
hardworking families go without the coverage they deserve; or turns
its back on those in need. We are a nation that cares for its
citizens. We are a people who look out for one another. That is what
makes this the United States of America.
So, we need to do
a few things to provide affordable health insurance to every single
American. The first thing we need to do is protect what's working in
our health care system. Let me repeat – if you like your health
care, the only thing reform will mean is your health care will cost
less. If anyone says otherwise, they are either trying to mislead
you or don't have their facts straight.
If you don't like
your health coverage or don't have any insurance, you will have a
chance to take part in what we're calling a Health Insurance
Exchange. This Exchange will allow you to one-stop shop for a health
care plan, compare benefits and prices, and choose a plan that's
best for you and your family – just as federal employees can do,
from a postal worker to a Member of Congress. You will have your
choice of a number of plans that offer a few different packages, but
every plan would offer an affordable, basic package. And one of
these options needs to be a public option that will give people a
broader range of choices and inject competition into the health care
market so that force waste out of the system and keep the insurance
companies honest.
Now, I know
there's some concern about a public option. In particular, I
understand that you are concerned that today's Medicare rates will
be applied broadly in a way that means our cost savings are coming
off your backs. These are legitimate concerns, but ones, I believe,
that can be overcome. As I stated earlier, the reforms we propose
are to reward best practices, focus on patient care, not the current
piece-work reimbursement. What we seek is more stability and a
health care system on a sound financial footing. And these reforms
need to take place regardless of what happens with a public option.
With reform, we will ensure that you are being reimbursed in a
thoughtful way tied to patient outcomes instead of relying on yearly
negotiations about the Sustainable Growth Rate formula that's based
on politics and the state of the federal budget in any given year.
The alternative is a world where health care costs grow at an
unsustainable rate, threatening your reimbursements and the
stability of our health care system.
What are not
legitimate concerns are those being put forward claiming a public
option is somehow a Trojan horse for a single-payer system. I'll be
honest. There are countries where a single-payer system may be
working. But I believe – and I've even taken some flak from members
of my own party for this belief – that it is important for us to
build on our traditions here in the United States. So, when you hear
the naysayers claim that I'm trying to bring about government-run
health care, know this – they are not telling the truth.
What I am trying
to do – and what a public option will help do – is put affordable
health care within reach for millions of Americans. And to help
ensure that everyone can afford the cost of a health care option in
our Exchange, we need to provide assistance to families who need it.
That way, there will be no reason at all for anyone to remain
uninsured.
Indeed, it is
because I am confident in our ability to give people the ability to
get insurance that I am open to a system where every American bears
responsibility for owning health insurance, so long as we provide a
hardship waiver for those who still can't afford it. The same is
true for employers. While I believe every business has a
responsibility to provide health insurance for its workers, small
businesses that cannot afford it should receive an exemption. And
small business workers and their families will be able to seek
coverage in the Exchange if their employer is not able to provide
it.
Insurance
companies have expressed support for the idea of covering the
uninsured – and I welcome their willingness to engage constructively
in the reform debate. But what I refuse to do is simply create a
system where insurance companies have more customers on Uncle Sam's
dime, but still fail to meet their responsibilities. That is why we
need to end the practice of denying coverage on the basis of
preexisting conditions. The days of cherry-picking who to cover and
who to deny – those days are over.
This is personal
for me. I will never forget watching my own mother, as she fought
cancer in her final days, worrying about whether her insurer would
claim her illness was a preexisting condition so it could get out of
providing coverage. Changing the current approach to preexisting
conditions is the least we can do – for my mother and every other
mother, father, son, and daughter, who has suffered under this
practice. And it will put health care within reach for millions of
Americans.
Now, even if we
accept all of the economic and moral reasons for providing
affordable coverage to all Americans, there is no denying that it
will come at a cost – at least in the short run. But it is a cost
that will not – I repeat, not – add to our deficits. Health care
reform must be and will be deficit neutral in the next decade.
There are already
voices saying the numbers don't add up. They are wrong. Here's why.
Making health care affordable for all Americans will cost somewhere
on the order of one trillion dollars over the next ten years. That
sounds like a lot of money – and it is. But remember: it is less
than we are projected to spend on the war in Iraq. And also
remember: failing to reform our health care system in a way that
genuinely reduces cost growth will cost us trillions of dollars more
in lost economic growth and lower wages.
That said, let me
explain how we will cover the price tag. First, as part of the
budget that was passed a few months ago, we've put aside $635
billion over ten years in what we are calling a Health Reserve Fund.
Over half of that amount – more than $300 billion – will come from
raising revenue by doing things like modestly limiting the tax
deductions the wealthiest Americans can take to the same level it
was at the end of the Reagan years. Some are concerned this will
dramatically reduce charitable giving, but statistics show that's
not true, and the best thing for our charities is the stronger
economy that we will build with health care reform.
But we cannot
just raise revenues. We also have to make spending cuts in part by
examining inefficiencies in the Medicare program. There will be a
robust debate about where these cuts should be made, and I welcome
that debate. But here's where I think these cuts should be made.
First, we should end overpayments to Medicare Advantage. Today, we
are paying Medicare Advantage plans much more than we pay for
traditional Medicare services. That's a good deal for insurance
companies, but not the American people. That's why we need to
introduce competitive bidding into the Medicare Advantage program, a
program under which private insurance companies offer Medicare
coverage. That will save $177 billion over the next decade.
Second, we need
to use Medicare reimbursements to reduce preventable hospital
readmissions. Right now, almost 20 percent of Medicare patients
discharged from hospitals are readmitted within a month, often
because they are not getting the comprehensive care they need. This
puts people at risk and drives up costs. By changing how Medicare
reimburses hospitals, we can discourage them from acting in a way
that boosts profits, but drives up costs for everyone else. That
will save us $25 billion over the next decade.
Third, we need to
introduce generic biologic drugs into the marketplace. These are
drugs used to treat illnesses like anemia. But right now, there is
no pathway at the FDA for approving generic versions of these drugs.
Creating such a pathway will save us billions of dollars. And we can
save another roughly $30 billion by getting a better deal for our
poorer seniors while asking our well-off seniors to pay a little
more for their drugs.
So, that's the
bulk of what's in the Health Reserve Fund. I have also proposed
saving another $313 billion in Medicare and Medicaid spending in
several other ways. One way is by adjusting Medicare payments to
reflect new advances and productivity gains in our economy. Right
now, Medicare payments are rising each year by more than they
should. These adjustments will create incentives for providers to
deliver care more effectively, and save us roughly $109 billion in
the process.
Another way we
can achieve savings is by reducing payments to hospitals for
treating uninsured people. I know hospitals rely on these payments
now because of the large number of uninsured patients they treat.
But as the number of uninsured people goes down with our reforms,
the amount we pay hospitals to treat uninsured people should go
down, as well. Reducing these payments gradually as more and more
people have coverage will save us over $106 billion, and we'll make
sure the difference goes to the hospitals that most need it.
We can also save
about $75 billion through more efficient purchasing of prescription
drugs. And we can save about one billion more by rooting out waste,
abuse, and fraud throughout our health care system so that no one is
charging more for a service than it's worth or charging a dime for a
service they did not provide.
But let me be
clear: I am committed to making these cuts in a way that protects
our senior citizens. In fact, these proposals will actually extend
the life of the Medicare Trust Fund by 7 years and reduce premiums
for Medicare beneficiaries by roughly $43 billion over 10 years. And
I'm working with AARP to uphold that commitment.
Altogether, these
savings mean that we have put about $950 billion on the table – not
counting some of the longer-term savings that will come about from
reform – taking us almost all the way to covering the full cost of
health care reform. In the weeks and months ahead, I look forward to
working with Congressto make up the difference so that health care
reform is fully paid for – in a real, accountable way. And let me
add that this does not count some of the longer-term savings that
will come about from health care reform. By insisting that reform be
deficit neutral over the next decade and by making the reforms that
will help slow the growth rate of health care costs over coming
decades, we can look forward to faster economic growth, higher
living standards, and falling, not rising, budget deficits.
I know people are
cynical we can do this. I know there will be disagreements about how
to proceed in the days ahead. But I also know that we cannot let
this moment pass us by.
The other day, my
friend, Congressman Earl Blumenauer, handed me a magazine with a
special issue titled, “The Crisis in American Medicine.” One article
notes “soaring charges.” Another warns about the “volume of
utilization of services.” And another asks if we can find a “better
way [than fee-for-service] for paying for medical care.” It speaks
to many of the challenges we face today. The thing is, this special
issue was published by Harper's Magazine in October of 1960.
Members of the
American Medical Association – my fellow Americans – I am here today
because I do not want our children and their children to still be
speaking of a crisis in American medicine fifty years from now. I do
not want them to still be suffering from spiraling costs we did not
stem, or sicknesses we did not cure. I do not want them to be
burdened with massive deficits we did not curb or a worsening
economy we did not rebuild.
I want them to
benefit from a health care system that works for all of us; where
families can open a doctor's bill without dreading what's inside;
where parents are taking their kids to get regular checkups and
testing themselves for preventable ailments; where parents are
feeding their kids healthier food and kids are exercising more;
where patients are spending more time with doctors and doctors can
pull up on a computer all the medical information and latest
research they'd ever want to meet that patient's needs; where
orthopedists and nephrologists and oncologists are all working
together to treat a single human being; where what's best about
America's health care system has become the hallmark of America's
health care system.
That is the
health care system we can build. That is the future within our
reach. And if we are willing to come together and bring about that
future, then we will not only make Americans healthier and not only
unleash America's economic potential, but we will reaffirm the
ideals that led you into this noble profession, and build a health
care system that lets all Americans heal. Thank you.
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