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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