30 April 2009

Obama on Health Care

A couple of disparate points from Obama himself recently on health care:

He's open to medical malpractice reform as part of compromises in the larger health reform package:
"I've said this to people like Mitch McConnell," he recalled. "I said, look, on health care reform, you may not agree with me that we should have a public plan. That may be philosophically just too much for you to swallow. On the other hand, there are some areas like reducing the costs of medical malpractice insurance where you do agree with me. If I'm taking some of your ideas and giving you credit for good ideas, the fact that you didn't get 100 percent can't be a reason every single time to oppose my position."
Maybe it's just a posture.  Congressional prospects for liability reform are not terrific.  But nice to see that he recognizes the need and is willing to say so publicly.  Also good to know that he is still emphasizing the need for a public plan option, a point also emphasized by the letter 16 Senate Democrats (some of them surprising) sent to Baucus and Kennedy yesterday urging them to retain the public plan as the negotiations continue.

Jonathan Cohn at TNR highlights a couple of key exchanges from Obama's extended interview.  In the first, Obama discusses the asymmetry of information that will prevent consumer-directed health care from achieving the cost savings some hope it might:
OBAMA: ...we should not overstate the degree to which consumers rather than doctors are going to be driving treatment, because, I just speak from my own experience, I’m a pretty-well-educated layperson when it comes to medical care; I know how to ask good questions of my doctor. But ultimately, he’s the guy with the medical degree. So, if he tells me, You know what, you’ve got such-and-such and you need to take such-and-such, I don’t go around arguing with him or go online to see if I can find a better opinion than his.
And in the second clip he discusses the challenges surrounding costs in end-of-life care:

OBAMA: ...I actually think that the tougher issue around medical care — it’s a related one — is what you do around things like end-of-life care--

LEONHARDT: Yes, where it’s $20,000 for an extra week of life.

OBAMA: Exactly. And I just recently went through this. I mean, I’ve told this story, maybe not publicly, but when my grandmother got very ill during the campaign, she got cancer; it was determined to be terminal. And about two or three weeks after her diagnosis she fell, broke her hip. [... long clip cut...] There is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place. It is very difficult to imagine the country making those decisions just through the normal political channels.

This is a huge issue that no prominent politician has dared to broach, in my memory.   He doesn't have answers, but he's raising the right questions.  We will see if there's a will out there to start filling in the right answers.


  1. I'm a Registered Respiratory Therapist who has worked adult critical care for many years, now in pediatrics. As to your reference of "20,000 dollars for one more week of life". I have seen so many cases over the years where the pt really has no hope of a good quality of life ever again, and yet, we do everything in our power to keep them alive. They end up dying in short order and we have now thrown away 100's of thousands of dollars for a week or so of a life that actually suffered for that time they bought.
    I always wonder why we can't give people the bad news that there is no help for whatever the terminal problem is, and stop throwing all of these medical dollars out the window just so family members can avoid the inevitable. I'm not saying withheld care from people if there is a greater chance of long term quality of life. I'm saying if it isn't going to change the outcome by more than a few weeks we should stop letting families think it will. We should remove the option. Or we tell them there insurance won't pay and they will be racking up a huge bill for a short term extension of life. We take our animals to the Vet when they are sick and the Vet says "your dog has terminal cancer and we can do chemo, however, it is very expensive, and it may or may not work". The Vet also says, "your animal will suffer and ultimately will die on a short period of time". The person generally won't opt for the animal suffering and they opt for putting the dog to sleep. I'm not promoting euthanasia. I'm promoting telling people at a certain point you will have to pay the price for the short term extension on a loved one's life. The public shouldn't have to help pay these bills with more taxes, due to pts inability to pay their own bills.
    My husband has a great idea called, "the 100 days plan". A person gets 100 days of hospitalization, for any reason, in their lifetimes. And once the 100 days are used up it then becomes that persons responsibility to be able to pay for any further services. In most cases of non terminal health issues 100 days in a lifetime will be more than sufficient. All of this might sound cold and callused, but we are throwing a lot of health care dollars away for people who's quality of life has been lost forever.

  2. Wow, a politician that finally understands, we can't afford to do everything for everybody. I once had a medical student who was observing ask me for advice. I told him to ask himself, before ordering a diagnostic study, if knowing the results would help him improve the patient's quality of life. If the answer was "no" then don't order it.

  3. Wow, a politician did it! This is probably the most difficult issue (from my perspective) relative to universal health care. We can't afford to do everything for everybody. And perhaps, not keep developing and buying new multimillion diagnostic equipment that is just a little faster than the last one, but costs twice as much, and wonder why we can't cover expenses.

  4. All right! But on the other hand, what is new is the Obama Administration's want to fast-track the digitalization of all US citizens’ healthcare report.

    Good luck.

    Health Insurance


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