I can't predict whether Obama's health care reform speech to the AMA will substantially improve chances for genuine reforms. [Caution: MSNBC video runs 55 minutes]
But I don't think we should underestimate the powerful message the President of the United States just delivered to the people who, if you read the speech carefully, Obama unmistakably identified as having utterly failed the nation's health care needs -- and it's not just the AMA.
The NYT covers the story; the excerpts below are from the as-delivered text released by the White House. Is there any doubt whom the President was talking about in these sections:
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.
And whom do you think the President is addressing when he lists what needs to be fixed? He first cites the huge regional disparities in costs and practices examined by Gawande in his New Yorker article:
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.
And it doesn't let up. Obama takes on AMA, the insurance/hospital industry, Pharma, all of them. They're all complicit in building and protecting an unsustainable, inhumane system. And he tells them they have to be part of the solution.
It was a stunning, powerful and courageous speech. He didn't back down on the public option or fixing compensation or letting the insurance/Pharma boys escape public compeition. He stroked the AMA for the few positive things they've supported, but he didn't give reform opponents another inch.
Reviews:
AP, Obama presses doctors to support reform, gets booed
Calling them "naysayers,""fear-mongers" and peddlers of "Trojan horse" falsehoods, Obama warned interest groups, lobbyists and others against using "fear tactics to paint any effort to achieve reform as an attempt to socialize medicine."
"There are those who will try and scuttle this opportunity no matter what," Obama said.
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