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Why Reform, Why Now

This afternoon the President gave a landmark, sweeping speech on health care reform to the American Medical Association in Chicago.
download .mp4 (599.6 MB) | read the transcript
This afternoon the President gave a landmark, sweeping speech on health care reform to the American Medical Association in Chicago. More so than at any time before, he explained his vision for comprehensive reform that addresses every weak point in our health care system. It is a vision that implements best practices that have allowed some towns and companies to cut costs by as much as half compared to others. It is a vision that makes sure everybody has access to quality, affordable coverage, whether your family hits a rough patch or you have a pre-existing condition. It is a vision in which patients’ and doctors’ interests are aligned. And it is a vision where Americans’ choices of doctors and coverage are maintained, and they also have a choice of a public option that can help keep private insurers honest.  It is a vision that focuses on prevention, making sure Americans stay healthy throughout their lives.
It is well worth the while to read through the entire speech, but here are a few key excerpts, including some key points you may not have heard before:
On the costs of inaction:
If we fail to act -- (applause) -- if we fail to act  -- and you know this because you see it in your own individual practices -- if we fail to act, premiums will climb higher, benefits will erode further, the rolls of the uninsured will swell to include millions more Americans -- all of which will affect your practice.
If we fail to act, one out of every five dollars we earn will be spent on health care within a decade.  And in 30 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.  It will, in fact, 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, or overwhelming deficits, or drastic cuts in our federal and state budgets.
So to say it as plainly as I can, health care is the single most important thing we can do for America's long-term fiscal health.  That is a fact.  That's a fact.  (Applause.)
On incentives for doctors:
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's 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 necessary.  It's a model that has taken the pursuit of medicine from a profession -- a calling -- to a business. 
That's not why you became doctors.  That's not why you put in all those hours in the Anatomy Suite or the O.R.  That's not what brings you back to a patient's bedside to check in, or makes you call a loved one of a patient to say it will be fine.  You didn't enter this profession to be bean-counters and paper-pushers.  You entered this profession to be healers.  (Applause.)  And that's what our health care system should let you be.  That's what this health care system should let you be.  (Applause.)
Now, that starts with reforming the way we compensate our providers -- 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 paid well 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 we're not promoting just more treatment, but better care. 
On making sure doctors and patients have all the right information:
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 drug and medical management is equally effective -- all of which drives up costs without improving a patient's health. 
So one thing we need to do is to figure out what works, and encourage rapid implementation of what works into your practices. That's why we're making a major investment in research to identify the best treatments for a variety of ailments and conditions. (Applause.) 
On America’s relationship with doctors:
But my signature on a bill is not enough.  I need your help, doctors, because to most Americans you are the health care system.  The fact is Americans -- and I include myself and Michelle and our kids in this -- we just do what you tell us to do.  (Laughter.)  That's what we do.  We listen to you, we trust you.  And that's why I will listen to you and work with you to pursue reform that works for you.  (Applause.) 
Together, if we take all these steps, I am convinced we can bring spending down, bring quality up; we can save hundreds of billions of dollars on health care costs while making our health care system work better for patients and doctors alike.  And when we align the interests of patients and doctors, then we're going to be in a good place.
On the Health Insurance Exchange and a public option:
Now, if you don't like your health care coverage or you don't have any insurance at all, you'll have a chance, under what we've proposed, 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 -- the same way, by the way, that federal employees can do, from a postal worker to a member of Congress.  (Applause.)  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. 
Again, this is for people who aren't happy with their current plan.  If you like what you're getting, keep it.  Nobody is forcing you to shift.  But if you're not, this gives you some new options.  And I believe one of these options needs to be a public option that will give people a broader range of choices  -- (applause) -- and inject competition into the health care market so that force -- so that we can force waste out of the system and keep the insurance companies honest.  (Applause.)
Now, I know that there's some concern about a public option.  Even within this organization there's healthy debate about it.  In particular, I understand that you're concerned that today's Medicare rates, which many of you already feel are too low, will be applied broadly in a way that means our cost savings are coming off your backs. 
And these are legitimate concerns, but they're ones, I believe, that can be overcome.  As I stated earlier, the reforms we propose to reimbursement are to reward best practices, focus on patient care, not on the current piecework reimbursements.  What we seek is more stability and a health care system that's on a sounder financial footing.
And the fact is these reforms need to take place regardless of whether there's a public option or not.  With reform, we will ensure that you are being reimbursed in a thoughtful way that's tied to patient outcomes, instead of relying on yearly negotiations about the Sustainable Growth Rate formula that's based on politics and the immediate state of the federal budget in any given year.  (Applause.) 
And I just want to point out the alternative to such reform is a world where health care costs grow at an unsustainable rate.  And if you don't think that's going to threaten your reimbursements and the stability of our health care system, you haven't been paying attention.
So the public option is not your enemy; it is your friend, I believe. 
Perhaps the most rousing moment of the speech came about half way through, as he stated the underlying moral basis for health reform:
We are not a nation that accepts nearly 46 million uninsured men, women and children.  (Applause.)  We are not a nation that lets hardworking families go without coverage, or turns its back on those in need.  We're a nation that cares for its citizens.  We look out for one another.  That's what makes us the United States of America.  We need to get this done.  (Applause.)