Health Care Blog

Health Care Reform: Asked and Answered

Posted by Jesse Lee on June 25, 2009 at 2:07 PM EDT

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The President held a forum at the White House yesterday, where he discussed the pressing need for health care reform, and fielded questions and concerns from some of the 164 audience members. The audience represented a diverse array of health care stakeholders – including doctors, nurses, insurance company executives, small business owners, as well as patients from across the country. If you weren’t able to watch it last night, you can go to ABC’s website to watch "Prescription for America" in its entirety.

The President tackled a variety of questions, talking at length about costs, choice, and effective treatment. Health care reform is a complex problem – people have been talking about it since Harry Truman – with no simple solution. The President called for a "uniquely American" solution that will allow us to control costs and provide quality care while preserving choice. The President emphasized that this reform is needed now because the status quo is unacceptable, and a show of hands from the audience showed unanimous agreement with him:

Understand that the status quo is untenable, which is why you saw, even though we've got Republicans, Democrats, independents, people from all parts of the health care sector represented here, everybody understands we can't keep doing what we're doing. It is bankrupting families. I get letters every single day from people who've worked hard and don't have health insurance. It is bankrupting businesses who are frustrated that they can't provide the same kind of insurance that they used to provide to their employees. And it's bankrupting our government at the state and federal levels

Nobody disputes that costs are unsustainable, and the President explained they will only continue to rise without reform:

The average family has seen their premiums double in the last nine years. Costs for families are going up three times faster than wages. So if you're happy with your health care right now – and many people are happy with their health care right now – the problem is, 10 years from now, you're not going to be happy because it's going to cost twice as much or three times as much as it does right now. Out-of-pocket expenses have gone up 62 percent. Businesses increasingly are having to cut back on health care or – if you talk to ordinary workers, they're seeing this all the time – employers even if they don't want to are having to pass on costs to others.

So unfortunately whatever it is that we're doing right now isn't working, Diane. What we see is great examples of outstanding care, businesses that are working with their employees on prevention, but it's not spreading through the system. And unfortunately government, whether you like it or not, is going to already be involved. We pay for Medicare, we pay for Medicaid. There are a whole host of rules, both at the state and federal level, governing how health care is administered.

And so the key is for us to try to figure out how do we take that involvement not to completely replace what we have but to build on what works and stop doing what doesn't work. And I think that we can do that through a serious health care reform initiative.

The President underscored the need to identify best practices – he used the Mayo Clinic as an example. The Mayo Clinic has top quality care and is one-third less expensive than average, while some of the most expensive places have worse health outcomes. By duplicating these best practices across the system, we can achieve the best possible care while controlling costs. The President explained that driving down costs is essential to being able to expand coverage:

Now, what I've said is that if we are smart, we should be able to design a system in which people still have choices of doctors and choices of plans that make sure that the necessary treatment is provided, but we don't have a huge amount of waste in the system, that we are providing adequate coverage for all people, and that we are driving down costs over the long term.

If we don't drive down costs then we're not going to be able to achieve all those other things. And I think that on the issue that's already been raised by the two doctors, the issue of evidence-based care, I have great confidence that doctors are going to always want to do the right thing for their patients if they've got good information and if their payment incentives are not such that it actually costs them money to provide the appropriate care.

And right now what we have is a situation because doctors are paid fee-for-service and there are all sorts of rules governing how they operate; as a consequence oftentimes it is harder for them, more expensive for them to do what is appropriate. And we should change those incentive structures.

The President pointed out that a reform plan must also work with insurance companies to modify policies and curb costs:

So if you're happy with your plan, as I said, you keep it. Now, there are some restrictions we want to place on insurers. Pre-existing conditions is a tool that has prevented a lot of people from either not being able to get insurance or, if they lose their job, they can't find insurance. We think those policies should end. So there are going to be some areas where we want to regulate the insurers a little more.

Now, in exchange, they're going to have a bigger customer pool. And so we think that they may not make as much profit on every single person that they provide coverage to. On the other hand, overall, I think they can still be profitable.

In terms of cost, understand that the system is already out of whack in terms of costs as it is. So if we do nothing, costs are going to keep on going up 6, 7, 8 percent per year, and government, businesses, and families are all going to find themselves either losing their health care or paying a lot more out of pocket. That's going to happen if we do nothing.

What I've said is, let's change the system so that our overall cost curve starts going down by investing in a range of things – prevention, health IT, et cetera. We will have some upfront costs and the estimates, as Charlie said, have been anywhere from a trillion to $2 trillion. But what we've said is, what my administration has said, what I've said, is that whatever it is that we do, we pay for. So it doesn't add to our deficit.

He again emphasized how a public option can work while maintaining, and improving, a competitive private insurance market:

But what we've said is that we can set up a public option in which they're collecting premiums just like any private insurer, that doctors are reimbursed at a fair rate, but because administrative costs are lower, we are able to keep private insurers honest in terms of the growth of costs of premiums and deductibles and so forth.

Now, you'll always hear folks say that the free market can do it better; government can't run anything. And what I say is, well, if that's the case, nobody is going to choose the public option. So the private insurers, who I think are very confident that they're providing a good service and a good product to their customers, should feel confident that they can compete with just one other option.

A lot of the objection to the public option idea is not practical, it's ideological. People don't like the idea of government being involved. But keep in mind that the two areas where government is involved – are involved in health care – Medicare and the VA – actually, there's pretty high satisfaction among the people who participate.

For the President, there is no issue for which change is more urgent and necessary, and despite decades of frustrated attempts at reform, the President made clear he believes the time is now:

But the one thing I'm absolutely confident about is that whenever this country has met a significant challenge to our long-term well-being, that we ultimately rise up and meet it. And this is one of those moments where the stars are aligned. We've got insurers who are interested, doctors who are interested, nurses, patients, AARP is here and they've seen some of the potential benefits, we're actually going to be filling the "doughnut hole," drug companies have said that they'd be willing to reduce the costs for seniors for prescription drugs as part of health care reform.

But we have to have the courage and the willingness to cooperate and compromise in order to make this happen. And if we do, it's not going to be a completely smooth ride, there are going to be times over the next couple months where we think health care is dead, it's not going to happen. But if we keep our eye on the prize, and we recognize that America has always been up to these big challenges, and we can't afford not to act, then I'm absolutely convinced that we can get it done this time.

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The President & Health Care Reform - Prime Time TV

Posted by Katherine Brandon on June 24, 2009 at 7:43 PM EDT

Don’t miss the President in a special television event on health care reform tonight, airing at 10:00 PM on the East coast on ABC – watch clips as they become available on ABC's website. In an hour dedicated to answering tough questions and concerns on the President’s proposals to reduce health care costs and provide quality health care for all Americans while ensuring choice, tune in for a unique opportunity to see how a public option will affect you and your family.

During yesterday's news conference, the President answered a number of questions about his health care plan. Watch the clip below from his press conference where the President responds to a question from ABC's Jake Tapper with a discussion of how a public plan will help keep private insurance companies honest.

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read the transcript

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Health Reform for Every Region, Every State, Every American

Posted by Jesse Lee on June 24, 2009 at 4:09 PM EDT

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During the course of the spring, the White House Health Reform team went on the road to engage every part of the country, traveling to Michigan, Vermont, Iowa , North Carolina and California to hear out people’s concerns and get their input on how to lower costs, ensure choice, and provide access to quality coverage for everybody.

Today the President met with Governors Jennifer Granholm (D-MI), Jim Douglas (R-VT), Jim Doyle (D-WI), Mike Rounds (R-SD), and Christine Gregoire (D-WA), all of whom helped co-host forums in their regions. Speaking to the press afterwards, he explained why he wanted to revisit that profoundly enlightening tour as Health Care Reform heads into yet another pivotal period in Congress:

THE PRESIDENT: …And so they've reported back to me. There's no perfect unanimity across the table in terms of every single aspect of reform. I think everybody here wants to make sure that governors have flexibility, that they have input into how legislation is being shaped on the Hill. But they have done my administration and I think the American people a terrific service in bringing some of these individual stories to us. And we're committed to working with them in the weeks and months to come to make sure that when we get health reform done, it is in partnership with the states where the rubber so often hits the road.

And one of the advantages they have, as Joe Biden put it, they've planted a mole inside our administration. (Laughter.) Kathleen Sebelius, very recently a governor, knows exactly what all of them are struggling with, and she and Nancy-Ann are going to be interacting with them on a regular basis as we move this agenda forward.

So I want to thank them publicly. And I look forward to working with them to get this done for the American people and for the people of their respective states in the weeks to come.

Thank you.

Q Is there any give in your deadline, Mr. President?

THE PRESIDENT: We need to get it done.

Q This year?

THE PRESIDENT: We need to get it done this year.

Those forums were also led by working people in their respective regions who could give a snapshot of the problems people were facing there. Joyce Shilakes took that role in the Michigan forum. As the wife of a General Motors employee who knows his future is uncertain, and whose own health care coverage is uncertain as a result, one of her central motivations for supporting comprehensive reform is as fundamental as it is ubiquitous in America: the desire for peace of mind.

It is worth reading the remarks she gave in Michigan back in the spring as a reminder of what the fight here is really about:

Hello. As you have heard, my name is Joyce Shilakes and I am very honored to be here with you today and to be asked to share my personal experiences that lead me to form a health care discussion group with my family and colleagues last December.

As a clinical social worker, every day I work with individuals who are struggling with mental and physical illness. One of the most frustrating and disheartening aspects of my job is watching my clients struggle to pay for treatments and medications that would stabilize their illness and help them to maintain productive lives. All too often, they are forced to choose between buying the expensive medications they need or paying for the basic needs of survival such as food, shelter and gas for themselves and their families.

This is a choice that no person should have to make. I have watched as they place their healthcare on hold only to have their symptoms worsen, their lives placed at risk, their jobs and families suffer – all because they have no insurance or were unable to afford the co-pays.

But my desire for a changed health care policy does not arise from my professional experiences alone. On a personal basis, my husband and I live with the very real threat of falling into the ranks of the uninsured if my husband’s job with General Motors were to be eliminated. This is especially anxiety provoking considering the fact that we are both Cancer survivors and under the current system we would be unlikely to find affordable medical coverage.

While I'm sure you can imagine, Cancer is a difficult disease to face under the best of circumstances. Facing it without insurance would be a horrendous burden. My breast cancer treatment alone ran over $100,000 eight years ago. Someone without insurance and faced with this disease today would likely be forced to choose between a chance at life bought by bankrupting themselves and their family, or choosing to die.

But speaking to a much larger issue, as someone who lives in the Detroit area and whose community, life and livelihood and benefited by the success of the Big 3, I have watched as our struggling automakers lose ground to foreign manufacturers who are not faced with the same health care responsibilities. The health care issue is now beginning to undermine the very fabric of our nation as our automaker and large businesses employing thousands are forced to close their doors and lay off employees, in part due to the lack of sustainable health system.

These are some of the reasons that I, and my colleagues, jumped at the chance to become involved in last December’s health care discussion. For the first time, we felt that we had a president who was receptive and encouraging of input from all Americans. We wanted to lend our voices to the chorus of others who have been clamoring for change. Today, I must admit to having more than a glimmer of hope that we can work together to bring about a comprehensive American system of health care that will provide high quality health services for all citizens of our nation. I look forward to participating with you in that endeavor.

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A Significant Breakthrough to Assist Our Seniors

Posted by Katherine Brandon on June 22, 2009 at 2:29 PM EDT

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Today, the President announced a landmark agreement with pharmaceutical companies, who pledged $80 billion in prescription drug discounts over the next 10 years. This compromise is the latest step towards a new consensus amongst health care stakeholders to help reduce costs and provide quality care for all Americans – last month a coalition of health care industry leaders agreed to $2 trillion in savings over 10 years.

The President was joined by Senators Max Baucus and Chris Dodd, and introduced by AARP President Barry Rand, who called the plan a "new opportunity" for those who have been burdened by the costs of prescription drugs.

(President Barack Obama speaks about the agreement to lower drug costs for seniors, Monday, June 22, 2009, in the Diplomatic Reception Room of the White House. With the President are, from left, CEO of AARP Barry Rand, Senator Max Bachaus (D-MT) and Senator Chris Dodd (D-CT). Official White House Photo by Chuck Kennedy)

The agreement, which was reached between Sen. Baucus, Administration officials, and the nation’s pharmaceutical companies, will ultimately reduce the price of prescription drugs by half for millions of America’s seniors. As part of the upcoming health care reform legislation, drug manufacturers that participate in Medicare Part D will either pay a rebate to Medicare or offer a substantial discount of at least 50 percent on prescription drugs to seniors who fall within the infamous "doughnut hole"— payments between $2700 and $6153.75 not covered by Medicare. The deal will help close this unfair gap in coverage, providing relief for millions of seniors who have been burdened by these out-of-pocket expenses, making it easier for them to get the prescriptions that they need.

In addition to providing half-price discounts, the pharmaceutical companies will offer other discounts and savings to total an $80 billion reduction in costs. The President said this historic compromise marks a turning point in the journey towards health care reform that will lower costs for all Americans:

So as part of the health care reform I expect Congress to enact this year, Medicare beneficiaries whose spending falls within this gap will now receive a discount on prescription drugs of at least 50 percent from the negotiated price their plan pays. It's a reform that will make prescription drugs more affordable for millions of seniors, and restore a measure of fairness to Medicare Part D. It's a reflection of the importance of this single step for America's seniors that it has earned the support of AARP, which has been fighting for years to address this anomaly in the system on behalf of older Americans. AARP is committed, as I am, to achieving health care reform by the end of this year. And I'm committed to continuing to work with AARP to ensure that any reforms we pursue are carried out in a way that protects America's seniors, who know as well as anyone what's wrong with our health care system and why it's badly in need of reform.

Our goal – our imperative – is to reduce the punishing inflation in health care costs while improving patient care. And to do that we're going to have to work together to root out waste and inefficiencies that may pad the bottom line of the insurance industry, but add nothing to the health of our nation. To that end, the pharmaceutical industry has committed to reduce its draw on the health care system by $80 billion over the next 10 years as part of overall health care reform.

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Streamed and Interactive at 2:30: Health Reform Stakeholder Meeting with Physicians

Posted by Jesse Lee on June 18, 2009 at 1:43 PM EDT
[UPDATE: This event has now concluded, check back with WhiteHouse.gov for similar events in the future.]

Since the White House Forum on Health Reform way back in the beginning of March, the White House has been bringing working Americans and health care leaders into the process. There have been regional forums across the country, and the White House has held "Stakeholder Discussions" here in the White House on a broad variety of topics. Every one of those meetings has been streamed live in line with the President’s commitment to transparency.

We are going to experiment with something different around this afternoon’s Stakeholder Meeting with Physicians, which will have a particular focus on prevention and wellness. Over at Facebook we have a unique application that will embed our live stream and allow you to comment, question, and chat about the meeting. An aide from the White House Office of Health Reform will also be keeping track of the chat and letting the participants in the meeting know what people are talking about. Alternatively, you can of course watch the meeting on our site, and we will have a comment form you can use to let us know your thoughts and questions that way too..
- Go to White House Live Facebook application
- Watch and comment through our site
- As always, learn more at HealthReform.gov.
UPDATE: Rebecca Adelman of HHS is also at the meeting, and is helping us keep a written record:

4:10: Zeke Emanuel is wrapping up the meeting now. Jennifer Cannistra just announced to the group that we received over 1,000 comments on Facebook and through WhiteHouse.gov during this meeting. She closes with a comment from Facebook on the obstacle poverty can be to focusing on prevention and wellness for your family, and ties the comment to initiatives in the President's "United We Serve" program and Serve.gov.

4:05: Dr. Alice Chen, Executive Director of Doctors for America, is reading from a sizable binder full of comments sent to her from physicians across the country. One physician told her, "the best prevention is providing people with health insurance."

4:00: We are now hearing final comments from each physician to close the meeting. Notably, one doctor is saying we can talk about health care reform and prevention until we are blue in the face, but we won't have the primary care workforce we need to truly change the system unless we talk about medical education and changing the incentives that deter many new doctors from entering the primary care field.

3:41: Dr. Vivek Murthy, President and Co-founder of Doctors for America, is urging that medical education be changed so that medical students are trained in prevention. During his time in medical school, he says he spent six weeks on cell biology, but the only training offered for preventative care came in the form of an evening, optional, elective which he says was sparsely attended. "That culture has to change," he said.

3:35: Dr. Omega C. Logan Silva is suggesting that the only way to treat obesity is to prevent obesity. Her idea is to enlist the support of retired physicians to speak directly to young children to educate them about nutrition and health with the eventual goal of changing national attitudes about food.

3:25: Reversing obesity trends is a critical focus of many of the physicians in the room. Some are suggesting mandatory physical education and nutritional education be implemented in schools, and one expert on the subject here is Secretary Joe Thompson from Arkansas who has been collecting Body Mass Index information in his state for six years and has engaged in an effort to make Health part of every policy decision in the state. Secretary Thompson says "we did everything we could think of" to curb obesity trends, including changing the foods served in cafeterias, increasing physical and nutritional education, and he says he believes they have halted the increase in obesity in his state.

3:00: Leading the discussion today along side Mike Hash is Dr. Dora Hughes from HHS, Dr. Bob Kocher and Dr. Zeke Emanuel, Dr. Kavita Patel, and HHS's Dr. Meena Seshamani. Zeke Emanuel is asking the physicians for "actionable ideas" as we now are in the thick of health care reform. One physician answers the first question from Facebook by suggesting employers allot a certain number of hours for regular preventative check-ups.

2:50: Jennifer Cannistra from the Office of Health Reform reads the first question submitted on Facebook: for those people working 12-14 hours a day, how can we make it easier to focus on prevention?

2:45: We're just kicking off the third physicians stakeholders discussion in the Old Executive Office Building. Mike Hash from the White House Office of Health Reform is welcoming both the group of 25 doctors present in the room and the viewers watching this discussion streamed online. During today's discussion we will take questions submitted on www.facebook.com to involve even more people in the conversation. For this third stakeholder discussion with physicians, the plan is to focus the conversation on how to use prevention and wellness initiatives to cut health care costs and improve quality of care.
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A Healthy Harvest

Posted by Katherine Brandon on June 17, 2009 at 6:34 PM EDT

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The First Lady hosted a harvest party in the White House kitchen garden today with the students from Bancroft Elementary to celebrate their hard work. As you may remember, the 5th graders helped start the organic kitchen garden back in March. Today, with help from the First Lady, they got to prepare a healthy meal with produce fresh from the garden. The kids harvested lettuce and sugar snap peas then cooked a delicious lunch consisting of salad, baked chicken and brown rice. And once kids finished their salads, they were rewarded with a cupcake topped with fresh garden berries. This was not only a culmination of their efforts, but it was also the realization of a small dream for the First Lady. She explained that planting an organic garden was one of the first things she wanted to do at the White House because of the severity of health issues facing America’s children:

But I also thought that this would be a fun and interesting way to talk to kids about healthy eating and nutrition. The President and Congress are going to begin to address health care reform, and these issues of nutrition and wellness and preventative care is going to be the focus of a lot of conversation coming up in the weeks and months to come. And these are issues that I care deeply about, especially when they affect America's children.

Obesity, diabetes, heart disease, high-blood pressure are all diet-related health issues that cost this country more than $120 billion each year. That's a lot of money. While the dollar figure is shocking in and of itself, the effect on our children's health is even more profound. Nearly a third of the children in this country are either overweight or obese, and a third will suffer from diabetes at some point in their lifetime. In Hispanic and African American communities, those numbers climb even higher so that nearly half of the children in those communities will suffer the same fate. Those numbers are unacceptable.

(First Lady Michelle Obama hosts the Bancroft Elementary School for the garden harvest of the White House in Washington, Tuesday, June 16, 2009. Offical White House Photographer Samantha Appleton)

With children not exercising and not eating right, childhood obesity has become an epidemic in America that threatens to cause younger generations to have a shorter life span than their parents. So how do we get our kids to eat healthier? The First Lady stated that if the food tastes good, they’ll eat it:

Well, I've learned that if it's fresh and grown locally, it's probably going to taste better. That's what I learned. And that's how I've been able to get my children to try different things, and in particular fruits and vegetables. By making this small change in our family's diet and adding more fresh produce for my family, Barack, the girls, me, we all started to notice over a very short period of time that we felt much better and we had more energy, right? And so I wanted to share this little piece of experience that I had with the rest of the nation, a wider audience, which is what brings us here today.

This gorgeous and bountiful garden that you saw over there has given us the chance to not just have some fun, which we've had a lot of it, but to shed some light on the important -- on the important food and nutrition issues that we're going to need to address as a nation. We have to deal with these issues.

More than 90 pounds of produce has been harvested so far. Some of it has been used for meals at the White House, but much of it has gone to area soup kitchens. While fresh fruits and vegetables are delicious, unfortunately they are not easily accessible to everyone, especially those in low-income areas. As the First Lady explained, for those Americans who live in areas where healthy food is out of reach, a healthy future is also out of reach. This is why community gardens are so exciting. They provide the opportunity to make healthy, affordable food readily available while bringing communities together. People are learning the benefits of community gardening -- over 1 million community gardens are flourishing right now, many in underserved urban communities. These gardens are bringing neighbors together to create a healthier community and a healthier future for the kids.

(First Lady Michelle Obama hosts the Bancroft Elementary School for the garden harvest of the White House in Washington, Tuesday, June 16, 2009. Offical White House Photographer Samantha Appleton)

However, the First Lady explained that the government must also take a role in ensuring our kids have access to healthy and nutritious food. The USDA’s National School Lunch Program serves 30 million meals a year in low-income schools. The school meals serve as a main source of nourishment for these kids, so it is essential that they are healthy. Additionally, the Child Nutrition Act, which regulates federal nutrition programs, is up for reauthorization later this year. By making our children’s nutrition a top priority, we can help assure a healthier future.

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