deal with our own end-of-life care.
And that's one of the things I think that we can all promote, and
this is not a big government program. This is something that each of us
individually can do, is to draft and sign a living will so that we're
very clear with our doctors about how we want to approach the end of life.
I don't think that we can make judgments based on peoples' spirit.
That would be a pretty subjective decision to be making. I think we
have to have rules that say that we are going to provide good, quality
care for all people.
GIBSON: But the money may not have been there for her pacemaker or
for your grandmother's hip replacement.
OBAMA: Well, and -- and that's absolutely true. And end-of-life
care is one of the most difficult sets of decisions that we're going to
have to make.
I don't want bureaucracies making those decisions, but understand
that those decisions are already being made in one way or another. If
they're not being made under Medicare and Medicaid, they're being made
by private insurers.
We don't always make those decisions explicitly. We often make
those decisions by just letting people run out of money or making the
deductibles so high or the out-of-pocket expenses so onerous that they
just can't afford the care.
And all we're suggesting -- and we're not going to solve every
difficult problem in terms of end-of-life care. A lot of that is going
to have to be, we as a culture and as a society starting to make better
decisions within our own families and for ourselves.
But what we can do is make sure that at least some of the waste that
exists in the system that's not making anybody's mom better, that is
loading up on additional tests or additional drugs that the evidence
shows is not necessarily going to improve care, that at least we can let
doctors know and your mom know that, you know what? Maybe this isn't
going to help. Maybe you're better off not having the surgery, but
taking the painkiller.
And those kinds of decisions between doctors and patients, and
making sure that our incentives are not preventing those good decision,
and that -- that doctors and hospitals all are aligned for patient care,
that's something we can achieve.
We're not going to solve every single one of these very difficult
decisions at end of life, and ultimately that's going to be between
physicians and patients. But we can make real progress on this front if
we work a little bit harder.
SAWYER: Is that a conversation you could have had with your mom?
STURM: What I wanted to say was, that the arrhythmia
specialist who put the pacemaker in said that it cost Medicare $30,000
at the time. She had been in the hospital two or three times a month
before that, so let's say 20, 30 times being in the hospital, maybe
going to rehab, the cost was so much more. And that's what would have
happened had she not had the pacemaker.
OBAMA: Well, and that's a good example of where -- if we've got
experts who are looking at this, and they are advising doctors across
the board that the pacemaker may ultimately save money, then we
potentially could have done that faster.
I mean, this can cut both ways. The point is, we want to use
science, we want doctors and -- and medical experts to be making
decisions that all too often right now are driven by skewed policies, by
out-dated means of reimbursement, or by insurance companies.