TRANSCRIPT: 'Questions for the President: Prescription for America'

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.

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