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

DR. JOHN CORBOY, NEUROLOGIST & MEDICAL PROFESSOR: Well, I think you still have to provide the appropriate care. And I think we all know that there is a significant amount of care that actually is inappropriate and unnecessary.

And the question then is -- for you, Mr. President, is, what can you

convince -- what can you do to convince the American public that there

actually are limits to what we can pay for with our American health care


And if there are going to be limits, who is going to design the

system and who is going to enforce the rules for a system like that?

OBAMA: Well, you're asking the right question. And let me say,

first of all, this is not an easy problem. If it was easy, it would

have been solved a long time ago, because we've talking about this for

decades, since Harry Truman.

We've been talking about how do we provide care that is

high-quality, gives people choices, and how can we come up with a

uniquely American plan? Because one of the ideological debates that I

think has prevented us from making progress is some people say this is

socialized medicine, others say we need a completely free market system.

We need to come up with something that is uniquely American. 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 makes 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 of those other things. And I think that on the issue that

has 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 often times it is harder for them, more

expensive for them, to do what is appropriate.

And we should change those incentive structures.

GIBSON: And people, I think, understand that you want to get away

from quantity for quantity's sake, because that's the way the doctor

makes more money, and get to quality.

But the question is, how do you do that? How do you get to the

point and still assure people, as both of the doctors have asked, that

their cousins, their nephews, their husbands, their wives, are going to

get everything that is necessary?

OBAMA: Well, let's take an example. And I -- they may be

represented here, I wasn't sure, but the Mayo Clinic, everybody has

heard of it. It has got some of the best quality care in the world.

People fly from all over the world to Rochester, Minnesota, in order to

get outstanding care. It turns out that Mayo Clinic oftentimes provides

care that is as much as one-third less expensive than the average that's

provided or -- or some other health care systems that aren't doing as

good of a job. Now, why is that?

Well, part of it is that they have set up teams that work together

so that, if you go first to your primary care physician and they order a

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