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