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

still going to be working for themselves. They're still going to be

focused on patient care. And in terms of how doctors are reimbursed,

it's going to be the same system that we have now, except we can start

making some changes so that, for example, we're rewarding quality of

outcomes rather than the number of procedures that are done.

And this is true not just for doctors, it's also true for

hospitals. One of the things that we could say to hospitals is, reduce

your readmission rate, which is also often a sign that health outcomes

have not been so good.

And it turns out that hospitals, when they're incentivized, actually

can find ways to do it that, every study shows, does not have adverse

effects on outcomes.

GIBSON: You keep coming back to that point, about, if you like what

you have, you can keep it.

OBAMA: Right.

GIBSON: I will return to that subject when we get to the issue of

the public option and whether the government should be in the insuring


But one of the things when we talk about the kinds of changes that

may occur, the elderly are affected. Medicare will be affected.

Twenty-eight percent -- 26-28 percent of money in Medicare is spent in

the last year of life. The elderly are very critically affected.

Just a quick sound bite from a couple of people to lay out the

parameters of the problem.



at the Mayo Clinic in Rochester, Minnesota.

I see too many patients who have terminal illnesses or no hope of

recovery who receive weeks or months of intensive care unit treatment,

only to prolong their death. I find this approach very distressing and

the waste of money is appalling.

We just can't afford to provide all treatments to all people.

ROBERT WASSON: My name is Robert Wasson. My mother is 74

years old. She has terminal cancer in the stomach lining that has

spread to the lungs. She deserves to be treated medically to the best

of their ability.

To say it's too expensive is not right. I just don't think you can

put a price tag on quality time with loved ones, especially at the end

of their lives.


SAWYER: And we have with us a couple of people who really represent

the opposite ends on this spectrum too. I want to talk, if I can, to

Jane Sturm.

Your mother, Hazel...

JANE STURM: Caregiver for 105-year-old mother: Yes.

SAWYER: Hazel Homer (ph), 100 years old and she wanted...

STURM: She's 105 now. Over 105. But at 100 the doctor had said to her, I can't do anything more unless you have a pacemaker. I said, go for it. She said, go for it. But the arrhythmia specialist said, no, it's too old.

Her doctor said, I'm going to make an appointment, because a picture

is worth a thousand words. And when the other arrhythmia specialist saw

her, saw her joy of life and so on, he said, I'm going for it.

So that was over five years ago. My question to you is, outside the

medical criteria for prolonging life for somebody elderly, is there any

consideration that can be given for a certain spirit, a certain joy of

living, quality of life? Or is it just a medical cutoff at a certain age?

OBAMA: Well, first of all, I want to meet your mom.


OBAMA: And I want to find out what's she's eating.


OBAMA: But, look, the first thing for all of us to understand is

that we actually have some -- some choices to make about how we want to

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