11 Observations on Obama's Health Care Speech

June 15, 2009— -- I believe President Obama's speech to the American Medical Association Monday was the most comprehensive statement about reform he has ever made publicly. And given the setting, some might say it was also one of his more courageous statements.

I offer the following summary -- with a few passing questions/comments thrown in:

1) He kept hammering at the fiscal disaster that awaits us if we do nothing. And I think this is the first time he used General Motors as an example: "If we do not fix our health care system, America may go the way of GM; paying more, getting less, and going broke."

2) He also kept speaking to the fear of change and was particularly harsh on the special interest groups that use fear tactics "to paint any effort to achieve reform as an attempt to socialize medicine."

3) So he also kept speaking about keeping what you have if you like it. "If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away. No matter what."

Comment: What's the "reform" about simply allowing you to keep your present plan as is?

4) Next he commented on two reforms that almost everyone agrees are necessary: electronic medical records and prevention.

Comment: At this point, he ignored the fact that there is no evidence that prevention long term saves money -- e.g., we may get so good at it that everyone lives to 90 and gets Alzheimer's.

5) Then he got to two much more sensitive -- for his AMA audience -- reform issues:

(At this point, dead silence from the audience -- but thunderous applause erupted at the end of the next paragraph.)

"That is not why you became doctors... You did not enter this profession to be bean-counters and paper-pushers. You entered this profession to be healers -- and that's what our health care system should let you be." He then talked about improving the incentives for primary care.

"So one thing we need to do is figure out what works, and encourage rapid implementation of what works into your practices... Let me be clear: identifying what works is not about dictating what kind of care should be provided. It's about providing patients and doctors with the information they need to make the best medical decisions."

(Applause throughout this section -- and an example of where Obama very cannily spoke to physician fears about reform.)

6) He then told the doctors he will listen to them and will "pursue reform that works for you." (Applause) But when he next went to malpractice reform, he at first got major applause when he talked about their "fear of lawsuits" but some booing (the only time I think) when he said he does not support caps on malpractice awards.

7) He mentioned (as he did in his letter last week to the Senate committees) "explanding the role of a commission created by a Republican Congress called the Medicare Payment Advisory Commission..." which sounds to me very much like the "Federal Health Board" proposed by Tom Daschle.

8) He then turned to the 46 million uninsured and got major applause when he said, "We are a people who look out for one another. That is what makes this the United States of America."

He made a big pitch for a "Health Insurance Exchange" which will be like the program for federal employees where they can choose from a list of insurance plans approved by the government -- and immediately said that "one of these options needs to be a public option that will give people a broader range of choices and inject competition into the health care market."

Comment: This is the big sticking point with Republicans and something the AMA said last week they were opposed to. However, the AMA has tried to back away from that stance a little bit and today there was moderate applause for this idea. He also threw another bone to this audience by saying the annual process for setting payments for doctors -- the Sustainable Growth Rate -- needs to be reformed.