TRANSCRIPT: 'Questions for the President: Prescription for America'
Charles Gibson, Diane Sawyer moderate health care forum at the White House.
June 24, 2009— -- The following is a transcript from ABC News' health care forum, "Questions for the President: Prescription for America" on June 24, 2009, in the East Room of the White House.
ANNOUNCER: From the White House, a special edition of "Primetime."
OBAMA: We have finally decided to fix what's broken about health
care in America.
ANNOUNCER: The president calls for sweeping reforms. What the
changes would mean to your family.
(UNKNOWN): What's going to happen if my cancer comes back?
ANNOUNCER: Who decides what doctors you can see and the treatment
(UNKNOWN): Who should decide whether you live or die? The government?
ANNOUNCER: And how much are we willing to pay? Real people, real
fears, and tonight, real answers.
OBAMA: We need to get this done.
ANNOUNCER: Questions for the president, prescription for America.
Now, from White House, Charles Gibson and Diane Sawyer.
(END VIDEO CLIP)
GIBSON: Good evening. Diane and I are delighted that you could
join us this evening. We are going to be talking about what will be the
number one subject for public discourse all through this summer, and
that is health care reform.
SAWYER: The president has said it's the ticking time bomb at the
center of the American economy, and so we have gathered 164 people in
the East Room of the White House tonight. They're from all over the
country, all walks of life, on the front lines of health care in
America. They are doctors, businessmen, patients, Republicans,
Democrats, independents. And we know we can't cover every question
tonight, but we're going to get the conversation started.
GIBSON: They will be questioning the president, as will we. And we
think by the end of the evening, you will have a pretty good sense of
what the parameters of this debate are, just what's at stake for each of
you and for the country as a whole, because this will be discussed, as
we said, all through the summer in the Congress. It will be discussed,
I think, also in your living room. Every family, I think, will be
So with that as preface, we want to thank the president for giving
us his parlor and his living room tonight to do this broadcast.
OBAMA: Thank you so much, Charlie.
GIBSON: Mr. President, I think this could be an interesting evening.
OBAMA: Thank you so much, Diane.
SAWYER: Mr. President, thank you.
OBAMA: Grateful to have you.
SAWYER: And while we head into the East Room, we're going to have
the audience waiting for us there. Dr. Tim Johnson, who's our medical
editor, is going to give everyone a sense of some the key questions.
We're heading to the East Room.
DR. TIMOTHY JOHNSON: First: access and choice. The president constantly
stresses that, if you like what you have, you can keep it. But he also
wants to offer more choice and competition with a one-stop shopping list
of approved private insurance plans through a so-called health insurance
So far, he has also insisted that a public option be one of the
choices. It has sometimes been described as Medicare like, meaning the
government would be involved with the financing, but patients would be
able to choose their own doctors and hospitals.
He says this public option would keep pressure on private insurance
to hold down costs. Critics say government's advantages -- easy
funding, huge bargaining power -- would eventually put private insurers
out of business, which could affect your current coverage.
Second: effective treatment. The president agrees with experts who
say that about a third of what we now spend on health care is
unnecessary. He says we reward doctors and hospitals the wrong way,
paying for simply doing more tests and procedures, rather than paying
for good outcomes.
And he stresses that primary care, readily available family doctors,
physician assistants and nurse practitioners is essential in promoting
prevention, making sure we get screening tests and lifestyle advice, and
coordination, orchestrating the care of specialists and home care for
Critics say that, if third-party government experts set the rules
for what is covered and paid for, patients and doctors will have less of
a voice and choice.
And, finally, cost control. The president insists that increasing
coverage without controlling costs is a formula for economic disaster.
That will be a tough job, given that estimates for reform now run
between $1 trillion and $2 trillion over 10 years.
Besides savings from the reform of Medicare and Medicaid, he has
advocated new tax revenue by limiting deductions for charitable giving,
but he has not yet agreed to taxing any insurance benefits from
employers as income. Critics say his plan spends too much and the
government just does not have the money.
So, Diane and Charlie, three huge challenges, a formula for
heartburn, which, by the way, is something we doctors can fix.
GIBSON: Dr. Tim Johnson there outlining some of the parameters of
the debate. And we're going to try to loosely organize things. We have
this -- we're calling this prescription of America, but basically this
is, how does this affect me? How does it affect all of you at the
doctor's office? Should there be a public option, public -- government
insurance in all of this? And what is the cost of all of this? Can we
And as we mentioned, 164 people here from all walks of life, Mr.
President. Before we start, I'm curious. I want to get a show of
hands. How many of you -- whether you agree with the president's
approach or not, how many of you agree that we need to change the health
care system in America?
And is there anybody here who believes the system should be left
Interesting. But there is a lot of disagreement, because the devil
is in the details, as we all know.
OBAMA: Let's -- let's stop now.
OBAMA: Let's go. We're ready to...
GIBSON: So, as we say, all of this is, how does this affect me?
And we want to get your questions.
And I want to start with Dr. Orrin Devinsky. Is he here? Dr.
DR. ORRIN DEVINSKY, EPILEPSY SPECIALIST: Yes, in the past, politicians who have sought to reform health care have tried to limit costs by reducing
tests, access to specialists, but they've not been good at taking their
own medicine. When they or their family members get sick, they often
get extremely expensive evaluations and expert care.
If a national health plan was approved and your family participated,
and, President Obama, if your wife or your doctor became seriously ill,
and things were not going well, and the plan physicians told you they
were doing everything that reasonably could be done, and you sought out
opinions from some medical leaders and major centers, and they said
there's another option that you should -- should pursue, but it was not
covered in the plan, would you potentially sacrifice the health of your
family for the greater good of insuring millions? Or would you do
everything you possibly could as a father and husband to get the best
health care and outcome for your family?
OBAMA: Well, first of all, Doctor, I think it's a terrific
question, and it's something that touches us all personally, especially
when you start talking about end-of-life care.
As some of you know, my grandmother recently passed away, which was
a very painful thing for me. She's somebody who helped raise me.
But she's somebody who contracted what was diagnosed as terminal
cancer. There was unanimity about that. They expected that she'd have
six to nine months to live. She fell and broke her hip. And then the
question was, does she get hip replacement surgery, even though she was
fragile enough that they weren't sure how long she would last, whether
she could get through the surgery.
I think families all across America are going through decisions like
that all the time. And you're absolutely right that, if it's my family
member, it's my wife, if it's my children, if it's my grandmother, I
always want them to get the very best care.
But here's the problem that we have in our current health care
system, is that there is a whole bunch of care that's being provided
that every study, every bit of evidence that we have indicates may not
be making us healthier.
GIBSON: But you don't know what that test is.
OBAMA: Well, oftentimes we do, though. There are going to be
situations where there are going to be disagreements among experts, but
often times we do know what makes sense and what doesn't. And this is
just one aspect of what is a broader issue.
And if I could just pull back just for a second, understand that the
status quo is untenable, which is why you saw -- even though we've got
Republicans, Democrats, independents, people from all parts of the
health care sector represented here, everybody understands we can't keep
doing what we're doing.
It is bankrupting families. I get letters every single day from
people who have worked hard and don't have health insurance.
It is bankrupting businesses who are frustrated that they can't
provide the same kind of insurance that they used to provide to their
employees. And it's bankrupting our government at the state and federal
So we know things are going to have to change. One aspect of it,
the doctor identified, is, can we come up with ways that don't prevent
people from getting the care they need, but also make sure that because
of all kinds of skewed incentives, we are getting a lot of quantity of
care, but we're not getting the kind of quality that we need.
SAWYER: I want to ask about this, Mr. President, because you said
to me when we talked yesterday that you think if everyone has the right
information, that doctors will make the right decisions, patients will
make the right decisions. And you just said we think we do know what is
And Dr. John Corboy from Colorado, do we always know? And what
if a patient comes to you and says, no, I want that extra CT-scan, I
think I need that extra CT-scan, and you're at the risk of being sued,
among other things, what are you going to do?
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
test, you don't then have to duplicate having two more tests with other
specialists, because they were in the room when you first met with that
primary care physician.
They know how to manage chronic diseases in an effective way so that
we have people who are getting regular checkups, if they're trying to
manage diabetes, as opposed to us paying for a $30,000 foot amputation
because we didn't manage the disease properly.
So they are doing all kinds of smart things that we could easily
duplicate across the system, but we don't. And our job in this -- in
this summer and this fall, in which I think everybody understands we've
got to move in a different direction, is to identify the best ways to
achieve the best possible care in a way that controls costs and is
affordable for the American economy long term.
SAWYER: Mr. President, you mentioned the Mayo Clinic, and I'm going
to cross as I talk here, if you don't mind. But I've been reading a lot
of the e-mail questions that we've been getting online. They've been
saying the Mayo Clinic is exactly the point. They're doing it. Private
industry is doing it. Private hospitals are doing it. The Safeway
company is taking action.
Why get the government involved in something that is being done
already in the private sector and, with the right initiative and
impetus, could be done in the private sector without government involvement?
OBAMA: Well, you just said "with the right initiative." And,
unfortunately, that initiative hasn't been forthcoming. And as a
consequence, what's happening is -- here's what's happening to ordinary
families, because I know one of those boxes was, "How does this affect you?"
The average family has seen their premiums double in the last nine
years. Costs for families are going up three times faster than wages.
So if you're happy with your health care right now -- and many people
are happy with their health care right now -- the problem is, 10 years
from now, you're not going to be happy, because it's going to cost twice
as much or three times as much as it does right now.
Out-of-pocket expenses have gone up 62 percent. Businesses
increasingly are having to cut back on health care or -- and if you talk
to ordinary workers, they're seeing this all the time -- employers, even
if they don't want to, are having to pass on costs to others.
So -- so, unfortunately, whatever it is that we're doing right now
isn't working, Diane. What we see is great examples of outstanding
care, businesses that are working with their employees on prevention,
but it's not spreading through the system.
And, unfortunately, government, whether you like it or not, is going
to already be involved. You know, we pay for Medicare. We pay for
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