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

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

you'll receive?

(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

debating this.

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

exchange.

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

chronic diseases.

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

afford it?

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

unchanged?

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.

(LAUGHTER)

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.

Devinsky?

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

level.

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

over-treatment.

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

system?

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