Obama's Health Care Speech: Experts Sound Off

Sept. 10, 2009— -- Following President Obama's speech on health care reform Wednesday night, the ABC News Medical Unit solicited comments from some of the country's leading health care policy experts. A number of them responded with their thoughts, and while more than half of the responses supported the ideas presented in the speech, many also had at least some reservations.

Some of the experts contacted were very pleased:

"No one could hear President Obama's speech and fail to be convinced by the urgency of action on health reform," said Karen Davis, president of the Commonwealth Fund and a nationally recognized economist with a distinguished career in public policy and research. "He painted the need for reform in both human and economic terms…and made it clear that failure is not an option."

Dr. Henry Black, clinical professor of internal medicine at New York University, said he was "very impressed with the tone, firmness and especially the way he systematically dealt with all the accusations that have been leveled at him and the need for reform." Black further noted that he was "particularly pleased that some sort of public option was included."

Obama "added his passion to balance the passion on the other side," said Robert Field, professor of health management and policy at Drexel University in Philadelphia. "He painted himself as a centrist, who differs from those on the left and the right. ... His position on the public plan sowed the seeds of compromise. He explained the position for it but clearly indicated that he will compromise."

"I thought it was a great speech ... all in all, a wonderful performance," said Timothy Jost, a professor of law at Washington and Lee University.

While most had something positive to say, there was also some tough criticism:

Gail Wilensky, a senior fellow at Project Hope, an international health education foundation, said Obama's speech was "moving and emotional at the end but ... would have been more powerful if there had been more of that and less of some of the earlier discussion."

Wilensky also shared her thoughts on health care spending. "I strongly support the need to slow spending on Medicare as well as the rest of health care spending, but doing it by reforming the delivery system will take time and be uncertain in its path," she said. "The sure ways to get money out of Medicare is by whacking prices, and this doesn't go after inefficiency and reimbursement."

Some Health Policy Experts Concerned With Obama Speech

Wilensky said she was was "most disappointed by his comments on the public plan. What he failed to mention is not whether it receives taxpayer support but whether it uses the power of government to set below cost reimbursement.

"This is what Medicare and Medicaid do," she continued. "Medicare produces a 6 percent loss on average for hospitals and pays physicians 80 percent of what private insurance pays. Most hospitals and physicians participate because Medicare is too big a market to ignore, but Medicare shifts costs to private payers -- daring them to try to set up networks without them or not wanting to forego the patients.

"That's the destabilizing part of a public plan. The president is a smart man. I can't believe he doesn't get this part."

Black, though impressed with the speech, said he was left with "one big question" about how his talk of Medicare savings will play with the elderly.

"Will they be reassured that cuts in spending won't compromise benefits?" he asked.

David Nash of the Jefferson School of Population Health in Philadelphia, said, "He did not call for a major Medicare overhaul, and he did not create major new federal bureaucracies to make his plan operational. Much more work needs to be done."

Alan Sager, a professor of health policy and management at Boston University, questioned health care's financial burden: "Federal payments for health care would have to be frozen for a little over a year in order to finance one-half of the projected cost of the president's new benefits," he said. "That would require a one-time saving, like taking one step backward on an up escalator. Could it be done? Could it be done in a way that was clinically safe?"

Some criticized Obama's desire to increase competition.

"My main critique is the embrace of choice and competition as a mantra," said Theodore Marmor, professor of public policy and management at Yale University. "This market economy cliche is not plausible in health care."

And one expert likened the health care reform effort to making a request of a "magic genie."

"It is like finding a magic lamp and asking the genie for a health care reform package," said Jay Wolfson, professor of public health and medicine at the University of South Florida in Tampa. "The guy rubbing the lamp knows what he wants but is going to rely on the genie to go back into the lamp and figure out how to engineer the solution.

"I am not convinced that we know more than we knew before the president's speech about the what -- and more importantly, the how," Wolfson continued. "The genie has to go back into the lamp and figure out what the heck he is going to do -- and the answer will not be for the genie to hope that there is another lamp somewhere with another genie in it who can provide the answer magically."