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Obama's Speech to the AMA


His promises to the people and the doctors:
"If you like your doctor, you will be able to keep your doctor.
If you like your healthcare plan, you will be able to keep your healthcare plan."

How do we make system work better? According to Obama:
1) Upgrade medical records to electronic (part of recovery act) (immediate applause and laughter), record should be private but transferrable to all your docs. Less paper pushing & admin costs. Easier for physicians because they know what drugs someone is on, what tests have been done, and reduce medical errors.
2) Invest more in preventive care. (lukewarm then warming applause). Each of us take more responsibility for our own health and health of our children. Stop smoking, go for screening, start exercising, cut back on junk food, reduce obesity. Promote prevention instead of managing disease. Reward workers for taking good care of their health, ex: if you have low cholesterol you pay lower premiums through work for insurance. (Safeway) Cancer, CV dz, DM, lung dz, stroke are all preventable. Still will only dent rising healthcare costs.
Demographics account for part of rising cost. Bulk of cost is dt nature of delivery system. System equates expense and quantity of care with superior care, but quality is lost. Medicine has changed from a calling/profession to a business. Healthcare system should let doctors be healers.
3) Bundle payments so that you get paid well for overall tx of dz. Encourage teaming. Give bonuses for good outcomes. Rethink cost of medical education. Encourage primary care physicians in underserved areas. Invest in national health service corps making primary care training more affordable. (lukewarm applause)
4) Improve quality of medical info getting to docs. Harness collective knowledge and experience for better medicine. Examine which tx are most effective. Long delay in transfer of knowledge. Get latest research to practicing doctors. Encourage rapid implementation of what works. Identify best treatments for conditions. (what about wholism?) Provide pts and docs with info to make best decisions. We're not making the most of what we know. Americans think doctors are the healthcare system. He's saying he's going to listen to docs to get reform that works for docs.
5) Fear of lawsuits... (big applause and hooting) Some docs feel need to order more tests to avoid legal vulnerability. Not advocating caps on malpractice (not quite a boo but crowd is skeptical). Explore ideas on pt safety, let docs practice medicine, encourage broad use of evidence based guidelines, scale back excessive defense of medicine, provide better care instead of more treatment.
6) A way to evaluate waste, costs, quality. Commission created by republican congress: medicare payment advisory commission. Recommended 2 billion in savings that never became law. He's working to get those reconsidered.
7) Get affordable insurance to every single American. Now uninsured goes to ER and costs all Americans. We are not a nation that accepts 46 million uninsured, turns back on those in need, we care, we look out for one another....etc. We need to get things done. Health Insurance Exchange is one stop shopping for healthcare plan, choose what's best for yourself. Federal employees all shop from same menu, choice of plans. New options for those who aren't happy with what they've got. Public option is new. "Keep the insurance companies honest" by competition. There is concern about public option. Today's medicare rates applied broadly? Too low? He doesn't say. Wants to reward best practices. Seek more stability, sounder financial footing. Reimbursement in thoughtful way tied to pt outcomes not politics. "Public option is your friend" (silence) "Trojan horse" for single payer system? Single payer works well in some places but he says we should respect our traditions here. Debunks those who say he's socializing medicine. Wants to give assistance to families who need it so everyone can afford at least basic public plan. Hardship Waiver. Individuals responsible for having insurance, businesses responsible for insuring employees, help available if you can't. Doesn't want to pay off existing insurance system, won't do it.
8) NO MORE DENYING COVERAGE BASED ON PRE-EXISTING CONDITIONS. No more cherry picking.
9) Cost of new system will not add to budget deficit, will be deficit neutral in next decade. Asserts that numbers do add up. Projected cost: 1 trillion in next 10 years. This will be less than Iraq war. Not fixing system will cost more. How to cover the cost: $635 billion over 10 years in health reserve fund, over half of that comes from revenue by limiting tax deductions of wealthy to end of Reagan year. Worry that it will reduce charitable giving: false. Also spending cuts: examine medicare inefficiencies, make cuts, he thinks no more overpayments to Medicare Advantage Plans (this is subsidy to insurance companies). Competitive bidding for Medicare Advantage will save 177 billion in next decade. (lukewarm response). Use medicare to reduce hospital admissions, often people are readmitted after first admission within a month, discourage hospitals from causing this, $25billion savings. Generic biologic drugs need to be introduced to tx common dz like anemia, $30billion savings. $313 savings in other ways: adjust medicare payments to reflect advancements in economy, encourage efficiency, reduce payments to hospitals for treating uninsureds $106 billion savings, $75 billion through more efficient purchasing of pharmaceuticals, more from fraud elimination. Protect seniors. Extend medicare trust fund by 7 years, $43 billion more to medicare. Together savings: 950 billion on the table. Does not count longer term savings, just this decade we are deficit neutral, greater rewards in future.

Conclusion: Doesn't want this medical crisis to continue another 50 years or to curse future generations with massive deficits. No dread about doctor's bills. Best of system becomes hallmark of system. He's talking about coming together to bring a better future...reaffirm ideals of medicine.

Comments

( 2 comments — Leave a comment )
machmed
Jun. 15th, 2009 08:52 pm (UTC)
not to be a cynic, but...
The problem with any "affordable" government health care is that it only gives people easier access to cheap, trash allopathic medicine, and ultimately encourages general care doctors to medicate more low-income, uneducated patients than they already are.

Medicate, medicate, medicate. That's all I hear when these politicians talk about socialized medicine.

I'm not entirely against social welfare programs for the general population (I'm not necessarily crazy about them either), but I don't find anything very appealing about this effort.

With that said, point number 2 is probably a good start for many people.
liveonearth
Jun. 15th, 2009 11:52 pm (UTC)
Re: not to be a cynic, but...
Yeah, point 2 is our big hope, and he really did emphasize it. The other reason for optimism is the intent to give incentives for outcomes, not procedures or prescriptions. He's got a big battle ahead, but I think the angle Obama is taking is more likely to bear fruit than any of the other possibilities out there.
( 2 comments — Leave a comment )

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