ABC's health care townhall has just begun. Join the liveblog below.
There is an editorial by Dr. Tim Johnson at the beginning which is summarizing Obama's requirements for health care reform:
- Health Insurance Exchange. Obama has so far insisted in a government public option.
- Effective Treatment - which includes primary care; home care for chronic care
- Cost Control
Tally from the audience - no one thinks that the system should stay the same.
1st Question - from a doctor - Wants to know if Obama would pursue all treatments for a family member even if the treatment was not covered under the government plan?
Obama's answer - talking about his grandmother and how she was diagnosed with terminal cancer and fell and broke her hip. Debated whether or not hip surgery would be worth doing. Now he is talking about unnecessary procedures and Gibson is trying to interrupt and disagree with Obama.
Follow-up question from Doctor - What can Obama do to convince Americans that there are limits to care?
Obama: You are asking the right question. High quality, Uniquely American plan. Ideological debate - Socialized medicine vs. Completely Free-Market. Choices of doctors and plans. Necessary treatments provided with minimal waste. Evidence-based care. Obama has great faith that Doctors will provide the right care if we are paying them appropriately.
Gibson: People understand that Quality not Quantity are more important. How are you going to deliver on this? Gibson has a real, aggressive tone of voice.
Obama: Mayo clinic example. Better care and 1/3 of the cost because of their reimbursement plan and they work in teams.
Diane Sawyer: Talking about Mayo Clinic and private clinics are doing the right thing so why do we need government intervention? Diane is being really aggressive as well.
Obama: The initiative is not there in the private sector. Talking about high costs of health care right now. What we are doing right now is not working. Government is already involved in health care - medicare, medicaid, laws and regulations in place with providers.
Gibson: People are afraid of government involvement.
Obama: People are concerned. The devil you know is the better than the devil you don't. That is understandable. There has been a big debate over Medicare, SCHIP. These things are always tough politically.
We do know what does work and what doesn't. What is lacking is not knowledge. What is lacking is political will. Genuine change does not come from Washington but from the people saying it is time to move forward.
Nursing Student and Emergency Tech: There is a shortage of care right now. Patient load is increasing because patients don't have access to insurance or primary care. What is Obama going to do to place primary care Doctors and Nurse Practitioners back in the community so the ER is not America's source of primary care?
Obama: First of all, we need more people like the questioner who are dedicated to going to school. We are not going to be able to do it overnight due to training. Immediately, we can change incentives around wanting to become a primary care doctor. Right now, it is more lucrative to be a specialist. Doctors are making decision based on their huge student loans. Loan forgiveness for doctors going into primary care. Look at medicaid and medicare reimbursement rates; doctors working with nurses; looking at incentives favor care vs. fee for service.
Gibson: How much debt will Mary have after medical school?
Mary: $300,000.
Obama: We need to explore loan forgiveness programs if they commit to primary care for a certain number of years.
Gibson: Right-wing talking point - How do you get an appointment?
Obama: This will be phased in. If we make the right incentives, more young people will choose this profession. Student loan forgiveness; eliminate unnecessary paperwork; get nurses involved.
President of AMA: How are you going to assure the medical decisions will still between Doctors and the patient?
Obama: Thanks AMA. We had a terrific exchange of ideas. We are working with all stakeholders. Most important point - If you are happy with your plan and your Doctor, you can keep them. There is a greater danger of you losing your plan if we do nothing. If you are unhappy with your insurance or you don't have insurance, there will be a marketplace. People can compare different health care plans and people can sign up for the plan that fits there needs. Doctors will not be working for the government. Doctors will be reimbursed like now, except we are rewarding for outcomes vs. # of treatments. Example: Hospitals reduce # of re-admits and get incentives.
Gibson: Right-wing talking point - Should the government be in the health care business? Don't answer, we'll come back to it.
Mayo Clinic Dr: I see too many patients who have terminal patients who receive weeks or months of treatments that prolong lives. It is too expensive.
Son of Terminal Mother: How can you put a price on extra time with loved ones at the end of their life?
Daughter of 105 old Mom: What is the consideration for performing treatments
Obama: We have some choices to make on our own end-of-life care. Each of us individually should draft a living will. I don't think we can make judgments based on people's joy of life. We will provide good, quality care but end of life is expensive. But right now, private insurers are making these decisions (Gibson doesn't like that answer) through higher deductibles or maximum benefits. These are hard decisions between doctors and patients. We need to make sure that our reimbursements are not hindering this process.
We want to use science and doctors to make these decisions not insurance companies.
Gibson: We're taking a commercial break. When we come back, we will talk about the government being in the business of health care which makes many people very uncomfortable. I better not read one article about this being a commercial for Obama's health care plan. Gibson is horribly biased.
Gibson: $1-$2 trillion cost. Can we afford this?
HR Person: How far is government going to go into my personal life? How and who will pay for health care services?
Obama: If you are happy with your plan and your Doctor, you can keep them. We want to place regulate insurers a little more such as eliminating pre-existing conditions. In terms of cost, the system is out of whack now. If we do nothing, the costs are going up 6 - 10% and we will have people losing insurance. To bring costs down - technology, prevention, etc. Whatever if it is we do, we pay for. Does not add to deficit. 2/3 will be re-allocation from current government health care costs. 1/3 will come from new revenue. Cap itemized deductions from top 2-3% of people (Gibson looks pissed here). All this money is hard $$. This doesn't count savings from prevention and eliminating paperwork. Changing reimbursement structure. But, CBO will not credit us for these savings.
Sawyer: Quick break. Then we'll talk about the government being in the insurance business (sensing a trend here?)
Policy Wonk from George H.W. Bush Admin: How do we pay for this? (Question - got cut-off).
Obama: There are a lot of options. This is not an easy question especially with our slowed economy.
Break until after local news. Then, the conversation about the "scary" public option.
Okay - we are back at Nightline. Gibson is still a giant tool.
Gibson: Where there needs to be a public option, very contraversial. Your critics on the Republican Finance Committee talking points, blah, blah, blah. What do you say to them?
Obama: They are wrong. (Audience laughter). We want to set-up a market place. Giving the American people the same option that government employees or Congresspeople do. There is a range of options available - private insurers will participate. Compare deductibles and benefits. What we have said is that there should be a public option as one of the multiple options. We set up a non-profit, low administrative option that can serve as competition to the private insurers. Now, the argument that has been made that public option will crowd out private insurers. Not a level playing field. Doctors will be reimbursed at a fair rate and collect premiums. This will keep insurers honest.
Now, you always hear that free market can do it better than anyone else. Government can't run anything. If that is true, than no one will choose the public plan. Private insurers should feel that they compete with just 1 other option. Most of the criticism of the public plan is not practical. It is ideological. They do not like the idea of government being involved. Keep in mind - the two places that government is involved in health care are medicare and the VA. There is very high satisfaction there.
CEO of Aetna is here (are you kidding me???).
Sawyer: Insurance premiums skyrocketing and record profits for insurance companies. Is the president right that you need to keep honest?
CEO: It is hard to compete against someone who is referring the game. So, I think in the context of thinking about a government plan. Let's work with existing stakeholders to identify problems and solve them and not introduce new problems with government plan.
Obama: I want to make clear. Whatever rules are in place, the public plan would have to follow those same rules. So, we are talking an unlevel playing field. One of the incentives for insurers to get involved is they will have a whole lot of new paying customers. If we are going to go forward to provide coverage to uninsured or underinsured (and that is a lot of working people). If they are going to give all these new customers to the insurance industry, one of the things we have to do in return we need to change practices and have some competition. No cherry-picking only the healthy and no pre-existing conditions exclusions. The public option is one tool to accomplish this. (Gibson is trying to interrupt).
Insurance companies will still thrive.
Gibson (is really upset now): Citing some right-wing nonsense from The Lewin Group. 2/3rds of people will go to public option. CEO of Lewin Group just happens to be here.
Gibson is now pointing his finger at Obama: You keep saying if you like the coverage you have, you can keep it. But, if your employer goes to public plan you can't keep it.
Obama: It's important to understand that there are a whole series of ways to decision this. One option is you are eligible for an employer plan, you can't go to the public option. That is a firewall. To employers, there is going to be a pay or play option. If you a large employer don't pay for insurance, you will pay a penalty on that.
One thing I have to say is that it is not a bad thing. If we are reimbursing at fair pay and we are not paying lots of subsidies, if the public plan can do it cheaper and provides good quality care, that is the competition we are talking about. I don't think you are going to get a lot of complaints from people if it is a better deal. If it isn't a better deal, than people aren't going to choose it. But, we think we can set up a plan that will increase options not decrease them.
Obama's public option answer is brilliant. Too bad ABC didn't cover it in the prime time slot.
Questioner: I am pretty satisfied with my plan. I am concerned with government take over. Isn't it going to tax me?
Obama: If we don't do anything, costs are going to go out of control. Medicaid/Medicare are the biggest drivers of the deficit. If we don't change reimbursement structure; prevention, etc., Medicaid/Medicare will be broke. A lot of what we are talking about is re-allocating of costs so we spend money smarter. There is going to be an initial need for money. I suggest capping rich deductions. If we are doing this right, you in private plans will see cost savings over time.
Gibson: (Freaking out because Obama mentions tax increases for Gibson and Obama) - Why did you oppose McCain's plan when you are now for it?
Obama: (Trying to answer question - but Gibson won't STFU). I still strongly disagree with McCain's plan. What is being discussed in Congress is capping the employer benefit at a certain level. Obama continues to believe that is not the best way to do it. Because what we would see is Employers drop coverage and that won't work. Obama likes his idea better. There will be a compromise.
Another Fucking Cost Question: Other countries do it cheaper why can't we?
Obama: You are right. We spend more with not better outcomes. A lot of other countries use different methods. All use a single-payer plan or Medicare for all. For us to completely change our system, would be hugely disruptive and would result in having to change doctors and other providers.
Uninsured Question: What are you going to do for people who make to much money to qualify for subsidy and can't afford a plan?
Obama: This is a huge problem. That is why exchange is a good option. You will be part of a big pool that will give you bargaining power. Subsidies are also going to be available.
ABC's Dr. Johnson: There will need to be significant re-training. Shouldn't we start doing that soon?
Obama: Over time change system. Hope people in paperwork will move into caregiver side. Also, we have an aging population, so health care is a growth industry. We don't want to spend our money badly.