Obama Calls on Help of the AMA

Below are excerpts of President Obama's hour-long speech to the AMA House of Delegates on June 15.

“... From the moment I took office as president, the central challenge we've confronted as a nation has been the need to lift ourselves out of the worst recession since World War II. In recent months, we've taken a series of extraordinary steps, not just to repair the immediate damage to our economy, but to build a new foundation for lasting and sustained growth....

“All this is important. But even as we've made progress, we know that the road to prosperity remains long, and it remains difficult. And we also know that one essential step on our journey is to control the spiraling cost of health care in America. And in order to do that, we're going to need the help of the AMA....

“When it comes to the cost of our health care, then, the status quo is unsustainable.... So to say it as plainly as I can, health care is the single most important thing we can do for America's long-term fiscal health. That is a fact....

“First, we need to upgrade our medical records by switching from a paper to an electronic system of record keeping. And we've already begun to do this with an investment we made as part of our recovery act. It simply doesn't make sense that patients in the 21st century are still filling out forms with pens on papers that have to be stored away somewhere....

“The second step that we can all agree on is to invest more in preventive care so we can avoid illness and disease in the first place....

“But what accounts for the bulk of our costs is the nature of our health care delivery system itself—a system where we spend vast amounts of money on things that aren't necessarily making our people any healthier; a system that automatically equates more expensive care with better care....

“It's a model that rewards the quantity of care rather than the quality of care; that pushes you, the doctor, to see more and more patients even if you can't spend much time with each; and gives you every incentive to order that extra MRI or EKG, even if it's not necessary. It's a model that has taken the pursuit of medicine from a profession—a calling—to a business....

“[Changing this] starts with reforming the way we compensate our providers—doctors and hospitals. We need to bundle payments so you aren't paid for every single treatment you offer a patient with a chronic condition like diabetes, but instead paid well for how you treat the overall disease. We need to create incentives for physicians to team up, because we know that when that happens, it results in a healthier patient. We need to give doctors bonuses for good health outcomes, so we're not promoting just more treatment, but better care....

“And as we seek to contain the cost of health care, we also have to ensure that every American can get coverage they can afford.... Now, if you don't like your health care coverage or you don't have any insurance at all, you'll have a chance, under what we've proposed, to take part in what we're calling a Health Insurance Exchange. This exchange will allow you to one-stop shop for a health care plan, compare benefits and prices, and choose a plan that's best for you and your family—the same way, by the way, that federal employees can do, from a postal worker to a member of Congress. You will have your choice of a number of plans that offer a few different packages, but every plan would offer an affordable, basic package....

“Now, I know that there's some concern about a public option. Even within this organization, there's healthy debate about it. In particular, I understand that you're concerned that today's Medicare rates, which many of you already feel are too low, will be applied broadly in a way that means our cost savings are coming off your backs....

“And these are legitimate concerns, but they're ones, I believe, that can be overcome. As I stated earlier, the reforms we propose to reimbursement are to reward best practices, focus on patient care, not on the current piecework reimbursements. What we seek is more stability and a health care system that's on a sounder financial footing.

“What I am trying to do—and what a public option will help do—is put affordable health care within reach for millions of Americans. And to help ensure that everyone can afford the cost of a health care option in our exchange, we need to provide assistance to families who need it. That way, there will be no reason at all for anyone to remain uninsured....

“Members of the American Medical Association, and my fellow Americans, I'm here today because I don't want our children and their children to still be speaking of a crisis in American medicine 50 years from now. I don't want them to still be suffering from spiraling costs that we did not stem, or sicknesses that we did not cure. I don't want them to be burdened with massive deficits we did not curb or a worsening economy that we did not rebuild.

“I want them to benefit from a health care system that works for all of us.... We will reaffirm the ideals that led you into this noble profession, and we'll build a health care system that lets all Americans heal.”

The full text of the president's speech is posted at<www.whitehouse.gov/the_press_office/Remarks-by-the-President-to-the-Annual-Conference-of-the-American-Medical-Association>.▪