Obama's Speech – Healthcare Reform


I wasn’t able to watch President Obama’s speech last evening.

I did read it at Politico.com, though, and I have hope in him that he can pull our country through this giant morass that we are in.

The part of his speech relating to health care is below.

For that same reason, we must also address the crushing cost of health care.

This is a cost that now causes a bankruptcy in America every thirty seconds. By the end of the year, it could cause 1.5 million Americans to lose their homes. In the last eight years, premiums have grown four times faster than wages. And in each of these years, one million more Americans have lost their health insurance. It is one of the major reasons why small businesses close their doors and corporations ship jobs overseas. And it’s one of the largest and fastest-growing parts of our budget.

Given these facts, we can no longer afford to put health care reform on hold.

Already, we have done more to advance the cause of health care reform in the last thirty days than we have in the last decade. When it was days old, this Congress passed a law to provide and protect health insurance for eleven million American children whose parents work full-time. Our recovery plan will invest in electronic health records and new technology that will reduce errors, bring down costs, ensure privacy, and save lives. It will launch a new effort to conquer a disease that has touched the life of nearly every American by seeking a cure for cancer in our time. And it makes the largest investment ever in preventive care, because that is one of the best ways to keep our people healthy and our costs under control.

This budget builds on these reforms. It includes an historic commitment to comprehensive health care reform – a down-payment on the principle that we must have quality, affordable health care for every American. It’s a commitment that’s paid for in part by efficiencies in our system that are long overdue. And it’s a step we must take if we hope to bring down our deficit in the years to come.

Now, there will be many different opinions and ideas about how to achieve reform, and that is why I’m bringing together businesses and workers, doctors and health care providers, Democrats and Republicans to begin work on this issue next week.

I suffer no illusions that this will be an easy process. It will be hard. But I also know that nearly a century after Teddy Roosevelt first called for reform, the cost of our health care has weighed down our economy and the conscience of our nation long enough. So let there be no doubt: health care reform cannot wait, it must not wait, and it will not wait another year.

The gist of President Obama’s plan is to provide comprehensive health care for everyone (i.e. “open access” to health care) while reigning in costs. We’re going to spend more money to implement electronic medical records, to find a cure for cancer, and to invest in preventative care.

These are all laudable goals, but a system with increased expenses and decreased costs is difficult or impossible to attain without significantly affecting access to care and quality of care.

Want to take a bite out of cancer deaths? The cancer caused by smoking cigarettes kills a quarter of a million people each year. Put a $10 “advance health care tax” on every pack of cigarettes sold to pay for future health care costs. That will cut down dramatically on smoking and will increase funding for future smoking-related cancer cases.

Electronic medical records will help in the administration of health care, but only if the records are universal, complete, and easily accessible. No health care provider is going to spend tens of thousands of dollars to implement an electronic medical records system when there is no unified records system and when the return on the investment amounts to decreased productivity and increased costs. Kevin MD has posted a lot of information on this problem. Read more about his posts here.

The thing about President Obama’s speech that worries me the most goes back to the Engineer’s Triangle.

There is a dynamic tension between quality medical care, timely medical care, and free medical care.

If the government is going to make medical care free or low cost, that leaves two other variables in the equation.
Are we going to settle for free and timely care and take a hit in quality?
Or are we going to get free and quality care that will be difficult to access?

I’m betting on the second option – one in which care in this country will become time-rationed like in every other socialized medical system. It won’t be that you can’t have the medical care, it’s just that you may die waiting to receive it because so many other people are also in line to get the same free care. After all, we only have “limited resources” and we have to contain costs, you know.

Much of the medical care that some take for granted now, such as expensive lifesaving drugs and expensive end-of-life care, will become unavailable.

Not sure how I feel about this one. I think that our nation wastes exorbitant amounts of money on expensive care that has little or no effect on patient outcomes. That money could be put to much better use by providing primary care services to patients who cannot afford and currently have no access to it.

I’m just concerned that the pendulum is going to swing too far in the other direction and that increasing amounts of expensive but reasonable treatment will also be curtailed to cut costs.


  1. IMHO–my fear is that if such “reforms” are rushed, they will be made in haste. As a result, rather than developing a well-thought out solution–there’s going to be some boondoggle put out by Congress.

  2. as one who works with the elderly in the hospital end of life care is out of control…it has little to do with the patient and much more to do with family that won’t let go..I spend a lot of my day doing more harm than good…a demented bilateral amputee with dementia on a feeding tube with chronic mrsa infected wounds should not be a full code….it is selfish on so many levels. I have no sympathy for the family…they avoid their own emotional pain by not letting the patient arrive at the inevitable conclusion of life which is death. When did death become so alien and something to be avoided at all costs? The greatest respect you can give someone is to offer them a dignified and peaceful passing. If such care would become scarce it would be a good thing. We would save many people from uneccessary suffering and possible have more resources for those who would benefit more. The young should respect the old but the old need to make way for the young.

  3. Gee…I wonder if they’ll READ the health care reform BEFORE they pass it?

    WC… Perhaps this is the time you blogging docs should UNITE and be a voice in Washington.???

    So.. what would actually happen to the insurance companies as we know them today?

    How would doctor salaries be paid?

    I was thinking about this today..from a totally selfish perspective.

    I was wondering if I would be able to see the same urologist who has been with me through thick and thin?

    And..I wonder… as someone who is about to have her 6th magIII lasix renal scan… would those be limited too?

    In my case…it is to stay on top of the status of my kidney and ureter.

    After how they rushed that 787 bill through.. I don’t trust them.

    They have the opportunity, they rushing their agendas through.

    I can tell you…the average person only hears FREE health care and they do not appreciate that FREE health care will come at a price.

    There is such good info in the blogasphere. You docs really should find a way to call attention to your posts that deal with these issues.

  4. Like your comments, I agree. An emphasis on preventive care is great, the problem is that so many people are not interested in preventing their future health problems…if they were, fast food and cigs would have already taken a major hit. Until people begin to take responsibility for their own health, prevention will amount to throwing money around with no measurable results to show for it. “You can lead a horse to water…yadda, yadda, yadda”….

  5. According to the Washington Post (http://www.washingtonpost.com/wp-dyn/content/article/2009/02/25/AR2009022502587_pf.html)

    Obama wants to create a 634 Billion dollar reserve fund. How? “About half the money for the new fund would come by capping itemized tax deductions for Americans in the top income bracket. The proposal, which administration officials characterize as a “shared-responsibility issue,” would reduce the value of tax deductions for families earning more than $250,000 by about 20 percent, according to administration documents.”

    Also, “For example, experts have identified hospital readmissions — especially for elderly patients — as a sign of poor care and unnecessary expense. About 18 percent of Medicare patients are readmitted to the hospital within 30 days of an original visit. The new approach would establish flat fees for the first hospitalization and 30 days of follow-up, sometimes done by separate facilities. Hospitals or clinics with high readmission rates could be paid less.”

    And lastly in an article on ABC news it is believed he is going to decrease remimburement for physicians.

    So to recap. We are going to decrease the amount we are going to pay you. We are going to decrease the amount of that you are going to keep. And, you better not try to get your chronically ill patients out to the hospital lest you not get paid for there return visit. On the other hand admits are stacking up in the ED because there is no place to put them on the floor.

    My wife is also a physcian. We have done the math. If the Obama feels that the continued taxation of couples over 250K is the answer, our area is going to lose one of two subspecialist for 75 miles. It will be better for us financially for her not to work and stay home with the kids. This goes to WCs access to care. If you decrease the amount of subspecialist by 50% in an area, the wait of 3 months today will be 6 months tomorrow. Get ready, and be prepared to heal thy self.

  6. To continue my rant: Re: hospital readmissions. To quote the above sited article “readmits are a sign of poor care”. So it is the MDs fault that the patient has a 60 pack year smoking history, has a led a sedentary lifestyle, his father died at the age of 50 due to an MI (yes we should be able to control genetics as well), not to mention it is our fault that the cells in his gut decided to become cancerous leading to 2 or three surgeries and a few admits for obstruction, pnuemonia, etc… The reason it is called chronic illness is that it is chronic. Yes acute illness should get better during an admit but these “elderly patients” have a CHRONIC ILLNESS. ARRRRRGH.

  7. You write, Put a $10 “advance health care tax” on every pack of cigarettes sold to pay for future health care costs. That will cut down dramatically on smoking and will increase funding for future smoking-related cancer cases.

    It will probably also lead to a huge expansion of the, untaxed, black market for cigarettes.

    I think that our nation wastes exorbitant amounts of money on expensive care that has little or no effect on patient outcomes. That money could be put to much better use by providing primary care services to patients who cannot afford and currently have no access to it.

    These rationing decisions may be made by 8th graders. On the other hand, by passing a law that makes every American citizen also a doctor, there will be no wait to see a doctor. If 8th graders can provide oversight to doctors, nobody really needs to waste all of that time on college, medical school, and residency. This medical school stuff is just elitism gone wild.

  8. “If 8th graders can provide oversight to doctors, nobody really needs to waste all of that time on college, medical school, and residency. This medical school stuff is just elitism gone wild.”

    LMAO Rogue, you are on a roll.

  9. White coat, I posted a series similar to this, and especially harped on smoking. We really don’t need high tech EMRS, open acess and the like until Americans takes responsibility and stop smoking, eating fast foods and laying on the couch. The feds should focus on eliminating smoking, and encouraging health food and exercise. As to cigarettes, I say out law tobaacco. RogueMedic, are you listening?

    • PookieMD,

      As to cigarettes, I say out law tobaacco. RogueMedic, are you listening?

      Our history of prohibition has not been good.

      Otherwise law abiding people will break the prohibition laws. How else do we explain people in jail solely for possession of prohibited substances?

      We need to eliminate the current prohibitions, not add more failures. How many wars on drugs can we afford to lose at a time? Or do we just consider it to be one big failed war on drugs, with unlimited potential for growth? Kind of like the growth potential of the bailout.

      If we outlaw sins of commission, why not outlaw sins of omission. Maybe we need a law to force people to exercise a minimum amount of hours per week. There is no reason to be unreasonable. We need to allow people some flexibility to organize their own schedules. To do otherwise would lead to too much opposition. This way people will feel they have some control over things. Once people have learned to blindly obey, we can move on to other things.

      We need to encourage responsibility.


      Unfortunately, prohibitions may be the worst way to try to accomplish this. We will be constantly depriving people of decisions to make. Eventually there are no decisions left, except Obey and Don’t Obey.

      The idea that you can make it so that a society is wonderful to live in, just by passing the right laws – laws to control the behavior of others – is very unhealthy.

      If you want to modify behavior, criminalization of self-destructive behaviors we do not like is just going to lead to less respect for the law. Do we really want a society that is less law-abiding than the current society?

  10. I hate the idea of a nationalized healthcare system so I don’t even know why I’m saying this, but why does it have to be all or nothing? Can’t just primary care be nationalized, but specialty care out of pocket? Why is it, when the government gets involved with something, it has to get its freakin’ claws into ALL aspects of it?

  11. Whatever the government develops, one thing MUST be done…Congress and the President must also live under the same system!

    Then they will see what the rest of us get. They will get the same wait times, the same lack of access, whatever. It is only fair.

    They should not get the care they currently get, which is far over and above what even the “average” American gets.

  12. John Maxfield on

    Actually, as shown in Denmark, smoking lowers health care costs. Presumably they die earlier of less complex diseases. If money is the issue, then the government should subsidize smoking.

  13. I’ve been involved in taxes for longer then I care to acknowledge, both on the individual side (all my employed life history!!) and from a legal point of view since satisfying the bar and pursuing tax law. I’ve provided a lot of advice and corrected a lot of wrongs, and I must say that what you’ve put up makes impeccable sense. Please persist in the good work – the more people know the better they’ll be outfitted to handle with the tax man, and that’s what it’s all about.

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