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Obama on choice of physician

Obama on choice of physician

Remarks by the President in Town Hall on Health Care

The White House
Grand Junction, Colorado
August 15, 2009
Question: As a child I had polio, and I had a series of surgeries, 52 of them, to correct my poor structure of bones — between here, Denver, Montrose, and the Mayo Clinic in Phoenix, Arizona. I have been blessed with a good insurance, generally excellent doctors and care. However, my major concern in cost, even with good — even with a good insurance, the cost has been high, practically when I have been gone out of the network. Why should our doctor treatment choice be limited by a geographic area or the state? What kind of competition is this, Mr. President? (Applause.)
The President: This raises an important question, because it goes to the overall debate that’s taking place out there right now. When we talk about reform, you hear some opponents of reform saying that somehow we are trying to ration care, or restrict the doctors that you can see, or you name it. Well, that’s what’s going on right now. It’s just that the decisions are being made by the insurance companies.
Now, in fairness, we probably could not construct a system in which you could see any doctor anywhere in the world anytime, regardless of expense. That would be a hard system to set up. So if you live in Maine, you know, we’re going to fly you into California, put you up. I mean, you can see — and I’m not trying to make light of it — you can just see the difficulty.
So any system we design, there are going to have to be some choices that have to be made in terms of where you go to see your doctor, what’s going on, et cetera. That’s being done currently in the private marketplace.
(President Obama then uses this as a segue to discuss other aspects of reform.)
http://www.whitehouse.gov/the_press_office/Remarks-By-The-President-In-Town-Hall-On-Health-Care-Grand-Junction-Colorado/

“So if you live in Maine, you know, we’re going to fly you into California, put you up.”
Obviously, giving someone who lives in Maine the choice of having the option for an expense-paid trip to California to receive health care is not one of the goals of health care reform. That’s not exactly what is meant by choice. This was an exaggeration on the part of the President to make the point that, of course, we can’t have choice.
And the reason we can’t have choice? Because the politicians have decided on a model of reform using private insurers that take away choice by mechanisms such as limiting the panels of contracted providers. He blames the insurance companies for this, but then accepts the intrusive role of the private insurers as inevitable because we “… could not construct a system in which you could see any doctor…”
This bungled response was not because President Obama doesn’t understand the policy issues. Clearly he does. He knows that a single-payer Medicare-for-all program would provide patients with free choice of their physicians. But he also realizes that he has made a policy decision that would not allow that. Thus the diversion into the all-expense-paid transcontinental trip. Oh wait… that’s only for the insurance executives.
Tell President Obama and Congress that we demand to have free choice of our own physicians. No more private insurers’ closed panels that take away our choices.

Obama on choice of physician

Remarks by the President in Town Hall on Health Care

The White House
Grand Junction, Colorado
August 15, 2009

Question: As a child I had polio, and I had a series of surgeries, 52 of them, to correct my poor structure of bones — between here, Denver, Montrose, and the Mayo Clinic in Phoenix, Arizona. I have been blessed with a good insurance, generally excellent doctors and care. However, my major concern in cost, even with good — even with a good insurance, the cost has been high, practically when I have been gone out of the network. Why should our doctor treatment choice be limited by a geographic area or the state? What kind of competition is this, Mr. President? (Applause.)

The President: This raises an important question, because it goes to the overall debate that’s taking place out there right now. When we talk about reform, you hear some opponents of reform saying that somehow we are trying to ration care, or restrict the doctors that you can see, or you name it. Well, that’s what’s going on right now. It’s just that the decisions are being made by the insurance companies.

Now, in fairness, we probably could not construct a system in which you could see any doctor anywhere in the world anytime, regardless of expense. That would be a hard system to set up. So if you live in Maine, you know, we’re going to fly you into California, put you up. I mean, you can see — and I’m not trying to make light of it — you can just see the difficulty.

So any system we design, there are going to have to be some choices that have to be made in terms of where you go to see your doctor, what’s going on, et cetera. That’s being done currently in the private marketplace.

(President Obama then uses this as a segue to discuss other aspects of reform.)

http://www.whitehouse.gov/the_press_office/Remarks-By-The-President-In-Town-Hall-On-Health-Care-Grand-Junction-Colorado/

Comment:

By Don McCanne, MD

“So if you live in Maine, you know, we’re going to fly you into California, put you up.”

Obviously, giving someone who lives in Maine the choice of having the option for an expense-paid trip to California to receive health care is not one of the goals of health care reform. That’s not exactly what is meant by choice. This was an exaggeration on the part of the President to make the point that, of course, we can’t have choice.

And the reason we can’t have choice? Because the politicians have decided on a model of reform using private insurers that take away choice by mechanisms such as limiting the panels of contracted providers. He blames the insurance companies for this, but then accepts the intrusive role of the private insurers as inevitable because we “… could not construct a system in which you could see any doctor…”

This bungled response was not because President Obama doesn’t understand the policy issues. Clearly he does. He knows that a single-payer Medicare-for-all program would provide patients with free choice of their physicians. But he also realizes that he has made a policy decision that would not allow that. Thus the diversion into the all-expense-paid transcontinental trip. Oh wait… that’s only for the insurance executives.

Tell President Obama and Congress that we demand to have free choice of our own physicians. No more private insurers’ closed panels that take away our choices.

Opinion: Canadian health system works

By Miriam Schubert
Marin Independent Journal
08/16/2009

CANADIANS have voted Tommy Douglas, known as the father of the Canadian Medicare system, the greatest Canadian of all time. Canadians may complain, but they love their system, which provides lifelong medical care for everyone. There are private clinics but everyone pays Medicare taxes.

I am a Canadian and had breast cancer while living in Montreal. Last year, while living in California, the cancer recurred. Where do we get these myths about Canadian health care?

In Canada I was able to choose my surgeon, oncologist and radiologist from all the doctors in Montreal. I also chose a McGill University hospital for my surgery. After the operation, my oncologist prescribed all the needed tests, including a bone scan and an MRI, which were all done immediately.

I then started chemotherapy. At every appointment I had blood tests, my tumor markers were monitored, I saw my oncologist and had a breast exam. I saw my surgeon every three months. Throughout, my treatment was orchestrated by all the doctors who worked consistently as a team. After chemo I had a PET scan. Results were good, and I continued to see my oncologist and surgeon yearly.

Because my team thought ultrasounds the best diagnostic tool for my dense breasts, I had those every six months as well as annual mammogram and breast MRI. The radiologist also examined me at every imaging appointment.

Here, we are covered by Kaiser. Tumor markers are not routinely followed at Kaiser, but my oncologist did agreed to test them last year. They were high. I continued to have tests every six months. The markers kept rising and I requested a PET scan. My oncologist said he could not justify it. Not justify it! This was a phrase I had never heard in Canada.

Finally, I broke a rib and that was enough to justify a PET scan. It revealed boney metastases and I got radiation therapy. I am now on a drug treatment regime recommended by my Canadian doctor, to which my Kaiser doctor has agreed.

My markers are low and I am feeling very well. But Kaiser has refused to do ultrasounds or MRIs. I get a mammogram every two years. I have never seen the radiologist who has decided mammograms provide adequate testing. My oncologist, whom I see regularly, has not examined my breast in 18 months.

Where is the rationing? I never had to argue to get treatment in Canada. I never had to know so much about my illness or to be such an advocate for my own case. I used to get calls, from my physicians in Canada, suggesting treatment. Not here.

I worked almost 40 years as a physical therapist in Montreal. I have treated thousands of patients with hip and knee replacements. There is no rationing, by age or anything else, and anyone who needs a joint replacement gets it. The medical team makes the decision. The waiting period, in Quebec, for a hips and knees is now three months. Furthermore, ceramic hips are considered the most durable kind of prosthesis and they are used regularly in Canada. My son is an orthopaedist in Iowa and bemoans the fact that ceramic, total hip replacements are not available in the USA.

I have had good care here, but the care in Quebec was better. Everything was done to get me healthy. And here, the out of pocket cost is much higher than the Medicare taxes I was paying in Canada.

There, when I was earning a high salary I paid high taxes. When I became ill and could not work, I paid nothing. Here, as I get older and sicker, my costs rise. What an unconscionable system, completely counter to what one expects of a civilized society. Civil society means caring for one another, the healthy caring for the sick and the young for the old.

How did this idea get lost in the USA?

Miriam Schubert lives in San Rafael. She was a lifelong resident of Quebec until she married an American and moved here three years ago.

Conservative leader David Cameron on the NHS

We are proud of the NHS

By David Cameron
Conservatives
The Blue Blog
August 13, 2009
People still care about the issues they care about, and thanks to the internet they can voice their concerns whenever they want. Just look at all the support which the NHS (National Health Service) has received on Twitter over the last couple of days. It is a reminder – if one were needed – of how proud we in Britain are of the NHS.
Millions of people are grateful for the care they have received from the NHS – including my own family. One of the wonderful things about living in this country is that the moment you’re injured or fall ill – no matter who you are, where you are from, or how much money you’ve got – you know that the NHS will look after you.
That’s why we as a Party are so committed not just to the principles behind the NHS, but to doing all we can to improve the way it works in practice. So yes, we will spend more on the NHS, but we will also improve it so that it is more efficient and responsive to patients. People working on the frontline will actually be able get on with the job they signed up for, without getting tied up in a web of targets. And we will put more power in the hands of patients by giving them better information about the care they can expect to receive.
Underlying these reforms, and our whole approach to the NHS, will be one big ambition – that future generations will be even prouder of the NHS than we are today.
http://www.conservatives.com/News/Blogs/We_are_proud_of_the_NHS.aspx

The Right Honourable David Cameron MP is the leader of the Conservative Party in the United Kingdom. Many believe that he will replace Gordon Brown as Prime Minister.
For those of us in the United States who want to know more about the horrors of their government-run, socialist system of health care, Conservative David Cameron would be the first to expose how government ownership and management are a threat to the health of the people. But that is not his message.
As he says, “One of the wonderful things about living in this country is that the moment you’re injured or fall ill – no matter who you are, where you are from, or how much money you’ve got – you know that the NHS will look after you.” He has joined the people of his nation in supporting the NHS, in reaction to the outrageous distortions and lies being propagated in the United States.
Karen Ignagni, President and CEO of America’s Health Insurance Plans (AHIP) recently stated, “As the American people have learned the facts, support for a government-run plan has plummeted.”(AHIP release, Aug 4)
What facts? Lies about the United Kingdom’s NHS? Lies about Canada’s medicare? Or lies about the consequences of providing all of us the benefits of our Medicare program which is working so well for our senior citizens and individuals with long-term disabilities?
The British and Canadians have identified the lies and are waging a campaign to set the record straight. We need to greatly intensify our efforts to do the same here.

Conservative leader David Cameron on the NHS

We are proud of the NHS

By David Cameron
Conservatives
The Blue Blog
August 13, 2009

People still care about the issues they care about, and thanks to the internet they can voice their concerns whenever they want. Just look at all the support which the NHS (National Health Service) has received on Twitter over the last couple of days. It is a reminder – if one were needed – of how proud we in Britain are of the NHS.

Millions of people are grateful for the care they have received from the NHS – including my own family. One of the wonderful things about living in this country is that the moment you’re injured or fall ill – no matter who you are, where you are from, or how much money you’ve got – you know that the NHS will look after you.

That’s why we as a Party are so committed not just to the principles behind the NHS, but to doing all we can to improve the way it works in practice. So yes, we will spend more on the NHS, but we will also improve it so that it is more efficient and responsive to patients. People working on the frontline will actually be able get on with the job they signed up for, without getting tied up in a web of targets. And we will put more power in the hands of patients by giving them better information about the care they can expect to receive.

Underlying these reforms, and our whole approach to the NHS, will be one big ambition – that future generations will be even prouder of the NHS than we are today.

http://www.conservatives.com/News/Blogs/We_are_proud_of_the_NHS.aspx

Comment:

By Don McCanne, MD

The Right Honourable David Cameron MP is the leader of the Conservative Party in the United Kingdom. Many believe that he will replace Gordon Brown as Prime Minister.

For those of us in the United States who want to know more about the horrors of their government-run, socialist system of health care, Conservative David Cameron would be the first to expose how government ownership and management are a threat to the health of the people. But that is not his message.

As he says, “One of the wonderful things about living in this country is that the moment you’re injured or fall ill – no matter who you are, where you are from, or how much money you’ve got – you know that the NHS will look after you.” He has joined the people of his nation in supporting the NHS, in reaction to the outrageous distortions and lies being propagated in the United States.

Karen Ignagni, President and CEO of America’s Health Insurance Plans (AHIP) recently stated, “As the American people have learned the facts, support for a government-run plan has plummeted.”(AHIP release, Aug 4)

What facts? Lies about the United Kingdom’s NHS? Lies about Canada’s medicare? Or lies about the consequences of providing all of us the benefits of our Medicare program which is working so well for our senior citizens and individuals with long-term disabilities?

The British and Canadians have identified the lies and are waging a campaign to set the record straight. We need to greatly intensify our efforts to do the same here.

Canadian health system has a fan in Schweitzer

By MIKE DENNISON
Billings Gazette
Friday, August 14, 2009

BELGRADE – As Gov. Brian Schweitzer warmed up the crowd Friday for President Barack Obama, he paid a lengthy compliment to a health care system that leading Democrats, including the president, have declared “off the table” as a reform here: the Canadian single-payer system.

“Did you know that, just 300 miles north of here, did you know they offered universal health care 62 years ago?” he said, referring to Canada’s system of providing government-funded health insurance for all citizens.

Schweitzer, a Democrat, said he sometimes mentions the Canadian system when he hears people say that universal health coverage is a radical, new idea being rushed through the political process.

Quoting a Canadian journalist, Schweitzer said it was said that “there’s more likelihood of a person in Canada being struck by lightning than there is a likelihood of a Canadian going to the United States for their health care.”

Most of the crowd of 1,300 in the Gallatin Field Airport hangar roared its approval.

Each Canadian province provides health insurance for all of its citizens, funded by the provincial and state governments. Canadian citizens see private physicians, who bill the province for the care they provide.

Canada’s government insurance covers most basic health care for all citizens, on an equal basis. This type of government-funded insurance is often called a single-payer system, because one “payer” – the government – covers basic medical care.

Minutes later, Obama made it clear that he does not favor adopting such a system in the United States.

“I’m not in favor of a Canadian system, I’m not in favor of a British system, I’m not in favor of a French system,” he said. “What we’ve said is let’s find a uniquely American system.”

Obama said the majority of people in America get health insurance through their employers, and “we want to build on that.”

“For us to completely change that, it would be too disruptive,” he said. “Max (Baucus) and I agree, that’s not the right way to go.”

Baucus, a Montana Democrat, who also spoke before Obama appeared, is chairman of the Senate Finance Committee, which is drawing up a key health-reform bill. Baucus has said from the beginning that considering a single-payer system for the United States is “off the table” because it’s not politically possible.

http://www.billingsgazette.com/news/state-and-regional/montana/article_02d665da-8955-11de-94f2-001cc4c002e0.html

Uwe Reinhardt on ethics and economics of end-of-life care

End-of-Life Care: Where Ethics Meet Economics

By Uwe Reinhardt
The New York Times
August 14, 2009
… the debate — really, shouting match — over health-care reform has focused on end-of-life care in recent weeks…
An earlier report in The Wall Street Journal had quoted physicians at Memorial Sloan-Kettering Canter Center in New York stating that “the standard treatment regimen for advanced colon cancer, which can include Erbitux [and Eloxatin and Avastin] in the mix, is close to $250,000 for 19-20 months of treatment. … And for that money, patients may get only a few months [of added life].”
And therein lies a dilemma increasingly faced by modern societies.
Readers are well advised to read Senator Isakson’s thoughtful comments on end-of-life planning, along with an equally thoughtful research brief “Advance Care Planning: Preferences for Care at the End of Life,” published in March 2003 by the Agency for Health Care Research and Quality.
The thrust of that research brief, as of the Senate bill and of Section 1233 of the House bill, was to enhance the probability that the end-of-life care actually received by a person should conform to his or her own preferences, rather than either the physician’s or the government’s preferences.
Health spending in the United States has doubled every 10 years during the past four decades. It may well do so again in the coming decade. As health spending grows year after year roughly twice as fast as the payroll that supports private health spending in this country, Americans sooner or later will have to confront the hard questions about access to expensive treatments, perhaps after a rational national conversation, if such can still be had in America.

Posted reader comment:
Ethics meets economics not only at the end of life, but throughout a lifetime of health care. Economics provides us with various alternatives on financing health care, and ethics provides us with the decency to do it the right way.
But the pervasive noise seems to be drowning reason out. For example, when a protester complained to Sen. Specter that he wasn’t listening to what they wanted, Sen. Specter asked him to tell him just that. The protester was flummoxed, and only after being prompted by several others in the audience, he said, “tort reform.”
It would be tragic if those crafting reform allow themselves to be influenced by those who understand neither the economics nor the ethics. Perhaps it would be even worse if they allow themselves to be influenced by the moneyed interests who understand very well the economics, but could care less about the ethics.
— Don McCanne, MD
http://economix.blogs.nytimes.com/2009/08/14/end-of-life-care-where-ethics-meet-economics/#more-26155

Uwe Reinhardt on ethics and economics of end-of-life care

End-of-Life Care: Where Ethics Meet Economics

By Uwe Reinhardt
The New York Times
August 14, 2009

… the debate — really, shouting match — over health-care reform has focused on end-of-life care in recent weeks…

An earlier report in The Wall Street Journal had quoted physicians at Memorial Sloan-Kettering Canter Center in New York stating that “the standard treatment regimen for advanced colon cancer, which can include Erbitux [and Eloxatin and Avastin] in the mix, is close to $250,000 for 19-20 months of treatment. … And for that money, patients may get only a few months [of added life].”

And therein lies a dilemma increasingly faced by modern societies.

Readers are well advised to read Senator Isakson’s thoughtful comments on end-of-life planning, along with an equally thoughtful research brief “Advance Care Planning: Preferences for Care at the End of Life,” published in March 2003 by the Agency for Health Care Research and Quality.

The thrust of that research brief, as of the Senate bill and of Section 1233 of the House bill, was to enhance the probability that the end-of-life care actually received by a person should conform to his or her own preferences, rather than either the physician’s or the government’s preferences.

Health spending in the United States has doubled every 10 years during the past four decades. It may well do so again in the coming decade. As health spending grows year after year roughly twice as fast as the payroll that supports private health spending in this country, Americans sooner or later will have to confront the hard questions about access to expensive treatments, perhaps after a rational national conversation, if such can still be had in America.

Posted reader comment:

Ethics meets economics not only at the end of life, but throughout a lifetime of health care. Economics provides us with various alternatives on financing health care, and ethics provides us with the decency to do it the right way.

But the pervasive noise seems to be drowning reason out. For example, when a protester complained to Sen. Specter that he wasn’t listening to what they wanted, Sen. Specter asked him to tell him just that. The protester was flummoxed, and only after being prompted by several others in the audience, he said, “tort reform.”

It would be tragic if those crafting reform allow themselves to be influenced by those who understand neither the economics nor the ethics. Perhaps it would be even worse if they allow themselves to be influenced by the moneyed interests who understand very well the economics, but could care less about the ethics.

— Don McCanne, MD

http://economix.blogs.nytimes.com/2009/08/14/end-of-life-care-where-ethics-meet-economics/#more-26155

Helen Thomas on single payer

Health care for all

By Helen Thomas
San Francisco Chronicle
Politics Blog
August 12, 2009
It’s all so sad. Well-organized conservatives have launched a full-scale attack on health care reform. And they appear to be winning — for now.
I covered the battle to create the Medicare system back in the 1960s. The cries of “socialized medicine” worked for years until President Johnson rammed Medicare through Congress in 1965.
What kind of a nation are we if we do not provide everyone with the excellent medical care that only some of us now receive?
I continue to think the so-called single-payer system is the only answer to the nation’s obligation to make sure that no one lacks health care. Yes, single payer means a government-run health insurance program for all — the prevailing system in Canada and in many nations in Europe.
President Obama is making a big mistake by ignoring the single-payer proposal.
In 2003 before he became a U.S. senator from Illinois, Obama actually called himself a single-payer “proponent.” But now that he is president, Obama has buckled to Republicans and conservative Blue Dog Democrats in pursuit of consensus. My question is if Congress passes a watered-down version of health care that doesn’t truly cover everyone, is the result worth it?
President Obama should lay down markers for real health care reform — meaning we all kick in to a national program instead of fattening the pocketbooks of the insurance financiers.
Instead, the president has given up on Medicare for all, calling single payer “impractical.”
He still has time to do the right thing and nothing to lose.
For the full article:
http://www.sfgate.com/cgi-bin/blogs/nov05election/detail?blogid=14&entry_id=45426

Helen Thomas doesn’t ever give up, thank goodness. As she writes, President Obama “still has time to do the right thing.”