Ok, Ok. I must admit that sitting about 40 or 50 feet from President Obama as he delivered his talk this morning at the annual meeting of the American Medical Association House of Delegates was pretty special (I even have the pictures to prove it).
The talk, surprisingly, included a number of comments about cancer and the importance of health care reform as it related to the treatment of cancer and the impact of cancer on the lives of ordinary people. The difference here, perhaps, is that this President knew and loved one of those “ordinary people.” That person was his mother. He used the opportunity of this address to once again remind us of his family’s personal travail trying to pay for her medical care and the impact that had on their lives at a very difficult time.
I must admit that when I heard that the President was coming to Chicago to address the AMA House of Delegates I was a bit surprised. After all, the House is filled with physicians who are very committed to the care of their patients, but are also very politically savvy. They are for the most part doctors in private practice, and it is no secret they are generally conservative in their political views and don’t welcome government involvement in medical care payment and decision-making.
So I give the President a great deal of credit for his willingness to face this audience. Not surprisingly, he was masterful. He articulated his positions clearly and effectively even if some of them were not warmly received. To me, that is not a sign of confrontation but a sign of strength. It gives the parties an opportunity to clearly understand the limits of the discussions and where negotiations are possible. In other words, you may not like what you hear but you know where you stand.
However, that is not what this blog is about. This blog is about where we are headed with health care reform, how that is going to impact the care we physicians offer our patients, the care our patients receive—especially our patients with cancer. This discussion is all about access to quality, affordable health care and how we get there.
The President’s comments contained many of the positions that have been articulated elsewhere. I don’t follow the President’s speeches closely, but I have read and heard some of these sound bites previously.
The basic themes?
· The status quo is unacceptable.
· We need to make investments in health information technology and create effective standards to transfer information from one place to another electronically.
· We need to adjust our Medicare payment system and make it more stable.
· We need to address medical liability issues and costs.
· Controlling spiraling health care costs is one essential step to the road to prosperity for our country.
The President also made reference to the same basic observation that I make regularly in my lectures and writings: we spend far more money for health care per person in this country than other developed countries, and we have a life expectancy that is near the bottom of the list for developed economies. We are not getting value for the money we are spending on health, and it is going to bankrupt us as a nation if we do not “bend the curve” of constantly increasing spending for health care.
Then there were the references to the burdens placed on patients and their families by our current health care payment system. He noted that we are “paying more, getting less, and going broke. The status quo is unsustainable.” Health care is not a luxury, but a necessity. The costs of fixing the system are considerable, but the cost of inaction is greater. If we don’t act, health care costs will consume 20-30% of our gross domestic product in the foreseeable future.
For a long time, I have been an advocate for preventive care. I have also been an advocate for improving the quality of care we provide our patients. Clearly these are items on the President’s agenda.
He highlighted the passage recently of the bill which will move control of tobacco to the jurisdiction of the Food and Drug Administration. The President wants to invest more in preventive care, which he emphasized starts with individual responsibility, including not smoking or stopping smoking, getting screened for diseases including cancer where early detection and prevention is known to work, decreasing junk foods, and getting kids more active including playing outside once again instead of sitting in a room watching TV. He even highlighted the vegetable garden he and his wife planted at the White House (although he gave most of the credit to his wife).
There was obviously a lot of discussion in the speech about his suggestions about how to reform health care, but those are more political and currently in flux so I am not going to discuss them here. He did get the attention of the doctors when he said he wanted to reverse the trend of taking medicine from a profession to a business. “That’s not what made you a doctor. You entered this profession to be a healer.”
When he talked about specific measures to reduce the costs of medical care, one of the items that caught my attention was his recommendation to speed up availability of generic biologic therapies—such as targeted cancer therapies—quickly. That, he said, would save billions of dollars over the next ten years..
And then the conclusion: “I don’t want your children and their children to be talking about a health care crisis 50 years from now.”
The reference to his mom was poignant and personal. As the President noted, he has talked about this before, and he has obviously included cancer patients in his past discussions and his presentations. His goal? To change the system so others don’t have to experience what his family experienced in their time of need.
That led me to thinking about the story a good friend of mine told me a couple of months ago. His mother had melanoma, diagnosed at a late stage, and her days were short. His father had worked three jobs a week, for years, yet couldn’t afford his wife’s medical care. Not a slouch, not uninsured, just a hard working man with a dying wife. My friend recounted with anger that his mother could deal with her fate, but got very upset day after day as she was dying when another bill arrived and she didn’t know how it was going to be paid. After her death, his father was advised by an attorney to file bankruptcy—one of the many who have done so every year as a result of health care costs.
And then there was the young couple I met while I was here in the meeting in Chicago. They are both working professionals in their field. After I talked with the wife, I found out her husband had cancer. He is young, in his 30’s and the cancer is advanced. Yet he keeps on working, and is going to receive treatment on a clinical trial. They certainly didn’t expect this, and there was no family history of colon cancer. The husband told me he had insurance, and the bills could be handled so far. But imagine what it must be like to be a young couple, diagnosed with advanced cancer, and need intensive treatment to at least delay the disease.
No one, my friends, plans for that personally, psychologically, or financially.
So the problems are all around us. And I suspect the solutions are also all around us.
The President came to Chicago to state his case, and asked for collaboration and engagement going forward. He received a more enthusiastic reception than I would have expected.
It is the personal stories that bring the message home. We can talk theoretically about rebuilding information technology, redesigning payment systems, whether or not a public plan is going to be part of the solution and if so how that plan is going to be designed.
However, my friends, at the end of the day, it’s all about the people. The people we know, the people we love and the people we care for.
The President knows that up close and personal. My friend knows that up close and personal, and that young couple I met by sheer coincidence knows that up close and personal. In fact, most of us know that up close and personal.
Moving forward, we know that there are times we are going to have to agree to disagree if we are going to get health care reform done. The President reached out to the doctors here in Chicago, honestly and openly. And for once, a politician came into this House of Delegates and told the story reasonably straight, even the difficult parts.
However, ultimately, it’s the people we have to think about. For the doctors in this country, those people are our patients, our friends and our families. And I suspect that many of those doctors are willing to take that next step and join in partnership to do what must be done.
Mr. President, thanks for coming to Chicago.