Yesterday, Americans had a chance to stand up and ask President Obama, face to face, about proposed changes to America’s health care system. And stand up they did—both at the White House, where the special edition of ABC’s “Primetime” was filmed; and virtually via Digg.com, which ABCNews.com used to select popular questions voted on by online users.
“Questions for the President: Prescription for America,” moderated by ABC’s Charles Gibson and Diane Sawyer, gathered participants ranging from the CEO of Aetna Insurance and noted physicians, to “regular” citizens. Audience members were selected by ABC News for their “divergent opinions in this historic debate,” according to a press release preceding the event.
Obama and Gibson, comfortably seated and encircled by audience members on three sides, fielded questions presented in a town-hall format.
Surprisingly, the toughest questions focused not on the huge price tag attached to health care reform, but rather to some of the moral issues such reform might create. Dr. Orrin Devinsky, a neurologist at New York University’s Langone Medical Center, asked the President if a government-run plan might generate a class of “elites,” those who can afford to opt out of a public plan and pay for care on their own.
Devinsky asked if Obama would promise not to seek special care for his family, if they became sick and the public plan he proposes limited their treatment options.
Obama sidestepped the promise request, commenting that “There’s a whole bunch of care that’s being provided that every study, that every bit of evidence that we have indicates may not be making us healthier.” He took the opportunity to push for evidence-based medicine: decisions based on “evidence and results, not tests and referrals.”
Another neurologist, Dr. John Corboy of the University of Colorado Health Science Center, questioned the President about who would determine the treatment limits in the system; who would enforce those limits, and how Obama might convince the American people to accept such limits.
The President clearly didn’t have an answer to that. “Our job this summer and this fall is to identify the best ways to achieve the best possible care,” he responded.
End-of-life issues were raised, as well. Currently just under $100 billion of Medicare’s annual $327 billion budget is spent on patients in their final year of life. Audience member Jane Sturm asked if any proposed limits on treatment would take into account a person’s “spirit and quality of life.” She cited her basically healthy 100-year-old mother, who was at first denied a pacemaker, but later got one by going to another doctor.
Obama replied, “I don’t think we can make judgments based on people’s spirit. I think that we are going to have to have rules that say we are going to provide good, quality care for all people.”
Questions were also raised about public vs. private insurance, and whether a new national plan would drive private insurance companies out of business; or force Americans out of their preferred private insurance, and into the government’s plan.
In addition, several audience members, including Gail Wilensky (who ran Medicare under the senior President Bush) questioned the cost of the President’s proposed plan.
Earlier in the day, on a “Good Morning, America” interview with Diane Sawyer, Obama outlined how the government would raise the estimated $1 trillion a new health care plan is estimated to cost. He cited a possible $300 billion in savings via cuts in the current system; an additional $600 billion reallocated from the current system; and $300 billion in revenue from increased taxes on the rich (individuals making over $200,000/families over $250,000).
“We have to have the courage and the willingness to cooperate and compromise in order to make this happen,” said Obama. “…I’m absolutely convinced that we can get it done this time.”
So, what would this new health care system look like, for those of us with breast cancer?
No one can provide specifics at this point. But the presumption could be made that many limits would be age-based; and that perhaps, over a certain age, a woman with an aggressive breast cancer would be denied, say, a prophylactic mastectomy. Or an older woman whose breast cancer had metastasized might be restricted to a certain number of chemo courses, where now there is no limit.
Treatment limits of some kind will almost surely be included in the President’s preferred health care reform bill. And, while some may see denial of treatment as morally wrong, I believe it makes sense, both fiscally and culturally.
I hear President Obama when he says we must “cooperate and compromise.” To me, that means those of us in the Boomer and “greatest” generations have to step aside for GenX and the Millennials.
If there are only so many dollars in the system, let’s spend them on our children and grandchildren, those who’ll shape the world’s future. In doing so, we prove our courage by letting go. And we leave an invaluable legacy: a healthier America.
Published On: June 25, 2009