President's Weekly Address - Health Care, 7/24

President Obama puts out a weekly video address, which is on YouTube and iTunes among other places. Here is his address from July 24th, covering some of the questions surrounding the new health care proposals

See also our recent health care discussion about its high cost


  1. First and foremost, I just think it's awesome that the President is doing this. What a good and intelligent use of technology, that communicates more directly with today's public than giving regular press briefings would. And since the message comes directly from him to the audience, he doesn't need an intermediary to insert their own opinions or potential spin.

    Not that he isn't spinning himself. But I do find this address, covering some health care questions, to be interesting.

    I want to open the floor for health care reform discussion again. Refer back to our health care discussion to see where we left off.

    To begin generally - do you see reform of some kind getting passed this year?

  2. Nope - not this year.

    While I want reform, parts of Obama's plan scares the bejeesus out of me:

    1) "Community Rating" - a number of percentages have been tossed around regarding the cap on how much a person can be charged over the "normal rate", but all of these scare the hell out of me. Why, should a young, healthy person, be subjected to paying the same rate for the same coverage as a 50-year old with an over-sized heart? This makes no sense, and ends up having the low cost subscribers subsidizing the high cost subscribers.

    2) "Forced Healthcare" - I'm all for universal coverage, but if you're going to require everyone to have healthcare, make it free, and fully government run (a la Spain). Mandated private healthcare just seems ludicrous.

    On a related note, I think one of the easiest low-hanging fruits out there is to lower the amount of debt med school graduates graduate with. I recently learned that med school in Spain is free to attend. Graduates are required by law to perform 8 hours of work a day in the government hospitals in order to "pay off their debt" to the government. They can, however, have a side practice with which they do whatever they want(you want to provide mastectomies to chimpanzees? go for it!). I'm a fan of this approach if we want to go universal coverage.

  3. I agree with you in principle on all counts, but I think some further scrutiny is in order. On item #1, I think the main issue the healthcare policy is trying to avoid is when people either get dropped from coverage or coverage won't insure someone because of their medical problems. Excuse me, isn't that the entire point of insurance? It's criminal to start denying coverage to people who've been paying for insurance, when the very definition of the product is to help those people.

    As for #2, what would you prefer as an intermediary step? Moving directly to government-run universal health care is too big a change to happen as our first step - surely you agree? So why not move to make it cheaper and available to everyone, with gov't paying the bill for the poorest people who can't afford it on their own?

    Your final note about lowering the cost of med school is interesting, and the subject of a pretty interesting blog by Penelope Trunk which I also linked to when discussing teacher performance. Trunk also says "why pay doctors, professors, and med schools so much?" and maybe that would lead to cheaper care.

    Your proposal has a different payment solution (public service, akin to serving in the military for ROTC in college) but the same concept. I hope but am not certain that reducing the cost of med school would reduce the cost of paying doctor's salaries - other factors of course being their insurance and other costs of care.

  4. Flat out, I don't see how Obama's proposal will make insurance cheaper and more available to everyone (this has to do with both my lack of complete research, and my understanding of what I've read).

    I really wish I remember the argument a coworker told me, but I'll have to follow up as it made complete sense at the time. Poop!

  5. I'm not sure if I can answer that either. But I will quote from our favorite Atul Gawande article about health care costs. It seems we can save a ton of money by figuring out cheaper ways to give better care:

    "To make matters worse, Fisher found that patients in high-cost areas were actually less likely to receive low-cost preventive services, such as flu and pneumonia vaccines, faced longer waits at doctor and emergency-room visits, and were less likely to have a primary-care physician. They got more of the stuff that cost more, but not more of what they needed.

    In an odd way, this news is reassuring. Universal coverage won’t be feasible unless we can control costs. Policymakers have worried that doing so would require rationing, which the public would never go along with. So the idea that there’s plenty of fat in the system is proving deeply attractive. “Nearly thirty per cent of Medicare’s costs could be saved without negatively affecting health outcomes if spending in high- and medium-cost areas could be reduced to the level in low-cost areas,” Peter Orszag, the President’s budget director, has stated."

    Nearly thirty percent of Medicare costs, saved? In other words, simply figuring out how to foot the bill isn't enough - we have to figure out how to give better and cheaper care, something that could be a reality.

  6. An exchange sounds like a good idea, but I don't see how this would help over a website that lists health insurance providers and their phone numbers. I think the first admirable step Obama is taking to help those whose coverage has been dropped and/or denied due to a pre-existing condition. Unfortunately, I don't think Obama's plan will address any of the cost problems. I think Scott is right, that it will allow everyone to get coverage, but the costs to the healthy 25 year old are going to go way up.

  7. I like primary care physicians. One of the supposed 'cons' of HMO's is that you must see a primary-care physician as a gate-keeper before seeing specialists. Fans of PPO's like to be able to go directly to the specialist and have their insurance pay for it.

    Last winter, I had a pretty bad cold and stayed home from work. A runny nose and a tickly sore throat turned into spending all day in bed, no energy and little appetite. A lot of Tylenol Cold and Gatorade and I was fully functional within a week.

    About 6-8 weeks after that, I got a runny nose again. I started thinking that it would be weird to get another cold so quickly and I'd rather not miss more time from my new job. The runny nose stuck around, and I kept waiting for it to get worse or for it to get better. Two weeks later, after talking to my co-workers, I realize that for the first time in my life I have allergies. I didn't know what the hell was going on with my sinuses, but I got some Benadryl and Claritin and the runny nose went away.

    My point is that the general public knows so little about medicine, that I internally laugh when someone schedules an appointment directly with a specialist, just because their insurance allows them to.

    My suggestion: force everyone in America who wants health insurance to go through a gate-keeper style primary care physician. This should result in more preventive care, more Tylenol and bed rest, fewer MRI's and blood tests. Let professionals decide when a patient needs a specialist. However, when they do need a specialist, let them choose their doctor. These are coming into practice a little more often with "open-ended HMOs" and "gatekeeper PPOs". You guys should do some research into those to see if their has been any studies on costs and success rate.

  8. These are also called POS (Point of Service) Plans.

  9. Um, "You guys should do some research into those to see if their has been any studies on costs and success rate" - woah woah, excuse me? Yes, boss-man, let me get right on that...

    Aaron I like your idea about making the primary care doctor a staple of any insurance plan. I actually like having a primary care doctor, I don't know why most people wouldn't. It's way nicer to see the same doctor all the time who knows you and your history, rather than random specialists who are always starting over in terms of figuring out what your medical disposition is.

    Anyway I think it's clear that none of this legislation really addresses cost. It is terrifying that our politicians are essentially asking the wrong questions when it comes to the expenses of health care. But then again, that's the difference between the viewpoint of someone who is a professionally trained surgeon (Gawande) and my Senator, who is a professionally trained blowhard.