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Obama Addresses Physicians at AMA Meeting(ZT)
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发表时间:2009-06-15
更新时间:2009-06-15
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发信人: acne (麦地米虫), 信区: MedicalCareer
标 题: Obama Addresses Physicians at AMA Meeting(ZT)
发信站: BBS 未名空间站 (Mon Jun 15 18:06:35 2009, 美东)

June 15, 2009

2009 Annual Meeting of the AMA House of Delegates
Hyatt Regency Hotel
Chicago, Ill.

From the moment I took office as President, the central challenge we have
confronted as a nation has been the need to lift ourselves out of the worst
recession since World War II. In recent months, we have taken a series of
extraordinary steps, not just to repair the immediate damage to our economy,
but to build a new foundation for lasting and sustained growth. We are
creating new jobs. We are unfreezing our credit markets. And we are stemming
the loss of homes and the decline of home values.

But even as we have made progress, we know that the road to prosperity
remains long and difficult. We also know that one essential step on our
journey is to control the spiraling cost of health care in America.

Today, we are spending over $2 trillion a year on health care – almost 50
percent more per person than the next most costly nation. And yet, for all
this spending, more of our citizens are uninsured; the quality of our care
is often lower; and we aren't any healthier. In fact, citizens in some
countries that spend less than we do are actually living longer than we do.

Make no mistake: the cost of our health care is a threat to our economy. It
is an escalating burden on our families and businesses. It is a ticking time
-bomb for the federal budget. And it is unsustainable for the United States
of America.

It is unsustainable for Americans like Laura Klitzka, a young mother I met
in Wisconsin last week, who has learned that the breast cancer she thought
she'd beaten had spread to her bones; who is now being forced to spend time
worrying about how to cover the $50,000 in medical debts she has already
accumulated, when all she wants to do is spend time with her two children
and focus on getting well. These are not worries a woman like Laura should
have to face in a nation as wealthy as ours.

Stories like Laura's are being told by women and men all across this country
– by families who have seen out-of-pocket costs soar, and premiums double
over the last decade at a rate three times faster than wages. This is
forcing Americans of all ages to go without the checkups or prescriptions
they need. It's creating a situation where a single illness can wipe out a
lifetime of savings.

Our costly health care system is unsustainable for doctors like Michael Kahn
in New Hampshire, who, as he puts it, spends 20 percent of each day
supervising a staff explaining insurance problems to patients, completing
authorization forms, and writing appeal letters; a routine that he calls
disruptive and distracting, giving him less time to do what he became a
doctor to do and actually care for his patients.

Small business owners like Chris and Becky Link in Nashville are also
struggling. They've always wanted to do right by the workers at their family
-run marketing firm, but have recently had to do the unthinkable and lay off
a number of employees – layoffs that could have been deferred, they say,
if health care costs weren't so high. Across the country, over one third of
small businesses have reduced benefits in recent years and one third have
dropped their workers' coverage altogether since the early 90's.

Our largest companies are suffering as well. A big part of what led General
Motors and Chrysler into trouble in recent decades were the huge costs they
racked up providing health care for their workers; costs that made them less
profitable, and less competitive with automakers around the world. If we do
not fix our health care system, America may go the way of GM; paying more,
getting less, and going broke.

When it comes to the cost of our health care, then, the status quo is
unsustainable. Reform is not a luxury, but a necessity. I know there has
been much discussion about what reform would cost, and rightly so. This is a
test of whether we – Democrats and Republicans alike – are serious about
holding the line on new spending and restoring fiscal discipline.

But let there be no doubt – the cost of inaction is greater. If we fail to
act, premiums will climb higher, benefits will erode further, and the rolls
of uninsured will swell to include millions more Americans.

If we fail to act, one out of every five dollars we earn will be spent on
health care within a decade. In thirty years, it will be about one out of
every three – a trend that will mean lost jobs, lower take-home pay,
shuttered businesses, and a lower standard of living for all Americans.

And if we fail to act, federal spending on Medicaid and Medicare will grow
over the coming decades by an amount almost equal to the amount our
government currently spends on our nation's defense. In fact, it will
eventually grow larger than what our government spends on anything else
today. It's a scenario that will swamp our federal and state budgets, and
impose a vicious choice of either unprecedented tax hikes, overwhelming
deficits, or drastic cuts in our federal and state budgets.

To say it as plainly as I can, health care reform is the single most
important thing we can do for America's long-term fiscal health. That is a
fact.

And yet, as clear as it is that our system badly needs reform, reform is not
inevitable. There's a sense out there among some that, as bad as our
current system may be, the devil we know is better than the devil we don't.
There is a fear of change – a worry that we may lose what works about our
health care system while trying to fix what doesn't.

I understand that fear. I understand that cynicism. They are scars left over
from past efforts at reform. Presidents have called for health care reform
for nearly a century. Teddy Roosevelt called for it. Harry Truman called for
it. Richard Nixon called for it. Jimmy Carter called for it. Bill Clinton
called for it. But while significant individual reforms have been made –
such as Medicare, Medicaid, and the children's health insurance program –
efforts at comprehensive reform that covers everyone and brings down costs
have largely failed.

Part of the reason is because the different groups involved – physicians,
insurance companies, businesses, workers, and others – simply couldn't
agree on the need for reform or what shape it would take. And another part
of the reason has been the fierce opposition fueled by some interest groups
and lobbyists – opposition that has used fear tactics to paint any effort
to achieve reform as an attempt to socialize medicine.

Despite this long history of failure, I am standing here today because I
think we are in a different time. One sign that things are different is that
just this past week, the Senate passed a bill that will protect children
from the dangers of smoking – a reform the AMA has long championed – and
one that went nowhere when it was proposed a decade ago. What makes this
moment different is that this time – for the first time – key stakeholders
are aligning not against, but in favor of reform. They are coming together
out of a recognition that while reform will take everyone in our health care
community doing their part, ultimately, everyone will benefit.

And I want to commend the AMA, in particular, for offering to do your part
to curb costs and achieve reform. A few weeks ago, you joined together with
hospitals, labor unions, insurers, medical device manufacturers and drug
companies to do something that would've been unthinkable just a few years
ago – you promised to work together to cut national health care spending by
two trillion dollars over the next decade, relative to what it would
otherwise have been. That will bring down costs, that will bring down
premiums, and that's exactly the kind of cooperation we need.

The question now is, how do we finish the job? How do we permanently bring
down costs and make quality, affordable health care available to every
American?

That's what I've come to talk about today. We know the moment is right for
health care reform. We know this is an historic opportunity we've never seen
before and may not see again. But we also know that there are those who
will try and scuttle this opportunity no matter what – who will use the
same scare tactics and fear-mongering that's worked in the past. They'll
give dire warnings about socialized medicine and government takeovers; long
lines and rationed care; decisions made by bureaucrats and not doctors. We'
ve heard it all before – and because these fear tactics have worked, things
have kept getting worse.

So let me begin by saying this: I know that there are millions of Americans
who are content with their health care coverage – they like their plan and
they value their relationship with their doctor. And that means that no
matter how we reform health care, we will keep this promise: If you like
your doctor, you will be able to keep your doctor. Period. If you like your
health care plan, you will be able to keep your health care plan. Period. No
one will take it away. No matter what. My view is that health care reform
should be guided by a simple principle: fix what's broken and build on what
works.

If we do that, we can build a health care system that allows you to be
physicians instead of administrators and accountants; a system that gives
Americans the best care at the lowest cost; a system that eases up the
pressure on businesses and unleashes the promise of our economy, creating
hundreds of thousands of jobs, making take-home wages thousands of dollars
higher, and growing our economy by tens of billions more every year. That's
how we will stop spending tax dollars to prop up an unsustainable system,
and start investing those dollars in innovations and advances that will make
our health care system and our economy stronger.

That's what we can do with this opportunity. That's what we must do with
this moment.

Now, the good news is that in some instances, there is already widespread
agreement on the steps necessary to make our health care system work better.

First, we need to upgrade our medical records by switching from a paper to
an electronic system of record keeping. And we have already begun to do this
with an investment we made as part of our Recovery Act.

It simply doesn't make sense that patients in the 21st century are still
filling out forms with pens on papers that have to be stored away somewhere.
As Newt Gingrich has rightly pointed out, we do a better job tracking a
FedEx package in this country than we do tracking a patient's health records
. You shouldn't have to tell every new doctor you see about your medical
history, or what prescriptions you're taking. You should not have to repeat
costly tests. All of that information should be stored securely in a private
medical record so that your information can be tracked from one doctor to
another – even if you change jobs, even if you move, and even if you have
to see a number of different specialists.

That will not only mean less paper pushing and lower administrative costs,
saving taxpayers billions of dollars. It will also make it easier for
physicians to do their jobs. It will tell you, the doctors, what drugs a
patient is taking so you can avoid prescribing a medication that could cause
a harmful interaction. It will help prevent the wrong dosages from going to
a patient. And it will reduce medical errors that lead to 100,000 lives
lost unnecessarily in our hospitals every year.

The second step that we can all agree on is to invest more in preventive
care so that we can avoid illness and disease in the first place. That
starts with each of us taking more responsibility for our health and the
health of our children. It means quitting smoking, going in for that
mammogram or colon cancer screening. It means going for a run or hitting the
gym, and raising our children to step away from the video games and spend
more time playing outside.

It also means cutting down on all the junk food that is fueling an epidemic
of obesity, putting far too many Americans, young and old, at greater risk
of costly, chronic conditions. That's a lesson Michelle and I have tried to
instill in our daughters with the White House vegetable garden that Michelle
planted. And that's a lesson that we should work with local school
districts to incorporate into their school lunch programs.

Building a health care system that promotes prevention rather than just
managing diseases will require all of us to do our part. It will take
doctors telling us what risk factors we should avoid and what preventive
measures we should pursue. And it will take employers following the example
of places like Safeway that is rewarding workers for taking better care of
their health while reducing health care costs in the process. If you're one
of the three quarters of Safeway workers enrolled in their “Healthy
Measures” program, you can get screened for problems like high cholesterol
or high blood pressure. And if you score well, you can pay lower premiums.
It's a program that has helped Safeway cut health care spending by 13
percent and workers save over 20 percent on their premiums. And we are open
to doing more to help employers adopt and expand programs like this one.

Our federal government also has to step up its efforts to advance the cause
of healthy living. Five of the costliest illnesses and conditions – cancer,
cardiovascular disease, diabetes, lung disease, and strokes – can be
prevented. And yet only a fraction of every health care dollar goes to
prevention or public health. That is starting to change with an investment
we are making in prevention and wellness programs that can help us avoid
diseases that harm our health and the health of our economy.

But as important as they are, investments in electronic records and
preventive care are just preliminary steps. They will only make a dent in
the epidemic of rising costs in this country.

Despite what some have suggested, the reason we have these costs is not
simply because we have an aging population. Demographics do account for part
of rising costs because older, sicker societies pay more on health care
than younger, healthier ones. But what accounts for the bulk of our costs is
the nature of our health care system itself – a system where we spend vast
amounts of money on things that aren't making our people any healthier; a
system that automatically equates more expensive care with better care.

A recent article in the New Yorker, for example, showed how McAllen, Texas
is spending twice as much as El Paso County – not because people in McAllen
are sicker and not because they are getting better care. They are simply
using more treatments – treatments they don't really need; treatments that,
in some cases, can actually do people harm by raising the risk of infection
or medical error. And the problem is, this pattern is repeating itself
across America. One Dartmouth study showed that you're no less likely to die
from a heart attack and other ailments in a higher spending area than in a
lower spending one.

There are two main reasons for this. The first is a system of incentives
where the more tests and services are provided, the more money we pay. And a
lot of people in this room know what I'm talking about. It is a model that
rewards the quantity of care rather than the quality of care; that pushes
you, the doctor, to see more and more patients even if you can't spend much
time with each; and gives you every incentive to order that extra MRI or EKG
, even if it's not truly necessary. It is a model that has taken the pursuit
of medicine from a profession – a calling – to a business.

That is not why you became doctors. That is not why you put in all those
hours in the Anatomy Suite or the O.R. That is not what brings you back to a
patient's bedside to check in or makes you call a loved one to say it'll be
fine. You did not enter this profession to be bean-counters and paper-
pushers. You entered this profession to be healers – and that's what our
health care system should let you be.

That starts with reforming the way we compensate our doctors and hospitals.
We need to bundle payments so you aren't paid for every single treatment you
offer a patient with a chronic condition like diabetes, but instead are
paid for how you treat the overall disease. We need to create incentives for
physicians to team up – because we know that when that happens, it results
in a healthier patient. We need to give doctors bonuses for good health
outcomes – so that we are not promoting just more treatment, but better
care.

And we need to rethink the cost of a medical education, and do more to
reward medical students who choose a career as a primary care physicians and
who choose to work in underserved areas instead of a more lucrative path.
That's why we are making a substantial investment in the National Health
Service Corps that will make medical training more affordable for primary
care doctors and nurse practitioners so they aren't drowning in debt when
they enter the workforce.

The second structural reform we need to make is to improve the quality of
medical information making its way to doctors and patients. We have the best
medical schools, the most sophisticated labs, and the most advanced
training of any nation on the globe. Yet we are not doing a very good job
harnessing our collective knowledge and experience on behalf of better
medicine. Less than one percent of our health care spending goes to
examining what treatments are most effective. And even when that information
finds its way into journals, it can take up to 17 years to find its way to
an exam room or operating table.

As a result, too many doctors and patients are making decisions without the
benefit of the latest research. A recent study, for example, found that only
half of all cardiac guidelines are based on scientific evidence. Half. That
means doctors may be doing a bypass operation when placing a stent is
equally effective, or placing a stent when adjusting a patient's drugs and
medical management is equally effective – driving up costs without
improving a patient's health.

So, one thing we need to do is figure out what works, and encourage rapid
implementation of what works into your practices. That's why we are making a
major investment in research to identify the best treatments for a variety
of ailments and conditions.

Let me be clear: identifying what works is not about dictating what kind of
care should be provided. It's about providing patients and doctors with the
information they need to make the best medical decisions.

Still, even when we do know what works, we are often not making the most of
it. That's why we need to build on the examples of outstanding medicine at
places like the Cincinnati Children's Hospital, where the quality of care
for cystic fibrosis patients shot up after the hospital began incorporating
suggestions from parents. And places like Tallahassee Memorial Health Care,
where deaths were dramatically reduced with rapid response teams that
monitored patients' conditions and “multidisciplinary rounds” with
everyone from physicians to pharmacists. And places like the Geisinger
Health system in rural Pennsylvania and the Intermountain Health in Salt
Lake City, where high-quality care is being provided at a cost well below
average. These are islands of excellence that we need to make the standard
in our health care system.

Replicating best practices. Incentivizing excellence. Closing cost
disparities. Any legislation sent to my desk that does not achieve these
goals does not earn the title of reform. But my signature on a bill is not
enough. I need your help, doctors. To most Americans, you are the health
care system. Americans – me included – just do what you recommend. That is
why I will listen to you and work with you to pursue reform that works for
you. And together, if we take all these steps, we can bring spending down,
bring quality up, and save hundreds of billions of dollars on health care
costs while making our health care system work better for patients and
doctors alike.

Now, I recognize that it will be hard to make some of these changes if
doctors feel like they are constantly looking over their shoulder for fear
of lawsuits. Some doctors may feel the need to order more tests and
treatments to avoid being legally vulnerable. That's a real issue.And while
I'm not advocating caps on malpractice awards which I believe can be unfair
to people who've been wrongfully harmed, I do think we need to explore a
range of ideas about how to put patient safety first, let doctors focus on
practicing medicine, and encourage broader use of evidence-based guidelines.
That's how we can scale back the excessive defensive medicine reinforcing
our current system of more treatment rather than better care.

These changes need to go hand-in-hand with other reforms. Because our health
care system is so complex and medicine is always evolving, we need a way to
continually evaluate how we can eliminate waste, reduce costs, and improve
quality. That is why I am open to expanding the role of a commission created
by a Republican Congress called the Medicare Payment Advisory Commission –
which happens to include a number of physicians. In recent years, this
commission proposed roughly $200 billion in savings that never made it into
law. These recommendations have now been incorporated into our broader
reform agenda, but we need to fast-track their proposals in the future so
that we don't miss another opportunity to save billions of dollars, as we
gain more information about what works and what doesn't in our health care
system.

As we seek to contain the cost of health care, we must also ensure that
every American can get coverage they can afford. We must do so in part
because it is in all of our economic interests. Each time an uninsured
American steps foot into an emergency room with no way to reimburse the
hospital for care, the cost is handed over to every American family as a
bill of about $1,000 that is reflected in higher taxes, higher premiums, and
higher health care costs; a hidden tax that will be cut as we insure all
Americans. And as we insure every young and healthy American, it will spread
out risk for insurance companies, further reducing costs for everyone.

But alongside these economic arguments, there is another, more powerful one.
It is simply this: We are not a nation that accepts nearly 46 million
uninsured men, women, and children. We are not a nation that lets
hardworking families go without the coverage they deserve; or turns its back
on those in need. We are a nation that cares for its citizens. We are a
people who look out for one another. That is what makes this the United
States of America.

So, we need to do a few things to provide affordable health insurance to
every single American. The first thing we need to do is protect what's
working in our health care system. Let me repeat – if you like your health
care, the only thing reform will mean is your health care will cost less. If
anyone says otherwise, they are either trying to mislead you or don't have
their facts straight.

If you don't like your health coverage or don't have any insurance, you will
have a chance to take part in what we're calling a Health Insurance
Exchange. This Exchange will allow you to one-stop shop for a health care
plan, compare benefits and prices, and choose a plan that's best for you and
your family – just as federal employees can do, from a postal worker to a
Member of Congress. You will have your choice of a number of plans that
offer a few different packages, but every plan would offer an affordable,
basic package. And one of these options needs to be a public option that
will give people a broader range of choices and inject competition into the
health care market so that force waste out of the system and keep the
insurance companies honest.

Now, I know there's some concern about a public option. In particular, I
understand that you are concerned that today's Medicare rates will be
applied broadly in a way that means our cost savings are coming off your
backs. These are legitimate concerns, but ones, I believe, that can be
overcome. As I stated earlier, the reforms we propose are to reward best
practices, focus on patient care, not the current piece-work reimbursement.
What we seek is more stability and a health care system on a sound financial
footing. And these reforms need to take place regardless of what happens
with a public option. With reform, we will ensure that you are being
reimbursed in a thoughtful way tied to patient outcomes instead of relying
on yearly negotiations about the Sustainable Growth Rate formula that's
based on politics and the state of the federal budget in any given year. The
alternative is a world where health care costs grow at an unsustainable
rate, threatening your reimbursements and the stability of our health care
system.

What are not legitimate concerns are those being put forward claiming a
public option is somehow a Trojan horse for a single-payer system. I'll be
honest. There are countries where a single-payer system may be working. But
I believe – and I've even taken some flak from members of my own party for
this belief – that it is important for us to build on our traditions here
in the United States. So, when you hear the naysayers claim that I'm trying
to bring about government-run health care, know this – they are not telling
the truth.

What I am trying to do – and what a public option will help do – is put
affordable health care within reach for millions of Americans. And to help
ensure that everyone can afford the cost of a health care option in our
Exchange, we need to provide assistance to families who need it. That way,
there will be no reason at all for anyone to remain uninsured.

Indeed, it is because I am confident in our ability to give people the
ability to get insurance that I am open to a system where every American
bears responsibility for owning health insurance, so long as we provide a
hardship waiver for those who still can't afford it. The same is true for
employers. While I believe every business has a responsibility to provide
health insurance for its workers, small businesses that cannot afford it
should receive an exemption. And small business workers and their families
will be able to seek coverage in the Exchange if their employer is not able
to provide it.

Insurance companies have expressed support for the idea of covering the
uninsured – and I welcome their willingness to engage constructively in the
reform debate. But what I refuse to do is simply create a system where
insurance companies have more customers on Uncle Sam's dime, but still fail
to meet their responsibilities. That is why we need to end the practice of
denying coverage on the basis of preexisting conditions. The days of cherry-
picking who to cover and who to deny – those days are over.

This is personal for me. I will never forget watching my own mother, as she
fought cancer in her final days, worrying about whether her insurer would
claim her illness was a preexisting condition so it could get out of
providing coverage. Changing the current approach to preexisting conditions
is the least we can do – for my mother and every other mother, father, son,
and daughter, who has suffered under this practice. And it will put health
care within reach for millions of Americans.

Now, even if we accept all of the economic and moral reasons for providing
affordable coverage to all Americans, there is no denying that it will come
at a cost – at least in the short run. But it is a cost that will not – I
repeat, not – add to our deficits. Health care reform must be and will be
deficit neutral in the next decade.

There are already voices saying the numbers don't add up. They are wrong.
Here's why. Making health care affordable for all Americans will cost
somewhere on the order of one trillion dollars over the next ten years. That
sounds like a lot of money – and it is. But remember: it is less than we
are projected to spend on the war in Iraq. And also remember: failing to
reform our health care system in a way that genuinely reduces cost growth
will cost us trillions of dollars more in lost economic growth and lower
wages.

That said, let me explain how we will cover the price tag. First, as part of
the budget that was passed a few months ago, we've put aside $635 billion
over ten years in what we are calling a Health Reserve Fund. Over half of
that amount – more than $300 billion – will come from raising revenue by
doing things like modestly limiting the tax deductions the wealthiest
Americans can take to the same level it was at the end of the Reagan years.
Some are concerned this will dramatically reduce charitable giving, but
statistics show that's not true, and the best thing for our charities is the
stronger economy that we will build with health care reform.

But we cannot just raise revenues. We also have to make spending cuts in
part by examining inefficiencies in the Medicare program. There will be a
robust debate about where these cuts should be made, and I welcome that
debate. But here's where I think these cuts should be made. First, we should
end overpayments to Medicare Advantage. Today, we are paying Medicare
Advantage plans much more than we pay for traditional Medicare services.
That's a good deal for insurance companies, but not the American people.
That's why we need to introduce competitive bidding into the Medicare
Advantage program, a program under which private insurance companies offer
Medicare coverage. That will save $177 billion over the next decade.

Second, we need to use Medicare reimbursements to reduce preventable
hospital readmissions. Right now, almost 20 percent of Medicare patients
discharged from hospitals are readmitted within a month, often because they
are not getting the comprehensive care they need. This puts people at risk
and drives up costs. By changing how Medicare reimburses hospitals, we can
discourage them from acting in a way that boosts profits, but drives up
costs for everyone else. That will save us $25 billion over the next decade.

Third, we need to introduce generic biologic drugs into the marketplace.
These are drugs used to treat illnesses like anemia. But right now, there is
no pathway at the FDA for approving generic versions of these drugs.
Creating such a pathway will save us billions of dollars. And we can save
another roughly $30 billion by getting a better deal for our poorer seniors
while asking our well-off seniors to pay a little more for their drugs.

So, that's the bulk of what's in the Health Reserve Fund. I have also
proposed saving another $313 billion in Medicare and Medicaid spending in
several other ways. One way is by adjusting Medicare payments to reflect new
advances and productivity gains in our economy. Right now, Medicare
payments are rising each year by more than they should. These adjustments
will create incentives for providers to deliver care more effectively, and
save us roughly $109 billion in the process.

Another way we can achieve savings is by reducing payments to hospitals for
treating uninsured people. I know hospitals rely on these payments now
because of the large number of uninsured patients they treat. But as the
number of uninsured people goes down with our reforms, the amount we pay
hospitals to treat uninsured people should go down, as well. Reducing these
payments gradually as more and more people have coverage will save us over $
106 billion, and we'll make sure the difference goes to the hospitals that
most need it.

We can also save about $75 billion through more efficient purchasing of
prescription drugs. And we can save about one billion more by rooting out
waste, abuse, and fraud throughout our health care system so that no one is
charging more for a service than it's worth or charging a dime for a service
they did not provide.

But let me be clear: I am committed to making these cuts in a way that
protects our senior citizens. In fact, these proposals will actually extend
the life of the Medicare Trust Fund by 7 years and reduce premiums for
Medicare beneficiaries by roughly $43 billion over 10 years. And I'm working
with AARP to uphold that commitment.

Altogether, these savings mean that we have put about $950 billion on the
table – not counting some of the longer-term savings that will come about
from reform – taking us almost all the way to covering the full cost of
health care reform. In the weeks and months ahead, I look forward to working
with Congressto make up the difference so that health care reform is fully
paid for – in a real, accountable way. And let me add that this does not
count some of the longer-term savings that will come about from health care
reform. By insisting that reform be deficit neutral over the next decade and
by making the reforms that will help slow the growth rate of health care
costs over coming decades, we can look forward to faster economic growth,
higher living standards, and falling, not rising, budget deficits.

I know people are cynical we can do this. I know there will be disagreements
about how to proceed in the days ahead. But I also know that we cannot let
this moment pass us by.

The other day, my friend, Congressman Earl Blumenauer, handed me a magazine
with a special issue titled, “The Crisis in American Medicine.” One
article notes “soaring charges.” Another warns about the “volume of
utilization of services.” And another asks if we can find a “better way [
than fee-for-service] for paying for medical care.” It speaks to many of
the challenges we face today. The thing is, this special issue was published
by Harper's Magazine in October of 1960.

Members of the American Medical Association – my fellow Americans – I am
here today because I do not want our children and their children to still be
speaking of a crisis in American medicine fifty years from now. I do not
want them to still be suffering from spiraling costs we did not stem, or
sicknesses we did not cure. I do not want them to be burdened with massive
deficits we did not curb or a worsening economy we did not rebuild.

I want them to benefit from a health care system that works for all of us;
where families can open a doctor's bill without dreading what's inside;
where parents are taking their kids to get regular checkups and testing
themselves for preventable ailments; where parents are feeding their kids
healthier food and kids are exercising more; where patients are spending
more time with doctors and doctors can pull up on a computer all the medical
information and latest research they'd ever want to meet that patient's
needs; where orthopedists and nephrologists and oncologists are all working
together to treat a single human being; where what's best about America's
health care system has become the hallmark of America's health care system.

That is the health care system we can build. That is the future within our
reach. And if we are willing to come together and bring about that future,
then we will not only make Americans healthier and not only unleash America'
s economic potential, but we will reaffirm the ideals that led you into this
noble profession, and build a health care system that lets all Americans
heal. Thank you.






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