Below are excerpts of President Obama's hour-long speech to the AMA House
of Delegates on June 15.
"... From the moment I took office as president, the central
challenge we've confronted as a nation has been the need to lift ourselves out
of the worst recession since World War II. In recent months, we've 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
"All this is important. But even as we've made progress, we know that
the road to prosperity remains long, and it remains difficult. And we also
know that one essential step on our journey is to control the spiraling cost
of health care in America. And in order to do that, we're going to need the
help of the AMA....
"When it comes to the cost of our health care, then, the status quo
is unsustainable.... So to say it as plainly as I can, health care is the
single most important thing we can do for America's long-term fiscal health.
That is a fact....
"First, we need to upgrade our medical records by switching from a
paper to an electronic system of record keeping. And we've 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....
"The second step that we can all agree on is to invest more in
preventive care so we can avoid illness and disease in the first place....
"But what accounts for the bulk of our costs is the nature of our
health care delivery system itself—a system where we spend vast amounts
of money on things that aren't necessarily making our people any healthier; a
system that automatically equates more expensive care with better care....
"It's 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 necessary. It's a model that has
taken the pursuit of medicine from a profession—a calling—to a
"[Changing this] starts with reforming the way we compensate our
providers—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 paid well 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 we're not promoting just
more treatment, but better care....
"And as we seek to contain the cost of health care, we also have to
ensure that every American can get coverage they can afford.... Now, if you
don't like your health care coverage or you don't have any insurance at all,
you'll have a chance, under what we've proposed, 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—the same way, by the way, that
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....
"Now, I know that there's some concern about a public option. Even
within this organization, there's healthy debate about it. In particular, I
understand that you're concerned that today's Medicare rates, which many of
you already feel are too low, will be applied broadly in a way that means our
cost savings are coming off your backs....
"And these are legitimate concerns, but they're ones, I believe, that
can be overcome. As I stated earlier, the reforms we propose to reimbursement
are to reward best practices, focus on patient care, not on the current
piecework reimbursements. What we seek is more stability and a health care
system that's on a sounder financial footing.
"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....
"Members of the American Medical Association, and my fellow
Americans, I'm here today because I don't want our children and their children
to still be speaking of a crisis in American medicine 50 years from now. I
don't want them to still be suffering from spiraling costs that we did not
stem, or sicknesses that we did not cure. I don't want them to be burdened
with massive deficits we did not curb or a worsening economy that we did not
"I want them to benefit from a health care system that works for all
of us.... We will reaffirm the ideals that led you into this noble profession,
and we'll build a health care system that lets all Americans heal."