President Obama Holds a Health Care Town Hall at AARP

Mr. Cuthbert:
Hi everybody, I’m Mike Cuthbert. Welcome to this latest in a
series of AARP health care tele-town halls, where AARP
members can ask questions and voice their concerns about
health care in America at this critical juncture in the
health care reform effort. We’re joined today by
a very special guest, President Barack Obama. Joining him here with me
is AARP CEO A. Barry Rand, and our President, who’s an AARP volunteer, Jennie Chin Hansen. As we get into the
tele-town hall, any time you want to ask a
question of the President or the other panelists, simply
dial *3 on your phone. That’s *3 to ask questions. Now let’s hear from AARP’s
President, Jennie Chin Hansen. (applause) Ms. Hansen:
Thank you, Mike. And Mr. President, we’re
absolutely delighted that you could join us for this
town hall meeting. As one of AARP’s
40 million members, and as a volunteer
as Mike mentioned — one of actually nine million and
many of who are here including our board chair — I recognize that there is no greater priority than reforming
our health care system. Many of the stories
of our members, sadly, are becoming too commonplace. For some, skyrocketing health
care costs have forced them into bankruptcy. For others, losing a job has
definitely meant losing their health care coverage,
putting not only themselves, but their families, at risk. And too many businesses are
being forced to drop their health plans or to
close their doors. So those who are on Medicare
have told us that — how the Part D “donut hole”
is actually hurting them. Some of them are
— (inaudible) — that their costs are so high
that they’ve stopped taking their medications
whatso– completely. And as our guests
in the audience, as well as on the phone,
will no doubt tell you today, people who have insurance
coverage are paying more and oftentimes getting less. But as much as their needs are
necessary to get addressed, many of our members who have
called in these town halls are expressing confusion,
skepticism, and even fear about what
Congress has been doing on health care reform legislation. Our members have been clear
about what they want. They’ve told us that if they’re
happy with their health care coverage and their doctor,
they’d like to keep it that way, period. Those between 50 and 64 who’ve
had trouble getting coverage have also told us that they’re
sick and tired of being told that they cannot get covered
because of their age or a pre-existing condition. We’ve heard questions in other
town halls that we’ve hosted like, “Are they going to cut
Medicare so that my doctor will leave the program?” Or, “Will they ration
our care so that it’s — because of my age?” And finally, “Will the
government tell my doctor how to practice medicine?” In short, “What does this
really mean to me, my family, and my parents?” Mr. President, this is your
chance to answer some of those questions. You know that our
members are listening. The nation’s health care system
is in need of positive change and with your leadership, we
look forward to working together with you and create a health
care system that works for everyone. And with that, I want to
turn to our CEO, Barry Rand. (applause) Mr. Rand:
Well thank you,
Jennie, for the — my introduction
and Mr. President, a warm welcome to AARP. We’re pleased that you could
join us today and get a chance to listen to our members
and answer their questions. So again, we thank
you very much. I also want to welcome all of
you who are here on the phones and on the Web and here in the
audience today to this tele-town hall with President
Barack Obama. I want to thank
you for joining us. This is another way that AARP is
reaching out to hear what you have to say about
health care reform. Now, there’s a lot of
misinformation about health care reform, even on what AARP stands
for and what AARP supports. So this town hall is part of an
ongoing effort to debunk the myths and provide accurate
information for you and for our members that are on the
phones and on the Web. Now, I want to make it clear
that AARP has not endorsed any particular bill, any of the
bills that are being circulated around Congress today and
debated in Congress today. We continue to work with the members on both sides of the aisle and we continue to work with the administration to achieve what is right
for health care reform. Today we want to here from you;
your stories, your concerns, your dreams. Tell us about the
challenges that you face — whether or not it’s falling into
the infamous “donut hole” on Medicare Part B, or it’s being
denied coverage because of pre-existing conditions. What we believe in AARP is
that all Americans should have affordable health care choices. But our current system costs
too much, it wastes too much, it makes too many mistakes, and
it gives us too little of the value of our dollar back. And as troubling as that
sounds, if we don’t act, it will only get worse. It will only get worse. Now, we are here to make sure
you get a chance to hear the answers to your questions but
in fact, across the country, there are too many people
who lack affordable, quality health care. And this is closing the door
to their American dream. We have, right now, an historic
opportunity to change that, to change our destiny. We have a chance for all
Americans to have affordable health care, to lower drug
costs, to strengthen Medicare, to improve the quality and
the way care is delivered, and to gain real access
to long-term care. Now, during the August recess
you will find that members of Congress will be back
in their districts, they’ll be back in
their home states, and they’re anxious
to hear from you. This is the time that your
voice can make a difference. This is the time that you can
tell how much we need health care reform and the
time to act is now. You can make a difference. Together, we can make sure that
every American has access to affordable, quality health care
for our members and for the generations to come. And now, I have the distinct
honor to introduce the President of the United States,
Mr. Barack Obama. (applause) The President:
Thank you. Thank you. Thank you so much. (applause) I am just going to provide
some brief remarks, and then I want
to hear from you. It is wonderful
to be here today. I want to thank Mike for
moderating this discussion. I want to thank Jennie and
Barry for their extraordinary leadership here at AARP. Some of you may know
that 44 years ago today, when I was almost four years
old, after years of effort, Congress finally
passed Medicare, our promise as a nation that
none of our senior citizens would ever again go
without basic health care. It was a singular achievement — one that has helped seniors live longer, healthier and
more productive lives; it’s enhanced their
financial security; and it’s given us all the peace
of mind to know that there will be health care available for us
when we’re in our golden years. Today, we’ve got so many
dedicated doctors and nurses and other providers across America
providing excellent care, and we want to make sure our
seniors, and all our people, can access that care. But we all know that right
now, we’ve got a problem that threatens Medicare and our
entire health care system, and that is the spiraling cost
of health care in America today. As costs balloon, so
does Medicare’s budget. And unless we act,
within a decade — within a decade — the Medicare trust fund will be in the red. Now, I want to be clear: I don’t
want to do anything that will stop you from getting the
care you need — and I won’t. But you know and I know that
right now we spend a lot of money in our health care system
that doesn’t do a thing to improve people’s health. And that has to stop. We’ve got to get a better
bang for health care dollar. And that’s why I want to start
by taking a new approach that emphasizes prevention
and wellness, so that instead of just spending
billions of dollars on costly treatments when people get sick,
we’re spending some of those dollars on the care they need
to stay well: things like mammograms and cancer
screenings and immunizations — common-sense measures that will
save us billions of dollars in future medical costs. We’re also working to
computerize medical records, because right now, too many
folks wind up taking the same tests over and over and over
again because their providers can’t access previous results. Or they have to relay their
entire medical history — every medication they’ve taken,
every surgery they’ve gotten — every time they
see a new provider. Electronic medical records will
help to put an end to all that. We also want to start
rewarding doctors for quality, not just the quantity, of
care that they provide. Instead of rewarding them for
how many procedures they perform or how many tests they order,
we’ll bundle payments so providers aren’t paid for every
treatment they offer with a chronic — to a patient with a chronic condition like diabetes, but instead are paid for how
are they managing that disease overall. And we’ll create incentives for
physicians to team up and treat a patient better together,
because we know that produces better outcomes. And we certainly won’t cut
corners to try to cut costs, because we know
that doesn’t work. And that’s something that we
hear from doctors all across the country. For example, we know that when
we discharge people from the hospital a day early without any
kind of coordinated follow-up care, too often they wind up
right back in the hospital a few weeks later. If we had just provided the
right care in the first place, we’d save a whole lot of money
and a lot of human suffering, as well. Finally, we’ll eliminate
billions in unwarranted subsidies to insurance companies
in the Medicare Advantage program — giveaways that boost insurance company profits but don’t make you any healthier. And we’ll work to close that
donut hole in Medicare Part D that’s costing so many
folks so much money. Drug companies, as a consequence
of our reform efforts, have already agreed to provide
deeply discounted drugs, which will mean thousands of
dollars in savings for the millions of seniors paying full
price when they can least afford it. All of this is what health
insurance reform is all about: protecting your
choice of doctor; keeping your premiums fair;
holding down your health care and your prescription
drug costs; improving the care
that you receive — and that’s what health care
reform will mean to folks on Medicare. We’ve made a lot of progress
over the last few months. We’re now closer to health care
reform than we ever have been before. And that’s due in no small part
to the outstanding team that you have here at AARP, because
you’ve been doing what you do best, which is
organize and mobilize, and inform and educate people
all across the country about the choices that are out there;
pushing members of Congress to put aside politics
and partisanship; and finding solutions to
our health care challenges. I know it’s not easy. I know there are folks who
will oppose any kind of reform because they profit from the
way the system is right now. They’ll run all sorts of ads
that will make people scared. This is nothing that we
haven’t heard before. Back when President Kennedy,
and then President Johnson, were trying to pass Medicare,
opponents claimed it was “socialized medicine.” They said it was too much
government involvement in health care; that it would
cost too much; that it would undermine
health care as we know it. But the American people and
members of Congress understood better. They ultimately did
the right thing. And more than four
decades later, Medicare is still giving our
senior citizens the care and security they need and deserve. With the AARP standing on the
side of the American people, I’m confident that we can do
the right thing once again, and pass health insurance reform
and ensure that Medicare stays strong for generations to come. So I’m hoping that I can answer
any questions that you have here today. I’m absolutely positive that we
can make the health care system work better for you, work
better for your children, work better for your parents,
work better for your families, work better for your businesses;
work better for America. That’s our job. So thank you very much. (applause) Mr. Cuthbert:
Much as it would be every broadcaster’s dream to share the podium with the President
of the United States, he has to get
wired up for sound. So I’ll start with a question
that was e-mailed in before the program, which combines a couple
of factors you spoke about, Mr. President. He says: My brother
is 56 and uninsurable. He could afford
to buy insurance, but he can’t get it because he
has a preexisting condition and in his state there is
not a high-risk pool. When the President’s
program starts, will insurance companies be
required to cover people with preexisting conditions? Will he be able to get insurance
in the first phase of the plan, even if he’s willing
to pay the full amount? The President:
The answer is yes. And so let me talk just a little
bit about the kind of insurance reform that we’re proposing
as part of the broader reform package. Number one, if you’ve got
a preexisting condition, insurance companies will
still have to insure you. This is something
very personal for me. My mother, when she
contracted cancer, the insurance companies
started suggesting that, well, maybe this was a
preexisting condition; maybe you could have diagnosed
it before you actually purchased your insurance. Ultimately, they gave in, but
she had to spend weeks fighting with insurance companies while
she’s in the hospital bed, writing letters back and forth
just to get coverage for insurance that she had
already paid premiums on. And that happens all
across the country. We are going to
put a stop to that. That’s point number one. Point number two: We’re going to
reform the insurance system so that they can’t just drop
you if you get too sick. They won’t be able to drop you
if you change jobs or lose your job, as long as you’re
willing to pay your premiums. They are — we’re going to make sure that we eliminate sort of the lifetime cap that
creates a situation — a lot of times people get sick,
then they find out the fine print says that at a certain
point they just stop paying, or they’ll pay for your
hospitalization but they don’t pay for your doctor, or they pay
for your doctor but not your hospitalization. We want clear,
easy-to-understand, straightforward insurance
that people can purchase. So that’s point number one. Point number two is, in
addition to those reforms, we want to make sure that we
set up what’s called a health insurance exchange so that
anybody who wants insurance but can’t get it on
their job right now, they can go to this exchange;
they can select a plan that works for them or
their families — these are private-option plans,
but we also want to have a public option that’s in there
— but whatever you select, you will get high-quality
care for a reasonable cost, the same way Congress,
members of Congress, are able to select from a
menu of plans that they have available. And if you’re very — if the plan that you select is still too expensive for your income, then we would provide you a little bit of help so that you could actually afford the coverage. So the idea behind
reform is: Number one, we reform the insurance
companies so they can’t take advantage of you. Number two, that we provide
you a place to go to purchase insurance that is secure, that
isn’t full of fine print, that is actually going to
deliver on what you pay for. Number three, we want to make
sure that you’re getting a good bargain for your health care by
reducing some of the unnecessary tests and costs that
have raised rates. Even if you have
health insurance, your premiums have gone up three times faster than wages over the last 10 years. Your out-of-pocket costs
have gone up about 62%, which means that for people who
aren’t on Medicare right now, people let’s say
54 to — or 50-64, a lot of those folks are paying much higher premiums than they should be — hundreds or thousands of additional dollars that could be saved if we had a system that was more sensible than it is right now. Mr. Cuthbert:
We go to Margaret,
in Greeley, Colorado, for our first tele-town call. Go ahead, Margaret. Margaret, are you there? Let me ask Margaret’s
question for her. She wants to keep
her good coverage. Will it continue
with the new plan? The President:
Here’s a guarantee that I’ve made: If you have insurance that you like, then you will be
able to keep that insurance. If you’ve got a
doctor that you like, you will be able to
keep your doctor. Nobody is trying to change
what works in the system. We are trying to change what
doesn’t work in the system. And this — let me also address I think a misperception that’s been out there that somehow there is any discussion on Capitol Hill about
reducing Medicare benefits. Nobody is talking about
reducing Medicare benefits. Medicare benefits are there
because people contributed into a system. It works. We don’t want to change it. What we do want is to eliminate
some of the waste that is being paid for out of the Medicare
trust fund that could be used more effectively to cover more
people and to strengthen the system. So, for example, right now we’re
paying about $177 billion over 10 years to insurance companies
to subsidize them for participating in
Medicare Advantage. Now, insurance companies are
already really profitable. So what we’ve said is let’s
at least have some sort of competitive bidding process
where these insurance companies who are participating, they’re
not being subsidized on the taxpayer dime; if they
got better services — they have better services that
they can provide to seniors rather than through the
traditional Medicare program, they’re free to participate,
but we shouldn’t be giving them billions of dollars
worth of subsidies. That’s the kind of change
that we want to see. That will strengthen Medicare. But nobody is talking about
cutting Medicare benefits. And I just want to make that
absolutely clear because we’ve received some e-mails and
some letters where people are concerned that that may happen. Mr. Cuthbert:
Our operators, by the way,
are telling us that we have literally tons of questions from
people worried about keeping the care they have. On the other hand,
Ollie, in Texas, you’ve got a concern
on the other end. Hi, Ollie. Questioner:
Hello. Mr. Cuthbert:
Go ahead. May I start now? The President:
Yes. Questioner:
Yes, well, I am an AARP
volunteer, an AARP member. I support AARP’s position on
health care reform and I want to thank President Obama for making
this a priority issue on his agenda also. My question is there are so
many negative ads and so many negative articles about the
tremendous cost for health care reform that is being proposed
by different congressional committees. What we don’t hear is what the
dollar amount would be if we do nothing. And I think this is very
important because people are scared by the
trillions of dollars, and I know that if we do
nothing for the next 10 years, health care will
still keep on rising. And I want to know if the
President has any way of putting out some information as to what
it would cost if we do nothing. Thank you. The President:
Well, look, I think this
is a great question, Ollie, and so let me try to be as
specific as I can about the cost of doing nothing. I’ve already mentioned that
health care costs are going up much faster than inflation. So your wages, your income,
if you’re lucky, right now, maybe they’re going up 2%
a year, maybe 3% a year; for a lot of people, they’re
not going up at all because the economy’s in tough shape. But your health care costs
are still going up 6% a year, 7% a year. Some people are getting notices
in their mail their premium just went up 20%. On that trajectory, health care
costs will probably double again — your premiums will probably double again over the next 10 years. They may even go up
faster than that. The costs of Medicare are going
to keep on rising a lot faster than tax revenues coming in,
which means that the trust fund — you’ve got more money
going out than is coming in, which makes that more unstable. And we know that if we do
nothing we will probably end up seeing more people uninsured. We’re already seeing 14,000
people lose their health insurance every day
— 14,000 people. So the costs of doing nothing
are trillions of dollars in costs over the next couple
of decades — trillions — not billions, but trillions
of dollars in costs, without anybody getting
any better care. So what we’ve said is if we can
control health care inflation, how fast costs are going up,
then not only can we stabilize the Medicare trust fund, not
only can we help save families money on their premiums, but we
can actually afford to provide coverage to the people who
currently don’t have health care. Now, here’s the problem, that
in order for us to save money, in some cases, we’ve got to
spend some money up front. Let me give you some
very specific examples. Health care IT: Health care is
the only area where you still have to fill out five
different forms — when you go into a bank
you don’t have to do that. You’ve got an ATM. If you use your credit card,
they’ll find you real quick and the billing’s real easy — (laughter) — right? But if for some reason
you want health care, you fill out pencil and paper
— I guess they Xerox it — they give it to somebody else. Sometimes you see their files
and it’s all stuffed with papers, and nurses can’t read
the doctor’s handwriting. So for us to set up a system
like they have at the Cleveland Clinic that I just
visited in Ohio, where every medical record
— your privacy’s protected, but everything is
digitalized; everything — the minute you take a test, it
goes to all the doctors and all the specialists that you
might end up dealing with. So you end up just having that
one test instead of having to then go back to the doctor again
and again and again and have a bunch of different tests. Well, that saves money, but
you’ve got to get the computer equipment in the
first place to do it. So in some cases we’ve got
to spend some money on the front-end. I also think that if we provide
coverage for people who don’t have health insurance right
now, then they are going to be getting preventive care, they’re
going to be getting screenings, and so they don’t end up in
the emergency room with really expensive care that all
of us are paying for, even though we don’t know it. The average family is spending
about $900 a year in higher health care premiums, because
they are paying indirectly for uncompensated care. Essentially, the insurance
companies charge you a little more, and hospitals and doctors,
they’re all charging you a little bit more, because they’re
not getting reimbursed for people who don’t have
any care whatsoever. So what we’ve done is we’ve
said, look, over 10 years, the health care reform
proposals, to cover everybody, would cost about a trillion
dollars over 10 years. So that’s about
$100 billion a year. Keep in mind we spend $2
trillion every year on health care, so this is just a
fraction of what we spend. But we’re talking about a
trillion dollars over 10 years — that’s $100 billion a year. About 60% of that can be paid
for by taking money that’s already in the system but isn’t
working to make you healthier — that can pay for
about 60% of it. So really what we’re talking about is another 30 to $40 billion every year
to cover everybody, and we’re going to get most
of that money back if we’re providing more
prevention, more wellness, doctors and hospitals are being
reimbursed more intelligently. Over time that money will — that investment will more than pay for itself. But Ollie’s exactly right — you get these stories where, oh, there’s a trillion dollars
here, a trillion dollars there; after a while it
starts being real money, even here in Washington. And so I understand people being
scared that this is going to be way too costly. It’s not that costly if we
start making changes right now. Last point I would make, just to
give you a sense of why I know that we can get savings in the
system without over the long term spending more money. We spend about $6,000 per
person more than any other industrialized
nation on Earth — $6,000 more than the people
do in Denmark, or France, or Germany, or — every one of these other countries spend at least 50% less than we do, and you know what, they’re just as healthy. And I just had a doctor in the
Oval Office today who told me it’s not because
they’re healthier; it turns out they actually are
generally older and they smoke at a higher rate. And so, in fact, their costs
should be higher than ours. And yet they are spending $6,000
per person less than we are. Now, that’s money
out of your pocket. If you’re already retired, it’s
money that is out of your pocket because some of that money
could have been going into your retirement fund instead of going
to pay for your health care. If you’re working right now,
some of that money could be going into your paycheck instead
of going into your health benefits right now. It’s money that is being given
away, and we need to save it. That’s why health
reform is so important. Mr. Cuthbert:
We’d like to welcome you once again to the AARP national tele-town hall. Those of you on CNN can’t
dial *3, but we welcome you. Those of you on the
tele-town hall, however, if you have a question for the President of the United States on health care reform,
*3 on your phone, and it won’t take you
off the broadcast. Let’s go next to Illinois
and talk with Caroline with her question. Caroline, you’re on
the tele-town hall. Questioner:
Thank you. Hello, Mr. President,
from Joliet. The President:
Good to — tell everybody
in Joliet I said hi. (laughter) Questioner:
I will, thank you. I came from our AARP chapter
meeting this morning and I asked for questions. There were two big fears that
came out of the discussion. One had to do with the fear of
losing a preferred insurance plan, which I think you’ve
addressed to some extent this morning. The President:
Right. Questioner:
The other has to do with the knowledge that there will be millions of dollars of cuts
in Medicare over the years to accommodate baby boomers. So the question is, does this
translate into dictation of what can and cannot be given
to a senior as service? For example, will there be fewer
hip and knee replacements? Even if I decide when I’m 80
that I want a hip replacement, am I going to be
able to get that? Am I going to be able to see a
cardiologist if I have a heart condition, or other specialist? Or is that going to
all be primary care? I’m calling it rationing of
care, I’m coining it that. The President:
Yes — no, I think it’s an excellent question, Caroline, and I appreciate it because I
do think this is a concern that people have generally. My interest is not in getting
between you and your doctor, although keep in mind right now,
insurance companies are often getting between you
and your doctor. So it’s not as if these choices
aren’t already being made; it’s just they’re being made by
private insurance companies, without any real guidance as to
whether the decisions that are being made are good decisions to
make people healthier or not. So what we’ve said is we just
want to provide some guidelines to Medicare, and by extension,
the private sector, about what works
and what doesn’t. Some of you may have heard we
wanted to set up what we’re a IMAC — an independent
medical advisory committee — that would, on an annual basis,
provide recommendations about what treatments work best and
what gives you the best value for your health care dollar. And this is modeled on
something called MedPAC, which, by the way, Jennie, who is
sitting right next to me, is currently on, and gives
terrific recommendations every year about how we
could improve care — to reduce the number of tests,
or to make sure that we’re getting more generic drugs in
the system if those work and are cheaper — all kinds of recommendations like that. Unfortunately, right now they’re
just sitting on a shelf. So we don’t want to ration by
dictating to somebody, okay, you know what, we don’t think
that this senior should get a hip replacement. What we do want to be able to
do is to provide information to that senior and to her doctor
about this is the thing that is going to be most helpful to you
in dealing with your condition. So let’s say that
person is diabetic. It turns out that if hospitals
and doctors are providing reimbursements for a nurse
practitioner or a social worker to work with that diabetic to
control their diets and their medications, then they may avoid
having to get a foot amputation. That’s a good outcome. And by the way, that
will save money. That saves Medicare money. And if we save
money on Medicare, that means that it’s going to
be more stable and more solvent over the long term. So the thing that
I’m — if I were — look, I think I’m scheduled to
get my AARP card in a couple years, is that right? (laughter) Mr. Rand:
Anytime you want one. (laughter) Platinum. The President:
I know I’m
automatically getting — associate member, right? Okay. (laughter) So if I was thinking about
Medicare and making sure that I was secure, the thing that I
would be most worried about right now is health care
inflation keeps on going up and the trust fund in 10 years
is suddenly in the red. And now Congress has to make
some decisions: Are they going to put more money into Medicare,
especially given the deficits and the debt that
we already have? Or are they, at that point,
going to start making decisions about cutting benefits, but not
based on any science or what’s making people healthier — they’re just going to start making it based on politics? And what we’re saying is we can
avoid that scenario by starting to make some good decisions now
about how do we improve care, make the system more rational,
make it work better. That will actually stabilize
and save Medicare over the long term. One last point, because I think
Caroline also raised the issue of we’re taking some
money out of Medicare. The only things that we’re
talking about have nothing to do with benefits. It has to do with things like
subsidizing insurance companies or, for example, right now we
reimburse hospitals for the amount of time that you’re there
without checking to see if they’re doing a good
job in the first place. So they have no penalty. If you go into the hospital,
they’re supposed to fix you; suddenly you have to go
back three weeks later. That hospital gets
paid all over again, even though they didn’t get
it right the first time. Now, if you got your
car fixed at a mechanic, and three weeks later
you had to go back, and you had to pay again to get
your car fixed all over again, you’d be pretty
mad, wouldn’t you? And yet when it comes to health
care, that happens all the time. That happens all the time. And the hospital gets reimbursed
for the second time or the third time, even though they didn’t
get it right the first time. And so what we’re saying is,
let’s incentivize the hospitals; we’ll pay you a little bonus if
the person is not readmitted because you got it
right the first time. That will save money
over the long term. Those are the kinds of
changes we’re talking about. Mr. Cuthbert:
We have been very geographically in-specific in our conversation so far, so let’s get
geographically specific, like going to Jeanine
in our audience. She’s from Fairmont, Nebraska,
and has a very relevant question. Jeanine, welcome to
the tele-town hall. Questioner:
Hi, Mr. President. The President:
Hi, Jeanine. Questioner:
I’m concerned about affordability and preexisting conditions, and I’m glad to
hear you say what you have. My family and I live in rural
Nebraska and my husband and I are both — are self-employed, and we’re paying — and he was originally denied
because of a preexisting condition, and he’s
in a CHIPS pool. We’re paying $900 a month, and
we have a $8,000 deductible. The President:
Yes, that’s tough. Questioner:
Yes, and it’s, you know, and we’ve done this for about a year and a half. And we’re not alone. There are a lot of
people who do this. The President:
Well, Jeanine, you are a prime candidate for the health care exchange that I just described,
because essentially what you would be able to do is
you could just go online, you would be able to see a list
of participating insurers — which by the way,
is very important, because in most states right
now insurance companies are dominated by — or the insurance market is dominated by just one or two insurers, so you
don’t have a lot of choices. And this way, you would
have a lot of choices. They would all have to compete
on the basis of price, but they’d be abiding by
a certain set of rules, like you can’t exclude somebody
for a preexisting condition. And so you could then select
the plan that was best for you, do your own comparison
shopping; and if you qualified, then we would provide you a
little bit of help on your premiums to reduce your costs. So that’s what essentially we
could pay for if we take some of these inefficiencies and the
waste out of the system right now. That will pay for you getting
the kind of help you need, and we’d have insurance
regulations in place that would protect you from being scammed
in the insurance market, which unfortunately, a
lot of people suffer from. The other reason we can drive
your costs down is you’d be part of a huge pool, right? Part of the reason why large
companies are typically able to offer lower insurance premiums
for their employees than small companies is they’ve
got a big pool. The federal government
is a classic example. The Federal Health Employees
Program is a pretty good deal, because you’ve got several
million people who are part of it. So that gives you a lot of
bargaining power with the insurers. Well, the exchange will provide
that same market power to help negotiate with the insurers
to drive prices down. And the other thing
that we do want to do — now, this is controversial, and
I understand some people are worried about this — we do think that it makes sense to have a public option
alongside the private option. So you could still
choose a private insurer, but we’d also have a public plan
that you could choose from that would be non-for-profit,
wouldn’t have, hopefully, some of the same high
administrative costs, and would be potentially more
responsive to your needs at a lower cost. I think that helps keep the
insurance companies honest because now they have
somebody to compete with. And I have to say, the reason
this has been controversial is a lot of people have heard this
phrase “socialized medicine” and they say, we don’t want
government-run health care; we don’t want a
Canadian-style plan. Nobody is talking about that. We’re saying, let’s
give you a choice. You can choose the
private marketplace, or this other approach. And I got a letter the other
day from a woman; she said, I don’t want government-run
health care, I don’t want
socialized medicine, and don’t touch my Medicare. (laughter) And I wanted to say, well, I
mean, that’s what Medicare is, is it’s a government-run health
care plan that people are very happy with. But I think that we’ve been so
accustomed to hearing those phrases that sometimes we can’t
sort out the myth from the reality. Mr. Cuthbert:
In our tele-town hall, we go next to Lawrence, Kansas, and talk with Mitzi. Mitzi, you’re on
the tele-town hall. Questioner:
Mr. President, thank you so
much for doing the hard work of health care reform. The President:
Thank you, Mitzi. Questioner:
My question is, historically, older Americans, along with women of
child-bearing age and persons with preexisting conditions,
have paid more for health care coverage. And I want to know if reform
will eliminate the disparity for older Americans. The President:
Well, one thing that we
strongly believe in is you can’t discriminate in the
insurance market. And that’s actually what’s
happening right now. You’re not seeing it in Medicare
if you’re already in Medicare, but if you’re in the private
marketplace right now, essentially insurance
companies are cherry-picking. They want young, healthy people
because they can collect premiums and don’t
have to pay out a lot. And then as people get older,
then they start suddenly making it harder for those
folks to get coverage. And if they do get coverage,
it’s wildly expensive. And so part of the insurance
reforms we want to institute is to make sure that there’s what’s
called a community rating principle that keeps every
insurer operating fairly so that they can’t just select the
healthy, young people. If they want to participate
in, for example, this health care exchange,
they’ve got to take everybody. And that will help I think
reduce costs or level out costs for older Americans. And we also want to enshrine a
principle in there that says no discrimination against women,
because there is still oftentimes a gender bias in
terms of some of the coverage that people receive. Mr. Cuthbert:
We go next to North Carolina
for a question we had all week last week. I think every town
hall had this one. It’s from Colin. And, Colin, go ahead
and ask this question. Go ahead, Colin. Questioner:
This is his wife, Mary. The President:
Hi, Mary. Questioner:
Hi. The President:
What happened to Colin? (laughter) Questioner:
Well, I’m the one
they talked to. The President:
I got you. That’s how it is
in my house, too. (laughter) Questioner:
I have heard lots of rumors going around about this new plan, and I hope that the people
that are going to vote on this is going to read every
single page there. I have been told there is a
clause in there that everyone that’s Medicare age will be
visited and told to decide how they wish to die. This bothers me greatly and I’d
like for you to promise me that this is not in this bill. The President:
You know, I guarantee
you, first of all, we just don’t have enough
government workers to send to talk to everybody, to find
out how they want to die. I think that the only thing that
may have been proposed in some of the bills — and I actually think this is a good thing — is that it makes it easier for
people to fill out a living will. Now, Mary, you may be familiar
with the principle behind a living will, but it basically is
something that my grandmother — who, you may have heard,
recently passed away — it gave her some control ahead
of time, so that she could say, for example, if she
had a terminal illness, did she want extraordinary
measures even if, for example, her brain waves were
no longer functioning; or did she want just
to be left alone. That gives her some
decision-making power over the process. The problem is right now most of
us don’t give direction to our family members and so when
we get really badly sick, sadly enough, nobody’s
there to make the decisions. And then the doctor, who doesn’t
know what you might have preferred, they’re
making decisions, in consultation with your
kids or your grandkids, and nobody knows what
you would have preferred. So I think the idea there is to
simply make sure that a living will process is
easier for people — it doesn’t require you to hire
a lawyer or to take up a lot of time. But everything is
going to be up to you. And if you don’t want to
fill out a living will, you don’t have to. But it’s actually a useful tool
I think for a lot of families to make sure that
if, heaven forbid, you contract a terminal illness,
that you are somebody who is able to control this process in
a dignified way that is true to your faith and true to how you
think that end-of-life process should proceed. You don’t want somebody else
making those decisions for you. So I actually think it’s a good
idea to have a living will. I’d encourage
everybody to get one. I have one. Michelle has one. And we hope we don’t have
to use it for a long time, but I think it’s something
that is sensible. But, Mary, I just want to be
clear: Nobody is going to be knocking on your door; nobody is
going to be telling you you’ve got to fill one out. And certainly nobody is going to
be forcing you to make a set of decisions on end-of-life care
based on some bureaucratic law in Washington. Mr. Cuthbert:
Mr. President, she mentioned, not in her question, but in her preview, that she’s
talking about Section 1232, the infamous page 425, which
is being read as mandatory end-of-life care advice and
counseling for Medicare. As I read the bill, it’s
saying that Medicare will, for the first time, cover
consultation about end-of-life care, and that they will not pay
for such a consultation more than once every five years. This is being read as saying
every five years you’ll be told how you can die. The President:
Well, that would
be kind of morbid. (laughter) I think that the idea
in that provision, which may be in
the House bill — keep in mind that we’re still
having a whole series of negotiations, and if this is
something that really bothers people, I suspect that members
of Congress might take a second look at it. But understand
what the intent is. The intent here is to simply
make sure that you’ve got more information, and that
Medicare will pay for it. So, for example, there
are some people who — they get a terminal illness, and
they decide at a certain point they want to get hospice care. But they might not know how to
go about talking to a hospice, what does it mean,
how does it work. And they don’t want to — we don’t want them to have to pay for that out of pocket. So if Medicare is saying you
have the option of consulting with somebody about hospice
care, and we will reimburse it, that’s putting more power, more
choice in the hands of the American people, and it strikes
me that that’s a sensible thing to do. Mr. Cuthbert:
We go to Denver,
Colorado, next, and Sarah, another donut hole question. Go ahead, Sarah. Questioner:
Hi, this is my first
year in the donut hole, and it’s quite a frightening
thing to go through. I have Parkison’s so I will be
going through it year after year, and it looks like I
could last about two years, and then all of my savings will
be gone to the donut hole. So what do you intend to
replace the donut hole with? The President:
Well, we want to replace it with prescription drugs that won’t force you to use up
all your retirement. When the original Medicare
Part D was put forward — first of all, it
wasn’t paid for, so it automatically was
unstable financially. Then there was an agreement that
you couldn’t negotiate with the drug companies for the cheapest
available price on drugs. The American people pay about
77% more for drugs than any other country — 77%. Almost twice as much
as other countries do. So what we’ve said
is, as part of reform, let’s negotiate with the
pharmaceutical companies; we’ll cover more people —
that means potentially the pharmaceuticals will have more coverage — or more customers — but as part of the deal, they’ve
got to start providing much better discounts on their drugs. They’ve already committed that
if the health care reforms pass, they would provide $80
billion worth of discounts. That would be enough to cover
about half of the donut hole. So, right off the
bat, right now, without further negotiations,
the drug companies have already committed that they
would reduce — they would cut in half the costs
that folks have to go through when they’re in the
doughnut hole right now. That’s money directly in their
pocket that could be in their retirement savings. I think we can get potentially
an even better deal than that, because we’re overpaying 77%. But the problem is if we
don’t get health care reform, the pharmaceutical industry is
going to fight for every dime of profits that they’re
currently making — and filling that doughnut hole
is going to be very expensive because when the Medicare Part D
was originally passed nobody put in provisions to pay for — and so putting even more money into it at a time when Medicare
may go bankrupt — not “go bankrupt,” but go into
the red 10 years from now, that’s a big problem. That’s part of the reason
why reform is so important. And I think for AARP members
especially there are hundreds of thousands of people out there
who would directly benefit from reduced prescription drug costs
if we’re able to pass this bill. Mr. Cuthbert:
As you know, you may have heard, the cost of the program is a concern. Jane here in our audience
has a question about that, from Alexandria, Virginia. Jane. Questioner:
Hello, Mr. President. My question is some concern we
have about the possibility of a cost containment commission. If you could comment on that. The President:
The idea is not the cost —
it’s not a cost containment commission that’s been proposed. It’s been what I
just described — an independent medical advisory
committee modeled on the kind of committee that is
called MedPAC right now. It’s got people who are health
care experts, nurses, doctors, hospital administrators. The idea is how do you get the
most value for your health care dollar. Now, the objective
is to control costs. But it’s not cost containment by
just denying people care that they need. Instead it’s reducing costs by
changing the incentives and the delivery system in health care
so that people are not paying for care that they don’t need. The more we can reduce those
unnecessary costs in health care, the more money we have
to provide people with the necessary costs — the things that really pay high dividends in terms of people
becoming healthier. And this is pretty
straightforward. I mean, it’s pretty logical. If you think about your
own family budget — if you could figure out a way
to reduce your heating bill by insulating your windows, then
that money that you saved — you’re still warm inside; you’re
just as comfortable as you were — it’s just you’re not wasting all that energy and sending it in the form of higher bills to the electric company or the gas company. And that’s then money that
you can use to save for your retirement or help
your kid go to college. Well, it’s the same principle
within the health care system. If we can do the equivalent of
insulating some windows and making the house more efficient,
you’re still going to be warm; you’re just going to be
able to save some money. In this case, you’re
still going to be healthy; you will just have saved some
money and that money then we can use to lower your prescription
drug costs, for example. Mr. Cuthbert:
We have an Internet question next from Alpharetta, Georgia. Robert asks, if the new health
care reform bill is so great for all Americans, why are members
of Congress and other arms of government excluded from
having to participate? The President:
Well, I actually think that the health care exchange that people like Jeanine would be able to
participate in would be very similar to the kind of program
that we have for the federal health care employees. But keep in mind — I mean,
this is something that I can’t emphasize enough: You
don’t have to participate. You don’t — if you are happy with the health care that you’ve got, then keep it. If you like your
doctor, keep it. Nobody is going to
go out there and say, you’ve got to change
your health care plan. So this is not like Canada where
suddenly we are dismantling the system and everybody’s signed up
under some government program. All we’re doing is we’re saying,
if you’ve already got health care, the only thing we’re going
to do for you is we’re going to reform the insurance companies
so that they can’t cheat you, and we are — if you don’t
have health insurance, we’re going to make it a little
bit easier for you to be able to obtain health care. And hopefully, overall, we are
going to change the delivery systems so that we are saving
money as a society over the long term. So nobody is being forced
to go into this system, and frankly the —
if we do this right, then all we’re actually doing is giving the American people the same option that
members of Congress have, because they’ve got a
pretty good deal right now. And the fact of the matter is,
is that they don’t have to worry about losing their
health insurance. They have a bunch of different
options and different plans to select from. So if they’ve got a good
deal, why shouldn’t you? (applause) Mr. Cuthbert:
We hope that you’ve found this tele-town hall with President Obama, AARP CEO A. Barry Rand, and AARP President Jennie Chin Hansen to be informative,
interesting, helpful, and stimulating of
further discussion. If you have a personal story
you’d like to share with us about the impact the high cost
of health care has had on your family, please stay on the
line to leave us a message. Be sure to leave your contact
information so we can get back to you. Now for some closing remarks,
let’s get back to Barry Rand. Barry. Mr. Rand:
Well, I want to thank
you again, Mr. President, for joining us,
listening to our members, whether they’re here in person
or on the phone or on the Web, and for hearing their stories,
and getting a chance to talk directly and answer
their questions. So we thank you
very much for that. (applause) The President:
Well, I just want to say thank you to all of you for taking the time to get informed
on this issue. And I want to thank AARP for all
the good that it has done to provide greater security and
stability in the lives of people who are older. You know, this week celebrates
the anniversary of Medicare, and when you look at the
Medicare debate it is almost exactly the same as the debate
we’re having right now. Everybody who was in favor of
the status quo was trying to scare the American people saying
somehow that government is going to take over your health care,
you won’t be able to choose your own doctor, they’re
going to ration care, they’re going to tell you you
can’t get this or that or the other. And you know what? Medicare has been
extraordinarily popular, it has worked, it has made
people a lot healthier, given them security. And we can do the
same this time. Sometimes I get a little
frustrated because this is one of those situations where it’s
so obvious that the system we have isn’t working well for too
many people and that we could just be doing better. We’re not going to have a
perfect health care system; it’s a complicated system, there
are always going to be some problems out there. But we could be doing a lot
better than we’re doing right now. We shouldn’t be paying 50% more,
75% more than other countries that are just as
healthy as we are. We shouldn’t have prescription
drugs 77% higher in costs than ours. And we shouldn’t have people who
are working really hard every day without health care or
with $8,000 deductibles — which means they basically don’t
have health insurance unless they get in an accident
or they get really sick. That just doesn’t make sense. And the stories I get
are heartbreaking, all across the country, from
people who are just having a really tough time and
it’s going to get tougher. So we’ve got to have the courage
to be willing to change things. I know that sometimes people
have lost confidence in the country’s ability to
bring about changes, but I think this is one of those
times where we’ve really got to step up to the plate, and it
will ultimately make Medicare stronger, as well as the whole
health care system stronger. So thank you very
much, everybody. (applause) Mr. Cuthbert:
One of the most difficult parts of working on an effort like health care reform is to keep
in touch and keep up to date. May we suggest a website:, that’s healthactionnow —
all one word — dot org. It will tell you how to get in
touch with your congressman and the people who are
debating this whole issue, and tell you how to keep
involved until the very end, which we hope is soon. Mr. President, Mr.
CEO, Madam President, and everybody here and at
home on the tele-town hall, we thank you all
for participating. Keep up the good work, and
we’ll talk with you again. I’m Mike Cuthbert in Washington. Have a good day.

Daniel Yohans

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