Hospitals

Barack Obama rallies public around health care reform

President Barack Obama rallied the public around health care reform Thursday afternoon, drawing cheers, applause and “We love yous” from a crowd that seemed more impressed with him than with his topic, which the president did little to explain in any depth.

SHAKER HEIGHTS, Ohio — President Barack Obama rallied the public around health care reform Thursday afternoon, drawing cheers, applause and “We love yous” from a crowd that seemed more impressed with him than with his topic, which the president did little to explain in any depth.

By Monday, it was clear the president had made himself the leader of a public opinion campaign to get legislation that reforms the nation’s health care system — sooner rather than later. He has starred in at least one major public event each day for the last 10 days. Thursday, it was a private visit to the Cleveland Clinic and a town hall meeting at Shaker Heights High School.

Obama is seizing the moment to re-energize the American people about one of his campaign promises – creating a health care system that insures most people at a lower cost and provides better-quality care — at a time when the public has begun to question whether the president is aiming at too much reform, too fast.

“I had said, let’s get this done by August,” which is when Congress takes a summer break, Obama told his town hall audience. What the president said he meant was, “let’s get bills voted on in the House and the Senate” by the August break. That means Congress would reconcile the bills and get a bill to the president by fall. “Our target date is to get this done by fall. That’s the bottom line,” he said.

Obama also is trying to nettle congressional committee members to agree on ways to pay for reform. Some of those ways include raising income taxes for the rich, taxing high-end health benefits provided by employers — which Obama calls “Cadillac plans” — asking health care providers and product makers to cut their prices, and reforming the Medicare and Medicaid programs.

A handful of Senate and House committees have proposed reforms that would cost between $600 billion and $1.6 trillion over 10 years, some covering more of the uninsured than others. So far, though, the Congressional Budget Office has said the plans would add to the federal deficit by significantly increasing federal health care spending through a government-sponsored insurance plan and subsidies that would help low-income Americans buy insurance.

“We are going to phase this in in an intelligent, deliberate way. But I think there are some changes that have to take effect pretty quick,” Obama said. “Now, is it too much? I don’t think it’s too much. It’s only too much by the standards of Washington politics today,” which is defined by who is in and out, politically, and which special interest groups are saying what, he said.

“What we are talking about is not completely scrapping the health care system. All we’re saying is, if you’ve got health insurance you can keep it. If you don’t have health insurance, you can now afford to buy it, with some help,” Obama said. “If you have health insurance, we’re going to reform the insurance industry so that it can still make a profit … it just can’t (go on) collecting all the premiums but not wanting to pay out when people get sick.”

 A registered nurse who works at the Cleveland Clinic asked the president whether he would include in the reforms provisions to pay insurance companies for providing health education to their customers.

Preventive care “can make such a difference,” Obama said. “I was meeting with some of the officers here at the Cleveland Clinic. They’re all sitting up front here,” he said, gesturing toward Dr. Toby Cosgrove, the Clinic’s chief executive, and C. Martin Harris, its chief information officer.

Obama, who has held up the Clinic as a model of health care efficiency, said he was impressed by “the big fancy hospital with all the fancy equipment.” But he was more impressed with the Clinic’s electronic links with family clinics. “One of the things that a Clinic and a family physician can do is to focus on preventable diseases, making sure that you’re helping somebody with a nutritionist to keep your weight down before they get diabetes.”

“If they already have diabetes, then having a counselor … to make sure they maintaining their regiments to keep their diabetes under control. That is cost-efficient,” he said. The problem is, the health system doesn’t “incentivize” that kind of preventive work, paying, instead to treat patients for the complications of diabetes.

“In this reform package, there will be reimbursements and incentives for prevention and wellness, and we’re going to make sure that those are the things that don’t require an out-of-pocket cost for the patient so that they’re not being discouraged from using it but rather … encouraged to use it,” he said. “That makes all the difference in the world.”

The president drew rave reviews from people who attended his meeting, but some medical professionals reacted to his remarks — and to legislation proposed in the House — with concern.

“While we believe House Resolution 3200 is a positive step toward achieving comprehensive health system reform legislation this year, there are deficiencies in the proposed legislation as well,” said Dr. Roy H. Thomas, president of the Ohio State Medical Association (OSMA), in a written statement. “The bill lacks any medical liability reform measures, contains payment cuts for imaging services, bans new physician-owned hospitals and restricts those currently in operation, and does not have adequate measures to improve consumer responsibility in controlling one’s own health care costs,” said Thomas, who attended the Shaker Heights meeting.

“In addition, the current structure of the “public option” raises concerns, although the OSMA remains open to an alternative coverage proposal,” Thomas said. “Any such proposal should provide competition from a non-profit entity, self-supported through premiums and rigid solvency requirements, where payment rates to physicians are negotiated and where patients have access to out-of-network benefits.”