Putting Obama's News Conference Under the Microscope
By Alec MacGillis
Few would dispute that President Obama has developed a firm grasp on the details of health care policy -- it was nearly two years ago that he started his endless jousting with Hillary Rodham Clinton over the relative merits of their health care plans, and he's been entrenched in the issue ever since. As a result, he generally manages to argue his case without making glaring misstatements and while keeping his shading fairly subtle.
This shading was more evident than usual, though, in one area during Wednesday night's press conference -- his answers to three questions that all asked, in various iterations, whether Americans will need to make any sacrifices in their health care beyond the higher taxes that the wealthy may be required to pay.
Obama said repeatedly that they would not. But countless health care experts, including members of his own administration, say that, for the country to "bend the curve" on long-term health care spending, there will need to be some tough decisions made about what we pay for and what we do not -- decisions that will in some cases upset patients.
Answering the first such question, Obama made it sound as if any decisions by federal regulators about what health care is worth paying for would be based exclusively on whether a given procedure is effective. So, for instance, if a red bill is no more effective than a blue pill but costs twice as much, then physicians would be urged to prescribe the blue pill. "Why not pay half price for the thing that's going to make you well?" he asked.
It is true that the new effort being envisioned by the reform bills to emphasize "comparative effectiveness" research is, for now, supposed to be limited to only determining which treatments work, and not get into thorny cost-benefit analyses that many medical lobbies and patient groups oppose. But a senior administration official conceded just a couple weeks ago that that would mean delaying the necessary "harder question" of what to do "if new technology does work better and reduces risks but costs a lot more, and how to evaluate that."
Moments later, Obama was asked whether the bills' provisions to reduce Medicare spending would mean any sacrifices for Medicare recipients. Obama said flatly that they would not. His proposal to empower a federal commission to reform Medicare reimbursement rates, he said, would not result in denials of desired care. "It's not going to reduce Medicare benefits," he said. "What it's going to do is to change how those benefits are delivered so that they're more efficient."
In fact, part of the thinking behind empowering such a commission is because it would be in a better position to resist the entreaties of physicians and patient groups urging Medicare to cover a given treatment. Obama did not get into this, though. Instead, he segued to talking about pharmaceutical companies' offer to reduce the cost of drugs offered through the Medicare prescription benefit -- a feature that is separate from the debate over what the newly empowered commission will or will not approve.
A third reporter asked whether Obama could "guarantee that this legislation will lock in and say the government will never deny any services, that that's going to be decided by the doctor and the patient, and the government will not deny any coverage?" Perhaps because this question was posed even more dramatically than the prior two, Obama appeared uncomfortable this time giving an unqualified affirmative. But he still managed to make it sound like nothing was going to happen in health reform that would trouble any consumers.
"Can I guarantee that there are going to be no changes in the health care delivery system? No. The whole point of this is to try to encourage changes that work for the American people and make them healthier," he said. "The government already is making some of these decisions. More importantly, insurance companies right now are making those decisions. And part of what we want to do is to make sure that those decisions are being made by doctors and medical experts based on evidence, based on what works, because that's not how it's working right now."
Posted at 9:53 PM ET on Jul 22, 2009
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