The Trail: A Daily Diary of Campaign 2008


Health Care

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  | Category:  Health Care
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Did I miss the statement of outrage from the President of the AMA after President Obama implied that a significant number of professional U.S. physicians would subject a child to anesthesia and surgery to remove tonsils when the problem was allergies in order to boost their income? Is that not the definition of malpractice?

No wonder he does not support tort reform. He must believe medical malpractice is rampant.

The President of the ABA should be happy, but the President of the AMA should be furious. No self-respecting professional physician should remain a member of the AMA.

Posted by: LuckyAmerican | July 24, 2009 2:06 PM

President Obama is right. The whole point of reforming our health care system is “to encourage changes that work for the American people and make them healthier.” Unfortunately, however, several of the “reforms” making their way through Congress will do just the opposite – punish patients by saddling their caregivers with higher costs and more burdensome regulations.

It’s time the folks in Washington start taking a different approach. Health care reform, after all, is a lot like surgery. Simply hacking away at rising costs can have dire consequences, and fail to create the savings we need for a sustainable, quality-driven health care system.

So where should we start? Well, the first thing we must examine is how our physicians are compensated. Until we completely change the way the U.S. payment system is structured, we’ll never be able to bend the cost curve of health care spending. Sound payment reform can reduce disparities and harmful variations, expand access, and improve the quality of health care across the board.

Several months ago then-candidate Obama suggested taking a scalpel instead of an axe to health care reform. He was right on, and it’s time our lawmakers start trading in their suits for scrubs.

Posted by: accintouch | July 24, 2009 10:16 AM

to ghmbfisher:
I did not make the claim that one pill was as effective as another. I was paraphrasing the President. My point is only that, not all cost difference is due to packaging and marketing. Some is actually due to inferior, cheaper components. You state that synthroid and levothyroxine are equally efficatious for throid patients. They may well be, but I am saying that business is business, with pharmaceutical companies as well as battery plants, and, that quality and cost can, most assuredly, be related. In some cases you actually get, only what you pay for... not good when a life, or quality of a life, hangs in the balance.

Posted by: roanns | July 23, 2009 3:40 PM

My opinion is that there is no health care insurance that offers, and pays for, any and everything imaginable with no exceptions. I was happy to see that Obama as good as conceded that last night. I hope he gets through something that allows people care if they have to change jobs and have a "pre-existing condition," and I hope he is able to get Congress to get some people paying for some kind of option that keeps them out of the ER for sore throats, and also allows them to seek treatment for common illnesses before they become life-threatening. Such a policy might not provide heart surgery for people in their 80's who refuse to change their eating habits and monitor their diabetes, but it is going to save us a lot of money if many of the uninsured stop using the ER, and being admitted to hospitals for neglected, but simple, illnesses. We should all just be praying that whatever is being worked out in Washington is first, something that can be amended if it is not working well, and second, agreed to in a timely fashion. Am I the only fairly conservative person who sees that this issue is a horrid albatross around the neck of our economy; and, that any insurance will involve bureaucrats? Insurance company bureacrats decide who gets what and when now, as Obama pointed out last night. I hope good ole Olympia Snow and Susan Collins are hard at work on whatever plan we have in the end. I will trust that it is as well constructed as possible when they sign on. And I will be relieved. I lose my insurance when my husband retires. I've worked part time all these years, and been on his insurance. I'm healthy now, but have had a heart attack and asthma when I was obese. I'm having trouble getting insurance from "the insurance companies", so get on the ball, girls (Olympia and Susan.) I'm counting on you.

Posted by: olmamma | July 23, 2009 1:37 PM

Most doctors are conscientious but some are not (like a certain in-law of mine). They ring up the tests and procedures to make incredible amounts of money, and we all pay for it in raised premiums when it comes to private insurance and higher taxes (or a larger deficit) when it comes to Medicare or Medicaid. We absolutely need an impartial panel to advocate best practices and any one who is dubious of comparative-effectiveness research needs to read Sharon Begley’s eye-opening article:

Obama did a tremendous job last night pushing for the reforms we need I see him continuing to push against all the special interests making mountains of money at the expense of our health and pocketbooks. Don't let them fear-monger you into submission. Americans are closing in on the health care we deserve.

Posted by: zvelf | July 23, 2009 1:32 PM

Roanns asks a fair question on why the cheaper blue pill when the red pill is more expensive.

He then acknowledges that they are equally as effective so to me there is no question which to buy.

He then tries to compare pills to batteries and - sorry but they are not the same.


The expensive 'blue' pill is called "Synthroid" and is mfg by Abbott Labs. (Cost about $75.88 per hundred in the US and $26.00 per hundred in Canada.)

The cheaper 'pink' pill is called "Levothyroxine" and may be mfg by any number of companies - in my case it is Sandoz - a company just as respected as Abbott Labs. It is a generic. I have a government sponsored drug plan and it costs me $3.00 for 90 tabs.

The two are of equal quality and efficacy.

I don't know about Roanns but I am going to buy the cheaper one - as well we all should if we are going to control the cost of medical care and proved quality health care for all Americans.

Posted by: ghmbfisher | July 23, 2009 12:35 PM

What should be emphasized regarding health care is that between 85 and 90% of the American population HAS HEALTHCARE. Those without healthcare are to a large degree people under 30 years old who think they'll never get sick and won't buy
insurance. All children are assured by law
to have medical attention as required. All
poor people have healthcare through Medicaid. The elderly have healthcare through Medicare and nearly 40% of the
workforce has some kind of employer paid
healthcare. For the very few that fall through the cracks, hospital emergency
rooms are available. We complain now that those of us with healthcare plans must eventually pay for the healthcare of those without healthplans through taxes. Who do you think will pick up the tab when the employers stop providing healthcare plans since, under the proposed plan, for $750
per worker fine each year is a lot cheaper than what they're doing now? In summary,
90% of the population has healthcare and 100% have some type of access to medical sources. Finding ways to cut costs without creating a whole new government bureaucracy
is what we really need. That will take time to accomplish and we shouldn't jump into a half-baked plan that would pass through congress without anyone reading it, just as the failed stimulus bill. That
had 300 pages added at 2 AM by the Democrat caucus and most of Congress never
\read it.

Posted by: depoulins | July 23, 2009 12:32 PM

Why take a red pill when a blue pill, at half the cost is just as effective?
I worked for an automotive battery manufacturer for years. We made batteries for Sears, Motorcraft, Interstate,and lesser lights, in the battery selling business. We had our in plant manufacturing standards for components that went into all these batteries, but the individual customers had their own specifications as to how these components were arranged, determining cranking power, shelf life, resistance to heat, and length of a word, performance. The point is that, even though batteries all look pretty much the same, there can be a big difference in how they perform. Using my own experience as a guide, why would I trust that the blue battery (pill), costing less, is as good, at what it is supposed to do, as the red battery (pill)?

Posted by: roanns | July 23, 2009 11:04 AM

Great news conference by President Obama as usual.

It is obvious that the media elites, with their multimillion dollar salaries, are opposed to health care reform and thus the lukewarm reception last night.
Fortunately Obama is smarter than them and that’s why he’s going right over the media’s head to reach the American people directly.

Americans know Obama is right, and he will be remembered as the one President who made health care affordable for all Americans. It will be an achievement of historic proportions.

That’s the audacity of hope in action.

The journalists, for the most part, kept asking the same stupid questions: how are "we" (insert: we, with our 6 and 7 figure salaries) going to pay for it? what do "we"(insert: we, with our wasteful cadillac insurance plans) are going to have to give up?

They sounded like a bunch of children who didn't want to give up their lollypop.

What a shame.

Good thing that daddy Obama put them in their place. Did you see how frightened the first questioner was after Obama's opening? It was priceless.

Posted by: politicjock | July 23, 2009 11:03 AM

Last night Obama continuously lied to Americans! What BS!

Last night Obama continuously lied to Americans! What BS!

Last night Obama continuously lied to Americans! What BS!

Last night Obama continuously lied to Americans! What BS!

Posted by: Anoneemous | July 23, 2009 9:02 AM

This issue of choosing better treatments -- comparative care -- leads logically, if you put enough time into it and have enough economics background, to an elegant solution that indeed leaves the choices in the hands of the doctors/patients.

First the obvious: if payment is, for some categories of conditions, for outcomes in relation to specific narrowly-defined initial condition (certain precise heart conditions or diabetic conditions, etc.), then of course networks can profit exactly by choosing the most effective treatments that are affordable, since they are being paid according to outcome.

This is a lot easier than it sounds, since about 60% of all health care spending is for only about 6 conditions, according to the head of Mayo.

No rocket science in this pay-for-outcome so gets interesting to set up the public rules:

Posted by: HalHorvath | July 23, 2009 1:31 AM

marcom news is about as inciteful as a rock. A union supports Obama, big deal. A lot of different organizations support Obama, including the American Medical Association, who are comprised of doctors.

He also accuses Obama of lying without providing any evidence.

More inane chatter.

Posted by: tazmodious | July 23, 2009 1:01 AM

The anti health care reform crowd here hasn't said anything to convince me we shouldn't go forward on this.

Bandmom is complaining about the press.

Bessedhealth is complaining about rushing the process, yet health care reform has been on the burner since the Clinton presidency. That was over a decade ago.


austininc is complaining about the author of this column.

visionbrker. What does it mean to bend the cost curve? vision also complains that Obama sticks to his message. Makes sense to me if you are supporting what you are talking about. Didn't Bush coach the republican party to do the same?

Washingtondame, what does stuttering have to do with bills currently being drafted in congress?

curmudgeon. Your name tells me that it is you who should be happy.

Sorry, but you folks have no substance. You are, however, good at complaining about nothing. If this is all the repubs have, then they are pretty much useless to society anymore.

Posted by: tazmodious | July 23, 2009 12:55 AM

Oh, and he should have left the Henry Gates situation alone.

Posted by: Judy-in-TX | July 23, 2009 12:54 AM

There are some knowns about healthcare, and a few unknowns. We know that each party will use the facts to meet their own agenda, while minimizing any details that may undermine their case...We know it will cost a lot; we don't know if it will be worth it. Should I worry about that loser down the street if it means my kid will have to pay more for a doctor visit, or wait an hour and a half to see a doctor?_____
We know the drug and medical device companies are making billions - billions - under the present system and will fight-lie-cheat-bribe to keep what they have. That's the American way of business.
And millions - millions - of people and many, many children, not just a few poverty-stricken losers and loafers - are in need of medical care in America, while in Sweden, possibly the NERDIEST country in the world, cares for its sick, its elderly, its children and its women and still manages to fend off communism and bohemianism.....

But America is a manly country! Here its every man for himself as long as he can pay for it.

Posted by: kbtoledo | July 23, 2009 12:41 AM

Obama's health care plan is supported by AFSCME the public employee union. That is all anyone needs to know to determine that the plan stinks. AFSCME is the kiss of death because that bloated union is for anything that will rob taxpayers. Finally, anything Obama has to say is probably a lie, no matter how rhetorically brilliant it may sound. He has spent in six months as much as Bush did on the Iraq war $1 trillion with no end in sight. Barack has turned out to be a train wreck.

Posted by: marcom_news | July 23, 2009 12:26 AM

Wake up America. If you are not for healthcare reform you will continue to allow the health care industry fat cats dictate the story line. They will continue to scare you and NOTHING will get done. They will continue to tell you this is about rationing and loss of choice. Nothing could be farther from the truth. The AMA and the majority of physicians support healthcare reform. Please start to rally for single payer options. I am a physician, trust me, if you don't and are middle class, you will suffer the consequences of diminishing care at higher costs. If you don't do this I will just get richer, but I'm not sure this country will be a place where I will want to raise my children anymore.

Posted by: cindy2 | July 23, 2009 12:25 AM

If by firm grasp of the details of health care policy you mean a rambling incoherent unintelligible gobbledygook stew of hundreds of words strung together in a mind numbing fashion, then yeah, Obama has a firm grasp.

However, the press corps once again did NOT do its job. I guess you don't get called on if your question is not innocuous and pre-screened. And heaven forbid that anyone does any follow-up to ensure the question actually got answered. I guess you lose your bootlicker badge if you do that.

Posted by: bandmom22 | July 23, 2009 12:05 AM

The only thing I learned tonight was that this plan is good enough for you and me but not good enough for our elected representatives.

Posted by: harry9 | July 22, 2009 11:33 PM


There is absolutely NO NEED to rush this health care matter! Stop. Step back. The past 20 years has been a RAPE of the medical profession; don't perpetuate it.

And since the president said nothing would kick in until "2013," there are things that can be done in the meantime that will FREE PHYSICIANS to CARE FOR OUR PATIENTS!!! You won't have any doctors if this mess keeps up.

Although I voted for Barack Obama, I am most upset—infuriated, actually—with his handling of the health care reform debate.

Why is he ramming this down our throats before fully analyzing the pertinents of the issue?

Posted by: BlessedHealth | July 22, 2009 11:16 PM


FEMA, Secret Service, FBI, the U.S. military and intel agencies are among the federal enablers of volunteer community policing, anti-terrorism and town watch organizations transmogrified by Bush-Cheney into fronts for a nationwide, civilian Gestapo-like army.

This grassroots-based extrajudicial targeting and punishment "torture matrix" uses covertly implanted GPS tracking devices to stalk, harass, vandalize and terrorize unjustly "targeted" Americans and their families.

When "targets" travel, the GPS system alerts vigilantes affiliated with local units of this American Gestapo, and the harassment follows. Local police cooperation denies these targeted Americans their Constitutional right of equal protection under the law.

Silent, injury- and illness-inducing microwave and laser radiation "directed energy weapons" are being used to torture, and to degrade the lives of targeted citizens -- what could be described as a quiet, ideologically-motivated genocide.

This weaponization of the electromagnetic spectrum is every bit as socially significant as the invention of gunpowder -- but the mainstream media has yet to report in detail on the ramifications.

Victims charge that members of this civilian Gestapo have INFILTRATED THE HEALTH CARE SYSTEM, calling into question the quality of the services they receive when they need hospital or emergency care.

And companion array of “programs of personal financial destruction," using the IRS as a political weapon, sabotages the finances of targeted families. Their telecommunications and U.S. mail appear to be subject to warrantless surveillance, interception and tampering, including the alteration of financial accounts and credit card and utility billing statements.

This systematic bypass of the American judicial system makes a mockery of the rule of law -- and political "dissidents," "whistle-blowers" and those considered to be social "deviates" are among its prime targets.

Civil rights advocates: Wake up and smell the police state that has co-opted POTUS and a deluded Congress into becoming enablers of vigilante injustice and domestic torture.

OR (if link is corrupted / disabled):

See "GESTAPO USA" at ("stream" or "stories" list; malicious hackers have removed the main link from my blog page.)

Posted by: scrivener50 | July 22, 2009 11:12 PM

I think this Health Care Columnist needs to have his "EARS", examine. I watch and "HEARD" that Press Conference.

As a Citizen I heard a differ Press Conference, than what I just read in this Column. May the Columnist was to busy typing to really get it "RIGHT."

Since MacGills is so close to the Health Care System, he should make an Appointment to have his "EARS CHECKED."

Posted by: austininc4 | July 22, 2009 11:08 PM

Few would dispute that President Obama has developed a firm grasp on the details of health care policy --

I would dispute it. He covers the same talking points each time. if i have to hear one more time that "If you like your plan you can keep it" I'll scream.

This is the same president who mispronounced Geisinger Health Plans who he touts as a model. I guess his teleprompted doesn't have the phonetic spelling for him.

I sure hope the RIGHT reforms happen because they're needed but the endless cost shifting of medicare to private plans needs to stop.


Its a lovely concept but he needs to do it. And if he says what he really needs to do (RATION) then this bill is absolutely DOA. That's why he's talking around it.

Posted by: visionbrkr | July 22, 2009 10:59 PM

Passing a bad law now just to pass it will NOT improve the health care situation. Better to take the time to craft a really decent health reform package including provisions to put the screws on the malpractice lawyers and insurance companies, and overpriced pharmaceutical companies. After all, that's where MOST of the "health care" dollars eventually end up!

Posted by: Ojiisan | July 22, 2009 10:50 PM

For more on ObamaCare please read the article titled "Reagan Refutes The ObamaCare Hypothesis" posted on

Posted by: Cliffyworld | July 22, 2009 10:47 PM


The healthcare reform bill released by the House Of Representatives is an excellent bill as I understand it. It's a bill with a strong, robust, government-run public option, and an intelligent, reasonable initial funding plan to cover almost all of the American people. It is carefully written, and thoughtfully constructed, informed, prudent and wise. This bill will save trillions of dollars, and millions of your lives. It is also now supported by the AMA.

This is the type of bill that all Americans can feel good about. And this is the type of bill that has the potential to dramatically improve the quality of healthcare for all Americans. Rich, middle class and poor a like. Democrats, Republicans, Independents, and all other party affiliations. This bill has the potential to dramatically improve the quality of life of every American.

The house healthcare bill should be viewed as the minimum GOLD STANDARD by which all other proposed healthcare legislation should be judged. All supporters of true high quality healthcare reform should now place all your support behind this healthcare reform bill released by the United States House Of Representatives, as the minimum Gold standard for healthcare reform in America.

You should all now support this bill with all your might, and all of your unrelenting tenacity. This healthcare bill is a VERY, VERY GOOD! bill for all of the American people. Fight tooth, and nail for every bit of this bill if you have too. Be aggressive, creative, and relentless for this bill.

From this time forward, go BIGGER and DEEPER with the American people every day until passage of healthcare reform with a robust, government-run public option.

FIGHT!! like your life and the lives of your loved ones depends on it. BECAUSE IT DOES!


Senator Bernie Sanders on healthcare (

God Bless You

Jack Smith — Working Class

Posted by: JackSmith1 | July 22, 2009 10:44 PM

After watching Obama stutter and avoid and obfuscate his way through the questions, I am now even more convinced that health care reform will be costly, deadly disaster.

Posted by: WashingtonDame | July 22, 2009 10:38 PM

Changing the way benefits are delivered means that instead of getting paid for every test a doctor can dream up, there are incentives to increase the quality of care instead of the quantity. This could save money and also increase the length and quality of life for patients. Take my mother. A stress test killed her. It was obvious that her heart and physical condition wouldn't let her live through the surgery, but she wanted it anyway. She didn't even get to have the surgery. The stress test put her in intensive care and she eventually died. She would have live much longer without hoping for a futile surgery. Yet, medicare paid for it. Doctors had no incentive to stop her.

Posted by: goldie2 | July 22, 2009 10:29 PM

So, people use this argument against reform as if it wasn't already happening. Insurance companies veto treatments with their plans Exclusions and payment caps, plain and simple. WE have rationing already. And for some it is total rationing. No care at all. Why is the media not clear about this? It is as if the media were using the Republican talking points... which has been happening for years. The media is trying to scare up controversy and not illuminate the debate.

Posted by: goldie2 | July 22, 2009 10:24 PM

"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."

What, EXACTLY, does this mean? Not what it's intended to mean --- which is, "don't worry be happy, everything under reform is going to be so much call your Congressperson and Senator right away and urge them to pass this turkey, er, reform package..."

What is this phrase code for??

Posted by: Curmudgeon10 | July 22, 2009 10:18 PM

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