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President Obama holds a “town hall” meeting on health care reform, sponsored by the American Association of Retired Persons (AARP). The meeting is conducted by telephone at AARP’s Washington headquarters, where a small studio audience and approximately 180,000 callers from around the country listen and take part.
Rumor Control - In his introduction, AARP CEO A. Barry Rand tells the participants: “There’s a lot of misinformation about health care reform—even on what AARP stands for, and what AARP supports. This town hall is part of our ongoing effort to debunk myths and provide accurate information.… I want to make it clear that AARP has not endorsed any particular bill or any of the bills being debated in Congress today. We continue to work with members of Congress on both sides of the aisle and with the administration to achieve what is right for health care reform.” AARP president Jennie Chin Hansen notes some of the most prevalent myths and misinformation about health care reform as expressed in previous AARP-sponsored town halls: “Like, will the government tell my doctor how to practice medicine?” For his part, Obama says: “Nobody’s trying to change what does work in the system. We are trying to change what doesn’t work in the system.” He reassures the participants that “Nobody is talking about cutting Medicare benefits. I just want to make that absolutely clear.… [W]e do want 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 strengthen the system.”
Opposition Profiting from Status Quo - Of the anti-reform opposition, Obama says: “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.… Back when President Kennedy and then President Johnson were trying to pass Medicare, opponents claimed it was socialized medicine. 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 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.… 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.” If nothing is done to change the status quo, Obama says, the cost of health care coverage will rise dramatically. “Health care costs are going up much faster than inflation,” he says, “and your premiums will probably double again over the next 10 years.… We’re already seeing 14,000 people lose their health insurance every day. So the costs of doing nothing are trillions of dollars over the next couple of decades—trillions, not billions… without anybody getting any better care.” Controlling health care inflation will allow the government to stabilize the Medicare trust fund: “[N]ot 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.”
End-of-Life Rumors - One caller is concerned about rumors surrounding end-of-life care. “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,” she says. “This bothers me greatly, and I’d like for you to promise me that this is not in this bill.” The host elaborates: “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.” Obama replies, “Well, that would be kind of morbid,” and reassures the caller that the rumors are not true, adding, “Nobody is going to be knocking on your door.” He explains that one proposal would have Medicare pay for consultations between doctor and patients about living wills, hospice care, and other information critical to end-of-life decisions. “The intent here is to simply make sure that you’ve got more information, and that Medicare will pay for it,” he says. “The problem right now is that most of us don’t give direction to our family members, so when we get really badly sick… the [doctors] are making decisions in consultation with your kids or your grandkids and nobody knows what you would have preferred.” Obama is refuting rumors that claim under his reform proposal, elderly Americans would be encouraged to die sooner (see July 16, 2009 and July 23, 2009).
Pre-Existing Conditions - Insurers will no longer be able to deny care to people with so-called “pre-existing conditions.” Obama reflects on his mother, who died of cancer: “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 she’d already paid premiums on. And that happens all across the country. We’re going to put a stop to that.… 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.… We want clear, easy-to-understand, straightforward insurance that people can purchase.”
Keeping Existing Coverage - Obama reassures another caller that she will not have to drop the coverage she has. “Here’s a guarantee that I’ve made: If you have insurance that you like, then you’ll be able to keep that insurance. If you’ve got a doctor that you like, you’ll be able to keep your doctor. Nobody is going to say you’ve got to change your health care plan. This is not like Canada where suddenly we are dismantling the system and everybody’s signed up under some government program. 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.… 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.” Those dissatisfied with their coverage, or who have no coverage at all, would have a wider array of choices, including, perhaps, a government-run plan (the “public option”).
Rationing Health Care? - One caller asks, “Even if I decide when I’m 80 that I want a hip replacement, am I going to be able to get that?” Obama responds: “My interest is not in getting between you and your doctor—although keep in mind that right now insurance companies are often getting between you and your doctor. [Decisions] are being made by private insurance companies without any guidance as to whether [they] are good decisions to make people healthier or not. So we just want to provide some guidelines to Medicare, and by extension the private sector, about what [treatments] work and what doesn’t.… We don’t want to ration by dictating to somebody [that] we don’t think this senior should get a hip replacement. We do want to provide information to [you and your doctor about what] is going to be most helpful to you in dealing with your condition.” He gives the following analogy: “If you figure out a way to reduce your heating bill by insulating your windows… you’re still warm inside. [But] you’re not wasting all that energy and sending it in the form of higher bills to the electric or gas company. And that’s then money you can use to save for your retirement or help your kid go to college. Well, it’s the same principle within the health system.” Obama is refuting claims by health care opponents that the government intends to ration health care and deny elderly patients needed treatment (see November 23, 2008, January 27, 2009, February 9, 2009, February 11, 2009, February 18, 2009, May 13, 2009, June 24, 2009, June 25, 2009, July 10, 2009, July 16, 2009, July 17, 2009, July 21, 2009, July 23, 2009, July 23, 2009, July 23, 2009, July 23-24, 2009, July 24, 2009, July 28, 2009, July 28, 2009, and July 28, 2009).
Reform Not 'Socialized Medicine' - Obama assures the participants that his vision of health care reform is not socialism under any guise. “A lot of people have heard this phrase ‘socialized medicine,’” he says. “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.” He recalls: “I got a letter from a woman the other day. She said, ‘I don’t want government-run health care. I don’t want socialized medicine. And don’t touch my Medicare.‘… I wanted to say, ‘That’s what Medicare is. It’s a government-run health care plan that people are very happy with.’”
Conclusion - Obama says he doesn’t expect a perfect health care system. “But we could be doing a lot better than we’re doing right now,” he says. “We shouldn’t have people who are working really hard every day without health care or with $8,000 deductibles—which means basically they don’t have health insurance unless they get in an accident or they get really sick. That just doesn’t make sense. So we’ve got to have the courage to be willing to change things.” After the town hall ends, AARP board chair Bonnie Cramer says she believes Obama “really made it very clear that Medicare beneficiaries will not see cuts in Medicare services.” By speaking directly to older Americans, Cramer says, “He put to rest a lot of their concerns.” (Beam 7/28/2009; AARP Bulletin Today 7/29/2009; McKnights 7/29/2009)
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