A Town Hall, and a Health Care Model, in Green Bay

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The President just concluded a town hall at Southwest High School in Green Bay, Wisconsin, with a focus on one of the President’s top priorities for his entire presidency. Over the past two weeks, the President has spelled out his vision for health care reform, met with key Members of Congress, and dedicated his Weekly Address to discussing the urgency of getting reform done and the unprecedented coalition that has formed to support that goal.
But passing health care reform is no DC parlor game, it is an issue that affects every family in America, addressing a problem that hangs over the head of every parent who faces the question of whether they can afford to give their children the care they need. And so it makes sense that the President is leaving the Beltway to talk directly to the American people. However, Green Bay is not just any American town, rather it has shown itself to be a model of controlling health care costs which have skyrocketed across the country and which will continue to do so unless reform gets done. The Washington Post describes a study from the University of Dartmouth, which the President and many others have cited: 
In the final two years of a patient's life, for example, they found that Medicare spent an average of $46,412 per beneficiary nationwide, with the typical patient spending 19.6 days in the hospital, including 5.1 in the intensive-care unit. Green Bay patients cost $33,334 with 14.1 days in the hospital and just 2.1 days in the ICU, while in Miami and Los Angeles, the average cost of care exceeded $71,000, and total hospitalization was about 28 days with 12 in the ICU.
For a President who has looked at every possible avenue to lower costs and expand access for all Americans while ensuring patient choice, Green Bay was a natural venue. But of course even as a model, Green Bay could not solve all the problems themselves, showing even more why comprehensive reform is necessary.   In his remarks the President addressed the broad problems at hand:
For the government, the growing cost of Medicare and Medicaid is the biggest threat to our federal deficit, bigger than Social Security, bigger than all the investments that we've made so far.  So if you're worried about spending and you're worried about deficits, you need to be worried about the cost of health care.
We have the most expensive health care system in the world, bar none.  We spend almost 50 percent more per person on health care than the next most expensive nation -- 50 percent more.  But here's the thing, Green Bay:  We're not any healthier for it; we don't necessarily have better outcomes.  Even within our own country, there are a lot of the places where we spend less on health care, but actually have higher quality than places where we spend more.  And it turns out Green Bay is a good example.  Right here in Green Bay, you get more quality out of fewer health care dollars than many other communities across this country.  (Applause.)  That's something to be proud of.  I want to repeat that:  You spend less; you have higher quality here in Green Bay than in many parts of the country.  But across the country, spending on health care keeps on going up and up and up -- day after day, year after year.
I know that there are millions of Americans who are happy, who are content with their health care coverage -- they like their plan, they value their relationship with their doctor.  And no matter how we reform health care, I intend to keep this promise:  If you like your doctor, you'll be able to keep your doctor; if you like your health care plan, you'll be able to keep your health care plan.
And he also addressed some of the specific solutions he would like to see, in addition to measures already passed like improved health IT:
But the real cost savings will come from changing the incentives of a system that automatically equates expensive care with better care.  We've got to move from addressing -- we've got to address flaws that increase profits but don't actually increase the quality of care for patients.
We have to ask why places like Geisinger Health systems in rural Pennsylvania, or Intermountain Health in Salt Lake City, or communities like Green Bay can offer high-quality care at costs well below average, but other places in America can't.  We need to identify the best practices across the country, learn from the successes, and then duplicate those successes everywhere else.
And we should change the warped incentives that reward doctors and hospitals based on how many tests and procedures they do -- (applause) -- even if those tests and procedures aren't necessary or result from medical mistakes.  Doctors didn't get into the medical profession to be bean counters or paper pushers.  They're not interested in spending all their time acting like lawyers or business executives.  They became doctors to heal people, and that's what we have to free them to be able to do.
We also have to provide Americans who can't afford health insurance more affordable options.  That's a economic imperative but it's also a moral imperative, because we know that when somebody doesn't have health insurance, they're forced to get treatment at the ER, and all of us end up paying for it.  The average family pays a thousand dollars in extra premiums to pay for people going to the emergency room who don't have health insurance.  So you're already subsidizing other folks; it's just you're subsidizing the most expensive care.  You'd be better off subsidizing to make sure they were getting regular checkups.  We're already paying for it.  It's just it's hidden in your premiums.
So what we're working on is the creation of something called the Health Insurance Exchange, which would allow you to one-stop shop for a health care plan, compare benefits and prices, choose the plan that's best for you.  If you're happy with your plan, you keep it.  None of these plans, though, would be able to deny coverage on the basis of pre-existing conditions.  (Applause.)
Every plan should include an affordable, basic benefits package.  And if you can't afford one of these plans, we should provide assistance to make sure that you can.  (Applause.)  I also strongly believe that one of the options in the Exchange should be a public insurance option.  (Applause.)  And the reason is not because we want a government takeover of health care -- I've already said if you've got a private plan that works for you, that's great.  But we want some competition.  If the private insurance companies have to compete with a public option, it'll keep them honest and it'll help keep their prices down.  (Applause.)
Now, covering more Americans is obviously going to require some money up front.  We'll save money when they stop going to the emergency room and getting regular checkups, but it's going to cost some money up front.  Helping families lower their costs, there's going to be a cost to this.  And it comes at a time when we don't have a lot of extra money to spend, let's be honest.  When I came in we had a $1.3 trillion deficit.  And with the economic recession that we're going through, tax revenues are down -- I was talking to Governor Doyle -- tax revenues are down, more people are seeking help from the state.  So we've got a lot of pressure on our budget.
So that's why I've already promised that reform cannot add to our deficit over the next 10 years.  And to make that happen, we've already identified hundreds of billions of dollars worth of savings in our budget -- savings that will come from steps like reducing Medicare overpayments to insurance companies and rooting out waste and fraud and abuse in both Medicare and Medicaid.  And I'll be outlining hundreds of billions of dollars more in savings in the days to come.  And I'll be honest, even with these savings, reform will require some additional up front resources.  And that's why I've proposed that we scale back how much the highest-income Americans can deduct on their taxes back -- take it back to the rate that existed under the Reagan years, and we could use some of that money to help finance health care reform.  (Applause.)
In all these reforms, our goal is simple:  the highest-quality health care at the lowest-possible cost.  Let me repeat what I said before:  We want to fix what's broken, build on what works.
As the President made clear, no excuses, no endless delay. 
The President speaks at a town hall in Green Bay
(President Barack Obama speaks at a town hall meeting on health care reform Thursday, June 11, 2009, at Southwest High School in Green Bay, Wisconsin.  Official White House Photo by Chuck Kennedy.)
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