A Tele-Town Hall on Health Insurance Reform at the AARP

And that's why I want to start by taking a new approach that emphasizes prevention and wellness, so that instead of just spending billions of dollars on costly treatments when people get sick, we're spending some of those dollars on the care they need to stay well: things like mammograms and cancer screenings and immunizations – common-sense measures that will save us billions of dollars in future medical costs.

 

We're also working to computerize medical records, because right now, too many folks wind up taking the same tests over and over and over again because their providers can't access previous results.  Or they have to relay their entire medical history – every medication they've taken, every surgery they've gotten – every time they see a new provider. Electronic medical records will help to put an end to all that.

 

We also want to start rewarding doctors for quality, not just the quantity, of care that they provide. Instead of rewarding them for how many procedures they perform or how many tests they order, we'll bundle payments so providers aren't paid for every treatment they offer with a chronic – to a patient with a chronic condition like diabetes, but instead are paid for how are they managing that disease overall. And we'll create incentives for physicians to team up and treat a patient better together, because we know that produces better outcomes.

 

And we certainly won't cut corners to try to cut costs, because we know that doesn't work. And that's something that we hear from doctors all across the country. For example, we know that when we discharge people from the hospital a day early without any kind of coordinated follow-up care, too often they wind up right back in the hospital a few weeks later. If we had just provided the right care in the first place, we'd save a whole lot of money and a lot of human suffering, as well.

 

Finally, we'll eliminate billions in unwarranted subsidies to insurance companies in the Medicare Advantage program – giveaways that boost insurance company profits but don't make you any healthier. And we'll work to close that doughnut hole in Medicare Part D that's costing so many folks so much money. Drug companies, as a consequence of our reform efforts, have already agreed to provide deeply discounted drugs, which will mean thousands of dollars in savings for the millions of seniors paying full price when they can least afford it.

 

Number one, if you've got a preexisting condition, insurance companies will still have to insure you. This is something very personal for me. My mother, when she contracted cancer, the insurance companies started suggesting that, well, maybe this was a preexisting condition; maybe you could have diagnosed it before you actually purchased your insurance. Ultimately, they gave in, but 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 that she had already paid premiums on. And that happens all across the country. We are going to put a stop to that. That's point number one.

 

Point number two: 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, as long as you're willing to pay your premiums. They are – we're going to make sure that we eliminate sort of the lifetime cap that creates a situation – a lot of times people get sick, then they find out the fine print says that at a certain point they just stop paying, or they'll pay for your hospitalization but they don't pay for your doctor, or they pay for your doctor but not your hospitalization.

 

We want clear, easy-to-understand, straightforward insurance that people can purchase. So that's point number one.

 

Point number two is, in addition to those reforms, we want to make sure that we set up what's called a health insurance exchange so that anybody who wants insurance but can't get it on their job right now, they can go to this exchange; they can select a plan that works for them or their families – these are private-option plans, but we also want to have a public option that's in there – but whatever you select, you will get high-quality care for a reasonable cost, the same way Congress, members of Congress, are able to select from a menu of plans that they have available. And if you're very – if the plan that you select is still too expensive for your income, then we would provide you a little bit of help so that you could actually afford the coverage.

 

So the idea behind reform is: Number one, we reform the insurance companies so they can't take advantage of you. Number two, that we provide you a place to go to purchase insurance that is secure, that isn't full of fine print, that is actually going to deliver on what you pay for. Number three, we want to make sure that you're getting a good bargain for your health care by reducing some of the unnecessary tests and costs that have raised rates.

 

Even if you have health insurance, your premiums have gone up faster than wages over the last 10 years. Your out-of-pocket costs have gone up about 62 percent, which means that for people who aren't on Medicare right now, people let's say 54 to – or 50-64, a lot of those folks are paying much higher premiums than they should be – hundreds or thousands of additional dollars that could be saved if we had a system that was more sensible than it is right now.

 

Q: I have heard lots of rumors going around about this new plan, and I hope that the people that are going to vote on this is going to read every single page there. 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. This bothers me greatly and I'd like for you to promise me that this is not in this bill.

THE PRESIDENT: You know, I guarantee you, first of all, we just don't have enough government workers to send to talk to everybody, to find out how they want to die.

 

I think that the only thing that may have been proposed in some of the bills – and I actually think this is a good thing – is that it makes it easier for people to fill out a living will.