..

>> the house will come to order. it's my privilege to introduce doctor nancy h. nielsen, resident of the american medical association. [applause]

>> thank you. if you have watched the president, he goes thank you, thank you, and you sit down. good morning, everyone. it's a great, great honor and privilege for us to welcome back home to chicago the president chicago the president of the united states, barack obama. [applause] >> the president will be coming in and just a second, just a couple words to him. mr. president, we appreciate that you've taken the timeout of a busy schedule to join us, and we are grateful for your efforts to make the path towards reform as open and inclusive as possible, and in particular that we have been included in those efforts. you have said that a test of the

american ideal is whether we allow ourselves to be shaped by events and history, or whether we act to shape them. america's physicians want to help shape a better future for our patients and our country. [applause] >> we know firsthand that change is needed and that the status quo is acceptable. [applause] >> we appreciate the investment you have already made to help physicians in four areas. first, the purchase of health it equipment and we look forward to standards for intraoperative

ability. [applause] >> and we thank you for the investment in comparative effectiveness research to enhance quality medical care. [applause] >> in your budget, you use realistic numbers about the cost of treating medicare patients. and you chartered a course to replace the senseless medicare physician payment formula, and you're the first president to do it. and we thank you for that. [applause] >> you've recognized that medical liability concerns contribute to rising health care costs, and we appreciate your interest in addressing this problem.

it is critical to the physicians of this country. [applause] >> friends, i've had the opportunity to meet president obama at the white house, and i can attest to his willingness to listen and to engage. his focus on health care reform and the plight of the uninsured, and the concerns of those involved takes a courageous spirit and wise judgment. and we are grateful for his leadership. so please join me as the american medical association welcomes the president of the united states, arauca bala. [applausebarack obama.

[applause] >> thank you. thank you. thank you so much. it's good to see you. thank you. thank you so much. please everybody, be seated. thank you so much. your very kind. thank you. let me begin by thanking nancy for the wonderful introduction. i want to thank doctor joseph heyman, the chair of the board of trustees as well as doctor jeremy lazarus, speaker of house of delegates are thanks to all of you for bringing me home or even if it's just for a day. [applause] >> you know, from the moment i took office as president, the

central challenge we confronted as a nation has been the need to lift ourselves out of the worst recession since world war ii. and in recent months we have taken a series of extraordinary steps, not just to repair the immediate damage to our economy but to build a new foundation for lasting and sustained growth. we are here to create new jobs. to unfreeze our credit markets. for stemming the loss of homes and the decline of home values. all this is important. but even as we've made progress, we know that the road to prosperity remains long and it remains difficult. and we also know that one essential step on our journey is to control the spiraling cost of health care in america. and in order to do that we are

going to need the help of the ama. [applause] >> today we are spending over $2 trillion a year on health care. almost 50% more per person than the next most costly nation. and yet, as i think many of you are aware, for all of this spending, more of our citizens are uninsured. the quality of our care is often lower. and we aren't any healthier. in fact, citizens in some countries that spend substantially less than we do are actually living longer than we do. make no mistake. the cost of our health care is a threat to our economy. it's an escalating burden on our families and businesses. it's a ticking time bomb for the

federal budget. and it is unsustainable for the united states of america. it's unsustainable for americans like lauren could skip, a young mother who i met in wisconsin just last week, who learned that the breast cancer she thought she had been had spread to her bones. but who is now being forced to spend time worrying about how to cover the $50000 in medical debt she's already accumulated, worried about future debts that she is going to accumulate, when all she wants to do is spend time with her two children and focus on getting well. these are not the worries that a woman like laura should have to face in the nation as wealthy as ours. [applause] >> stories like laura's are

being told by women and men all across this country. by families who have seen out of pocket costs soar and premiums doubled over the last decade at a rate three times faster than wages. this is forcing americans of all ages to go without a checkups or the prescriptions they need. that you know they need. it's creating a situation where a single illness can wipe out a lifetime of savings. our costly health care system is unsustainable for doctors. like michael kahn in new hampshire who, as he puts it, spends 20% of each day supervising a staff, explaining insurance problems to patients, completing authorization forms, writing a few letters, a routine that he calls disruptive and distracting giving him less time to do what he became a doctor to do and actually care for his patients. [applause]

>> small-business owners, like chris and becky link and nashville are also struggling. they have always wanted to do right by the workers at the family-run marketing firm. but they recently had to do the unthinkable and lay off a number of employees, lay off that could have been deferred, they say, if health care costs weren't so high. across the country over one third of small businesses have reduced benefits in recent years, and one third have dropped their workers coverage altogether since the early '90s. our largest companies are suffering as well. a big part of what led general motors and chrysler into trouble in recent decades were the huge cost they racked up providing health care for their workers. cost that made them less profitable and less competitive with automakers around the

world. if we do not fix our health care system, america may go the way of gm. paying more, getting less and going broke. when it comes to the cost of health care, the status quo is unsustainable. [applause] >> the reform is not a luxury. is a necessity. when i hear people say, well why are you taking this on right now you have all these other problems. i keep reminding people i would love to be able to defer these issues, but we can't. i know there's been much discussion about what reform would cost, and rightly so. this is a test of whether we, democrats and republicans alike, are serious about holding the line on new spending and restoring fiscal discipline. but let there be no doubt, the

cost of inaction is greater. if we fail to act. [applause] >> if we fail to act, and you know this because you see it in your own individual practices. if we fail to act, premiums will climb higher, benefits will erode further, the rolls of the uninsured will swell to include millions more americans. all of which will affect your practice your if we fail to act, one out of every $5 we earned will be spent on health care within a decade. and in 30 days it will be about one out of every three, a trend that will mean lost jobs, lower take-home pay, shuttered businesses and a lower standard of living for all americans. and if we fail to act, federal spending on medicaid and medicare will grow over the coming decades by an amount almost equal to the amount our government currently spends on our nation's defense.

it will, in fact, eventually grow larger than what our government spends on anything else today. there's a scenario that will swap our federal and state budgets. and impose a vicious choice of either unprecedented tax hikes or overwhelming deficit, or drastic cuts in our federal and state budgets. so to say it as plainly as i can, health care is the single most important thing we can do for america's long term fiscal health. that is a fact. that's a fact. [applause] >> it's a fact, and the truth is most people know that it's a fact. and yet as clear as it is, that our system badly needs reform, reform is not inevitable.

there's a sense out there among some, and perhaps some members who are gathered here today of the ama, that as bad as our current system may be, and it's pretty bad, the devil we know is better than the devil we don't. there's a fear of change. a worried that we may lose what works about our health care system while trying to fix what doesn't. i'm here to tell you i understand that fear, and i understand the cynicism. there are scars leftover from past efforts at reform. after all, presidents have called for health care reform for nearly a century. teddy roosevelt called for it, harry truman call for it, richard nixon called for, jimmy carter called for it, bill clinton called for it. but while significant individual reforms have been made, such as medicare, medicaid and the children's health insurance

program, effort at toppings of reform that covers everyone and brings down costs have largely failed. and part of the reason is because of the different groups involved, doctors, insurance companies, businesses, workers, and others, simply couldn't agree on the need for reform for what shape it would take. and if we're honest, another part of the reason has been the fierce opposition fueled by some interest groups and lobbyists, opposition that has used fear tactics to paint any effort to achieve reform as an attempt to, yes, socialized medicine. despite his long history of failure, i'm standing here because i think we're in a different time. one time that things are different is that just this past week the senate passed a bill that will protect children from the dangers of smoking, and reform the ama has long championed.

[applause] >> this organization longchamp in, it went nowhere when it was proposed a decade ago. i'm going to sign this into law. now, what makes this -- what makes this moment different is that this time for the first time, key stakeholders are aligning not against but in favor of reform. they are coming out based they are coming together out of a recognition that while reform will take everyone in our health care community to do their part. everybody is going to have to pitch in. ultimately everybody will benefit. and i want to commend the ama in particular for offering to do your part to curb costs and achieve reform. just a week ago you joined

together with hospitals, labor unions, insurers, medical device manufacturers and drug companies to do something that would have been unthinkable just a few years ago. you promised to work together to get national health care spending by two clear dollars over the next decade relative to what it would have otherwise been. that will bring down costs. that will bring down premiums. that's exactly the kind of cooperation we need, and we appreciate that very much. thank you. [applause] >> now, the question is how do we finish the job. how do we permanently bring down costs and make quality affordable health care available to every single american. that's what i've come to talk about today. we note the moment is right for health care reform. we know this is a historic opportunity. we have never seen before and may not see again. but we also know that there are

those who will try and scuttle this opportunity no matter what. who will use the same scare tactics and fear mongering that's worked in the past. who will give warnings about socialized medicine and government takeovers, long lines and rationed care, decisions made by bureaucrats and not doctors here we have heard this all before. and because these fear tactics have worked, things that kept getting worse. so let me begin by saying this. to you and to the american people, i know that there are millions of americans who are content with their health care coverage. they like their plan, and most importantly they value their relationship with their doctor. they trust you. and that means that no matter how we reform health care, we will keep this promise to the american people. if you like your doctor, you will be able to keep your doctor.

period. [applause] >> if you like her health care plan, you will be able to keep your health care plan. period. [applause] >> no one will take it away. no matter what. my view is that health care reform should be guided by a simple principle. fix what's broken, and build on what works. and that's what we intend to do. if we do that, we can build a health care system that allows you to be physicians instead of administrators and accountants, a system that gives americans a system that gives americans the best care at the lowest cost, a system that uses up the pressure on businesses and unleashes the promise of our economy creating hundreds of thousands of jobs,

making take-home wages thousands of dollars higher, and growing our economy by tens of millions of dollars more every year. that's how we will stop spending tax dollars to prop up an unsustainable system and start investing those dollars in innovations and advances that will make our health care system and our economy strong. that's what we can do with this opportunity. and that's what we must do with this moment. now, the good news is that in some instances there is already widespread agreement on the steps necessary to make our health care system work better. first, we need to upgrade our medical records by switching from a paper to an electronic system of record keeping. we've already begun to do this with an investment be made as part of our recovery act. it's simply doesn't make sense that patients in the 21st century are still filling out

forms with pins on papers that have to be stored away somewhere. as newt gingrich has rightly pointed out, and i don't quote newt gingrich that often. [laughter] >> we do a better job tracking a fedex package in this country than we do tracking patient health records. [applause] >> you shouldn't have to tell every new doctor you see about your medical history or what prescriptions you're taking. you shouldn't have to repeat costly test. all that information should be stored securely in a private medical records so that your information can be tracked from one doctor to another, even if you change jobs, even if you move, even if you have to see a number of different specials. that's just common sense. [applause] >> and that will not only mean less paperpushing and lower

administrative costs, saving taxpayers billions of dollars, it will also meet all of you, physicians, will have an easier time doing her job. it will tell you the doctors what drugs a patient is taking so you can avoid prescribing a medication that could cause a harmful interaction. it will prevent the wrong dosages from going to a patient. it will reduce medical errors, it's estimated, that lead to 100,000 lives lost unnecessarily and our hospitals every year. so there shouldn't be any argument they are. and we want to make sure that we are helping providers computerized so we can get the system up and running. now the second step that we can all agree on is to invest more and preventive care so that we can avoid illness and disease in the first place. [applause] >> that starts with each of us taking more responsibility for our health and for the health of our children.

[applause] >> it means quitting smoking. it means going in for that mammogram or colon cancer screening. it means going for a run or hitting the gym and raising our children to step away from the video games and spend more time playing outside. [applause] >> it also means cutting down on all the junk food that's fueling an epidemic of obesity. [applause] >> gets put to farm many americans, young and old, up costly chronic conditions and that's a lesson michele and i have tried to instill in our daughters. some of you know, we started a white house vegetable garden. i say we generously because michele has done most of the work. [laughter] >> that's a lesson that we

should work with local school districts to incorporate into their school lunch programs. building a health care system that promotes prevention rather than just managing diseases will require all of us to do our part. it will take doctors telling us what risk factors we should avoid and what preventive measures we should pursue. it will take employers following the example of places like safeway that is rewarding workers for taking better care of their health while reducing health care costs in the process. if you're one of three quarters of safeway workers enrolled in their healthy measures program, you can get screened for problem like high cholesterol or high blood pressure, and if you score well you can pay lower premiums. you get more money in your paycheck. it's a program that has helped safeway cut health care spending by 13%, and workers save over 20% on their premiums. and we're open --

[applause] >> we're open to doing more to help employers adopt and expand programs like this one. now our federal government also has to step up its efforts to events because of healthy ones. five of the costliest illnesses and conditions, cancer, cardiovascular disease, diabetes, lung disease and strokes can be prevented. and yet only a fraction of every health care dollar goes to prevention for public health. that's starting to change with an investment we are making in prevention and wellness programs that can help us avoid diseases that harm our health and on the health of our economy. but as important as they are, investment in electronic records and preventive care, all the things that i just mentioned, they are just preliminary steps. they will only make a dent in

the epidemic of rising costs in this country. despite what some have suggested, the reason we have the spiraling costs is not simply because we got an aging population. demographics due account for part of rising costs because older, sicker societies pay more on health care than younger and healthier ones. and there is nothing intrinsically wrong in us taking better care of ourselves. but what accounts for the bulk of our cause is the nature of our health care delivery system itself. a system where we spend vast amounts of money on things that aren't necessarily making our people any healthier. a system that automatically equates more expensive care with better care. now a recent article in the new yorker, for example, showed how mcallen, texas, is spending

twice as much as el paso county. twice as much. not because people in mcallen, texas, are sicker than they are in el paso, not because they are getting better care or getting better outcomes. it's simply because they are using more treatments. treatments that in some cases they don't really need. treatments that in some cases can actually do people harmed by raising the risks of infection or medical error. and the problem is this pattern is repeating itself across america. one dartmouth study shows that you are less likely, -- you are no less likely to die from a heart attack and other ailments in a higher spending area than in a lower spending area. there are two main reasons for this. the first is a system of incentives where the more tests and services are provided, the

more money we pay. and a lot of people in this room know what i'm talking about. it's a model that rewards the quantity of care rather than the quality of care. that pushes you, the doctor, to see more and more patients, even if you can't spend much time with each. and gives you every incentive to order that extra mri or ekg, even if it's not necessary. it's a model that has taken the pursuit of medicine from a profession, a calling, to a business. that's not why he became doctors. that's not why you put in all those hours in the anatomy suite or the o.r., that's not what brings you back to a patient's bedside to check in or makes you call a loved one of a patient to say it will be fine.