When President Obama touches down today in Green Bay, Wis., he will be landing in one of the highest-value health communities in the nation, a city that by numerous measures has managed to control medical spending while steadily improving health outcomes.

President Obama focuses on health care reform in remarks to a Green Bay, Wisconsin, resident on Thursday, June 11. (Photo: Getty Images)

    Less May Be Better

    "If we could make the rest of the nation practice medicine the way that Green Bay does, we would have higher quality and significantly lower costs," said Peter Orszag, the Obama administration budget chief who has emerged as a key player on health-care reform.

    In his drive to rein in skyrocketing health-care costs, Obama is increasingly focused on wasteful medical care that does not extend life and may actually be harmful. Today's town-hall-style meeting, his first as president to promote health reform, is intended to spotlight one city's strategy for squeezing out waste without hurting quality.

Also see below:     

President Barack Obama | Remarks on Health Care Reform    •

    The event, coupled with a speech to the American Medical Association on Monday, represents a fresh push by the White House to sell the public on legislation that could dramatically alter how care is given and paid for in this country.

    "In the coming days and weeks as Congress moves to the issue, the president will be more active in making the public case for the urgent need to reform our health-care system," said White House spokesman Dan Pfeiffer.

    What Obama is likely to hear in Green Bay is testimony to the value of digital records, physician collaboration, preventive care and transparency, say those most involved in Wisconsin's innovative approach.

    "There's been a fairly steady progression of quality" in areas such as diabetes care and cancer screening, said Chris Queram, executive director of the Wisconsin Collaborative for Healthcare Quality, which publishes statewide performance measures. "Every physician believes he is doing the very best for their patients, but when they see data that their group is not practicing at the same level as across the state, it's a real positive motivator to improve."

    The federal Agency for Healthcare Research and Quality gives Wisconsin high scores on 100 measures, ranging from the treatment of heart disease to childhood asthma.

    But it is the findings of the Dartmouth Institute for Health Policy and Clinical Practice that have generated the most excitement in the Obama administration, all the way up to the Oval Office. For more than a decade, the New Hampshire researchers have documented and mapped wide variations in the cost and types of care given to American seniors through the Medicare program, concluding that spending more on health care has not resulted in better health.

    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.

    Some differences can be explained by big-city prices, acknowledged Elliott Fisher, principal investigator for the Dartmouth Atlas Project, "but the differences that are really important are due to the differences in utilization rates."

    Much of the evidence suggests that the more doctors, more drugs, more tests and more therapies given to patients, the worse they fare - and the unhappier they become, said Donald Berwick, president of the independent research group Institute of Quality Improvement.

    That has been the case at Gundersen Lutheran Health System in La Crosse, Wis., which has spending patterns comparable to Green Bay's. Persuading patients to sign medical directives and using electronic medical records to alert doctors and nurses, for example, the health system has dramatically reduced the intrusive, expensive end-of-life procedures that often drive up costs but rarely stave off death for long, said chief executive Jeffrey E. Thompson.

    "At the end of life, what most people want is for their wishes to be respected," not to undergo an aggressive battery of tests and treatments, he said.

    Richard Cooper, professor of medicine at the University of Pennsylvania, says he thinks the variations identified by the Dartmouth researchers - due primarily to enormous hospital expenses - are often related to patients' socioeconomic status. States such as Wisconsin have lower medical costs because they are predominantly white and middle class, he said. The notable exception is Milwaukee, with its "poverty corridor," he said. "Nobody wants to talk about the fact that if you want to deal with health care you have to deal with poverty."

    In Green Bay, health providers are partnering with employers to attack the root causes of high health-care costs, said George Kerwin, chief executive of Bellin Health System. Investments in primary care and free health assessments are beginning to pay dividends - even for the health system's own 3,000 employees, he said. After years of double-digit insurance premium hikes, Bellin has brought the increases down to less than 3 percent a year.

    In La Crosse, Thompson is using similar strategies.

    "In our country we've chosen to spend a ton of money on the health-care delivery part and not much" promoting healthier lifestyles, he said. As the single largest purchaser of care, the government "could use that leverage to focus on keeping people healthy rather than lots of technology-based treatment of disease," he said.

:::::::::::::::::::::::::::::::::::::::::::::::::

Remarks of President Barack Obama on Health Care Reform

Thursday 11 June 2009

by: Visit article original @ The Boston Globe

    Green Bay, Wisconsin

    Thank you. It is wonderful to be back here in Green Bay. I want to thank Southwest High School for hosting us today, and I want to thank Laura for sharing her story. It takes courage to do that, and it takes even more to battle a disease like cancer with such grace and determination.

    Laura's story is incredibly moving. Sadly, it is not unique. Every day in this country, more and more Americans are forced to worry not simply about getting well, but whether they can afford to get well. Millions more wonder if they can afford the routine care necessary to stay well. Even for those who have health insurance, rising premiums are straining their budgets to the breaking point - premiums that have doubled over the last nine years, and have grown at a rate three times faster than wages. Desperately-needed procedures and treatments are put off because the price is too high. And all it takes is a single illness to wipe out a lifetime of savings.

    Employers aren't faring any better. The cost of health care has helped leave big corporations like GM and Chrysler at a competitive disadvantage with their foreign counterparts. For small businesses, it's even worse. One month, they're forced to cut back on health care benefits. The next month, they have to drop coverage. The month after that, they have no choice but to start laying off workers.

    For the government, the growing cost of Medicare and Medicaid is one of the biggest threats to our federal deficit. Bigger than Social Security. Bigger than all the investments 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. We spend almost 50% more per person on health care than the next most costly nation. 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, a lot of the places where we spend less on health care actually have higher quality than places where we spend more. Right here in Green Bay, you get more quality out of fewer health care dollars than many other communities across the country. And yet, across the country, spending on health care goes up and up and up - day after day, year after year.

    I know that there are millions of Americans who are content with their health care coverage - they like their plan and they value their relationship with their doctor. And no matter how we reform health care, we will keep this promise: If you like your doctor, you will be able to keep your doctor. If you like your health care plan, you will be able to keep your health care plan.

    But in order to preserve what's best about our health care system, we have to fix what doesn't work. For we have reached a point where doing nothing about the cost of health care is no longer an option. The status quo is unsustainable. If we do not act and act soon to bring down costs, it will jeopardize everyone's health care. If we do not act, every American will feel the consequences. In higher premiums and lower take-home pay. In lost jobs and shuttered businesses. In a rising number of uninsured and a rising debt that our children and their children will be paying off for decades. If we do nothing, within a decade we will spending one out of every five dollars we earn on health care. In thirty years, it will be one out of every three. That is untenable, that is unacceptable, and I will not allow it as President of the United States.

    Health care reform is not part of some wish list I drew up when I took office. It is central to our economic future - central to the long-term prosperity of this nation. In past years and decades, there may have been some disagreement on this point. But not anymore. Today, we have already built an unprecedented coalition of folks who are ready to reform our health care system: physicians and health insurers; businesses and workers; Democrats and Republicans. A few weeks ago, some of these groups committed to doing something that would've been unthinkable just a few years ago: they promised to work together to cut national health care spending by two trillion dollars over the next decade. That will bring down costs, that will bring down premiums, and that's exactly the kind of cooperation we need.

    The question now is, how do we finish the job? How do we permanently bring down costs and make quality, affordable health care available to every American?

    My view is that reform should be guided by a simple principle: we fix what's broken and build on what works.

    In some cases, there's broad agreement on the steps we should take. In the Recovery Act, we've already made investments in health IT and electronic medical records that will reduce medical errors, save lives, save money, and still ensure privacy. We also need to invest in prevention and wellness programs that help Americans live longer, healthier lives.

    But the real cost savings will come from changing the incentives of a system that automatically equates expensive care with better care - from addressing flaws that increase profits without actually increasing the quality of care.

    We have to ask why places like the Geisinger Health system in rural Pennsylvania, 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 success, and replicate that success elsewhere. And we should change the warped incentives that reward doctors and hospitals based on how many tests or procedures they prescribe, even if those tests or procedures aren't necessary or result from medical mistakes. Doctors across this country did not get into the medical profession to be bean counters or paper pushers; to be lawyers or business executives. They became doctors to heal people. And that's what we must free them to do.

    We must also provide Americans who can't afford health insurance with more affordable options. This is both a moral imperative and an economic imperative, because we know that when someone without health insurance is forced to get treatment at the ER, all of us end up paying for it.

    So what we're working on is the creation of something called a Health Insurance Exchange - which would allow you to one-stop shop for a health care plan, compare benefits and prices, and choose the plan that's best for you. None of these plans would be able to deny coverage on the basis of a pre-existing condition, and all should include an affordable, basic benefit package. And if you can't afford one of the plans, we should provide assistance to make sure you can. I also strongly believe that one of the options in the Exchange should be a public insurance option - because if the private insurance companies have to compete with a public option, it will keep them honest and help keep prices down.

    Now, covering more Americans will obviously cost a good deal of money at a time where we don't have extra to spend. That's why I have already promised that reform will not add to our deficit over the next ten years. To make that happen, we have already identified hundreds of billions worth of savings in our budget - savings that will come from steps like reducing Medicare overpayments to insurance companies and rooting out waste, fraud and abuse in both Medicare and Medicaid. I will be outlining hundreds of billions more in savings in the days to come. And I'll be honest - even with these savings, reform will require additional sources of revenue. That's why I've proposed that we scale back how much the highest-income Americans can deduct on their taxes back to the rate from the Reagan years - and use that money to help finance health care.

    In all these reforms, our goal is simple: the highest-quality health care at the lowest-possible cost. We want to fix what's broken and build on what works. As Congress moves forward on health care legislation in the coming weeks, I understand there will be different ideas and disagreements on how to achieve this goal. I welcome those ideas, and I welcome that debate. But what I will not welcome is endless delay or a denial that reform needs to happen. When it comes to health care, this country cannot continue on its current path. I know there are some who believe that reform is too expensive, but I can assure you that doing nothing will cost us far more in the coming years. Our deficits will be higher. Our premiums will go up. Our wages will be lower, our jobs will be fewer, and our businesses will suffer.

    So to those who criticize our efforts, I ask, "What is the alternative?" What else do we say to all those families who now spend more on health care than housing or food? What do we tell those businesses that are choosing between closing their doors and letting their workers go? What do we say to all those Americans like Laura, a woman who has worked all her life; whose family has done everything right; a brave and proud woman whose child's school recently took up a penny drive to help pay her medical bills? What do we tell them?

    I believe we tell them that after decades of inaction, we have finally decided to fix what is broken about health care in America. We have decided that it's time to give every American quality health care at an affordable cost. We have decided that if we invest in reforms that will bring down costs now, we will eventually see our deficits come down in the long run. And we have decided to change the system so that our doctors and health care providers are free to do what they trained and studied and worked so hard to do: make people well again. That's what we can do in this country; that's what we can do at this moment, and now I'd like to hear your thoughts and answer your questions about how we get it done. Thank you.

www.truthout.org/061109S