OBAMA: Well, you're asking the right question. And let me say,
first of all, this is not an easy problem. If it was easy, it would
have been solved a long time ago, because we've talking about this for
decades, since Harry Truman.
We've been talking about how do we provide care that is
high-quality, gives people choices, and how can we come up with a
uniquely American plan? Because one of the ideological debates that I
think has prevented us from making progress is some people say this is
socialized medicine, others say we need a completely free market system.
We need to come up with something that is uniquely American. Now
what I've said is that if we are smart, we should be able to design a
system in which people still have choices of doctors and choices of
plans that makes sure that the necessary treatment is provided but we
don't have a huge amount of waste in the system. That we are providing
adequate coverage for all people, and that we are driving down costs
over the long term.
If we don't drive down costs, then we're not going to be able to
achieve all of those other things. And I think that on the issue that
has already been raised by the two doctors, the issue of evidence-based
care, I have great confidence that doctors are going to always want to
do the right thing for their patients, if they've got good information,
and if their payment incentives are not such that it actually costs them
money to provide the appropriate care.
And right now, what we have is a situation, because doctors are paid
fee-for-service, and there are all sorts of rules governing how they
operate, as a consequence often times it is harder for them, more
expensive for them, to do what is appropriate.
And we should change those incentive structures.