Ten days later, the Congressional Budget Office (CBO) scored the enormity of the cost for this option, which will not even provide universal coverage and may threaten to put private insurers out of business. The actual scoring of the cost is still controversial, and we do not know what the final plan will be like. The debate has continued to evolve, and the CBO’s figures have been disputed by, among others, Senator Max Baucus (D-MT). Some insurance companies believe they will not be able to compete with a public plan and have threatened that they may withdraw from the marketplace if such a plan is enacted.
3. Disparities in care and healthcare costs: Disparities in care and costs were a major theme of President Obama’s speech. All physicians and healthcare providers will have to address this issue, particularly when the data are released, shared, and analyzed.
4. Pre-existing conditions: President Obama’s advocacy of insurance coverage for pre-existing conditions for all brought a standing ovation. With passion, the President described his mother’s dilemma as she was dying of ovarian cancer and worrying whether she would lose her health insurance coverage. This is a universal concern that resonates with all of us. Those who are not insured are confronted with the precipice of being unable to afford healthcare, receiving inadequate treatment, and struggling with the specter of ultimate financial bankruptcy. This concept of community rating was a major tenet of AMA policy put forth to Clinton but opposed by the insurance companies; it is unclear how they would implement this process today.
5. Electronic health records: The president indicated enormous societal benefits that would ensue with the use of electronic health records. However, he did not discuss the lack of uniformity in electronic methodology standards, guidelines, the cost, the time required to implement them, the education that will be required, security of data, HIPPA concerns, the need for more technology overseers, and the hazards of an electrical outage or failure. Whether these benefits will truly justify the $19 billion that will prime the pump of a competitive adolescent industry is unclear.
6. Comparative effectiveness research: Comparative effectiveness research is necessary to address different treatment methods, some of which may not be effective. However, how this will be implemented, what it will cost, and who will decide what is effective was not addressed by President Obama in the speech.
7. Individual responsibility: Patients also have responsibilities. They must take better care of themselves by more healthy living: no smoking, regular exercise, good nutrition, appropriate rest, and drinking alcohol only in moderation to achieve optimal health. President Obama did not address healthcare literacy and comprehension, which many patients lack.
