Continue the White House transcript of the remarks by the President at a Facebook Town Hall!
MR. ZUCKERBERG: All right. So the next one is from another Facebook employee. Here’s James Mitchell. So, James Mitchell, where are you from?
THE PRESIDENT: Here’s James back here.
Q Hi, Mr. President.
THE PRESIDENT: Hey, James.
Q I'm James Mitchell, born in Chicago and raised out here in Cupertino, California. I have yet another question for you about the debt and health care.
THE PRESIDENT: Go ahead.
Q So the biggest threat we have fiscally is the rise in health care costs. Unfortunately, a lot of the solutions we hear to Medicare and Medicaid don’t involve actually slowing down the rise in health care costs. Instead, they involve shifting costs to beneficiaries and states. So my question is: Can you talk a bit more about what provisions of the Affordable Health Care Act are designed to slow down the rise of health care costs, and what policies you’d like to see enacted in the future to continue to slow down the rise of health care costs?
THE PRESIDENT: Let me give you a couple of examples, because you’re exactly right in how you describe it. I don’t want to just shift the health care costs on to the American people, I want to actually reduce health care costs.
Let’s take the example of health IT. We’re in Silicon Valley, so we can talk about IT stuff. I’ll try to sound like I know what I’m talking about. (Laughter.) The health care system is one of the few aspects of our society where a lot of stuff is still done on paper. The last time you guys went to a doctor’s office or maybe to your dentist’s office, how many people still had, like, to fill out a form on a clipboard? Right? And the reason for that is because a large chunk of our provider system is not automated. So what ends up happening is you may go to your primary care physician; he does some basic tests, he sees something of concern, he refers you to a specialist. You go to the specialist; he’ll do another test.
You’re getting charged, or your insurance company is getting charged, for both those tests, as opposed to the test that was taken by your primary care physician being emailed to the specialist. Or better yet, if it turns out that there may be three or four specialists involved, because it’s a difficult diagnosis -- this is all hypothetical; you look very healthy. (Laughter.) But let’s say there were a bunch of specialists. What would be ideal would be if you get all the specialists together with the primary care physician the first time you’re seen so that you’re not paying for multiple visits as well as multiple tests.
That’s not how it works right now. Now, part of it is technology. So what we did in the Affordable Care Act, building on what we did with the Recovery Act, is try to provide incentives to providers to start getting integrated, automated systems. And it’s tough because the individual doctor may say to him or herself, I don’t want to put out the initial capital outlay; that’s expensive even though it may make my system more efficient later on.
So providing some incentives, some help, for the front end investments for a community hospital or for individual providers so that we can slowly get this system more effective, that’s priority number one.
We know it can be done, by the way. Surprisingly enough, the health care system that is -- does the best job on this of anybody is actually the Veterans Administration, the VA health care system, because it’s a fully integrated system. Everybody is working for the VA, all the doctors, all the hospitals, all the providers, so they’ve been able to achieve huge cost savings just because everybody is on a single system.
It’s also, though, how we reimburse doctors and how we reimburse hospitals. So right now, what happens is, when you’ve taken those two tests, if you’re old enough to qualify for Medicare, well, each doctor sends their bill to Medicare and Medicare pays both bills. And let’s say that you end up getting an operation. They’ll send the bill for that, and Medicare pays that. Let’s say they didn’t do a very good job, or you got sick in the hospital, and you are readmitted and you have to be treated again and they have to do the operation all over again. Medicare then gets billed for the second operation.
I mean, imagine if that’s how it worked when you bought a car. So you go, you buy your car. A week later, the car doesn’t work. You go back to the dealer and they charged you to fix the bad job that they did in the first place. Well, that’s what Medicare does all the time. So we don’t provide incentives for performance. We just provide -- we just pay for the number of qualified items that were procedures that were performed or tests that were performed by the provider.
So what we want to do is to start changing how folks are reimbursed. Let’s take a hospital. We want to give -- this is sort of like Race to the Top, what Mark was talking about in education. We want to be able to say to a hospital, if you do a really good job reducing infection rates in the hospital, which kill tens of thousands of people across America every year and are a huge cause for readmission rates, and we know that hospitals can drastically reduce those reinfection rates just by simple protocols of how employees are washing their hands and how they’re moving from room to room and so forth -- there are hospitals who have done it -- if we can say to a hospital, you’ll get a bonus for that, Medicare will reimburse you for instituting these simple procedures, that saves the whole system money.
And that's what we’ve tried to do in the Affordable Care Act, is to start institutionalizing these new systems. But it takes time because we’ve got a private sector system -- it’s not like the VA -- a bunch of individual doctors, individual hospitals spread out all across the country with private insurers. So it’s not something that we can do overnight.
Our hope is, is that over the next five years, we’re able to see significant savings through these mechanisms, and that will save everybody -- not just people who are on Medicare and Medicaid -- it will save everybody money including folks here at Facebook. Because I’m sure that you guys provide health insurance and I suspect if you look at your health insurance bills they don't make you happy. Okay. (Applause.)
MR. ZUCKERBERG: So we have time for only one more question.
THE PRESIDENT: All right.
MR. ZUCKERBERG: It’s a question from Terry Atwater (ph) from Houston, Texas: “If you had to do anything differently during your first four years, what would it be?”
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