Notes on Obama's address to the AMA (semi-live)

So far, the one thing I note is that there are a lot of vague promises.

"You shouldn't have to tell your doctor your medications" ...I'm sorry, are you saying that I don't need to get a complete H&P to get paid? Or, are you encouraging for people to not take responsibility for their own healthcare?

 "It will take doctors telling us what risk factors we need to avoid..." ...Yes, but how do you get people to follow advice? You can lead a horse to water, and all that. How do you get people to monitor their diabetes? Just the other day, I had a patient who got admitted to the ICU for Diabetic ketoacidosis, racking up tens of thousands of dollars in care, which got passed on to the insured and the taxpayer because when her glucometer broke, she didn't want to spend the fifty bucks to replace it.

"Healers, not bean-counters" Nice vague statements. 

"Paid.... well.... for how you treat the overall disease"   ...and how do you treat willful ignorance?

I have a problem with this idea that a national healthcare system "injects competition." How competitive is a plan which draws it's premiums forcibly from the subscribers of it's competition, requires treatment by doctor by fiat, yet is not obligated to pay for it? The answer is:ultra-competitive. 

 Looks like he is currying favor by beating up on insurance companies.

Will the imagined trillions of dollars more that inaction will cost us, similar to the imagined jobs lost had we not acted with the stimulus spending?

"20% re-admitted within a month" ...I see this causing people to be kept in the hospital longer, or to be readmitted for a different diagnosis.

"paying less to hospitals for the uninsured" ...WTF?!?!?!?! A *CORE* problem we have is the unfunded mandate incurring costs which we then must pass along to the insured. Now he wants to exacerbate it?!?!?! 

...So, to wrap up, there is a lot of vagaries, but that last point, where he states that he will decrease payments for an unfunded mandate, a problem I see everyday, shows a stunning lack of understanding of the scope and nature of the problem. If this is how little he understands that portion, I shudder to think how ignorant he is of the rest of it.

In the end, I see costs outpacing projections, and healthcare rationing at the same time. The response to this by proponents will be that the costs would have been higher otherwise, and the rationing would have been more extreme.

Respectfully Submitted,
-doc Russia