Okay, it’s a girl’s turn. I see a lady right there.
Q Thank you. Thank you, Mr. President. You’ve talked a little bit about the government plan and the competition with other insurance companies, and we all know that in the insurance business everything is about managing risk. And I guess I’d like to know what your vision is for how we would better manage the risk, especially if there is going to be a government program. What’s your philosophy about primary care or the role of primary care? Do you subscribe to the medical home theory? How do you engage patients in this model so that that risk can be better managed and we can ultimately result in a population that has better health at a lower cost?
THE PRESIDENT: You sound very knowledgeable. Are you in the health care system?
Q Yes, I am. My name is Chris Waleski (phonetic) and I’m with (inaudible).
THE PRESIDENT: Well, look, in some ways you answered your own question because I think that the more we are incentivizing high quality primary care, prevention, wellness, management of chronic illnesses, the one things that it turns out is that about 20 percent of the patients account for 80 percent of the care and the costs of the health care system. And if we can get somebody first of all who is overweight to lose weight so that they don’t become diabetic, we save tons of money. Even after they’ve become diabetic, if we are working with them to manage their regiment of treatments in a steady way, then it might cost us $150 when you prorate the costs for a counselor to call the diabetic on a regular basis to make sure they’re taking their meds, and as a consequence, we don’t pay $30,000 for a foot amputation. (Applause.)
So there are all sorts of ways that I think that we want to improve care, and that helps us manage risk.
Now, people are still going to get sick, and they are still going to be really catastrophic costs. And there have been a lot of ideas floated around in Congress, are there ways that we can help to underwrite some of the catastrophic care that takes place that would help lower premiums.
I’m open to a whole range of these ideas, and one of the things, one of the approaches that I’ve tried to take is to not just put down my plan and say, “It’s my way or the highway.” First of all, one of the things it turns out is Congress doesn’t really like you to just tell them exactly what to do. (Laughter.) Steve Kagen can testify to that. (Laughter.) So it’s always better to — always better to be in a collaborative mode, and to listen.