Prescription for America

WASHINGTON -- President Obama's healthcare town hall meeting last night offered a preview of the debate this summer.

The hour-long ABC special reminded viewers of the sheer vastness of the legislative project now before Congress. In a single bill, lawmakers will attempt to regulate wasteful end-of-life spending, send more primary care doctors to medical school, prevent kids from getting fat, pay doctors in a more sensible way, eliminate inefficient treatments and cover 46 million uninsured Americans. Without increasing the deficit.

Obama was also forced to address one of the most difficult political obstacles he will have to confront: Americans' fear that changing in how healthcare is delivered could do more harm than good.

Millions of people can't get treatment now because they don't have health insurance, or they can't afford the out-of-pocket costs, or their insurers won't pay. As Obama pointed out, the ranks of the uninsured and underinsured will grow if Congress does nothing. Yet the majority of people have insurance now, and even if they sympathize with their less fortunate neighbors, some of them are scared that too much government tinkering could hurt them.

The president tried to reassure the 164 people in the audience at the White House and the millions more watching at home with his oft-repeated promise -- those who like their insurance will be able to keep it. Higher quality and lower costs can actually go hand in hand, he added, pointng to the world-class Mayo Clinic in Rochester, Minn., which delivers care about one-third cheaper than the average provider.

But the human issues at stake are not likely to recede as the debate intensifies. The son of a woman in her 70s with terminal cancer told ABC producers that he wanted every possible treatment for his mom, no matter how much it cost: "I just don't think you can put a price tag on quality time with loved ones, especially at the end of their lives," he said, as his ailing mother smiled sweetly at her family from her hospital bed.

A woman in the audience told Obama about how her 105-year-old mother had a pacemaker installed, against some of her doctors' advice, at age 100. It had improved her life significantly. Would the president's healthcare plan ask doctors to take into account qualities in patients like love of life, she wanted to know -- qualities that helped convince her mother's doctors to try the pacemaker despite their reservations about her age?

Obama stumbled a bit. He was not sure whether subjective attributes like that could be measured. Then he moved to safer ground -- some waste, like duplicate tests, is just waste. When the woman added that that the pacemaker had actually spared her mother expensive hospitalizations, the president looked relieved.

Fear that grand strategies for saving money and improving quality will supercede individual circumstances are not new, of course. They helped kill President Clinton's healthcare bill 16 years ago. The town hall last night was hardly a clear reflection of the national mood, and there is plenty of evidence in polls that the sour economy and skyrocketing health costs have significantly increased public demand for change. But the town hall also underscored the fact that the old fears have not disappeared.

As the president said, Americans "know they're living with the devil, but the devil they know may be better than the devil they don't."