Meet the Press | January 05, 2014
>>> the reason i visited the cleveland clinic is because, along with the mayo clinic , they have been able to drive down costs more than any other health care system out there while maintaining some of the highest quality.
>> that was president obama back in 2009 , and this morning i want to get beyond some of these political arguments over obamacare in washington, and that's why i've asked two top leaders in the medical field by the hospitals mentioned by the president to give their oversights on the future of obamacare. joining me from the mayo clinic is dr. john noseworthy and from the cleveland clinic , dr. delos cosgrove. dr. cosgrove, let me start with you. what is the impact of obamacare in 2014 ?
>> this started out to be three things. it started out to increase access. i think when it's fully developed, we will see increased access. it started out to improve quality of care, which is very available across the country, and i think with the transparency that it brings around quality, we'll see quality going up across the country. the real question is cost. and we really don't have the answer to that yet. we're going to have to see how this plays out over time .
>> i see it the same way. i think what it basically has done is expand insurance coverage, and what we need to do now is modernize the health care system to deliver care at cost. and sustainability of medical care in the long term is something the nation hasn't wanted to touch, but we have to have the courage to stand up to it.
>> and you see doctors deal with the fact that medicare rates and reimbursement rates are going down. it affects hospitals. medicare drives health care costs in this country, right?
>> in a large sense. about 50% of the costs are medicare costs.
>> and what kind of reform has got to happen beyond the health care reform that has to do with insurance, which is the affordable care act ?
>> what needs to happen now is we need to modernize the payment system to drive better outcomes to pay for results, not just activity. and we also need to take advantage of technology. right now we can provide great information knowledge, patient care across state borders using mental health , mobile and digital technology , and that's tied up in state laws for how health care is delivered and how it's paid for. and we have to fund the nih.
>> we'll get back to that in a second because that gets to research and what makes our health care system great. do you understand all the parts of obamacare, and will you be out promoting it?
>> we don't understand it all yet and we don't understand the implications, how it's going to affect hospitals and physicians, et cetera , who is going to get what sort of insurance and who is going to be covered with what sort of policy. so we really don't understand this. we do know, however, that we're going to be paid less for what we do --
>> hospitals will be paid less.
>> everybody is going to get paid less. there will be less money in the organization. and we've got to learn to be more efficient. and the health care system in the united states is not really a system. it's a whole bunch of cottage industries , and we're coming together as a system, and to drive more and more efficiency across our organization.
>> so here's a question about costs. one of the big issues is not you just get enough people insured so they can get insurance in an affordable way, but what do consumers of health care now do? the number of people going into hospitals is far down. a lot of people now have insurance. we saw this week they're still going to the er to get health care , which is very expensive. or maybe they're not spending their health dollars in the way they should for their overall wellness, which could still drive costs in the future.
>> there's no question that having insurance is a good step forward for everyone. but folks don't necessarily know what they've got when they go on the exchange is buy something until they get ill. preventative services may be covered but these narrow networks that likely will develop and can you keep your doctor, all of that will play out in the coming months. i think it's very important that we stay very close to this, but david, the affordable care act will take its own path. what we really need to do is the next series of steps. there are things the country needs to do, the government must do and health care providers.
>> such as?
>> first of all, they have to modernize the payment system , modernize medical care , they have to find a way to bring technology across state borders. we have to fund the nih, and ultimately the nation has to have the coverage to step up to the looming solvency of medicare .
>> does medicare have to become a different program? covers less, fewer benefits?
>> one thing medicare has to do is incense people to take care of themselves. we have to deal with obesity which is now 10% of the health care costs in the united states and going up, growing number of diabetes, et cetera . so we need to have incentives for individuals to take care of themselves, and that's not really as big a part of the new law as it should be.
>> are republicans reaching out to either one or both of you to really get a handle on an alternative that they might propose?
>> we have not been involved with the political discussion . we entered into discussion at the time the bill was put together and gave our opinions, but subsequently, we haven't heard a lot about this.
>> we've been actively involved with senate finance, house ways and means , energy and commerce . we have congressmen coming to us from both parties trying to understand more. for 150 years we wanted to share more about what it is we do. these are complex issues. making health care affordable for everyone in the country is going to take a lot of time, it's highly complex. but it's the right thing for the nation.
>> and this is not the end of it. we have to keep changing the law, modifying the law, amending the law, because it's not going to be a perfect law when we start out, and we have to reform the entire health care system , not just the aca.
>> i know you want to stay away from politics, and one of the big political questions right now in a lot of states is whether to legalize marijuana. we've seen colorado do it. i'm asking two doctors, how do you feel about that?
>> well, marijuana has been around in medical care and in recreational use for 5,000 years. it was on the american formula for 100 years, and it wasn't until 1970 it was declared a class 1 drug which means it has no value and has risk. between 1970 and 1995 , a lot of things happened at the state level and we've seen what's happened in california. right now we're in a situation where the cannabis system is a pain modifying system. there is an important bit of research that could happen there, but the federal government , of course, has not supported that. so there is a lot of unknowns about this, and we have the states and federal government . we have to see where it goes.
>> say nothing of being a legal issue, but --
>> we worry about it as a legal issue but also as a health issue. i don't think it's been clearly defined where its benefit is at this point, and it would be nice to have an opportunity to find out where it's been fishl aneficial and where it's not.
>> thank you for your opinions about obamacare. thank you both very much.
>> thank you, david.
>>> coming up here, we're back with our roundtable on some of the big battles and questions of the new year. and yes, the legalization of marijuana being one of them, whether the fight is headed next to more states and frequent guest here columnist david brooks is lighting up that debate. and why liberals are so pleased about the historical change of political power in new york city . plus a developing story we're following this morning, the battle for the future of iraq as [