Obama on health care policy: ‘No free lunch’

Dr. Nancy Snyderman Chief medical editor

NBC News’ chief medical editor Dr. Nancy Snyderman sat down with President Barack Obama at the White House Wednesday to discuss health care policy.

Portions of the interview aired on “Nightly News with Brian Williams.” and on TODAY. Snyderman's complete interview will be shown on “Dr. Nancy” (Noon-1 p.m. ET) on Thursday.

The following is an edited transcript of the full interview.

Dr. Nancy Snyderman: Mr. President, thank you for the invitation.

President Barack Obama: Thank you so much.

Snyderman: Today, in the Rose Garden ceremony, you talked about the need to buck up. And it seems like it was a message to Congress. Are you concerned that your health care information — the message got derailed, a little bit ...

Obama: Well, obviously, when I'm in the country, I am able to communicate a little more directly to the American people, and when I'm not, you know, those who want to defend the status quo are getting their message out more effectively.

And I think, though, Congress, overall, has been making extraordinary progress.  We are closer than we've ever been to fundamental reforms that provide people choice, make health care affordable, and solve some of these long-term structural problems that — that inhibit quality care.

So — so I'm optimistic, but I also understand this is a big deal, a big issue.

Snyderman: If you look at this big deal ...

Obama: Yes.

Snyderman:  ... do you have people at the bargaining table, the pharmaceutical industry hospitals in there?

I haven't heard anyone ask just for the American public to pony up here, that this is going to require some give for all the stakeholders involved. 

Obama:  Well, let me — let me talk about what I think the American people are going to have to do.

First of all, the American people have to recognize that there's no such thing as a free lunch.  Right?  So, we can't just provide care to everybody that has no cost whatsoever, you don't end up having to make any decisions. 

So, obviously, we've got to have a system that controls costs, gives people choices, but makes sure that we're getting a good bang for the buck. And we've got to have the American people doing something about their own care.

Snyderman: So, self-responsibility.

Obama: So, self-responsibility is going to be critical. This is probably not going to be something that's legislated. But I tell you what, every business out there is going to be looking at their health care bottom line. And increasingly what you're going to see is that businesses are going to incentivize their employees to stop smoking, lose weight, get exercise, get regular checkups.

What we can do is we can encourage those companies that have those sorts of wellness-prevention programs. We can make sure that it's easier to find a primary care physician to get a regular checkup, that everybody has basic insurance. But the American people are going to have to participate in their own health.

Snyderman: If you could talk about, you know, doing the right thing.

Obama: Right.

Snyderman: The reality is the average American wants to order à la carte, but wants to pay for the blue plate special. So, we like what we like.

Obama: Well, I think it's true, but certainly it's because of a lack of information.  

Snyderman: Is it really?

Obama: ... drug is just as good as a brand-name drug for a — if, then, they're happy to save money with the generic drug.

If, on the other hand, their doctors tell them the brand-name drug is the one to use, partly because maybe the drug manufacturers have taken the doctor to some junket somewhere, well, then, naturally they want to listen to their doctor.

So the question is, can we provide good information to doctors?  Can we provide good information to patients?

Obama: If you only need one test, why do you want five tests?

Snyderman: That's going to be a — that's going to be a big deal.

Obama: Absolutely.  If — if we know that the generic is cheaper, works just as well, why do you want the more expensive ... see cost savings and the American people are going to recognize that, you know, efficiency will pay off for them in the long term, not just for the system as a whole.

Snyderman: If you talk about history, how do you protect our small businesses from not falling under the crunch ... which is a real issue, obviously.

Obama: Well, that's what's happening now. We just had a report in the Wall Street Journal that small businesses are rapidly eliminating health care. They just can't afford it. And so what we have to do is compare doing nothing with doing something. Doing nothing, we're on the path where nobody who works for a small business is going to be getting health care out there because small businesses just can't afford it. 
           
If we move forward on health care reform, then we can do a couple of things. We can help small businesses pool their employees so that they can get a better deal with insurance companies. We can make sure that the smallest companies are exempted from having to pay into the system, but you know, there are a lot of companies where 75 employees, 100 employees, they can afford to pay into a system so that all their employees are taken care of.

Snyderman: But the companies that, maybe, have 10 or 20 — would you allow them to pool?

Obama: There are going to be companies that have 10 or 20. I think that what we want to do is, instead of forcing them to buy health insurance for their employees if they can't afford it, provide them the option of a pool, give them tax incentives, give them the resources so that they can drive down costs, and I think a lot of them are going to choose to do so.

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