Anyone who lives in Washington and has an official position viscerally understands the cost of a lack of privacy. Every dinner - especially ones with a journalist in attendance - is preceded by the mandatory, 'This is off the record.' But everyone also knows, nothing is really 'off the record.
We had a big controversy in the United States when there was a limited number of dialysis machines. In Seattle, they appointed what they called a 'God committee' to choose who should get it, and that committee was eventually abandoned. Society ended up paying the whole bill for dialysis instead of having people make those decisions.
The situation around Terri Schiavo was a deeply held conflict over what to do if someone isn't going to return to consciousness or competence. Who will decide? Even there, where we had settled legal rules, we still had disagreement. We're torn about these things.
The president recognizes that funding global health is good for national security, domestic health and global diplomacy. Consequently, President Obama has steadily increased funding for the President's Emergency Plan for AIDS Relief, or PEPFAR, which was created by President Bush and has strong bipartisan support.
Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality are merely lipstick cost control, more for show and public relations than for true change. Savings will require changing how doctors think about their patients. Doctors take the Hippocratic Oath too seriously, as an imperative to do everything for the patient regardless of the cost or effects on others.
Reasoning based on cost has been strenuously resisted; it violated the Hippocratic Oath, was associated with rationing, and derided as putting a price on life... Indeed, many physicians were willing to lie to get patients what they needed from insurance companies that were trying to hold down costs.