Chicago, Illinois | June 13, 2005
Congratulations! After four long years of endless studying, sleepless nights, and constant stress, who's ready to kick back, relax, and jump head first into their residency?
And who wishes people would stop making that joke? I thought so.
It's an honor to be back here at the University of Chicago. As most of you know, I used to teach over at the law school and my wife Michelle is in charge of community affairs at the hospital, so as a part of the family we're especially proud of you all right now.
We're also especially hopeful. With the caliber of talent and amazing dedication represented here today, I found myself thinking that in one of these chairs could sit the researcher who will finally win humanity's long battle against cancer. In one of these chairs could sit the scientist who transforms AIDS from one of the greatest disasters of the 20th century to one of the most curable diseases of the 21st. In one of these chairs could sit the doctor who says "Hey Barack, don't worry about that trick knee - you're just getting old." So that's hopeful too.
But this hope that I have for your class - this faith in our ability to overcome that which threatens to halt the march of human progress - is nothing new. It is as old as our history and as powerful as the idea of America itself. And that's because we've been here before.
Almost eighty years ago, when the University of Chicago's first graduating class sat here ready to collect their diplomas, who would have dared to believe that before the beginning of the next century, we would add thirty years to the average lifespan and witness a 90% drop in the rate of infant death? Who would have dared to believe that with a simple vaccine, we could eliminate a disease that left millions without the ability to walk? That we could transplant a heart or resuscitate one that stopped? That we could unlock the greatest mysteries of life from the most basic building blocks of our existence?
In a time where you were lucky to live past fifty and doomed if you came down with the flu, who would have dared to believe these things?
The people who once sat in your chairs - they did. The doctors and nurses, researchers and scientists who came before. Who grew up believing that in America, the most improbable of all experiments, the place where we continue to defy the odds and write our own history, they could be the ones to improve, extend, and save human life. They could be the healers.
As this new century unfolds, their success and your potential have led us to a moment of unparalleled promise in health and medicine. Just like a century ago, technology and treatments that were once barely imagined are now imminently possible.
Yet, while these are some of tomorrow's biggest potential breakthroughs, they are not today's biggest medical challenge. Today, as we continue to find new ways to live longer and better, the greatest single threat to the health of our nation is not a scarcity of genius or a failure of discovery; it is a lack of collective will to ensure that every single American has access to effective, affordable health care. It is our inability, after years and years of talk and gridlock, to finally do something about the crushing cost of health care in America.
This has long stopped being about a single issue that politicians bring up during an election year. This is now a national crisis.
45 million Americans are uninsured - over 5 million more in the last four years. This isn't just a moral shame, it's an economic disaster that's catching Americans in a vicious cycle. Because the uninsured can't afford health care, they put off seeing a doctor or end up in the ER when they get sick. Then their care is more expensive, and so premiums for all Americans go up - to the tune of $922 a family. Because everyone's premiums go up, more Americans lose their health care.
All the while, costs just keep climbing and climbing. Family premiums are up by nearly 65% over the last five years. Deductibles are up 50%. Co-payments for care and prescriptions are through the roof. From the smallest mom and pop stores to major corporations like GM, businesses who can't afford these rising costs cut back on insurance, workers, or both. States with bigger Medicaid bills and smaller budgets are being forced to choose whether they want their citizens to be unhealthy or uneducated. And over half of all family bankruptcies today are caused by medical bills.
The cost crisis is affecting your profession too. Whether it's Medicaid reimbursements, the rising price of medical malpractice insurance, or having HMOs look over your shoulder, all the hard work and sacrifice you've put in during medical school isn't as rewarding as it once was.
So now, just like generations before, you must dare to believe - not only as tomorrow's physicians, but as tomorrow's parents, workers, business owners, and citizens. You must choose: Will the groundbreaking miracles you discover over the next generation reach only the luckiest few? Or will history look back at this moment as the time when we finally made care available at a cost that won't bring the world's largest economy to its knees?
For you guys, this is about more than just the statistics and the numbers. Part of the philosophy of the Pritzker School of Medicine has always been the recognition that "medicine does not exist in a social vacuum." Living here over the last four years, you've seen this. Surrounding us right now on the south side of Chicago are poor kids sitting in those ERs who could never afford a physical. Children suffering from adult diabetes because parents can't afford to provide the proper nutrition. Worried mothers thumbing through checkbooks, not knowing if they can pay for this month's medicine.
There isn't one person sitting here today who wants to turn a sick patient away because they can't pay. Not one person who wants the cure they discover denied to those whose lives depend on it. Each of you has dedicated yourselves to this calling because where there is a sick person, you want to heal them. Where there is a life in jeopardy, you want to save it.
And so today, when you leave here, it will not only be with great knowledge, but with even greater responsibility. Because if we do nothing about the rising cost of health care, experts believe that in ten years, the number of uninsured will grow to 54 million. And if we do nothing to expand access to the uninsured, costs will keep rising.
But while this is a national crisis, it still isn't part of the national conversation. It's an issue where we haven't seen any leadership over the last four years; an issue that Washington continues to duck. We just spent three entire weeks arguing over the filibuster, but I can count on one hand the number of times we've talked about health care since I was sworn in last January. Yet, when I come back here and talk to families in Illinois, that's all they tell me about.
This isn't just limited to one party either. In part, the fear of reform stems from the experience President Clinton had in the early '90s when he recognized the emerging health care crisis and sought a comprehensive answer. For that, he deserves great credit.
But the resulting political firestorm, fanned by the insurance lobby and other powerful interests who had a stake in maintaining the status quo, badly singed the Clinton Administration.
Since then, health care continues to be fodder for candidates, but quickly recedes into the background when elections come and go.
And with each passing year, the problem grows and the solutions become more difficult.
We cannot turn our heads any longer.
Challenging as it is, fixing the health care system is not an impossible problem to solve. I'm not saying it will be easy, or that all the solutions are right in front of us. We may not be able to build consensus on every detail right away, but where we do agree, we should act now to bring down skyrocketing costs.
One place to start is by bringing the health care system into the 21st century. In our lifetimes, we've seen some of the greatest advances in the history of technology and the sharing of information. Yet, you're about to enter a profession where too much care is still provided with a pen and paper. Where too much information about patients isn't shared between doctors or readily available to them in the first place. And where we still don't have the information to know what care has worked most effectively and efficiently to make patients healthy.
For too many Americans, the time lost as a result of archaic record-keeping has been the margin between life and death.
But embracing 21st century technology is not just about reducing errors and improving the quality of medical care. It's also about cost.
We spend nearly one and a half trillion dollars a year on health care in America. But a quarter of that money - one out of every four dollars - is spent on non-medical costs; most of it bills and paperwork. Nearly every other industry in the world has saved billions on these administrative costs by doing it all online. Every transaction you make at a bank now costs them less than a penny. Even at the Veterans Administration, where it used to cost nine dollars to pull up your medical record, new technology means you can call up the same record on the internet for free.
Yet, because we haven't updated technology in the rest of the health care industry, a single transaction still costs up to twenty-five dollars - not one dime of which goes toward improving the quality of our health care. Doctors are forced to fumble through paperwork and don't have all of the information about each patient at the click of a mouse. Mistakes are easily made and today, patients are given the right kind of care only half of the time. In fact, a recent study showed that medical error alone kills up to 98,000 people a year - that's more than die from AIDS each year. This is due not only to outdated medical technology, but the fact that we don't have a health care system that measures the quality of care patients are provided - that tells us what works, what doesn't, and where mistakes were made.
But by bringing our health care system on-line, we could start improving the quality of care and cutting the cost of it. We could save thousands of lives and save families billions of dollars. Just imagine if every doctor and nurse could sit by a patient's bedside with a laptop and pull up their entire medical history - information from every past doctor they've seen - with the click of a mouse. If every patient had an electronic bracelet that you could scan to find out the exact type and amount of medication they needed so there were no mistakes made. If you could go on-line and monitor a patient's breathing and heart rate while they were home to track their recovery.
We know all of this possible - so what are we waiting for? It's time for this country to start taking on the big challenges and asking the big questions again. Why couldn't we help every health care provider who does business with the federal government that they need to convert their entire system to electronic transactions? Why couldn't we help connect our hospitals so they could share technology and information about what works and what doesn't? This way we could start creating a virtual system of health care in America where knowledge about each individual's health needs and health history is readily available to every single person who provides them care.
And while we're at it, why couldn't we start rewarding the quality of care and the effort to prevent disease instead of only rewarding treatment itself? This way there would be actual incentives to provide good care and it would cut down on wasteful spending on the wrong kind of care. As tomorrow's doctors, you can help here too by making sure that all the drugs you prescribe aren't just the latest pharmaceutical fad, but the cheapest and most effective medicine for your patients.
So why couldn't we do all of this? The answer is, we can. We can bring down the cost of health care in America and insure every American, and your generation can lead the way.
Of course, no one's forcing you to meet these challenges. Each of you has been blessed with extraordinary gifts and talent. And so if you want, you can leave here and focus on your own medical career and your own success, not giving another thought to the plight of the growing millions who can't afford the care you will provide. After all, there is no community service requirement in the real world; and no one's forcing you to care.
But I hope that you do. Not because you have a debt to all of those who helped you get to where you are, although you do have that debt. Not because you have an obligation to those are less fortunate, although you do have that obligation. You need to take on the challenges that your country is facing because you have an obligation to yourself. Because our individual salvation depends on collective salvation. Because it's only when you hitch your wagon to something larger than yourself that you will realize your true potential.
Looking out at this class of 2005, I think my hope is well-placed. With the field you have chosen, you've already shown how much you care about the lives of others; how strongly you have heard the calling to be healers in this world. Today, I ask you to remember that call always, and to remember how it could include more than the patient sitting in your office. It could also include the patients who can't afford to get there, the ones who aren't being provided the best care, and the general health of all Americans.
When you think about these challenges, I also ask you to remember that in this country, our history of overcoming the seemingly impossible always comes about because individuals who care really can make a difference. America is great because Americans are good.
And as you go forth from here in your own life, you can keep this history alive if you only find the courage to try. Good luck with this journey, and congratulations on all of your achievements. Thank you.
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