Ross Mackenzie

Ever wish you could rap with the president? Here's your chance - an imaginary conversation in an occasional series. Quotation marks indicate actual words Barack Obama has used.

Mr. President, thanks for the opportunity.

Happy to do it. What's on your mind?

Could we start with health care? You've said you want a plan providing improved care for reduced cost, and extending health insurance coverage to perhaps 50 million more Americans. You also want a taxpayer-financed public option to private insurance.

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I set an August deadline that obviously will be missed. But it will happen, as Madame Pelosi has said it will. We simply must have a public competitor to keep the private sector honest. We also need a remedy for the current system allowing doctors to limit care and rip off patients.

Do you truly believe most doctors are the enemy?

Look. "You come in and you've got a bad sore throat, or your child has a bad sore throat or has repeated sore throats. The doctor may look at the reimbursement system and say to himself, 'You know what? I make a lot more money if I take this kid's tonsils out.'" Stuff like that. It's sick. Doctors take out too many tonsils. They push too many pills.

By limiting tonsillectomies and the number of pills doctors prescribe, wouldn't you be building in to your new structure precisely the rationing you deny it would contain?

As my Budget Director, Peter Orszag, has recommended, we would have a panel of doctors and bureaucrats determining who would receive what level of care. These are difficult decisions, so it would be a distinguished panel.

Rationing by whomever, by whatever entity, no matter how distinguished, is still rationing. And how do you improve care by limiting the options available to doctors and telling them what they can charge? And with a trillion-dollar deficit already, which worries at least the Chinese, how are you proposing to finance your plan?

Through cost-savings. Look. "If there's a blue pill and a red pill and the blue pill is half the price of the red pill and works just as well, why not pay half price for the thing that's going to make you well?...Part of what we want to do is make sure that those decisions are being made by doctors and medical experts based on evidence, based on what works - because that's not how it's working now."

Ross Mackenzie

Ross Mackenzie lives with his wife and Labrador retriever in the woods west of Richmond, Virginia. They have two grown sons, both Naval officers.

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