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State of the Union Addresses Medicare, Gun Control

By Robert Lowes

Medscape Medical News

Feb. 13, 2012 -- In his fifth State of the Union address, President Barack Obama spoke mostly as a job creator in chief, deficit reducer in chief, and commander in chief. But he took a few minutes to put health care policy on his second-term agenda, including the public health issue of gun violence.

"What I’ve said tonight," said Obama, "matters little if we don’t come together to protect our most precious resource: our children."

Shortly after the school massacre in Newtown, Conn., on Dec. 14, Obama proposed a ban on military-style assault rifles and high-capacity magazines, universal background checks in gun sales, higher spending on mental health services, and other measures aimed at lessening gun violence.

In his address before Congress, Obama urged the gathered lawmakers to put these proposals to a vote in the name of victims of gun violence, such as Hadiya Pendleton, a high-schooler who performed at Obama's second inauguration as a band majorette, only to be shot eight days later in her home city of Chicago, "just a mile away from my house," Obama said.

"Hadiya’s parents, Nate and Cleo, are in this chamber tonight, along with more than two dozen Americans whose lives have been torn apart by gun violence," Obama said. "They deserve a vote."

In staking out these positions, Obama antagonized the National Rifle Association (NRA) but made common cause with much of the medical community. Major medical societies such as the American Medical Association, the American Academy of Pediatrics, and the American Congress of Obstetricians and Gynecologists have voiced support for a bill sponsored by Sen. Dianne Feinstein (D-Calif.) that would ban the sale of assault rifles.

Although the lion's share of the domestic portion of Obama's speech focused on creating jobs, he also talked about Medicare.

The president repeated his vision for Medicare in an era of budget cuts. Obama's menu of reforms includes reducing taxpayer subsidies to prescription drug companies, increasing financial obligations for the wealthiest seniors, and shifting provider reimbursement to a pay-for-performance model.

"We’ll bring down costs by changing the way our government pays for Medicare, because our medical bills shouldn’t be based on the number of tests ordered or days spent in the hospital. They should be based on the quality of care that our seniors receive," the president said.

However, cuts to programs such as Medicare and Social Security should not be so severe that they put the burden mainly on seniors and the middle class, "while asking nothing more from the wealthiest and most powerful," Obama said. Earlier this week, his administration announced that it opposed the idea of raising the eligibility age of Medicare from 65 to 67, a measure supported by congressional Republicans.

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