I had the pleasure of being in the East Wing of the White House on Wednesday, one of about 160 people in the audience as President Obama appeared on national television, fielding questions about health care.

It was my first look at the President at close quarters. I came away with the impression that the President was possibly the most knowledgeable person in the room when it came to the current health care crisis. That's no small thing given the people who were there. We have had Presidents whose understanding of issues seemed confined to the precise talking points prepared by aides in  briefings. This  President knew his material well and  was improvising as smartly as a jazz pianist, in response to questions.

The other thing I sensed was the President's  tremendous passion for this cause. If there is something more important on his agenda, I don't know what it is. What also came across is that compared to everyone else who was there (physicians like me, the CEO of Aetna, the head of the AMA), the President was probably the only one whose interests in the health care debate were not self serving. His sole motivation seems to be to head off disaster, which seems inevitable if reform does not take place.

An important moment for me personally came when a young woman asked the President the very question that I had been prepared to ask. She wanted to know  why we could not emulate the example of other advanced democracies that manage to cover all their citizens for about half what it seems to cost us.  The President's answer was  revealing; he pointed out that most of those countries had a one-payer system whereas we in America,  "...have an employer based system that has grown up over decades. For us to completely change our system, root and branch, would be hugely disruptive and I think would end up resulting in people having to completely change their doctors, their health care providers in a way that I'm not prepared to go. This is one-sixth of our economy.  I think that we can build on what works, fix what's broken, and still have some substantial money."

The obstacles in the President's way are considerable:  1) people and businesses who are profiting hugely from the status quo;  2) a  general fear of government interference;  3) fear in Congress about the amount of money to be spent on health care reform and finally, 4) the fact that legislators who have to make change happen often serve the interests of the people who gave them the most campaign money--pharma, insurers, organized medicine. These contributions are what taint our political process--call it  first world corruption. 

I got back to my hotel room at 10pm, just as the session (which had been recorded "live to tape") was finally being aired.  I was surprised to see that one commercial shown during the health care debate was on behalf of "Patients United Now"--a group I know little about. The ad was sowing seeds of fear by having a Canadian patient talk about the difficulties of that system. They couldn't wait to hear what the President had to say it seems.

Oh yes, and the other thing on television competing on the other channels was the news of Governor Sanford's whereabouts. As to that . . . less is more.