Consider the Dark Ages, wherein disease was considered caused by evil spirits. The Cure? Prayer. Blood-letting. Drilling holes in the skull to let the demon out.
That kind of thought persisted well into the 19th century. Even by the American Civil War, doctors were still often little more than butchers and charlatans. A soldier who took a bullet in a limb could reasonably expect to have his limb hacked off with a dull blade that just came out of the leg of someone with gangrene and no anesthesia to speak of. The lucky ones got a sip of tequila or some other hard liquor.
Many so-called doctors even traveled the country prescribing a variety of chemicals for ailments that ranged from completely ineffective to downright lethal.
Then in the 20th century a general shift towards the scientific method and repeated technological booms created medical technologies that have all but eliminated the risk of death from former killers such as broken bones and mild lacerations. Even simple habits such as washing one's hands when they get dirty have drastically reduced the risk of disease and death...
Thus, it is quite perplexing when President Obama implies that doctors still think the ideal medical solution is to hack a limb off rather than prescribe medication. He argues it's because a doctor can collect more money for the limb.
The President said:
If a family care physician works with his or her patient to help them lose weight, modify diet, monitors whether they're taking their medications in a timely fashion, they might get reimbursed a pittance. But if that same diabetic ends up getting their foot amputated, that's 30,000, 40, $50,000 immediately the surgeon is reimbursed. But why not make sure that we're also reimbursing the care that prevents the amputation? Right? That will save us money.
This is clearly not as straightforward as the famous Tonsil Quote, wherein the President discussed doctors going for tonsil operations instead of antibiotics because they could be better reimbursed, but it also demonstrates a pattern of thought, a pattern that indicates the President either still believes the United States has medieval medical care or doctors are greedy mad scientists looking to make a quick buck.
Further, it may explain why there has been little to no mention of tort reform in the raging health care debate happening in Congress. Any person who knows anything about providing medical care knows that a patient can sue a doctor for almost anything in this day and age, whereas back in the day they would gladly pay a doctor to do his level best to kill their loved one without even realizing it. With no penalty for frivolously filing and the cost of an actual trial significantly higher than a settlement, the doctor is very likely to end up paying in that event. Thus, it makes virtually no sense for any doctor to risk surgery when not absolutely necessary.
So, if the President thinks the tort law in this country is so lax that a doctor could run around amputating limbs and organs for a quick buck, it makes perfect sense that there's no discussion of tort reform of any kind in his health care plans. Unfortunately, time machines do not yet exist. Otherwise the President could take a trip back a hundred years and see that truly, the American health care system is not nearly as limb-hungry as he thinks.