I find it so bracing to read and hear Obama confront tough issues, lay out the facts as he and his staff know them, and open the dialogue with key stakeholders. In an interview with David Leonhardt in Sunday’s New York Times Magazine, the President addressed some of the current burning hotplate dilemmas our country is facing. His health care discourse was particularly meaningful to me because I was responsible for health care benefits at Texaco (before Chevron gobbled it up) and wished I could weigh in on the quality and cost of care issues facing the company at that time the way the President is doing now.

Instead of the platitudes we usually hear from politicians, such as “we have the best medical care in all the world,” Obama talked about the power and limitations of patient advocacy and education. (He actually said, “There is always going to be an asymmetry of information between patient and provider.” How about that for a classy sentence?) He spoke of comparative-effectiveness studies which review data to determine which widely-used treatments fail to improve outcomes, and which effective treatments are not used often enough. And he dared to speak honestly of end-of-life care. That’s a real heart-stopper, because it demands that we balance deeply held beliefs that sustaining life is worth any cost with the painful reality that the cost of care during the final phases of life (including costs for the chronically ill) is staggeringly high, perhaps even 80% of the total health care bill.

Obama talked about the personal situation he faced when his grandmother was diagnosed with terminal cancer during his campaign; MD’s gave her at best nine months to live. And they would be an even more difficult nine months because she had recently broken her hip, yet the hip replacement surgery for her hip was itself risky. Did it make sense to perform risky and expensive hip replacement surgery on a woman who already had one foot in the grave? She had the surgery, did fine for two weeks, then her condition deteriorated. Obama said he would have paid privately for the surgery no matter the cost, but wondered whether our current model of paying for surgery for terminally ill patients is sustainable.

Obama posits that these difficult moral issues must be addressed by doctors, scientists and ethicists, and  these guided conversations will not be easy. So, as with so many other issues, he is again showing us all that while certain problems will be difficult to address, difficult is not impossible. As I said, how refreshing and bracing to finally grapple with these tough choices, and to have some real leadership in the process.