That video is carefully edited to remove "I don’t want bureaucracies making those decisions,… they are already being made… If not under Medicare & Medicaid, they’re being made by private insurers... that’s a good example of where if we’ve got experts looking at this, that the pacemaker may ultimately save money, then we potentially could have done that faster." Instead the video cuts to Obama's comments about ineffective medications or treatments.

For a real transcript, see here: http://tabright.com/2009/06/26/transcript-president-obama-on-abc-townhall-june-23rd-health-care-reform-aka-prescription-for-america/

Obama: I don’t want bureaucracies making those decisions, but understand that those decisions are already being made in one way or another. If they’re not being made under Medicare and Medicaid, they’re being made by private insurers.

We don’t always make those decisions explicitly. We often make those decisions by just letting people run out of money or making the deductibles so high or the out-of-pocket expenses so onerous that they just can’t afford the care.

And all we’re suggesting - and we’re not going to solve every difficult problem in terms of end-of-life care. A lot of that is going to have to be, we as a culture and as a society starting to make better decisions within our own families and for ourselves.

But what we can do is make sure that at least some of the waste that exists in the system that’s not making anybody’s mom better, that is loading up on additional tests or additional drugs that the evidence shows is not necessarily going to improve care, that at least we can let doctors know and your mom know that, you know what? Maybe this isn’t going to help. Maybe you’re better off not having the surgery, but taking the painkiller.

And those kinds of decisions between doctors and patients, and making sure that our incentives are not preventing those good decision, and that - that doctors and hospitals all are aligned for patient care, that’s something we can achieve.

We’re not going to solve every single one of these very difficult decisions at end of life, and ultimately that’s going to be between physicians and patients. But we can make real progress on this front if we work a little bit harder.