When President Obama says he has the best healthcare in the world, he isn't kidding.
The White House medical unit, with a staff of four doctors plus nurses and physicians' assistants, is steps from his office. Treatment is free for Obama and his family (as well as for the vice president and his family).
During the president's travels, a doctor and nurse ride in a limousine in his motorcade. An emergency medical technician comes too, with an ambulance.
Air Force One is stocked with equipment for an on-board operating room. On overseas trips, two medical teams usually travel with the president, one on the plane and one pre-positioned on the ground so the president will always have a rested doctor and nurse at the ready.
The first family receives VIP treatment at military hospitals. And Obama has virtually instant access to medical specialists that few, if any, Americans could duplicate.
"If the president comes to us this morning with a mole on his cheek, a dermatologist will be seeing him today," said Dr. Rob Darling, a retired Navy captain who was a White House physician for President Clinton.
During the Clinton administration, a White House doctor and nurse typically traveled with the first lady when she went overseas separately from the president, but she did not have a medical team embedded in her everyday entourage, Darling said.
A White House spokesman declined to describe the arrangements for Michelle Obama.
The personal physicians and access to military hospitals come on top of a choice of 10 family health insurance options that Obama receives along with all other federal employees.
White House spokesman Reid Cherlin declined to say which health insurance plan the Obama family has. But under the federal Blue Cross Blue Shield plan -- the most popular among government employees -- a doctor visit costs $20 and generic drugs are $10.
The federal government contributes an average of $764 per month toward premiums for federal workers with family coverage, and employees contribute an average of $357 per month, said Helen Darling, president of the National Business Group on Health (and no relation to the former White House doctor).
At military hospitals, the president typically is not charged for outpatient care, said a White House official who declined to be identified. The president's insurance carrier is usually billed for inpatient care, but the hospital's commander has authority to waive the fees if the administrative expense of applying for reimbursement would exceed the payment to the hospital, the official said.
When the president's insurance carrier is billed, he is responsible for copays and deductibles, the official said.
Cherlin said in a statement that Obama is pushing for healthcare reform because "he'd like every American to have access to the same high-quality care that's available to government officials and staff."
Much of the extraordinary medical support provided to the president and his family is to help protect them if an attack occurs. The doctor and nurse who travel with the president's motorcade are positioned just outside the "kill zone" -- as close as possible while still far enough away to be likely to survive a bomb targeting the presidential limousine.
White House physicians, all of whom are military doctors with combat training, undergo a year of additional training once they are selected for a White House post.
The physicians see their role as mirroring the Secret Service in assuring "the continuity of government" in the broadest sense, protecting the nation's leader not only against an assassination attempt but against incapacitation through heart attack, cancer or other medical condition, said Darling, the former White House physician.
But he added that doctors who treat the president provide a level of care intended to free him as much as possible from medical worries.
After President Clinton had surgery for a torn tendon in his knee, a doctor and a physical therapist worked with him in his private gym at the White House twice a day for more than a month.
"That was the most rehabilitated knee in the history of mankind," Darling said. "The purpose was, he had to get back to the business of the people."
Clinton had to make a 20% copayment for his knee surgery, but his physical therapy was free, according to "The White House Physician: A History from Washington to George W. Bush."
White House doctors are "the creme de la creme of military medicine," said Ludwig Deppisch, author of the book.
The current director of the White House medical unit, Navy Capt. Jeffrey Kuhlman, is a physician with a master's in public health. He is board certified in three specialties, including family medicine.
Just as important as the in-house staff is the roster of specialists the president's physician can call upon, Deppisch noted.
"The president and his physician can call anybody in the country, and the specialist will respond. Nobody will say no to the president," Deppisch said.
When President Reagan had prostate surgery in 1987, a team from the Mayo Clinic flew to Bethesda Naval Hospital to perform the surgery.
After President Eisenhower's heart attack, Harvard Medical School professor Paul Dudley White supervised the president's recovery.
"He was one of the most respected cardiologists in the country," Deppisch said. "He never submitted a bill."