The President:
Can America, the wealthiest nation on Earth,
do what every other
advanced nation does,
which is make sure that every
person here can get adequate
health care coverage,
whether they're young or old,
whether they are rich or poor?
And I think that the effort in
the House and the Senate has
been to control costs to reform
the insurance industry to deal
with some of the structural
deficit issues surrounding
entitlements, and to do that all
in a context in which everybody
is getting a fair shake.
And right now frankly there are
30 million people who don't have
health insurance at all.
There are a whole bunch of
people who aren't added to that
list who all they have is a
catastrophic plan, and again,
they never go visit a doctor
unless they're really sick.
The way we tried to do it was
not a government-run health care plan, Paul.
I mean, that was some good
poll-tested language that has
been used quite a bit, but the
fact of the matter is, is that,
as Dick just alluded to, the way
we've structured it through the
exchange would be to
allow people to pool,
allow everybody to
join a big group,
and for people who can't afford
it, to give them subsidies,
including small businesses.
And so the question is whether
there is a way for us to arrive
at an agreement that
would reach those people.
John Boehner, I
looked at your bill.
I think, as I said, there is
some overlap on some issues.
But when it comes to
the coverage issue,
the Congressional Budget Office
says yours would potentially
increase coverage
for 3 million people,
and the efforts of the House
and the Senate would cover 30 million.
That's a 27-million-person
difference.
We can have an honest
disagreement as to whether we
should try to give some help
to those 27 million people who
don't have coverage.
And so that's I think
the last aspect of this,
and this is probably going to
be the most contentious because
there is no doubt that providing
those tax credits to families
and small businesses
costs money.
And we do raise revenues
in order to pay for that.
And it may be that the
other side just feels as if,
you know what, it's just
not worth us doing that.
But one of the things I hope
we don't do is to pretend that
somehow for free we're going to
be able to get those 30 million
people covered.
We're not.
If we think it's important as a
society to not leave people out,
then we're going to have to
figure out how to pay for it.
If we don't, then we should
acknowledge that we're not going
to do that.
But what we shouldn't do is
pretend that we're going to do
it and that there is some magic
wand to do it without paying for it.
So with that what I'm going to
do is I will go to whoever you
want first, Mitch.
Senator McConnell:
Mr. President,
Dr. John Barrasso is going to
make our opening statement on
coverage.
The President:
And then I will call Henry Waxman,
and we'll just go
back and forth.
Senator Barrasso:
Thank you very much --
The President:
And because we are short on time,
let's keep our remarks
relatively brief.
Senator Barrasso:
Thank you very much,
Mr. President.
For people who don't know me,
I practiced medicine in Casper,
Wyoming for 25 years as
an orthopedic surgeon,
taking care of
families in Wyoming.
I've been the chief of staff
at the largest hospital in our state.
My wife is a breast
cancer survivor.
Bobbi has been through
three operations,
a couple of bouts
of chemotherapy.
We've seen this from all
the different sides of care.
And this discussion needs to
be about all Americans because
everyone is affected, not
just people that don't have insurance.
And I've had dozens and dozens
of visits to senior centers and
town hall meetings, and
visited at service clubs,
and if you go to any community
in America and you ask the
question, "Do you believe that
this bill up here -- that this
bill, if it becomes law, do you
believe you will pay more for
your health care,
you personally?"
Every hand goes up.
And then you say, "Do you
believe if this bill becomes
law, overall health care in this
spending -- its spending in the
country will go up?"
Every hand goes up.
And then you ask the most
personal question of all,
"Do you believe if
this bill becomes law,
the quality of your personal
care will get worse?"
Every hand goes up.
And most worried of
all are the seniors,
when you go to the
senior centers,
because they know there's going
to be $500 billion taken away
from those who depend upon
Medicare for their health care,
and it's not just
Medicare Advantage.
It's hospitals; it's the
doctors; it's the nursing homes;
it's home health, which is a
lifeline for people that are
home alone; it's hospice, for
people in their final days of life.
That's all going to be cut.
That's why the seniors
are most concerned.
And even the White House own
actuary if this goes into play,
one in five hospitals, one
in five nursing homes will be
operating at a loss in 10 years.
That's what we're looking at.
Now, for 25 years practicing
medicine I never asked anybody
if they were a Republican or
a Democrat or an independent;
didn't ask if they had insurance
or not; took care of everybody.
And many, many doctors
-- I know Dr. Coburn,
Dr. Boustany -- do that,
we take care of everyone,
regardless of ability to pay.
Doctors work long hours;
nurses work long hours.
And, Mr. President, when you
say with catastrophic plans,
they don't go for
care until later,
I say sometimes the people
with catastrophic plans are the
people that are best consumers
of health care in using the way
they use their
health care dollars,
because a lot of people come
in and say, my knee hurts,
maybe I should get an MRI,
they say, and then they say,
will my insurance cover it?
That's the first question.
And if I say yes, then they
say, okay, let's do it.
If I say, no, then
they say, well,
what will it going to cost?
And what's it cost ought
to be the first question.
And that's why sometimes people
with catastrophic problem --
catastrophic health plans ask
the best questions, shop around,
are the best consumers
of health care.
But to put 15 million
more people on Medicaid,
a program where many doctors
in the country do not see them,
as Senator Grassley said
-- you know, you say,
how are you going
to help those folks?
And, Mr. President, when I
talk to doctors, they say,
I have a way: Put all the
doctors who take care of
Medicaid patients under the
Federal Torts Claim Act.
That will help them, because
they're not getting paid enough
to see the patients.
But if Medicare -- if they
accept those patients and then
their liability insurance is
covered under the Federal Tort
Claims Act, I think you'd have
a lot more participation in that program.
I do believe we have the best
health care system in the world.
That's why the premier of one of
the Canadian provinces came here
just last week to have
his heart operated on.
He said, "It's my
heart, it's my life.
I want to go where
it's the best."
And he came to
the United States.
It's where a member of
parliament -- a Canadian member
of parliament with cancer came
to the United States for her care.
They all have coverage there,
but what they want is care -- so
coverage does not equal care.
What we heard from Senator
Conrad is also right.
Half of all the money we spend
in this country on health care
is on just 5 percent
of the people.
Those are people, for the
most part, that eat too much,
exercise too little, and smoke.
And as a result, we need
to focus on those people.
So the focus ought to be
on the best possible care.
People are happy with the
quality of care they get,
the availability, but they sure
don't like the affordability
because it's not affordable.
And, you know, Mr. President,
the first week in medical school
we got our stethoscopes and
the professor of cardiology,
who just died this past year,
he said, this is to listen.
This is to listen to your
patients -- listen to their
heart, listen to their lungs,
but it's a constant reminder to
listen to them, listen to
what they are telling you.
And it means to listen to
the other people in the room.
If you're seeing a child, listen
to what the mother is saying.
If you're with an
elderly person,
listen to what their
adult child is saying.
And it's a constant
reminder to listen.
And I have great concerns that
people around this table are not
listening to the American
people and are fearful of the
consequences of this large bill,
which is why only one in three
people in America support
what is being proposed here.
And that's why so many
people, Mr. President,
are saying it's
time to start over.
The President:
Let me just -- there's one thing I've got to --
there are a number
of issues, as usual,
that I've got significant
difference with.
I'm just am curious.
Would you be satisfied if every
member of Congress just had
catastrophic care?
Do you think we'd be better
health care purchasers?
I mean, is that a change
that we should make?
Senator Barrasso:
Yes,
I think actually we would.
We'd really focus on it.
You'd have more, as you
say, skin in the game -- and
especially if they
had a savings account,
a health savings account.
They could put their
money into that --
The President:
Would you feel the same way if --
Senator Barrasso:
-- and they'd be spending the money out of that.
The President:
Would you feel the same way if you were making
$40,000, or you had --
that was your income?
Because that's the reality
for a lot of folks.
I mean, it is very important
for us -- when you say,
to listen -- to listen to that
farmer that Tom mentioned in
Iowa; to listen to the folks
that we get letters from --
because the truth
of the matter, John,
is they're not
premiers of anyplace,
they're not sultans
from wherever.
They don't fly into Mayo and
suddenly decide they're going to
spend a couple million
dollars on the absolute,
best health care.
They're folks who are left out.
And this notion somehow that for
them the system was working and
that if they just ate a little
better and were better health
care consumers they could
manage is just not the case.
The vast majority of these 27
million people or 30 million
people that we're talking
about, they work every day.
Some of them work two jobs.
But if they're working
for a small business,
they can't get health care.
If they are self-employed,
they can't get health care.
And you know what, it is a
scary proposition for them.
And so we can debate whether or
not we can afford to help them,
but we shouldn't pretend somehow
that they don't need help.
I get too many letters
saying they need help.
And so, I want to go to --
Senator Barrasso:
Mr. President,
having a high-deductible plan
and a health savings account
is an option for members of
Congress and
federal employees --
The President:
If -- that's right,
because members of Congress
get paid $176,000 a year.
Senator Barrasso:
-- 16,00 employees did take advantage of that.
The President:
Because they --
Senator Barrasso:
And so, it's the same plan --
The President:
-- because members of Congress --
Senator Barrasso:
-- that the Park Rangers get in the Yellowstone National Park.
The President:
John -- John,
members of Congress are in the
top income brackets
of the country.
And health savings accounts
I think can be a useful tool,
but every study has shown that
the people who use them are
folks who've got a lot
of disposable income.
And the people that we're
talking about don't.
Let's go to Henry.
Henry Waxman.
Representative Waxman:
Mr. President,
I just wonder if some of our
Republican friends would like to
have seniors on Medicare have
catastrophic coverage only.
I'd say to the seniors
in this country,
and we've heard mention of them
being the people who are worried
about this Medicare -- this
health care bill -- they ought
to worry if we
don't do something.
Because not only will we
hear ideas of putting them on
catastrophic coverage only,
because that will save a lot of
money -- Paul Ryan has a
proposal right now to say that
Medicare recipients in the
future ought to have just a
little voucher, and then
they can shop for their own insurance.
They could be prudent shoppers.
Well, yesterday I had a hearing
with some people who were
supposed to be prudent shoppers.
They were people from California
who were told by Anthem
Wellpoint that their insurance
was going to go up 30 percent -- 39 percent.
And could you imagine, seniors,
if you have to go shopping with
your voucher and then
you're told, oh, by the way,
this private policy that you're
going to have to buy just went
up 39 percent?
And the way to save the federal
government money is to shift it
on to the seniors.
That's where we're going
if we don't do anything.
Now, what do we do
that makes sense?
We've got to hold down
health care costs.
You can't -- we had some ideas
that we seem to agree about to
hold down health care costs.
One idea I did find peculiar,
and that's to have the medical
malpractice issue at
the federal level.
And the Republican proposal is
to adopt the California law.
Well, the California
law is in effect.
It's been in effect
since the 1970s.
And Californians are faced
with a 39 percent increase,
so it isn't holding down
their health care costs.
We've got to really look at
holding down health care costs.
That's hard to do, unless we
have insurance reform so we
could get more people
buying health care.
I thought Tom Harkin just
summed it up so well.
All these issues go together.
If you don't bring more
people in to be covered,
segment the groups that are
covered in high-risk pools,
they pay more money -- everybody
else is going to get a break.
Well, under the
Republican proposal,
the people who get a break for
insurance are the people who are healthy.
The people who have to pay more
are the people who are sick.
Is that what we want
in this country?
Now, I hear people all
day say, Mr. President,
the public doesn't
want your plan.
Well, if I heard the kind of
rhetoric over and over again
that I've heard from
some of the Republicans,
I wouldn't want
your plan either.
A federal takeover
of health care?
That's not what's
being proposed.
Somebody said that people ought
to be able to buy a policy that
suits their needs.
Well, how many people are
going to come forward and say,
I don't want certain things
covered -- and then find out
that they're sick and
they need that coverage.
We need to have a market
like the federal government
employees, like
members of Congress.
We know what we can choose.
If somebody wants to choose
a health savings account,
that means because they want
to put some of their money away
because it's tax-free and it's
a really great deal if you got a
lot of money.
But most people want to know
they're going to have necessary
medical coverage for the doctors
and the hospitals when they need it.
And you have something
that's basic to everybody.
Well, they ought to have that
for people who are buying
private insurance as well.
We had three
witnesses yesterday.
A woman told us that in her
family she had a child with a
hole in the heart.
And that -- because -- that
became a preexisting condition.
So she has health insurance
coverage through this individual market.
But she says, "I barely use it,
because I'm just -- I'm afraid
to use my health insurance."
She is now told she is going to
have this 39 percent increase.
She said her health insurance is
going to cost her about as much
as her mortgage
payment each month.
She is afraid to drop it,
because she doesn't know where
she could ever get
health coverage again.
Another woman had asthma,
and that was considered a
preexisting condition.
She was going to face a 39
percent increase, as well.
Now, if they were pooled with
everybody else in that small
business and individual market,
which is what our bill does,
then there are more people
buying insurance and there's
more -- there's more leverage.
It's spreading the cost, not
making people have to pay more
of these costs.
The people who we're talking
about are people in small
businesses where the small
business can't get insurance
because, well, they got one
employee with a real serious
medical problem.
So nobody in that group
is going to get coverage,
the employer can't afford it.
Or women, it costs more for
small businesses if they're in
that workforce, especially
if they're older.
They don't want to get coverage.
They don't want to give
them coverage either.
We have single adults, a lot
of them not very healthy,
dealing with chronic conditions,
parents and families living on
low incomes.
They need help from Medicaid.
We have to hold down the cost
by bringing everybody into the system.
Now, in Medicare,
what does our bill do?
It protects the solvency of the
program for an additional seven
to nine years.
For Medicare, we close
the doughnut hole,
which means that when
seniors have to pay for those
prescription drugs, they don't
have to do it all on their own.
We keep them with
a Medicare policy,
and we provide preventative
services and they don't have to
pay for them because we know
preventive services will keep us
from having to pay
for more costly care.
This bill is good for people
on Medicare and if we don't get
this passed they're going
to get squeezed like crazy.
This bill is good for the
American working people.
This bill is good for
our health care system.
And for us to take the
Republican proposal -- we cover
instead of 30 million
people, 3 million;
we wouldn't hold down
the deficit a bit;
we would still have all those
preexisting conditions that
would keep people from getting
their insurance coverage.
Maybe if people go and pretend
to be patients we could stop
some of those false claims,
but I'm sure those false claims
happen in the private insurance
market and not just the public
insurance market.
But not only are we
covering more people,
we're doing innovative ways to
deliver the care that will make
it less costly.
And as we develop innovative
ways to deliver care,
especially with chronic care,
that will hold down the costs of
care and those ideas would be
picked up by the private sector.
They always follow what Medicare
does and then they adopt it
because they want
to hold down costs.
So you can't solve any
problem -- insurance reform,
holding down costs,
protecting Medicare,
dealing with the deficit --
unless you deal with it all.
And Mr. President, you're not
going to be able to do this
piecemeal and I have doubts
about whether the Republicans
are going to help you because
I haven't heard a lot of
willingness to come and work
with you now or did I hear it a
year ago -- I hope I'm wrong.
The President:
Well, I'm going
to be equal opportunity here and
say we're not making
campaign speeches right now.
And I think your
points I agree with,
but I still think that there's
a lot of areas of agreement that
we've discussed so far.
This is an area, though, that
-- in which we do have some
philosophical disagreements.
And so what I -- I think it's
-- I want to go to a Republican.
The question I would
ask to my colleagues,
my friends on the
Republican side, would be,
are there areas of coverage for
people who don't have health
care that you would embrace and
agree with beyond what has been
presented in Republican
Leader Boehner's bill.
There may not be.
I mean, that may be sort of the
threshold at which all of you
think we can afford to provide
help to people who don't have
coverage, but there may be some
other ideas that haven't already
been presented or aren't
embodied in your legislation,
John, that I'd be
happy to hear about.
Representative Boehner:
I want to yield to Peter Roskam from Illinois.
Representative Roskam:
Thank you.
Mr. President, thanks
for your hospitality.
For the benefit of the group I
want to take you for a couple of
minutes to an experience that
I had with then-State Senator
Obama in the state of Illinois
when he took on a very
controversial initiative
regarding the death penalty situation.
And lest you think that the
death penalty is sort of a
junior varsity
issue -- it's not.
It's crimes, it's
claims of innocence,
it's penalties forever.
And then-State Senator Obama
approached Republicans and said,
look, let's fix this, let's
recognize the problem here,
let's fix it.
But it was very different than
what I sense is happening today.
What I sense is
happening today is,
"what is it going to take for
you Republicans to vote for our bill?"
That's the subtext
that I'm getting.
My sense is that this
is a problem of message,
it's not a problem
with the messenger.
You've got an incredibly skilled
messenger who has been out these
past several months in joint
session speeches and a whole
host of other
venues, interviews,
talking -- you've all seen
it, you've all participated,
you've all listened -- and
I think the American people,
when the conversation first
began about expanding coverage,
lowering cost, were
actually hopeful.
And it wasn't just a bumper
sticker -- I think they were
actually hopeful about what
was going to be happening.
And they listened and they
listened and they listened.
And my sense -- now, I can't
speak for every one of your
districts, but in my district
they've become increasing
disappointed with what they have
seen come out of this process.
And this is not a prop --
this is the Senate bill.
And my district
says, you know what,
that's sure looking like just
something that's now being
popped in the microwave,
taken out, a little salt,
a little pepper, some Republican
bread crumbs on the top,
and put it back in front
of the public to say, well,
do you like it now?
And my district really doesn't.
I don't know, I suppose you
represent some districts that do.
And I think one of the problems,
to get to this coverage issue,
is that the premise of this bill
is that coverage is expanded
through Medicaid, welfare.
Speaker Pelosi a couple of
minutes ago -- or a couple of
hours ago, actually said
that health care reform is
entitlement reform.
Speaker Pelosi:
Yes.
Representative Roskam:
Yes.
I would put a brighter light on
that and say it's entitlement expansion.
Think about what we're doing.
The CBO when they wrote to Harry
Reid -- wrote to Senator Reid a
couple of months
ago, they said, look,
there's about 15 million people
that are going to be put on Medicaid.
And Medicaid is
a house of cards.
Medicaid is not something that
is serving the public very well.
The state controller in Illinois
-- and we all come from states
with real trauma -- the state
controller in Illinois recently
wrote that as bond rating
agencies continue to downgrade
Illinois rankings to the
lowest in the nation,
the state can't afford
further jeopardizing.
This bill, section 2001
of the Senate bill,
takes away all of the
flexibility as it relates to
changes in Medicaid.
That is making our states I
think ultimately hidebound in
how they approach these things.
This is something that in
my view isn't sustainable.
Governor Brian Schweitzer of
Montana said -- let me give you
a quick quote -- "One of the
least effective programs in
terms of health care in the
history of the country is called Medicaid.
About 20 percent of America is
on a Medicaid program and they
would like to shift" -- "they"
meaning Washington -- "would
like to shift it and grow it
to somewhere around 25 or 30 percent."
Now, Medicaid is a system
that isn't working.
Almost everyone agrees.
But what Congress intends to
do is to increase the number of
people on Medicaid so that
they can do it on the cheap.
It isn't working for anybody.
Look, the foundation of
the expansion is Medicaid.
And in my view, and I think the
view of folks in my district and
I think many, many
people across America,
it is a flawed foundation.
And we can do much, much better.
A Republican proposal that's out
there would reduce the number of
uninsured by 3 million people.
So, look, you heard
it today in many,
many forms -- this -- you
remember the old -- in closing,
you remember the old game
you used to play as a kid,
Etch A Sketch, and you'd start
out with the Etch A Sketch,
that little thing where you try
and draw something and you dial
the dials and over a period of
time the more you dialed the
more crazy it looked and
then finally you'd say, oh,
let's just go like that
and do the Etch A Sketch.
I'll tell you what, a year's
worth of work and this is what
has come up with?
The American public, as far as
the ones that I have heard from,
are vehemently opposed to this.
And they say, look, take the
Etch A Sketch, go like this,
let's start over, let's do
incremental things where there's
common ground.
I yield back.
The President:
I want to make
sure that everybody gets an
opportunity to speak.
But I just want to caution
everybody, it's now 4:15 p.m.
There are a number of folks who
haven't had a chance to speak.
The question I had was, were
there ideas about expansion
beyond the 3 million that that
was in Leader Boehner's bill,
and I didn't get an answer
on it -- so in addition to,
and it may be that the answer
is that's all we can do.
I should point out this one
issue about Medicaid that I
think that's important.
Most of the people we'd like to
be in the exchange and giving
them subsidies.
And I think over time
(inaudible) see as an evolution,
if you created a
large enough pool,
where people could purchase it
through an exchange the same way
that members of Congress do.
The problem we've got right
now is that very poor people,
they've got coverage
through Medicaid.
And it's somewhat flawed.
There are problems with
doctor reimbursements,
there are problems long-term in
terms of solvency both for the
state and the federal level,
so all those things need to be fixed.
But the fact of the matter
is if their kid gets sick,
they can go to a doctor.
The people who are really left
in the cold are working families
who make too much for Medicaid
and don't have anywhere to go.
That's the group that right
now is getting the worst deal.
They're paying taxes,
they're working,
but they've got nowhere to go.
Now, for those 15 million
people who've got nothing,
I promise you they would say to
themselves having some coverage
through Medicaid is
a pretty good deal.
I'd prefer to have them in an
exchange where over time we've
got everybody in a pool, similar
to the pool that members of
Congress enjoyed.
But that's not the situation
that we have right now.
I just want to remind everybody
though that the group that is
being left out, because you
threw out the word "welfare,"
which is, you know, one that
obviously most American people
-- they don't want to be part
of welfare -- the fact of the
matter is, is that very poor
people right now have coverage
that is superior to what a lot
of folks who make a little more
money, are working very
hard trying to support their
families, do not.
Now, I know that Max has been
trying to get in for a while,
but there are some other folks
that haven't had a chance to
speak, so I want to
call on them first.
And then if I've got time,
Max, I'll allow you to wrap up.
But I'm going to go to Chris and
Murray -- Chris and Patty Murray
on our side, as well as Charlie
Rangel who want to speak,
and what we'll do is we'll
alternate to make sure that
we've got -- and I know that
Joe Barton is interested in
speaking, as well, and there
may be a couple of other
Republicans.
Go ahead.
Senator Dodd:
Well, thank you, Mr. President,
and I'll try and keep this
brief and turn it over to Patty,
so we'll take the time for one
person and divide it in two.
Let me first of all thank you
as well and thank all of our
colleagues who have done this.
This has been tremendously
helpful I think today.
It's been said earlier --
maybe it needs to be focused,
as well -- like many of
you, like all of you here,
in my state there
are 31 hospitals,
and they're terrific people.
Whether or not the quality of
care is equal for everyone in
this country is
certainly questionable,
but certainly the quality of the
people who are our health care
providers -- the
nurses, the doctors,
and others -- do an incredible
job every single day.
And the sense -- I was struck
when the REPRESENTATIVE was
talking about the death penalty
issue that was debated some time
ago in Illinois.
I think most of us around this
table here would agree today
that every person, if they're
confronted with a legal problem
has a right to a lawyer.
That's something we've
accepted as a country.
It's somewhat ironic, I suppose
-- and history may judge us
accordingly -- that while
everyone was entitled to a
lawyer, regardless of what
you've been charged with,
that you don't have
a right to a doctor.
And yet at the same time we
acknowledge that we provide
care: If you show up
in an emergency room,
we take care of you.
And that's a great testimony
about who we are as a people.
The problem is of course the
costs associated with that.
I think there's a false
assumption that that's one group
of people, and
they're out there,
and they have no impact on
what happens to those who have
insurance today, and somehow
they should be taking better
care of themselves, they
should quit smoking,
they should eat better,
they should get a job;
that somehow the
responsibility rests with them.
If you can accept
that, which I don't,
the fact of the matter is that
sector of our population affects
everyone else.
It costs us about $248 billion
a year in lost productivity when
you have increased numbers of
uninsured people in the country.
At this very hour, there's a
cost with every single insured
person in this
country of roughly $1,100
a year to pay for that cost
of that person showing up in
that emergency room,
or getting that care.
That's a hidden tax that
Americans are paying today when
people show up for
that kind of support.
There are -- today before we
wrap up and go back to our
offices and go back to our
homes this evening here in the
District of Columbia, 14,000 of
our fellow citizens will have
lost their health care today.
And every day that we're here
debating and discussing this,
14,000 Americans lose
their health care.
Roughly six to eight people will
have lost their lives today as
we gather around this table
because they're uninsured,
based on a Harvard study and
National Science Foundation
study; that we lose that many
people on a daily basis because
we lack -- because they
lack health insurance.
So there are tremendous
costs associated with this.
Henry said it well, Tom said
it well, and Mr. President,
you certainly
encapsulize it very well.
These are not segmented issues.
And while incremental approaches
are something I (inaudible)
support and approach after 30
years here in dealing with major
issues, but this issue
defies incremental approach.
You can't get from one point to
the next incrementally unless
you deal with it holistically,
and that's really what we're
trying to do.
And you may disagree about
whether or not we're doing too
much on mandates or too much
here or there -- and that's a
legitimate debate -- but you
can't get to affordability,
you can't get to quality,
you can't deal with the major
economic issues if you
don't deal with coverage.
You just can't.
There's no way to do it.
You've got to have broadening
coverage if you're going to have
any effort or any successful
effort in reaching those questions.
Lastly, I'll just
say this to you.
A guy in my state, Kevin Galvin
(phonetic) -- Kevin employs
seven people, a maintenance
operation in Hartford, Connecticut.
He wanted to
provide health care.
And like the stories
you've all heard,
he lost a fellow of 24 years
because the guy had a health
care issue, he finally had to
take less pay, took another job,
because there was
health care provided.
But Kevin did more than just
tell me a story about himself,
Mr. President, and what happened
to his seven employees because
they couldn't get health care.
He went out in my city in
Connecticut and organized 19,000
small businesses, and they
changed the law in Connecticut
regarding pooling
in small businesses,
because here was a small
business guy who wanted to take
care of his people and watched
tragically day after day what
happened to individuals because
he could not provide it for them
any longer.
And I think people like Kevin
Galvin exist in every district
in every state who want to
provide that health care,
understand how valuable it is
to them, their productivity,
and of course the importance
of their employees.
But coverage is
the critical issue.
We know that in the next
10 years -- factually,
Mr. President -- in the next
10 years every state in this
country will have a 10 percent
increase in uninsured people.
We know that in 30 states in
our country in that same 10-year
period there will be a
30-percent increase in the uninsured.
And half the population under
the age of 65 will at one point
or another in the next 10
years be without insurance.
So it's not some
isolated group out there.
This is the critical
constituency that is -- this is
the lynchpin that holds
all of this together.
So coverage is
absolutely critical.
Representative Barton:
Thank you, Mr. President.
I want to commend you for
asking us to come here,
and I will say that never have
so many members of the House and
Senate behaved so well for so
long before so many television cameras.
(laughter)
So if we ever get to a
conference committee,
we may want you to
be the moderator.
I do think, though, that there
is a fundamental difference in
the vision that you and your
friends on the majority have put
forward, and the vision that
myself and those of us in the
minority have put forward.
It's the fundamental
role of government.
We believe that we should use
free markets to empower people
and give them choices.
And for the best of intentions,
yourself and most of your allies
in the Democratic Party seem
to believe that the government,
either through a mandate
or through a regulatory
requirement, knows better and
will do better for health care
for most Americans.
Now, whether you have a mandate
or simply give the Secretary of
Health and Human Services the
ability by regulation to require
something, that's a difference
without -- that's a distinction
without much of a difference.
So the six commonsense ideas
that various Republicans have
put out here is not
incrementalism in the sense that
it doesn't go together, but it
does not radically change the
basic health care
system of America.
If you give the ability to sell
insurance across state lines,
and prevent a state
from precluding it,
if the insurance company can
prove that it's solvent and that
it will pay the benefit, health
care costs will go down in that
state and premiums will go down.
There was a study just out
that in the state of California
health care premiums would go
down 50 percent if Californians
could buy insurance
from Nevada or Oregon.
If you create a catastrophic
high-risk pool and put the cap
on it that Leader Boehner did
on his alternative on the House
floor, and allow small
businesses to create the kind of
pools that we've talked about,
you're going to be able to give
those Americans who can't
get insurance because of a
preexisting condition and want
it the ability to get into those things.
And their premiums will
not go up catastrophically.
They will not go
up astronomically.
And one of the things that
we seem to have agreement on,
according to yourself
and Senator Durbin,
is medical malpractice.
Now, your proposal in the House
bill and the Senate bill pay lip
service to medical malpractice,
but they don't really do it.
Again, if you take the Boehner
proposal that was put together
and put up on the House floor,
and it's based on what's
happened in Texas -- in Texas,
which put in medical malpractice
reform in 2003 -- premiums for
medical malpractice have gone
down 27 percent.
Texas has gained 18,000 doctors
since this reform was put in.
There are 55 rural counties
in Texas that now have an obstetrician.
If that is extrapolated
nationally,
you're not going to save the
$54 billion that Senator Durbin
alluded to and that
yourself alluded to.
If you combine the direct
savings with the indirect
savings, because the price of
practicing defensive medicine
goes down, you've probably
saved $150 billion a year.
Now, that's real money.
So what we're saying, Mr.
President -- we're not
talking about incrementalism.
We're talking about, as Leader
Boehner said and Mr. McConnell
-- Senator McConnell said, let's
start over in the sense that we
change the vision and work
together to do the things that
we agree upon, but do it in a
way that doesn't destroy the
fundamental market system that's
made the American health care
system the best in the world.
And if we do that,
we can make a deal.
Thank you, Mr. President.
Thank you, Leader Boehner.
The President:
Joe, I'll respond to you right (inaudible) because
I think we should wrap it up.
You're right, the proposal that
John Boehner has put forward
doesn't radically change
the existing system.
And that I think is why 3
million out of the 30 million
who don't have coverage, or 40
million, don't get coverage.
The proposal that's been put
forward by the House and the
Senate Democrats also doesn't
radically change it in the sense
that the vast majority of people
who currently have health care
will still get it, it's just
they'll see it a little cheaper.
People who do not have
coverage will start getting it.
So that's -- it's not -- neither
of these proposals are radical.
The question is, which one works
best for the American people?
And that's what we'll
see if we can determine.
We're running short on time.
I know that some folks are going
to at some point have to get going.
I am going to reserve the
prerogative of making sure that
everybody who has not had a
chance to speak is allowed to
speak, and then I will wrap up.
That means that we're probably
going to go a little bit later
than we had anticipated.
But, as I said, by the
standards of Washington,
we're still in
the ballpark here.
I'm going to call on
Charlie Rangel first.
We'll go to one of our
Republican colleagues.
Patty Murray is going to
have an opportunity to speak.
Again, there may be some
comments -- there may be some
other Republicans who are
interested in speaking.
We'll go to -- we're going to
actually go to Ron Wyden first.
Then, we're going to go
to another Republican.
And we're going to
end with John Dingell,
who was there when the idea of
everybody having health care was
first introduced by his
father many decades ago.
Representative Waxman:
Mr. President,
why don't you just call on
Republicans who haven't talked,
because some of them have
talked numerous times?
The President:
I agree, but I want to make sure that they may
want to respond to
whatever is said.
Go ahead, Ron.
Senator Wyden:
Thank you very much,
Mr. President.
And I think this has been a
very constructive session.
For the last six hours, we have
essentially heard Republicans
talk about incremental coverage
and Democrats talk about
comprehensive or broader
kind of coverage.
And I want to outline something
that I think could bring both
sides together for just
a couple of minutes.
First, on the incremental
point, the evidence shows that
incremental reform not only
does less, it costs more.
And the experts that both
Democrats and Republicans rely
on have found this -- the
Lewin Group, for example,
that Republicans quote from,
they say that and both sides use them.
Also, history.
We have been doing incremental
reform in this country since 1994.
Since the blowup of
the Clinton plan,
that's exactly what
we've been doing,
and costs have been gobbling
up everything in sight in the
private sector and
in the government.
So I would submit that instead
of this debate about incremental
reform or comprehensive reform,
we could all be for real reform.
And real reform, in effect,
changes the incentives that
drive the system and
particularly empower the consumer.
Mr. President, I've been very
pleased that you've constantly
been coming back to the system
for members of Congress.
Folks, all of us can fire
our insurance company,
every one of us.
And as far as I'm concerned,
we've got to stay in this battle
until everybody in the United
States has that right to hold
the insurance companies
accountable and to fire them.
And one of the promising
points you made this afternoon,
Mr. President, that I appreciate
is the point on interstate
shopping, because this is
another opportunity, in my view,
done properly -- properly
to empower the consumer.
Now, colleagues, our system --
the one that we enjoy -- already
allows interstate competition
for health insurance.
That's the way the federal
system works right now.
And there are good
consumer protections.
So, Mr. President, when you made
that offer to all of us today to
work with us on this, not only
am I going to follow up on what
I think is a very gracious
offer to try to bring both sides
together, it allows us to build
on the exchanges that we have
today, which begin to empower
people with more choices and competition.
And if we just keep
building on that,
starting with this effort to
bring both sides together on
interstate competition, looking
in my view at the federal
employee system to do it, I
think we can resolve a lot of
our differences.
So I appreciate the opportunity
to speak, Mr. President.
I want colleagues to know that
I'm going to be following up
with both sides of the aisle
this afternoon and your
administration to bring
this group together.
Senator McConnell:
Mr. President,
all of my members have had a
chance to speak at least once,
several of them a
number of times.
Jon Kyl reminds me that
the HSAs, for example,
are not exactly for rich people;
that the median income of a user
of a HSA is $69,000 a year.
All of us are representatives
of the American people,
but I have a feeling we haven't
been listening to them very carefully.
Representative Roskam mentioned
what the people in his district
think, and I expect all of you
are experts on what the people
in your districts think.
But we know from the polling
that's been done in this country
how the American people feel
about this 2,700-page bill.
We know how they feel about it.
This is not a close call.
If you average all of
the polls in America,
we know that the American people
oppose this proposal by -- on an
average of 55 to 37 percent.
They have also been asked -- and
we keep reading in the newspaper
that where we're headed next is
to the reconciliation approach.
Well, Gallup also
asked that question.
It explained to the American
people what it meant so they
understood what this word
that we use around Washington
actually means.
And in the Gallup poll, the
American people were opposed
using that, 52 to 39 [percent].
So this has been a fabulous
discussion, Mr. President.
We have a lot of
experts around the room.
But I think it's
really important,
since we represent
the American people,
that we not ignore
their view on this.
They have paid attention to this
issue like no other issue since
I have been in the
United States Senate.
Health care is a
uniquely personal issue.
Obviously, you get more
interested in the subject the
older you get.
But every American cares deeply
about the quality of their
health care, and access to
health care and cost of health care.
They have followed this
debate like no other,
and they have rendered a
judgment about what we have
attempted to do so far.
The solution to that is to put
that on the shelf and to start
over with a blank piece of paper
and go step by step to see what
we can agree on to improve the
American health care system,
which is already -- as all of
us agree -- the finest in the world.
The President:
I'm just going to make this remark,
and then I'm going to call on
Patty Murray -- I'm going to
save the two lions of the House
here for the end -- because
there's been a lot of comments
from every Republican about the
polls and what they're hearing
from their constituents.
And, as I said, I hear from
constituents in every one of
your districts and every
one of your states.
And what's interesting is
actually when you poll people
about the individual elements
in each of these bills,
they're all for them.
So you ask them, do you want to
prohibit preexisting conditions?
Yes, I'm for that.
Do you want to make sure that
everybody can get basic coverage
that's affordable?
Yes, I'm for that.
Do you want to make sure that
insurance companies can't take
advantage of you and that you've
got the ability, as Ron said,
to fire an insurance company
that's not doing a good job and
hire one that is, but also, that
you've got some basic consumer protections?
Yes, we like that.
So polls I think are important
in taking a temperature of the public.
If you polled people
and asked them,
is the system working right now
and should we move forward with
health reform, they'd
also say yes to that.
And my hope had been,
and continues to be,
that based on this conversation
there might be enough areas of
overlap that we could
realistically think about moving
forward without -- without a
situation in which everybody
just goes to their respective
corners and this ends up being a
political fight, because this is
something that really has to be solved.
We've got three people who have
not had an opportunity to speak today.
If you don't mind, I
will -- would like to,
in the interest of time, just
go ahead and let each of them speak.
If there's an intervention that
somebody on the Republican side
wants to make, then I
will recognize them.
Then I will allow anybody
of your choice, Mitch,
to wrap things up.
I think Speaker Pelosi may want
to say just a quick summary of
what she's thinking.
And then I will talk a
little bit about next steps.
And if everybody could keep
their remarks relatively brief,
that'd be very helpful.
Patty.
Senator Murray:
Mr. President, thank you.
And this has been I think
a very good discussion.
And I think all of us come to
this table today having heard a
lot of stories and talked to a
lot of people and bring their
passions with us today.
And I certainly am one of those.
And every time we talk about
this -- every time I think about
this, I remember a little boy
that I met last spring who is 11
years-old, whose name
was Marcelis (ph).
And he told me that
his mom, single mom,
taking care of him and
his two younger sisters,
was going to work every day,
had a job managing a fast-food
restaurant, was doing
okay but she got sick.
And when she got sick she had
to take time off from work and
because she was missing so
much work she lost her job.
When she lost her job,
she lost her health care.
And because she lost
her health care,
she couldn't get in to
see a doctor, and sadly,
Marcelis's mom died.
I think about him every time
we talk about this bill.
And what happened to her is
happening to so many Americans
who when they get sick today
don't have any choices.
They have nowhere to go.
Either they don't have insurance
or they've been denied insurance
because they don't -- because
they have a preexisting
condition or they're a small
business whose premiums have
gone up so dramatically that
they can no longer afford to
provide it for their employees.
Too many Americans today are
in a box and they don't have a choice.
Frankly, it's why so many
Americans today are passionate
about a public option.
It was a choice for them that
they felt was important to them.
But in the bill that you have
presented and that we've been
working on that is so important
is it finally gets some people
out of that box of no choices --
by giving them an exchange that
they can go to, by taking care
of the insurance reforms so
they're not denied coverage,
by opening up community health
centers so people have choices,
by making sure that we lower the
cost for all Americans because
when we provide coverage for
30 million Americans it lowers
the cost of everyone who has
insurance today by $1,000 a year
a family -- this is why this is
so important.
And what I have listened for
today is whether the alternative
proposal that has come before us
gives people those choices that
they need.
And that's what I'm listening
for and I go back to Marcelis
and I think, will that proposal
make sure that nobody loses
their mom again because
they didn't have a choice?
And that's why it's so important
that we move forward with what
we have and open that door
for so many Americans.
The President:
Thank you.
Senator McConnell:
Mr. President, Dr. Coburn.
Senator Coburn:
If we don't think about what the key goal is
-- the key goal is to reconnect
purchase and payment so we
become good purchasers.
Whether we create --
what system we do,
if we don't reconnect the
mechanism of payment with
purchase, we're not going to
get good value out of our health care system.
And I outlined one out of every
three dollars that doesn't help
anybody get well, doesn't
prevent them from getting sick.
And there's enough potential
there in that pool of money that
we don't have to have
the government run it.
What in fact we can do is we can
create and allow that money for
everybody to have the kind of
access that Senator Murray wants
that individual to have.
The thing that I think is --
draws us apart is the level of
involvement in the government
in making those choices.
And I would just put forward
to you that we ought to have
another talk like this as we can
get closer and closer on some
ideas because we all
want the same thing,
but how we get there, whether or
not we're in charge of it or the
individual patient
is in charge of it,
personally making their own
choices with the asset value
that is capable, based on what
we're already spending in health care.
We don't need to spend a penny
more in health care in this country.
What we need to do is spend it
much more wisely and much more effectively.
The President:
I'll pick up
on some themes in my close.
Charlie Rangel.
Representative Rangel:
Thank you, Mr. President,
and I appreciate the fact that
you saved the best for last.
The President:
Absolutely.
(laughter)
Representative Rangel:
I had
really hoped that when we came
here that we were really
going to push over the top.
We are so close to
national health insurance,
we are so close to allowing
people that go to work every day
and don't know what can happen
to them when they lose their job
and lose their health insurance.
I know that they call the
Senate the upper house,
but I was amazed how it seems as
though they believe the American
people only listen to those
from Wyoming and Kentucky.
But having said that,
for my New Yorkers,
even though we have more
self confidence than we need,
I would want them to know that
they are Americans and that we
do listen to them and that the
states that oppose this great
plan, doesn't speak
for all of America.
Having said that, some people
have called those who oppose us
as being the "party of no."
I don't think so,
notwithstanding the fact we got
five Republicans from the Ways
and Means Committee here at your summit.
Now, we spent hundreds of hours
in three committees and Ways and
Means and there wasn't
one bill before us.
And I would think that instead
of taking the President's time,
that this is where the House and
the Senate would take care of
legislative business, especially
if we agree on 70 percent.
For God's sake, then,
for the 10 or 20 percent,
why do you say scrap what we got
unless it ends up with that you
have made up your mind that
we're not going to have a health bill?
And then I would say that most
all of America would find it not
more difficult to understand
why the bill is so big,
or why we use reconciliation.
I think one of the big
problems America would have is,
why does it take 60
to get a majority?
And I have to explain, well,
that's the Senate and they're
different than most Americans
in understanding it.
So what I would hope would
happen is that we leave here not
thinking that we're
going to start all over.
We can't get back those times.
This is the last year for a
whole lot of people in the
House of Representatives who we
believe we represent the people, too.
Why can't we take
what we've agreed to?
I mean, sick people,
scared people,
are not Republican
and Democrats.
They're Americans.
And you've made it abundantly
clear that you have the same
sensitivity, you recognize
the fiscal crisis,
you know what can happen to our
country if we're not educated,
if we're not strong
in a healthy way.
Have staff or somebody bring
together those issues that
cannot be contradicted in
terms of what you want.
And I know you want more than
just 3 million people insured.
You can explain why it's
difficult for you to do it.
But I know you would want
to achieve having most all
Americans or all Americans with
the same health benefits because
that's so important.
And then, Mr. President, after
we start learning to agree with
each other, and it's not a
question of no but it's the
Congress working its will
for the good of people,
then we can work out -- and God
knows Mr. Camp and I have tried
desperately hard, and Jim
McCrery before him -- to realize
people aren't concerned
with the debate.
They're concerned with what
are we going to produce.
And I don't care
what your color is,
I don't care what your party is,
that if you're sick you're sick,
and you don't check
out the doctor.
And they're not going to check
out whether or not you're
Republican or Democrat.
So I just hope that we can
change this to a positive thing
where you can say let's leave
here at least talking about what
we agree on.
Let's stop knocking each other
as who's the smartest and who's
the most patriotic.
And let's really, then, confine
the public argument to where we disagree.
And rest assured, I can assure
you that they won't be concerned
with how big the bill was.
I have no clue as to how big
the Social Security bill was,
how large, how many pages
was in the Medicare bill.
And I don't really think that
someone sick in the emergency
room is concerned about the size
of the bill that we are trying
to help them with.
So I appreciate this.
The President:
John Dingell.
Representative Dingell:
Mr. President, thank you.
And God bless you for your
leadership in this matter.
The country desperately needs
you and desperately needs this legislation.
I saw the cartoon, two
people are sitting down,
and one of them
says, "Terrible news.
Our health care rates are
going to go up 40 percent."
The other guy
says, "Don't worry,
good news is you're not
concerned because you have
preexisting conditions."
(laughter)
This solves both
problems, the bill.
And Mr. President, again, we
desperately need your lead.
Now, having said that, when my
dad started out on this years
ago, Harry Truman said, you know
the reason people don't have
health care in this country?
They can't afford it.
And he was right.
And it's still the case today.
I saw this morning a statement
that was made with regard to
starting over.
This comes from a respected
Republican leader,
Governor Schwarzenegger of
California, February 23, 2010:
"I think any Republican
who says you should start from
scratch, I think that's bogus
talk and that's partisan talk."
I think we need to buckle down
and get to the business of
solving the biggest problem that
this country has coming down the
road at us.
In 2025, the cost of a family's
health insurance is going to
double -- $25,000.
I don't know anybody
who can afford that.
You can argue about Cadillac
plans and other nonsense.
That's not going
to be important.
And in 2080, the cost of all
of our health care is going to
equal the gross
domestic product.
It's a recipe for disaster.
We have much in common,
I want you to know,
and I hope and pray
you will take a look.
We cover young adults under
their parents' -- under their
parents' insurance.
That's a Republican offer.
We prohibit dropping insurance
coverage when the patient gets
sick, but we don't -- and
the Republicans do, too,
but they don't cover
preexisting conditions.
Both of us prohibit annual
and lifetime limits.
High-risk pools, we
have and they have.
But high-risk pools carry
with them some risk,
because it constitutes an
incentive for a race to the
bottom, whereby people will move
their insurance coverage to the
place where they have the
least regulation and the least
protection for the consumers.
And it also includes, and
amongst the other 14 items where
we're agreed on, is the
availability of health savings accounts.
There are a lot of other things
here that we have and we need.
I would say that I've seen some
of my friends who I knew before
they were virgins.
They were pushing, for example,
use of the extraordinary
budgetary mechanism, as to
get this decided by 51 votes.
Seems like a great idea,
if -- and I'm curious,
why in the name of common sense
are we being so fussy about
having the decisions in the
people's House and the people's
Senate decided on the basis of
a simply majority, 51 votes?
And if there's something
wrong with that,
I wish somebody would tell me
why we ought not give the people
that kind of representation.
I would note that also
mandatory coverage, mandates.
That was in a bill introduced
by my good friend Bill Thomas,
Chairman of the Ways
and Means Committee,
and 20 members of the U.S. Senate.
They said -- and they
were not fussy about that.
And I think we ought
to look to see,
here we have a chance
to serve the people.
I have people coming to my
office with tears in their eyes.
They can't get coverage.
They have preexisting
conditions.
A young dental surgeon I knew
couldn't get health care.
Why?
Because she had breast
cancer years before;
she couldn't get care.
And I've seen a lot of
other cases like that,
people who would have
drive-through pregnancies or
drive-through mastectomies, and
all manner of high-handed abuse
by the insurance companies.
I'm always surprised when I can
find somebody that's defending
the insurance companies after
the things that they do to the
ordinary people in this country.
They could cancel your insurance
policy while you're on the
gurney headed into
the operating room.
Somebody would -- if somebody
would explain that to me,
I would be deeply grateful.
But the fact of the matter is,
we have a chance to do something
that Dan Webster
one time observed.
I thought it was -- I thought it
was a very useful thing that he said.
And I think we
ought to -- he said,
"Let us see whether we also,
in our day and generation,
may not perform something
worthy to be remembered."
It's on -- Madam Speaker,
as you well know,
it's on the wall of the
House of Representatives.
It's there for us in the House,
and my colleagues in the Senate
will know it, those few who I
see again and serve with us will
recognize that as something.
We have before us a
hideous challenge.
The last perfect legislation
that was presented to mankind
was delivered to the Israelis
at the base of Mount Sinai.
It was on stone tablets
written in the fingers of God.
(laughter)
Nothing like that has been
presented to mankind since.
What we're going to
do is not perfect,
but it's sure going
to make it better,
and it's going to ease a huge
amount of pain and suffering at
a cost which we can afford,
which has been costed out by the
Office of Management and Budget
-- the Congressional Budget
Office, saying, it's
budget-neutral and in fact
reduces the budget.
I beg you, my friends, let us
go forward on this great task.
The President:
Thank you, John.
Representative Dingell:
Thank you, Mr. President.
The President:
Speaker Pelosi
wants to say a brief word.
John, do you want to
say anything in closing?
And then I will wrap up.
Nancy.
Speaker Pelosi:
Thank you very much,
Mr. President.
As one who has abided by
the three and a half minute,
I'm going to take a few seconds
more now in closing to extend
thanks to you, Mr. President,
for bringing us together,
for your great leadership,
and without it,
we would not be so very
close to affordability,
accountability for the
insurance companies,
and accessibility for so many
more Americans to improve their
health care, to
lower their cost.
Mr. President, I harken back
to that meeting a year ago.
At that time, Senator Grassley
said -- questioned you about the
public option.
And you said, "The public option
is one way to keep the insurance
companies honest and to
increase competition.
If you have a better way,
put it on the table."
Well, I bring that up because
we come such a long way.
We're talking about how
close we are on this,
how far apart we are here.
But as a representative of
the House of Representatives,
I want you to know that we were
there that day in support of a
public option, which
would save $120 billion,
keep the insurance
companies honest,
and increase competition.
We've come a long way to
agreeing to a Republican idea --
the exchanges.
Senator Enzi has been
a leader in that.
Senator Snowe, along
with Senator Durbin,
had legislation to that
effect -- bipartisan.
It caused the insurance
companies opposed the public option.
They couldn't take
the competition.
We have in our bill
market-oriented,
encouraging to the private
sector, initiatives.
I think the insurance industry,
left to its own devices,
has behaved shamefully.
And we must act on behalf
of the American people.
We have lived on their
playing field all this time.
It's time for the insurance
companies to exist on the
playing field of
the American people.
I believe I have news for
some of my colleagues,
because we have very
much more in common.
Senator Coburn, you had so
many positive suggestions,
which I didn't hear much
else of, but from you we did.
And I think you'd be pleased to
know that after much debate in
our House, we came up
with value not volume;
others have called it quality
not quantity in terms of
utilization, over-utilization.
Senator McCain, when
you talk about Florida,
we're talking about addressing
the regional disparities in
terms of compensation
and health care.
So we have addressed many
of these issues in the bill.
I think it's really
important to note, though,
and I want the record to show --
because two statements were made
here that are not factual in
relationship to these bills.
My colleague, Mr.
-- Leader Boehner,
the law of the land is there is
no public funding of abortion
and there is no public funding
of abortion in these bills.
And I don't want our listeners
or viewers to get the wrong
impression from what you said.
Mr. Camp -- Mr. Camp, you said
that the Medicare cuts in this
bill cut benefits for
seniors; they do not.
They do not.
So I want the record to show,
just in those two cases,
where we may have differences
of opinion and of approach and
evaluation of the value
of different things,
but certain things are facts
about our bills that I cannot
let the opposite view
stand when they are stated.
Yes, it's hard to do this.
The misrepresentation campaign
that has gone on about these
bills, it's a wonder
anybody would support them,
as Mr. Waxman said.
But the fact is this, the
President said many of these
provisions on their own are
largely supported by the
American people.
So this will take courage to do.
Social Security was hard.
Medicare was hard.
Health care reform for all
Americans -- insurance reform is hard.
But we will get it done.
And as we leave this debate
I think that many of the
differences that we have
are complicated and they're legitimate.
They're differences of opinion
about the role of government and the rest.
But I think it's really clear
in one point that the American
people understand very clearly,
they understand that there
should be an end to
discrimination on the basis of
preexisting conditions.
The proposals that we have put
forth end discrimination on the
basis of preexisting conditions;
the Republican bill does not.
With that, Mr. President,
I thank you again for the
opportunity to discuss the
differences and to try to find
some common ground on this.
The President:
Well, listen,
this has been hard work.
And I want to, first of all,
thank everybody for being here
and conducting themselves in
an extraordinarily civil tone.
And as I said, given the number
of folks that were around this
table, the fact that we're only
an hour late is -- beats my prediction.
(laughter)
Here's what I'd like to do --
and I'm going to take about 10 minutes.
I want to go through
where I think we agree,
and I want to summarize
where I think we disagree.
And then I'll address some of
the process issues that have
been brought up by a
number of the Republicans.
We agree that we need some
insurance market reforms.
We don't agree on all of them,
but we agree on some of them.
I think that if you look at the
ones that we don't agree on --
since there's been a lot of
reference to what the American
people want -- it turns out that
the ones that are not included
in the Republican
plans right now,
but are included in
the Democratic plans,
are actually very popular.
I know there's been a discussion
about whether government should
intrude in the insurance market,
but it turns out that on things
like capping
out-of-pocket expenses,
or making sure that people are
able to purchase insurance even
if they've got a
preexisting condition,
overwhelmingly people say the
insurance market should be regulated.
And so one thing that I'd ask
from my Republican friends is to
look at the list of insurance
reforms and make sure that those
that you have not included in
your plans right now are ones in
fact that you don't think the
American people should get.
Because I strongly believe
in these insurance reforms.
I've talked to too many families
who have health insurance and
find out that what they have
does not provide them with the
coverage they needed and
they end up being bankrupt,
or they end up going without
care, or they get care too late,
as was the case in the story
that Patty Murray mentioned.
The second thing I think we
agree on is the idea that
allowing small businesses and
individuals who are right now
trapped in the individual market
and as a consequence have to buy
very expensive insurance and
effectively oftentimes just go
without insurance could be
solved if we allowed them to do
what members of Congress do,
which is be part of a large group.
Again, the idea of an exchange
is not a government takeover;
it is how the market works,
which is if you have a lot of
purchasing power you
get a better deal.
That's how Walmart
drives its prices down,
because everybody who wants to
supply Walmart -- Walmart tells
them, you give me the
best deal possible.
And as a consequence, the
supplier gives them a much
better deal than they do the
mom-and-pop shop on the corner.
Well, we should be able to give
small businesses and individuals
who are self-employed, who
aren't able to get insurance
through a large employer,
to have that same deal.
It sounds like we've got some
philosophical difference as to
whether there should be some
minimum benefits in that
exchange, some
baseline of coverage.
Again, there's a baseline
of coverage for members of Congress.
And the reason we set that up
is because we want to make sure
that any federal employee who is
part of this big pool is getting
good, quality coverage
-- not perfect coverage,
not gold-plated coverage,
but adequate coverage.
It may be -- and I'd ask my
Republican colleagues to look
and see, is that an area
that can be resolved.
There has been a lot of
discussion and one of the main
tools the Republicans have
offered to drive down costs is
purchasing insurance
across state lines.
This is an idea that is embodied
in the House and Senate bill,
but, again, the details differ.
The approach that John Boehner
and some of the Republicans
appear to take is to say,
let's just open things up;
anybody can buy anything
anywhere regardless of what
state insurance laws are, and
that will drive competition and cost.
The philosophical concern I have
on that is that you potentially
get what's been referred
to as a race to the bottom.
And for people who may not be
following the intricacies of the
insurance market, let me give an
example that people understand,
and that's credit cards.
In the credit card market, part
of what happened was we ended up
allowing people to get credit
cards from every other --
whatever state, and there were
a few states that decided,
you know what, we're going to
have the least restrictions on
credit card companies
that we could have.
And what ended up happening was
that every single credit card
company suddenly lo and behold
started locating in that state
which had the absolute worst
regulations in consumer
protections, and all these fees
and practices that people don't
like, folks weren't happy about.
So the question I'm
going to have is,
is there a way for us to deal
with the interstate purchase of
health insurance, but in a
way that provides, again,
some baseline protections,
because what we don't want is a
race to the bottom.
We want everybody to have the
basic protections that make sense.
And that's not a big
government takeover.
That is a standard thing that we
do in almost every area of life.
We protect people with respect
to the food that they buy,
with respect to the
drugs that they purchase.
We license and regulate the
medical profession because we
don't think anybody should just
be able to cut somebody open.
We want somebody like Tom or
John to actually know what
they're doing before they
start practicing medicine.
And the same should apply when
it comes to how we think about insurance.
Medical malpractice
has been mentioned.
Now, look, let me be honest.
This is something historically
that Democrats have been more
resistant to than Republicans.
I will note that when we had
a Republican President and
Republican control of the House
and Republican control of the
Senate, somehow it didn't
happen, and I'm surprised, but we --
Senator Alexander:
We needed 60 votes in the Senate, too,
Mr. President.
(laughter)
The President:
See there?
So as a consequence, what I have
suggested is that we explore
building on what we've already
done administratively without
law, asking Kathleen to help
states come up with new ideas.
I've suggested, well,
let's take a look at Tom,
the suggestion you had, that
gives states even more incentive
to start thinking about
reducing defensive medicine.
I have to tell you, Joe Barton,
that how you got from $5 billion
to $150 billion, I didn't
quite follow the math.
It sounded -- I'm not sure you
did, either, but it's okay.
But here's my commitment, is
that if folks were serious about
getting this done, I'd be
interested in seeing if we could
work on something.
Now, I actually agree with Dick
Durbin with respect to hard caps
because of the story that he
told about the woman who burned her face.
I think there are situations in
which there is actually a very
severe problem, and I would
distinguish that between some of
the frivolous lawsuits that are
out there that really do create
a defensive medical problem, and
OBGYNs are the ones who get hit
the hardest because people are
so sympathetic when a child is
born with severe disabilities,
and they can just be crippling
on OBGYNs.
The same is true for
neurologists and so forth.
So there may be some ways
that we can work on that.
Now, I guess what I'm saying
is I've put forward then very
substantial ideas that are
embraced by Republicans.
Peter, they're not -- I forget
what metaphor you used about --
before you popped
it in the microwave,
whether it was bacon bits or
sprinkles or -- breadcrumbs,
that was what it was.
When it comes to the exchange,
that is a market-based approach,
it's not a
government-run approach.
There were criticisms
about the public option;
that's when supposedly there
was going to be a government
takeover of health care, and
even after the public option
wasn't available, we still
hear the same rhetoric.
And it turns out that what we're
now referring to is we have an
argument about how much we
should regulate the insurance industry.
We have a concept
of an exchange,
which previously has been
an idea that was embraced by
Republicans before
I embraced it,
and somehow suddenly it
became less of a good idea.
With respect to the
most contentious issue,
I'm not sure we
can bridge the gap,
and that's what we're going to
have to explore and that's the
issue of how do we provide
coverage not only for people who
don't have health insurance
right now but also for people
who have preexisting conditions
and are being priced out of the
market, or potentially lose
their jobs and will find
themselves in a situation
where they don't get coverage.
An interesting thing happened
a couple of weeks ago,
and that is a report came out
that for the first time it turns
out that more Americans are
now getting their health care
coverage from government than
those that are getting it from
the private sector.
And you know what, that's
without a bill from the
Democrats or from
President Obama.
Has nothing to do
with "Obamacare."
It has to do with the fact that
employers are shedding employees
from health care plans.
And more and more,
folks, if they can,
are trying to get into the
Social Security system and the
Medicare system earlier through
disability or what have you,
so that they can get some help.
The point that Tom Harkin made,
the point that Chris Dodd made,
the point that Henry made, and
a number of other people made,
I think is very
important to understand.
I did not propose and I don't
think any of the Democrats
proposed something complicated
just for the sake of being complicated.
We'd love to have
a five-page bill.
It would save an
awful lot of work.
The reason we didn't do it is
because it turns out that baby
steps don't get you to the
place where people need to go.
They need help right now.
And so a step-by-step approach
sounds good in theory,
but the problem is, for example,
we can't solve the preexisting
condition problem if we don't
do something about coverage.
Now, it is absolutely true --
and I think this is important to
get on the table, because we
dance around this sometime -- in
order to help the 30 million,
that's going to cost some money.
And the primary way we do it
is to say that, for example,
people who currently get all
their income in capital gains
and dividends, they
don't pay a Medicare tax,
even though the guy who cleans
the building for them does on
his salary or his wages.
And so what we say is, if
you make more than $250,000
a year if you're a family
and your income is from those
sources, then you should do --
you should have to do the same
thing that everybody
else has to do.
Somebody mentioned the fact that
we say to small businesses -- I
think Jon Kyl, you said,
we're taxing small businesses.
Look, we exempt 95 percent
of small businesses from any
obligations whatsoever because
we understand that small
businesses generally have a
tough time enough -- they don't
need any more government burden.
What we do say is, if you
can afford to provide health
insurance, you have
more than 50 employees,
meaning you're in the top
4 percent of businesses,
and you're not providing
coverage and you're forcing
other businesses or other
individuals to pick up the tab
because your employees are
either going to the Medicaid
system or they're going to the
emergency room -- we don't think that's fair.
So we say, you've
got to pony up some.
It's not an employer mandate.
It just says you've got
to pay your fair share,
because otherwise all of
us have to pick up the tab.
And that, by the way,
contributes to the overall
deficit that
Medicaid is running.
In fact, most small businesses
through this program get huge
subsidies by becoming
members of the exchange.
That's where the money is going.
The money is not going to some
big welfare program -- the money
is going to give tax
credits to small businesses,
tax credits to those
who are self-employed,
to buy into this pool.
And that's not a
radical proposition;
it's consistent with the idea
of a market-based approach.
And finally, with respect
to bending the cost curve,
we actually have a
lot of agreement here.
This is an area where if I sat
down with Tom Coburn I suspect
we could agree on 95 percent of
the things that have to be done.
Because the things you talk
about in terms of -- and I wrote
some of them down -- in terms
of reducing medical errors,
in terms of incentivizing
doctors to coordinate better and
work in groups better, in
terms of price transparency,
improving prevention -- those
are all things that not only do
I embrace but we've included
every single one of those ideas
in these bills.
Now, the irony is that that's
part of where we got attacked
for a "government takeover"
because what happened was when
we set up the idea of a MedPAC,
which is basically a panel of
doctors and health care experts
who would recommend ways to make
the delivery system better so
that we can squeeze out that
one-third in Medicare and
Medicaid that's wasted -- a
Republican idea -- that was part
of the ammunition you all used
to say that the government is
going to take away your health care.
So if we're serious about
delivery system reform,
if we're serious about squeezing
out the waste that Tom Coburn
referred to, you should embrace
those mechanisms that are in this bill.
I will end by saying this.
I suspect that if the Democrats
and the administration were
willing to start over and then
adopt John Boehner's bill,
we'd get a whole bunch
of Republican votes.
And I don't know how many
Democratic votes we'd get,
but we'd get a whole
bunch of Republican votes.
The concern I think that
a lot of the colleagues,
both in the House
and the Senate,
on the Democratic side have, is
that after a year and a half --
or more appropriately after five
decades -- of dealing with this
issue, starting over they
suspect means not doing much or
doing the proposal that John
Boehner or other Republicans
find acceptable; and that it's
not possible for our Republican
colleagues to move in the
direction of, for example,
covering more than
3 million people;
it's not possible to move more
robustly in the direction of
dealing with the preexisting
condition issue in a realistic
way; it's not possible to make
sure that we get people out of a
high-risk pool and get them
into a situation where,
as Tom Harkin put it,
healthy people, young people,
rich people, poor
people, old people,
sick people -- everybody is
part of a system that works.
That I think is the concern.
Having said that, what I'd like
to propose is that I've put on
the table now some things that
I didn't come in here saying I
supported, but that I was
willing to work with potential
Republican sponsors on.
I'd like the Republicans to do
a little soul searching and find
out are there some things that
you'd be willing to embrace that
get to this core problem of 30
million people without health
insurance and dealing seriously
with the preexisting condition issue.
I don't know, frankly,
whether we can close that gap.
And if we can't close that gap,
then I suspect Mitch McConnell
and Harry Reid, Nancy
Pelosi and John Boehner,
are going to have a lot of
arguments about procedures in
Congress about moving forward.
I will tell you this, that
when I talk to the parents of
children who don't have health
care because they've got
diabetes or they've got
some chronic heart disease,
when I talk to small
businesspeople who are laying
people off because they just
got their insurance premium,
they don't want us to wait.
They can't afford
another five decades.
And the truth of the matter is,
is that, politically speaking,
there may not be any reason
for Republicans to want to do anything.
I mean, we can debate what our
various constituencies think.
I know that -- I don't need
a poll to know that most of
Republican voters are opposed to
this bill and might be opposed
to the kind of compromise
we could craft.
So it would be very hard for
you politically to do this.
But I thought it was worthwhile
for us to make this effort.
We've got a lot of
other things to do.
I don't think, Tom, that we're
going to have another one of
these because people
don't have seven,
eight hours a day to work
some of these things through.
What I do know is this: If we
saw movement -- significant
movement, not just gestures --
then you wouldn't need to start
over because essentially
everybody here knows what the issues are.
And procedurally, it could
get done fairly quickly.
We cannot have another
year-long debate about this.
So the question that I'm going
to ask myself and I ask of all
of you is, is there enough
serious effort that in a month's
time or a few weeks'
time or six weeks' time,
we could actually
resolve something.
And if we can't, then I think
we've got to go ahead and make
some decisions and then
that's what elections are for.
We have honest disagreements
about the vision for the country
and we'll go ahead and test
those out over the next several
months till November.
All right?
But I very much appreciate
everybody being here.
Thank you for being
so thoughtful.
And hopefully we'll all keep our
constituents in mind as we move forward.
Thank you, everybody.
(applause)
