English subtitles for clip: File:Bipartisan Meeting on Health Reform- Part 5.webm

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The President:
Can America, the wealthiest nation on Earth,

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do what every other
advanced nation does,

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which is make sure that every
person here can get adequate

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health care coverage,
whether they're young or old,

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whether they are rich or poor?

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And I think that the effort in
the House and the Senate has

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been to control costs to reform
the insurance industry to deal

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with some of the structural
deficit issues surrounding

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entitlements, and to do that all
in a context in which everybody

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is getting a fair shake.

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And right now frankly there are
30 million people who don't have

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health insurance at all.

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There are a whole bunch of
people who aren't added to that

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list who all they have is a
catastrophic plan, and again,

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they never go visit a doctor
unless they're really sick.

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The way we tried to do it was
not a government-run health care plan, Paul.

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I mean, that was some good
poll-tested language that has

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been used quite a bit, but the
fact of the matter is, is that,

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as Dick just alluded to, the way
we've structured it through the

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exchange would be to
allow people to pool,

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allow everybody to
join a big group,

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and for people who can't afford
it, to give them subsidies,

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including small businesses.

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And so the question is whether
there is a way for us to arrive

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at an agreement that
would reach those people.

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John Boehner, I
looked at your bill.

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I think, as I said, there is
some overlap on some issues.

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But when it comes to
the coverage issue,

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the Congressional Budget Office
says yours would potentially

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increase coverage
for 3 million people,

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and the efforts of the House
and the Senate would cover 30 million.

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That's a 27-million-person
difference.

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We can have an honest
disagreement as to whether we

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should try to give some help
to those 27 million people who

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don't have coverage.

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And so that's I think
the last aspect of this,

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and this is probably going to
be the most contentious because

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there is no doubt that providing
those tax credits to families

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and small businesses
costs money.

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And we do raise revenues
in order to pay for that.

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And it may be that the
other side just feels as if,

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you know what, it's just
not worth us doing that.

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But one of the things I hope
we don't do is to pretend that

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somehow for free we're going to
be able to get those 30 million

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people covered.

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We're not.

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If we think it's important as a
society to not leave people out,

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then we're going to have to
figure out how to pay for it.

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If we don't, then we should
acknowledge that we're not going

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to do that.

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But what we shouldn't do is
pretend that we're going to do

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it and that there is some magic
wand to do it without paying for it.

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So with that what I'm going to
do is I will go to whoever you

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want first, Mitch.

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Senator McConnell:
Mr. President,

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Dr. John Barrasso is going to
make our opening statement on

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coverage.

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The President:
And then I will call Henry Waxman,

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and we'll just go
back and forth.

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Senator Barrasso:
Thank you very much --

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The President:
And because we are short on time,

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let's keep our remarks
relatively brief.

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Senator Barrasso:
Thank you very much,
Mr. President.

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For people who don't know me,
I practiced medicine in Casper,

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Wyoming for 25 years as
an orthopedic surgeon,

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taking care of
families in Wyoming.

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I've been the chief of staff
at the largest hospital in our state.

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My wife is a breast
cancer survivor.

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Bobbi has been through
three operations,

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a couple of bouts
of chemotherapy.

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We've seen this from all
the different sides of care.

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And this discussion needs to
be about all Americans because

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everyone is affected, not
just people that don't have insurance.

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And I've had dozens and dozens
of visits to senior centers and

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town hall meetings, and
visited at service clubs,

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and if you go to any community
in America and you ask the

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question, "Do you believe that
this bill up here -- that this

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bill, if it becomes law, do you
believe you will pay more for

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your health care,
you personally?"

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Every hand goes up.

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And then you say, "Do you
believe if this bill becomes

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law, overall health care in this
spending -- its spending in the

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country will go up?"

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Every hand goes up.

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And then you ask the most
personal question of all,

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"Do you believe if
this bill becomes law,

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the quality of your personal
care will get worse?"

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Every hand goes up.

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And most worried of
all are the seniors,

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when you go to the
senior centers,

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because they know there's going
to be $500 billion taken away

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from those who depend upon
Medicare for their health care,

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and it's not just
Medicare Advantage.

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It's hospitals; it's the
doctors; it's the nursing homes;

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it's home health, which is a
lifeline for people that are

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home alone; it's hospice, for
people in their final days of life.

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That's all going to be cut.

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That's why the seniors
are most concerned.

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And even the White House own
actuary if this goes into play,

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one in five hospitals, one
in five nursing homes will be

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operating at a loss in 10 years.

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That's what we're looking at.

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Now, for 25 years practicing
medicine I never asked anybody

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if they were a Republican or
a Democrat or an independent;

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didn't ask if they had insurance
or not; took care of everybody.

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And many, many doctors
-- I know Dr. Coburn,

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Dr. Boustany -- do that,
we take care of everyone,

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regardless of ability to pay.

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Doctors work long hours;
nurses work long hours.

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And, Mr. President, when you
say with catastrophic plans,

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they don't go for
care until later,

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I say sometimes the people
with catastrophic plans are the

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people that are best consumers
of health care in using the way

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they use their
health care dollars,

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because a lot of people come
in and say, my knee hurts,

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maybe I should get an MRI,
they say, and then they say,

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will my insurance cover it?

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That's the first question.

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And if I say yes, then they
say, okay, let's do it.

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If I say, no, then
they say, well,

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what will it going to cost?

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And what's it cost ought
to be the first question.

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And that's why sometimes people
with catastrophic problem --

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catastrophic health plans ask
the best questions, shop around,

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are the best consumers
of health care.

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But to put 15 million
more people on Medicaid,

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a program where many doctors
in the country do not see them,

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as Senator Grassley said
-- you know, you say,

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how are you going
to help those folks?

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And, Mr. President, when I
talk to doctors, they say,

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I have a way: Put all the
doctors who take care of

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Medicaid patients under the
Federal Torts Claim Act.

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That will help them, because
they're not getting paid enough

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to see the patients.

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But if Medicare -- if they
accept those patients and then

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their liability insurance is
covered under the Federal Tort

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Claims Act, I think you'd have
a lot more participation in that program.

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I do believe we have the best
health care system in the world.

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That's why the premier of one of
the Canadian provinces came here

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just last week to have
his heart operated on.

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He said, "It's my
heart, it's my life.

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I want to go where
it's the best."

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And he came to
the United States.

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It's where a member of
parliament -- a Canadian member

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of parliament with cancer came
to the United States for her care.

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They all have coverage there,
but what they want is care -- so

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coverage does not equal care.

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What we heard from Senator
Conrad is also right.

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Half of all the money we spend
in this country on health care

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is on just 5 percent
of the people.

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Those are people, for the
most part, that eat too much,

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exercise too little, and smoke.

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And as a result, we need
to focus on those people.

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So the focus ought to be
on the best possible care.

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People are happy with the
quality of care they get,

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the availability, but they sure
don't like the affordability

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because it's not affordable.

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And, you know, Mr. President,
the first week in medical school

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we got our stethoscopes and
the professor of cardiology,

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who just died this past year,
he said, this is to listen.

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This is to listen to your
patients -- listen to their

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heart, listen to their lungs,
but it's a constant reminder to

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listen to them, listen to
what they are telling you.

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And it means to listen to
the other people in the room.

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If you're seeing a child, listen
to what the mother is saying.

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If you're with an
elderly person,

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listen to what their
adult child is saying.

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And it's a constant
reminder to listen.

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And I have great concerns that
people around this table are not

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listening to the American
people and are fearful of the

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consequences of this large bill,
which is why only one in three

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people in America support
what is being proposed here.

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And that's why so many
people, Mr. President,

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are saying it's
time to start over.

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The President:
Let me just -- there's one thing I've got to --

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there are a number
of issues, as usual,

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that I've got significant
difference with.

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I'm just am curious.

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Would you be satisfied if every
member of Congress just had

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catastrophic care?

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Do you think we'd be better
health care purchasers?

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I mean, is that a change
that we should make?

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Senator Barrasso:
Yes,
I think actually we would.

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We'd really focus on it.

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You'd have more, as you
say, skin in the game -- and

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especially if they
had a savings account,

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a health savings account.

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They could put their
money into that --

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The President:
Would you feel the same way if --

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Senator Barrasso:
-- and they'd be spending the money out of that.

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The President:
Would you feel the same way if you were making

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$40,000, or you had --
that was your income?

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Because that's the reality
for a lot of folks.

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I mean, it is very important
for us -- when you say,

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to listen -- to listen to that
farmer that Tom mentioned in

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Iowa; to listen to the folks
that we get letters from --

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because the truth
of the matter, John,

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is they're not
premiers of anyplace,

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they're not sultans
from wherever.

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They don't fly into Mayo and
suddenly decide they're going to

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spend a couple million
dollars on the absolute,

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best health care.

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They're folks who are left out.

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And this notion somehow that for
them the system was working and

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that if they just ate a little
better and were better health

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care consumers they could
manage is just not the case.

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The vast majority of these 27
million people or 30 million

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people that we're talking
about, they work every day.

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Some of them work two jobs.

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But if they're working
for a small business,

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they can't get health care.

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If they are self-employed,
they can't get health care.

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And you know what, it is a
scary proposition for them.

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And so we can debate whether or
not we can afford to help them,

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but we shouldn't pretend somehow
that they don't need help.

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I get too many letters
saying they need help.

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And so, I want to go to --

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Senator Barrasso:
Mr. President,
having a high-deductible plan

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and a health savings account
is an option for members of

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Congress and
federal employees --

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The President:
If -- that's right,

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because members of Congress
get paid $176,000 a year.

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Senator Barrasso:
-- 16,00 employees did take advantage of that.

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The President:
Because they --

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Senator Barrasso:
And so, it's the same plan --

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The President:
-- because members of Congress --

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Senator Barrasso:
-- that the Park Rangers get in the Yellowstone National Park.

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The President:
John -- John,
members of Congress are in the

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top income brackets
of the country.

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And health savings accounts
I think can be a useful tool,

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but every study has shown that
the people who use them are

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folks who've got a lot
of disposable income.

233
00:12:07,728 --> 00:12:10,158
And the people that we're
talking about don't.

234
00:12:10,161 --> 00:12:12,461
Let's go to Henry.

235
00:12:12,461 --> 00:12:13,831
Henry Waxman.

236
00:12:13,828 --> 00:12:15,528
Representative Waxman:
Mr. President,

237
00:12:15,528 --> 00:12:18,498
I just wonder if some of our
Republican friends would like to

238
00:12:18,494 --> 00:12:22,964
have seniors on Medicare have
catastrophic coverage only.

239
00:12:22,961 --> 00:12:25,061
I'd say to the seniors
in this country,

240
00:12:25,061 --> 00:12:28,361
and we've heard mention of them
being the people who are worried

241
00:12:28,361 --> 00:12:31,791
about this Medicare -- this
health care bill -- they ought

242
00:12:31,795 --> 00:12:34,165
to worry if we
don't do something.

243
00:12:34,161 --> 00:12:36,761
Because not only will we
hear ideas of putting them on

244
00:12:36,761 --> 00:12:38,961
catastrophic coverage only,
because that will save a lot of

245
00:12:38,961 --> 00:12:43,191
money -- Paul Ryan has a
proposal right now to say that

246
00:12:43,194 --> 00:12:46,524
Medicare recipients in the
future ought to have just a

247
00:12:46,528 --> 00:12:50,628
little voucher, and then
they can shop for their own insurance.

248
00:12:50,628 --> 00:12:53,198
They could be prudent shoppers.

249
00:12:53,194 --> 00:12:55,724
Well, yesterday I had a hearing
with some people who were

250
00:12:55,728 --> 00:12:57,828
supposed to be prudent shoppers.

251
00:12:57,828 --> 00:13:01,398
They were people from California
who were told by Anthem

252
00:13:01,394 --> 00:13:09,524
Wellpoint that their insurance
was going to go up 30 percent -- 39 percent.

253
00:13:09,528 --> 00:13:13,228
And could you imagine, seniors,
if you have to go shopping with

254
00:13:13,227 --> 00:13:15,597
your voucher and then
you're told, oh, by the way,

255
00:13:15,594 --> 00:13:18,894
this private policy that you're
going to have to buy just went

256
00:13:18,895 --> 00:13:20,625
up 39 percent?

257
00:13:20,628 --> 00:13:23,928
And the way to save the federal
government money is to shift it

258
00:13:23,928 --> 00:13:24,998
on to the seniors.

259
00:13:24,994 --> 00:13:28,294
That's where we're going
if we don't do anything.

260
00:13:28,294 --> 00:13:30,864
Now, what do we do
that makes sense?

261
00:13:30,861 --> 00:13:33,261
We've got to hold down
health care costs.

262
00:13:33,261 --> 00:13:36,431
You can't -- we had some ideas
that we seem to agree about to

263
00:13:36,428 --> 00:13:39,498
hold down health care costs.

264
00:13:39,494 --> 00:13:42,694
One idea I did find peculiar,
and that's to have the medical

265
00:13:42,695 --> 00:13:47,695
malpractice issue at
the federal level.

266
00:13:47,695 --> 00:13:51,925
And the Republican proposal is
to adopt the California law.

267
00:13:51,928 --> 00:13:53,658
Well, the California
law is in effect.

268
00:13:53,661 --> 00:13:56,431
It's been in effect
since the 1970s.

269
00:13:56,428 --> 00:14:00,498
And Californians are faced
with a 39 percent increase,

270
00:14:00,494 --> 00:14:03,194
so it isn't holding down
their health care costs.

271
00:14:03,194 --> 00:14:06,264
We've got to really look at
holding down health care costs.

272
00:14:06,261 --> 00:14:10,731
That's hard to do, unless we
have insurance reform so we

273
00:14:10,728 --> 00:14:13,858
could get more people
buying health care.

274
00:14:13,861 --> 00:14:16,931
I thought Tom Harkin just
summed it up so well.

275
00:14:16,928 --> 00:14:19,328
All these issues go together.

276
00:14:19,328 --> 00:14:22,998
If you don't bring more
people in to be covered,

277
00:14:22,994 --> 00:14:26,464
segment the groups that are
covered in high-risk pools,

278
00:14:26,461 --> 00:14:31,091
they pay more money -- everybody
else is going to get a break.

279
00:14:31,094 --> 00:14:33,424
Well, under the
Republican proposal,

280
00:14:33,428 --> 00:14:37,558
the people who get a break for
insurance are the people who are healthy.

281
00:14:37,561 --> 00:14:41,491
The people who have to pay more
are the people who are sick.

282
00:14:41,494 --> 00:14:44,194
Is that what we want
in this country?

283
00:14:44,194 --> 00:14:47,724
Now, I hear people all
day say, Mr. President,

284
00:14:47,728 --> 00:14:50,798
the public doesn't
want your plan.

285
00:14:50,795 --> 00:14:54,565
Well, if I heard the kind of
rhetoric over and over again

286
00:14:54,561 --> 00:14:56,231
that I've heard from
some of the Republicans,

287
00:14:56,227 --> 00:14:58,257
I wouldn't want
your plan either.

288
00:14:58,261 --> 00:15:00,331
A federal takeover
of health care?

289
00:15:00,328 --> 00:15:02,828
That's not what's
being proposed.

290
00:15:02,828 --> 00:15:09,328
Somebody said that people ought
to be able to buy a policy that

291
00:15:09,328 --> 00:15:11,028
suits their needs.

292
00:15:11,027 --> 00:15:13,397
Well, how many people are
going to come forward and say,

293
00:15:13,394 --> 00:15:16,494
I don't want certain things
covered -- and then find out

294
00:15:16,494 --> 00:15:20,364
that they're sick and
they need that coverage.

295
00:15:20,361 --> 00:15:23,091
We need to have a market
like the federal government

296
00:15:23,094 --> 00:15:25,124
employees, like
members of Congress.

297
00:15:25,127 --> 00:15:27,327
We know what we can choose.

298
00:15:27,328 --> 00:15:30,028
If somebody wants to choose
a health savings account,

299
00:15:30,027 --> 00:15:32,857
that means because they want
to put some of their money away

300
00:15:32,861 --> 00:15:36,791
because it's tax-free and it's
a really great deal if you got a

301
00:15:36,795 --> 00:15:37,865
lot of money.

302
00:15:37,861 --> 00:15:40,791
But most people want to know
they're going to have necessary

303
00:15:40,795 --> 00:15:46,865
medical coverage for the doctors
and the hospitals when they need it.

304
00:15:46,861 --> 00:15:51,091
And you have something
that's basic to everybody.

305
00:15:51,094 --> 00:15:52,964
Well, they ought to have that
for people who are buying

306
00:15:52,961 --> 00:15:55,661
private insurance as well.

307
00:15:55,661 --> 00:15:57,831
We had three
witnesses yesterday.

308
00:15:57,828 --> 00:16:01,528
A woman told us that in her
family she had a child with a

309
00:16:01,528 --> 00:16:03,858
hole in the heart.

310
00:16:03,861 --> 00:16:07,461
And that -- because -- that
became a preexisting condition.

311
00:16:07,461 --> 00:16:12,591
So she has health insurance
coverage through this individual market.

312
00:16:12,594 --> 00:16:15,324
But she says, "I barely use it,
because I'm just -- I'm afraid

313
00:16:15,328 --> 00:16:17,528
to use my health insurance."

314
00:16:17,528 --> 00:16:20,698
She is now told she is going to
have this 39 percent increase.

315
00:16:20,695 --> 00:16:23,995
She said her health insurance is
going to cost her about as much

316
00:16:23,994 --> 00:16:27,064
as her mortgage
payment each month.

317
00:16:27,061 --> 00:16:29,061
She is afraid to drop it,
because she doesn't know where

318
00:16:29,061 --> 00:16:31,791
she could ever get
health coverage again.

319
00:16:31,795 --> 00:16:35,295
Another woman had asthma,
and that was considered a

320
00:16:35,294 --> 00:16:37,024
preexisting condition.

321
00:16:37,027 --> 00:16:41,127
She was going to face a 39
percent increase, as well.

322
00:16:41,127 --> 00:16:45,697
Now, if they were pooled with
everybody else in that small

323
00:16:45,695 --> 00:16:51,625
business and individual market,
which is what our bill does,

324
00:16:51,628 --> 00:16:54,528
then there are more people
buying insurance and there's

325
00:16:54,528 --> 00:16:56,698
more -- there's more leverage.

326
00:16:56,695 --> 00:17:00,065
It's spreading the cost, not
making people have to pay more

327
00:17:00,061 --> 00:17:01,491
of these costs.

328
00:17:01,494 --> 00:17:07,024
The people who we're talking
about are people in small

329
00:17:07,027 --> 00:17:09,997
businesses where the small
business can't get insurance

330
00:17:09,994 --> 00:17:12,724
because, well, they got one
employee with a real serious

331
00:17:12,728 --> 00:17:13,828
medical problem.

332
00:17:13,828 --> 00:17:15,898
So nobody in that group
is going to get coverage,

333
00:17:15,895 --> 00:17:18,295
the employer can't afford it.

334
00:17:18,294 --> 00:17:22,424
Or women, it costs more for
small businesses if they're in

335
00:17:22,428 --> 00:17:25,258
that workforce, especially
if they're older.

336
00:17:25,261 --> 00:17:28,031
They don't want to get coverage.

337
00:17:28,027 --> 00:17:31,157
They don't want to give
them coverage either.

338
00:17:31,161 --> 00:17:34,631
We have single adults, a lot
of them not very healthy,

339
00:17:34,628 --> 00:17:38,128
dealing with chronic conditions,
parents and families living on

340
00:17:38,127 --> 00:17:39,227
low incomes.

341
00:17:39,227 --> 00:17:41,127
They need help from Medicaid.

342
00:17:41,127 --> 00:17:45,997
We have to hold down the cost
by bringing everybody into the system.

343
00:17:45,994 --> 00:17:51,124
Now, in Medicare,
what does our bill do?

344
00:17:51,127 --> 00:17:54,597
It protects the solvency of the
program for an additional seven

345
00:17:54,594 --> 00:17:56,264
to nine years.

346
00:17:56,261 --> 00:17:59,391
For Medicare, we close
the doughnut hole,

347
00:17:59,394 --> 00:18:01,664
which means that when
seniors have to pay for those

348
00:18:01,661 --> 00:18:06,161
prescription drugs, they don't
have to do it all on their own.

349
00:18:06,161 --> 00:18:10,161
We keep them with
a Medicare policy,

350
00:18:10,161 --> 00:18:13,561
and we provide preventative
services and they don't have to

351
00:18:13,561 --> 00:18:16,791
pay for them because we know
preventive services will keep us

352
00:18:16,795 --> 00:18:20,195
from having to pay
for more costly care.

353
00:18:20,194 --> 00:18:22,724
This bill is good for people
on Medicare and if we don't get

354
00:18:22,728 --> 00:18:26,798
this passed they're going
to get squeezed like crazy.

355
00:18:26,795 --> 00:18:29,695
This bill is good for the
American working people.

356
00:18:29,695 --> 00:18:32,595
This bill is good for
our health care system.

357
00:18:32,594 --> 00:18:36,164
And for us to take the
Republican proposal -- we cover

358
00:18:36,161 --> 00:18:39,191
instead of 30 million
people, 3 million;

359
00:18:39,194 --> 00:18:42,294
we wouldn't hold down
the deficit a bit;

360
00:18:42,294 --> 00:18:46,764
we would still have all those
preexisting conditions that

361
00:18:46,761 --> 00:18:50,461
would keep people from getting
their insurance coverage.

362
00:18:50,461 --> 00:18:54,791
Maybe if people go and pretend
to be patients we could stop

363
00:18:54,795 --> 00:18:57,795
some of those false claims,
but I'm sure those false claims

364
00:18:57,795 --> 00:19:00,895
happen in the private insurance
market and not just the public

365
00:19:00,895 --> 00:19:02,225
insurance market.

366
00:19:02,227 --> 00:19:04,957
But not only are we
covering more people,

367
00:19:04,961 --> 00:19:08,861
we're doing innovative ways to
deliver the care that will make

368
00:19:08,861 --> 00:19:11,061
it less costly.

369
00:19:11,061 --> 00:19:14,731
And as we develop innovative
ways to deliver care,

370
00:19:14,728 --> 00:19:18,498
especially with chronic care,
that will hold down the costs of

371
00:19:18,494 --> 00:19:22,164
care and those ideas would be
picked up by the private sector.

372
00:19:22,161 --> 00:19:25,191
They always follow what Medicare
does and then they adopt it

373
00:19:25,194 --> 00:19:27,394
because they want
to hold down costs.

374
00:19:27,394 --> 00:19:31,224
So you can't solve any
problem -- insurance reform,

375
00:19:31,227 --> 00:19:33,997
holding down costs,
protecting Medicare,

376
00:19:33,994 --> 00:19:37,864
dealing with the deficit --
unless you deal with it all.

377
00:19:37,861 --> 00:19:40,331
And Mr. President, you're not
going to be able to do this

378
00:19:40,328 --> 00:19:43,598
piecemeal and I have doubts
about whether the Republicans

379
00:19:43,594 --> 00:19:45,924
are going to help you because
I haven't heard a lot of

380
00:19:45,928 --> 00:19:49,658
willingness to come and work
with you now or did I hear it a

381
00:19:49,661 --> 00:19:51,191
year ago -- I hope I'm wrong.

382
00:19:51,194 --> 00:19:54,464
The President:
Well, I'm going
to be equal opportunity here and

383
00:19:54,461 --> 00:19:58,131
say we're not making
campaign speeches right now.

384
00:19:58,127 --> 00:20:01,027
And I think your
points I agree with,

385
00:20:01,027 --> 00:20:04,497
but I still think that there's
a lot of areas of agreement that

386
00:20:04,494 --> 00:20:06,164
we've discussed so far.

387
00:20:06,161 --> 00:20:09,931
This is an area, though, that
-- in which we do have some

388
00:20:09,928 --> 00:20:12,058
philosophical disagreements.

389
00:20:12,061 --> 00:20:16,491
And so what I -- I think it's
-- I want to go to a Republican.

390
00:20:16,494 --> 00:20:20,624
The question I would
ask to my colleagues,

391
00:20:20,628 --> 00:20:24,298
my friends on the
Republican side, would be,

392
00:20:24,294 --> 00:20:30,394
are there areas of coverage for
people who don't have health

393
00:20:30,394 --> 00:20:36,964
care that you would embrace and
agree with beyond what has been

394
00:20:36,961 --> 00:20:42,891
presented in Republican
Leader Boehner's bill.

395
00:20:42,895 --> 00:20:43,795
There may not be.

396
00:20:43,795 --> 00:20:47,365
I mean, that may be sort of the
threshold at which all of you

397
00:20:47,361 --> 00:20:52,491
think we can afford to provide
help to people who don't have

398
00:20:52,494 --> 00:20:57,094
coverage, but there may be some
other ideas that haven't already

399
00:20:57,094 --> 00:21:01,994
been presented or aren't
embodied in your legislation,

400
00:21:01,994 --> 00:21:04,794
John, that I'd be
happy to hear about.

401
00:21:04,795 --> 00:21:07,695
Representative Boehner:
I want to yield to Peter Roskam from Illinois.

402
00:21:07,695 --> 00:21:09,025
Representative Roskam:
Thank you.

403
00:21:09,027 --> 00:21:11,097
Mr. President, thanks
for your hospitality.

404
00:21:11,094 --> 00:21:13,264
For the benefit of the group I
want to take you for a couple of

405
00:21:13,261 --> 00:21:16,531
minutes to an experience that
I had with then-State Senator

406
00:21:16,528 --> 00:21:20,398
Obama in the state of Illinois
when he took on a very

407
00:21:20,394 --> 00:21:25,264
controversial initiative
regarding the death penalty situation.

408
00:21:25,261 --> 00:21:28,331
And lest you think that the
death penalty is sort of a

409
00:21:28,328 --> 00:21:31,158
junior varsity
issue -- it's not.

410
00:21:31,161 --> 00:21:35,361
It's crimes, it's
claims of innocence,

411
00:21:35,361 --> 00:21:38,661
it's penalties forever.

412
00:21:38,661 --> 00:21:44,091
And then-State Senator Obama
approached Republicans and said,

413
00:21:44,094 --> 00:21:47,364
look, let's fix this, let's
recognize the problem here,

414
00:21:47,361 --> 00:21:48,191
let's fix it.

415
00:21:48,194 --> 00:21:51,864
But it was very different than
what I sense is happening today.

416
00:21:51,861 --> 00:21:55,461
What I sense is
happening today is,

417
00:21:55,461 --> 00:21:59,361
"what is it going to take for
you Republicans to vote for our bill?"

418
00:21:59,361 --> 00:22:02,391
That's the subtext
that I'm getting.

419
00:22:02,394 --> 00:22:07,764
My sense is that this
is a problem of message,

420
00:22:07,761 --> 00:22:10,331
it's not a problem
with the messenger.

421
00:22:10,328 --> 00:22:14,198
You've got an incredibly skilled
messenger who has been out these

422
00:22:14,194 --> 00:22:19,024
past several months in joint
session speeches and a whole

423
00:22:19,027 --> 00:22:21,197
host of other
venues, interviews,

424
00:22:21,194 --> 00:22:23,794
talking -- you've all seen
it, you've all participated,

425
00:22:23,795 --> 00:22:26,025
you've all listened -- and
I think the American people,

426
00:22:26,027 --> 00:22:30,227
when the conversation first
began about expanding coverage,

427
00:22:30,227 --> 00:22:32,857
lowering cost, were
actually hopeful.

428
00:22:32,861 --> 00:22:34,961
And it wasn't just a bumper
sticker -- I think they were

429
00:22:34,961 --> 00:22:37,961
actually hopeful about what
was going to be happening.

430
00:22:37,961 --> 00:22:41,631
And they listened and they
listened and they listened.

431
00:22:41,628 --> 00:22:43,858
And my sense -- now, I can't
speak for every one of your

432
00:22:43,861 --> 00:22:48,731
districts, but in my district
they've become increasing

433
00:22:48,728 --> 00:22:53,628
disappointed with what they have
seen come out of this process.

434
00:22:53,628 --> 00:22:56,528
And this is not a prop --
this is the Senate bill.

435
00:22:56,528 --> 00:22:58,258
And my district
says, you know what,

436
00:22:58,261 --> 00:23:02,091
that's sure looking like just
something that's now being

437
00:23:02,094 --> 00:23:04,894
popped in the microwave,
taken out, a little salt,

438
00:23:04,895 --> 00:23:07,795
a little pepper, some Republican
bread crumbs on the top,

439
00:23:07,795 --> 00:23:10,765
and put it back in front
of the public to say, well,

440
00:23:10,761 --> 00:23:12,261
do you like it now?

441
00:23:12,261 --> 00:23:13,561
And my district really doesn't.

442
00:23:13,561 --> 00:23:16,631
I don't know, I suppose you
represent some districts that do.

443
00:23:16,628 --> 00:23:20,858
And I think one of the problems,
to get to this coverage issue,

444
00:23:20,861 --> 00:23:26,531
is that the premise of this bill
is that coverage is expanded

445
00:23:26,528 --> 00:23:29,628
through Medicaid, welfare.

446
00:23:29,628 --> 00:23:32,158
Speaker Pelosi a couple of
minutes ago -- or a couple of

447
00:23:32,161 --> 00:23:34,091
hours ago, actually said
that health care reform is

448
00:23:34,094 --> 00:23:35,494
entitlement reform.

449
00:23:35,494 --> 00:23:37,164
Speaker Pelosi:
Yes.

450
00:23:37,161 --> 00:23:39,331
Representative Roskam:
Yes.

451
00:23:39,328 --> 00:23:45,558
I would put a brighter light on
that and say it's entitlement expansion.

452
00:23:45,561 --> 00:23:46,791
Think about what we're doing.

453
00:23:46,795 --> 00:23:50,795
The CBO when they wrote to Harry
Reid -- wrote to Senator Reid a

454
00:23:50,795 --> 00:23:52,495
couple of months
ago, they said, look,

455
00:23:52,494 --> 00:23:55,464
there's about 15 million people
that are going to be put on Medicaid.

456
00:23:55,461 --> 00:23:57,591
And Medicaid is
a house of cards.

457
00:23:57,594 --> 00:24:01,694
Medicaid is not something that
is serving the public very well.

458
00:24:01,695 --> 00:24:04,795
The state controller in Illinois
-- and we all come from states

459
00:24:04,795 --> 00:24:09,765
with real trauma -- the state
controller in Illinois recently

460
00:24:09,761 --> 00:24:13,931
wrote that as bond rating
agencies continue to downgrade

461
00:24:13,928 --> 00:24:16,498
Illinois rankings to the
lowest in the nation,

462
00:24:16,494 --> 00:24:21,264
the state can't afford
further jeopardizing.

463
00:24:21,261 --> 00:24:25,631
This bill, section 2001
of the Senate bill,

464
00:24:25,628 --> 00:24:28,558
takes away all of the
flexibility as it relates to

465
00:24:28,561 --> 00:24:30,531
changes in Medicaid.

466
00:24:30,528 --> 00:24:35,458
That is making our states I
think ultimately hidebound in

467
00:24:35,461 --> 00:24:37,161
how they approach these things.

468
00:24:37,161 --> 00:24:41,261
This is something that in
my view isn't sustainable.

469
00:24:41,261 --> 00:24:45,361
Governor Brian Schweitzer of
Montana said -- let me give you

470
00:24:45,361 --> 00:24:48,691
a quick quote -- "One of the
least effective programs in

471
00:24:48,695 --> 00:24:53,095
terms of health care in the
history of the country is called Medicaid.

472
00:24:53,094 --> 00:24:56,324
About 20 percent of America is
on a Medicaid program and they

473
00:24:56,328 --> 00:24:59,058
would like to shift" -- "they"
meaning Washington -- "would

474
00:24:59,061 --> 00:25:03,261
like to shift it and grow it
to somewhere around 25 or 30 percent."

475
00:25:03,261 --> 00:25:06,061
Now, Medicaid is a system
that isn't working.

476
00:25:06,061 --> 00:25:07,931
Almost everyone agrees.

477
00:25:07,928 --> 00:25:10,428
But what Congress intends to
do is to increase the number of

478
00:25:10,428 --> 00:25:13,228
people on Medicaid so that
they can do it on the cheap.

479
00:25:13,227 --> 00:25:15,127
It isn't working for anybody.

480
00:25:15,127 --> 00:25:21,227
Look, the foundation of
the expansion is Medicaid.

481
00:25:21,227 --> 00:25:24,897
And in my view, and I think the
view of folks in my district and

482
00:25:24,895 --> 00:25:27,595
I think many, many
people across America,

483
00:25:27,594 --> 00:25:29,624
it is a flawed foundation.

484
00:25:29,628 --> 00:25:31,698
And we can do much, much better.

485
00:25:31,695 --> 00:25:35,925
A Republican proposal that's out
there would reduce the number of

486
00:25:35,928 --> 00:25:38,098
uninsured by 3 million people.

487
00:25:38,094 --> 00:25:40,724
So, look, you heard
it today in many,

488
00:25:40,728 --> 00:25:44,328
many forms -- this -- you
remember the old -- in closing,

489
00:25:44,328 --> 00:25:46,528
you remember the old game
you used to play as a kid,

490
00:25:46,528 --> 00:25:50,058
Etch A Sketch, and you'd start
out with the Etch A Sketch,

491
00:25:50,061 --> 00:25:52,061
that little thing where you try
and draw something and you dial

492
00:25:52,061 --> 00:25:55,231
the dials and over a period of
time the more you dialed the

493
00:25:55,227 --> 00:25:58,227
more crazy it looked and
then finally you'd say, oh,

494
00:25:58,227 --> 00:26:01,397
let's just go like that
and do the Etch A Sketch.

495
00:26:01,394 --> 00:26:04,524
I'll tell you what, a year's
worth of work and this is what

496
00:26:04,528 --> 00:26:05,798
has come up with?

497
00:26:05,795 --> 00:26:09,725
The American public, as far as
the ones that I have heard from,

498
00:26:09,728 --> 00:26:11,828
are vehemently opposed to this.

499
00:26:11,828 --> 00:26:15,428
And they say, look, take the
Etch A Sketch, go like this,

500
00:26:15,428 --> 00:26:18,558
let's start over, let's do
incremental things where there's

501
00:26:18,561 --> 00:26:19,561
common ground.

502
00:26:19,561 --> 00:26:20,491
I yield back.

503
00:26:20,494 --> 00:26:24,694
The President:
I want to make
sure that everybody gets an

504
00:26:24,695 --> 00:26:26,765
opportunity to speak.

505
00:26:26,761 --> 00:26:30,031
But I just want to caution
everybody, it's now 4:15 p.m.

506
00:26:30,027 --> 00:26:34,557
There are a number of folks who
haven't had a chance to speak.

507
00:26:34,561 --> 00:26:37,761
The question I had was, were
there ideas about expansion

508
00:26:37,761 --> 00:26:47,031
beyond the 3 million that that
was in Leader Boehner's bill,

509
00:26:47,027 --> 00:26:50,727
and I didn't get an answer
on it -- so in addition to,

510
00:26:50,728 --> 00:26:53,428
and it may be that the answer
is that's all we can do.

511
00:26:53,428 --> 00:26:56,258
I should point out this one
issue about Medicaid that I

512
00:26:56,261 --> 00:26:59,491
think that's important.

513
00:26:59,494 --> 00:27:03,264
Most of the people we'd like to
be in the exchange and giving

514
00:27:03,261 --> 00:27:06,161
them subsidies.

515
00:27:06,161 --> 00:27:09,691
And I think over time
(inaudible) see as an evolution,

516
00:27:09,695 --> 00:27:11,325
if you created a
large enough pool,

517
00:27:11,328 --> 00:27:15,958
where people could purchase it
through an exchange the same way

518
00:27:15,961 --> 00:27:18,131
that members of Congress do.

519
00:27:18,127 --> 00:27:24,627
The problem we've got right
now is that very poor people,

520
00:27:24,628 --> 00:27:28,428
they've got coverage
through Medicaid.

521
00:27:28,428 --> 00:27:30,498
And it's somewhat flawed.

522
00:27:30,494 --> 00:27:33,664
There are problems with
doctor reimbursements,

523
00:27:33,661 --> 00:27:35,891
there are problems long-term in
terms of solvency both for the

524
00:27:35,895 --> 00:27:39,125
state and the federal level,
so all those things need to be fixed.

525
00:27:39,127 --> 00:27:41,527
But the fact of the matter
is if their kid gets sick,

526
00:27:41,528 --> 00:27:44,828
they can go to a doctor.

527
00:27:44,828 --> 00:27:51,998
The people who are really left
in the cold are working families

528
00:27:51,994 --> 00:27:59,824
who make too much for Medicaid
and don't have anywhere to go.

529
00:27:59,828 --> 00:28:04,498
That's the group that right
now is getting the worst deal.

530
00:28:04,494 --> 00:28:07,624
They're paying taxes,
they're working,

531
00:28:07,628 --> 00:28:10,428
but they've got nowhere to go.

532
00:28:10,428 --> 00:28:14,328
Now, for those 15 million
people who've got nothing,

533
00:28:14,328 --> 00:28:18,928
I promise you they would say to
themselves having some coverage

534
00:28:18,928 --> 00:28:21,728
through Medicaid is
a pretty good deal.

535
00:28:21,728 --> 00:28:25,158
I'd prefer to have them in an
exchange where over time we've

536
00:28:25,161 --> 00:28:28,591
got everybody in a pool, similar
to the pool that members of

537
00:28:28,594 --> 00:28:30,924
Congress enjoyed.

538
00:28:30,928 --> 00:28:33,428
But that's not the situation
that we have right now.

539
00:28:33,428 --> 00:28:35,998
I just want to remind everybody
though that the group that is

540
00:28:35,994 --> 00:28:39,324
being left out, because you
threw out the word "welfare,"

541
00:28:39,328 --> 00:28:43,958
which is, you know, one that
obviously most American people

542
00:28:43,961 --> 00:28:47,261
-- they don't want to be part
of welfare -- the fact of the

543
00:28:47,261 --> 00:28:50,731
matter is, is that very poor
people right now have coverage

544
00:28:50,728 --> 00:28:56,458
that is superior to what a lot
of folks who make a little more

545
00:28:56,461 --> 00:28:58,731
money, are working very
hard trying to support their

546
00:28:58,728 --> 00:29:00,558
families, do not.

547
00:29:00,561 --> 00:29:05,791
Now, I know that Max has been
trying to get in for a while,

548
00:29:05,795 --> 00:29:09,365
but there are some other folks
that haven't had a chance to

549
00:29:09,361 --> 00:29:11,891
speak, so I want to
call on them first.

550
00:29:11,895 --> 00:29:14,965
And then if I've got time,
Max, I'll allow you to wrap up.

551
00:29:14,961 --> 00:29:19,661
But I'm going to go to Chris and
Murray -- Chris and Patty Murray

552
00:29:19,661 --> 00:29:22,361
on our side, as well as Charlie
Rangel who want to speak,

553
00:29:22,361 --> 00:29:24,761
and what we'll do is we'll
alternate to make sure that

554
00:29:24,761 --> 00:29:29,161
we've got -- and I know that
Joe Barton is interested in

555
00:29:29,161 --> 00:29:30,961
speaking, as well, and there
may be a couple of other

556
00:29:30,961 --> 00:29:31,631
Republicans.

557
00:29:31,628 --> 00:29:32,998
Go ahead.

558
00:29:32,994 --> 00:29:35,024
Senator Dodd:
Well, thank you, Mr. President,

559
00:29:35,027 --> 00:29:36,897
and I'll try and keep this
brief and turn it over to Patty,

560
00:29:36,895 --> 00:29:40,965
so we'll take the time for one
person and divide it in two.

561
00:29:40,961 --> 00:29:44,331
Let me first of all thank you
as well and thank all of our

562
00:29:44,328 --> 00:29:45,498
colleagues who have done this.

563
00:29:45,494 --> 00:29:47,464
This has been tremendously
helpful I think today.

564
00:29:47,461 --> 00:29:49,631
It's been said earlier --
maybe it needs to be focused,

565
00:29:49,628 --> 00:29:52,458
as well -- like many of
you, like all of you here,

566
00:29:52,461 --> 00:29:54,191
in my state there
are 31 hospitals,

567
00:29:54,194 --> 00:29:55,464
and they're terrific people.

568
00:29:55,461 --> 00:29:58,531
Whether or not the quality of
care is equal for everyone in

569
00:29:58,528 --> 00:30:00,198
this country is
certainly questionable,

570
00:30:00,194 --> 00:30:03,164
but certainly the quality of the
people who are our health care

571
00:30:03,161 --> 00:30:04,561
providers -- the
nurses, the doctors,

572
00:30:04,561 --> 00:30:07,661
and others -- do an incredible
job every single day.

573
00:30:07,661 --> 00:30:12,161
And the sense -- I was struck
when the REPRESENTATIVE was

574
00:30:12,161 --> 00:30:15,161
talking about the death penalty
issue that was debated some time

575
00:30:15,161 --> 00:30:16,731
ago in Illinois.

576
00:30:16,728 --> 00:30:19,098
I think most of us around this
table here would agree today

577
00:30:19,094 --> 00:30:22,264
that every person, if they're
confronted with a legal problem

578
00:30:22,261 --> 00:30:24,491
has a right to a lawyer.

579
00:30:24,494 --> 00:30:26,324
That's something we've
accepted as a country.

580
00:30:26,328 --> 00:30:28,428
It's somewhat ironic, I suppose
-- and history may judge us

581
00:30:28,428 --> 00:30:30,998
accordingly -- that while
everyone was entitled to a

582
00:30:30,994 --> 00:30:33,894
lawyer, regardless of what
you've been charged with,

583
00:30:33,895 --> 00:30:35,425
that you don't have
a right to a doctor.

584
00:30:35,428 --> 00:30:38,728
And yet at the same time we
acknowledge that we provide

585
00:30:38,728 --> 00:30:41,258
care: If you show up
in an emergency room,

586
00:30:41,261 --> 00:30:42,891
we take care of you.

587
00:30:42,895 --> 00:30:45,965
And that's a great testimony
about who we are as a people.

588
00:30:45,961 --> 00:30:47,761
The problem is of course the
costs associated with that.

589
00:30:47,761 --> 00:30:51,831
I think there's a false
assumption that that's one group

590
00:30:51,828 --> 00:30:53,528
of people, and
they're out there,

591
00:30:53,528 --> 00:30:56,728
and they have no impact on
what happens to those who have

592
00:30:56,728 --> 00:30:58,798
insurance today, and somehow
they should be taking better

593
00:30:58,795 --> 00:31:00,725
care of themselves, they
should quit smoking,

594
00:31:00,728 --> 00:31:02,828
they should eat better,
they should get a job;

595
00:31:02,828 --> 00:31:06,358
that somehow the
responsibility rests with them.

596
00:31:06,361 --> 00:31:08,531
If you can accept
that, which I don't,

597
00:31:08,528 --> 00:31:12,598
the fact of the matter is that
sector of our population affects

598
00:31:12,594 --> 00:31:14,364
everyone else.

599
00:31:14,361 --> 00:31:19,591
It costs us about $248 billion
a year in lost productivity when

600
00:31:19,594 --> 00:31:22,794
you have increased numbers of
uninsured people in the country.

601
00:31:22,795 --> 00:31:26,595
At this very hour, there's a
cost with every single insured

602
00:31:26,594 --> 00:31:28,994
person in this
country of roughly $1,100

603
00:31:28,994 --> 00:31:32,464
a year to pay for that cost
of that person showing up in

604
00:31:32,461 --> 00:31:34,791
that emergency room,
or getting that care.

605
00:31:34,795 --> 00:31:37,765
That's a hidden tax that
Americans are paying today when

606
00:31:37,761 --> 00:31:40,461
people show up for
that kind of support.

607
00:31:40,461 --> 00:31:44,131
There are -- today before we
wrap up and go back to our

608
00:31:44,127 --> 00:31:46,397
offices and go back to our
homes this evening here in the

609
00:31:46,394 --> 00:31:49,924
District of Columbia, 14,000 of
our fellow citizens will have

610
00:31:49,928 --> 00:31:51,458
lost their health care today.

611
00:31:51,461 --> 00:31:54,431
And every day that we're here
debating and discussing this,

612
00:31:54,428 --> 00:31:57,658
14,000 Americans lose
their health care.

613
00:31:57,661 --> 00:32:00,591
Roughly six to eight people will
have lost their lives today as

614
00:32:00,594 --> 00:32:03,294
we gather around this table
because they're uninsured,

615
00:32:03,294 --> 00:32:05,394
based on a Harvard study and
National Science Foundation

616
00:32:05,394 --> 00:32:08,894
study; that we lose that many
people on a daily basis because

617
00:32:08,895 --> 00:32:11,695
we lack -- because they
lack health insurance.

618
00:32:11,695 --> 00:32:13,995
So there are tremendous
costs associated with this.

619
00:32:13,994 --> 00:32:16,124
Henry said it well, Tom said
it well, and Mr. President,

620
00:32:16,127 --> 00:32:18,257
you certainly
encapsulize it very well.

621
00:32:18,261 --> 00:32:20,761
These are not segmented issues.

622
00:32:20,761 --> 00:32:23,431
And while incremental approaches
are something I (inaudible)

623
00:32:23,428 --> 00:32:26,498
support and approach after 30
years here in dealing with major

624
00:32:26,494 --> 00:32:30,094
issues, but this issue
defies incremental approach.

625
00:32:30,094 --> 00:32:33,264
You can't get from one point to
the next incrementally unless

626
00:32:33,261 --> 00:32:35,761
you deal with it holistically,
and that's really what we're

627
00:32:35,761 --> 00:32:36,531
trying to do.

628
00:32:36,528 --> 00:32:38,998
And you may disagree about
whether or not we're doing too

629
00:32:38,994 --> 00:32:41,294
much on mandates or too much
here or there -- and that's a

630
00:32:41,294 --> 00:32:44,624
legitimate debate -- but you
can't get to affordability,

631
00:32:44,628 --> 00:32:47,198
you can't get to quality,
you can't deal with the major

632
00:32:47,194 --> 00:32:50,464
economic issues if you
don't deal with coverage.

633
00:32:50,461 --> 00:32:51,591
You just can't.

634
00:32:51,594 --> 00:32:52,924
There's no way to do it.

635
00:32:52,928 --> 00:32:55,428
You've got to have broadening
coverage if you're going to have

636
00:32:55,428 --> 00:32:58,598
any effort or any successful
effort in reaching those questions.

637
00:32:58,594 --> 00:33:01,164
Lastly, I'll just
say this to you.

638
00:33:01,161 --> 00:33:04,191
A guy in my state, Kevin Galvin
(phonetic) -- Kevin employs

639
00:33:04,194 --> 00:33:08,094
seven people, a maintenance
operation in Hartford, Connecticut.

640
00:33:08,094 --> 00:33:10,524
He wanted to
provide health care.

641
00:33:10,528 --> 00:33:12,258
And like the stories
you've all heard,

642
00:33:12,261 --> 00:33:15,391
he lost a fellow of 24 years
because the guy had a health

643
00:33:15,394 --> 00:33:18,724
care issue, he finally had to
take less pay, took another job,

644
00:33:18,728 --> 00:33:20,628
because there was
health care provided.

645
00:33:20,628 --> 00:33:23,298
But Kevin did more than just
tell me a story about himself,

646
00:33:23,294 --> 00:33:25,894
Mr. President, and what happened
to his seven employees because

647
00:33:25,895 --> 00:33:27,325
they couldn't get health care.

648
00:33:27,328 --> 00:33:30,298
He went out in my city in
Connecticut and organized 19,000

649
00:33:30,294 --> 00:33:33,094
small businesses, and they
changed the law in Connecticut

650
00:33:33,094 --> 00:33:35,124
regarding pooling
in small businesses,

651
00:33:35,127 --> 00:33:37,697
because here was a small
business guy who wanted to take

652
00:33:37,695 --> 00:33:41,125
care of his people and watched
tragically day after day what

653
00:33:41,127 --> 00:33:44,097
happened to individuals because
he could not provide it for them

654
00:33:44,094 --> 00:33:44,994
any longer.

655
00:33:44,994 --> 00:33:47,864
And I think people like Kevin
Galvin exist in every district

656
00:33:47,861 --> 00:33:50,861
in every state who want to
provide that health care,

657
00:33:50,861 --> 00:33:53,661
understand how valuable it is
to them, their productivity,

658
00:33:53,661 --> 00:33:55,631
and of course the importance
of their employees.

659
00:33:55,628 --> 00:33:57,728
But coverage is
the critical issue.

660
00:33:57,728 --> 00:33:59,798
We know that in the next
10 years -- factually,

661
00:33:59,795 --> 00:34:02,625
Mr. President -- in the next
10 years every state in this

662
00:34:02,628 --> 00:34:06,998
country will have a 10 percent
increase in uninsured people.

663
00:34:06,994 --> 00:34:09,464
We know that in 30 states in
our country in that same 10-year

664
00:34:09,461 --> 00:34:12,631
period there will be a
30-percent increase in the uninsured.

665
00:34:12,628 --> 00:34:16,398
And half the population under
the age of 65 will at one point

666
00:34:16,394 --> 00:34:20,824
or another in the next 10
years be without insurance.

667
00:34:20,828 --> 00:34:23,428
So it's not some
isolated group out there.

668
00:34:23,428 --> 00:34:25,858
This is the critical
constituency that is -- this is

669
00:34:25,861 --> 00:34:28,691
the lynchpin that holds
all of this together.

670
00:34:28,695 --> 00:34:34,395
So coverage is
absolutely critical.

671
00:34:34,394 --> 00:34:37,024
Representative Barton:
Thank you, Mr. President.

672
00:34:37,027 --> 00:34:39,127
I want to commend you for
asking us to come here,

673
00:34:39,127 --> 00:34:42,627
and I will say that never have
so many members of the House and

674
00:34:42,628 --> 00:34:46,328
Senate behaved so well for so
long before so many television cameras.

675
00:34:46,328 --> 00:34:47,458
(laughter)

676
00:34:47,461 --> 00:34:49,231
So if we ever get to a
conference committee,

677
00:34:49,227 --> 00:34:52,497
we may want you to
be the moderator.

678
00:34:52,494 --> 00:34:55,724
I do think, though, that there
is a fundamental difference in

679
00:34:55,728 --> 00:34:59,228
the vision that you and your
friends on the majority have put

680
00:34:59,227 --> 00:35:03,997
forward, and the vision that
myself and those of us in the

681
00:35:03,994 --> 00:35:05,694
minority have put forward.

682
00:35:05,695 --> 00:35:08,825
It's the fundamental
role of government.

683
00:35:08,828 --> 00:35:13,428
We believe that we should use
free markets to empower people

684
00:35:13,428 --> 00:35:15,298
and give them choices.

685
00:35:15,294 --> 00:35:19,694
And for the best of intentions,
yourself and most of your allies

686
00:35:19,695 --> 00:35:23,995
in the Democratic Party seem
to believe that the government,

687
00:35:23,994 --> 00:35:27,224
either through a mandate
or through a regulatory

688
00:35:27,227 --> 00:35:32,297
requirement, knows better and
will do better for health care

689
00:35:32,294 --> 00:35:34,094
for most Americans.

690
00:35:34,094 --> 00:35:36,724
Now, whether you have a mandate
or simply give the Secretary of

691
00:35:36,728 --> 00:35:41,798
Health and Human Services the
ability by regulation to require

692
00:35:41,795 --> 00:35:45,965
something, that's a difference
without -- that's a distinction

693
00:35:45,961 --> 00:35:47,891
without much of a difference.

694
00:35:47,895 --> 00:35:52,295
So the six commonsense ideas
that various Republicans have

695
00:35:52,294 --> 00:35:56,594
put out here is not
incrementalism in the sense that

696
00:35:56,594 --> 00:36:00,924
it doesn't go together, but it
does not radically change the

697
00:36:00,928 --> 00:36:03,398
basic health care
system of America.

698
00:36:03,394 --> 00:36:08,864
If you give the ability to sell
insurance across state lines,

699
00:36:08,861 --> 00:36:12,361
and prevent a state
from precluding it,

700
00:36:12,361 --> 00:36:15,561
if the insurance company can
prove that it's solvent and that

701
00:36:15,561 --> 00:36:19,461
it will pay the benefit, health
care costs will go down in that

702
00:36:19,461 --> 00:36:21,431
state and premiums will go down.

703
00:36:21,428 --> 00:36:25,758
There was a study just out
that in the state of California

704
00:36:25,761 --> 00:36:30,861
health care premiums would go
down 50 percent if Californians

705
00:36:30,861 --> 00:36:34,831
could buy insurance
from Nevada or Oregon.

706
00:36:34,828 --> 00:36:39,798
If you create a catastrophic
high-risk pool and put the cap

707
00:36:39,795 --> 00:36:42,725
on it that Leader Boehner did
on his alternative on the House

708
00:36:42,728 --> 00:36:48,328
floor, and allow small
businesses to create the kind of

709
00:36:48,328 --> 00:36:52,398
pools that we've talked about,
you're going to be able to give

710
00:36:52,394 --> 00:36:55,224
those Americans who can't
get insurance because of a

711
00:36:55,227 --> 00:37:00,257
preexisting condition and want
it the ability to get into those things.

712
00:37:00,261 --> 00:37:03,791
And their premiums will
not go up catastrophically.

713
00:37:03,795 --> 00:37:05,965
They will not go
up astronomically.

714
00:37:05,961 --> 00:37:08,991
And one of the things that
we seem to have agreement on,

715
00:37:08,994 --> 00:37:12,264
according to yourself
and Senator Durbin,

716
00:37:12,261 --> 00:37:14,531
is medical malpractice.

717
00:37:14,528 --> 00:37:18,158
Now, your proposal in the House
bill and the Senate bill pay lip

718
00:37:18,161 --> 00:37:23,391
service to medical malpractice,
but they don't really do it.

719
00:37:23,394 --> 00:37:26,664
Again, if you take the Boehner
proposal that was put together

720
00:37:26,661 --> 00:37:30,391
and put up on the House floor,
and it's based on what's

721
00:37:30,394 --> 00:37:34,724
happened in Texas -- in Texas,
which put in medical malpractice

722
00:37:34,728 --> 00:37:40,498
reform in 2003 -- premiums for
medical malpractice have gone

723
00:37:40,494 --> 00:37:43,224
down 27 percent.

724
00:37:43,227 --> 00:37:48,357
Texas has gained 18,000 doctors
since this reform was put in.

725
00:37:48,361 --> 00:37:54,261
There are 55 rural counties
in Texas that now have an obstetrician.

726
00:37:54,261 --> 00:37:57,591
If that is extrapolated
nationally,

727
00:37:57,594 --> 00:38:01,394
you're not going to save the
$54 billion that Senator Durbin

728
00:38:01,394 --> 00:38:03,664
alluded to and that
yourself alluded to.

729
00:38:03,661 --> 00:38:06,931
If you combine the direct
savings with the indirect

730
00:38:06,928 --> 00:38:11,328
savings, because the price of
practicing defensive medicine

731
00:38:11,328 --> 00:38:17,528
goes down, you've probably
saved $150 billion a year.

732
00:38:17,528 --> 00:38:19,328
Now, that's real money.

733
00:38:19,328 --> 00:38:22,928
So what we're saying, Mr.
President -- we're not

734
00:38:22,928 --> 00:38:25,058
talking about incrementalism.

735
00:38:25,061 --> 00:38:28,861
We're talking about, as Leader
Boehner said and Mr. McConnell

736
00:38:28,861 --> 00:38:33,391
-- Senator McConnell said, let's
start over in the sense that we

737
00:38:33,394 --> 00:38:38,164
change the vision and work
together to do the things that

738
00:38:38,161 --> 00:38:41,831
we agree upon, but do it in a
way that doesn't destroy the

739
00:38:41,828 --> 00:38:45,858
fundamental market system that's
made the American health care

740
00:38:45,861 --> 00:38:47,631
system the best in the world.

741
00:38:47,628 --> 00:38:50,798
And if we do that,
we can make a deal.

742
00:38:50,795 --> 00:38:51,595
Thank you, Mr. President.

743
00:38:51,594 --> 00:38:52,664
Thank you, Leader Boehner.

744
00:38:52,661 --> 00:38:55,831
The President:
Joe, I'll respond to you right (inaudible) because

745
00:38:55,828 --> 00:38:59,528
I think we should wrap it up.

746
00:38:59,528 --> 00:39:03,398
You're right, the proposal that
John Boehner has put forward

747
00:39:03,394 --> 00:39:07,564
doesn't radically change
the existing system.

748
00:39:07,561 --> 00:39:12,691
And that I think is why 3
million out of the 30 million

749
00:39:12,695 --> 00:39:16,095
who don't have coverage, or 40
million, don't get coverage.

750
00:39:16,094 --> 00:39:20,194
The proposal that's been put
forward by the House and the

751
00:39:20,194 --> 00:39:24,064
Senate Democrats also doesn't
radically change it in the sense

752
00:39:24,061 --> 00:39:27,531
that the vast majority of people
who currently have health care

753
00:39:27,528 --> 00:39:30,958
will still get it, it's just
they'll see it a little cheaper.

754
00:39:30,961 --> 00:39:35,961
People who do not have
coverage will start getting it.

755
00:39:35,961 --> 00:39:39,131
So that's -- it's not -- neither
of these proposals are radical.

756
00:39:39,127 --> 00:39:42,297
The question is, which one works
best for the American people?

757
00:39:42,294 --> 00:39:45,924
And that's what we'll
see if we can determine.

758
00:39:45,928 --> 00:39:47,198
We're running short on time.

759
00:39:47,194 --> 00:39:50,094
I know that some folks are going
to at some point have to get going.

760
00:39:50,094 --> 00:39:52,994
I am going to reserve the
prerogative of making sure that

761
00:39:52,994 --> 00:39:56,094
everybody who has not had a
chance to speak is allowed to

762
00:39:56,094 --> 00:39:59,564
speak, and then I will wrap up.

763
00:39:59,561 --> 00:40:01,761
That means that we're probably
going to go a little bit later

764
00:40:01,761 --> 00:40:02,891
than we had anticipated.

765
00:40:02,895 --> 00:40:05,295
But, as I said, by the
standards of Washington,

766
00:40:05,294 --> 00:40:08,094
we're still in
the ballpark here.

767
00:40:08,094 --> 00:40:10,864
I'm going to call on
Charlie Rangel first.

768
00:40:10,861 --> 00:40:12,731
We'll go to one of our
Republican colleagues.

769
00:40:12,728 --> 00:40:17,428
Patty Murray is going to
have an opportunity to speak.

770
00:40:17,428 --> 00:40:19,998
Again, there may be some
comments -- there may be some

771
00:40:19,994 --> 00:40:24,794
other Republicans who are
interested in speaking.

772
00:40:24,795 --> 00:40:28,795
We'll go to -- we're going to
actually go to Ron Wyden first.

773
00:40:28,795 --> 00:40:30,325
Then, we're going to go
to another Republican.

774
00:40:30,328 --> 00:40:32,658
And we're going to
end with John Dingell,

775
00:40:32,661 --> 00:40:39,531
who was there when the idea of
everybody having health care was

776
00:40:39,528 --> 00:40:44,928
first introduced by his
father many decades ago.

777
00:40:44,928 --> 00:40:45,598
Representative Waxman:
Mr. President,

778
00:40:45,594 --> 00:40:47,864
why don't you just call on
Republicans who haven't talked,

779
00:40:47,861 --> 00:40:50,391
because some of them have
talked numerous times?

780
00:40:50,394 --> 00:40:52,264
The President:
I agree, but I want to make sure that they may

781
00:40:52,261 --> 00:40:56,131
want to respond to
whatever is said.

782
00:40:56,127 --> 00:40:56,997
Go ahead, Ron.

783
00:40:56,994 --> 00:40:57,964
Senator Wyden:
Thank you very much,
Mr. President.

784
00:40:57,961 --> 00:41:01,861
And I think this has been a
very constructive session.

785
00:41:01,861 --> 00:41:08,091
For the last six hours, we have
essentially heard Republicans

786
00:41:08,094 --> 00:41:14,064
talk about incremental coverage
and Democrats talk about

787
00:41:14,061 --> 00:41:17,291
comprehensive or broader
kind of coverage.

788
00:41:17,294 --> 00:41:20,164
And I want to outline something
that I think could bring both

789
00:41:20,161 --> 00:41:24,761
sides together for just
a couple of minutes.

790
00:41:24,761 --> 00:41:29,031
First, on the incremental
point, the evidence shows that

791
00:41:29,027 --> 00:41:36,397
incremental reform not only
does less, it costs more.

792
00:41:36,394 --> 00:41:40,324
And the experts that both
Democrats and Republicans rely

793
00:41:40,328 --> 00:41:44,658
on have found this -- the
Lewin Group, for example,

794
00:41:44,661 --> 00:41:51,731
that Republicans quote from,
they say that and both sides use them.

795
00:41:51,728 --> 00:41:53,958
Also, history.

796
00:41:53,961 --> 00:41:59,591
We have been doing incremental
reform in this country since 1994.

797
00:41:59,594 --> 00:42:03,094
Since the blowup of
the Clinton plan,

798
00:42:03,094 --> 00:42:05,164
that's exactly what
we've been doing,

799
00:42:05,161 --> 00:42:07,561
and costs have been gobbling
up everything in sight in the

800
00:42:07,561 --> 00:42:10,561
private sector and
in the government.

801
00:42:10,561 --> 00:42:15,431
So I would submit that instead
of this debate about incremental

802
00:42:15,428 --> 00:42:20,658
reform or comprehensive reform,
we could all be for real reform.

803
00:42:20,661 --> 00:42:25,831
And real reform, in effect,
changes the incentives that

804
00:42:25,828 --> 00:42:30,828
drive the system and
particularly empower the consumer.

805
00:42:30,828 --> 00:42:33,358
Mr. President, I've been very
pleased that you've constantly

806
00:42:33,361 --> 00:42:38,191
been coming back to the system
for members of Congress.

807
00:42:38,194 --> 00:42:43,924
Folks, all of us can fire
our insurance company,

808
00:42:43,928 --> 00:42:45,328
every one of us.

809
00:42:45,328 --> 00:42:48,798
And as far as I'm concerned,
we've got to stay in this battle

810
00:42:48,795 --> 00:42:52,265
until everybody in the United
States has that right to hold

811
00:42:52,261 --> 00:42:55,831
the insurance companies
accountable and to fire them.

812
00:42:55,828 --> 00:42:59,158
And one of the promising
points you made this afternoon,

813
00:42:59,161 --> 00:43:04,061
Mr. President, that I appreciate
is the point on interstate

814
00:43:04,061 --> 00:43:08,731
shopping, because this is
another opportunity, in my view,

815
00:43:08,728 --> 00:43:13,758
done properly -- properly
to empower the consumer.

816
00:43:13,761 --> 00:43:18,331
Now, colleagues, our system --
the one that we enjoy -- already

817
00:43:18,328 --> 00:43:22,228
allows interstate competition
for health insurance.

818
00:43:22,227 --> 00:43:25,897
That's the way the federal
system works right now.

819
00:43:25,895 --> 00:43:29,425
And there are good
consumer protections.

820
00:43:29,428 --> 00:43:33,058
So, Mr. President, when you made
that offer to all of us today to

821
00:43:33,061 --> 00:43:37,161
work with us on this, not only
am I going to follow up on what

822
00:43:37,161 --> 00:43:41,061
I think is a very gracious
offer to try to bring both sides

823
00:43:41,061 --> 00:43:46,331
together, it allows us to build
on the exchanges that we have

824
00:43:46,328 --> 00:43:52,698
today, which begin to empower
people with more choices and competition.

825
00:43:52,695 --> 00:43:55,695
And if we just keep
building on that,

826
00:43:55,695 --> 00:43:59,065
starting with this effort to
bring both sides together on

827
00:43:59,061 --> 00:44:03,731
interstate competition, looking
in my view at the federal

828
00:44:03,728 --> 00:44:08,028
employee system to do it, I
think we can resolve a lot of

829
00:44:08,027 --> 00:44:09,697
our differences.

830
00:44:09,695 --> 00:44:12,825
So I appreciate the opportunity
to speak, Mr. President.

831
00:44:12,828 --> 00:44:17,128
I want colleagues to know that
I'm going to be following up

832
00:44:17,127 --> 00:44:19,197
with both sides of the aisle
this afternoon and your

833
00:44:19,194 --> 00:44:23,294
administration to bring
this group together.

834
00:44:23,294 --> 00:44:24,664
Senator McConnell:
Mr. President,

835
00:44:24,661 --> 00:44:28,291
all of my members have had a
chance to speak at least once,

836
00:44:28,294 --> 00:44:30,064
several of them a
number of times.

837
00:44:30,061 --> 00:44:34,761
Jon Kyl reminds me that
the HSAs, for example,

838
00:44:34,761 --> 00:44:40,061
are not exactly for rich people;
that the median income of a user

839
00:44:40,061 --> 00:44:44,131
of a HSA is $69,000 a year.

840
00:44:44,127 --> 00:44:46,727
All of us are representatives
of the American people,

841
00:44:46,728 --> 00:44:52,458
but I have a feeling we haven't
been listening to them very carefully.

842
00:44:52,461 --> 00:44:55,161
Representative Roskam mentioned
what the people in his district

843
00:44:55,161 --> 00:44:58,631
think, and I expect all of you
are experts on what the people

844
00:44:58,628 --> 00:45:01,058
in your districts think.

845
00:45:01,061 --> 00:45:04,061
But we know from the polling
that's been done in this country

846
00:45:04,061 --> 00:45:09,961
how the American people feel
about this 2,700-page bill.

847
00:45:09,961 --> 00:45:11,391
We know how they feel about it.

848
00:45:11,394 --> 00:45:14,224
This is not a close call.

849
00:45:14,227 --> 00:45:17,027
If you average all of
the polls in America,

850
00:45:17,027 --> 00:45:19,897
we know that the American people
oppose this proposal by -- on an

851
00:45:19,895 --> 00:45:24,195
average of 55 to 37 percent.

852
00:45:24,194 --> 00:45:27,664
They have also been asked -- and
we keep reading in the newspaper

853
00:45:27,661 --> 00:45:31,591
that where we're headed next is
to the reconciliation approach.

854
00:45:31,594 --> 00:45:34,794
Well, Gallup also
asked that question.

855
00:45:34,795 --> 00:45:38,265
It explained to the American
people what it meant so they

856
00:45:38,261 --> 00:45:42,991
understood what this word
that we use around Washington

857
00:45:42,994 --> 00:45:45,064
actually means.

858
00:45:45,061 --> 00:45:47,691
And in the Gallup poll, the
American people were opposed

859
00:45:47,695 --> 00:45:51,895
using that, 52 to 39 [percent].

860
00:45:51,895 --> 00:45:54,725
So this has been a fabulous
discussion, Mr. President.

861
00:45:54,728 --> 00:45:57,028
We have a lot of
experts around the room.

862
00:45:57,027 --> 00:45:58,657
But I think it's
really important,

863
00:45:58,661 --> 00:46:00,691
since we represent
the American people,

864
00:46:00,695 --> 00:46:03,165
that we not ignore
their view on this.

865
00:46:03,161 --> 00:46:06,331
They have paid attention to this
issue like no other issue since

866
00:46:06,328 --> 00:46:09,458
I have been in the
United States Senate.

867
00:46:09,461 --> 00:46:13,361
Health care is a
uniquely personal issue.

868
00:46:13,361 --> 00:46:15,591
Obviously, you get more
interested in the subject the

869
00:46:15,594 --> 00:46:16,324
older you get.

870
00:46:16,328 --> 00:46:20,998
But every American cares deeply
about the quality of their

871
00:46:20,994 --> 00:46:24,494
health care, and access to
health care and cost of health care.

872
00:46:24,494 --> 00:46:27,994
They have followed this
debate like no other,

873
00:46:27,994 --> 00:46:31,894
and they have rendered a
judgment about what we have

874
00:46:31,895 --> 00:46:34,865
attempted to do so far.

875
00:46:34,861 --> 00:46:39,831
The solution to that is to put
that on the shelf and to start

876
00:46:39,828 --> 00:46:46,058
over with a blank piece of paper
and go step by step to see what

877
00:46:46,061 --> 00:46:50,361
we can agree on to improve the
American health care system,

878
00:46:50,361 --> 00:46:56,991
which is already -- as all of
us agree -- the finest in the world.

879
00:46:56,994 --> 00:46:58,264
The President:
I'm just going to make this remark,

880
00:46:58,261 --> 00:47:00,231
and then I'm going to call on
Patty Murray -- I'm going to

881
00:47:00,227 --> 00:47:05,397
save the two lions of the House
here for the end -- because

882
00:47:05,394 --> 00:47:09,264
there's been a lot of comments
from every Republican about the

883
00:47:09,261 --> 00:47:12,331
polls and what they're hearing
from their constituents.

884
00:47:12,328 --> 00:47:16,098
And, as I said, I hear from
constituents in every one of

885
00:47:16,094 --> 00:47:21,024
your districts and every
one of your states.

886
00:47:21,027 --> 00:47:25,757
And what's interesting is
actually when you poll people

887
00:47:25,761 --> 00:47:30,331
about the individual elements
in each of these bills,

888
00:47:30,328 --> 00:47:32,598
they're all for them.

889
00:47:32,594 --> 00:47:35,064
So you ask them, do you want to
prohibit preexisting conditions?

890
00:47:35,061 --> 00:47:36,891
Yes, I'm for that.

891
00:47:36,895 --> 00:47:39,995
Do you want to make sure that
everybody can get basic coverage

892
00:47:39,994 --> 00:47:41,094
that's affordable?

893
00:47:41,094 --> 00:47:44,024
Yes, I'm for that.

894
00:47:44,027 --> 00:47:48,527
Do you want to make sure that
insurance companies can't take

895
00:47:48,528 --> 00:47:51,428
advantage of you and that you've
got the ability, as Ron said,

896
00:47:51,428 --> 00:47:54,898
to fire an insurance company
that's not doing a good job and

897
00:47:54,895 --> 00:48:01,165
hire one that is, but also, that
you've got some basic consumer protections?

898
00:48:01,161 --> 00:48:03,591
Yes, we like that.

899
00:48:03,594 --> 00:48:13,594
So polls I think are important
in taking a temperature of the public.

900
00:48:13,594 --> 00:48:15,194
If you polled people
and asked them,

901
00:48:15,194 --> 00:48:19,264
is the system working right now
and should we move forward with

902
00:48:19,261 --> 00:48:22,731
health reform, they'd
also say yes to that.

903
00:48:22,728 --> 00:48:26,028
And my hope had been,
and continues to be,

904
00:48:26,027 --> 00:48:30,097
that based on this conversation
there might be enough areas of

905
00:48:30,094 --> 00:48:33,994
overlap that we could
realistically think about moving

906
00:48:33,994 --> 00:48:39,594
forward without -- without a
situation in which everybody

907
00:48:39,594 --> 00:48:42,064
just goes to their respective
corners and this ends up being a

908
00:48:42,061 --> 00:48:45,291
political fight, because this is
something that really has to be solved.

909
00:48:45,294 --> 00:48:49,564
We've got three people who have
not had an opportunity to speak today.

910
00:48:49,561 --> 00:48:53,191
If you don't mind, I
will -- would like to,

911
00:48:53,194 --> 00:48:55,994
in the interest of time, just
go ahead and let each of them speak.

912
00:48:55,994 --> 00:49:00,124
If there's an intervention that
somebody on the Republican side

913
00:49:00,127 --> 00:49:04,027
wants to make, then I
will recognize them.

914
00:49:04,027 --> 00:49:07,427
Then I will allow anybody
of your choice, Mitch,

915
00:49:07,428 --> 00:49:10,258
to wrap things up.

916
00:49:10,261 --> 00:49:15,431
I think Speaker Pelosi may want
to say just a quick summary of

917
00:49:15,428 --> 00:49:16,658
what she's thinking.

918
00:49:16,661 --> 00:49:19,061
And then I will talk a
little bit about next steps.

919
00:49:19,061 --> 00:49:22,291
And if everybody could keep
their remarks relatively brief,

920
00:49:22,294 --> 00:49:23,894
that'd be very helpful.

921
00:49:23,895 --> 00:49:24,595
Patty.

922
00:49:24,594 --> 00:49:25,724
Senator Murray:
Mr. President, thank you.

923
00:49:25,728 --> 00:49:28,258
And this has been I think
a very good discussion.

924
00:49:28,261 --> 00:49:31,461
And I think all of us come to
this table today having heard a

925
00:49:31,461 --> 00:49:34,731
lot of stories and talked to a
lot of people and bring their

926
00:49:34,728 --> 00:49:36,098
passions with us today.

927
00:49:36,094 --> 00:49:37,594
And I certainly am one of those.

928
00:49:37,594 --> 00:49:40,094
And every time we talk about
this -- every time I think about

929
00:49:40,094 --> 00:49:44,024
this, I remember a little boy
that I met last spring who is 11

930
00:49:44,027 --> 00:49:46,827
years-old, whose name
was Marcelis (ph).

931
00:49:46,828 --> 00:49:50,898
And he told me that
his mom, single mom,

932
00:49:50,895 --> 00:49:52,765
taking care of him and
his two younger sisters,

933
00:49:52,761 --> 00:49:56,131
was going to work every day,
had a job managing a fast-food

934
00:49:56,127 --> 00:49:59,157
restaurant, was doing
okay but she got sick.

935
00:49:59,161 --> 00:50:02,491
And when she got sick she had
to take time off from work and

936
00:50:02,494 --> 00:50:06,094
because she was missing so
much work she lost her job.

937
00:50:06,094 --> 00:50:09,024
When she lost her job,
she lost her health care.

938
00:50:09,027 --> 00:50:11,057
And because she lost
her health care,

939
00:50:11,061 --> 00:50:13,431
she couldn't get in to
see a doctor, and sadly,

940
00:50:13,428 --> 00:50:16,628
Marcelis's mom died.

941
00:50:16,628 --> 00:50:20,658
I think about him every time
we talk about this bill.

942
00:50:20,661 --> 00:50:24,991
And what happened to her is
happening to so many Americans

943
00:50:24,994 --> 00:50:29,224
who when they get sick today
don't have any choices.

944
00:50:29,227 --> 00:50:31,057
They have nowhere to go.

945
00:50:31,061 --> 00:50:34,591
Either they don't have insurance
or they've been denied insurance

946
00:50:34,594 --> 00:50:37,324
because they don't -- because
they have a preexisting

947
00:50:37,328 --> 00:50:40,398
condition or they're a small
business whose premiums have

948
00:50:40,394 --> 00:50:43,664
gone up so dramatically that
they can no longer afford to

949
00:50:43,661 --> 00:50:45,561
provide it for their employees.

950
00:50:45,561 --> 00:50:49,161
Too many Americans today are
in a box and they don't have a choice.

951
00:50:49,161 --> 00:50:52,391
Frankly, it's why so many
Americans today are passionate

952
00:50:52,394 --> 00:50:53,664
about a public option.

953
00:50:53,661 --> 00:50:57,831
It was a choice for them that
they felt was important to them.

954
00:50:57,828 --> 00:51:00,058
But in the bill that you have
presented and that we've been

955
00:51:00,061 --> 00:51:03,661
working on that is so important
is it finally gets some people

956
00:51:03,661 --> 00:51:07,831
out of that box of no choices --
by giving them an exchange that

957
00:51:07,828 --> 00:51:11,398
they can go to, by taking care
of the insurance reforms so

958
00:51:11,394 --> 00:51:14,994
they're not denied coverage,
by opening up community health

959
00:51:14,994 --> 00:51:19,624
centers so people have choices,
by making sure that we lower the

960
00:51:19,628 --> 00:51:22,858
cost for all Americans because
when we provide coverage for

961
00:51:22,861 --> 00:51:26,991
30 million Americans it lowers
the cost of everyone who has

962
00:51:26,994 --> 00:51:32,124
insurance today by $1,000 a year
a family -- this is why this is

963
00:51:32,127 --> 00:51:32,957
so important.

964
00:51:32,961 --> 00:51:36,231
And what I have listened for
today is whether the alternative

965
00:51:36,227 --> 00:51:39,827
proposal that has come before us
gives people those choices that

966
00:51:39,828 --> 00:51:41,328
they need.

967
00:51:41,328 --> 00:51:44,798
And that's what I'm listening
for and I go back to Marcelis

968
00:51:44,795 --> 00:51:48,895
and I think, will that proposal
make sure that nobody loses

969
00:51:48,895 --> 00:51:51,665
their mom again because
they didn't have a choice?

970
00:51:51,661 --> 00:51:54,091
And that's why it's so important
that we move forward with what

971
00:51:54,094 --> 00:51:57,924
we have and open that door
for so many Americans.

972
00:51:57,928 --> 00:51:59,428
The President:
Thank you.

973
00:51:59,428 --> 00:52:09,058
Senator McConnell:
Mr. President, Dr. Coburn.

974
00:52:09,061 --> 00:52:14,491
Senator Coburn:
If we don't think about what the key goal is

975
00:52:14,494 --> 00:52:19,764
-- the key goal is to reconnect
purchase and payment so we

976
00:52:19,761 --> 00:52:21,291
become good purchasers.

977
00:52:21,294 --> 00:52:24,064
Whether we create --
what system we do,

978
00:52:24,061 --> 00:52:28,691
if we don't reconnect the
mechanism of payment with

979
00:52:28,695 --> 00:52:32,995
purchase, we're not going to
get good value out of our health care system.

980
00:52:32,994 --> 00:52:36,464
And I outlined one out of every
three dollars that doesn't help

981
00:52:36,461 --> 00:52:39,731
anybody get well, doesn't
prevent them from getting sick.

982
00:52:39,728 --> 00:52:44,928
And there's enough potential
there in that pool of money that

983
00:52:44,928 --> 00:52:47,158
we don't have to have
the government run it.

984
00:52:47,161 --> 00:52:50,391
What in fact we can do is we can
create and allow that money for

985
00:52:50,394 --> 00:52:53,724
everybody to have the kind of
access that Senator Murray wants

986
00:52:53,728 --> 00:52:56,058
that individual to have.

987
00:52:56,061 --> 00:53:01,131
The thing that I think is --
draws us apart is the level of

988
00:53:01,127 --> 00:53:03,997
involvement in the government
in making those choices.

989
00:53:03,994 --> 00:53:06,464
And I would just put forward
to you that we ought to have

990
00:53:06,461 --> 00:53:10,491
another talk like this as we can
get closer and closer on some

991
00:53:10,494 --> 00:53:14,664
ideas because we all
want the same thing,

992
00:53:14,661 --> 00:53:17,691
but how we get there, whether or
not we're in charge of it or the

993
00:53:17,695 --> 00:53:19,895
individual patient
is in charge of it,

994
00:53:19,895 --> 00:53:23,125
personally making their own
choices with the asset value

995
00:53:23,127 --> 00:53:26,827
that is capable, based on what
we're already spending in health care.

996
00:53:26,828 --> 00:53:29,528
We don't need to spend a penny
more in health care in this country.

997
00:53:29,528 --> 00:53:34,598
What we need to do is spend it
much more wisely and much more effectively.

998
00:53:34,594 --> 00:53:38,794
The President:
I'll pick up
on some themes in my close.

999
00:53:38,795 --> 00:53:40,165
Charlie Rangel.

1000
00:53:40,161 --> 00:53:42,161
Representative Rangel:
Thank you, Mr. President,

1001
00:53:42,161 --> 00:53:44,931
and I appreciate the fact that
you saved the best for last.

1002
00:53:44,928 --> 00:53:45,528
The President:
Absolutely.

1003
00:53:45,528 --> 00:53:47,858
(laughter)

1004
00:53:47,861 --> 00:53:50,391
Representative Rangel:
I had
really hoped that when we came

1005
00:53:50,394 --> 00:53:54,594
here that we were really
going to push over the top.

1006
00:53:54,594 --> 00:53:58,824
We are so close to
national health insurance,

1007
00:53:58,828 --> 00:54:03,698
we are so close to allowing
people that go to work every day

1008
00:54:03,695 --> 00:54:06,565
and don't know what can happen
to them when they lose their job

1009
00:54:06,561 --> 00:54:09,361
and lose their health insurance.

1010
00:54:09,361 --> 00:54:12,631
I know that they call the
Senate the upper house,

1011
00:54:12,628 --> 00:54:17,958
but I was amazed how it seems as
though they believe the American

1012
00:54:17,961 --> 00:54:23,191
people only listen to those
from Wyoming and Kentucky.

1013
00:54:23,194 --> 00:54:27,424
But having said that,
for my New Yorkers,

1014
00:54:27,428 --> 00:54:31,398
even though we have more
self confidence than we need,

1015
00:54:31,394 --> 00:54:36,224
I would want them to know that
they are Americans and that we

1016
00:54:36,227 --> 00:54:41,727
do listen to them and that the
states that oppose this great

1017
00:54:41,728 --> 00:54:45,928
plan, doesn't speak
for all of America.

1018
00:54:45,928 --> 00:54:51,698
Having said that, some people
have called those who oppose us

1019
00:54:51,695 --> 00:54:53,525
as being the "party of no."

1020
00:54:53,528 --> 00:54:56,628
I don't think so,
notwithstanding the fact we got

1021
00:54:56,628 --> 00:55:00,458
five Republicans from the Ways
and Means Committee here at your summit.

1022
00:55:00,461 --> 00:55:04,591
Now, we spent hundreds of hours
in three committees and Ways and

1023
00:55:04,594 --> 00:55:07,924
Means and there wasn't
one bill before us.

1024
00:55:07,928 --> 00:55:12,498
And I would think that instead
of taking the President's time,

1025
00:55:12,494 --> 00:55:14,864
that this is where the House and
the Senate would take care of

1026
00:55:14,861 --> 00:55:19,531
legislative business, especially
if we agree on 70 percent.

1027
00:55:19,528 --> 00:55:23,228
For God's sake, then,
for the 10 or 20 percent,

1028
00:55:23,227 --> 00:55:28,457
why do you say scrap what we got
unless it ends up with that you

1029
00:55:28,461 --> 00:55:32,061
have made up your mind that
we're not going to have a health bill?

1030
00:55:32,061 --> 00:55:35,931
And then I would say that most
all of America would find it not

1031
00:55:35,928 --> 00:55:39,458
more difficult to understand
why the bill is so big,

1032
00:55:39,461 --> 00:55:41,961
or why we use reconciliation.

1033
00:55:41,961 --> 00:55:45,731
I think one of the big
problems America would have is,

1034
00:55:45,728 --> 00:55:48,258
why does it take 60
to get a majority?

1035
00:55:48,261 --> 00:55:50,561
And I have to explain, well,
that's the Senate and they're

1036
00:55:50,561 --> 00:55:53,361
different than most Americans
in understanding it.

1037
00:55:53,361 --> 00:55:57,861
So what I would hope would
happen is that we leave here not

1038
00:55:57,861 --> 00:56:00,761
thinking that we're
going to start all over.

1039
00:56:00,761 --> 00:56:02,531
We can't get back those times.

1040
00:56:02,528 --> 00:56:06,998
This is the last year for a
whole lot of people in the

1041
00:56:06,994 --> 00:56:11,824
House of Representatives who we
believe we represent the people, too.

1042
00:56:11,828 --> 00:56:14,628
Why can't we take
what we've agreed to?

1043
00:56:14,628 --> 00:56:16,628
I mean, sick people,
scared people,

1044
00:56:16,628 --> 00:56:18,498
are not Republican
and Democrats.

1045
00:56:18,494 --> 00:56:19,924
They're Americans.

1046
00:56:19,928 --> 00:56:22,358
And you've made it abundantly
clear that you have the same

1047
00:56:22,361 --> 00:56:25,431
sensitivity, you recognize
the fiscal crisis,

1048
00:56:25,428 --> 00:56:29,028
you know what can happen to our
country if we're not educated,

1049
00:56:29,027 --> 00:56:31,457
if we're not strong
in a healthy way.

1050
00:56:31,461 --> 00:56:35,161
Have staff or somebody bring
together those issues that

1051
00:56:35,161 --> 00:56:38,761
cannot be contradicted in
terms of what you want.

1052
00:56:38,761 --> 00:56:42,031
And I know you want more than
just 3 million people insured.

1053
00:56:42,027 --> 00:56:45,097
You can explain why it's
difficult for you to do it.

1054
00:56:45,094 --> 00:56:49,324
But I know you would want
to achieve having most all

1055
00:56:49,328 --> 00:56:52,958
Americans or all Americans with
the same health benefits because

1056
00:56:52,961 --> 00:56:54,191
that's so important.

1057
00:56:54,194 --> 00:56:58,664
And then, Mr. President, after
we start learning to agree with

1058
00:56:58,661 --> 00:57:01,931
each other, and it's not a
question of no but it's the

1059
00:57:01,928 --> 00:57:05,798
Congress working its will
for the good of people,

1060
00:57:05,795 --> 00:57:11,265
then we can work out -- and God
knows Mr. Camp and I have tried

1061
00:57:11,261 --> 00:57:15,431
desperately hard, and Jim
McCrery before him -- to realize

1062
00:57:15,428 --> 00:57:18,258
people aren't concerned
with the debate.

1063
00:57:18,261 --> 00:57:21,761
They're concerned with what
are we going to produce.

1064
00:57:21,761 --> 00:57:24,061
And I don't care
what your color is,

1065
00:57:24,061 --> 00:57:27,791
I don't care what your party is,
that if you're sick you're sick,

1066
00:57:27,795 --> 00:57:29,725
and you don't check
out the doctor.

1067
00:57:29,728 --> 00:57:32,758
And they're not going to check
out whether or not you're

1068
00:57:32,761 --> 00:57:34,491
Republican or Democrat.

1069
00:57:34,494 --> 00:57:40,494
So I just hope that we can
change this to a positive thing

1070
00:57:40,494 --> 00:57:44,894
where you can say let's leave
here at least talking about what

1071
00:57:44,895 --> 00:57:46,995
we agree on.

1072
00:57:46,994 --> 00:57:50,894
Let's stop knocking each other
as who's the smartest and who's

1073
00:57:50,895 --> 00:57:52,665
the most patriotic.

1074
00:57:52,661 --> 00:57:58,031
And let's really, then, confine
the public argument to where we disagree.

1075
00:57:58,027 --> 00:58:02,857
And rest assured, I can assure
you that they won't be concerned

1076
00:58:02,861 --> 00:58:04,531
with how big the bill was.

1077
00:58:04,528 --> 00:58:08,658
I have no clue as to how big
the Social Security bill was,

1078
00:58:08,661 --> 00:58:11,991
how large, how many pages
was in the Medicare bill.

1079
00:58:11,994 --> 00:58:15,364
And I don't really think that
someone sick in the emergency

1080
00:58:15,361 --> 00:58:19,831
room is concerned about the size
of the bill that we are trying

1081
00:58:19,828 --> 00:58:20,728
to help them with.

1082
00:58:20,728 --> 00:58:26,528
So I appreciate this.

1083
00:58:26,528 --> 00:58:28,728
The President:
John Dingell.

1084
00:58:28,728 --> 00:58:30,998
Representative Dingell:
Mr. President, thank you.

1085
00:58:30,994 --> 00:58:33,964
And God bless you for your
leadership in this matter.

1086
00:58:33,961 --> 00:58:39,431
The country desperately needs
you and desperately needs this legislation.

1087
00:58:39,428 --> 00:58:44,158
I saw the cartoon, two
people are sitting down,

1088
00:58:44,161 --> 00:58:47,091
and one of them
says, "Terrible news.

1089
00:58:47,094 --> 00:58:50,424
Our health care rates are
going to go up 40 percent."

1090
00:58:50,428 --> 00:58:52,058
The other guy
says, "Don't worry,

1091
00:58:52,061 --> 00:58:56,261
good news is you're not
concerned because you have

1092
00:58:56,261 --> 00:58:58,131
preexisting conditions."

1093
00:58:58,127 --> 00:58:58,957
(laughter)

1094
00:58:58,961 --> 00:59:01,361
This solves both
problems, the bill.

1095
00:59:01,361 --> 00:59:04,131
And Mr. President, again, we
desperately need your lead.

1096
00:59:04,127 --> 00:59:07,257
Now, having said that, when my
dad started out on this years

1097
00:59:07,261 --> 00:59:09,961
ago, Harry Truman said, you know
the reason people don't have

1098
00:59:09,961 --> 00:59:11,831
health care in this country?

1099
00:59:11,828 --> 00:59:13,528
They can't afford it.

1100
00:59:13,528 --> 00:59:15,028
And he was right.

1101
00:59:15,027 --> 00:59:17,397
And it's still the case today.

1102
00:59:17,394 --> 00:59:23,164
I saw this morning a statement
that was made with regard to

1103
00:59:23,161 --> 00:59:24,561
starting over.

1104
00:59:24,561 --> 00:59:27,361
This comes from a respected
Republican leader,

1105
00:59:27,361 --> 00:59:31,631
Governor Schwarzenegger of
California, February 23, 2010:

1106
00:59:31,628 --> 00:59:34,498
"I think any Republican
who says you should start from

1107
00:59:34,494 --> 00:59:39,664
scratch, I think that's bogus
talk and that's partisan talk."

1108
00:59:39,661 --> 00:59:43,631
I think we need to buckle down
and get to the business of

1109
00:59:43,628 --> 00:59:48,928
solving the biggest problem that
this country has coming down the

1110
00:59:48,928 --> 00:59:50,498
road at us.

1111
00:59:50,494 --> 00:59:54,764
In 2025, the cost of a family's
health insurance is going to

1112
00:59:54,761 --> 00:59:57,031
double -- $25,000.

1113
00:59:57,027 --> 00:59:58,697
I don't know anybody
who can afford that.

1114
00:59:58,695 --> 01:00:01,565
You can argue about Cadillac
plans and other nonsense.

1115
01:00:01,561 --> 01:00:03,161
That's not going
to be important.

1116
01:00:03,161 --> 01:00:08,391
And in 2080, the cost of all
of our health care is going to

1117
01:00:08,394 --> 01:00:11,124
equal the gross
domestic product.

1118
01:00:11,127 --> 01:00:13,797
It's a recipe for disaster.

1119
01:00:13,795 --> 01:00:16,625
We have much in common,
I want you to know,

1120
01:00:16,628 --> 01:00:18,998
and I hope and pray
you will take a look.

1121
01:00:18,994 --> 01:00:22,264
We cover young adults under
their parents' -- under their

1122
01:00:22,261 --> 01:00:23,691
parents' insurance.

1123
01:00:23,695 --> 01:00:25,765
That's a Republican offer.

1124
01:00:25,761 --> 01:00:30,391
We prohibit dropping insurance
coverage when the patient gets

1125
01:00:30,394 --> 01:00:34,224
sick, but we don't -- and
the Republicans do, too,

1126
01:00:34,227 --> 01:00:37,157
but they don't cover
preexisting conditions.

1127
01:00:37,161 --> 01:00:39,891
Both of us prohibit annual
and lifetime limits.

1128
01:00:39,895 --> 01:00:42,525
High-risk pools, we
have and they have.

1129
01:00:42,528 --> 01:00:45,298
But high-risk pools carry
with them some risk,

1130
01:00:45,294 --> 01:00:48,424
because it constitutes an
incentive for a race to the

1131
01:00:48,428 --> 01:00:53,198
bottom, whereby people will move
their insurance coverage to the

1132
01:00:53,194 --> 01:00:55,364
place where they have the
least regulation and the least

1133
01:00:55,361 --> 01:00:58,231
protection for the consumers.

1134
01:00:58,227 --> 01:01:02,857
And it also includes, and
amongst the other 14 items where

1135
01:01:02,861 --> 01:01:06,661
we're agreed on, is the
availability of health savings accounts.

1136
01:01:06,661 --> 01:01:11,491
There are a lot of other things
here that we have and we need.

1137
01:01:11,494 --> 01:01:15,864
I would say that I've seen some
of my friends who I knew before

1138
01:01:15,861 --> 01:01:17,461
they were virgins.

1139
01:01:17,461 --> 01:01:29,331
They were pushing, for example,
use of the extraordinary

1140
01:01:29,328 --> 01:01:37,558
budgetary mechanism, as to
get this decided by 51 votes.

1141
01:01:37,561 --> 01:01:41,491
Seems like a great idea,
if -- and I'm curious,

1142
01:01:41,494 --> 01:01:46,164
why in the name of common sense
are we being so fussy about

1143
01:01:46,161 --> 01:01:50,261
having the decisions in the
people's House and the people's

1144
01:01:50,261 --> 01:01:57,491
Senate decided on the basis of
a simply majority, 51 votes?

1145
01:01:57,494 --> 01:01:58,964
And if there's something
wrong with that,

1146
01:01:58,961 --> 01:02:01,961
I wish somebody would tell me
why we ought not give the people

1147
01:02:01,961 --> 01:02:05,661
that kind of representation.

1148
01:02:05,661 --> 01:02:10,791
I would note that also
mandatory coverage, mandates.

1149
01:02:10,795 --> 01:02:15,765
That was in a bill introduced
by my good friend Bill Thomas,

1150
01:02:15,761 --> 01:02:17,391
Chairman of the Ways
and Means Committee,

1151
01:02:17,394 --> 01:02:19,694
and 20 members of the U.S. Senate.

1152
01:02:19,695 --> 01:02:24,865
They said -- and they
were not fussy about that.

1153
01:02:24,861 --> 01:02:27,731
And I think we ought
to look to see,

1154
01:02:27,728 --> 01:02:31,598
here we have a chance
to serve the people.

1155
01:02:31,594 --> 01:02:35,124
I have people coming to my
office with tears in their eyes.

1156
01:02:35,127 --> 01:02:38,127
They can't get coverage.

1157
01:02:38,127 --> 01:02:40,457
They have preexisting
conditions.

1158
01:02:40,461 --> 01:02:44,131
A young dental surgeon I knew
couldn't get health care.

1159
01:02:44,127 --> 01:02:45,127
Why?

1160
01:02:45,127 --> 01:02:48,257
Because she had breast
cancer years before;

1161
01:02:48,261 --> 01:02:49,991
she couldn't get care.

1162
01:02:49,994 --> 01:02:53,424
And I've seen a lot of
other cases like that,

1163
01:02:53,428 --> 01:02:57,658
people who would have
drive-through pregnancies or

1164
01:02:57,661 --> 01:03:04,561
drive-through mastectomies, and
all manner of high-handed abuse

1165
01:03:04,561 --> 01:03:06,491
by the insurance companies.

1166
01:03:06,494 --> 01:03:11,594
I'm always surprised when I can
find somebody that's defending

1167
01:03:11,594 --> 01:03:14,824
the insurance companies after
the things that they do to the

1168
01:03:14,828 --> 01:03:17,258
ordinary people in this country.

1169
01:03:17,261 --> 01:03:20,661
They could cancel your insurance
policy while you're on the

1170
01:03:20,661 --> 01:03:23,191
gurney headed into
the operating room.

1171
01:03:23,194 --> 01:03:25,624
Somebody would -- if somebody
would explain that to me,

1172
01:03:25,628 --> 01:03:28,258
I would be deeply grateful.

1173
01:03:28,261 --> 01:03:31,031
But the fact of the matter is,
we have a chance to do something

1174
01:03:31,027 --> 01:03:34,497
that Dan Webster
one time observed.

1175
01:03:34,494 --> 01:03:39,924
I thought it was -- I thought it
was a very useful thing that he said.

1176
01:03:39,928 --> 01:03:41,828
And I think we
ought to -- he said,

1177
01:03:41,828 --> 01:03:48,358
"Let us see whether we also,
in our day and generation,

1178
01:03:48,361 --> 01:03:52,391
may not perform something
worthy to be remembered."

1179
01:03:52,394 --> 01:03:56,264
It's on -- Madam Speaker,
as you well know,

1180
01:03:56,261 --> 01:03:58,331
it's on the wall of the
House of Representatives.

1181
01:03:58,328 --> 01:04:01,128
It's there for us in the House,
and my colleagues in the Senate

1182
01:04:01,127 --> 01:04:05,197
will know it, those few who I
see again and serve with us will

1183
01:04:05,194 --> 01:04:07,124
recognize that as something.

1184
01:04:07,127 --> 01:04:09,497
We have before us a
hideous challenge.

1185
01:04:09,494 --> 01:04:14,364
The last perfect legislation
that was presented to mankind

1186
01:04:14,361 --> 01:04:20,331
was delivered to the Israelis
at the base of Mount Sinai.

1187
01:04:20,328 --> 01:04:23,928
It was on stone tablets
written in the fingers of God.

1188
01:04:23,928 --> 01:04:24,628
(laughter)

1189
01:04:24,628 --> 01:04:28,198
Nothing like that has been
presented to mankind since.

1190
01:04:28,194 --> 01:04:30,194
What we're going to
do is not perfect,

1191
01:04:30,194 --> 01:04:32,394
but it's sure going
to make it better,

1192
01:04:32,394 --> 01:04:36,524
and it's going to ease a huge
amount of pain and suffering at

1193
01:04:36,528 --> 01:04:40,098
a cost which we can afford,
which has been costed out by the

1194
01:04:40,094 --> 01:04:43,824
Office of Management and Budget
-- the Congressional Budget

1195
01:04:43,828 --> 01:04:46,858
Office, saying, it's
budget-neutral and in fact

1196
01:04:46,861 --> 01:04:48,191
reduces the budget.

1197
01:04:48,194 --> 01:04:52,694
I beg you, my friends, let us
go forward on this great task.

1198
01:04:52,695 --> 01:04:53,395
The President:
Thank you, John.

1199
01:04:53,394 --> 01:04:55,364
Representative Dingell:
Thank you, Mr. President.

1200
01:04:55,361 --> 01:04:57,961
The President:
Speaker Pelosi
wants to say a brief word.

1201
01:04:57,961 --> 01:04:59,661
John, do you want to
say anything in closing?

1202
01:04:59,661 --> 01:05:01,531
And then I will wrap up.

1203
01:05:01,528 --> 01:05:04,358
Nancy.

1204
01:05:04,361 --> 01:05:05,961
Speaker Pelosi:
Thank you very much,
Mr. President.

1205
01:05:05,961 --> 01:05:08,631
As one who has abided by
the three and a half minute,

1206
01:05:08,628 --> 01:05:12,458
I'm going to take a few seconds
more now in closing to extend

1207
01:05:12,461 --> 01:05:15,461
thanks to you, Mr. President,
for bringing us together,

1208
01:05:15,461 --> 01:05:18,161
for your great leadership,
and without it,

1209
01:05:18,161 --> 01:05:23,031
we would not be so very
close to affordability,

1210
01:05:23,027 --> 01:05:25,227
accountability for the
insurance companies,

1211
01:05:25,227 --> 01:05:28,227
and accessibility for so many
more Americans to improve their

1212
01:05:28,227 --> 01:05:31,197
health care, to
lower their cost.

1213
01:05:31,194 --> 01:05:33,964
Mr. President, I harken back
to that meeting a year ago.

1214
01:05:33,961 --> 01:05:37,391
At that time, Senator Grassley
said -- questioned you about the

1215
01:05:37,394 --> 01:05:39,094
public option.

1216
01:05:39,094 --> 01:05:43,024
And you said, "The public option
is one way to keep the insurance

1217
01:05:43,027 --> 01:05:45,957
companies honest and to
increase competition.

1218
01:05:45,961 --> 01:05:49,531
If you have a better way,
put it on the table."

1219
01:05:49,528 --> 01:05:54,198
Well, I bring that up because
we come such a long way.

1220
01:05:54,194 --> 01:05:56,264
We're talking about how
close we are on this,

1221
01:05:56,261 --> 01:05:58,261
how far apart we are here.

1222
01:05:58,261 --> 01:06:03,661
But as a representative of
the House of Representatives,

1223
01:06:03,661 --> 01:06:08,291
I want you to know that we were
there that day in support of a

1224
01:06:08,294 --> 01:06:13,994
public option, which
would save $120 billion,

1225
01:06:13,994 --> 01:06:15,894
keep the insurance
companies honest,

1226
01:06:15,895 --> 01:06:18,925
and increase competition.

1227
01:06:18,928 --> 01:06:22,298
We've come a long way to
agreeing to a Republican idea --

1228
01:06:22,294 --> 01:06:23,324
the exchanges.

1229
01:06:23,328 --> 01:06:26,228
Senator Enzi has been
a leader in that.

1230
01:06:26,227 --> 01:06:28,797
Senator Snowe, along
with Senator Durbin,

1231
01:06:28,795 --> 01:06:33,095
had legislation to that
effect -- bipartisan.

1232
01:06:33,094 --> 01:06:37,694
It caused the insurance
companies opposed the public option.

1233
01:06:37,695 --> 01:06:41,625
They couldn't take
the competition.

1234
01:06:41,628 --> 01:06:44,298
We have in our bill
market-oriented,

1235
01:06:44,294 --> 01:06:50,124
encouraging to the private
sector, initiatives.

1236
01:06:50,127 --> 01:06:53,997
I think the insurance industry,
left to its own devices,

1237
01:06:53,994 --> 01:06:57,394
has behaved shamefully.

1238
01:06:57,394 --> 01:07:00,964
And we must act on behalf
of the American people.

1239
01:07:00,961 --> 01:07:04,861
We have lived on their
playing field all this time.

1240
01:07:04,861 --> 01:07:08,091
It's time for the insurance
companies to exist on the

1241
01:07:08,094 --> 01:07:10,494
playing field of
the American people.

1242
01:07:10,494 --> 01:07:13,324
I believe I have news for
some of my colleagues,

1243
01:07:13,328 --> 01:07:16,158
because we have very
much more in common.

1244
01:07:16,161 --> 01:07:19,031
Senator Coburn, you had so
many positive suggestions,

1245
01:07:19,027 --> 01:07:23,697
which I didn't hear much
else of, but from you we did.

1246
01:07:23,695 --> 01:07:26,725
And I think you'd be pleased to
know that after much debate in

1247
01:07:26,728 --> 01:07:30,428
our House, we came up
with value not volume;

1248
01:07:30,428 --> 01:07:33,258
others have called it quality
not quantity in terms of

1249
01:07:33,261 --> 01:07:35,991
utilization, over-utilization.

1250
01:07:35,994 --> 01:07:38,694
Senator McCain, when
you talk about Florida,

1251
01:07:38,695 --> 01:07:42,395
we're talking about addressing
the regional disparities in

1252
01:07:42,394 --> 01:07:45,964
terms of compensation
and health care.

1253
01:07:45,961 --> 01:07:49,231
So we have addressed many
of these issues in the bill.

1254
01:07:49,227 --> 01:07:51,897
I think it's really
important to note, though,

1255
01:07:51,895 --> 01:07:55,765
and I want the record to show --
because two statements were made

1256
01:07:55,761 --> 01:07:59,591
here that are not factual in
relationship to these bills.

1257
01:07:59,594 --> 01:08:03,264
My colleague, Mr.
-- Leader Boehner,

1258
01:08:03,261 --> 01:08:06,261
the law of the land is there is
no public funding of abortion

1259
01:08:06,261 --> 01:08:09,191
and there is no public funding
of abortion in these bills.

1260
01:08:09,194 --> 01:08:12,424
And I don't want our listeners
or viewers to get the wrong

1261
01:08:12,428 --> 01:08:14,428
impression from what you said.

1262
01:08:14,428 --> 01:08:22,628
Mr. Camp -- Mr. Camp, you said
that the Medicare cuts in this

1263
01:08:22,628 --> 01:08:26,828
bill cut benefits for
seniors; they do not.

1264
01:08:26,828 --> 01:08:28,228
They do not.

1265
01:08:28,227 --> 01:08:31,257
So I want the record to show,
just in those two cases,

1266
01:08:31,261 --> 01:08:34,961
where we may have differences
of opinion and of approach and

1267
01:08:34,961 --> 01:08:37,861
evaluation of the value
of different things,

1268
01:08:37,861 --> 01:08:42,131
but certain things are facts
about our bills that I cannot

1269
01:08:42,127 --> 01:08:45,897
let the opposite view
stand when they are stated.

1270
01:08:45,895 --> 01:08:48,625
Yes, it's hard to do this.

1271
01:08:48,628 --> 01:08:51,358
The misrepresentation campaign
that has gone on about these

1272
01:08:51,361 --> 01:08:54,031
bills, it's a wonder
anybody would support them,

1273
01:08:54,027 --> 01:08:55,227
as Mr. Waxman said.

1274
01:08:55,227 --> 01:08:59,057
But the fact is this, the
President said many of these

1275
01:08:59,061 --> 01:09:02,391
provisions on their own are
largely supported by the

1276
01:09:02,394 --> 01:09:03,324
American people.

1277
01:09:03,328 --> 01:09:06,458
So this will take courage to do.

1278
01:09:06,461 --> 01:09:08,591
Social Security was hard.

1279
01:09:08,594 --> 01:09:10,294
Medicare was hard.

1280
01:09:10,294 --> 01:09:13,964
Health care reform for all
Americans -- insurance reform is hard.

1281
01:09:13,961 --> 01:09:15,691
But we will get it done.

1282
01:09:15,695 --> 01:09:18,025
And as we leave this debate
I think that many of the

1283
01:09:18,027 --> 01:09:21,497
differences that we have
are complicated and they're legitimate.

1284
01:09:21,494 --> 01:09:24,924
They're differences of opinion
about the role of government and the rest.

1285
01:09:24,928 --> 01:09:27,628
But I think it's really clear
in one point that the American

1286
01:09:27,628 --> 01:09:32,198
people understand very clearly,
they understand that there

1287
01:09:32,194 --> 01:09:36,164
should be an end to
discrimination on the basis of

1288
01:09:36,161 --> 01:09:38,531
preexisting conditions.

1289
01:09:38,528 --> 01:09:42,698
The proposals that we have put
forth end discrimination on the

1290
01:09:42,695 --> 01:09:47,925
basis of preexisting conditions;
the Republican bill does not.

1291
01:09:47,928 --> 01:09:50,458
With that, Mr. President,
I thank you again for the

1292
01:09:50,461 --> 01:09:54,861
opportunity to discuss the
differences and to try to find

1293
01:09:54,861 --> 01:09:56,691
some common ground on this.

1294
01:09:56,695 --> 01:10:00,265
The President:
Well, listen,
this has been hard work.

1295
01:10:00,261 --> 01:10:08,191
And I want to, first of all,
thank everybody for being here

1296
01:10:08,194 --> 01:10:12,494
and conducting themselves in
an extraordinarily civil tone.

1297
01:10:12,494 --> 01:10:15,224
And as I said, given the number
of folks that were around this

1298
01:10:15,227 --> 01:10:20,657
table, the fact that we're only
an hour late is -- beats my prediction.

1299
01:10:20,661 --> 01:10:23,191
(laughter)

1300
01:10:23,194 --> 01:10:30,164
Here's what I'd like to do --
and I'm going to take about 10 minutes.

1301
01:10:30,161 --> 01:10:32,331
I want to go through
where I think we agree,

1302
01:10:32,328 --> 01:10:34,958
and I want to summarize
where I think we disagree.

1303
01:10:34,961 --> 01:10:37,191
And then I'll address some of
the process issues that have

1304
01:10:37,194 --> 01:10:43,564
been brought up by a
number of the Republicans.

1305
01:10:43,561 --> 01:10:52,991
We agree that we need some
insurance market reforms.

1306
01:10:52,994 --> 01:10:58,464
We don't agree on all of them,
but we agree on some of them.

1307
01:10:58,461 --> 01:11:01,961
I think that if you look at the
ones that we don't agree on --

1308
01:11:01,961 --> 01:11:06,091
since there's been a lot of
reference to what the American

1309
01:11:06,094 --> 01:11:10,124
people want -- it turns out that
the ones that are not included

1310
01:11:10,127 --> 01:11:12,627
in the Republican
plans right now,

1311
01:11:12,628 --> 01:11:14,258
but are included in
the Democratic plans,

1312
01:11:14,261 --> 01:11:16,161
are actually very popular.

1313
01:11:16,161 --> 01:11:21,731
I know there's been a discussion
about whether government should

1314
01:11:21,728 --> 01:11:27,398
intrude in the insurance market,
but it turns out that on things

1315
01:11:27,394 --> 01:11:30,624
like capping
out-of-pocket expenses,

1316
01:11:30,628 --> 01:11:36,858
or making sure that people are
able to purchase insurance even

1317
01:11:36,861 --> 01:11:39,131
if they've got a
preexisting condition,

1318
01:11:39,127 --> 01:11:45,597
overwhelmingly people say the
insurance market should be regulated.

1319
01:11:45,594 --> 01:11:53,124
And so one thing that I'd ask
from my Republican friends is to

1320
01:11:53,127 --> 01:11:57,557
look at the list of insurance
reforms and make sure that those

1321
01:11:57,561 --> 01:12:00,861
that you have not included in
your plans right now are ones in

1322
01:12:00,861 --> 01:12:07,161
fact that you don't think the
American people should get.

1323
01:12:07,161 --> 01:12:10,231
Because I strongly believe
in these insurance reforms.

1324
01:12:10,227 --> 01:12:14,927
I've talked to too many families
who have health insurance and

1325
01:12:14,928 --> 01:12:19,798
find out that what they have
does not provide them with the

1326
01:12:19,795 --> 01:12:23,495
coverage they needed and
they end up being bankrupt,

1327
01:12:23,494 --> 01:12:28,094
or they end up going without
care, or they get care too late,

1328
01:12:28,094 --> 01:12:34,364
as was the case in the story
that Patty Murray mentioned.

1329
01:12:34,361 --> 01:12:37,431
The second thing I think we
agree on is the idea that

1330
01:12:37,428 --> 01:12:44,398
allowing small businesses and
individuals who are right now

1331
01:12:44,394 --> 01:12:50,624
trapped in the individual market
and as a consequence have to buy

1332
01:12:50,628 --> 01:12:54,228
very expensive insurance and
effectively oftentimes just go

1333
01:12:54,227 --> 01:12:57,697
without insurance could be
solved if we allowed them to do

1334
01:12:57,695 --> 01:13:04,965
what members of Congress do,
which is be part of a large group.

1335
01:13:04,961 --> 01:13:08,931
Again, the idea of an exchange
is not a government takeover;

1336
01:13:08,928 --> 01:13:12,998
it is how the market works,
which is if you have a lot of

1337
01:13:12,994 --> 01:13:14,824
purchasing power you
get a better deal.

1338
01:13:14,828 --> 01:13:17,158
That's how Walmart
drives its prices down,

1339
01:13:17,161 --> 01:13:20,791
because everybody who wants to
supply Walmart -- Walmart tells

1340
01:13:20,795 --> 01:13:24,765
them, you give me the
best deal possible.

1341
01:13:24,761 --> 01:13:28,431
And as a consequence, the
supplier gives them a much

1342
01:13:28,428 --> 01:13:31,898
better deal than they do the
mom-and-pop shop on the corner.

1343
01:13:31,895 --> 01:13:35,895
Well, we should be able to give
small businesses and individuals

1344
01:13:35,895 --> 01:13:39,825
who are self-employed, who
aren't able to get insurance

1345
01:13:39,828 --> 01:13:44,098
through a large employer,
to have that same deal.

1346
01:13:44,094 --> 01:13:47,264
It sounds like we've got some
philosophical difference as to

1347
01:13:47,261 --> 01:13:50,991
whether there should be some
minimum benefits in that

1348
01:13:50,994 --> 01:13:54,364
exchange, some
baseline of coverage.

1349
01:13:54,361 --> 01:13:59,261
Again, there's a baseline
of coverage for members of Congress.

1350
01:13:59,261 --> 01:14:01,961
And the reason we set that up
is because we want to make sure

1351
01:14:01,961 --> 01:14:06,891
that any federal employee who is
part of this big pool is getting

1352
01:14:06,895 --> 01:14:11,065
good, quality coverage
-- not perfect coverage,

1353
01:14:11,061 --> 01:14:15,591
not gold-plated coverage,
but adequate coverage.

1354
01:14:15,594 --> 01:14:18,494
It may be -- and I'd ask my
Republican colleagues to look

1355
01:14:18,494 --> 01:14:24,324
and see, is that an area
that can be resolved.

1356
01:14:24,328 --> 01:14:26,298
There has been a lot of
discussion and one of the main

1357
01:14:26,294 --> 01:14:28,924
tools the Republicans have
offered to drive down costs is

1358
01:14:28,928 --> 01:14:32,998
purchasing insurance
across state lines.

1359
01:14:32,994 --> 01:14:37,094
This is an idea that is embodied
in the House and Senate bill,

1360
01:14:37,094 --> 01:14:40,694
but, again, the details differ.

1361
01:14:40,695 --> 01:14:45,225
The approach that John Boehner
and some of the Republicans

1362
01:14:45,227 --> 01:14:49,627
appear to take is to say,
let's just open things up;

1363
01:14:49,628 --> 01:14:53,358
anybody can buy anything
anywhere regardless of what

1364
01:14:53,361 --> 01:15:00,631
state insurance laws are, and
that will drive competition and cost.

1365
01:15:00,628 --> 01:15:08,628
The philosophical concern I have
on that is that you potentially

1366
01:15:08,628 --> 01:15:10,998
get what's been referred
to as a race to the bottom.

1367
01:15:10,994 --> 01:15:15,164
And for people who may not be
following the intricacies of the

1368
01:15:15,161 --> 01:15:18,161
insurance market, let me give an
example that people understand,

1369
01:15:18,161 --> 01:15:20,991
and that's credit cards.

1370
01:15:20,994 --> 01:15:25,524
In the credit card market, part
of what happened was we ended up

1371
01:15:25,528 --> 01:15:30,698
allowing people to get credit
cards from every other --

1372
01:15:30,695 --> 01:15:33,995
whatever state, and there were
a few states that decided,

1373
01:15:33,994 --> 01:15:36,764
you know what, we're going to
have the least restrictions on

1374
01:15:36,761 --> 01:15:40,491
credit card companies
that we could have.

1375
01:15:40,494 --> 01:15:43,794
And what ended up happening was
that every single credit card

1376
01:15:43,795 --> 01:15:46,965
company suddenly lo and behold
started locating in that state

1377
01:15:46,961 --> 01:15:49,391
which had the absolute worst
regulations in consumer

1378
01:15:49,394 --> 01:15:56,694
protections, and all these fees
and practices that people don't

1379
01:15:56,695 --> 01:16:00,125
like, folks weren't happy about.

1380
01:16:00,127 --> 01:16:03,327
So the question I'm
going to have is,

1381
01:16:03,328 --> 01:16:11,828
is there a way for us to deal
with the interstate purchase of

1382
01:16:11,828 --> 01:16:14,498
health insurance, but in a
way that provides, again,

1383
01:16:14,494 --> 01:16:18,864
some baseline protections,
because what we don't want is a

1384
01:16:18,861 --> 01:16:19,961
race to the bottom.

1385
01:16:19,961 --> 01:16:27,031
We want everybody to have the
basic protections that make sense.

1386
01:16:27,027 --> 01:16:28,897
And that's not a big
government takeover.

1387
01:16:28,895 --> 01:16:34,895
That is a standard thing that we
do in almost every area of life.

1388
01:16:34,895 --> 01:16:37,765
We protect people with respect
to the food that they buy,

1389
01:16:37,761 --> 01:16:41,191
with respect to the
drugs that they purchase.

1390
01:16:41,194 --> 01:16:43,964
We license and regulate the
medical profession because we

1391
01:16:43,961 --> 01:16:47,091
don't think anybody should just
be able to cut somebody open.

1392
01:16:47,094 --> 01:16:49,964
We want somebody like Tom or
John to actually know what

1393
01:16:49,961 --> 01:16:54,791
they're doing before they
start practicing medicine.

1394
01:16:54,795 --> 01:17:01,065
And the same should apply when
it comes to how we think about insurance.

1395
01:17:01,061 --> 01:17:04,031
Medical malpractice
has been mentioned.

1396
01:17:04,027 --> 01:17:05,997
Now, look, let me be honest.

1397
01:17:05,994 --> 01:17:09,064
This is something historically
that Democrats have been more

1398
01:17:09,061 --> 01:17:10,961
resistant to than Republicans.

1399
01:17:10,961 --> 01:17:15,561
I will note that when we had
a Republican President and

1400
01:17:15,561 --> 01:17:17,791
Republican control of the House
and Republican control of the

1401
01:17:17,795 --> 01:17:23,065
Senate, somehow it didn't
happen, and I'm surprised, but we --

1402
01:17:23,061 --> 01:17:24,931
Senator Alexander:
We needed 60 votes in the Senate, too,

1403
01:17:24,928 --> 01:17:26,298
Mr. President.

1404
01:17:26,294 --> 01:17:27,724
(laughter)

1405
01:17:27,728 --> 01:17:28,558
The President:
See there?

1406
01:17:28,561 --> 01:17:37,091
So as a consequence, what I have
suggested is that we explore

1407
01:17:37,094 --> 01:17:39,694
building on what we've already
done administratively without

1408
01:17:39,695 --> 01:17:46,265
law, asking Kathleen to help
states come up with new ideas.

1409
01:17:46,261 --> 01:17:48,461
I've suggested, well,
let's take a look at Tom,

1410
01:17:48,461 --> 01:17:52,491
the suggestion you had, that
gives states even more incentive

1411
01:17:52,494 --> 01:17:54,764
to start thinking about
reducing defensive medicine.

1412
01:17:54,761 --> 01:17:58,391
I have to tell you, Joe Barton,
that how you got from $5 billion

1413
01:17:58,394 --> 01:18:01,794
to $150 billion, I didn't
quite follow the math.

1414
01:18:01,795 --> 01:18:06,425
It sounded -- I'm not sure you
did, either, but it's okay.

1415
01:18:06,428 --> 01:18:12,428
But here's my commitment, is
that if folks were serious about

1416
01:18:12,428 --> 01:18:16,498
getting this done, I'd be
interested in seeing if we could

1417
01:18:16,494 --> 01:18:17,664
work on something.

1418
01:18:17,661 --> 01:18:22,591
Now, I actually agree with Dick
Durbin with respect to hard caps

1419
01:18:22,594 --> 01:18:25,394
because of the story that he
told about the woman who burned her face.

1420
01:18:25,394 --> 01:18:28,464
I think there are situations in
which there is actually a very

1421
01:18:28,461 --> 01:18:31,731
severe problem, and I would
distinguish that between some of

1422
01:18:31,728 --> 01:18:35,958
the frivolous lawsuits that are
out there that really do create

1423
01:18:35,961 --> 01:18:40,461
a defensive medical problem, and
OBGYNs are the ones who get hit

1424
01:18:40,461 --> 01:18:45,291
the hardest because people are
so sympathetic when a child is

1425
01:18:45,294 --> 01:18:48,694
born with severe disabilities,
and they can just be crippling

1426
01:18:48,695 --> 01:18:49,725
on OBGYNs.

1427
01:18:49,728 --> 01:18:52,758
The same is true for
neurologists and so forth.

1428
01:18:52,761 --> 01:18:56,461
So there may be some ways
that we can work on that.

1429
01:18:56,461 --> 01:19:03,731
Now, I guess what I'm saying
is I've put forward then very

1430
01:19:03,728 --> 01:19:08,898
substantial ideas that are
embraced by Republicans.

1431
01:19:08,895 --> 01:19:11,525
Peter, they're not -- I forget
what metaphor you used about --

1432
01:19:11,528 --> 01:19:13,528
before you popped
it in the microwave,

1433
01:19:13,528 --> 01:19:16,458
whether it was bacon bits or
sprinkles or -- breadcrumbs,

1434
01:19:16,461 --> 01:19:23,591
that was what it was.

1435
01:19:23,594 --> 01:19:26,794
When it comes to the exchange,
that is a market-based approach,

1436
01:19:26,795 --> 01:19:29,795
it's not a
government-run approach.

1437
01:19:29,795 --> 01:19:31,665
There were criticisms
about the public option;

1438
01:19:31,661 --> 01:19:34,461
that's when supposedly there
was going to be a government

1439
01:19:34,461 --> 01:19:39,131
takeover of health care, and
even after the public option

1440
01:19:39,127 --> 01:19:42,797
wasn't available, we still
hear the same rhetoric.

1441
01:19:42,795 --> 01:19:46,995
And it turns out that what we're
now referring to is we have an

1442
01:19:46,994 --> 01:19:52,024
argument about how much we
should regulate the insurance industry.

1443
01:19:52,027 --> 01:19:53,827
We have a concept
of an exchange,

1444
01:19:53,828 --> 01:19:57,428
which previously has been
an idea that was embraced by

1445
01:19:57,428 --> 01:19:59,298
Republicans before
I embraced it,

1446
01:19:59,294 --> 01:20:07,324
and somehow suddenly it
became less of a good idea.

1447
01:20:07,328 --> 01:20:12,698
With respect to the
most contentious issue,

1448
01:20:12,695 --> 01:20:14,295
I'm not sure we
can bridge the gap,

1449
01:20:14,294 --> 01:20:16,524
and that's what we're going to
have to explore and that's the

1450
01:20:16,528 --> 01:20:21,758
issue of how do we provide
coverage not only for people who

1451
01:20:21,761 --> 01:20:25,361
don't have health insurance
right now but also for people

1452
01:20:25,361 --> 01:20:29,261
who have preexisting conditions
and are being priced out of the

1453
01:20:29,261 --> 01:20:33,131
market, or potentially lose
their jobs and will find

1454
01:20:33,127 --> 01:20:36,327
themselves in a situation
where they don't get coverage.

1455
01:20:36,328 --> 01:20:38,928
An interesting thing happened
a couple of weeks ago,

1456
01:20:38,928 --> 01:20:43,658
and that is a report came out
that for the first time it turns

1457
01:20:43,661 --> 01:20:45,591
out that more Americans are
now getting their health care

1458
01:20:45,594 --> 01:20:49,124
coverage from government than
those that are getting it from

1459
01:20:49,127 --> 01:20:50,927
the private sector.

1460
01:20:50,928 --> 01:20:53,198
And you know what, that's
without a bill from the

1461
01:20:53,194 --> 01:20:55,494
Democrats or from
President Obama.

1462
01:20:55,494 --> 01:20:59,164
Has nothing to do
with "Obamacare."

1463
01:20:59,161 --> 01:21:04,061
It has to do with the fact that
employers are shedding employees

1464
01:21:04,061 --> 01:21:06,031
from health care plans.

1465
01:21:06,027 --> 01:21:08,857
And more and more,
folks, if they can,

1466
01:21:08,861 --> 01:21:11,761
are trying to get into the
Social Security system and the

1467
01:21:11,761 --> 01:21:14,361
Medicare system earlier through
disability or what have you,

1468
01:21:14,361 --> 01:21:19,461
so that they can get some help.

1469
01:21:19,461 --> 01:21:23,361
The point that Tom Harkin made,
the point that Chris Dodd made,

1470
01:21:23,361 --> 01:21:26,961
the point that Henry made, and
a number of other people made,

1471
01:21:26,961 --> 01:21:29,161
I think is very
important to understand.

1472
01:21:29,161 --> 01:21:33,831
I did not propose and I don't
think any of the Democrats

1473
01:21:33,828 --> 01:21:39,058
proposed something complicated
just for the sake of being complicated.

1474
01:21:39,061 --> 01:21:41,191
We'd love to have
a five-page bill.

1475
01:21:41,194 --> 01:21:43,594
It would save an
awful lot of work.

1476
01:21:43,594 --> 01:21:47,424
The reason we didn't do it is
because it turns out that baby

1477
01:21:47,428 --> 01:21:55,028
steps don't get you to the
place where people need to go.

1478
01:21:55,027 --> 01:21:57,627
They need help right now.

1479
01:21:57,628 --> 01:22:01,128
And so a step-by-step approach
sounds good in theory,

1480
01:22:01,127 --> 01:22:04,357
but the problem is, for example,
we can't solve the preexisting

1481
01:22:04,361 --> 01:22:07,561
condition problem if we don't
do something about coverage.

1482
01:22:07,561 --> 01:22:12,961
Now, it is absolutely true --
and I think this is important to

1483
01:22:12,961 --> 01:22:16,131
get on the table, because we
dance around this sometime -- in

1484
01:22:16,127 --> 01:22:24,697
order to help the 30 million,
that's going to cost some money.

1485
01:22:24,695 --> 01:22:28,995
And the primary way we do it
is to say that, for example,

1486
01:22:28,994 --> 01:22:32,824
people who currently get all
their income in capital gains

1487
01:22:32,828 --> 01:22:37,358
and dividends, they
don't pay a Medicare tax,

1488
01:22:37,361 --> 01:22:41,661
even though the guy who cleans
the building for them does on

1489
01:22:41,661 --> 01:22:45,961
his salary or his wages.

1490
01:22:45,961 --> 01:22:49,231
And so what we say is, if
you make more than $250,000

1491
01:22:49,227 --> 01:22:53,457
a year if you're a family
and your income is from those

1492
01:22:53,461 --> 01:22:59,031
sources, then you should do --
you should have to do the same

1493
01:22:59,027 --> 01:23:02,397
thing that everybody
else has to do.

1494
01:23:02,394 --> 01:23:09,124
Somebody mentioned the fact that
we say to small businesses -- I

1495
01:23:09,127 --> 01:23:12,757
think Jon Kyl, you said,
we're taxing small businesses.

1496
01:23:12,761 --> 01:23:18,361
Look, we exempt 95 percent
of small businesses from any

1497
01:23:18,361 --> 01:23:20,761
obligations whatsoever because
we understand that small

1498
01:23:20,761 --> 01:23:23,391
businesses generally have a
tough time enough -- they don't

1499
01:23:23,394 --> 01:23:26,824
need any more government burden.

1500
01:23:26,828 --> 01:23:30,698
What we do say is, if you
can afford to provide health

1501
01:23:30,695 --> 01:23:34,395
insurance, you have
more than 50 employees,

1502
01:23:34,394 --> 01:23:39,424
meaning you're in the top
4 percent of businesses,

1503
01:23:39,428 --> 01:23:42,058
and you're not providing
coverage and you're forcing

1504
01:23:42,061 --> 01:23:45,531
other businesses or other
individuals to pick up the tab

1505
01:23:45,528 --> 01:23:47,428
because your employees are
either going to the Medicaid

1506
01:23:47,428 --> 01:23:51,458
system or they're going to the
emergency room -- we don't think that's fair.

1507
01:23:51,461 --> 01:23:54,991
So we say, you've
got to pony up some.

1508
01:23:54,994 --> 01:23:56,424
It's not an employer mandate.

1509
01:23:56,428 --> 01:24:00,458
It just says you've got
to pay your fair share,

1510
01:24:00,461 --> 01:24:03,791
because otherwise all of
us have to pick up the tab.

1511
01:24:03,795 --> 01:24:08,195
And that, by the way,
contributes to the overall

1512
01:24:08,194 --> 01:24:13,494
deficit that
Medicaid is running.

1513
01:24:13,494 --> 01:24:18,224
In fact, most small businesses
through this program get huge

1514
01:24:18,227 --> 01:24:21,457
subsidies by becoming
members of the exchange.

1515
01:24:21,461 --> 01:24:23,791
That's where the money is going.

1516
01:24:23,795 --> 01:24:27,595
The money is not going to some
big welfare program -- the money

1517
01:24:27,594 --> 01:24:30,164
is going to give tax
credits to small businesses,

1518
01:24:30,161 --> 01:24:32,361
tax credits to those
who are self-employed,

1519
01:24:32,361 --> 01:24:34,331
to buy into this pool.

1520
01:24:34,328 --> 01:24:36,128
And that's not a
radical proposition;

1521
01:24:36,127 --> 01:24:41,327
it's consistent with the idea
of a market-based approach.

1522
01:24:41,328 --> 01:24:44,698
And finally, with respect
to bending the cost curve,

1523
01:24:44,695 --> 01:24:46,395
we actually have a
lot of agreement here.

1524
01:24:46,394 --> 01:24:50,424
This is an area where if I sat
down with Tom Coburn I suspect

1525
01:24:50,428 --> 01:24:54,158
we could agree on 95 percent of
the things that have to be done.

1526
01:24:54,161 --> 01:24:56,991
Because the things you talk
about in terms of -- and I wrote

1527
01:24:56,994 --> 01:25:02,394
some of them down -- in terms
of reducing medical errors,

1528
01:25:02,394 --> 01:25:06,164
in terms of incentivizing
doctors to coordinate better and

1529
01:25:06,161 --> 01:25:11,461
work in groups better, in
terms of price transparency,

1530
01:25:11,461 --> 01:25:15,361
improving prevention -- those
are all things that not only do

1531
01:25:15,361 --> 01:25:20,131
I embrace but we've included
every single one of those ideas

1532
01:25:20,127 --> 01:25:24,227
in these bills.

1533
01:25:24,227 --> 01:25:28,627
Now, the irony is that that's
part of where we got attacked

1534
01:25:28,628 --> 01:25:33,728
for a "government takeover"
because what happened was when

1535
01:25:33,728 --> 01:25:40,028
we set up the idea of a MedPAC,
which is basically a panel of

1536
01:25:40,027 --> 01:25:45,597
doctors and health care experts
who would recommend ways to make

1537
01:25:45,594 --> 01:25:48,564
the delivery system better so
that we can squeeze out that

1538
01:25:48,561 --> 01:25:52,461
one-third in Medicare and
Medicaid that's wasted -- a

1539
01:25:52,461 --> 01:25:59,461
Republican idea -- that was part
of the ammunition you all used

1540
01:25:59,461 --> 01:26:06,061
to say that the government is
going to take away your health care.

1541
01:26:06,061 --> 01:26:09,291
So if we're serious about
delivery system reform,

1542
01:26:09,294 --> 01:26:11,924
if we're serious about squeezing
out the waste that Tom Coburn

1543
01:26:11,928 --> 01:26:18,298
referred to, you should embrace
those mechanisms that are in this bill.

1544
01:26:18,294 --> 01:26:27,564
I will end by saying this.

1545
01:26:27,561 --> 01:26:36,631
I suspect that if the Democrats
and the administration were

1546
01:26:36,628 --> 01:26:43,628
willing to start over and then
adopt John Boehner's bill,

1547
01:26:43,628 --> 01:26:50,458
we'd get a whole bunch
of Republican votes.

1548
01:26:50,461 --> 01:26:54,431
And I don't know how many
Democratic votes we'd get,

1549
01:26:54,428 --> 01:26:57,798
but we'd get a whole
bunch of Republican votes.

1550
01:26:57,795 --> 01:27:02,765
The concern I think that
a lot of the colleagues,

1551
01:27:02,761 --> 01:27:04,731
both in the House
and the Senate,

1552
01:27:04,728 --> 01:27:08,628
on the Democratic side have, is
that after a year and a half --

1553
01:27:08,628 --> 01:27:15,498
or more appropriately after five
decades -- of dealing with this

1554
01:27:15,494 --> 01:27:24,424
issue, starting over they
suspect means not doing much or

1555
01:27:24,428 --> 01:27:30,128
doing the proposal that John
Boehner or other Republicans

1556
01:27:30,127 --> 01:27:36,897
find acceptable; and that it's
not possible for our Republican

1557
01:27:36,895 --> 01:27:41,665
colleagues to move in the
direction of, for example,

1558
01:27:41,661 --> 01:27:44,791
covering more than
3 million people;

1559
01:27:44,795 --> 01:27:51,395
it's not possible to move more
robustly in the direction of

1560
01:27:51,394 --> 01:27:54,564
dealing with the preexisting
condition issue in a realistic

1561
01:27:54,561 --> 01:27:58,931
way; it's not possible to make
sure that we get people out of a

1562
01:27:58,928 --> 01:28:02,728
high-risk pool and get them
into a situation where,

1563
01:28:02,728 --> 01:28:07,258
as Tom Harkin put it,
healthy people, young people,

1564
01:28:07,261 --> 01:28:10,261
rich people, poor
people, old people,

1565
01:28:10,261 --> 01:28:15,091
sick people -- everybody is
part of a system that works.

1566
01:28:15,094 --> 01:28:17,394
That I think is the concern.

1567
01:28:17,394 --> 01:28:22,494
Having said that, what I'd like
to propose is that I've put on

1568
01:28:22,494 --> 01:28:26,564
the table now some things that
I didn't come in here saying I

1569
01:28:26,561 --> 01:28:32,231
supported, but that I was
willing to work with potential

1570
01:28:32,227 --> 01:28:35,397
Republican sponsors on.

1571
01:28:35,394 --> 01:28:38,064
I'd like the Republicans to do
a little soul searching and find

1572
01:28:38,061 --> 01:28:44,731
out are there some things that
you'd be willing to embrace that

1573
01:28:44,728 --> 01:28:48,158
get to this core problem of 30
million people without health

1574
01:28:48,161 --> 01:28:55,761
insurance and dealing seriously
with the preexisting condition issue.

1575
01:28:55,761 --> 01:29:00,661
I don't know, frankly,
whether we can close that gap.

1576
01:29:00,661 --> 01:29:04,791
And if we can't close that gap,
then I suspect Mitch McConnell

1577
01:29:04,795 --> 01:29:07,065
and Harry Reid, Nancy
Pelosi and John Boehner,

1578
01:29:07,061 --> 01:29:10,331
are going to have a lot of
arguments about procedures in

1579
01:29:10,328 --> 01:29:15,258
Congress about moving forward.

1580
01:29:15,261 --> 01:29:20,661
I will tell you this, that
when I talk to the parents of

1581
01:29:20,661 --> 01:29:26,361
children who don't have health
care because they've got

1582
01:29:26,361 --> 01:29:31,391
diabetes or they've got
some chronic heart disease,

1583
01:29:31,394 --> 01:29:33,364
when I talk to small
businesspeople who are laying

1584
01:29:33,361 --> 01:29:38,931
people off because they just
got their insurance premium,

1585
01:29:38,928 --> 01:29:41,428
they don't want us to wait.

1586
01:29:41,428 --> 01:29:45,658
They can't afford
another five decades.

1587
01:29:45,661 --> 01:29:51,831
And the truth of the matter is,
is that, politically speaking,

1588
01:29:51,828 --> 01:29:55,898
there may not be any reason
for Republicans to want to do anything.

1589
01:29:55,895 --> 01:29:59,665
I mean, we can debate what our
various constituencies think.

1590
01:29:59,661 --> 01:30:05,291
I know that -- I don't need
a poll to know that most of

1591
01:30:05,294 --> 01:30:11,194
Republican voters are opposed to
this bill and might be opposed

1592
01:30:11,194 --> 01:30:14,464
to the kind of compromise
we could craft.

1593
01:30:14,461 --> 01:30:19,731
So it would be very hard for
you politically to do this.

1594
01:30:19,728 --> 01:30:24,398
But I thought it was worthwhile
for us to make this effort.

1595
01:30:24,394 --> 01:30:25,994
We've got a lot of
other things to do.

1596
01:30:25,994 --> 01:30:28,694
I don't think, Tom, that we're
going to have another one of

1597
01:30:28,695 --> 01:30:33,795
these because people
don't have seven,

1598
01:30:33,795 --> 01:30:36,195
eight hours a day to work
some of these things through.

1599
01:30:36,194 --> 01:30:43,064
What I do know is this: If we
saw movement -- significant

1600
01:30:43,061 --> 01:30:51,361
movement, not just gestures --
then you wouldn't need to start

1601
01:30:51,361 --> 01:30:57,461
over because essentially
everybody here knows what the issues are.

1602
01:30:57,461 --> 01:31:02,931
And procedurally, it could
get done fairly quickly.

1603
01:31:02,928 --> 01:31:06,428
We cannot have another
year-long debate about this.

1604
01:31:06,428 --> 01:31:11,558
So the question that I'm going
to ask myself and I ask of all

1605
01:31:11,561 --> 01:31:18,161
of you is, is there enough
serious effort that in a month's

1606
01:31:18,161 --> 01:31:24,291
time or a few weeks'
time or six weeks' time,

1607
01:31:24,294 --> 01:31:26,264
we could actually
resolve something.

1608
01:31:26,261 --> 01:31:28,831
And if we can't, then I think
we've got to go ahead and make

1609
01:31:28,828 --> 01:31:31,498
some decisions and then
that's what elections are for.

1610
01:31:31,494 --> 01:31:34,924
We have honest disagreements
about the vision for the country

1611
01:31:34,928 --> 01:31:39,298
and we'll go ahead and test
those out over the next several

1612
01:31:39,294 --> 01:31:40,624
months till November.

1613
01:31:40,628 --> 01:31:41,358
All right?

1614
01:31:41,361 --> 01:31:43,961
But I very much appreciate
everybody being here.

1615
01:31:43,961 --> 01:31:47,091
Thank you for being
so thoughtful.

1616
01:31:47,094 --> 01:31:53,364
And hopefully we'll all keep our
constituents in mind as we move forward.

1617
01:31:53,361 --> 01:31:54,631
Thank you, everybody.

1618
01:31:54,628 --> 01:31:57,328
(applause)