| 00:02:3010 sec. |
Obama, Barack - President
Good morning, everybody. Welcome. Thank you so much for participating today. I am very grateful to all of you because I know how busy you are. |
| 00:02:4013 sec. |
Obama, Barack - President
What I want to do is just make a few brief remarks on the front end, and then we're going to allow leadership from the both the House and the Senate... |
| 00:02:5358 sec. |
Obama, Barack - President
Last year obviously was one of the toughest years we've had on record, and all of us in one way or another were devoted to focusing on breaking the... |
| 00:03:511 min. |
Obama, Barack - President
I have said repeatedly -- I said at the State of the Union, I said last night when I was meeting with the Business Roundtable -- that in addition to... |
| 00:04:5245 sec. |
Obama, Barack - President
Some of you know that I get 10 letters, out of the 40,000 that I receive every day, for me to take upstairs to the residence and read every single night.... |
| 00:05:3735 sec. |
Obama, Barack - President
I hear from small businesses who have just opened up their new rates from their insurance company and it turns out that the rates have gone up 20, 30,... |
| 00:06:1244 sec. |
Obama, Barack - President
So this is an issue that is affecting everybody. It's affecting not only those without insurance, but it's affecting those with insurance. And when... |
| 00:06:5617 sec. |
Obama, Barack - President
In the individual markets, it's even worse. Businesses are having to make decisions about just dropping coverage altogether for their employees. If... |
| 00:07:1337 sec. |
Obama, Barack - President
And I don't need to tell people here about the effects on the federal budget. We've got some people who've been working a very long time on figuring... |
| 00:07:501 min. |
Obama, Barack - President
Now, I'm telling all of you things you already know. Maybe more personally I should just mention the fact that I now have about as good health care... |
| 00:08:5743 sec. |
Obama, Barack - President
My mother, who was self-employed, didn't have reliable health care, and she died of ovarian cancer. And there's probably nothing that modern medicine... |
| 00:09:4020 sec. |
Obama, Barack - President
Now, everybody here has those same stories somewhere in their lives. Everybody here understands the desperation that people feel when they're sick.... |
| 00:10:0056 sec. |
Obama, Barack - President
You know, I was looking through some of the past statements that people have made, and I think this concern is bipartisan. John McCain has talked about... |
| 00:10:5639 sec. |
Obama, Barack - President
So here's the bottom line. We all know this is urgent. And unfortunately over the course of the year, despite all the hearings that took place and... |
| 00:11:3533 sec. |
Obama, Barack - President
I said at the State of the Union, and I'll repeat, I didn't take this on because I thought it was good politics. This is such a complicated issue that... |
| 00:12:0830 sec. |
Obama, Barack - President
I've looked very carefully at John Boehner's plan that he put forward. I've looked at Tom Coburn and Senator Burr's plan that's been put out there.... |
| 00:12:3829 sec. |
Obama, Barack - President
And so when I look at the ideas that are out there, there is overlap. It's not perfect overlap, it's not a hundred percent overlap, but there's some... |
| 00:13:0740 sec. |
Obama, Barack - President
The basic concept is that we would set up an exchange, meaning a place where individuals and small businesses could go and get choice and competition... |
| 00:13:4721 sec. |
Obama, Barack - President
We think it is a plan that works with the existing system, the employer-based system, the private health care system, but allows a lot of people who... |
| 00:14:0824 sec. |
Obama, Barack - President
We also have some insurance reforms in there that, for example, prohibit people who have preexisting conditions from being banned from getting coverage.... |
| 00:14:3255 sec. |
Obama, Barack - President
In each of these cases there are corresponding ideas on the Republican side that we should be able to bridge. So I promise not to make a long speech.... |
| 00:15:2717 sec. |
Obama, Barack - President
I don't know that those gaps can be bridged. And it may be that at the end of the day we come out of here and everybody says, well, you know, we have... |
| 00:15:4425 sec. |
Obama, Barack - President
But I'd like to make sure that this discussion is actually a discussion and not just us trading talking points. I hope that this isn't political theater... |
| 00:16:0939 sec. |
Obama, Barack - President
That's what the American people are looking for. As controversial as the efforts to reform health care have been thus far, when you ask people, should... |
| 00:16:4825 sec. |
Obama, Barack - President
So, with that, I just want to say again how much I appreciate everybody for participating. And I am going to now turn it over to Senator McConnell... |
| 00:17:1313 sec. |
McConnell, Mitch Jr. - U.S. Senator, [R] Kentucky
Thank you very much, Mr. President. John Boehner and I have selected Lamar Alexander of Tennessee to make our opening framing statement, and let me... |
| 00:17:2616 sec. |
Alexander, Lamar - U.S. Senator, [R] Tennessee
Thanks, Mitch and John. Mr. President, thank you very much for the invitation. Appreciate being here. Several of us were part of the summits that... |
| 00:17:4228 sec. |
Alexander, Lamar - U.S. Senator, [R] Tennessee
As a former governor, I also want to try to represent governors' views. They have a big stake in it. I know you met with some governors just the last... |
| 00:18:1028 sec. |
Alexander, Lamar - U.S. Senator, [R] Tennessee
And more importantly, we want to talk about -- we believe we have a better idea. And that's to take many of the examples that you just mentioned about... |
| 00:18:3826 sec. |
Alexander, Lamar - U.S. Senator, [R] Tennessee
I'd like to begin with a story. When I was elected governor some of the media went up to the Democratic leaders of the legislature and said, "What... |
| 00:19:0415 sec. |
Alexander, Lamar - U.S. Senator, [R] Tennessee
I'd like to say the same thing to you. I mean, we want you to succeed, because if you succeed our country succeeds. But we would like, respectfully,... |
| 00:19:1934 sec. |
Alexander, Lamar - U.S. Senator, [R] Tennessee
I was trying to think about if there were any kind of event that this could be compared with, and I was thinking of the Detroit Auto Show, that you'd... |
| 00:19:5330 sec. |
Alexander, Lamar - U.S. Senator, [R] Tennessee
Your stories are a lot like the stories I hear. When I went home for Christmas, after we had that 25 days of consecutive debate and voted on Christmas... |
| 00:20:239 sec. |
Alexander, Lamar - U.S. Senator, [R] Tennessee
And that's about -- that's where we are. But we think to do that we have to start by taking the current bill and putting it on the shelf and starting... |
| 00:20:3254 sec. |
Alexander, Lamar - U.S. Senator, [R] Tennessee
Now, you've presented ideas. There's an 11-page memo on the -- I think it's important for people to understand there's not a presidential bill. There... |
| 00:21:2622 sec. |
Alexander, Lamar - U.S. Senator, [R] Tennessee
It means that from a governor's point of view, there are going to be what our Democratic governor calls "the mother of all unfunded mandates." Nothing... |
| 00:21:4817 sec. |
Alexander, Lamar - U.S. Senator, [R] Tennessee
And in addition, it dumps 15 to 18 million low-income Americans into a Medicaid program that none of us would want to be a part of because 50 percent... |
| 00:22:0523 sec. |
Alexander, Lamar - U.S. Senator, [R] Tennessee
When fully implemented, the bill would spend about $2.5 trillion a year, and it still has the sweetheart deals in it. One is out; some are still in.... |
| 00:22:289 sec. |
Alexander, Lamar - U.S. Senator, [R] Tennessee
So our view, with all respect, is that this is a car that can't be recalled and fixed, and that we ought to start over. But we'd like to start over. |
| 00:22:3735 sec. |
Alexander, Lamar - U.S. Senator, [R] Tennessee
When I go down on the floor -- and I've been there a lot on this issue -- some of my Democratic friends will say, well, Lamar, where's the Republican... |
| 00:23:1219 sec. |
Alexander, Lamar - U.S. Senator, [R] Tennessee
Our country is too big, too complicated, too decentralized for Washington, a few of us here, just to write a few rules about remaking 17 percent of... |
| 00:23:3128 sec. |
Alexander, Lamar - U.S. Senator, [R] Tennessee
And it doesn't work for most of us. I mean, if you look around the table -- and I'm sure it's true on the Democratic side, as it is on the Republican... |
| 00:23:5933 sec. |
Alexander, Lamar - U.S. Senator, [R] Tennessee
And I'd like to just mention those in a sentence or two. You mentioned Mike Enzi's work on the small business health care plan. That's a good start.... |
| 00:24:3252 sec. |
Alexander, Lamar - U.S. Senator, [R] Tennessee
Number three, put an end to junk lawsuits against doctors. In our state, half the counties, pregnant women have to drive to the big city to have prenatal... |
| 00:25:2436 sec. |
Alexander, Lamar - U.S. Senator, [R] Tennessee
Now, some say we need to rein in the insurance companies; maybe we do. But I think it's important to note that if we took all the profits of the insurance... |
| 00:26:001 min. |
Alexander, Lamar - U.S. Senator, [R] Tennessee
Now, in conclusion, I have a suggestion and a request for how to make this a bipartisan and truly productive session. And I hope that those who are... |
| 00:27:1123 sec. |
Alexander, Lamar - U.S. Senator, [R] Tennessee
So this is the only place, the Senate, where the rights to the minority are protected and sometimes, as Senator Byrd has said, the minority can be right.... |
| 00:27:3435 sec. |
Alexander, Lamar - U.S. Senator, [R] Tennessee
When Republicans were trying to change the rules a few years ago -- you and I were both there; Senator McCain was very involved in that -- about getting... |
| 00:28:0928 sec. |
Alexander, Lamar - U.S. Senator, [R] Tennessee
Senator Byrd in his book -- Senator Reid in his book, writing about the Gang of 14, said that the end of the filibuster requiring 60 votes to pass a... |
| 00:28:3736 sec. |
Alexander, Lamar - U.S. Senator, [R] Tennessee
Senator Pat Moynihan said before he died that he couldn't remember a big piece of social legislation that passed that wasn't bipartisan. And after... |
| 00:29:1318 sec. |
Alexander, Lamar - U.S. Senator, [R] Tennessee
And we know how to do that. I mean, John Boehner and George Miller did that on No Child Left Behind. Mike Enzi and Ted Kennedy wrote 35 bills together.... |
| 00:29:3130 sec. |
Alexander, Lamar - U.S. Senator, [R] Tennessee
But to do that, we'll have to renounce jamming it through in a partisan way. And if we don't, then the rest of what we do today will not be relevant.... |
| 00:30:0133 sec. |
Alexander, Lamar - U.S. Senator, [R] Tennessee
So if we can do that -- start over -- we can write a health care bill. It means putting aside jamming it through. It means working together the way... |
| 00:30:34 |
Alexander, Lamar - U.S. Senator, [R] Tennessee
Thank you very much. |
| 00:30:3430 sec. |
Obama, Barack - President
Well, thank you, Lamar. Both I and Lamar went a little bit over our original allocated time. (Laughter.) Not wanting to be a hypocrite, I wanted... |
| 00:31:0419 sec. |
Obama, Barack - President
What I will then do is just address -- John, are you going to make the presentation yourself? Okay. What I will then do is just address a couple of... |
| 00:31:23 |
Obama, Barack - President
All right? Nancy. |
| 00:31:2333 sec. |
Pelosi, Nancy - U.S. Representative, [D] California
Yes, Mr. President. Thank you very much for bringing us here today. I will try to stick to the time because we have many people to hear from. Thank... |
| 00:31:5645 sec. |
Pelosi, Nancy - U.S. Representative, [D] California
You began your remarks, Mr. President, by saying there was a glimmer of bipartisanship in the Senate for the passage of the jobs bill. I want you to... |
| 00:32:4134 sec. |
Pelosi, Nancy - U.S. Representative, [D] California
That day, March 5th, we all remember the bipartisan spirit, the hope that was in the room, and also when Senator Kennedy came into the room and declared... |
| 00:33:1560 sec. |
Pelosi, Nancy - U.S. Representative, [D] California
As we sit around this table, I think we should be mindful of what they do when they sit around their kitchen table. What we do here must be relevant... |
| 00:34:1518 sec. |
Pelosi, Nancy - U.S. Representative, [D] California
I have a letter -- and Michigan seems to be where I get some mail on this subject since I've travelled there recently -- the woman who said that their... |
| 00:34:3333 sec. |
Pelosi, Nancy - U.S. Representative, [D] California
I can't mention health care in Michigan without acknowledging Chairman Dingell. His institutional memory of how difficult it was to pass Medicare,... |
| 00:35:0631 sec. |
Pelosi, Nancy - U.S. Representative, [D] California
You have talked about how the present system is unsustainable for families, for businesses large, modern and large, small -- any size, and how it's... |
| 00:35:3736 sec. |
Pelosi, Nancy - U.S. Representative, [D] California
But I want to talk for a moment about what it means to the economy. Imagine an economy where people could change jobs, start businesses, become self-employed,... |
| 00:36:1316 sec. |
Pelosi, Nancy - U.S. Representative, [D] California
Think of an economy with that dynamism of people following their pursuits, taking risks -- we want them to take risks and yet we lock them down, and... |
| 00:36:2956 sec. |
Pelosi, Nancy - U.S. Representative, [D] California
So this bill is not only about the health security of America. It's about jobs. In its life it will create 4 million jobs -- 400,000 jobs almost immediately;... |
| 00:37:2541 sec. |
Pelosi, Nancy - U.S. Representative, [D] California
This is not just about health care for America; it's about a healthier America. This legislation is about innovation; it's about prevention; it's about... |
| 00:38:0628 sec. |
Pelosi, Nancy - U.S. Representative, [D] California
So it is -- it's a very important initiative that we have to take. And I want to say, because Medicare was mentioned, unless we pass this legislation... |
| 00:38:3430 sec. |
Pelosi, Nancy - U.S. Representative, [D] California
That day, March 5th, Senator Kennedy said health care is a right, not a privilege. Let us move in a way -- who can say "ram"? We started this six... |
| 00:39:0418 sec. |
Pelosi, Nancy - U.S. Representative, [D] California
But I just hope that as we sit around this table, we understand the urgency that the American people have about this issue, how it affects not only... |
| 00:39:221 min. |
Reid, Harry - U.S. Senator, [D] Nevada
Mr. President, my friends in the House and in the Senate, I want to spend a few minutes talking about Nevada, about our country, and not what's going... |
| 00:40:5726 sec. |
Reid, Harry - U.S. Senator, [D] Nevada
I say to my friend, Lamar, who I have great respect and admiration for, you're entitled to your opinions, but not your own facts. Your opinion is something... |
| 00:41:2343 sec. |
Reid, Harry - U.S. Senator, [D] Nevada
Last Monday, a week ago Monday, all over America, results were run from a poll done by the Kaiser Foundation. It was interesting what that poll said:... |
| 00:42:0647 sec. |
Reid, Harry - U.S. Senator, [D] Nevada
And the doughnut hole. What is the doughnut hole? Well, a senior citizen will tell you what the doughnut hole is. Under the Medicare law that is... |
| 00:42:5355 sec. |
Reid, Harry - U.S. Senator, [D] Nevada
No one has said -- I read what the President has online -- no one has talked about reconciliation but that's what you folks have talked about ever since... |
| 00:43:4830 sec. |
Reid, Harry - U.S. Senator, [D] Nevada
It's as if there's a different mindset, a different set of facts than the reality. Remember, Chairman Dodd in the HELP Committee held weeks of markups.... |
| 00:44:181 min. |
Reid, Harry - U.S. Senator, [D] Nevada
So the bill on the floor that my friend Lamar is lamenting here has significant input from the Republicans. So let's look at the facts a little bit... |
| 00:45:2543 sec. |
Reid, Harry - U.S. Senator, [D] Nevada
These facts show that the story that I told about Jesus is not just a story of some young businessman in Reno, Nevada, running a restaurant that gets... |
| 00:46:0849 sec. |
Reid, Harry - U.S. Senator, [D] Nevada
I know, it's obvious, we've heard it -- our Republican friends oppose our legislation. And that is your right. But also, it becomes your responsibility... |
| 00:46:5717 sec. |
Reid, Harry - U.S. Senator, [D] Nevada
So we're ready to listen. I so appreciate the President getting us together. I want the American people to know that we need to work together, and... |
| 00:47:1421 sec. |
Reid, Harry - U.S. Senator, [D] Nevada
I've spoken with Madam Speaker on many occasions, numerous times, about health care. We spent most of the last year talking about health care. I so... |
| 00:47:3526 sec. |
Obama, Barack - President
Well, thank you very much, Harry. Everybody went a little over time, which is not surprising with a room full of elected officials. I wanted to give... |
| 00:48:0128 sec. |
Obama, Barack - President
I just want to address very quickly, Lamar, the issue of process that you raised at the beginning and then we'll move on and start talking about the... |
| 00:48:2916 sec. |
Obama, Barack - President
On the other hand, when I listened to some of the steps that you thought Republicans would be open to, I thought, well, a bunch of these things are... |
| 00:48:4531 sec. |
Obama, Barack - President
So part of the goal here I think is to figure out what are the areas that we do agree on, what are the areas where we don't agree, and at the end of... |
| 00:49:1637 sec. |
Obama, Barack - President
So rather than start at the outset talking about legislative process and what's going to happen in the Senate and the House and this and that, what... |
| 00:49:5340 sec. |
Obama, Barack - President
And what I'd like to do then is to start first with something I heard everybody agree on, every single speaker, and that was the issue of cost. It... |
| 00:50:3332 sec. |
Obama, Barack - President
Now, I've already indicated some statistics, but I just want to reemphasize these. More than a quarter of small businesses have reported a premium... |
| 00:51:0527 sec. |
Obama, Barack - President
By one estimate, without health care reform, by the end of the decade premiums for businesses would more than double in most states. And the total... |
| 00:51:3234 sec. |
Obama, Barack - President
As I mentioned earlier, I hear stories from people all the time about how these costs have very concrete impacts on their lives. I spoke to a family,... |
| 00:52:061 min. |
Obama, Barack - President
And so one of the goals that I set out very early on in this process was how do we control costs? Now, what we have done, as I mentioned earlier, was... |
| 00:53:1030 sec. |
Obama, Barack - President
For folks who even with those lower costs still can't afford coverage, we'd provide some subsidies. But here's what I want to emphasize is that even... |
| 00:53:408 sec. |
Obama, Barack - President
So, Lamar, when you mentioned earlier that you said premiums go up -- that's just not the case, according to the Congressional Budget Office. |
| 00:53:4812 sec. |
Alexander, Lamar - U.S. Senator, [R] Tennessee
Mr. President, if you're going to contradict me, I ought to have a chance to -- the Congressional Budget Office report says that premiums will rise... |
| 00:54:006 sec. |
Obama, Barack - President
No, no, no, no -- let me -- and this is an example of where we've got to get our facts straight. |
| 00:54:06 |
Alexander, Lamar - U.S. Senator, [R] Tennessee
That's my point. |
| 00:54:061 min. |
Obama, Barack - President
Well, exactly. So let me respond to what you just said, Lamar, because it's not factually accurate. Here's what the Congressional Budget Office says.... |
| 00:55:08 |
Alexander, Lamar - U.S. Senator, [R] Tennessee
Well, may I -- may I -- |
| 00:55:0842 sec. |
Obama, Barack - President
Let me just finish, Lamar. Now, the -- what we've done is we've tried to take every single cost containment idea that's out there. Every proposal... |
| 00:55:5029 sec. |
Obama, Barack - President
You mentioned the idea of buying across state lines, insurance. That's something that I've put in my proposal that's actually in the Senate proposal.... |
| 00:56:1935 sec. |
Obama, Barack - President
But I just think it's very important to understand that what we've done is to try to take every single cost containment idea that's out there and try... |
| 00:56:54 |
Alexander, Lamar - U.S. Senator, [R] Tennessee
Mr. President, I've had my time -- |
| 00:56:5434 sec. |
Obama, Barack - President
And what I'd like to do also is to make sure that you maybe suggest some of the ideas that are currently in the bill that you think are good, because,... |
| 00:57:2832 sec. |
Alexander, Lamar - U.S. Senator, [R] Tennessee
Mr. President, let me -- let me show some respect for my colleagues here. They're all here eager to speak, all sure they could do a better job than... |
| 00:58:00 |
Obama, Barack - President
Good. |
| 00:58:008 sec. |
Alexander, Lamar - U.S. Senator, [R] Tennessee
So I appreciate the opportunity that Mitch and John gave me to talk. You've made some interesting points, and why not let other members of Congress... |
| 00:58:0817 sec. |
Obama, Barack - President
I think it's a great idea. I'd like to get this issue settled about whether premiums are reduced before we leave today, because I'm pretty certain... |
| 00:58:253 sec. |
Obama, Barack - President
Mitch, who would you like to talk about cost? |
| 00:58:2810 sec. |
McConnell, Mitch Jr. - U.S. Senator, [R] Kentucky
Yes, Mr. President, since some liberties have been taken here, let me just make a quick observation. Then I'm going to call on Dr. Coburn to make our... |
| 00:58:3835 sec. |
McConnell, Mitch Jr. - U.S. Senator, [R] Kentucky
One thing I think we need to be acutely aware of, ladies and gentlemen, we are here representing the American people. And Harry mentioned several polls.... |
| 00:59:137 sec. |
McConnell, Mitch Jr. - U.S. Senator, [R] Kentucky
Now, I'd like to call on Dr. Tom Coburn -- he's been a practicing physician for many years -- to address the cost containment issue. |
| 00:59:20 |
Obama, Barack - President
Tom. |
| 00:59:2044 sec. |
Coburn, Thomas "Tom" A. M.D. - U.S. Senator, [R] Oklahoma
Thank you. Well, Mr. President, thanks for having us do this. I think today is going to be enlightening. The first thing I would do is put out a... |
| 01:00:0424 sec. |
Coburn, Thomas "Tom" A. M.D. - U.S. Senator, [R] Oklahoma
The second thing we know is, from the Congressional Research Service, that most of the mal drivers today in health care come from government rules and... |
| 01:00:2837 sec. |
Coburn, Thomas "Tom" A. M.D. - U.S. Senator, [R] Oklahoma
So what I thought we ought to do is maybe talk about why does it cost so much? Because the thing that keeps people from getting access to care in our... |
| 01:01:0534 sec. |
Coburn, Thomas "Tom" A. M.D. - U.S. Senator, [R] Oklahoma
So when you break down the cost, what we know is 33 percent of the cost in health care shouldn't be there. And how do we go about doing that, and what... |
| 01:01:3935 sec. |
Coburn, Thomas "Tom" A. M.D. - U.S. Senator, [R] Oklahoma
If you look at Thomson Reuters -- when they look at all of this, they say at least 15 percent of government-run health care is fraud. Well, when you... |
| 01:02:1446 sec. |
Coburn, Thomas "Tom" A. M.D. - U.S. Senator, [R] Oklahoma
What's the other area? What we do know -- and I'm guilty of this; Dr. Barrasso is guilty of it; Dr. Boustany is guilty of it -- is a large portion... |
| 01:03:0037 sec. |
Coburn, Thomas "Tom" A. M.D. - U.S. Senator, [R] Oklahoma
So it seems to me if cost is the number one thing that's keeping people from getting care, then the efforts of us as we go after cost ought to be to... |
| 01:03:3711 sec. |
Coburn, Thomas "Tom" A. M.D. - U.S. Senator, [R] Oklahoma
What would happen to access in this country if tomorrow everybody's health care costs went down 15 percent? Access would markedly increase. |
| 01:03:4836 sec. |
Coburn, Thomas "Tom" A. M.D. - U.S. Senator, [R] Oklahoma
So what I would hope we would do is that we would go back and concentrate on the areas that have the biggest pot of gold for us. And the biggest pot... |
| 01:04:2449 sec. |
Coburn, Thomas "Tom" A. M.D. - U.S. Senator, [R] Oklahoma
We also know there's some other real things that we ought to address. There are conflict of interests within the medical field. There's nothing wrong... |
| 01:05:1331 sec. |
Coburn, Thomas "Tom" A. M.D. - U.S. Senator, [R] Oklahoma
So I think if -- I think it's great that we're coming together, but the goal is in, where's the cost excesses? And what I would hope we would do is... |
| 01:05:4426 sec. |
Coburn, Thomas "Tom" A. M.D. - U.S. Senator, [R] Oklahoma
How do we do that in terms of creating an elimination of fraud? When you compare the private sector fraud rates, it's 1 percent, compared to Medicare... |
| 01:06:1023 sec. |
Coburn, Thomas "Tom" A. M.D. - U.S. Senator, [R] Oklahoma
And my hope would be that we would look at where the money is, and if truly it's accurate -- and I don't know many people that will disagree that one... |
| 01:06:3327 sec. |
Coburn, Thomas "Tom" A. M.D. - U.S. Senator, [R] Oklahoma
In your new bill, you have good fraud programs, but you lack the biggest thing to do. The biggest thing on fraud is to have undercover patients so... |
| 01:07:009 sec. |
Reid, Harry - U.S. Senator, [D] Nevada
Mr. President, if I could just say, I'm not an expert on much but I am filibusters and we've got 40 members of Congress here. |
| 01:07:094 sec. |
Obama, Barack - President
Tom, you made some powerful points. You want to just wrap up real quick? |
| 01:07:136 sec. |
Coburn, Thomas "Tom" A. M.D. - U.S. Senator, [R] Oklahoma
No, I'll just finish with that, is with one out of three dollars not helping everybody, we ought to go for where it is. |
| 01:07:1929 sec. |
Obama, Barack - President
Well, Tom, I appreciate what you said. I think we're going to have Steny Hoyer go next. I just want to make this quick point. Every good idea that... |
| 01:07:4814 sec. |
Obama, Barack - President
Let's recognize, though, that those savings in the government systems, which will help taxpayers and allow us to do more, doesn't account for the rising... |
| 01:08:0216 sec. |
Obama, Barack - President
Now, the private marketplace, you mentioned the issue of medical malpractice and frivolous lawsuits, and as you indicated, these are areas where Secretary... |
| 01:08:1811 sec. |
Obama, Barack - President
On the prevention side, there's a whole host of provisions inside the legislation that's been passed by the House and the Senate, and I think Steny... |
| 01:08:2912 sec. |
Obama, Barack - President
So we've identified some areas we agree on and then the question just is, does that help the average family in the individual market who potentially... |
| 01:08:4111 sec. |
Coburn, Thomas "Tom" A. M.D. - U.S. Senator, [R] Oklahoma
Well, let me just respond to one thing. You get cost-shifted every penny that gets wasted on Medicare, and that gets cost-shifted to the private sector.... |
| 01:08:52 |
Obama, Barack - President
It would help. |
| 01:08:52 |
Coburn, Thomas "Tom" A. M.D. - U.S. Senator, [R] Oklahoma
-- we're shifting it to the private sector. |
| 01:08:523 sec. |
Obama, Barack - President
You and I agree on this. Steny. |
| 01:08:5540 sec. |
Hoyer, Steny H. - U.S. Representative, [D] Maryland
Mr. President, thank you very much. A quote I will use is, we should have available and affordable health care to every American citizen, to every... |
| 01:09:3540 sec. |
Hoyer, Steny H. - U.S. Representative, [D] Maryland
Every one of us has a story. I had a message on my telephone answering machine just a little while ago, a couple of weeks ago. A woman that I know... |
| 01:10:1546 sec. |
Hoyer, Steny H. - U.S. Representative, [D] Maryland
I had a small business in my district, like all of you, who last year paid $1,100 -- a couple, healthy, paid $1,100. Their bill is going to go up to... |
| 01:11:0122 sec. |
Hoyer, Steny H. - U.S. Representative, [D] Maryland
Cost containment is clearly one of those issues that we need to deal with -- cost containment for that small business that is having a 67 percent increase;... |
| 01:11:2336 sec. |
Hoyer, Steny H. - U.S. Representative, [D] Maryland
Many in my caucus believe that one way of doing that is to increase competition, to have an open, free market that is transparent. I think all of us... |
| 01:11:5943 sec. |
Hoyer, Steny H. - U.S. Representative, [D] Maryland
And in addition to that, Senator Coburn, we certainly agree with you that one in three dollars is not being spent as effectively as it should be. And... |
| 01:12:4239 sec. |
Hoyer, Steny H. - U.S. Representative, [D] Maryland
So I think we have agreement on conflict of interest in delivery of medicine as well. We've dealt that -- with that in our bill; we've dealt with it... |
| 01:13:219 sec. |
Hoyer, Steny H. - U.S. Representative, [D] Maryland
You mentioned the school lunch and food stamp programs. I'm sure we can get there, too, an agreement. We certainly agree with the premise you stated.... |
| 01:13:3033 sec. |
Hoyer, Steny H. - U.S. Representative, [D] Maryland
What have we done? We've stopped premium discrimination. That clearly ups cost. If you're in a small market, as the President pointed out, you're... |
| 01:14:0332 sec. |
Hoyer, Steny H. - U.S. Representative, [D] Maryland
We want to go after fraud, waste, and abuse -- I'll reiterate that -- a transparent market; stop premium discrimination; and make sure that people with... |
| 01:14:3533 sec. |
Hoyer, Steny H. - U.S. Representative, [D] Maryland
We believe there needs to be better coordination of care. You're a doctor. You have a number of doctors in the room. We believe that there ought... |
| 01:15:0820 sec. |
Hoyer, Steny H. - U.S. Representative, [D] Maryland
But I would suggest to you that one of the things that many in my caucus felt very strongly about in terms of competition was having a public option.... |
| 01:15:2832 sec. |
Hoyer, Steny H. - U.S. Representative, [D] Maryland
Now, Senator Baucus is going to speak more specifically in terms of our cost containment, but doughnut hole certainly is one of the issues that we need... |
| 01:16:0022 sec. |
Hoyer, Steny H. - U.S. Representative, [D] Maryland
But I think what the American public that's listening and watching expects us to do, Mr. President, is what you're doing -- bringing us together, coming... |
| 01:16:226 sec. |
Hoyer, Steny H. - U.S. Representative, [D] Maryland
Thank you, Mr. President. |
| 01:16:2834 sec. |
Obama, Barack - President
Before you go, Max, I just want to ask, whether it's you, Tom, or anybody else on the Republican side, and maybe some of the House members might be... |
| 01:17:0224 sec. |
Obama, Barack - President
The issue of prevention, and that includes, by the way, things like how our kids are eating and getting exercise. And I'm proud of the First Lady for... |
| 01:17:2615 sec. |
Obama, Barack - President
The issue of defensive medicine, as I indicated, Secretary Sebelius is working on this, but I think that there are things that we could do at the state... |
| 01:17:4156 sec. |
Obama, Barack - President
I would be interested in hearing from any of our Republican colleagues what objections they have to what we consider one of the biggest ways of driving... |
| 01:18:3721 sec. |
Obama, Barack - President
I know some of you have agreed to this as a concept in the past. And so my question is, is there something in terms of the way the House and Senate... |
| 01:18:58 |
Obama, Barack - President
John. |
| 01:18:5814 sec. |
Boehner, John A. - U.S. Representative, [R] Ohio
Well, Mr. President, I'd like to yield to Mr. Kline from Minnesota, who will talk about the small business health plans in terms of how we would propose... |
| 01:19:1225 sec. |
Kline, John - U.S. Representative, [R] Minnesota
Thank you, Leader. Thank you, Mr. President. I think that Senator Alexander framed our overall position very well when he said that we're looking... |
| 01:19:3712 sec. |
Kline, John - U.S. Representative, [R] Minnesota
We have proposed in both the House and the Senate in fact for a number of years that small businesses be able to band together in small business health... |
| 01:19:4941 sec. |
Kline, John - U.S. Representative, [R] Minnesota
We all know, and I've heard everybody say here, that small businesses are the engine that drives our economy. We also know that about half of the uninsured... |
| 01:20:3045 sec. |
Kline, John - U.S. Representative, [R] Minnesota
And it will lower the cost of premiums for these small businesses and allow them to insure more people, and to keep people that are already insured... |
| 01:21:157 sec. |
Obama, Barack - President
Okay. Max is going to go, and then I'll go to you, Rob. |
| 01:21:229 sec. |
Obama, Barack - President
Max, do you want to address this issue of how we can allow people to buy into large groups, how the Senate bill accomplishes it, and I don't know if... |
| 01:21:3148 sec. |
Baucus, Max - U.S. Senator, [D] Montana
Sure. Absolutely, though I'd first like to say something that just strikes me just in spades. Frankly, we all have studied this issue a lot -- health... |
| 01:22:1932 sec. |
Baucus, Max - U.S. Senator, [D] Montana
Let's take the list, for example, that Lamar mentioned. As you've said, Mr. President, we are basically including most of those provisions, if not... |
| 01:22:5131 sec. |
Baucus, Max - U.S. Senator, [D] Montana
In addition, you mentioned lawsuits. Secretary Sebelius is working to try and find ways to encourage states to settle, resolve issues before they become... |
| 01:23:2222 sec. |
Baucus, Max - U.S. Senator, [D] Montana
Expanding HSAs -- that's fine, there's nothing wrong with HSAs -- but we also have to have products for poorer people, lower-income people. HSAs work... |
| 01:23:4452 sec. |
Baucus, Max - U.S. Senator, [D] Montana
With respect to small business, we're not that far apart. Some suggest association health plans where small business people can band together in an... |
| 01:24:3617 sec. |
Baucus, Max - U.S. Senator, [D] Montana
I might add that we're also providing tax incentives, tax credits, for businesses and small business that wants to purchase health insurance for its... |
| 01:24:5320 sec. |
Baucus, Max - U.S. Senator, [D] Montana
So the main point is we're not really that far apart. We're trying to find ways for small business to pool, small business to take advantage of competition,... |
| 01:25:1332 sec. |
Baucus, Max - U.S. Senator, [D] Montana
So I might say, too, that if you look at all the provisions that Steny outlined, may help them, we agree. We agree on prevention. There are major... |
| 01:25:4532 sec. |
Baucus, Max - U.S. Senator, [D] Montana
It's another example -- we really are close. And I think that once we keep pushing on those areas that we're close, this will make a difference. Exchanges,... |
| 01:26:1726 sec. |
Baucus, Max - U.S. Senator, [D] Montana
I also think that we should -- hospitals should publish the cost of their basic procedures, what's an appendectomy or a colonoscopy or whatnot, to enable... |
| 01:26:4310 sec. |
Baucus, Max - U.S. Senator, [D] Montana
And fraud and waste, we talked about that. We have major provisions in our bill to reduce fraud and waste. Mr. President, I compliment you because... |
| 01:26:533 sec. |
Obama, Barack - President
We took some additional ideas from folks like Congressman Roskam. |
| 01:26:5619 sec. |
Baucus, Max - U.S. Senator, [D] Montana
They're great ideas and we addressed unnecessary readmission rates in hospitals, et cetera. The main point is we basically agree. There's not a lot... |
| 01:27:15 |
Obama, Barack - President
Mitch, is there somebody -- |
| 01:27:155 sec. |
McConnell, Mitch Jr. - U.S. Senator, [R] Kentucky
Yes, Mr. President. I'm going to yield to John here. |
| 01:27:20 |
Obama, Barack - President
John. |
| 01:27:205 sec. |
Boehner, John A. - U.S. Representative, [R] Ohio
I'd like to yield to Dave Camp to continue this conversation about cost containment. |
| 01:27:256 sec. |
Obama, Barack - President
Dave. |
| 01:27:3127 sec. |
Camp, David "Dave" Lee - U.S. Representative, [R] Michigan
Thank you, Leader Boehner, and thank you, Mr. President, for the invitation today. I think as we focus this part of the conversation on cost, a lot... |
| 01:27:5822 sec. |
Camp, David "Dave" Lee - U.S. Representative, [R] Michigan
The non-partisan actuaries at the Center for Medicare and Medicaid Services say on page four of their letter on the Senate-passed bill that it would... |
| 01:28:2024 sec. |
Camp, David "Dave" Lee - U.S. Representative, [R] Michigan
A key way of reducing costs that's missing from the House and Senate bills is responsible lawsuit reform that guarantees injured parties, much like... |
| 01:28:4439 sec. |
Camp, David "Dave" Lee - U.S. Representative, [R] Michigan
On page four of its letter to Senator Hatch, CBO found that this common-sense reform would reduce the federal deficit by more than $50 billion. Now,... |
| 01:29:2352 sec. |
Camp, David "Dave" Lee - U.S. Representative, [R] Michigan
These changes are such as they ban the use of over-the-counter medication out of both of these plans. There's a new cap on FSA contributions of $2,500.... |
| 01:30:1533 sec. |
Camp, David "Dave" Lee - U.S. Representative, [R] Michigan
Now, another concern I have is the Senate bill, which on page 982 creates an unelected board charged with recommending even more Medicare reductions.... |
| 01:30:486 sec. |
Camp, David "Dave" Lee - U.S. Representative, [R] Michigan
Now, holding down health care costs for the government is important. But I think it's also important to hold down costs for families and employees. |
| 01:30:5430 sec. |
Obama, Barack - President
Dave, I don't mean to interrupt. But the -- we're going to have the whole section talking about deficits. And we can talk about the changes in Medicare.... |
| 01:31:244 sec. |
Obama, Barack - President
So I don't want to try to cut you off. Please finish up -- |
| 01:31:28 |
Camp, David "Dave" Lee - U.S. Representative, [R] Michigan
Well, I'm almost -- I'm almost done. |
| 01:31:283 sec. |
Obama, Barack - President
-- but I just want to kind of point out that -- |
| 01:31:3115 sec. |
Camp, David "Dave" Lee - U.S. Representative, [R] Michigan
I'm almost done. I do want to say on this issue on premiums, CBO, in their letter, on page four, does say that the estimated average premium per person... |
| 01:31:464 sec. |
Obama, Barack - President
This is the discussion that I just had to -- about Lamar. And -- |
| 01:31:506 sec. |
Camp, David "Dave" Lee - U.S. Representative, [R] Michigan
Yes, they do say that. And they do say that the value of the benefit is higher, and that is why it goes up. |
| 01:31:56 |
Obama, Barack - President
Right. |
| 01:31:5640 sec. |
Camp, David "Dave" Lee - U.S. Representative, [R] Michigan
But the reason the value of the benefit is higher is because of the mandates contained in the legislation. And this is one of our big concerns with... |
| 01:32:366 sec. |
Obama, Barack - President
Okay, I'm going to let -- Rob, feel free to respond to anything that Dave indicated or to any of the other issues that have been discussed. |
| 01:32:4235 sec. |
Andrews, Robert - U.S. Representative, [D] New Jersey
Thank you, Mr. President. I want to thank my friend Tom Coburn, and John Kline, for the spirit of conversation which they offered and try to carry... |
| 01:33:1733 sec. |
Andrews, Robert - U.S. Representative, [D] New Jersey
And then the President asked the question about whether we can find agreement on pooling the purchasing power of small businesses and individuals so... |
| 01:33:5026 sec. |
Andrews, Robert - U.S. Representative, [D] New Jersey
But there is one substantive difference that I want to ask about, because we are concerned about it. If we can resolve this, I think we could agree.... |
| 01:34:1625 sec. |
Andrews, Robert - U.S. Representative, [D] New Jersey
Now, under the association health plan proposal, that rule wouldn't apply to that lady and her baby; that there would be no protection of her in that... |
| 01:34:4117 sec. |
Andrews, Robert - U.S. Representative, [D] New Jersey
So I think the issue is, if we could find a way to agree, that in a case like this where a lady has a baby by C-section and has the ability to not have... |
| 01:34:5821 sec. |
Kline, John - U.S. Representative, [R] Minnesota
If I could just respond to that, my friend knows very well that there are large companies today who operate under what I'm proposing for association... |
| 01:35:19 |
Andrews, Robert - U.S. Representative, [D] New Jersey
We do. |
| 01:35:1919 sec. |
Kline, John - U.S. Representative, [R] Minnesota
-- many of those now would fall into what we've been calling Cadillac plans because they provide very excellent service. So I think that, frankly,... |
| 01:35:385 sec. |
Andrews, Robert - U.S. Representative, [D] New Jersey
But, John, would you favor a standard that says they have to do something like that or would you just leave it up to the insurance company? |
| 01:35:437 sec. |
Kline, John - U.S. Representative, [R] Minnesota
I would say that we put the association health plans in exactly the same position that large companies are today with exactly the same rules under -- |
| 01:35:5026 sec. |
Andrews, Robert - U.S. Representative, [D] New Jersey
See, we don't -- I mean, with all respect, we don't agree with that. We don't agree with the idea that the insurance company should get to make that... |
| 01:36:167 sec. |
Obama, Barack - President
Good. This has been a useful conversation. Paul Ryan wants to make a comment but -- |
| 01:36:2316 sec. |
McConnell, Mitch Jr. - U.S. Senator, [R] Kentucky
Mr. President, could I just interject one quick point here very quick, just in terms of trying to keep everything fair, which I know you want to do.... |
| 01:36:395 sec. |
Ryan, Paul - U.S. Representative, [R] Wisconsin
I think the Republican leaders are controlling the time for the Republicans, if I'm not mistaken -- is that right? |
| 01:36:4418 sec. |
Obama, Barack - President
I don't think that's quite right, but I'm just going back and forth here, Mitch. I think we're just trying to go back and forth, but that's okay. ... |
| 01:37:0224 sec. |
Ryan, Paul - U.S. Representative, [R] Wisconsin
All right. Rob, here's basically what we're looking at. The difference is this: We don't think all the answers lie in Washington regulating all of... |
| 01:37:2642 sec. |
Ryan, Paul - U.S. Representative, [R] Wisconsin
And so we simply say, look, if the National Restaurant Association or the National Federation of Independent Business, on behalf of their members, wants... |
| 01:38:085 sec. |
Camp, David "Dave" Lee - U.S. Representative, [R] Michigan
Paul, would you yield -- Mr. President, can I ask him to yield? |
| 01:38:133 sec. |
Obama, Barack - President
We're not in a formal hearing here -- (laughter) -- so go ahead. |
| 01:38:1611 sec. |
Camp, David "Dave" Lee - U.S. Representative, [R] Michigan
Paul, I read your -- and I thought one of the things that you said is that there should be some minimum consumer protections in the exchanges that you've... |
| 01:38:2725 sec. |
Ryan, Paul - U.S. Representative, [R] Wisconsin
And there are in every state. And so what we're simply saying is, look, lots of us have offered lots of different ideas. We've got dozens of Republican... |
| 01:38:52 |
Camp, David "Dave" Lee - U.S. Representative, [R] Michigan
Depends on who it is, Paul. |
| 01:38:5211 sec. |
Ryan, Paul - U.S. Representative, [R] Wisconsin
But should we regulate all this? Should people in Washington decide exactly how this works and what you can and cannot buy? It's just a difference... |
| 01:39:0328 sec. |
Obama, Barack - President
No, no, no, look -- this is an important point. We've got a couple other people who want to speak. We've gone about 55 minutes on this section. We're... |
| 01:39:31 |
Reid, Harry - U.S. Senator, [D] Nevada
Senator Schumer for the Senate -- |
| 01:39:318 sec. |
Obama, Barack - President
I know Senator Schumer wants to speak, and I know that Jim Clyburn wants to say something very quickly and -- |
| 01:39:39 |
McConnell, Mitch Jr. - U.S. Senator, [R] Kentucky
And Jon Kyl would like to as well. |
| 01:39:3923 sec. |
Obama, Barack - President
And Jon. What I want to do, though, is just focus in on this philosophical debate. This is a legitimate debate. And it actually speaks to the point... |
| 01:40:0249 sec. |
Obama, Barack - President
When I was young, just got out of college, I had to buy auto insurance. I had a beat-up old car. And I won't name the name of the insurance company,... |
| 01:40:517 sec. |
Obama, Barack - President
Now, it's one thing if you've got an old beat-up car that you can't get fixed. It's another thing if your kid is sick, or you've got breast cancer. |
| 01:40:5851 sec. |
Obama, Barack - President
So the general idea has been here that we should set up some minimum standards within the exchange, that a plan that people are buying into, whether... |
| 01:41:4943 sec. |
Obama, Barack - President
I just want to point out, though, that the principle of pooling is at the center of both the Senate and the House bill. And the reason I'm pointing... |
| 01:42:3236 sec. |
Obama, Barack - President
And that's a legitimate argument. I don't disagree with that. But I just wanted to point out that when we start talking about how much government... |
| 01:43:08 |
Obama, Barack - President
Chuck, go ahead. |
| 01:43:085 sec. |
Schumer, Charles E. - U.S. Senator, [D] New York
Thank you, Mr. President. And I thank you. I think this has been a constructive dialogue. |
| 01:43:1320 sec. |
Schumer, Charles E. - U.S. Senator, [D] New York
I was glad to hear my friend Tom Coburn's remarks. I think we agree with most of them, and particularly the point that about a third of all of the... |
| 01:43:3330 sec. |
Schumer, Charles E. - U.S. Senator, [D] New York
And the real nub of this is how do we wring that waste out, that fraud, abuse, duplication, without interfering with the good care that we want every... |
| 01:44:0324 sec. |
Schumer, Charles E. - U.S. Senator, [D] New York
Or how about -- probably it's happening right now -- there's some salesman talking to some doctor and saying, hey, my company will finance a machine... |
| 01:44:2715 sec. |
Schumer, Charles E. - U.S. Senator, [D] New York
So these are the things we have to go after. And Tom, I thought your suggestion of undercover patients -- and I tried to check here, I don't think... |
| 01:44:4226 sec. |
Schumer, Charles E. - U.S. Senator, [D] New York
Senator Cantwell put a provision in the Senate bill that said we ought to reward doctors for doing quality, not quantity, so that doctors -- and they're... |
| 01:45:0826 sec. |
Schumer, Charles E. - U.S. Senator, [D] New York
Maria Cantwell has a provision in there which I would think you folks could agree on, that says that we ought to reward doctors for the quality, not... |
| 01:45:3437 sec. |
Schumer, Charles E. - U.S. Senator, [D] New York
So I think we can do all of these things. But it does -- but if we're going to eliminate the waste, fraud and abuse in Medicare, it does mean we're... |
| 01:46:1125 sec. |
Schumer, Charles E. - U.S. Senator, [D] New York
And I think that's where we can find common ground on some of the things you've mentioned, some of the things that are in our bill. And I hope, at... |
| 01:46:36 |
McConnell, Mitch Jr. - U.S. Senator, [R] Kentucky
Mr. President, can we turn to Jon Kyl. I'm sorry -- |
| 01:46:3611 sec. |
Obama, Barack - President
Sure. I'm sorry, you had Jon. We're going to go to Jon. And then we're going to go to Jim Clyburn. And then I think we're going to take a break,... |
| 01:46:47 |
Obama, Barack - President
So, Jon. |
| 01:46:4733 sec. |
Kyl, Jon - U.S. Senator, [R] Arizona
Thank you, Mr. President. I think you framed the issue very well just a moment ago, because there are some fundamental differences between us here... |
| 01:47:2022 sec. |
Kyl, Jon - U.S. Senator, [R] Arizona
Now, there is a mix of both, of course, in health care. But there is a big difference between our approaches. And there is so much in the bills that... |
| 01:47:421 min. |
Kyl, Jon - U.S. Senator, [R] Arizona
Now, let me give you a couple of examples. Dave Camp, I think, pointed out the answer to the dispute that you and Lamar Alexander had a moment ago,... |
| 01:48:4926 sec. |
Kyl, Jon - U.S. Senator, [R] Arizona
There is an actuarial requirement of 60 percent actuarial value in the exchange for the least costly plan. But the average in the country today of... |
| 01:49:1546 sec. |
Kyl, Jon - U.S. Senator, [R] Arizona
Second example, you say, how can we help small businesses? Well, we know one way you don't help small businesses is by raising the payroll -- the Medicare... |
| 01:50:0133 sec. |
Kyl, Jon - U.S. Senator, [R] Arizona
So when you raise these taxes in all of the different fees that are in this legislation, it inevitably increases the costs on the consumer. And why... |
| 01:50:3430 sec. |
Kyl, Jon - U.S. Senator, [R] Arizona
The last quick point, one of the worst things about this is for people that have catastrophic medical expenses today after you've spent 7.5 percent... |
| 01:51:0420 sec. |
Obama, Barack - President
Okay, Jon. I'm going to go to you, Jim, but I -- since as has tended to happen here, we end up talking about criticisms of the existing bill as opposed... |
| 01:51:2452 sec. |
Obama, Barack - President
Just to go back to the original argument that Lamar and I had and we've now chased around for quite some time. Look, if I'm a self-employed person... |
| 01:52:1630 sec. |
Obama, Barack - President
What the Congressional Budget Office is saying is, is that if I now have the opportunity to actually buy a decent package inside the exchange that costs... |
| 01:52:461 min. |
Obama, Barack - President
Now, you can still -- you still have an option of -- no, no, let me finish. The way that this bill is structured uses a high-cost pool, a catastrophic... |
| 01:54:039 sec. |
Obama, Barack - President
So what we're basically saying is we're going to do the same thing for these other folks that we do for ourselves -- on the taxpayers' dime, by the... |
| 01:54:1226 sec. |
Obama, Barack - President
Now, there is a legitimate philosophical difference around that, but I think it's just very important for us to remember that saying there's a baseline... |
| 01:54:3835 sec. |
Obama, Barack - President
This, by the way, goes to the other difference that we have when it comes to interstate purchase of insurance. Actually, this is a Republican idea,... |
| 01:55:1356 sec. |
Obama, Barack - President
So do you guys. But again, the one difference, as I understand it, and the reason you're not supporting the approach that we take, is what we say is... |
| 01:56:099 sec. |
Obama, Barack - President
So what we've said is, well, if we can set a baseline, then you can have interstate competition, but it's not a race to the bottom; rather everybody... |
| 01:56:1835 sec. |
Obama, Barack - President
Now, these are legitimate arguments to have. But I just want to point out that this issue of government regulation, which we're going to also be talking... |
| 01:56:5310 sec. |
Obama, Barack - President
So, Jim. And then what we're going to do is we're just going to move on to the next topic. But anybody who wants to pick up on what we've just talked... |
| 01:57:0330 sec. |
Clyburn, James E. - U.S. Representative, [D] South Carolina
Thank you very much, Mr. President. And, Mr. President, leaders, and members of the Congress, there are two cost containment issues that I think have... |
| 01:57:3347 sec. |
Clyburn, James E. - U.S. Representative, [D] South Carolina
They told me that their emergency room activities have doubled over the past several years. They were looking for some assistance to expand the size... |
| 01:58:2038 sec. |
Clyburn, James E. - U.S. Representative, [D] South Carolina
Now, they said to me that some of these people do not have health insurance, but many of them do have health insurance but they cannot afford the $1,500... |
| 01:58:581 min. |
Clyburn, James E. - U.S. Representative, [D] South Carolina
Now, I think that no matter what kind of plan you develop, there will be many people left uncovered, and we need a safety net for those people. I believe... |
| 02:00:0243 sec. |
Clyburn, James E. - U.S. Representative, [D] South Carolina
Secondly, Mr. President, a lot of other things have been said about what I have on this paper, but one other thing I would like to mention, and it has... |
| 02:00:4535 sec. |
Clyburn, James E. - U.S. Representative, [D] South Carolina
I would hope that when we start designing plans for the members of small businesses let's keep in mind that the employees of those small businesses... |
| 02:01:2048 sec. |
Clyburn, James E. - U.S. Representative, [D] South Carolina
And finally, Mr. President, this morning I was doing one of these call-in shows on C-SPAN. A gentleman called in and he was very, very emotional. ... |
| 02:02:0820 sec. |
Clyburn, James E. - U.S. Representative, [D] South Carolina
What we're doing here fixes that, and I do believe that we ought to really be honest with the American people when we talk about what we are doing with... |
| 02:02:2822 sec. |
Obama, Barack - President
Okay. I think this has actually been a very useful conversation. What I'm going to do is move on to the next topic, but maybe after we break for lunch... |
| 02:02:5038 sec. |
Obama, Barack - President
One thing, Jon, you shook your head when I said that people would be able to choose the better plan because the notion was, well, people are mandated.... |
| 02:03:2825 sec. |
Kyl, Jon - U.S. Senator, [R] Arizona
Well, Mr. President, if I could clarify, that's for a very limited period of time, number one. Secondly, the incentives are set up so that employers... |
| 02:03:5313 sec. |
Kyl, Jon - U.S. Senator, [R] Arizona
So with all due respect, I disagree. And it's just a fundamental disagreement between us. Does Washington know best about the coverage people should... |
| 02:04:0637 sec. |
Obama, Barack - President
Can I just say that, at this point, any time that a question is phrased as, "Does Washington know better," I think we're kind of tipping the scales... |
| 02:04:4329 sec. |
Obama, Barack - President
Rather than go through the problem, because I think everybody understands out there the issue of people with preexisting conditions not being able to... |
| 02:05:1259 sec. |
Obama, Barack - President
I just want to go through areas where I think we agree on insurance reforms, or at least some Republicans and some Democrats agree. I think we agree... |
| 02:06:1119 sec. |
Obama, Barack - President
In addition, though, there are some other insurance reforms that have been proposed by the House and Senate in their legislation that I think we should... |
| 02:06:3016 sec. |
Obama, Barack - President
So what I'd do is, since I want to make sure that Mitch doesn't give me a time clock tally again, let me first go to Mitch and I don't know who wants... |
| 02:06:467 sec. |
Boehner, John A. - U.S. Representative, [R] Ohio
Mr. President, I'd like to yield to Dr. Boustany to continue this conversation about insurance reform. |
| 02:06:5339 sec. |
Boustany, Charles W. Jr. - U.S. Representative, [R] Louisiana
Thank you, Leader Boehner, and thank you, Mr. President. I come at this as a physician, a cardiovascular surgeon with over 20 years of practice doing... |
| 02:07:3236 sec. |
Boustany, Charles W. Jr. - U.S. Representative, [R] Louisiana
Now, we've all been through a long year -- town hall meetings, telephone calls, e-mails -- it goes on and on. And one thing that has become very clear,... |
| 02:08:0834 sec. |
Boustany, Charles W. Jr. - U.S. Representative, [R] Louisiana
So how can we achieve all this? Well, we've talked about some of it. I think one of the things we ought to really look at is how do you simplify,... |
| 02:08:4246 sec. |
Boustany, Charles W. Jr. - U.S. Representative, [R] Louisiana
A second area is how do you really promote choice and competition. We've all talked about it and I think we've had a lot of discussion already on those... |
| 02:09:2824 sec. |
Boustany, Charles W. Jr. - U.S. Representative, [R] Louisiana
We've talked about small business health plans. Again, I ran a small business; it was a medical practice. And when I wanted insurance when those premiums... |
| 02:09:5231 sec. |
Boustany, Charles W. Jr. - U.S. Representative, [R] Louisiana
Small business health plans is one way to really deal with this and allow for pooling. And where our big disagreement is, frankly, it's with how you... |
| 02:10:2329 sec. |
Boustany, Charles W. Jr. - U.S. Representative, [R] Louisiana
The same goes for purchasing insurance across state lines. I'm glad to hear our Democratic colleagues agree that this is an approach that needs to... |
| 02:10:5239 sec. |
Boustany, Charles W. Jr. - U.S. Representative, [R] Louisiana
Health savings accounts -- these are very, very popular among small business owners and families. And I think the one impediment today is the inability... |
| 02:11:3111 sec. |
Boustany, Charles W. Jr. - U.S. Representative, [R] Louisiana
We all agree on prohibiting insurance companies from arbitrarily cancelling insurance policies. That's a no-brainer; there's strong agreement on both... |
| 02:11:4229 sec. |
Boustany, Charles W. Jr. - U.S. Representative, [R] Louisiana
Now, with regard to preexisting conditions, this is an issue that is very difficult and many of us and our families may have been faced with. I can... |
| 02:12:1140 sec. |
Boustany, Charles W. Jr. - U.S. Representative, [R] Louisiana
Now, what we propose is using risk pools, expanding these risk pools, and reinsurance. It's an affordable way to do it. It creates certainty for a... |
| 02:12:5123 sec. |
Boustany, Charles W. Jr. - U.S. Representative, [R] Louisiana
The other thing we do is we create a way for small business owners to actually shop and compare apples to apples -- transparency -- and this is critical.... |
| 02:13:1420 sec. |
Boustany, Charles W. Jr. - U.S. Representative, [R] Louisiana
So, again, I think it's clear that the American people have rejected the bills that have gone through so far because they see increases in premiums... |
| 02:13:3419 sec. |
Boustany, Charles W. Jr. - U.S. Representative, [R] Louisiana
What American families want is a common step -- a common-sense step-by-step approach that will really lower the costs for families and small businesses.... |
| 02:13:5336 sec. |
Obama, Barack - President
Okay. Thanks, Charles. We're going to go to George Miller -- and if you want to respond to some specific things that Charles raised or make some more... |
| 02:14:293 sec. |
Baucus, Max - U.S. Senator, [D] Montana
Mr. President, I don't know if anybody -- we weren't told of what the time limits are. |
| 02:14:323 sec. |
Obama, Barack - President
Well, I'm trying to be flexible. |
| 02:14:354 sec. |
Baucus, Max - U.S. Senator, [D] Montana
I know, I'm just curious if you've got a certain amount of time in mind. |
| 02:14:393 sec. |
Obama, Barack - President
We've got about half an hour remaining for this section. So if people can keep their points brief. |
| 02:14:426 sec. |
Reid, Harry - U.S. Senator, [D] Nevada
Mr. President, from the Senate we have Senator Harkin and Rockefeller to respond for the Democrats. |
| 02:14:484 sec. |
Obama, Barack - President
Right. And I've got a list. George. |
| 02:14:5237 sec. |
Miller, George - U.S. Representative, [D] California
Thank you very much. This issue of insurance reform is I think where most families intersect with their insurance companies, with the health security... |
| 02:15:2932 sec. |
Miller, George - U.S. Representative, [D] California
But we think -- and our bill goes further than some of the suggestions you've made in the interim since the House and Senate have passed these bills... |
| 02:16:0122 sec. |
Miller, George - U.S. Representative, [D] California
Clearly now when we see the request in California for a 38 percent increase and in Michigan for a 56 percent increase, I think in Maine it's 27 percent... |
| 02:16:2333 sec. |
Miller, George - U.S. Representative, [D] California
But the one area where there still seems to be disagreement -- it was not in the substitute offered by the Republicans when we were on the floor --... |
| 02:16:5627 sec. |
Miller, George - U.S. Representative, [D] California
And the fact of the matter is -- you hate to admit this at my age, but I sit here with two artificial hips, a little bit of arthritis, and I have a... |
| 02:17:2324 sec. |
Miller, George - U.S. Representative, [D] California
And if you have acne, it's a way of denying you care. In fact, as you see from one of the Blue Cross companies here -- there's three pages of things... |
| 02:17:4717 sec. |
Miller, George - U.S. Representative, [D] California
So what does that mean when you want to change jobs; what does that mean when you want to start your own company? It means you go without insurance... |
| 02:18:0417 sec. |
Miller, George - U.S. Representative, [D] California
This is a real issue to American families. Fifty-six million people right now have insurance policies where preexisting conditions can knock them out... |
| 02:18:2123 sec. |
Miller, George - U.S. Representative, [D] California
And so now you're trapped, you have a preexisting condition, you can continue maybe -- maybe -- with that insurance company if you pay more, but you... |
| 02:18:4442 sec. |
Miller, George - U.S. Representative, [D] California
Now, the interesting thing was, during these negotiations Senator Dodd and I worked very hard on these issues. Most of the business community signed... |
| 02:19:2627 sec. |
Miller, George - U.S. Representative, [D] California
And so I think that this is a very important part of this discussion. I know when I go home to my district I hear about this from the people I represent.... |
| 02:19:5340 sec. |
Miller, George - U.S. Representative, [D] California
And yes, you can go to a high-risk pool; so yes, because you have a preexisting condition, because I have two artificial hips, I can go to the most... |
| 02:20:3317 sec. |
Miller, George - U.S. Representative, [D] California
Now, fortunately, in our discussions, as I said, a lot of the business organizations have agreed that these things should be phased out over time. ... |
| 02:20:5016 sec. |
Miller, George - U.S. Representative, [D] California
So I would just hope that we would focus on this issue of what real insurance reform looks like with respect to the impacts on families and individuals... |
| 02:21:064 sec. |
Obama, Barack - President
Thank you, George. |
| 02:21:1022 sec. |
McCain, John S. III - U.S. Senator, [R] Arizona
Well, thank, Mr. President, and thank you for doing this. And I understand the four categories, but there's a big category that the people in my state... |
| 02:21:3244 sec. |
McCain, John S. III - U.S. Senator, [R] Arizona
Now, both of us during the campaign promised change in Washington. In fact, eight times you said that negotiations on health care reform would be conducted... |
| 02:22:1644 sec. |
McCain, John S. III - U.S. Senator, [R] Arizona
One of the things that -- as provisions of this legislation that was particularly offensive was the carveout for 800,000 Florida seniors exempt from... |
| 02:23:0020 sec. |
McCain, John S. III - U.S. Senator, [R] Arizona
And at the town hall meetings that I conduct all over my state, people are angry. We promised them change in Washington and what we got was a process... |
| 02:23:2026 sec. |
McCain, John S. III - U.S. Senator, [R] Arizona
So then we got into the special interests, whether it be the Hospital Association or the AMA or others. And one of them that was particularly egregious... |
| 02:23:4636 sec. |
McCain, John S. III - U.S. Senator, [R] Arizona
Their over $2-million-a-year lobbyist was here at the White House and was reported to say in the media “a deal is a deal.” And part of that deal was... |
| 02:24:22 |
Obama, Barack - President
John, can I just say -- |
| 02:24:2222 sec. |
McCain, John S. III - U.S. Senator, [R] Arizona
Can I just finish, please? And then at Christmas Day -- I believe it was Christmas, the Majority Leader said, “A number of states are treated differently... |
| 02:24:4427 sec. |
McCain, John S. III - U.S. Senator, [R] Arizona
So when my constituents and Americans now who overwhelmingly reject this proposal, say, go, back to the beginning -- they want us to go back to the... |
| 02:25:1123 sec. |
McCain, John S. III - U.S. Senator, [R] Arizona
So I hope that that would be an argument for us to go through this 2,400-page document, remove all the special deals for the special interests and favored... |
| 02:25:342 sec. |
McCain, John S. III - U.S. Senator, [R] Arizona
I thank you, Mr. President. |
| 02:25:368 sec. |
Obama, Barack - President
Let me just make this point, John, because we're not campaigning anymore. The election is over. |
| 02:25:44 |
McCain, John S. III - U.S. Senator, [R] Arizona
I'm reminded of that every day. (Laughter.) |
| 02:25:4444 sec. |
Obama, Barack - President
Yes. So we can spend the remainder of the time with our respective talking points going back and forth. We were supposed to be talking about insurance.... |
| 02:26:2823 sec. |
Obama, Barack - President
My concern is, is that if we do that, then we're essentially back on FOX News or MSNBC on the split screen just arguing back and forth. So my hope... |
| 02:26:517 sec. |
Obama, Barack - President
And this would probably be a good time to turn it over to Secretary Sebelius, who -- |
| 02:26:589 sec. |
McCain, John S. III - U.S. Senator, [R] Arizona
Could I just say, Mr. President, the American people care about what we did and how we did it. And I think it’s a subject that we should discuss. ... |
| 02:27:0721 sec. |
Obama, Barack - President
They absolutely do care about it, John. And I think that the way you characterized it obviously would get some strong objections from the other side.... |
| 02:27:2824 sec. |
Obama, Barack - President
So, Kathleen, why don't you just address some of the issues related to insurance reform. There’s some agreement here, but I know that on the Republican... |
| 02:27:5215 sec. |
Obama, Barack - President
You’ve been both a governor as well as an insurance commissioner. Maybe you can talk a little bit about what you’ve seen at all those different levels... |
| 02:28:0726 sec. |
Sebelius, Kathleen - Secretary
Well, thank you, Mr. President. And I know there are lots of people who want to comment on these topics, but I don't think there’s any question and... |
| 02:28:3320 sec. |
Sebelius, Kathleen - Secretary
According to the American Medical Association, in their study yesterday, 99 percent of the market in metropolitan areas, 75 percent of the markets across... |
| 02:28:5333 sec. |
Sebelius, Kathleen - Secretary
And I think the rules allow people to be locked out from the front end if you’ve got preexisting conditions; allow people to be thrown out with a stop... |
| 02:29:2648 sec. |
Sebelius, Kathleen - Secretary
So the common areas I think of agreement -- high-risk pools. There are lots of states across the country running high-risk pools. As an insurance... |
| 02:30:1447 sec. |
Sebelius, Kathleen - Secretary
They don't work very well. They are a stopgap measure that the House and Senate have proposed to get people from here to a new market. I think what... |
| 02:31:0114 sec. |
Sebelius, Kathleen - Secretary
And we had the drive-by deliveries in Kansas, where people were being kicked out of the hospital 18 hours after having a baby, to save money, only to... |
| 02:31:1549 sec. |
Sebelius, Kathleen - Secretary
So getting rid of preexisting conditions, getting rid of caps on yearly benefits and longtime benefits, allowing kids to stay on plans are ideas that... |
| 02:32:0438 sec. |
Sebelius, Kathleen - Secretary
How many of your dollars are you actually spending on provider care, on prescriptions, on treatments; and how much is going to overhead and CEO salaries... |
| 02:32:4252 sec. |
Sebelius, Kathleen - Secretary
It's a lot cheaper to insure people who promise never to get sick. I watched it as insurance commissioner. But segregating that market is not insurance,... |
| 02:33:348 sec. |
Obama, Barack - President
Okay. Eric. |
| 02:33:4211 sec. |
Cantor, Eric - U.S. Representative, [R] Virginia
Mr. President, thank you again very much for having us and for staying with us for the six hours. I appreciate that. I don't know if you will after... |
| 02:33:537 sec. |
Obama, Barack - President
Let me just guess -- that that's the 2,400-page health care bill. Is that right? |
| 02:34:0012 sec. |
Cantor, Eric - U.S. Representative, [R] Virginia
Well, actually, Mr. President, this is the Senate bill along with the 11-page proposal that you put up online that really I think is the basis for the... |
| 02:34:1235 sec. |
Cantor, Eric - U.S. Representative, [R] Virginia
But I do want to go back to your suggestion as to why we're here. And you suggested that maybe we are here to find some points of agreement to bridge... |
| 02:34:4743 sec. |
Cantor, Eric - U.S. Representative, [R] Virginia
We don't care for this bill. I think you know that. The American people don't care for the bill. I think that we've demonstrated in polling that... |
| 02:35:3024 sec. |
Cantor, Eric - U.S. Representative, [R] Virginia
But let's -- in the spirit of trying to come together, let's try and say, maybe if -- if we assume that Washington could do that, could really take... |
| 02:35:5434 sec. |
Cantor, Eric - U.S. Representative, [R] Virginia
First of all, the cost, and Jon Kyl laid out the tremendous cost in the nearly trillion dollars of this bill. And I don't quite know, because CBO said... |
| 02:36:2824 sec. |
Cantor, Eric - U.S. Representative, [R] Virginia
But also, Mr. President, when we were here abut a year ago across the street, you started the health care summit by saying one of the promises you want... |
| 02:36:5243 sec. |
Cantor, Eric - U.S. Representative, [R] Virginia
Well, the CBO sent a letter -- I think it was to Leader Reid -- about the Senate bill. And in that letter, it suggested that between 8 million and... |
| 02:37:3521 sec. |
Cantor, Eric - U.S. Representative, [R] Virginia
The problem is when you start to mandate all of the essential benefits, there are going to be some insurance premium increases. None of us really want... |
| 02:37:5631 sec. |
Cantor, Eric - U.S. Representative, [R] Virginia
So I guess my question to you is, in the construct of this bill, if we want to find agreement, we really do need to set this aside. And we really do... |
| 02:38:2731 sec. |
Obama, Barack - President
Well, let me -- since you asked me a question, let me respond. The 8 to 9 million people that you refer to that might have to change their coverage... |
| 02:38:5838 sec. |
Obama, Barack - President
Point number two, when we do props like this -- stack it up and you repeat 2,400 pages, et cetera -- you know, the truth of the matter is that health... |
| 02:39:3645 sec. |
Obama, Barack - President
Now, let me respond to your question. We could set up a system where food was probably cheaper than it is right now if we just eliminated meat inspectors... |
| 02:40:2151 sec. |
Obama, Barack - President
But we don't do that. We make some decisions to protect consumers in every aspect of our lives. And we have bipartisan support for doing it, because... |
| 02:41:121 min. |
Obama, Barack - President
Now, we can have a philosophical disagreement about how much insurance regulation is appropriate. What you've indicated to me, just based on the bills... |
| 02:42:1847 sec. |
Obama, Barack - President
Now, let me just close by saying this. Preexisting conditions is one that theoretically we all say we agree on. Theoretically, everybody thinks it's... |
| 02:43:0540 sec. |
Obama, Barack - President
Here is the problem. What happens is the reason that all our rates -- as members of Congress or as elected officials -- are pretty low -- is we've... |
| 02:43:4525 sec. |
Obama, Barack - President
That's the concept of pooling, is you get the healthy and the young people alongside the not-so-healthy and the older people. But we're all kind of... |
| 02:44:1023 sec. |
Obama, Barack - President
When you get into something like a high-risk pool what happens is all the sicker, older people are in that pool; all the younger people, they end up... |
| 02:44:3325 sec. |
Obama, Barack - President
Now, on preexisting conditions we've got a similar situation. The challenge we have -- I'd love to just pass a law that said, insurance companies,... |
| 02:44:5828 sec. |
Obama, Barack - President
So we've tried to respond to a difficult problem by saying, well, let's make sure everybody has some coverage. Without that it's hard to do. So I... |
| 02:45:26 |
Cantor, Eric - U.S. Representative, [R] Virginia
Mr. President, if I could respond. |
| 02:45:263 sec. |
Obama, Barack - President
Please. |
| 02:45:2924 sec. |
Cantor, Eric - U.S. Representative, [R] Virginia
We, again, have a very difficult bridge to gap here, because I know that this is something that we don't want to look at, but these are, as you say,... |
| 02:45:5338 sec. |
Cantor, Eric - U.S. Representative, [R] Virginia
We just can't afford this. I mean, that's the ultimate -- that's the ultimate problem here, is in a perfect world everyone would have everything they... |
| 02:46:317 sec. |
Obama, Barack - President
I think the cost issue is legitimate, and whether we can afford it or not, we'll be discussing that. I think that's an entirely legitimate discussion. |
| 02:46:38 |
Biden, Joseph "Joe" R. Jr. - Vice President, [D] United States
Mr. President, can I have 10 second? Literally, 10 seconds. |
| 02:46:384 sec. |
Obama, Barack - President
Go ahead. |
| 02:46:4214 sec. |
Biden, Joseph "Joe" R. Jr. - Vice President, [D] United States
We don't have a philosophic disagreement. If you agree that you can't be dropped, there has to be dependent coverage, if there's no annual lifetime... |
| 02:46:5610 sec. |
Biden, Joseph "Joe" R. Jr. - Vice President, [D] United States
So this idea we have a fundamental, philosophic difference -- you're either in or you're out. You either say your government can't do it, none of it,... |
| 02:47:066 sec. |
Obama, Barack - President
The cost issue is legitimate; we're going to address it. I want to -- |
| 02:47:1214 sec. |
Cantor, Eric - U.S. Representative, [R] Virginia
Mr. President, if I could, it's not the -- it's the cost issue, but it's being driven by the fact that you've got in the bill -- which I assume that... |
| 02:47:2622 sec. |
Obama, Barack - President
Only in the exchange. Only as part of the pool that people who don't have health insurance would buy into. If you were working at a big company that... |
| 02:47:4831 sec. |
Obama, Barack - President
I've got, on the Democratic side, a couple of people that want to speak, and there are probably a couple of Republicans. We're already over time. ... |
| 02:48:199 sec. |
Slaughter, Louise - U.S. Representative, [D] New York
Thank you, Mr. President, and thanks to all of my colleagues for being here. I am pretty succinct and pretty timely. I will not take up a lot of time,... |
| 02:48:2822 sec. |
Slaughter, Louise - U.S. Representative, [D] New York
The first one is the preexisting conditions absolutely has to go. It is cruel, it is capricious, and it is done only to enhance the bottom line. This... |
| 02:48:5023 sec. |
Slaughter, Louise - U.S. Representative, [D] New York
Eight states in this country right now have declared that domestic violence is a preexisting condition on the grounds, I assume, that if you've been... |
| 02:49:1334 sec. |
Slaughter, Louise - U.S. Representative, [D] New York
In 1991, women were not included in any of the trials at the NIH because we had hormones. It wasn’t until we had a critical mass of women here that... |
| 02:49:4737 sec. |
Slaughter, Louise - U.S. Representative, [D] New York
Now, think about that for a minute, if you will. We couldn't do that because we said kindly would you stop doing that. It took legislation. Doing... |
| 02:50:2434 sec. |
Slaughter, Louise - U.S. Representative, [D] New York
In the 13, 15 years since that has happened we have done nothing about health care; we don't export so much anymore; the automobile business is basically... |
| 02:50:5834 sec. |
Slaughter, Louise - U.S. Representative, [D] New York
Also since the Clinton health care plan we've seen some pretty awful things. We saw hospitals abandoned to the streets; critically ill, elderly, mentally... |
| 02:51:3232 sec. |
Slaughter, Louise - U.S. Representative, [D] New York
So what are we going to be doing then? We're going to be once again abandoning our elderly, abandoning our mentally ill and our seriously ill to the... |
| 02:52:0419 sec. |
Slaughter, Louise - U.S. Representative, [D] New York
I even had one constituent -- you will not believe this, and I know you won't, but it's true -- her sister died. This poor woman had no dentures --... |
| 02:52:2317 sec. |
Slaughter, Louise - U.S. Representative, [D] New York
This is the last chance as far as I'm concerned, particularly on the export business. We have fallen behind, we're no longer the biggest manufacturer... |
| 02:52:40 |
Slaughter, Louise - U.S. Representative, [D] New York
Thank you very much. |
| 02:52:4033 sec. |
Obama, Barack - President
Louise, thank you. I was just informed -- and by the way, this has been a terrific conversation so far -- the House had to schedule a vote on an item,... |
| 02:53:1347 sec. |
Obama, Barack - President
What I'd like to do is to break so that the House can take the vote. When we come back we will start with Mike and we will return to finish up the... |