Health Care Push and Pushback
PHLLIPS: You're looking at live pictures now as the president of the United states is getting ready to step up to the podium there at Shaker Heights High School. That's just outside of Cleveland, Ohio. And basically, this is the epicenter of the U.S. health care debate for the president right now. He's about to make his daily pitch for reform. And he's going to open it up to Q and A there in a town hall-type format. And we're going to take it in its entirety. As you know, well, we've got some information on actually who interviewed -- or introduced the president. Chad pointed him out just prior to -- all right, here it is. Rick Baka (ph) actually introduced the president. That's who you heard from him. And he worked the night shift there at a warehouse, part of the Teamster Local Union 507, talking about health care, pensions. Perfect way to enter right into the president's speech. Let's go ahead and listen.</s>BARACK OBAMA, PRESIDENT OF THE UNITED STATES: Thanks. Please, everybody have a seat. Thank you. Hello.</s>OBAMA: Hello, Shaker Heights. Hello, Ohio. It is great to be here. There are a couple of quick announcements I want to make. First of all, please give Rick a big round of applause for his introduction.</s>OBAMA: Some special guests that we've got. First of all, the governor of the great state of Ohio, Ted Strickland, is in the house.</s>OBAMA: There he is right there. Your state treasurer, Kevin Boyce, is here.</s>OBAMA: Your secretary of state, Jennifer Brunner, is here.</s>OBAMA: The mayor of the great city of Cleveland, Frank Jackson, is here.</s>OBAMA: Shaker Heights Mayor Earl Leiken is here.</s>OBAMA: The Shaker Heights school superintendent, Mark Freeman, is here.</s>OBAMA: Not here, but a couple of my favorite people, Congresswoman Marsha Fudge and Sherrod Brown, couldn't be here today. They've got work to do in Washington. It is good to be back in the great state of Ohio.</s>OBAMA: Now, I know there are those who like to report on the back and forth in Washington, but, you know, my only concern is the people who sent us to Washington, the families feeling the pain of this recession, the folks I've met across this country who have lost jobs and savings and health insurance but haven't lost hope. The citizens who defied the Senate and the skeptics who went to the polls to demand real and lasting change. Change was the cause of my campaign. It is the cause of my presidency. And when my administration came into office, we were facing the worst economy since the Great Depression. We were losing an average of 700,000 jobs per month. Hundreds of thousands of Ohioans have felt that pain firsthand. Our financial system was on the verge of collapse, meaning families and small businesses couldn't get the credit they need. And experts were warning that there was a serious chance that our economy could slip into a depression. Because of the action we took in those first weeks, we've been able to pull our economy back from the brink. Now that the most immediate danger is past, there are some who question those steps. So, let me report to you exactly what we've done. We passed a two- year recovery act that meant an immediate tax cut for 95 percent of Americans and small business, 95 percent.</s>OBAMA: It extended unemployment insurance and health coverage for those who lost their jobs in this recession.</s>OBAMA: It provided emergency assistance to states like Ohio to prevent even deeper playoffs of police officers and firefighters and teachers and other essential personnel.</s>OBAMA: At the same time, we took needed steps to keep the banking system from collapsing, to get credit flowing again and to help responsible homeowners hurt by falling home prices to stay in their homes. In the second phase, we're now investing in projects to repair and upgrade roads and bridges, ports and water systems and in schools and clean-energy initiatives throughout Ohio and all across the country. These are projects that are creating good jobs and bring lasting improvements to our communities and our country. There's no doubt that the steps we've taken can help stave off a much deeper disaster and even greater job loss. They've saved and helped create jobs and have begun to put the brakes on this devastating recession. But I know that for the millions of Americans who are looking for work, for those who are struggling in this economy, full recovery can't come soon enough. I hear from you at town hall meetings like this. I read your letters. The stories I hear are the first thing I think about in the morning. They're the last thing I think about at night. They're the focus of my attention every waking minute of every day. The simple truth is that it took us years to get into this mess, and it will take more than a few months to dig our way out of it.</s>OBAMA: But I want to promise you this, Ohio, we will get there.</s>OBAMA: And we are doing everything in our power to get our people back to work.</s>OBAMA: I love you back.</s>OBAMA: We also have to do more than just rescue this economy from recession. We need to address the fundamental problems that allowed this crisis to happen in the first place. Otherwise, we'd be guilty of the same short-term thinking that got us into this mess. That's what Washington has done for decades. We put things off. And that's what we have to change. Now is the time to rebuild this economy stronger than before. Strong enough to compete in the 21st century. Strong enough to avoid the waves of boom and bust that have time and time again unleashed a torrent of misfortune on middle-class families across the country. That's why we are building a new-energy economy that will unleash the innovative potential of America's entrepreneurs and create millions of new jobs, helping to end our dependence on foreign oil. We're transforming our education system from cradle to college, so that this nation once again has the best-educated workforce on the planet. We are pursuing health insurance reform so that every American has access to quality, affordable health coverage.</s>OBAMA: I want to talk about health care just for a second. I want to be clear. Reform isn't just about the nearly 46 million Americans without health insurance. I realize that with all the charges and the criticism being thrown out there in Washington, many Americans may be wondering, well, how does my family or my business stand to benefit from health insurance reform? What's in this for me? Folks are asking me. So, I want to answer those questions briefly. If you have health insurance, the reform we're proposing will give you more security. You just heard Rick's story. Reform will keep the government out of your health care decisions, giving you the option to keep your coverage if you're happy with it. So, don't let folks say that somehow we're going to be forcing government-run health care. It's just not true. And it will keep the insurance companies out of your health care decisions too...</s>OBAMA: ... by stopping insurers from cherry-picking who they cover and holding insurers to a higher standard for what they cover.</s>OBAMA: You won't have to worry about receiving a surprise bill in the mail, because we'll limit the amount your insurance company can force you to pay out of your own pocket.</s>OBAMA: You won't have to worry about pre-existing conditions because...</s>OBAMA: ... never again will anyone in America be denied coverage because of a previous illness or injury.</s>OBAMA: I don't think it's too soon for the families who've seen their premiums rise faster than wages year after year. It's not too soon for the businesses forced to drop coverage or shed workers because of mounting health care expenses. It's not too soon for taxpayers asked to close widening deficits that stem from rising health care costs, costs that threaten to leave our children with a mountain of debt. Reform may be coming too soon for some in Washington, but it's not soon enough for the American people. We can get this done. We don't shirk from a challenge.</s>OBAMA: We haven't asked -- you know -- there are no preprogrammed questions. All you have to do is, first of all, everybody should sit down.</s>QUESTION: Hello.</s>OBAMA: Hello.</s>QUESTION: Good afternoon, Mr. President. Thanks for taking my question. My name is Norma Goodman (ph). My question regarding health care is twofold. It appears that your plan has the health care industry funding your health care reform. And I think you just alluded to that a little. It poses a concern for me. I'm the owner of a Medicare-certified home care agency.</s>QUESTION: And, by the way, my agency wanted to invite you to come on a home visit with us.</s>OBAMA: Yes, I -- I don't think so. The -- I should point out, if I'm not mistaken, that the home care industry has actually endorsed this reform effort and are moving forward. But, well, go ahead and finish your question.</s>QUESTION: Well, that is my concern, that your budget proposal has lined up, from MedPAC's recommendations, cuts for the next several years, that will amount to, I don't know, $13 billion or something like that over the next few years, so...</s>OBAMA: OK, well, let me -- let me just respond. The -- the MedPAC idea is to have health care experts and doctors sit down and figure out, how can we improve Medicare; how can we make it more cost- efficient? It is not an exercise in just cutting reimbursement rates. In fact, in some cases, we may need higher reimbursement rates for certain aspects. I actually think home care ends up being cost- efficient, in many cases...</s>QUESTION: Thank you.</s>OBAMA: ... rather than institutional care, and it helps keep people in their homes.</s>OBAMA: But right now, the way the reimbursement system is set up, you don't have that incentive to just have the one test and then use information technology to distribute it throughout the system. So those are the kinds of changes that we want to make. You know, we think that the more that we're encouraging efficient, smart care, that's going to be good for providers. That's going to be good for patients. That actually frees up more money so that we in some cases can provide higher reimbursements for folks who right now are not getting sufficient reimbursement. It's a matter of using the dollars that we're spending more wisely than we're spending them right now. OK? All right.</s>QUESTION: Thank you.</s>OBAMA: Thank you. The gentleman in the red right there.</s>QUESTION: Well, first, Mr. President, welcome to Shaker Heights.</s>OBAMA: Thank you.</s>QUESTION: The city that makes things work.</s>OBAMA: Well, I'll tell you what. I think Senator Reid said today that he thought that we can get this bill out of the Senate Finance Committee by the time of recess, and that, in early fall, they will come back and actually vote on the bill. Now, I haven't talked to him today. My attitude is, I want to get it right, but I also want to get it done promptly. And, so, as long as I see folks working diligently and consistently, then I am comfortable with moving a process forward that builds as much consensus as possible. What I don't want is what I refer to in my speech delay for the sake of delay, delay because people are worried about making tough decisions or casting tough votes. That's what I don't want to see. So, if people are legitimately working out tough problems -- and some of these problems are tough. This is a big system. And it's complicated. So, I have no problem if I think people are really working through these difficult issues, in making sure that we get it right. But I don't want to delay just because of politics. And I have to tell you, sometimes, delays in Washington occur because people just don't want to do anything that they think might be controversial. And you know what? That's not how America has made progress in the past. Medicare was controversial. Social Security was controversial. People accused Franklin Delano Roosevelt of being a socialist because he wanted to set up a system to make seniors a little more secure. Going to the moon was controversial. But, at some point, if we are going to move this country forward, we can't be afraid to change, especially a system that we know is broken. We have got to get it done and we have got to get it done soon.</s>OBAMA: All right. This young -- that lady right there, who is waving at me.</s>UNIDENTIFIED FEMALE: Thank you very much. My name is Semanthie Brooks. And I am the director of community advocacy for the Benjamin Rose Institute in Cleveland.</s>OBAMA: OK.</s>UNIDENTIFIED FEMALE: I also represent a group called Senior Voice. And we, by the way, sent over 4,000 signatures to our congressional members asking their support of Medicare. And, so, my question is about Medicare and the doughnut hole in particular. We know that about 3.4 million seniors will fall into the doughnut hole on an annual basis. This represents about one in four seniors that will participate in the Part D program. When seniors fall into the doughnut hole, they then have to make choices about whether or not they take their medications. They break their pills in half. They make a decision about buying medication or purchasing food. My question to you, Mr. President, is that will you support legislation that is currently being introduced in the House to close the doughnut hole over the next several years?</s>OBAMA: Well, the -- I'm going to do more than that for you. In our health care reform proposal, we have already extracted concessions from the pharmaceutical industry that we know will right away close half of that doughnut hole. They have already put $80 billion on the table. That's part of the reason AARP endorsed the bill. Now, by the way, for those of you who don't know what the doughnut hole is, the way the Medicare prescription drug plan works is that it helps you pay for your prescription drugs, until you hit a certain ceiling, a certain level of several thousand dollars, and then, suddenly, the subsidies, the help from the federal government just go away. And you have got to pay out-of-pocket expenses of several more thousands of dollars until you get to the point where help kicks in again. So, that's why they call it the doughnut hole, because there is a hole right in the middle where you don't get any help. And it costs seniors thousands of dollars. One of the things that we can do through reform is to make sure that we are moving to close that doughnut hole. That's a commitment that will be contained in this health care reform bill that we get passed.</s>OBAMA: All right. This young man right here. We will get a young guy in here.</s>UNIDENTIFIED MALE: Hi, Mr. President. My name is Brooks Boran (ph). I am going to be a junior in high school. My question is, for students, how can we help get this reform passed?</s>OBAMA: Well, I appreciate that. I like that.</s>OBAMA: Well, first of all, I very much appreciate that, as a junior in high school, you are still thinking about -- you are already thinking about this, because, usually, young people, they think they are in destructible, so they don't need health care.</s>OBAMA: And, in fact, a high proportion of the uninsured are actually young people, particularly right after they graduate from college. They haven't gotten a job yet that provides health care, and they are very vulnerable if, heaven forbid, something happens to them. There have been a couple of ideas that we have talked about, for example, extending the insurance of parents, making insurance companies -- keep kids on their insurance until they are 25. That would help a lot. But the question you asked was, how can you help get it done? Number one, make sure you are persuading your parents, if they are not already convinced. But mom is right there. So, she is already on board. I think that activism right now, in calling your congresspeople, calling your senators, making sure they know this is important, that is something that everybody here needs to do, because, frankly, they are hearing from the other side. All those folks who are out there saying we can't afford this, this is socialism, this will lead to government-run health care, all the folks who are getting ginned up on talk radio and some of these cable news shows, you know, I have to say that they have an effect on members of Congress. It makes members of Congress nervous. So, they need to hear from folks who are saying in a very commonsense way this is something we can do. It's going to be paid for. It is not going to add to the deficit. It will, in fact, control the deficit over the long term. And young people should particularly be concerned about that, because, if health care inflation keeps going up at the rate that it is, you won't -- when your generation is running things, won't be able to afford anything else in the federal budget. Medicare and Medicaid will consume all our health care dollars -- or all our federal dollars. That's a huge problem. But the last thing I just want to emphasize to people, when you contact your senators, when you contact your -- your members of Congress, make sure to make this a personal testimony. Tell your story about why you're concerned, because, sometimes, these debates get so abstract. And I have to remind people, you know, I get a story about a woman who contracts cancer, and, suddenly, not only is she worrying about her cancer, but she's also worrying about the $100,000 worth of unpaid medical bills that she's having to deal with and her family can't afford. I hear from people who say, you know: "I have always worked hard. I have always done well. I have got a good job. I left my job to start my business. Suddenly, I find that I can't get health insurance because of a preexisting condition. And so I'm going to have to close up my business and I'm going to have to go back to doing something where I can get health insurance." I mean, those stories, everybody knows them. And one of the things that I emphasized yesterday that people I think don't maybe think about enough is, if all that money is being eaten up in premiums, even if your employer is paying for them, guess what? That means that employer has got less money to give you a raise. So, you wonder why, for the last 10 years, wages and incomes have been flat. If you look on average, people haven't gotten a raise. Why is that? Well, part of it is because it's all been taken up in increased health care costs, even if the companies are profitable. And, you know, the -- the group that actually understands this best is folks who were members of unions. Because -- and the reason is, what happens? You guys go into negotiations, and your employer, even if they're well-meaning, even if they want to cooperate with the union, they say, "Look, guys, I can't afford to give you a raise" -- "I can't afford to raise the hourly wage because, look at what's happened to my health care rates." And your whole negotiation ends up being how much more of a health care burden are you going to have to carry, when you thought those benefits were already locked in. So that's why health care reform is so important, even if you've got health insurance, because it is taking money out of your pockets, and it's leaving a lot of people in very dire straits. So -- all right? OK.</s>OBAMA: This young lady right here. There's a gentleman who's coming with a microphone.</s>UNIDENTIFIED FEMALE: Hello, Mr. President. I'm Dr. Dinalee Macrin (ph), and I have a question. The Republicans and some Democrats want to tax health care benefits. Using one of the local Council of Smaller Enterprise plans, an individual male would pay $1,500 at the age of 24, $5,200 at age 50, and almost $10,000, for the same plan. For a female employee, it would cost $3,300 at age 24 and $6,400 at age 50. Family plans are more. A tax credit can only benefit those who make enough money to use a tax credit.</s>OBAMA: Mm-hmm.</s>UNIDENTIFIED FEMALE: Most people don't need a tax credit. How would you make the taxing of benefits equitable to older and female workers?</s>OBAMA: Well, let me -- just to make sure I understand your question, or I will try to answer what I think your question was. First of all, in terms of taxing benefits, I said I -- I oppose the taxing of health care benefits that people are already receiving. So, that's not a proposal that I'm supportive of. There is being discussed in the Senate Finance Committee the fact that some folks have Cadillac plans, meaning -- let's, just to give you an example. The average member of Congress' plan I think is somewhere, it's either $13,000 or $17,000 or $14,000. It's somewhere in that range, so that's a pretty good plan. That's what members of Congress get. Now, what the Senate Finance Committee has been saying is, maybe when you get to a $25,000 plan, so one that's a lot more expensive and a lot fancier than the one that even members of Congress get, maybe at that point what you should do is you should sort of cap the exclusion, the tax deduction that is available so that we're discouraging, you know, these really fancy plans that end up driving up costs.</s>OBAMA: That's the debate that's been taking place. And I think that is at least -- you know, I haven't signed on to that approach, but I think it's a legitimate debate to have. But what I have said, and I have taken off the table would be the idea that you just described, which would be that you would actually provide -- you would eliminate the tax deduction that employers get for providing you with health insurance. Because, frankly, a lot of employers would then stop providing health care and we'd probably see more people lose their health insurance than currently have it. And that's not, obviously, our objective in reform. OK? All right.</s>QUESTION: Yes.</s>QUESTION: Hi. I'm Brandon Patterson and I'm Shaker Heights senior class president. And I want to say, on behalf of the entire...</s>OBAMA: Well, keep in mind that one way of dealing with this is having health insurance reform so that young people are covered under their parents' plan while they're in that transition period from college to a job. But anybody under the plan that we've proposed and actually we're seeing consensus in Congress about, anybody would be eligible to go ahead and get health insurance through what we're calling this exchange with subsidies with help from the federal government if you can't afford it, so that you'd still be able to get health insurance even if you're 20 or 21 or 22, as long as you are eligible financially. I mean, if you're LeBron James, I love LeBron, but he doesn't need a subsidy from the federal government for health insurance.</s>OBAMA: But assuming you're -- you qualify in terms of income where you're a working person who's not making a lot of money, doesn't get health insurance on the job, regardless of age, you would then be eligible to go ahead and buy health insurance through this exchange. That's the whole idea, is that we're creating a system where anybody who doesn't have health insurance is able to go and look up and see these choices. By the way, this exchange has a lot of private plan options in it, if that's what you prefer. And you could choose the plan that you think works best for you, and we would then help you be able to purchase that insurance. And any insurer who was in the exchange would have to abide by certain rules, like you can't exclude people for preexisting conditions, like they can't just drop you if they decide that you get too sick. You can't lose your insurance just because you change jobs. Right? So we would be reforming the insurance industry and you would be able to get access for insurance that you could count on over the long term. All right? OK. It's a young lady's turn. Let's see. I have sort of neglected, I think, way up there. All right. That young lady who's standing up right there.</s>OBAMA: No, no, no. I'm sorry. I know you're excited, but I was pointing at her, right there.</s>QUESTION: Thank you, Mr. President. My name is Amy Vance (ph). I'm an R. N. that works for the Cleveland Clinic in community outreach. We serve the uninsured, and are doing some great things there. This is Connie Robinson (ph). She's a counselor also that works with me.</s>QUESTION: My question is, in the health care reform bill that you are putting together, are there going to be provisions for insurance companies to get paid for providing health education and health promotion type of things for their people, as well as more help with mental health services, because it's a huge deficit?</s>OBAMA: Well, you know, I have long been a supporter of mental health services as part of a package, and I think that's important. But I really want to focus on, in addition, what you just mentioned, which is issues of prevention and wellness. This can make such a huge difference. And, you know, I was meeting with some of the officers here at the Cleveland Clinic. They're all sitting up front here, very serious guys. They do outstanding work.</s>OBAMA: One of the things that's exciting, though, in addition to the big, fancy hospital with all the fancy equipment, they also, you know, are linked up with all these family clinics, all throughout the area. And one of the things that a clinic and a family physician can do is to focus on preventable diseases -- making sure that you're helping somebody with a nutritionist to keep their weight down before they get diabetes, as opposed to, you know, paying for surgery for a foot amputation.</s>OBAMA: If they already have diabetes, then having a counselor who's working with them monthly to make sure that they are maintaining the regimens to keep their diabetes under control, that is cost- efficient. But the problem is right now that a lot of the health system doesn't reimburse and incentivize that kind of preventive work and that wellness work. And so what we want to do is absolutely in this reform package, there will be reimbursements for and incentives for prevention and wellness, and we're going to make sure that those are the things that don't require out-of-pocket costs for the patient so that they're not being discouraged from using it, but rather they're being encouraged from using it. That will make all the difference in the world.</s>QUESTION: Thank you, Mr. President. I'm 14 years old. I'm going to be a freshman here.</s>OBAMA: OK, Parker.</s>QUESTION: All right. How can you reassure many Americans around the country that your health care proposal isn't too much, too fast?</s>OBAMA: Well, I think that's a great question. That's a great question.</s>OBAMA: First of all, I do think that, sometimes, people get the idea -- you know, I had said, let's get this done by August. Now, what I was referring to is, let's get bills voted out of the House and the Senate by August. That still means that we would have to come back in the fall. We would have to reconcile the differences between the Senate bill and the House bill, have a new bill. It would go back to the Senate and the House again to be voted on, then finally come to my desk. Our target date is to get this done by the fall. That's the bottom line. But, keep in mind that even if we got it done in the fall, most of these changes would be phased in over several years. So, it's not as if you are going to wake up tomorrow and, suddenly, the health care system has all changed completely. We are going to phase this in, in an intelligent, deliberate way. But there are some changes that I think have to take effect pretty quick. For example, making sure that we're reducing prescription drugs for seniors, we shouldn't have to wait a long time to get that done.</s>OBAMA: We shouldn't have to wait a long time to make sure that people don't lose their insurance because of a preexisting condition. There are some things that I think that we can start implementing where there is a pretty broad consensus it needs to get done. Now, is it too much? I don't think it is too much. It is only too much by the standards of Washington politics today, which is, basically, that anything just becomes this big tangle of who is up and who is down and who is advantaged and who is not, and the special interests and lobbyists are all scurrying around. By that standard, I know I am working people pretty hard up on Capitol Hill. But you know what? This is not too much. What we're talking about is not completely scrapping the existing health care system. All we're saying is, if you have got health insurance, you can keep it. If you don't have health insurance, you can now afford to buy it with some help. If you have health insurance, we're going to reform the insurance industry, so that it can still make a profit. It can still offer good services to its patients -- or to its customers. It just can't engage in some of these rules that basically have them collecting a lot of premiums, but not wanting to pay out when people really need it and when people get sick.</s>OBAMA: So -- and what we want to do -- now, here's what is complicated, is changing the delivery systems so that we actually start getting more quality for less money.</s>OBAMA: That's going to take some time. It's not going to happen overnight. The reason I visited the Cleveland Clinic is because, along with the Mayo Clinic, they have been able to drive down costs more than any other health care system out there, while maintaining some of the highest quality. Now, when I asked, you know, "how did you go about doing it," well, they started this thing -- when was it started? Cleveland Clinic?</s>OBAMA: 1921. And they -- what they have done is, for example, doctors who are part of the Cleveland Clinic get paid a salary, instead of being paid fee-for-service. So that makes it easier for them to make some of these changes, because people don't feel like maybe they're losing some money out of pocket, they just know that they're getting a salary. Now, that's not, maybe, the thing that every doctor is going to want to do. But there are other ways that we can take that same approach, where they start thinking in terms of what's needed for the patient, and making sure that they're getting reimbursed for what's good for the patient, and they don't, then, have to worry about what's the government saying or what's the insurance company saying? Am I going to get reimbursed for this? Am I not going to get reimbursed for this? Do I have to fill out 15,000 forms? I have said before, most people who are doctors or nurses, they didn't get into it to fill out forms, they got into it to make people feel better, to heal the sick.