President Obama Hosts a Health Reform Town Hall in Ohio

President Obama Hosts a Health Reform Town Hall in Ohio


(applause) The President:
Hello, Shaker Heights! Hello, Ohio! It is great to be here. There are a couple of quick
acknowledgments I want to make. First of all, please give Rick
a big round of applause for his introduction. (applause) Some special
guests that we’ve got. First of all, the governor
of the great state of Ohio, Ted Strickland, is in the house. (applause) There
he is right there. Your State Treasurer
Kevin Boyce is here. (applause) Your Secretary of
State Jennifer Brunner is here. (applause) The mayor of the
great city of Cleveland, Frank Jackson, is here. (applause) Shaker Heights
Mayor Earl Leiken is here. (applause) The Shaker Heights
school superintendent Mark Freeman is here. (applause) Not here, but a
couple of my favorite people: Congresswoman Marcia Fudge and
Sherrod Brown couldn’t be here today. They’ve got work to
do in Washington. (applause) It is good to be back
in the great state of Ohio. (applause) Now, I know there are
those who like to report on the back-and-forth in Washington. But 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
cynics 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. But 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 has passed, 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 businesses —
95 percent. (applause) It extended
unemployment insurance and health coverage for those
who lost their jobs in this recession. (applause) It provided emergency
assistance to states like Ohio to prevent even deeper layoffs
of police officers and firefighters and teachers and
other essential personnel. (applause) 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 have helped 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, and 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 that 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
years to get into this mess, and it will take more than a few
months to dig our way out of it. (applause) But I want to
promise you this, Ohio, we will get there — (applause) — and we are doing everything in our power to get our
people back to work. (applause) Audience Member:
We love you, Barack! The President:
I love you back. (laughter and applause.) 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’re 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. (applause) We are — we’re
transforming our education system, from cradle to college,
so that this nation once again has the best-educated
workforce on the planet. (applause) We are pursuing
health insurance reform so that every American has
access to quality, affordable health coverage. (applause) 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 that, 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 — (applause) — by stopping insurers from cherry-picking who they cover, and holding insurers to a higher
standard for what they cover. (applause) 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. (applause) You won’t have
to worry about preexisting conditions, because — (applause) — never again will anyone in America be denied coverage because of a previous
illness or injury. (applause) You won’t have to
worry about losing coverage if you lose or leave your job,
because every American who needs insurance will have access to
affordable plans through a health insurance exchange —
a marketplace where insurance companies will compete to cover
you, not to deny you coverage. (applause) And if you run a
small business and you’re looking to provide insurance
for your employees, you’ll be able to choose a plan
through this exchange, as well. I’ve heard from small business
owners across America trying to do the right thing, but year
after year premiums rise higher and choices grow more limited. And that’s certainly
true right here in Ohio. Now, if you’re a taxpayer
concerned about deficits, I want you to understand I’m
concerned about deficits, too. Because in the eight years
before we came into office, Washington enacted
two large tax cuts, primarily for the
wealthiest Americans, added a prescription drug
benefit to Medicare, funded two wars — all without
paying for it — (laughter and applause) — didn’t pay for it.
The national debt doubled. We were handed a $1.3 trillion
deficit when we walked in the door — one we necessarily had
to add to in the short term to deal with this financial crisis. Now, I have to tell
you, I have to say, that folks have a lot of nerve
who helped get us into this fiscal hole and then start
going around trying to talk about fiscal responsibility. (applause) I’m always a little
surprised that people don’t have a little more shame — (laughter) — about having
created a mess and then
try to point fingers, but that’s another topic. (laughter) Because the truth is, is that I am now President and I am — (applause) — and I am responsible, and together we have to restore a sense of responsibility in Washington. (applause) We have to do what
businesses and families do — we’ve got to cut out the things
we don’t need to pay for the things we do. And that’s why I pledged that I
will not sign health insurance reform — as badly as
I think it’s necessary, I won’t sign it if that reform
adds even one dime to our deficit over the next decade
— and I mean what I say. (applause) Now, we have
estimated that two-thirds of the cost of reform to bring health
care security to every American can actually be paid for by
reallocating money that’s already in the system but
is being wasted in federal health care programs. So let me repeat what I just
said: About two-thirds of health care reform can be paid
for not with new revenues, not with tax hikes, just with
taking money that’s not being spent wisely and moving it into
things that will actually make people healthy. And that includes, by the way
— right now we spend more than $100 billion in unwarranted
subsidies that go to insurance companies as part of Medicare
— subsidies that do nothing to improve care for our seniors. We ought to take that money and
use it to actually treat people and cover people, not to
line pockets of insurers. (applause) And I’m pleased that
Congress has already embraced these proposals. And while they’re currently
working through proposals to finance the remaining costs, I
continue to insist that health care reform not be paid for
on the backs of middle-class families. (applause) Now, in addition
to making sure that this plan doesn’t add to the
deficit in the short term, the bill I sign must also slow
the growth of health care costs, while improving care,
in the long run. I just came from the Cleveland
Clinic where I toured the cardiac surgery unit, met some
of the doctors who are achieving incredible results
for their patients. There’s important work being
done there as well as at the University Hospitals
and MetroHealth. (applause) And Cleveland Clinic
has one of the best health information technology
systems in the country. And that means they can track
patients and their progress. It means that they can see
what treatments work and what treatments are unnecessary. It means they can provide
better care for patients. They don’t have to duplicate
test after test because it’s all online. They can help patients manage
chronic diseases like diabetes and high blood pressure and
asthma and emphysema by coordinating with doctors and
nurses both in the hospital and in the community. And here’s the remarkable thing:
They actually have some of the lowest costs for the best care. That’s the interesting thing
about our health care system. Often, better care
produces lower, not higher, expenses, because better care
leads to fewer errors that cost money and lives. You, or your doctor, don’t have
to fill out the same form a dozen times. Medical professionals are free
to treat people — not just illnesses. And patients are provided
preventive care earlier — like mammograms and physicals —
to avert more expensive and invasive treatment later. That’s why our proposals include
a variety of reforms that would save both money and improve care
— and why the nation’s largest organizations representing
doctors and nurses have embraced our plan. Our proposals would change
incentives so that doctors and nurses finally are free to
give patients the best care, not just the most
expensive care. And we also want to create an
independent group of doctors and medical experts who are
empowered to eliminate waste and inefficiency in Medicare — a
proposal that could save even more money. So overall, our proposals will
improve the quality of care for our seniors, save them thousands
of dollars on prescription drugs, and that, by the way, is
why AARP has endorsed our reform efforts, as well. (applause) So the fact is,
lowering costs is essential for families and businesses here in
Ohio and all across the country. Let’s take the Ohio example —
over the past few years premiums have risen nearly nine
times faster than wages. That’s something that Rick and
his wife understand very well. As we meet today, we’re seeing
double-digit rate increases on insurance premiums
all over America. There are reports of insurers
raising rates by 28 percent in California; seeking a 23 percent
increase in Connecticut; proposing as much as a 56
percent increase in Michigan. If we don’t act, these premium
hikes will just be a preview of coming attractions. And that’s a future
you can’t afford. That is a future that
America can’t afford. We spend one of every six of
our dollars on health care in America, and that’s on track
to double in the next three decades. The biggest driving force behind
our federal deficit is the skyrocketing cost of
Medicare and Medicaid. Small businesses struggle to
cover workers while competing with large businesses. Large businesses struggle to
cover workers while competing in the global economy. And we’ll never know the full
cost of the dreams put on hold, the entrepreneurial ideas
that are allowed to languish, the small businesses never
founded — because of the fear of being without insurance, or
having to pay for a policy on your own. So, Ohio, that’s
why we seek reform. And in pursuit of this reform
we’ve forged a consensus that has never before been reached
in the history of this country. Senators and representatives in
five committees are working on legislation; three have
already produced a bill. Health care providers have
agreed to do their part to reduce the rate of growth
in health care spending. Hospitals have agreed
to bring down costs. The drug companies have agreed
to make prescription drugs more affordable for seniors. The American Nurses Association,
the American Medical Association, representing
millions of nurses and doctors who know our health
care system best, they’ve announced their
support for reform. (applause) So we have never
been closer — we have never been closer to
achieving quality, affordable health care
for all Americans. But at the same time, there are
those who would seek to delay and defeat reform — is
that the air-conditioning? (laughter) That’s good.
It’s a little warm. (applause) You can still hear me, though. You know, we had one Republican
strategist who told his party that even though they
may want to compromise, it’s better politics
to “go for the kill.” Another Republican senator said
that defeating health reform is about “breaking” me — when it’s
really the American people who are being broken by rising
health care costs and declining coverage. (applause) You know, the
Republican — the Republican Party chair, seeking
to stall our efforts, recently went so far as to say
that health insurance reform was happening “too soon.” Well, first of all,
let me just be clear. If there’s not a deadline in
Washington, nothing happens. (laughter) Nothing ever happens. And, you know, we just
heard today that, well, we may not be able to get the
bill out of the Senate by the end of August — or the
beginning of August. That’s okay. I just want people to keep on working. Just keep working. (applause) I want the bill to
get out of the committees; and then I want that
bill to go to the floor; and then I want that bill to be
reconciled between the House and the Senate; and then
I want to sign a bill. And I want it done by
the end of this year. (applause) I want
it done by the fall. (applause) Whenever I hear
people say that it’s happening too soon, I think
that’s a little odd. We’ve been talking about health
care reform since the days of Harry Truman. (laughter) How could it be too soon? 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. (applause) We can get this done. We don’t shirk from a challenge. (applause) We can get this done. People keep on saying,
wow, this is really hard, why are you taking it on? You know, America doesn’t
shirk from a challenge. We were reminded of
that earlier this week, when Americans and people all
over the world marked the 40th anniversary of the moment that
the astronauts of the Apollo 11 walked on the
surface of the moon. It was the realization of a goal
President Kennedy had set nearly a decade earlier. Ten years earlier he’d said
we’re going to the moon. And there were times
where people said, oh, this is foolish,
this is impossible. But President Kennedy understood
and the American people set about proving what this nation
is capable of doing when we set our minds to doing it. There are those now who are
seeing our failure to address stubborn problems as a sign that
our best days are behind us; that somehow we’ve lost our
sense of purpose, and toughness, and capacity to lead; that we
can’t do big things anymore. Well, I believe that
this generation, like generations past, stand
ready to defy the skeptics and the naysayers, that we can once
again summon this American spirit. We can rescue our economy. We can rebuild it
stronger than before. We can achieve quality,
affordable health care for every single American. That’s what we’re
called upon to do. That’s what we will do
with your help, Ohio. (applause) With your help. (applause) All right, thank you. All right. All right, this is the fun part
where we get to ask questions. I’m going to — I’m going to
take off my jacket, guys, so if you want to do the same
thing — it’s a little hot. (applause) All right. Now, here’s how this
is going to work. There are really no rules. We haven’t asked — you know,
there’s no preprogrammed questions. All you have to do
is — first of all, everybody should sit down. (laughter) The second thing is,
I’m just going to call on as many people as we can during
the time that we have, and I’m going to — just
to make sure it’s fair, I’m going to call on
girl, boy, girl, boy. (laughter) So just raise your
hand if you’ve got a question. Try to keep the question
relatively brief; I’ll try to keep my
answer relatively brief, and we’ll try to get
through as many as we can. And introduce yourself,
if you don’t mind. There are people in the audience
with mics and so if you can wait for the microphone so you can
introduce yourself and then ask the question so that
everybody can hear you. Okay?
All right. This young lady right there in
the colorful blouse right there — that’s you. Colorful dress. Norma Goodman:
Hello? The President:
Hello. Norma Goodman:
Good afternoon, Mr. President. Thank you for
taking my question. My name is Norma Goodman. 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. And by the way, my agency wanted
to invite you to come on a home visit with us. (laughter) But your proposed
budget includes drastic
cuts to reimbursement. I feel that that threatens the
— you’re shaking your head no? The President:
I don’t think so. 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 go ahead and finish your question. Norma Goodman:
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. The President:
Okay, well, let me just respond. 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 rather than institutional
care — and it helps keep people in their homes. (applause) In rural communities,
in rural communities, there are certain areas where
doctors aren’t reimbursed at an adequate level, and so you’re
seeing too many doctors leave those communities. So what we do want to make sure
of, though, is that we are, in our reimbursement systems,
we’re incentivizing smart things. So, for example, right now if a
hospital is reimbursed for the number of tests that it does,
then that may not give them much of an incentive to make their
system more efficient so that once you take that first test
and you’ve gone in the hospital, then you end up having that test
sent around to everybody so you don’t have to take
five more tests. 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. 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’d 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. Okay, all right. Question:
Thank you. The President:
Thank you. Gentleman in the
red right there. Audience Member:
Well, first, Mr. President, welcome to Shaker Heights. The President:
Thank you. Audience Member:
The city that makes things work. (Laughter and applause) My question and maybe
my request is this: Are you willing to urge
Senator Reid and Speaker Pelosi to stay in Washington
and get this job done? The President:
Well, I 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
referred 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. I mean, 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
and 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 now 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’re
going to move this country forward, we can’t
be afraid to change, especially a system
that we know is broken. We’ve got to get it done and
we’ve got to get it done soon. (applause) All right. This young — that lady right
there, who’s waving at me. (laughter) Semanthie Brooks:
Thank you very much. My name is Semanthie Brooks and
I’m the director of Community Advocacy for the Benjamin
Rose Institute in Cleveland. The President:
Okay. (applause) Semanthie Brooks:
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? (applause) The President:
Well, 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’ve 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’ve 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’s 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. (applause) All right. This young man
right here. We’ll get a young guy in here. Brooks Boran (phonetic):
Hi, Mr. President. My name is Brooks Boran (phonetic). I am going to be a
junior in high school. My question is, for a student,
how can we help get this reform passed? (applause) The President:
Well, I appreciate that, I like that. Well, first of all, I very much
appreciate that as a junior in high school you’re still
thinking about — you’re already thinking about this, because
usually young people, they think they’re
indestructible so they don’t need health care. (laughter) 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’ve talked about — for example, extending
the insurance of parents, making insurance companies
provide — keep kids on their insurance until they’re 25. That would help a lot. (applause) But the question you
asked was how can you help get it done. Number one, make sure you’re
persuading your parents if they’re not already convinced. But Mom is right there,
so she’s already on board. (laughter) I think that
activism right now, in calling your congress
people, calling your senators, making sure they know this is
important — that’s 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 — 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 common-sense 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 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,
“I’ve always worked hard, I’ve always done well,
I’ve got a good job. I left my job to
start my business. Suddenly I find out I can’t get
health insurance because of a 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 group that
actually understands this best is folks who are 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 pocket and it’s leaving a lot
of people in very dire straits. So, all right? (applause) Okay. This young lady
right here. There’s a gentleman who is
coming with a microphone. Dr. Diana Lee Macron (phonetic):
Hello, Mr. President. I’m Dr. Diana Lee Macron (phonetic). 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 at age 60 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. Most people don’t
need a tax credit. How would you make the taxing of
benefits equitable to older and female workers? The President:
Well, let me — just to
make sure I understand your question — or I’ll try
to answer what I think your question was. First of all, in terms
of taxing benefits, I said I oppose the taxing of
health care benefits that people are already receiving, so
that’s not a proposal that I’m supportive of. (applause) 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’s 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 these really fancy plans that end up
driving up costs. That’s the debate that’s
been taking place, and I think that is at least
— I haven’t signed on to that approach, but I think it’s a
legitimate debate to have. But what I said and I’ve 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 then
would 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. Okay? All right, let’s see, this young man right here. He’s got a bowtie on,
he looks very sharp. (applause) Here,
you can use my mic. Brandon Patterson:
Hi, I’m Brandon Patterson and I’m Shaker Heights
senior class president. And I want to say, on behalf
of the entire — (applause) (Inaudible) — but my question
is — she kind of touched on it earlier, and you kind of
said that you’re going to, with the health care, extend
the age where we can go on our parents’ health care. But we see that many states
have passed reforms where they extended the age to 26 and
30 and still statistics show that we, at 19 — or 29 — that we still
are the main — the largest percent of people who do
not have health insurance. So my question to
you is exactly, how can we be guaranteed? The President:
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 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. (laughter) 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? Okay. It’s a young lady’s turn. Let’s see — I’ve sort of
neglected I think way up there. All right, that young lady
standing up right there — no, no, no, I’m sorry, I
know you’re excited, but I was pointing
at her right there. (laughter) But I
love you too, though. (laughter) Okay,
right there — yes. No, right there — yes. Question:
Me? The President:
You, yes. Aimee Vance:
Thank you, Mr. President. My name is Aimee Vance. I’m an RN that works for the
Cleveland Clinic and Community Outreach. We serve the uninsured and are
doing some great things there. This is Connie Robinson;
she’s a counselor also that
works with me. (laughter) 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. (applause) The President:
Well, I’ve 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. One of the things that’s
exciting, though, in addition to the big fancy
hospital with all the fancy equipment, they’ve also — 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 are helping
somebody with a nutritionist to keep their weight down before
they get diabetes as opposed to, you know, paying for a surgery
for a foot amputation. (applause) 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. (applause) All right.
How much time we have? Okay, I’ve got
time — I’m sorry, guys — I only have time
for one more question. One more question. And I’ve got to say,
I apologize, guys, but I’m going to go with — I’m
going to go with another young person here — this
young man right there, who’s got a jacket on, so
he’s looking very sharp. (laughter and applause) Thanks for dressing up, guys — you got the
bowtie, you got the jacket. I didn’t dress that good
when I was their age. (laughter) Parker Smith:
Thank you, Mr. President. My name is Parker Smith. I’m 14 years old; I’m going
to be a freshman here. The President:
Okay, Parker. Parker Smith:
All right. How can you reassure many
Americans around the country that your health care proposal
isn’t too much, too fast? The President:
Well, I think
that’s a great question. That’s a great question. (applause) 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’d
have to come back in the fall; we’d 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’re going
to wake up tomorrow and suddenly the health care system is
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. (applause) 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’s a
pretty broad consensus it needs to get done. Now, is it too much? I don’t think it’s too much. It’s only too much by the
standards of Washington politics today, which is basically that
anything just becomes this big tangle of who’s
up and who’s down, and who’s advantaged
and who’s not, and the special interests and
the lobbyists are all scurrying around. By that standard — I know I’m
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’ve 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. (applause) 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. 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 how did
you go about doing it, well, they started this thing
— when was it started, Cleveland Clinic? 1921. And they — what they’ve
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’ve 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, and that’s what we want
to free them up to do, but it will take a
little time to get there. (applause) So, all
right, everybody, stay on your
members of Congress. Keep up the heat. We’ve got to get this done. Thank you. Love you. Bye. (applause)

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