English subtitles for clip: File:Bipartisan Meeting on Health Reform- Part 4.webm

1
00:00:00,300 --> 00:00:01,230
The President:
All right, Joe, let's talk

2
00:00:01,233 --> 00:00:04,863
about cost because -- and now we're not talking about cost

3
00:00:04,867 --> 00:00:07,267
to families but we're talking about deficit, how much

4
00:00:07,266 --> 00:00:10,536
respective ideas cost. I think this is a good place

5
00:00:10,533 --> 00:00:12,703
to talk about Medicare as well because it's been brought

6
00:00:12,700 --> 00:00:15,430
up several times.
Joe, go ahead.

7
00:00:15,433 --> 00:00:17,463
The Vice President:
Mr. President, I'll try to be

8
00:00:17,467 --> 00:00:19,597
brief. There's a lot to talk about. I'd like to focus it

9
00:00:19,600 --> 00:00:23,630
though on the deficit, impact on the deficit

10
00:00:23,633 --> 00:00:25,933
which we're all talking about.

11
00:00:25,934 --> 00:00:29,064
And I must tell you, maybe I've been arount too long, but

12
00:00:29,066 --> 00:00:31,036
I am always reluctant,

13
00:00:31,033 --> 00:00:34,103
after being here 37 years, to tell people

14
00:00:34,100 --> 00:00:36,130
what the American people think.

15
00:00:36,133 --> 00:00:40,033
I think it requires a little bit
of humility to be able to know

16
00:00:40,033 --> 00:00:41,903
what the American people think.

17
00:00:41,900 --> 00:00:45,570
But -- and I don't, I can't
swear I do.

18
00:00:45,567 --> 00:00:47,897
I know what I think, I think I
know what they think, but I'm

19
00:00:47,900 --> 00:00:50,370
not sure what they think.

20
00:00:50,367 --> 00:00:54,237
And the second point I'd make
is, this probably has an echo --

21
00:00:54,233 --> 00:00:57,763
this is slightly off point, but
this debate about the

22
00:00:57,767 --> 00:01:00,897
philosophic differences echo the
debate that probably took place

23
00:01:00,900 --> 00:01:06,070
in the mid-'30s on Social
Security -- it was mandated.

24
00:01:06,066 --> 00:01:08,066
And it was mandated because
everybody knew you couldn't get

25
00:01:08,066 --> 00:01:10,766
insurance unless everybody was
in the pool.

26
00:01:10,767 --> 00:01:13,067
And they knew if only some
people were in the pool, what

27
00:01:13,066 --> 00:01:15,036
would happen is a lot of people
when they got old we would take

28
00:01:15,033 --> 00:01:17,403
care of them anyway and you'd
have to pay for them.

29
00:01:17,400 --> 00:01:20,170
So it's kind of a -- it's not
the same thing, I'm not making

30
00:01:20,166 --> 00:01:41,966
the exact, but it's the same
philosophic debate that took

31
00:01:26,934 --> 00:01:31,604
But, look, I think, if I can lay
out, Mr. President, what I think

32
00:01:31,600 --> 00:01:35,030
we all agree on, and then figure
out whether as a way to deal

33
00:01:35,033 --> 00:01:38,103
with the deficit end of this --
bending the cost curve, to use a

34
00:01:38,100 --> 00:01:40,870
phrase you and many others have
used, Mr. President.

35
00:01:40,867 --> 00:01:43,567
First of all, everybody agrees
we have the finest docs and the

36
00:01:41,967 --> 00:01:58,537
place back in the '30s.

37
00:01:43,567 --> 00:01:46,537
finest hospitals and the finest
nurses in the world, and we

38
00:01:46,533 --> 00:01:49,363
don't have quite enough of them
but we have the finest.

39
00:01:49,367 --> 00:01:52,537
Everybody also agrees, I got
from this morning but I think we

40
00:01:52,533 --> 00:01:57,433
had before, that Senator Coburn
is right that we waste a heck of

41
00:01:57,433 --> 00:02:00,633
a lot of money and that
somewhere around a third of all

42
00:02:00,633 --> 00:02:05,863
the dollars we spend on Medicare
is -- goes for nothing useful.

43
00:02:05,867 --> 00:02:11,667
The third thing it seems -- I
assume we can all agree on is

44
00:02:11,667 --> 00:02:15,697
that over the last decade costs
have doubled for health care in

45
00:02:15,700 --> 00:02:18,770
America -- costs have doubled
for government-provided health

46
00:02:18,767 --> 00:02:21,167
care, but everybody's
health care.

47
00:02:21,166 --> 00:02:26,296
And that that meant that right
now everybody knows that that

48
00:02:26,300 --> 00:02:29,870
wrecks budgets, it wrecks state
budgets, it wrecks family

49
00:02:29,867 --> 00:02:33,237
budgets, it wrecks federal
budgets.

50
00:02:33,233 --> 00:02:38,503
Every 35 cents of every dollar
spent on health care is spent by

51
00:02:38,500 --> 00:02:40,930
the federal government or the
state governments for Medicare

52
00:02:40,934 --> 00:02:45,304
and Medicaid -- 35 cents on the
dollar.

53
00:02:45,300 --> 00:02:48,500
That doesn't count veterans and
other things, just those two.

54
00:02:48,500 --> 00:02:52,100
And so -- and what's happened is
-- on the dollar, on every

55
00:02:52,100 --> 00:02:53,730
health care dollar.

56
00:02:53,734 --> 00:02:57,334
And so we're facing, all of us
around this table, Democrat and

57
00:02:57,333 --> 00:03:03,563
Republicans, are facing the fact
that there's $919 billion now

58
00:03:03,567 --> 00:03:07,597
we're spending on Medicare and
the federal portion of Medicaid,

59
00:03:07,600 --> 00:03:10,730
and that if things -- I don't
see any firewall is going to

60
00:03:10,734 --> 00:03:14,034
keep costs from doubling again,
we're going to be talking about

61
00:03:14,033 --> 00:03:23,463
in the year 2019 we're going to
be spending $1.7 trillion

62
00:03:23,467 --> 00:03:26,667
if we don't do
something to bend that curve.

63
00:03:26,667 --> 00:03:30,997
And the fourth point I think we
can agree on is that whether you

64
00:03:31,000 --> 00:03:36,430
agree how it was arrived at, CBO
has gone out and scored the

65
00:03:36,433 --> 00:03:41,203
various plans as to whether or
not they'd bend the cost curve,

66
00:03:41,200 --> 00:03:43,030
and everybody is acting
in good faith.

67
00:03:43,033 --> 00:03:46,303
John's plan, they've gone out
and points out over 20 years it

68
00:03:46,300 --> 00:03:49,900
will -- and I don't know if
that's the Republican plan or

69
00:03:49,900 --> 00:03:53,330
John -- I don't think there's
any one plan that is out there,

70
00:03:53,333 --> 00:03:58,363
but John's plan cuts those costs
by $300 billion over 20 years,

71
00:03:58,367 --> 00:03:59,897
according to CBO.

72
00:03:59,900 --> 00:04:04,070
The Senate plan cuts it by over
a trillion dollars over 20

73
00:04:04,066 --> 00:04:07,036
years; $100 billion over 10.

74
00:04:07,033 --> 00:04:11,533
Again, we can argue on the
margins, but the fact is it's

75
00:04:11,533 --> 00:04:14,463
not just CBO that said this --
you had the Business

76
00:04:14,467 --> 00:04:19,197
Roundtable/Hewitt study that
shows that the Senate plan slows

77
00:04:19,200 --> 00:04:25,500
growth by 15 to 20 percent and
that business costs per employee

78
00:04:25,500 --> 00:04:31,230
by the year 2019 would be $3,000
less per employee.

79
00:04:31,233 --> 00:04:35,963
Again, it may be wrong -- it may
be wrong-exact amount, it may be

80
00:04:35,967 --> 00:04:39,897
$3,800, it may be $2,200 -- but
it cuts costs.

81
00:04:39,900 --> 00:04:46,870
And so it seems to me that there
is -- and I might add, that in

82
00:04:46,867 --> 00:04:51,667
the process here, it wasn't part
of the -- specifically part of a

83
00:04:51,667 --> 00:04:57,137
long-term debt debate, but, you
know, as has been pointed out

84
00:04:57,133 --> 00:05:04,163
here, we're not cutting Medicare
benefits in this; we're trying

85
00:05:04,166 --> 00:05:06,666
to eliminate the third of the
problem that's a waste.

86
00:05:06,667 --> 00:05:10,667
And as Senator Enzi, who I have
an inordinate amount of respect

87
00:05:10,667 --> 00:05:13,167
for, points out, he said it'd be
nice if we put some of these

88
00:05:13,166 --> 00:05:16,736
savings back into Medicare.

89
00:05:16,734 --> 00:05:19,134
Well, the fact is we do.

90
00:05:19,133 --> 00:05:23,933
We closed the prescription drug
doughnut hole.

91
00:05:23,934 --> 00:05:28,404
We provide for preventative care
for seniors because they don't

92
00:05:28,400 --> 00:05:30,300
have now without a co-pay.

93
00:05:30,300 --> 00:05:36,430
And we also -- it's everyone --
I think most every major study

94
00:05:36,433 --> 00:05:40,133
agrees that it's going to extend
the life of Medicare trust fund,

95
00:05:40,133 --> 00:05:46,033
and it changes -- these changes,
the actuarial group pointed out,

96
00:05:46,033 --> 00:05:52,333
would save about $200 on a
premium per Medicare recipient

97
00:05:52,333 --> 00:05:54,203
out there, the people who are
paying.

98
00:05:54,200 --> 00:06:01,070
So look -- and the source of how
we do this is getting rid of

99
00:06:01,066 --> 00:06:06,866
waste, making sure that we don't
overpay insurance companies

100
00:06:06,867 --> 00:06:11,197
for Medicare Advantage.

101
00:06:11,200 --> 00:06:14,870
I want to remind everybody about
Medicare Advantage, because some

102
00:06:14,867 --> 00:06:17,537
of us around here -- probably
all of us around this table were

103
00:06:17,533 --> 00:06:19,133
here when it got put in.

104
00:06:19,133 --> 00:06:21,503
What was the rationale for
Medicare Advantage?

105
00:06:21,500 --> 00:06:24,970
The rationale for Medicare
Advantage a decade ago was that

106
00:06:24,967 --> 00:06:29,867
private insurers could provide
insurance -- better insurance --

107
00:06:29,867 --> 00:06:32,497
cheaper than the
government can do it.

108
00:06:32,500 --> 00:06:34,000
They can do it better.

109
00:06:34,000 --> 00:06:37,230
And we said the reason why we're
going to pay them more than what

110
00:06:37,233 --> 00:06:40,933
they're going to give at the
front end is to incentivize them

111
00:06:40,934 --> 00:06:43,964
to get into business
of doing it.

112
00:06:43,967 --> 00:06:46,697
And so we paid them a $1.15

113
00:06:46,700 --> 00:06:48,500
for every dollar's worth --
what we could have

114
00:06:48,500 --> 00:06:50,000
bought for a dollar.

115
00:06:50,000 --> 00:06:53,800
We did that -- and it was a
rational thing to try -- we did

116
00:06:53,800 --> 00:06:57,670
that because we wanted them to
get engaged in the business we

117
00:06:57,667 --> 00:07:01,067
thought government didn't do as
well as the private sector did.

118
00:07:01,066 --> 00:07:02,396
Well, here we are.

119
00:07:02,400 --> 00:07:05,930
We're overpaying insurance
companies about 15 cents on the

120
00:07:05,934 --> 00:07:10,634
buck that we could buy for a
dollar, and we call

121
00:07:10,633 --> 00:07:12,433
for eliminating that.

122
00:07:12,433 --> 00:07:17,733
And so the other point I'd make,
Mr. President, is that we're in

123
00:07:17,734 --> 00:07:23,664
a situation here where at the
end of the day nobody in this

124
00:07:23,667 --> 00:07:27,137
room -- I don't think anybody in
this room -- is going to say,

125
00:07:27,133 --> 00:07:30,003
you know something, we are
really going to be reforming the

126
00:07:30,000 --> 00:07:35,770
health care system without
affecting the effect on the

127
00:07:35,767 --> 00:07:38,097
long-term deficit.

128
00:07:38,100 --> 00:07:41,000
Unless we bend that cost curve,
we're in trouble.

129
00:07:41,000 --> 00:07:45,300
And Mr. President, we can argue,
which we will, about whether or

130
00:07:45,300 --> 00:07:48,830
not the way you and I want to go
after dealing with the long-term

131
00:07:48,834 --> 00:07:52,104
debt, whether commissions make
sense, whether or not we're ever

132
00:07:52,100 --> 00:07:55,830
going to deal with -- this is a
big entitlement,

133
00:07:55,834 --> 00:07:57,704
this is a big entitlement.

134
00:07:57,700 --> 00:07:59,800
Medicare -- it exists.

135
00:07:59,800 --> 00:08:04,070
We've got to figure out how to
keep it from bankrupting the

136
00:08:04,066 --> 00:08:10,866
country without denying seniors
what they're entitled to in a

137
00:08:10,867 --> 00:08:15,067
nation like ours: decent health
care that provides

138
00:08:15,066 --> 00:08:15,966
for their needs.

139
00:08:15,967 --> 00:08:18,667
So I'd like us, Mr. President --
and I'm going to hush -- I'd

140
00:08:18,667 --> 00:08:22,767
like us to talk about, if we
can, specifically what

141
00:08:22,767 --> 00:08:23,997
we all agree on.

142
00:08:24,000 --> 00:08:27,700
What do we do about bending the
cost curve?

143
00:08:27,700 --> 00:08:30,330
What's the best way to do it?

144
00:08:30,333 --> 00:08:32,563
And I yield the floor.

145
00:08:32,567 --> 00:08:35,437
Representative Boehner:
Mr. President, Mr. Ryan is going

146
00:08:35,433 --> 00:08:39,603
to open this conversation on
behalf of us.

147
00:08:39,600 --> 00:08:41,300
Representative Ryan:
Look, we agree on the problem

148
00:08:41,300 --> 00:08:44,230
here, and the problem is health inflation is driving us off

149
00:08:44,233 --> 00:08:45,763
of a fiscal cliff.

150
00:08:45,767 --> 00:08:48,937
Mr. President, you said health
care reform is budget reform.

151
00:08:48,934 --> 00:08:51,304
You're right.
We agree with that.

152
00:08:51,300 --> 00:08:54,570
Medicare right now has a $38
trillion unfunded liability.

153
00:08:54,567 --> 00:08:57,697
That's $38 trillion in empty
promises to my parents'

154
00:08:57,700 --> 00:09:00,900
generation, our generation, our
kids' generation.

155
00:09:00,900 --> 00:09:03,470
Medicaid is growing at 21
percent this year.

156
00:09:03,467 --> 00:09:05,497
It's suffocating state's
budgets.

157
00:09:05,500 --> 00:09:07,830
It's adding trillions in
obligations that we have no

158
00:09:07,834 --> 00:09:09,434
means to pay for it.

159
00:09:09,433 --> 00:09:12,233
Now, you're right to frame the
debate on cost

160
00:09:12,233 --> 00:09:13,733
and health inflation.

161
00:09:13,734 --> 00:09:17,364
And in September when you spoke
to us in the well of the House,

162
00:09:17,367 --> 00:09:19,997
you basically said -- and I
totally agree with this -- "I

163
00:09:20,000 --> 00:09:23,500
will not sign a plan that adds
one dime to our deficits either

164
00:09:23,500 --> 00:09:25,600
now or in the future. "

165
00:09:25,600 --> 00:09:28,030
Since the Congressional Budget
Office can't score your bill

166
00:09:28,033 --> 00:09:30,603
because it doesn't have
sufficient detail, but it tracks

167
00:09:30,600 --> 00:09:33,670
very similar to the Senate bill,
I want to unpack the Senate

168
00:09:33,667 --> 00:09:35,897
score a little bit.

169
00:09:35,900 --> 00:09:39,500
And if you take a look at these
CBO analysis, analysis from your

170
00:09:39,500 --> 00:09:42,530
chief actuary, I think it's very
revealing.

171
00:09:42,533 --> 00:09:45,203
This bill does not control
costs.

172
00:09:45,200 --> 00:09:48,270
This bill does not reduce
deficits.

173
00:09:48,266 --> 00:09:51,366
Instead this bill adds a new
health care entitlement at a

174
00:09:51,367 --> 00:09:53,697
time when we have no idea
how to pay for the

175
00:09:53,700 --> 00:09:55,870
entitlements we already have.

176
00:09:55,867 --> 00:09:58,237
And let me go through
why I say that.

177
00:09:58,233 --> 00:10:01,703
The Majority Leader said the
bill scores as reducing the

178
00:10:01,700 --> 00:10:05,830
deficit $131 billion over the
next 10 years.

179
00:10:05,834 --> 00:10:07,134
First, a little bit about CBO.

180
00:10:07,133 --> 00:10:08,763
I work with them
every single day.

181
00:10:08,767 --> 00:10:11,397
Very good people, great
professionals,

182
00:10:11,400 --> 00:10:13,130
they do their jobs well.

183
00:10:13,133 --> 00:10:16,533
But their job is to score what
is placed in front of them.

184
00:10:16,533 --> 00:10:19,403
And what has been placed in
front of them is a bill that is

185
00:10:19,400 --> 00:10:21,900
full of gimmicks and smoke and
mirrors.

186
00:10:21,900 --> 00:10:23,370
What do I mean when I say that--

187
00:10:23,367 --> 00:10:27,667
Well, first off, the bill has 10
years of tax increases, about

188
00:10:27,667 --> 00:10:31,367
half a trillion dollars, with 10
years of Medicare cuts, about

189
00:10:31,367 --> 00:10:35,367
half a trillion dollars, to pay
for six years of spending.

190
00:10:35,367 --> 00:10:38,567
Now, what's the true 10-year
cost of this bill in 10 years?

191
00:10:38,567 --> 00:10:40,537
That's $2. 3 trillion.

192
00:10:40,533 --> 00:10:42,403
It does a couple of other
things.

193
00:10:42,400 --> 00:10:46,530
It takes $52 billion in higher
Social Security tax revenues and

194
00:10:46,533 --> 00:10:50,003
counts them as offsets, but
that's really reserved

195
00:10:50,000 --> 00:10:51,400
for Social Security.

196
00:10:51,400 --> 00:10:53,970
So either we're double-counting
them or we don't intend on

197
00:10:53,967 --> 00:10:55,967
paying those Social Security
benefits.

198
00:10:55,967 --> 00:11:00,237
It takes $72 billion and claims
money from the CLASS Act --

199
00:11:00,233 --> 00:11:02,463
that's the long-term care
insurance program.

200
00:11:02,467 --> 00:11:05,067
It takes the money from premiums
that are designed for that

201
00:11:05,066 --> 00:11:08,566
benefit and instead counts them
as offsets.

202
00:11:08,567 --> 00:11:10,797
The Senate Budget Committee
chairman said that this is a

203
00:11:10,800 --> 00:11:14,270
Ponzi scheme that would make
Bernie Madoff proud.

204
00:11:14,266 --> 00:11:18,336
Now, when you take a look at the
Medicare cuts, what this bill

205
00:11:18,333 --> 00:11:21,103
essentially does is treats
Medicare like a piggy bank.

206
00:11:21,100 --> 00:11:24,070
It raids a half a trillion
dollars out of Medicare not to

207
00:11:24,066 --> 00:11:27,096
shore up Medicare's solvency but
to spend on

208
00:11:27,100 --> 00:11:28,470
this new government program.

209
00:11:28,467 --> 00:11:32,697
Now, when you take a look at
what this does, it is --

210
00:11:32,700 --> 00:11:35,430
according to the chief actuary
of Medicare, he's saying as much

211
00:11:35,433 --> 00:11:38,003
of 20 percent of Medicare's
providers will either go out of

212
00:11:38,000 --> 00:11:41,170
business or will have to stop
seeing Medicare beneficiaries.

213
00:11:41,166 --> 00:11:44,396
Millions of seniors who are on
-- who have chosen Medicare

214
00:11:44,400 --> 00:11:47,770
Advantage will lose the coverage
that they now enjoy.

215
00:11:47,767 --> 00:11:51,497
You can't say that you're using
this money to either extend

216
00:11:51,500 --> 00:11:53,600
Medicare solvency and also
offset the

217
00:11:53,600 --> 00:11:55,100
cost of this new
program.

218
00:11:55,100 --> 00:11:56,800
That's double-counting.

219
00:11:56,800 --> 00:11:59,500
And so when you take a look at
all of this, when you strip out

220
00:11:59,500 --> 00:12:02,630
the double-counting and what I
would call these gimmicks, the

221
00:12:02,633 --> 00:12:06,933
full 10-year cost of this bill
has a $460 billion deficit.

222
00:12:06,934 --> 00:12:08,964
The second 10-year
cost of this bill has

223
00:12:08,967 --> 00:12:11,697
a $1. 4 trillion deficit.

224
00:12:11,700 --> 00:12:14,500
And I think probably the most
cynical gimmick in this bill is

225
00:12:14,500 --> 00:12:16,670
something that we all probably
agree on.

226
00:12:16,667 --> 00:12:19,797
We don't think we should cut
doctors 21 percent next year.

227
00:12:19,800 --> 00:12:22,230
We've stopped those cuts from
occurring every year for the

228
00:12:22,233 --> 00:12:23,503
last seven years.

229
00:12:23,500 --> 00:12:26,270
We all call this here in
Washington the "doc fix.

230
00:12:26,266 --> 00:12:27,896
" Well, the doc fix, according

231
00:12:27,900 --> 00:12:30,400
to your numbers cost $371 billion.

232
00:12:30,400 --> 00:12:33,000
It was in the first iteration of
all these bills.

233
00:12:33,000 --> 00:12:35,730
But because it was a big price
tag, and it made the score look

234
00:12:35,734 --> 00:12:38,834
bad, made it look like a
deficit, that provision was

235
00:12:38,834 --> 00:12:42,704
taken out, and it's been going
on as stand-alone legislation.

236
00:12:42,700 --> 00:12:45,200
But ignoring these costs does
not remove them

237
00:12:45,200 --> 00:12:46,600
from the backs
of taxpayers.

238
00:12:46,600 --> 00:12:50,530
Hiding spending does not reduce
spending.

239
00:12:50,533 --> 00:12:52,103
And so when you take a look at
all of this,

240
00:12:52,100 --> 00:12:53,230
it just doesn't add up.

241
00:12:53,233 --> 00:12:56,003
And so let's just -- I'll finish
with the cost-curve.

242
00:12:56,000 --> 00:12:57,930
Are we bending the cost curve
down or are we

243
00:12:57,934 --> 00:12:59,564
bending the cost curve up?

244
00:12:59,567 --> 00:13:02,697
Well, if you look at your own
chief actuary at Medicare,

245
00:13:02,700 --> 00:13:04,100
we're bending it up.

246
00:13:04,100 --> 00:13:08,130
He's claiming that we're going
up $222 billion -- adding more

247
00:13:08,133 --> 00:13:11,133
to the unsustainable fiscal
situation we have.

248
00:13:11,133 --> 00:13:14,933
And so when you take a look at
this, it's really deeper than

249
00:13:14,934 --> 00:13:17,834
the deficits or the budget

250
00:13:17,834 --> 00:13:19,564
gimmicks or the actuarial analysis.

251
00:13:19,567 --> 00:13:21,967
There really is a difference
between us.

252
00:13:21,967 --> 00:13:23,867
And we've been talking about how
much we agree on different

253
00:13:23,867 --> 00:13:26,297
issues, but there really is a
difference between us.

254
00:13:26,300 --> 00:13:29,270
And it's basically this: We
don't think the government

255
00:13:29,266 --> 00:13:31,266
should be in control of all of
this.

256
00:13:31,266 --> 00:13:33,466
We want people to be in control.

257
00:13:33,467 --> 00:13:36,167
And that, at the end of the day,
is the big difference.

258
00:13:36,166 --> 00:13:40,066
Now, we've offered lots of ideas
all last year, all this year,

259
00:13:40,066 --> 00:13:43,466
because we agree the status quo
is unsustainable.

260
00:13:43,467 --> 00:13:45,197
It's got to get fixed.

261
00:13:45,200 --> 00:13:46,500
It's bankrupting families.

262
00:13:46,500 --> 00:13:48,030
It's bankrupting our government.

263
00:13:48,033 --> 00:13:50,263
It's hurting families with
preexisting conditions.

264
00:13:50,266 --> 00:13:52,136
We all want to fix this.

265
00:13:52,133 --> 00:13:55,433
But we don't think that this is
the answer to the solution.

266
00:13:55,433 --> 00:13:58,403
And all of the analysis we get
proves that point.

267
00:13:58,400 --> 00:14:01,170
Now, I will just simply say this
-- and I respectfully disagree

268
00:14:01,166 --> 00:14:04,696
with the Vice President about
what the American people are or

269
00:14:04,700 --> 00:14:06,870
are not saying, or whether we're
qualified

270
00:14:06,867 --> 00:14:09,337
to speak on their behalf.

271
00:14:09,333 --> 00:14:12,433
So we are all representatives of
the American people.

272
00:14:12,433 --> 00:14:13,663
We all do town hall meetings.

273
00:14:13,667 --> 00:14:15,697
We all talk to our constituents.

274
00:14:15,700 --> 00:14:18,770
And I've got to tell you, the
American people are engaged.

275
00:14:18,767 --> 00:14:21,267
And if you think they want a
government takeover of health

276
00:14:21,266 --> 00:14:23,136
care, I would respectfully
submit you're

277
00:14:23,133 --> 00:14:24,763
not listening to them.

278
00:14:24,767 --> 00:14:28,767
So what we simply want to do is
start over, work on a clean

279
00:14:28,767 --> 00:14:32,167
sheet of paper, move through
these issues step by step, and

280
00:14:32,166 --> 00:14:36,466
fix them and bring down health
care costs and not raise them.

281
00:14:36,467 --> 00:14:39,137
and that basically the point.

282
00:14:39,133 --> 00:14:41,233
The President:
I'm going to call

283
00:14:41,233 --> 00:14:43,433
on Xavier Becerra, but I just

284
00:14:43,433 --> 00:14:46,033
want to follow up on a couple
points.

285
00:14:46,033 --> 00:14:47,603
There are some strong
disagreements on the numbers

286
00:14:47,600 --> 00:14:54,470
here, Paul, but I don't want to
get too bogged down.

287
00:14:54,467 --> 00:15:00,867
First question I have is whether
your side thinks Medicare

288
00:15:00,867 --> 00:15:03,967
Advantage is working well,
because I think it's important

289
00:15:03,967 --> 00:15:08,497
just to point out that -- when
we keep on talking about cuts in

290
00:15:08,500 --> 00:15:12,300
Medicare, what we're really
talking about is what Joe

291
00:15:12,300 --> 00:15:16,900
alluded to, which is a decision
was made a while back to set up

292
00:15:16,900 --> 00:15:25,200
a system in which Medicare
costs, let's say, a dollar under

293
00:15:25,200 --> 00:15:29,900
the government program that 80
percent of people still use and

294
00:15:29,900 --> 00:15:33,970
are perfectly satisfied with and
there's no showing that it's not

295
00:15:33,967 --> 00:15:35,967
working for them.

296
00:15:35,967 --> 00:15:39,267
We said we'd give it to private
insurers and we'd give them a

297
00:15:39,266 --> 00:15:42,036
bonus of a $1. 15

298
00:15:42,033 --> 00:15:45,133
for every dollar in the
normal plan.

299
00:15:45,133 --> 00:15:49,163
And it turns out that people
aren't healthier because of that

300
00:15:49,166 --> 00:15:52,896
extra $15 -- or 15 cents.

301
00:15:52,900 --> 00:15:57,730
It's estimated that it's costing
us about $180 billion over 10

302
00:15:57,734 --> 00:16:02,164
years and, say, $18 billion a
year.

303
00:16:02,166 --> 00:16:05,296
And essentially what my proposal
would do, and what the House and

304
00:16:05,300 --> 00:16:09,600
Senate proposals would do, would
say, instead of having the

305
00:16:09,600 --> 00:16:14,870
insurance companies get that
money, let's take that money --

306
00:16:14,867 --> 00:16:21,097
the savings are between $400
billion and $500 billion a year

307
00:16:21,100 --> 00:16:24,270
-- and let's devote some of that
money to closing the doughnut

308
00:16:24,266 --> 00:16:28,136
hole, which has already been
talked about.

309
00:16:28,133 --> 00:16:34,363
Seniors who need more
prescription drugs than Medicare

310
00:16:34,367 --> 00:16:37,397
currently is willing to pay for
hit this gap where suddenly

311
00:16:37,400 --> 00:16:39,970
they've got to use it out of
pocket, and they just stop

312
00:16:39,967 --> 00:16:42,567
taking the drugs, or they break
them in half, or what have you.

313
00:16:42,567 --> 00:16:43,397
Let's fill that.

314
00:16:43,400 --> 00:16:49,730
That costs around $30 billion a
year, or $300 billion.

315
00:16:49,734 --> 00:16:54,434
And let's make some other
changes that would result in

316
00:16:54,433 --> 00:16:58,233
actually the 80 percent of
seniors who aren't in Medicare

317
00:16:58,233 --> 00:17:00,433
Advantage getting a better deal.

318
00:17:00,433 --> 00:17:05,463
So we can address some of the
broader issues, but I just want

319
00:17:05,467 --> 00:17:09,397
to focus on Medicare Advantage
because I haven't seen an

320
00:17:09,400 --> 00:17:12,500
independent analyst look at this
and say seniors are healthier

321
00:17:12,500 --> 00:17:14,970
for it or taxpayers are better
off for it.

322
00:17:14,967 --> 00:17:17,197
That's what we're talking about
reforming.

323
00:17:17,200 --> 00:17:23,970
We're not talking about cutting
benefits under the Medicare

324
00:17:23,967 --> 00:17:28,067
program as is required under
law.

325
00:17:28,066 --> 00:17:30,696
What we're talking about is
Medicare Advantage.

326
00:17:30,700 --> 00:17:35,270
And it may be that some people
here think that it's working.

327
00:17:35,266 --> 00:17:37,066
I know that there are some
Republicans who are sitting at

328
00:17:37,066 --> 00:17:38,966
this table who don't think it's
working.

329
00:17:38,967 --> 00:17:44,597
You can argue and say, okay,
let's not do Medicare Advantage

330
00:17:44,600 --> 00:17:48,670
and let's not close the doughnut
hole, for example, or there may

331
00:17:48,667 --> 00:17:50,637
be other ways you want to spend
that money.

332
00:17:50,633 --> 00:17:53,033
But I just want to establish
whether we've got some agreement

333
00:17:53,033 --> 00:17:56,303
that the Medicare Advantage
program, which is what we are

334
00:17:56,300 --> 00:18:01,730
proposing to reform, is actually
not a good deal for taxpayers or

335
00:18:01,734 --> 00:18:05,304
for seniors, and certainly not a
good deal for the 80 percent of

336
00:18:05,300 --> 00:18:08,400
seniors who aren't in Medicare
Advantage, because, by the way,

337
00:18:08,400 --> 00:18:11,770
they're paying an extra premium
of about 90 bucks a year to

338
00:18:11,767 --> 00:18:15,267
subsidize the 20 percent who are
in Medicare Advantage.

339
00:18:15,266 --> 00:18:17,066
SENATOR McConnell:
Mr. President, John McCain also

340
00:18:17,066 --> 00:18:18,866
would like to address that
issue.

341
00:18:18,867 --> 00:18:20,167
THE PRESIDENT:
I'm sorry, so if

342
00:18:20,166 --> 00:18:21,936
somebody else wants to address

343
00:18:21,934 --> 00:18:24,734
SENATOR McCain:
I'd just make one comment.

344
00:18:24,734 --> 00:18:29,704
Why in the world then would we
carve out 800,000 people in

345
00:18:29,700 --> 00:18:34,030
Florida that would not have
their Medicare Advantage cut?

346
00:18:34,033 --> 00:18:37,233
Now, I proposed an amendment on
the floor to say everybody will

347
00:18:37,233 --> 00:18:38,633
be treated the same.

348
00:18:38,633 --> 00:18:41,563
Mr. President, why should we
carve out 800,000 people because

349
00:18:41,567 --> 00:18:44,497
they live in Florida to keep the
Medicare Advantage program and

350
00:18:44,500 --> 00:18:45,670
then want to do away with it?

351
00:18:45,667 --> 00:18:46,167
The President:
I think you make

352
00:18:46,166 --> 00:18:47,996
a legitimate point.

353
00:18:48,000 --> 00:18:49,430
Senator McCain:
Well, maybe --

354
00:18:49,433 --> 00:18:50,433
The President:
I thank you.

355
00:18:50,433 --> 00:18:51,503
Senator McCain:
Thank you very much.

356
00:18:51,500 --> 00:19:04,970
(Laughter. )

357
00:19:04,967 --> 00:19:06,067
The President:
I'm going to Xavier -- in

358
00:19:06,066 --> 00:19:07,936
fairness, I asked a

359
00:19:07,934 --> 00:19:11,804
question, so I'm going to let
one of the Republicans respond,

360
00:19:11,800 --> 00:19:15,030
and then I'll go to Xavier.

361
00:19:15,033 --> 00:19:16,463
Senator Coburn:
You know, the assumption

362
00:19:16,467 --> 00:19:17,297
-- I think it's

363
00:19:17,300 --> 00:19:19,500
important for the American
people to hear we have Medicare

364
00:19:19,500 --> 00:19:21,930
Part D, except no senior
in this country ever

365
00:19:21,934 --> 00:19:24,364
paid a tax dollar for it.

366
00:19:24,367 --> 00:19:27,297
And we're talking about filling
a doughnut hole on a program

367
00:19:27,300 --> 00:19:30,070
that they're already benefiting
from that's going to leave

368
00:19:30,066 --> 00:19:32,196
$11 trillion in debt for our
children.

369
00:19:32,200 --> 00:19:35,200
I'm not sure the seniors want us
to leave more debt for their

370
00:19:35,200 --> 00:19:37,600
children to fill a doughnut
hole.

371
00:19:37,600 --> 00:19:40,630
And when we talk about filling
the doughnut hole by taking away

372
00:19:40,633 --> 00:19:43,763
from people who can't afford to
buy a supplemental policy,

373
00:19:43,767 --> 00:19:47,067
that's where Medicare Part A
helps poor people in Oklahoma,

374
00:19:47,066 --> 00:19:51,266
is they get to buy Medicare Part
C -- we never call it Part C,

375
00:19:51,266 --> 00:19:53,496
but that's what it is -- and
they don't have

376
00:19:53,500 --> 00:19:55,370
to buy a
supplemental policy.

377
00:19:55,367 --> 00:19:58,837
So consequently, they get lots
of the benefits that other

378
00:19:58,834 --> 00:20:01,904
people who have better buying
power in Medicare

379
00:20:01,900 --> 00:20:03,730
with a
supplemental policy.

380
00:20:03,734 --> 00:20:07,564
So it's a tradeoff of whether or
not we say, where are we going

381
00:20:07,567 --> 00:20:08,497
to give the benefits.

382
00:20:08,500 --> 00:20:11,900
What we really should be doing
is saying, we're broke, Medicare

383
00:20:11,900 --> 00:20:13,630
is broke; we're working and
struggling

384
00:20:13,633 --> 00:20:15,463
together to try to get there.

385
00:20:15,467 --> 00:20:17,667
Let's not add new benefits
anywhere, and let's make sure

386
00:20:17,667 --> 00:20:21,137
the benefits that we have today
get applied more equitably.

387
00:20:21,133 --> 00:20:22,233
The President:
Well, I think

388
00:20:22,233 --> 00:20:23,733
that's a legitimate point.

389
00:20:23,734 --> 00:20:28,104
I would just point out that 80
percent of seniors are helping

390
00:20:28,100 --> 00:20:31,430
to pay in extra premiums
for the 20 percent

391
00:20:31,433 --> 00:20:35,563
who are in this
Medicare Advantage.

392
00:20:35,567 --> 00:20:38,897
And it's not means-tested, so
it's not as if the people who

393
00:20:38,900 --> 00:20:42,100
are in Medicare Advantage are
somehow the poor people who

394
00:20:42,100 --> 00:20:44,300
can't afford supplementals.

395
00:20:44,300 --> 00:20:45,330
It's pretty random.

396
00:20:45,333 --> 00:20:47,663
And what we also know is, and I
just want to point this out,

397
00:20:47,667 --> 00:20:51,397
Tom, $180 billion of it is going
to insurance companies.

398
00:20:51,400 --> 00:20:53,400
It's not going to seniors.

399
00:20:53,400 --> 00:20:55,900
It's going to insurance
companies, including big

400
00:20:55,900 --> 00:21:00,130
insurance company profits --
without any appreciable

401
00:21:00,133 --> 00:21:02,333
improvement in health care
benefits.

402
00:21:02,333 --> 00:21:04,803
That's not a good way for us to
spend money.

403
00:21:04,800 --> 00:21:08,700
I agree with you about the fact
that the prescription drug plan

404
00:21:08,700 --> 00:21:12,600
added to our deficits, because
we didn't pay for it.

405
00:21:12,600 --> 00:21:14,300
And I just have to point out
that didn't

406
00:21:14,300 --> 00:21:15,200
happen under my watch.

407
00:21:15,200 --> 00:21:17,170
That happened under
the previous Congress.

408
00:21:17,166 --> 00:21:21,096
There's some people -- John is
an example of somebody who was

409
00:21:21,100 --> 00:21:23,830
true to his convictions and
didn't vote for it.

410
00:21:23,834 --> 00:21:25,404
Senator Coburn:
I didn't vote for it.

411
00:21:25,400 --> 00:21:26,770
The President:
But the fact of

412
00:21:26,767 --> 00:21:29,237
the matter is, is that
that was costly.

413
00:21:29,233 --> 00:21:30,333
And we do have to
deal with that.

414
00:21:30,333 --> 00:21:33,833
On the other hand, that -- the
problem I don't think is, is

415
00:21:33,834 --> 00:21:36,034
that we gave seniors
prescription drug benefits.

416
00:21:36,033 --> 00:21:38,433
I think the problem is, is that
we didn't pay for it.

417
00:21:38,433 --> 00:21:40,533
And we should try to find a way
to pay for it.

418
00:21:40,533 --> 00:21:43,133
Taking some of that money out of
Medicare Advantage and putting

419
00:21:43,133 --> 00:21:46,403
it into that doughnut hole does
pay for it.

420
00:21:46,400 --> 00:21:50,230
I really breached protocol here,
but I thought that was important

421
00:21:50,233 --> 00:21:51,733
to just get clear.

422
00:21:51,734 --> 00:21:54,734
We are taking about Medicare
Advantage in terms of where

423
00:21:54,734 --> 00:21:58,434
these cuts come from, not
Medicare benefits through the

424
00:21:58,433 --> 00:22:01,833
traditional Medicare Plan. Xavier.

425
00:22:01,834 --> 00:22:05,034
Congressman Becerra:
Mr. President, thank you very

426
00:22:05,033 --> 00:22:06,233
much for bringing
us all together.

427
00:22:06,233 --> 00:22:08,263
And I do want to address
something that my friend, Paul

428
00:22:08,266 --> 00:22:10,596
Ryan said, because I almost
think that we can't have this

429
00:22:10,600 --> 00:22:13,830
discussion any further without
addressing something Paul said.

430
00:22:13,834 --> 00:22:19,664
Paul, you called into question
the Congressional Budget Office.

431
00:22:19,667 --> 00:22:23,597
Now, we can all agree to
disagree, we could all have our

432
00:22:23,600 --> 00:22:29,000
politics, but if there's no
referee on the field, we can

433
00:22:29,000 --> 00:22:31,100
never agree how the game should
be played.

434
00:22:31,100 --> 00:22:31,670
Congressman Ryan:
Let me clarify,

435
00:22:31,667 --> 00:22:32,467
just to be clear.

436
00:22:32,467 --> 00:22:33,967
Congressman Becerra:
No, no. Let me -- let me

437
00:22:33,967 --> 00:22:35,367
-- if I could
just finish.

438
00:22:35,367 --> 00:22:39,737
And so, I think we have to
decide do we believe in the

439
00:22:39,734 --> 00:22:44,204
Congressional Budget Office or
not, because Paul, you and I

440
00:22:44,200 --> 00:22:46,300
have sat on the Budget Committee
for years together.

441
00:22:46,300 --> 00:22:51,130
And you have, on any number of
occasions in those years, cited

442
00:22:51,133 --> 00:22:53,803
the Congressional Budget Office
to make your point, referred to

443
00:22:53,800 --> 00:22:57,530
the Congressional Budget
Office's projections

444
00:22:57,533 --> 00:22:58,863
to make your points.

445
00:22:58,867 --> 00:23:02,537
And today, you essentially said
you can't trust the

446
00:23:02,533 --> 00:23:03,763
Congressional Budget Office.

447
00:23:03,767 --> 00:23:05,097
Congressman Ryan:
No, that is not what I'm saying.

448
00:23:05,100 --> 00:23:05,800
Congressman Becerra:
Okay, well,

449
00:23:05,800 --> 00:23:06,400
that was my interpretation.

450
00:23:06,400 --> 00:23:07,230
Congressman Ryan:
No. Let me be clear.

451
00:23:07,233 --> 00:23:08,133
Congressman Becerra:
I apologize.

452
00:23:08,133 --> 00:23:09,033
I apologize if
I misinterpreted --

453
00:23:09,033 --> 00:23:10,103
Congressman Ryan:
I am not questioning

454
00:23:10,100 --> 00:23:11,030
the quality of the scoring --

455
00:23:11,033 --> 00:23:11,733
Congressman Becerra:
Paul -- Paul, if I

456
00:23:11,734 --> 00:23:12,364
could just finish my --

457
00:23:12,367 --> 00:23:13,637
Congressman Ryan:
-- I'm questioning the

458
00:23:13,633 --> 00:23:17,033
Congressman Becerra:
I take your point on

459
00:23:17,033 --> 00:23:18,333
your clarification.
But if I --

460
00:23:18,333 --> 00:23:19,063
Congressman Ryan:
Let me just

461
00:23:19,066 --> 00:23:20,096
say it, 10 years of tax

462
00:23:20,100 --> 00:23:21,800
increases, 10 years of
Medicare cuts to pay for

463
00:23:21,800 --> 00:23:23,830
six years of spending --

464
00:23:23,834 --> 00:23:24,434
Congressman Becerra:
Paul, if I could just

465
00:23:24,433 --> 00:23:25,163
try to make my point.

466
00:23:25,166 --> 00:23:26,966
Congressman Ryan:
Okay.

467
00:23:26,967 --> 00:23:28,337
Congressman Becerra:
So then I'm assuming

468
00:23:28,333 --> 00:23:30,203
then that you do

469
00:23:30,200 --> 00:23:33,130
believe that the CBO is a
legitimate agency to render

470
00:23:33,133 --> 00:23:36,003
decisions on spending for the
Congress.

471
00:23:36,000 --> 00:23:36,830
Congressman Ryan:
Xavier, you

472
00:23:36,834 --> 00:23:37,734
know I believe that.

473
00:23:37,734 --> 00:23:39,134
Congressman Becerra:
Okay, so then let's

474
00:23:39,133 --> 00:23:39,763
work with that.

475
00:23:39,767 --> 00:23:43,367
Because, quite honestly, if we
can't work with CBO numbers,

476
00:23:43,367 --> 00:23:45,037
we're lost; we're lost.

477
00:23:45,033 --> 00:23:47,233
Because then we really will get
into a food fight.

478
00:23:47,233 --> 00:23:55,033
And so, I apologize, Paul, if I
misinterpreted --

479
00:23:55,033 --> 00:23:55,603
Congressman Ryan:
Yes, look --

480
00:23:55,600 --> 00:23:56,130
Congressman Becerra: -- what I
had heard, I appreciate that we

481
00:23:56,133 --> 00:23:57,663
left the referee on the field.

482
00:23:57,667 --> 00:23:58,097
Congressman Ryan:
I'll just simply say --

483
00:23:58,100 --> 00:23:59,330
Congressman Becerra:
And so if the referee

484
00:23:59,333 --> 00:24:00,233
is on the field,

485
00:24:00,233 --> 00:24:01,433
then we have to at least accept
what the referee has said.

486
00:24:01,433 --> 00:24:07,833
And the referee said that the
bills that are before us reduce

487
00:24:07,834 --> 00:24:11,664
the deficit, the federal
government's deficit, by over

488
00:24:11,667 --> 00:24:14,467
$100 billion in the first 10
years.

489
00:24:14,467 --> 00:24:17,597
The Congressional Budget Office,
the referee -- not political

490
00:24:17,600 --> 00:24:22,770
parties; the referee -- said
that these bills reduce the

491
00:24:22,767 --> 00:24:26,767
deficit in the succeeding years,
after the first 10 years, by

492
00:24:26,767 --> 00:24:28,867
over a trillion dollars.

493
00:24:28,867 --> 00:24:30,467
Now, you're right.

494
00:24:30,467 --> 00:24:33,497
All the discussion makes it
clear it wasn't easy.

495
00:24:33,500 --> 00:24:35,530
There are going to be some
savings that we

496
00:24:35,533 --> 00:24:37,263
extract out of Medicare.

497
00:24:37,266 --> 00:24:41,036
What we do do in these bills is
try to make the point that as we

498
00:24:41,033 --> 00:24:44,303
reduce the deficit, we're not
going to put the onus, the

499
00:24:44,300 --> 00:24:49,530
burden of those cuts on seniors
who receive Medicare.

500
00:24:49,533 --> 00:24:52,063
We're asking the providers to
stop, as some of my colleagues

501
00:24:52,066 --> 00:24:57,466
in the Senate said,
over-utilizing or over-spending

502
00:24:57,467 --> 00:25:01,437
in services, so that we don't
see someone having four

503
00:25:01,433 --> 00:25:04,503
different X-rays for chest pain.

504
00:25:04,500 --> 00:25:07,800
And so what we're trying to do
is figure out the ways to reduce

505
00:25:07,800 --> 00:25:10,070
the costs without
impacting benefits.

506
00:25:10,066 --> 00:25:13,836
In fact, that's how in these two
bills that the Senate and House

507
00:25:13,834 --> 00:25:17,704
passed, we were actually able to
close the doughnut hole for

508
00:25:17,700 --> 00:25:21,930
prescription drug coverage in
Medicare and still extract,

509
00:25:21,934 --> 00:25:25,104
according to the CBO, over
$100 billion in savings.

510
00:25:25,100 --> 00:25:28,530
So, Mr. President, I would just
say the thing that I would love

511
00:25:28,533 --> 00:25:31,803
for us to get into the details
of, in terms of those deficit

512
00:25:31,800 --> 00:25:36,870
reductions that are made is the
fact that we do it while putting

513
00:25:36,867 --> 00:25:40,037
the brakes on Medicare
overpayments that went to

514
00:25:40,033 --> 00:25:43,963
insurance companies, which were
getting reimbursed at greater

515
00:25:43,967 --> 00:25:48,037
levels than were doctors and
hospitals that relied on a

516
00:25:48,033 --> 00:25:50,833
traditional Medicare fee for
service, to provide

517
00:25:50,834 --> 00:25:52,464
services to our seniors.

518
00:25:52,467 --> 00:25:57,597
We have any number of provisions
that deal with the issue of

519
00:25:57,600 --> 00:26:01,330
fraud, which (inaudible) says at
least a total of $60 billion.

520
00:26:01,333 --> 00:26:03,863
And working with some of our
Republican colleagues, we are

521
00:26:03,867 --> 00:26:07,967
doing exactly that, going after
the waste that's in the system,

522
00:26:07,967 --> 00:26:09,737
certainly the fraud.

523
00:26:09,734 --> 00:26:12,834
And that's how we extract the
number of the savings.

524
00:26:12,834 --> 00:26:17,504
And, finally, perhaps one of the
unsung secrets of what we

525
00:26:17,500 --> 00:26:21,000
learned from listening to
doctors and hospitals and all

526
00:26:21,000 --> 00:26:24,130
the different providers is that
we can actually do a far better

527
00:26:24,133 --> 00:26:27,133
job of coordinating care for
people.

528
00:26:27,133 --> 00:26:30,433
And if you make sure that
someone who walks in the door of

529
00:26:30,433 --> 00:26:33,233
any one of the great physicians
who are in this room when they

530
00:26:33,233 --> 00:26:36,533
were practicing and made sure
that we followed them through

531
00:26:36,533 --> 00:26:40,233
not just that first visit to the
primary care or family doctor,

532
00:26:40,233 --> 00:26:43,633
but then into the specialist and
then into the hospital and then

533
00:26:43,633 --> 00:26:47,033
afterwards to perhaps the
nursing home or the home health

534
00:26:47,033 --> 00:26:50,003
center, that what you do is if
you coordinate the care instead

535
00:26:50,000 --> 00:26:53,130
of have each provider do just
its share and forget about the

536
00:26:53,133 --> 00:26:55,703
patient, if you coordinate the
care, you can actually

537
00:26:55,700 --> 00:26:57,730
reduce costs dramatically.

538
00:26:57,734 --> 00:27:01,004
And that's how we were able to
reduce the costs for Medicare.

539
00:27:01,000 --> 00:27:03,400
That's how we were able to
extract, according to the

540
00:27:03,400 --> 00:27:06,000
referee on the field, the
Congressional Budget Office,

541
00:27:06,000 --> 00:27:10,000
over $100 billion in deficit
reduction and over a trillion

542
00:27:10,000 --> 00:27:13,070
dollars in deficit reduction in
the second 10 years.

543
00:27:13,066 --> 00:27:15,736
So I believe, Mr. President,
what we have is a chance to

544
00:27:15,734 --> 00:27:20,634
discuss how we can actually put
this country back on a good

545
00:27:20,633 --> 00:27:24,903
fiscal track and still do right
by our seniors in Medicare and

546
00:27:24,900 --> 00:27:27,000
increase the amount of people
who get covered by health

547
00:27:27,000 --> 00:27:33,730
insurance by about 31 million.

548
00:27:33,734 --> 00:27:34,934
Senator Grassley:
First of all,

549
00:27:34,934 --> 00:27:37,164
to clarify something, if anybody

550
00:27:37,166 --> 00:27:41,136
says that Medicare Advantage is
a subsidy going to insurance

551
00:27:41,133 --> 00:27:44,463
companies, let me say what the
statute says.

552
00:27:44,467 --> 00:27:50,297
The statute says that 75 -- with
a big differential where it goes

553
00:27:50,300 --> 00:27:54,000
-- 75 percent goes to
beneficiaries and benefits and

554
00:27:54,000 --> 00:28:00,130
25 percent to the federal
government.

555
00:28:00,133 --> 00:28:01,103
The President:
I'm sorry, Chuck,

556
00:28:01,100 --> 00:28:02,330
I just want to make sure -- I

557
00:28:02,333 --> 00:28:04,433
don't think that's -- that
doesn't sound right to me

558
00:28:04,433 --> 00:28:07,863
because that would mean 100
percent of it is going to either

559
00:28:07,867 --> 00:28:09,067
benefits or the federal
government, which means the

560
00:28:09,066 --> 00:28:10,796
insurance companies aren't
making any money there.

561
00:28:10,800 --> 00:28:12,670
Senator Grassley:
No, 75 percent

562
00:28:12,667 --> 00:28:14,637
to beneficiaries and benefits

563
00:28:14,633 --> 00:28:17,603
and 25 percent to the federal
government.

564
00:28:17,600 --> 00:28:22,930
We consider -- I consider CBO
"God" around here because it

565
00:28:22,934 --> 00:28:25,934
takes 60 votes in the Senate to
overrule them so I'm not

566
00:28:25,934 --> 00:28:32,834
questioning CBO, but in regard
to what Mr. Ryan said, I want to

567
00:28:32,834 --> 00:28:40,834
back it up with a quote from a
December 23rd letter from CBO

568
00:28:40,834 --> 00:28:42,964
about this double accounting:

569
00:28:42,967 --> 00:28:47,367
"The key point is that the
savings to the health insurance

570
00:28:47,367 --> 00:28:52,097
trust fund under" the bill
"would be received by the

571
00:28:52,100 --> 00:28:57,100
government only once, so they
cannot be set aside to pay for

572
00:28:57,100 --> 00:29:01,900
future Medicare spending and, at
the same time, pay for current

573
00:29:01,900 --> 00:29:05,130
spending on other parts of the
legislation."

574
00:29:05,133 --> 00:29:09,763
Then skip a couple sentences
and say: "To describe the full

575
00:29:09,767 --> 00:29:14,497
amount of the HI Trust Fund
savings as both" -- with

576
00:29:14,500 --> 00:29:17,230
emphasis upon "both" --
"improving the government's

577
00:29:17,233 --> 00:29:22,203
ability to pay future Medicare
benefits and financing new

578
00:29:22,200 --> 00:29:28,070
spending outside of Medicare
would essentially double-count a

579
00:29:28,066 --> 00:29:31,766
large share of those savings and
thus overstate the improvement

580
00:29:31,767 --> 00:29:34,597
in the government's fiscal
position. "

581
00:29:34,600 --> 00:29:37,630
Now, you can argue about the
exact amount of savings or

582
00:29:37,633 --> 00:29:41,733
whether there isn't any savings,
but you can't argue that you

583
00:29:41,734 --> 00:29:45,204
can't count a dollar twice --
you just can't argue that.

584
00:29:45,200 --> 00:29:48,730
Common sense tells you that.

585
00:29:48,734 --> 00:29:51,804
You don't even have to have an
accountant tell you that.

586
00:29:51,800 --> 00:29:56,500
Now, I think what we want to
remember here is that there are

587
00:29:56,500 --> 00:29:59,600
consequences to things we do.

588
00:29:59,600 --> 00:30:02,230
You change tax policy and
there's consequences

589
00:30:02,233 --> 00:30:04,103
to tax policy.

590
00:30:04,100 --> 00:30:07,830
You decide you're going to save
money in certain areas --

591
00:30:07,834 --> 00:30:09,804
there's consequences to that.

592
00:30:09,800 --> 00:30:12,670
So we have big tax increases.

593
00:30:12,667 --> 00:30:16,367
I think that without a doubt
when you put tax on labor it's

594
00:30:16,367 --> 00:30:21,837
harmful and it doesn't do
anything to create employment.

595
00:30:21,834 --> 00:30:26,904
Both bills hit small business
with higher tax rates -- the

596
00:30:26,900 --> 00:30:32,370
House bill by 33 percent; the
Senate bill by 20 percent.

597
00:30:32,367 --> 00:30:35,837
The House bill hits small
business harder, obviously; the

598
00:30:35,834 --> 00:30:40,734
Senate bill hits the middle
class harder.

599
00:30:40,734 --> 00:30:45,834
It's a fact that when you do
these things, you hurt the

600
00:30:45,834 --> 00:30:51,334
economy because small business
is the machine that brings

601
00:30:51,333 --> 00:30:54,463
employment in America -- 70
percent of new employment.

602
00:30:54,467 --> 00:30:57,037
We've got to be careful of how
you treat small business.

603
00:30:57,033 --> 00:31:01,663
And small business can be -- the
health care needs of small

604
00:31:01,667 --> 00:31:06,497
business can take -- be taken
care of with these association

605
00:31:06,500 --> 00:31:09,930
health plans and other things
that can be done

606
00:31:09,934 --> 00:31:12,534
to make it beneficial.

607
00:31:12,533 --> 00:31:14,863
Thirty-five states have
high-risk pools.

608
00:31:14,867 --> 00:31:19,467
Most of them, 150 percent is the
maximum cost.

609
00:31:19,467 --> 00:31:25,537
So you can build on those
high-risk pools to take care of

610
00:31:25,533 --> 00:31:29,903
people that have needs,
particularly those that would be

611
00:31:29,900 --> 00:31:33,630
hit by the mandate and might not
be able to afford the insurance

612
00:31:33,633 --> 00:31:35,103
without the high costs.

613
00:31:35,100 --> 00:31:38,030
The high cost of this
bill comes from

614
00:31:38,033 --> 00:31:41,433
an unconstitutional mandate.

615
00:31:41,433 --> 00:31:46,003
It comes from the fact that for
the first time in the 225-year

616
00:31:46,000 --> 00:31:49,470
history of the country, the
federal government is telling

617
00:31:49,467 --> 00:31:51,497
you, you got to buy something.

618
00:31:51,500 --> 00:31:53,830
That just doesn't make sense to
a lot of people at the

619
00:31:53,834 --> 00:31:55,764
grassroots of the Midwest.

620
00:31:55,767 --> 00:31:59,097
And if you think I don't listen
to my people, I've had 32 town

621
00:31:59,100 --> 00:32:01,500
meetings so far this year.

622
00:32:01,500 --> 00:32:03,630
I think I have a good
feeling of what's out

623
00:32:03,633 --> 00:32:05,233
there at the grassroots.

624
00:32:05,233 --> 00:32:10,263
Now, we have unrealistic cuts in
here -- not unrealistic from the

625
00:32:10,266 --> 00:32:13,636
standpoint of the way
CBO scored them.

626
00:32:13,633 --> 00:32:15,863
Not at all. CBO is
God around here.

627
00:32:15,867 --> 00:32:17,897
They say -- we give them
policies that are going to save

628
00:32:17,900 --> 00:32:21,730
X number of dollars, it's going
to save X number of dollars.

629
00:32:21,734 --> 00:32:24,634
But do you think that we're
going sit around in rural

630
00:32:24,633 --> 00:32:29,703
America, or even in urban --
downtown urban America, in the

631
00:32:29,700 --> 00:32:32,070
poverty parts of the city,
that we're going

632
00:32:32,066 --> 00:32:34,396
to let hospitals close down?

633
00:32:34,400 --> 00:32:39,570
And they raise the concern about
access to health care.

634
00:32:39,567 --> 00:32:45,167
No, we aren't going to reduce
benefits for seniors at all.

635
00:32:45,166 --> 00:32:50,966
But when you put our health care
institutions and our delivery

636
00:32:50,967 --> 00:32:55,567
system in jeopardy, well, people
-- you're going to promise

637
00:32:55,567 --> 00:32:57,797
people health care they aren't
going to get.

638
00:32:57,800 --> 00:33:01,900
If you're going to put 14 -- I
don't know whether it was 14 or

639
00:33:01,900 --> 00:33:05,300
18 million people under this
bill -- into Medicaid --

640
00:33:05,300 --> 00:33:08,700
Medicaid pays about, in my
state, I think

641
00:33:08,700 --> 00:33:10,500
about 60 or so percent.

642
00:33:10,500 --> 00:33:12,500
Medicare pays 80
percent of cost.

643
00:33:12,500 --> 00:33:14,230
Doctors don't take Medicaid.

644
00:33:14,233 --> 00:33:19,103
So you're going to promise 14 to
18 million people in Medicaid

645
00:33:19,100 --> 00:33:21,370
that they're going to be
covered.

646
00:33:21,367 --> 00:33:24,267
But if you don't have doctors to
service them, isn't that a

647
00:33:24,266 --> 00:33:28,496
little bit intellectually
dishonest, to promise something

648
00:33:28,500 --> 00:33:30,530
that you can't deliver on?

649
00:33:30,533 --> 00:33:36,503
And so there are these things in
this bill -- Medicare, Medicaid

650
00:33:36,500 --> 00:33:41,130
cuts that -- I don't see any
future Congress having any more

651
00:33:41,133 --> 00:33:45,333
guts than we do to close a rural
hospital.

652
00:33:45,333 --> 00:33:50,133
So I think that you got to take
into consideration -- you've got

653
00:33:50,133 --> 00:33:53,333
to take into consideration the
consequences of the acts or the

654
00:33:53,333 --> 00:33:58,363
unproven promises of cuts that
aren't going to materialize.

655
00:33:58,367 --> 00:34:00,637
That's just the way I see it.

656
00:34:00,633 --> 00:34:04,603
And working in those 31
meetings, hundreds of hours of

657
00:34:04,600 --> 00:34:08,070
meetings with Senator Baucus, I
learned a lot about health care.

658
00:34:08,066 --> 00:34:12,396
Now, we didn't get a bill out of
that bipartisan effort, but I'm

659
00:34:12,400 --> 00:34:15,870
sure glad I spent all that time
there because I learned a heck

660
00:34:15,867 --> 00:34:17,967
of a lot about our health care
system that I

661
00:34:17,967 --> 00:34:20,467
wouldn't have
otherwise known.

662
00:34:20,467 --> 00:34:21,797
The President:
Thank you, Chuck.

663
00:34:21,800 --> 00:34:23,830
I'm going to go to Kent next.

664
00:34:23,834 --> 00:34:30,564
I just want to make one point.

665
00:34:30,567 --> 00:34:35,737
If the notion is, is that we
can't make some hard decisions

666
00:34:35,734 --> 00:34:39,464
about how entitlements work
because it's just not realistic,

667
00:34:39,467 --> 00:34:42,667
nobody is going to have the guts
to do it, then we're in big

668
00:34:42,667 --> 00:34:50,267
trouble, because that means that
the federal budget and state

669
00:34:50,266 --> 00:34:53,196
budgets and then business
budgets and family budgets are

670
00:34:53,200 --> 00:34:55,930
all going to be gobbled up by
this thing.

671
00:34:55,934 --> 00:35:00,834
So I hope that in fact we've got
the courage to

672
00:35:00,834 --> 00:35:03,134
make some of these changes.

673
00:35:03,133 --> 00:35:14,603
Now, when I say that Medicare
Advantage is not a useful way

674
00:35:14,600 --> 00:35:18,700
for us to spend tax dollars to
provide health care to seniors,

675
00:35:18,700 --> 00:35:22,030
at least the way it's currently
structured, as I said, that's

676
00:35:22,033 --> 00:35:23,933
not a Democratic idea.

677
00:35:23,934 --> 00:35:27,364
I mean, there are a whole bunch
of Republican commentators and

678
00:35:27,367 --> 00:35:30,397
some of the folks who've sat
around this table before who

679
00:35:30,400 --> 00:35:33,770
suggested that that's probably
right.

680
00:35:33,767 --> 00:35:36,867
You can make an argument that
whatever savings we get out of

681
00:35:36,867 --> 00:35:40,667
Medicare Advantage should not go
to filling the

682
00:35:40,667 --> 00:35:42,137
doughnut hole, for example.

683
00:35:42,133 --> 00:35:46,463
That's a legitimate argument.

684
00:35:46,467 --> 00:35:48,097
You can make an argument
that it should go

685
00:35:48,100 --> 00:35:50,730
just to deficit reduction.

686
00:35:50,734 --> 00:35:52,364
Those are all legitimate
arguments.

687
00:35:52,367 --> 00:35:59,797
But my point is that the savings
that are obtained here are from

688
00:35:59,800 --> 00:36:03,000
a program in which insurance
companies are making a lot of

689
00:36:03,000 --> 00:36:07,870
money but seniors who are in
these kinds of programs are not

690
00:36:07,867 --> 00:36:11,867
better off, and the 80 percent
of the people who are [not] in

691
00:36:11,867 --> 00:36:15,967
these programs are paying an
extra 90 bucks a year to

692
00:36:15,967 --> 00:36:17,937
subsidize the folks
who are in them.

693
00:36:17,934 --> 00:36:20,104
And that just doesn't seem like
a good deal for

694
00:36:20,100 --> 00:36:23,530
them or for the taxpayer.
Kent Conrad.

695
00:36:23,533 --> 00:36:24,233
Senator Grassley:
Would you give

696
00:36:24,233 --> 00:36:25,103
me 30 seconds, please?

697
00:36:25,100 --> 00:36:26,070
The President:
Sure.

698
00:36:26,066 --> 00:36:29,266
Senator Grassley:
I think we've

699
00:36:29,266 --> 00:36:31,366
already had it laid out here in

700
00:36:31,367 --> 00:36:33,397
four or five different ways how
a heck of a lot

701
00:36:33,400 --> 00:36:35,200
of money could be saved.

702
00:36:35,200 --> 00:36:40,200
And I think that those things
that we can agree

703
00:36:40,200 --> 00:36:41,630
on we ought to
proceed on.

704
00:36:41,633 --> 00:36:46,203
But I think that it's legitimate
to take into consideration that

705
00:36:46,200 --> 00:36:52,800
if you're going to have program
cuts that CBO says out there in

706
00:36:52,800 --> 00:36:56,730
the second decade could be 15 to
20 percent a year -- that you

707
00:36:56,734 --> 00:36:59,704
got to have a system left to
serve the people that we're

708
00:36:59,700 --> 00:37:02,070
promising health insurance to.

709
00:37:02,066 --> 00:37:03,336
And that's the point I'm making.

710
00:37:03,333 --> 00:37:03,863
The President:
But what I'm

711
00:37:03,867 --> 00:37:04,437
saying is, Chuck -- I think it's

712
00:37:04,433 --> 00:37:04,963
a legitimate point.

713
00:37:04,967 --> 00:37:10,137
What I'm saying is that on
Medicare Advantage, that does

714
00:37:10,133 --> 00:37:14,133
not have to do with the concerns
that you've got about hospitals

715
00:37:14,133 --> 00:37:18,263
or doctors getting properly
reimbursed.

716
00:37:18,266 --> 00:37:20,496
This is a program that's going
to insurance companies.

717
00:37:20,500 --> 00:37:26,830
But I want to make sure that
Kent gets in here, because Kent

718
00:37:26,834 --> 00:37:28,704
knows something about the budget
as the chairman

719
00:37:28,700 --> 00:37:30,470
of the Budget Committee. Kent.

720
00:37:30,467 --> 00:37:31,067
Senator Conrad:
Well, thank you,

721
00:37:31,066 --> 00:37:32,066
Mr. President.

722
00:37:32,066 --> 00:37:37,036
Thank you for allowing us to
come and visit about what really

723
00:37:37,033 --> 00:37:43,433
is the 800-pound gorilla facing
the federal budget, and that is

724
00:37:43,433 --> 00:37:47,263
the health care accounts of the
United States -- Medicare,

725
00:37:47,266 --> 00:37:50,066
Medicaid, and the rest.

726
00:37:50,066 --> 00:37:55,436
What we all know that is true is
the biggest unfunded liability

727
00:37:55,433 --> 00:37:59,333
of the United States is
Medicare.

728
00:37:59,333 --> 00:38:05,503
What we all know is true, as the
trustees have told us, Medicare

729
00:38:05,500 --> 00:38:08,330
is going to go broke in eight
years.

730
00:38:08,333 --> 00:38:12,663
So the idea that we don't have
to do anything about Medicare is

731
00:38:12,667 --> 00:38:15,837
utterly disconnected from
reality.

732
00:38:15,834 --> 00:38:23,064
The idea that we don't have to
find savings in Medicare is an

733
00:38:23,066 --> 00:38:27,096
admission that we are headed for
a fiscal cliff that we're going

734
00:38:27,100 --> 00:38:28,730
to go right over.

735
00:38:28,734 --> 00:38:32,804
And if we really want to
endanger the benefits to people

736
00:38:32,800 --> 00:38:37,470
who are getting Medicare, the
best way to do that is to do

737
00:38:37,467 --> 00:38:43,667
nothing, because if we do
nothing, we will guarantee that

738
00:38:43,667 --> 00:38:47,067
Medicare goes broke.

739
00:38:47,066 --> 00:38:51,536
So together -- we can either do
this together or we can have

740
00:38:51,533 --> 00:38:53,833
this imposed on us.

741
00:38:53,834 --> 00:38:56,204
I very much hope we do it
together.

742
00:38:56,200 --> 00:38:59,630
Senator Coburn, and I'm sorry --
did he leave?

743
00:38:59,633 --> 00:39:03,203
-- I'm sorry that he's not here,
because he said something that I

744
00:39:03,200 --> 00:39:06,270
thought was one of the most
important comments made here

745
00:39:06,266 --> 00:39:09,666
today, and something that I
think has gotten way too little

746
00:39:09,667 --> 00:39:13,637
attention, and that's
the question of

747
00:39:13,633 --> 00:39:16,503
those who are chronically ill.

748
00:39:16,500 --> 00:39:22,630
As we analyzed Medicare, we
found a startling statistic:

749
00:39:22,633 --> 00:39:28,203
5 percent of Medicare
beneficiaries, 5 percent, use

750
00:39:28,200 --> 00:39:30,570
half of all the money.

751
00:39:30,567 --> 00:39:32,667
I think Paul knows this well.

752
00:39:32,667 --> 00:39:36,637
Five percent used 50 percent of
the money.

753
00:39:36,633 --> 00:39:37,703
Who are they?

754
00:39:37,700 --> 00:39:40,470
They're the chronically ill,
people who

755
00:39:40,467 --> 00:39:43,467
have multiple,
serious conditions.

756
00:39:43,467 --> 00:39:47,067
And I think Dr. Coburn was
really referencing that when he

757
00:39:47,066 --> 00:39:50,566
talked about the need to better
coordinate their care, because

758
00:39:50,567 --> 00:39:56,297
we are wasting massive amounts
of money and getting worse

759
00:39:56,300 --> 00:39:58,970
health care outcomes than we
could if we better

760
00:39:58,967 --> 00:40:00,467
coordinated their care.

761
00:40:00,467 --> 00:40:01,697
What do we mean by that?

762
00:40:01,700 --> 00:40:05,470
A study was done with 20,000
patients.

763
00:40:05,467 --> 00:40:07,767
They put a care coordinator on
each one of them.

764
00:40:07,767 --> 00:40:10,297
These are chronically ill
patients.

765
00:40:10,300 --> 00:40:14,470
And what they found was by
coordinating their care -- and

766
00:40:14,467 --> 00:40:16,797
the first thing they did, by the
way, is go into their kitchen

767
00:40:16,800 --> 00:40:20,030
tables, sit down, get out all
their prescription drugs; on

768
00:40:20,033 --> 00:40:24,303
average they found they were
taking 16.

769
00:40:24,300 --> 00:40:28,570
They found that by looking at
them they could eliminate eight.

770
00:40:28,567 --> 00:40:31,497
The result was hundreds of
thousands of dollars of savings

771
00:40:31,500 --> 00:40:34,270
per patient, better health care
outcomes.

772
00:40:34,266 --> 00:40:37,166
You know, I did this with my own
father-in-law

773
00:40:37,166 --> 00:40:38,936
in his final illness.

774
00:40:38,934 --> 00:40:41,934
Went to his kitchen table --
didn't know it was his final

775
00:40:41,934 --> 00:40:44,304
illness -- got out all his
prescription drugs.

776
00:40:44,300 --> 00:40:46,430
Sure enough he was taking 16.

777
00:40:46,433 --> 00:40:48,963
I get on the phone to the
doctor, I go down the list.

778
00:40:48,967 --> 00:40:52,537
Dr. Coburn, you were out of the
room -- I referenced you because

779
00:40:52,533 --> 00:40:55,633
you said something that really
triggered a thought in my mind

780
00:40:55,633 --> 00:40:57,303
that I think is important.

781
00:40:57,300 --> 00:41:02,230
Went down the list of what my
father-in-law was taking

782
00:41:02,233 --> 00:41:03,633
-- 16 prescription drugs.

783
00:41:03,633 --> 00:41:05,333
I get on the line to the doctor.

784
00:41:05,333 --> 00:41:07,833
He says, well, Kent -- I get
down to about the third one --

785
00:41:07,834 --> 00:41:08,804
he shouldn't be taking that.

786
00:41:08,800 --> 00:41:11,870
He shouldn't have been taking
that the last five years.

787
00:41:11,867 --> 00:41:13,697
I get a little further down the
list, two drugs.

788
00:41:13,700 --> 00:41:15,300
He says, well, Kent, he
shouldn't be

789
00:41:15,300 --> 00:41:16,300
taking those two drugs.

790
00:41:16,300 --> 00:41:17,870
They work against each other.

791
00:41:17,867 --> 00:41:19,937
I said, doc, how does this
happen?

792
00:41:19,934 --> 00:41:22,964
He said, Kent, it's very simple.

793
00:41:22,967 --> 00:41:25,497
He has got a heart condition, he
has got a serious lung

794
00:41:25,500 --> 00:41:31,270
condition, he has got orthopedic
issues, he's got doctors for

795
00:41:31,266 --> 00:41:33,896
each one of those, he's getting
prescription drugs mail-order,

796
00:41:33,900 --> 00:41:36,870
he's getting them at the
hospital pharmacy, he's getting

797
00:41:36,867 --> 00:41:38,997
them down at the beach.

798
00:41:39,000 --> 00:41:41,630
He's sick and confused, his wife
is sick and confused,

799
00:41:41,633 --> 00:41:45,063
we've got chaos.

800
00:41:45,066 --> 00:41:49,036
And my conclusion, after all of
these hundreds of hours of

801
00:41:49,033 --> 00:41:51,833
hearings and meetings with
Senator Grassley and Senator

802
00:41:51,834 --> 00:41:56,264
Baucus we're part of and Senator
Enzi was, indeed we do.

803
00:41:56,266 --> 00:41:59,566
We have a system that is
characterized, especially for

804
00:41:59,567 --> 00:42:01,767
those people, by chaos.

805
00:42:01,767 --> 00:42:06,937
We can do better, and we really
don't have a choice, because

806
00:42:06,934 --> 00:42:10,134
we've got a debt now, a gross
debt, 100 percent of our GDP

807
00:42:10,133 --> 00:42:14,233
headed for 400 percent that
nobody believes is sustainable.

808
00:42:14,233 --> 00:42:19,733
So I just pray that we find a
way to come together and deal

809
00:42:19,734 --> 00:42:23,004
with these things seriously,
because if we don't,

810
00:42:23,000 --> 00:42:25,530
we will rue the day.

811
00:42:25,533 --> 00:42:27,563
The President:
It's a little bit

812
00:42:27,567 --> 00:42:29,137
-- I might -- I want to make

813
00:42:29,133 --> 00:42:32,433
sure that we're balancing off
time between Democrats

814
00:42:32,433 --> 00:42:36,133
and Republicans here.

815
00:42:36,133 --> 00:42:40,333
And House and Senate, as well.

816
00:42:40,333 --> 00:42:43,203
John, go ahead.

817
00:42:43,200 --> 00:42:45,030
Congressman Boehner:
Mr. President, I'm going to say

818
00:42:45,033 --> 00:42:47,763
thank you for having us here.

819
00:42:47,767 --> 00:42:51,167
I think it's been a useful
conversation.

820
00:42:51,166 --> 00:42:55,296
And as I listened to you open up
this meeting, I thought to

821
00:42:55,300 --> 00:42:59,470
myself, I don't disagree with
anything that you said at the

822
00:42:59,467 --> 00:43:02,597
beginning of the meeting, in
terms of the premise

823
00:43:02,600 --> 00:43:04,600
for why we're here.

824
00:43:04,600 --> 00:43:06,630
The American families are
struggling with health care.

825
00:43:06,633 --> 00:43:08,403
We all know it.

826
00:43:08,400 --> 00:43:11,170
The American people want us to
address this

827
00:43:11,166 --> 00:43:13,336
in a responsible way.

828
00:43:13,333 --> 00:43:18,033
And so I believe -- do say
thanks for having us all here.

829
00:43:18,033 --> 00:43:21,163
I think our job, on behalf of
our constituents and on behalf

830
00:43:21,166 --> 00:43:24,266
of the American people, is to
listen.

831
00:43:24,266 --> 00:43:28,466
And I spend time in my district,
I spend time in a lot of places.

832
00:43:28,467 --> 00:43:30,767
I've heard an awful lot.

833
00:43:30,767 --> 00:43:33,067
And I can tell you the thing
that I've heard more than

834
00:43:33,066 --> 00:43:35,666
anything over the last six or
seven months is that the

835
00:43:35,667 --> 00:43:39,737
American people want us to scrap
this bill.

836
00:43:39,734 --> 00:43:43,234
They've said it loud, they've
said it clear.

837
00:43:43,233 --> 00:43:48,303
And let me help understand why.

838
00:43:48,300 --> 00:43:50,330
First thing is we've just talked
-- we've heard from the two

839
00:43:50,333 --> 00:43:56,233
budget directors about our
fiscal condition.

840
00:43:56,233 --> 00:43:59,703
We have Medicare that's going
broke.

841
00:43:59,700 --> 00:44:01,900
We have Social Security that's
going broke.

842
00:44:01,900 --> 00:44:04,900
We have Medicaid that is
bankrupting not only the federal

843
00:44:04,900 --> 00:44:07,770
government, but all the states.

844
00:44:07,767 --> 00:44:11,567
And yet, here we are having a
conversation about creating a

845
00:44:11,567 --> 00:44:16,597
new entitlement program that
will bankrupt our country.

846
00:44:16,600 --> 00:44:18,400
And it will bankrupt our
country.

847
00:44:18,400 --> 00:44:24,830
It's not that we can't do health
insurance reform to help bring

848
00:44:24,834 --> 00:44:27,464
down costs, to help save the
system.

849
00:44:27,467 --> 00:44:32,067
This bill -- this 2,700-page
bill will bankrupt our country.

850
00:44:32,066 --> 00:44:35,366
And secondly, Mr. President, I'd
point out that I think this is

851
00:44:35,367 --> 00:44:39,067
-- this right here is a
dangerous experiment.

852
00:44:39,066 --> 00:44:43,466
We may have problems in our
health care system, but we do

853
00:44:43,467 --> 00:44:46,767
have the best health care system
in the world, by far.

854
00:44:46,767 --> 00:44:51,537
And having a government takeover
of health care, and I truly

855
00:44:51,533 --> 00:44:55,863
believe that's what this is, is
a dangerous experiment with the

856
00:44:55,867 --> 00:44:58,037
best health care system in the
world that

857
00:44:58,033 --> 00:44:59,563
I don't think we should do.

858
00:44:59,567 --> 00:45:01,897
So why did I bring
this bill today?

859
00:45:01,900 --> 00:45:03,830
I'll tell you why I brought it.

860
00:45:03,834 --> 00:45:06,634
We have $500 billion in new
taxes here over

861
00:45:06,633 --> 00:45:08,903
the next 10 years.

862
00:45:08,900 --> 00:45:11,900
At a time when our economy is
struggling, the last thing we

863
00:45:11,900 --> 00:45:15,500
need to do is to be raising
taxes on the American people.

864
00:45:15,500 --> 00:45:19,230
Secondly, we've got $500 billion
worth of Medicare cuts here.

865
00:45:19,233 --> 00:45:21,133
I agree with Kent Conrad.

866
00:45:21,133 --> 00:45:24,263
We need to deal with the problem
of Medicare.

867
00:45:24,266 --> 00:45:26,396
But if we're going to deal with
the problem with Medicare and

868
00:45:26,400 --> 00:45:29,500
find savings in Medicare, why
don't we use it to extend the

869
00:45:29,500 --> 00:45:33,430
life of the Medicare program as
opposed to spending that $500

870
00:45:33,433 --> 00:45:38,163
billion, creating a new
entitlement program?

871
00:45:38,166 --> 00:45:39,566
But it's not just,
Mr. President,

872
00:45:39,567 --> 00:45:42,697
the taxes or the Medicare cuts.

873
00:45:42,700 --> 00:45:45,770
You've got -- you've got the
individual mandate in here,

874
00:45:45,767 --> 00:45:49,337
which I think is unwise and I do
believe is unconstitutional.

875
00:45:49,333 --> 00:45:52,703
You've got an employer mandate
in here that says that

876
00:45:52,700 --> 00:45:55,500
employers, you've got to provide
health insurance to the American

877
00:45:55,500 --> 00:45:58,670
people or you're going to pay
this tax.

878
00:45:58,667 --> 00:46:02,537
It's going to drive up the cost
of employment at a time when we

879
00:46:02,533 --> 00:46:05,163
have over 10 percent, or near 10
percent,

880
00:46:05,166 --> 00:46:07,966
unemployment in America.

881
00:46:07,967 --> 00:46:10,967
And beyond that, a lot of
employers are going to look at

882
00:46:10,967 --> 00:46:13,097
this and say, well, I'll pay the
tax.

883
00:46:13,100 --> 00:46:15,600
And they're going to dump their
employees into the so-called

884
00:46:15,600 --> 00:46:19,800
exchange, because in five years,
every American is going to have

885
00:46:19,800 --> 00:46:23,270
to go to the exchange to get
their health care.

886
00:46:23,266 --> 00:46:26,866
And who is going to design every
health care bill offered in the

887
00:46:26,867 --> 00:46:29,397
exchange under this bill?

888
00:46:29,400 --> 00:46:33,030
The federal government is going
to design every single health

889
00:46:33,033 --> 00:46:35,163
care bill in America within five
years,

890
00:46:35,166 --> 00:46:39,996
once this bill were to pass.

891
00:46:40,000 --> 00:46:43,170
I could go on and on and on.

892
00:46:43,166 --> 00:46:46,036
Let me just -- let me just make
one other point.

893
00:46:46,033 --> 00:46:51,303
I'll save you -- I'll save you
-- for 30 years, we've had a

894
00:46:51,300 --> 00:46:55,570
federal law that says that we're
not going to have taxpayer

895
00:46:55,567 --> 00:46:58,437
funding of abortions.

896
00:46:58,433 --> 00:47:00,433
We've had this debate in the
House.

897
00:47:00,433 --> 00:47:02,433
It was a very serious debate.

898
00:47:02,433 --> 00:47:05,833
But in the House -- the House
spoke, and the House upheld the

899
00:47:05,834 --> 00:47:09,764
language we have had in law for
30 years that there will be no

900
00:47:09,767 --> 00:47:12,337
taxpayer funding of abortions.

901
00:47:12,333 --> 00:47:17,103
This bill that we have before us
-- and there was no reference to

902
00:47:17,100 --> 00:47:21,600
that issue in your outline,
Mr. President, begins -- for the

903
00:47:21,600 --> 00:47:24,600
first time in 30 years, allows
for the taxpayer

904
00:47:24,600 --> 00:47:26,600
funding of abortions.

905
00:47:26,600 --> 00:47:31,670
So, Mr. President, what we've
been saying for a long time is,

906
00:47:31,667 --> 00:47:33,137
let's scrap the bill.

907
00:47:33,133 --> 00:47:36,363
Let's start with a clean sheet
of paper on those things that we

908
00:47:36,367 --> 00:47:37,937
can't agree on.

909
00:47:37,934 --> 00:47:41,864
Let's take a step-by-step
approach that will bring down

910
00:47:41,867 --> 00:47:44,497
the cost of health insurance in
America, because if we bring

911
00:47:44,500 --> 00:47:48,770
down the cost of health
insurance, we can expand access.

912
00:47:48,767 --> 00:47:51,967
Mr. President, I told you the
day after -- maybe it was the

913
00:47:51,967 --> 00:47:54,767
day you were sworn in as
President, that I would never

914
00:47:54,767 --> 00:47:57,137
say anything outside of the room
that I wouldn't

915
00:47:57,133 --> 00:47:59,363
say inside the room.

916
00:47:59,367 --> 00:48:01,137
I've been patient.

917
00:48:01,133 --> 00:48:04,303
I've listened to the debate
that's going on here.

918
00:48:04,300 --> 00:48:08,300
But why can't we agree on those
insurance reforms

919
00:48:08,300 --> 00:48:09,600
that we've talked about?

920
00:48:09,600 --> 00:48:11,330
Why can't we come to an
agreement on

921
00:48:11,333 --> 00:48:13,333
purchasing across state lines?

922
00:48:13,333 --> 00:48:16,703
Why can't we do something about
the biggest cost driver, which

923
00:48:16,700 --> 00:48:19,700
is medical malpractice and the
defensive medicine

924
00:48:19,700 --> 00:48:21,600
that doctors practice?

925
00:48:21,600 --> 00:48:23,930
Let's start with a clean sheet
of paper and we can actually get

926
00:48:23,934 --> 00:48:26,204
somewhere and we can get it into
law here in

927
00:48:26,200 --> 00:48:28,430
the next several months.

928
00:48:28,433 --> 00:48:30,633
The President:
John, the challenge

929
00:48:30,633 --> 00:48:31,803
I have here -- and

930
00:48:31,800 --> 00:48:36,200
this has happened periodically
-- is every so often we have a

931
00:48:36,200 --> 00:48:39,400
pretty good conversation trying
to get on some specifics, and

932
00:48:39,400 --> 00:48:44,930
then we go back to the standard
talking points the Democrats and

933
00:48:44,934 --> 00:48:47,804
Republicans have had for the
last year.

934
00:48:47,800 --> 00:48:51,400
And that doesn't drive us to an
agreement on issues.

935
00:48:51,400 --> 00:48:55,470
There are so many things that
you just said that people on

936
00:48:55,467 --> 00:48:59,367
this side would profoundly
disagree with and I would have

937
00:48:59,367 --> 00:49:06,667
to say, based on my analysis,
just aren't true, that I think

938
00:49:06,667 --> 00:49:09,837
the conversation would start
bogging down pretty quick.

939
00:49:09,834 --> 00:49:13,734
Now, we were trying to focus on
the deficit issue.

940
00:49:13,734 --> 00:49:19,834
And the fact of the matter is,
as we indicated before, that

941
00:49:19,834 --> 00:49:21,504
according to the Congressional
Budget Office,

942
00:49:21,500 --> 00:49:25,400
this would reduce the deficit.

943
00:49:25,400 --> 00:49:29,230
Paul has different ideas about
it.

944
00:49:29,233 --> 00:49:33,663
Other folks may think that there
are better ways of doing it.

945
00:49:33,667 --> 00:49:39,697
But right now what we're doing
is focusing on the issue of

946
00:49:39,700 --> 00:49:43,130
federal entitlements and whether
we can make some changes.

947
00:49:43,133 --> 00:49:45,533
I will come back to you I think
at the end of this session to

948
00:49:45,533 --> 00:49:48,403
answer a range of the questions
that you just asked.

949
00:49:48,400 --> 00:49:52,470
Right now what I want to do is
go to Jim Cooper, who I think

950
00:49:52,467 --> 00:49:58,837
everybody knows cares pretty
deeply about the federal budget.

951
00:49:58,834 --> 00:50:02,204
He's been championing this for a
very long time.

952
00:50:02,200 --> 00:50:04,100
Jim, do you want to address some
of the issues that have been

953
00:50:04,100 --> 00:50:07,500
raised in terms of both Medicare
and Medicaid?

954
00:50:07,500 --> 00:50:09,700
Representative Cooper:
Thank you, Mr. President.

955
00:50:09,700 --> 00:50:14,530
We're all here, we're dressed
up, we're on good behavior, but

956
00:50:14,533 --> 00:50:17,403
I think folks back home are
wondering how we behave when the

957
00:50:17,400 --> 00:50:20,370
camera is off.

958
00:50:20,367 --> 00:50:22,237
The deficit in my opinion is
probably the

959
00:50:22,233 --> 00:50:24,103
most single issue we face.

960
00:50:24,100 --> 00:50:26,070
Paul Ryan said it well -- health
inflation is

961
00:50:26,066 --> 00:50:30,096
driving us off a cliff.

962
00:50:30,100 --> 00:50:32,470
And I'm kind of intrigued by the
conversation because so far

963
00:50:32,467 --> 00:50:35,237
we've heard a lot of folks
trying to out-do each other in

964
00:50:35,233 --> 00:50:39,963
deficit reduction. I welcome that competition.

965
00:50:39,967 --> 00:50:44,437
Especially if it's backed up
with votes, because it's easy to

966
00:50:44,433 --> 00:50:48,333
talk tough on this; it's harder
to deliver.

967
00:50:48,333 --> 00:50:50,363
I personally like Senator
McCain's suggestion -- let's get

968
00:50:50,367 --> 00:50:53,237
rid of all the special deals.

969
00:50:53,233 --> 00:50:56,133
That's just a starting point.

970
00:50:56,133 --> 00:50:59,903
Paul Ryan is right again and Tom
Coburn is right when they point

971
00:50:59,900 --> 00:51:04,070
out that we're probably wasting
a third of medical spending.

972
00:51:04,066 --> 00:51:09,366
Medicare alone is $37 trillion
in the hole.

973
00:51:09,367 --> 00:51:12,097
And that means for all the folks
who want to talk tough and not

974
00:51:12,100 --> 00:51:17,300
vote tough -- that's not good
enough.

975
00:51:17,300 --> 00:51:20,700
It means that for all the folks
who want to do this next year or

976
00:51:20,700 --> 00:51:24,230
next decade or leave it to their
successor --

977
00:51:24,233 --> 00:51:28,903
that's not good enough.

978
00:51:28,900 --> 00:51:32,100
We've had some examples of how
we've behaved recently -- a

979
00:51:32,100 --> 00:51:36,330
wonderful bipartisan measure,
the Conrad/Gregg bill,

980
00:51:36,333 --> 00:51:38,933
completely bipartisan for years
and a bipartisan,

981
00:51:38,934 --> 00:51:41,034
fiscal responsibility commission.

982
00:51:41,033 --> 00:51:45,803
Was brought up for a vote in the
Senate; we had the 60 votes, but

983
00:51:45,800 --> 00:51:49,900
only 53 people showed up for
work.

984
00:51:49,900 --> 00:51:52,370
Seven people who had been
original co-sponsors of that

985
00:51:52,367 --> 00:51:57,167
measure suddenly got different
ideas when the

986
00:51:57,166 --> 00:51:59,396
moment of truth came.

987
00:51:59,400 --> 00:52:03,400
So, Mr. President, I'm thankful
you appointed a presidential

988
00:52:03,400 --> 00:52:06,800
fiscal responsibility commission
with Alan Simpson and Erskine

989
00:52:06,800 --> 00:52:11,700
Bowles, to try to force us as a
Congress and force the nation to

990
00:52:11,700 --> 00:52:13,400
address these fundamental
problems.

991
00:52:13,400 --> 00:52:18,230
Because if you love Medicare,
you need to act to save it fast.

992
00:52:18,233 --> 00:52:23,863
Every day matters.

993
00:52:23,867 --> 00:52:27,137
A report will come out issued by
the Treasury Department -- it's

994
00:52:27,133 --> 00:52:29,733
come out every year; it will
come out in the next few days --

995
00:52:29,734 --> 00:52:32,304
it's the only report that uses
real accounting to describe

996
00:52:32,300 --> 00:52:36,800
America's fiscal problems, and
the news is not pretty.

997
00:52:36,800 --> 00:52:39,030
It will reaffirm what's been
discussed here about Medicare

998
00:52:39,033 --> 00:52:43,603
and Medicaid and other vital
American programs being deeply

999
00:52:43,600 --> 00:52:45,400
in the hole.

1000
00:52:45,400 --> 00:52:48,800
And the opportunity of cost for
delay is extraordinary.

1001
00:52:48,800 --> 00:52:51,630
So we can face these problems,
Mr. President, we can solve them

1002
00:52:51,633 --> 00:52:55,403
with political will, but the
talking points won't do it.

1003
00:52:55,400 --> 00:52:57,970
We've got to acknowledge the
real questions.

1004
00:52:57,967 --> 00:53:00,097
And as every businessperson in
America knows, if you can't

1005
00:53:00,100 --> 00:53:02,900
measure it, you can't manage it.

1006
00:53:02,900 --> 00:53:04,870
And too many people in the
federal government are refusing

1007
00:53:04,867 --> 00:53:08,167
to measure it, much less take
the tough

1008
00:53:08,166 --> 00:53:10,336
votes that are required.

1009
00:53:10,333 --> 00:53:13,333
Because the reason we have a
Medicare Advantage program,

1010
00:53:13,333 --> 00:53:16,133
Mr. President, as you know, is
in 2003 when the other party was

1011
00:53:16,133 --> 00:53:18,703
completely in charge of
everything here, we passed a

1012
00:53:18,700 --> 00:53:20,630
program that as has been pointed
out was almost completely

1013
00:53:20,633 --> 00:53:26,603
unfunded and added $8 trillion
in one bill to

1014
00:53:26,600 --> 00:53:29,300
our children andgrandchildren.

1015
00:53:29,300 --> 00:53:32,570
Now, these benefits, if offered,
should be paid for.

1016
00:53:32,567 --> 00:53:35,237
So this is a challenge for
everybody in both parties

1017
00:53:35,233 --> 00:53:37,433
because nobody's hands
are clean in this.

1018
00:53:37,433 --> 00:53:39,433
But let's have a new day, a new
beginning --

1019
00:53:39,433 --> 00:53:41,003
I think we could do this.

1020
00:53:41,000 --> 00:53:43,500
And this bill is a great place
to start, because if you don't

1021
00:53:43,500 --> 00:53:46,600
think this bill reduces the
deficit enough according to CBO,

1022
00:53:46,600 --> 00:53:49,730
vote for more savings.

1023
00:53:49,734 --> 00:53:53,734
If you want to reform Medicare
some more, vote for it -- don't

1024
00:53:53,734 --> 00:53:55,834
just talk a good game.

1025
00:53:55,834 --> 00:53:58,404
So I hope the American people
are watching because -- and

1026
00:53:58,400 --> 00:53:59,630
they're going to be watching
after the

1027
00:53:59,633 --> 00:54:01,263
cameras are turned
off, too.

1028
00:54:01,266 --> 00:54:03,766
And I'm thankful you called this
meeting because this is a moment

1029
00:54:03,767 --> 00:54:07,267
of truth for our country, and
together

1030
00:54:07,266 --> 00:54:11,136
we can solve this
problem.

1031
00:54:11,133 --> 00:54:13,033
The President:
I want to see if

1032
00:54:13,033 --> 00:54:14,903
there are any Republicans who want to speak.

1033
00:54:14,900 --> 00:54:16,400
I still have Dick Durbin.

1034
00:54:16,400 --> 00:54:17,270
Senator McConnell:
Mr. President,

1035
00:54:17,266 --> 00:54:19,036
I think John McCain.

1036
00:54:19,033 --> 00:54:21,663
Senator Mccain:
Thank you, Mr. President.

1037
00:54:21,667 --> 00:54:24,497
I say to my friend from North
Dakota, none of us want to do

1038
00:54:24,500 --> 00:54:27,200
nothing -- but we do want to
start over.

1039
00:54:27,200 --> 00:54:30,930
And we've just had a discussion
about the 800,000 carveout and

1040
00:54:30,934 --> 00:54:34,664
all of the other special deals
and special interests that were

1041
00:54:34,667 --> 00:54:38,567
included in this bill, which is
more than offensive.

1042
00:54:38,567 --> 00:54:42,737
But I want to talk about one
specific issue on deficit

1043
00:54:42,734 --> 00:54:46,864
reduction and that is medical
malpractice reform.

1044
00:54:46,867 --> 00:54:49,967
Last year, Mr. President, you
said when you spoke to the

1045
00:54:49,967 --> 00:54:52,797
Congress you asked your
distinguished Secretary of

1046
00:54:52,800 --> 00:54:57,130
Health and Human Services to
look at ways that we could

1047
00:54:57,133 --> 00:55:00,063
address the issue and then again
this year -- and I pay close

1048
00:55:00,066 --> 00:55:01,796
attention to all of your
speeches.

1049
00:55:01,800 --> 00:55:03,770
The President:
Thank you.

1050
00:55:03,767 --> 00:55:04,837
That's more than Michelle does.

1051
00:55:04,834 --> 00:55:07,204
(laughter)

1052
00:55:07,200 --> 00:55:09,770
Senator McCain:
And the point is

1053
00:55:09,767 --> 00:55:12,637
that we don't have
to go very far.

1054
00:55:12,633 --> 00:55:15,933
There's two examples right now
of medical malpractice reform

1055
00:55:15,934 --> 00:55:17,134
that is working.

1056
00:55:17,133 --> 00:55:19,963
One is called California and the
other is called Texas.

1057
00:55:19,967 --> 00:55:23,367
I won't talk about California
because we Arizonians hate

1058
00:55:23,367 --> 00:55:25,567
California because they've
stolen our water.

1059
00:55:25,567 --> 00:55:26,237
(laughter)

1060
00:55:26,233 --> 00:55:30,863
But the fact is that
Texas has established a $750,000

1061
00:55:30,867 --> 00:55:36,367
cap for non-economic damages;
caps doctors at $250,000;

1062
00:55:36,367 --> 00:55:39,897
hospitals at $250,000; and any
additional institution,

1063
00:55:39,900 --> 00:55:45,930
$250,000; and patients harm to a
finding of medical malpractice

1064
00:55:45,934 --> 00:55:47,734
are not subject to any
limitations on

1065
00:55:47,734 --> 00:55:50,304
recoveries for economic losses.

1066
00:55:50,300 --> 00:55:52,070
And I hope you'll examine it.

1067
00:55:52,066 --> 00:55:54,096
But an important aspect of what
they've done

1068
00:55:54,100 --> 00:55:56,430
in Texas is the following.

1069
00:55:56,433 --> 00:55:58,663
Lawsuit filings are down.

1070
00:55:58,667 --> 00:56:02,297
Defensive medicine increases
annual medical

1071
00:56:02,300 --> 00:56:04,530
costs by 10 percent.

1072
00:56:04,533 --> 00:56:08,533
They've saved -- physicians
recruitment is up.

1073
00:56:08,533 --> 00:56:12,363
In the last two years 6,945 new
physicians have been licensed --

1074
00:56:12,367 --> 00:56:16,167
a 65 percent increase from two
years preceding their reforms;

1075
00:56:16,166 --> 00:56:19,566
31 percent increase in
recruitment of rural

1076
00:56:19,567 --> 00:56:21,267
emergency medicine physicians.

1077
00:56:21,266 --> 00:56:24,966
Amarillo lost 26 physicians in
the two years preceding the

1078
00:56:24,967 --> 00:56:27,567
legislation; has gained 37.

1079
00:56:27,567 --> 00:56:30,167
The largest malpractice
insurance company in the state

1080
00:56:30,166 --> 00:56:34,036
slashed its premiums by 35
percent, saving doctors some

1081
00:56:34,033 --> 00:56:37,303
$217 million over four years.

1082
00:56:37,300 --> 00:56:39,930
There are now over 30 companies
competing for business.

1083
00:56:39,934 --> 00:56:41,664
It's already there.

1084
00:56:41,667 --> 00:56:45,667
Now all we have to do is enact
this into legislation and it's

1085
00:56:45,667 --> 00:56:47,197
already been proven.

1086
00:56:47,200 --> 00:56:51,030
So I don't think we have to
experiment around.

1087
00:56:51,033 --> 00:56:53,863
There are two states that have
proven that you can enact

1088
00:56:53,867 --> 00:56:58,097
medical malpractice reform and
you can have great savings and

1089
00:56:58,100 --> 00:57:01,070
provide health care providers
with the incentives they need.

1090
00:57:01,066 --> 00:57:03,396
And I would just like to finally
mention one other thing.

1091
00:57:03,400 --> 00:57:05,370
There's an issue that's
overhanging this entire

1092
00:57:05,367 --> 00:57:07,567
conversation -- we all know what
it is.

1093
00:57:07,567 --> 00:57:11,767
It's whether the Majority Leader
of the Senate will impose the

1094
00:57:11,767 --> 00:57:14,797
"reconciliation," the 51 votes.

1095
00:57:14,800 --> 00:57:18,870
Now, having been in the majority
and the minority -- I prefer the

1096
00:57:18,867 --> 00:57:22,967
majority -- I understand the
frustration that the majority

1097
00:57:22,967 --> 00:57:27,737
feels when they can't get their
agenda through, and it's real

1098
00:57:27,734 --> 00:57:31,104
and I understand it and I have
some sympathy.

1099
00:57:31,100 --> 00:57:34,100
But I remember, and I think you
do too, Mr. President, the last

1100
00:57:34,100 --> 00:57:38,800
time when there was a proposal
that we Republicans in the

1101
00:57:38,800 --> 00:57:43,830
majority would adopt a 51-vote
majority on the issue of the

1102
00:57:43,834 --> 00:57:45,664
confirmation of judges.

1103
00:57:45,667 --> 00:57:48,697
There was a group of us that got
together, said, no, that's not

1104
00:57:48,700 --> 00:57:52,470
the right way to go because that
could deal a fatal blow to the

1105
00:57:52,467 --> 00:57:54,667
unique aspect of the United
States Senate,

1106
00:57:54,667 --> 00:57:56,997
which is a 60 vote majority.

1107
00:57:57,000 --> 00:58:01,470
And then we came to an agreement
and it was brought to a halt.

1108
00:58:01,467 --> 00:58:06,397
If a 51 vote reconciliation is
enacted on one-sixth of our

1109
00:58:06,400 --> 00:58:10,470
gross national product, never
before has there been -- there

1110
00:58:10,467 --> 00:58:15,097
has been reconciliation, but not
at the level of an issue of this

1111
00:58:15,100 --> 00:58:18,900
magnitude and I think it could
harm the future of our country

1112
00:58:18,900 --> 00:58:21,800
and our institution, which I
love a great deal,

1113
00:58:21,800 --> 00:58:23,230
for a long, long time.

1114
00:58:23,233 --> 00:58:23,703
The President:
Okay.

1115
00:58:23,700 --> 00:58:26,500
Let me just address two of the
points that you've made and then

1116
00:58:26,500 --> 00:58:28,100
I'm going to turn to Dick.

1117
00:58:28,100 --> 00:58:31,270
This issue of reconciliation has
been brought up.

1118
00:58:31,266 --> 00:58:37,666
Again, I think the American
people aren't always all that

1119
00:58:37,667 --> 00:58:42,497
interested in procedures inside
the Senate.

1120
00:58:42,500 --> 00:58:47,730
I do think that they want a vote
on how we're going to move this

1121
00:58:47,734 --> 00:58:54,204
forward, and I think that most
Americans think that a majority

1122
00:58:54,200 --> 00:58:56,970
vote makes sense.

1123
00:58:56,967 --> 00:59:02,297
But I also think that this is an
issue that could be bridged if

1124
00:59:02,300 --> 00:59:06,900
we can arrive at some agreement
on ways to move forward.

1125
00:59:06,900 --> 00:59:11,570
Medicare -- or the issue of
malpractice that you brought up,

1126
00:59:11,567 --> 00:59:14,497
I've already said that I think
this is a real issue.

1127
00:59:14,500 --> 00:59:17,900
I disagree with John Boehner
that -- John, when you say that

1128
00:59:17,900 --> 00:59:20,170
it's the single biggest driver
of medical inflation, that's

1129
00:59:20,166 --> 00:59:22,296
just not the case.

1130
00:59:22,300 --> 00:59:26,000
The Congressional Budget Office
took a look at the proposal

1131
00:59:26,000 --> 00:59:30,430
you've got for medical
malpractice and estimates that

1132
00:59:30,433 --> 00:59:35,933
the government system would save
about $50 billion over 10 years,

1133
00:59:35,934 --> 00:59:39,464
which is $5 billion a year --
which is real money but

1134
00:59:39,467 --> 00:59:43,567
understand that we've got a $2
trillion system.

1135
00:59:43,567 --> 00:59:46,137
Let's assume that you
extrapolate that into

1136
00:59:46,133 --> 00:59:48,033
the private marketplace.

1137
00:59:48,033 --> 00:59:51,863
Say it's another $5 billion or
another $10 billion.

1138
00:59:51,867 --> 00:59:56,267
It's still a small portion of
our overall

1139
00:59:56,266 --> 00:59:58,466
health inflation problems.

1140
00:59:58,467 --> 01:00:03,267
But having said that, it's still
something that I care about and

1141
01:00:03,266 --> 01:00:05,296
I've said I care about it.

1142
01:00:05,300 --> 01:00:09,170
Now, not only have I asked
Kathleen to initiate some pilot

1143
01:00:09,166 --> 01:00:14,766
programs at the state level, but
there are some examples of

1144
01:00:14,767 --> 01:00:19,067
legislation that I actually
would be interested in pursuing.

1145
01:00:19,066 --> 01:00:24,536
Tom Coburn, you and Richard Burr
have talked about incentivizing

1146
01:00:24,533 --> 01:00:30,933
and allowing states to
experiment much more vigorously

1147
01:00:30,934 --> 01:00:35,804
with ways to reduce frivolous
lawsuits, to pursue settlements,

1148
01:00:35,800 --> 01:00:37,870
to reduce defensive medicine.

1149
01:00:37,867 --> 01:00:39,897
That's something I'd like
to see if we could

1150
01:00:39,900 --> 01:00:41,400
potentially get going.

1151
01:00:41,400 --> 01:00:48,400
So I might not agree to what
John Boehner has proposed, and

1152
01:00:48,400 --> 01:00:52,670
it's interesting that I think
I've heard a lot today about how

1153
01:00:52,667 --> 01:00:56,767
we shouldn't have Washington
impose on the states ideas,

1154
01:00:56,767 --> 01:01:00,367
except when it comes to the
ideas that you guys like, in

1155
01:01:00,367 --> 01:01:05,297
which case it's fine to override
what states are doing.

1156
01:01:05,300 --> 01:01:07,500
There seems to be a little bit
of a contradiction on this, but

1157
01:01:07,500 --> 01:01:10,970
I think there may be a way of
doing it that allows states to

1158
01:01:10,967 --> 01:01:14,467
tackle this issue in a very
serious way.

1159
01:01:14,467 --> 01:01:17,397
And I'd be interested in working
with you, John, and working with

1160
01:01:17,400 --> 01:01:21,470
Tom to see if we can potentially
make that happen -- if we can

1161
01:01:21,467 --> 01:01:28,967
arrive at a package that also
deals with the other drivers of

1162
01:01:28,967 --> 01:01:30,737
health care inflation that are
so important.

1163
01:01:30,734 --> 01:01:32,364
Now, we're running out of time.

1164
01:01:32,367 --> 01:01:36,197
I've got Dick Durbin, and then
what we're going to just do is

1165
01:01:36,200 --> 01:01:41,200
go into coverage and that will
-- I know that Henry and John

1166
01:01:41,200 --> 01:01:44,930
and Charles have been interested
in talking about it, and frankly

1167
01:01:44,934 --> 01:01:47,504
is something that we haven't
spoken a lot about lately and

1168
01:01:47,500 --> 01:01:49,770
that is a whole bunch of people
who just don't have health care.

1169
01:01:49,767 --> 01:01:51,537
Go ahead, Dick.

1170
01:01:51,533 --> 01:01:53,503
Senator Durbin:
Mr. President,

1171
01:01:53,500 --> 01:01:54,600
I've been biding my time

1172
01:01:54,600 --> 01:01:55,570
throughout this entire meeting.

1173
01:01:55,567 --> 01:01:57,697
I thank you for inviting us on

1174
01:01:57,700 --> 01:01:59,000
the issue of medical
malpractice.

1175
01:01:59,000 --> 01:02:01,100
Before I was elected to
Congress,

1176
01:02:01,100 --> 01:02:02,370
I worked in a courtroom.

1177
01:02:02,367 --> 01:02:05,997
For years I defended doctors and
hospitals, and for years I sued

1178
01:02:06,000 --> 01:02:07,870
them on behalf of people who

1179
01:02:07,867 --> 01:02:09,437
were victims of medical
malpractice.

1180
01:02:09,433 --> 01:02:11,803
So I've sat at both tables in a
courtroom.

1181
01:02:11,800 --> 01:02:15,030
At least many years ago, I think
I kind of understood this area

1182
01:02:15,033 --> 01:02:16,833
of the law better than some.

1183
01:02:16,834 --> 01:02:20,104
But I listen time and again as
our friends on the other side,

1184
01:02:20,100 --> 01:02:22,230
when they're asked what are the
most important things you can do

1185
01:02:22,233 --> 01:02:24,703
when it comes to our health care
system in America, the first

1186
01:02:24,700 --> 01:02:26,870
thing they say is medical
malpractice -- it's the first

1187
01:02:26,867 --> 01:02:30,167
thing they say; today it was the
first thing that was said.

1188
01:02:30,166 --> 01:02:32,596
The point that's been made by
the President is if we do

1189
01:02:32,600 --> 01:02:35,970
believe the Congressional Budget
Office when Orrin Hatch asked

1190
01:02:35,967 --> 01:02:40,697
them how much will we save if we
implement the Republican plan on

1191
01:02:40,700 --> 01:02:42,770
medical malpractice
from the House,

1192
01:02:42,767 --> 01:02:45,937
they said $54 billion
over 10 years.

1193
01:02:45,934 --> 01:02:49,334
Five-point-four billion a year
is a lot of money, except in the

1194
01:02:49,333 --> 01:02:52,403
context of a $2. 5 trillion bill

1195
01:02:52,400 --> 01:02:54,670
that we pay each
year for health care.

1196
01:02:54,667 --> 01:02:58,867
It represents one-fifth of 1
percent of the amount of money

1197
01:02:58,867 --> 01:03:01,837
we spend each year on health
care.

1198
01:03:01,834 --> 01:03:04,534
The Congressional Budget Office
said something else.

1199
01:03:04,533 --> 01:03:07,533
They said, and as you lose
accountability for what the

1200
01:03:07,533 --> 01:03:13,333
doctors and hospitals are doing,
more people will die -- 4,800 a

1201
01:03:13,333 --> 01:03:15,463
year, according to the
Congressional Budget Office's

1202
01:03:15,467 --> 01:03:17,737
reference to this study.

1203
01:03:17,734 --> 01:03:20,964
Now, the Institute of Medicine
tells us 98,000 people a year

1204
01:03:20,967 --> 01:03:23,767
die in America because of
medical malpractice.

1205
01:03:23,767 --> 01:03:25,737
I think there are things that we
have put in

1206
01:03:25,734 --> 01:03:27,564
this bill to change that.

1207
01:03:27,567 --> 01:03:30,567
Most of you have heard of this
Dr. Gawande.

1208
01:03:30,567 --> 01:03:31,337
We've read him.

1209
01:03:31,333 --> 01:03:32,903
I've talked to him on the phone.

1210
01:03:32,900 --> 01:03:36,430
His checklist manifesto is a
very basic approach to reducing

1211
01:03:36,433 --> 01:03:39,633
medical errors, which is what we
should be focused on.

1212
01:03:39,633 --> 01:03:41,303
And I want to say,
Mr. President, I think what you

1213
01:03:41,300 --> 01:03:44,330
and the Secretary have done is
the right thing -- incentivizing

1214
01:03:44,333 --> 01:03:49,033
states to find innovative ways
to reduce medical errors and

1215
01:03:49,033 --> 01:03:52,363
reduce those lawsuits that
should not be filed.

1216
01:03:52,367 --> 01:03:55,737
But let me tell you what,
limiting the recovery for pain

1217
01:03:55,734 --> 01:03:59,734
and suffering for someone who is
entitled -- entitled, because

1218
01:03:59,734 --> 01:04:01,764
they are innocent
victims to be paid --

1219
01:04:01,767 --> 01:04:05,067
isn't eliminating junk lawsuits.

1220
01:04:05,066 --> 01:04:08,166
I will tell you that as far as
the President is concerned, in

1221
01:04:08,166 --> 01:04:09,666
his neighborhood there is a
great hospital,

1222
01:04:09,667 --> 01:04:11,367
which I will not name.

1223
01:04:11,367 --> 01:04:15,837
And at this hospital, a woman
went in for a simple removal of

1224
01:04:15,834 --> 01:04:19,204
a mole from her face, and under
general anesthesia, the oxygen

1225
01:04:19,200 --> 01:04:22,170
caught fire, burning her face.

1226
01:04:22,166 --> 01:04:25,296
She went through repeated
surgeries, scars, and deformity.

1227
01:04:25,300 --> 01:04:27,270
Her life will never be the same.

1228
01:04:27,266 --> 01:04:30,196
And you are saying that this
innocent woman is only entitled

1229
01:04:30,200 --> 01:04:32,330
to $250,000 in pain and
suffering.

1230
01:04:32,333 --> 01:04:34,103
I don't think it's fair.

1231
01:04:34,100 --> 01:04:35,800
Our jury system makes that
decision.

1232
01:04:35,800 --> 01:04:37,570
And the states -- 30 of them --

1233
01:04:37,567 --> 01:04:39,097
have made a decision
on what to do.

1234
01:04:39,100 --> 01:04:41,330
If you were asked a basic
question, over the last 20

1235
01:04:41,333 --> 01:04:44,633
years, has the number of paid
malpractice claims in America

1236
01:04:44,633 --> 01:04:47,463
doubled or been cut in half?

1237
01:04:47,467 --> 01:04:48,937
If you listened to most people,
you'd say they must have

1238
01:04:48,934 --> 01:04:52,634
doubled. No. According to the Kaiser Foundation,

1239
01:04:52,633 --> 01:04:53,663
they've been cut in half.

1240
01:04:53,667 --> 01:04:57,267
Oh, but how about the money
that's being paid for

1241
01:04:57,266 --> 01:04:58,466
these malpractice claims?

1242
01:04:58,467 --> 01:05:00,767
Clearly, that's going through
the roof. No.

1243
01:05:00,767 --> 01:05:04,737
Between 2003 and 2008, the total
amount paid for malpractice

1244
01:05:04,734 --> 01:05:07,604
claims in America
was cut in half,

1245
01:05:07,600 --> 01:05:09,800
from $8 billion to $4 billion.

1246
01:05:09,800 --> 01:05:11,170
This is an important issue.

1247
01:05:11,166 --> 01:05:12,066
I don't dispute it.

1248
01:05:12,066 --> 01:05:14,366
And I think we have treated it
as an important issue.

1249
01:05:14,367 --> 01:05:18,537
But to make it the overriding
issue, is to I think really

1250
01:05:18,533 --> 01:05:21,003
trivialize some of the other
things that should be part

1251
01:05:21,000 --> 01:05:22,270
of this conversation.

1252
01:05:22,266 --> 01:05:24,136
I have been asked to speak about
deficit reduction.

1253
01:05:24,133 --> 01:05:27,463
I will not, other than to say
one general thing.

1254
01:05:27,467 --> 01:05:30,437
When I hear my friend, John
Boehner, say that we have the

1255
01:05:30,433 --> 01:05:33,733
best health care in the world, I
don't dispute it for a moment.

1256
01:05:33,734 --> 01:05:36,634
If I were sick, this is the
country I want to be in -- with

1257
01:05:36,633 --> 01:05:40,103
these doctors, these hospitals,
and these medical professionals.

1258
01:05:40,100 --> 01:05:44,270
But step back for a second and
look at who we are in this room.

1259
01:05:44,266 --> 01:05:48,696
As was said many years ago, the
law in its majestic equality

1260
01:05:48,700 --> 01:05:51,170
forbids both the wealthy
and the poor

1261
01:05:51,166 --> 01:05:53,366
from sleeping under
bridges.

1262
01:05:53,367 --> 01:05:56,537
When it comes to the wealthy and
health care, per capita we're

1263
01:05:56,533 --> 01:05:58,363
the wealthiest people in
America.

1264
01:05:58,367 --> 01:06:01,667
The Federal Employees Health
Benefit program, administered by

1265
01:06:01,667 --> 01:06:04,667
the federal government, setting
minimum standards for the health

1266
01:06:04,667 --> 01:06:07,437
insurance that we enjoy as
individuals and want for our

1267
01:06:07,433 --> 01:06:10,103
families is all we're asking for
in this bill

1268
01:06:10,100 --> 01:06:12,230
for families across
America.

1269
01:06:12,233 --> 01:06:14,463
If you think it's a socialist
plot and it's wrong, for

1270
01:06:14,467 --> 01:06:15,767
goodness sakes, drop out of the

1271
01:06:15,767 --> 01:06:18,467
Federal Employees
Health Benefit program.

1272
01:06:18,467 --> 01:06:20,437
But if you think it's good
enough for your family,

1273
01:06:20,433 --> 01:06:22,433
shouldn't our health insurance
be good enough

1274
01:06:22,433 --> 01:06:24,033
for the rest of
America?

1275
01:06:24,033 --> 01:06:25,463
That's what it gets down to.

1276
01:06:25,467 --> 01:06:27,267
Why have this double standard?

1277
01:06:27,266 --> 01:06:28,866
Tom Harkin is right.

1278
01:06:28,867 --> 01:06:32,637
Why do we continue to
discriminate against people,

1279
01:06:32,633 --> 01:06:35,963
when we know that each one of us
is only one accident or one

1280
01:06:35,967 --> 01:06:40,137
diagnosis away from being one of
those unfortunate few who can't

1281
01:06:40,133 --> 01:06:42,303
afford or can't find health
insurance?