Już 62 580 użytkowników uczy się języków obcych z Edustation.
Możesz zarejestrować się już dziś i odebrać bonus w postaci 10 monet.
Jeżeli chcesz się dowiedzieć więcej o naszym portalu - kliknij tutaj
Jeszcze nie teraz ZAREJESTRUJ SIĘlub
Zaloguj »
ZAREJESTRUJ SIĘ
Nie masz konta?
President Obama's Primetime Press Conference on Health Reform
Poziom:
Temat: Społeczeństwo i nauki społeczne
The President:
Good evening.
Please be seated.
Before I take your questions, I
want to talk for a few minutes
about the progress we're making
on health insurance reform and
where it fits into our
broader economic strategy.
Six months ago, I took office
amid the worst recession in half
a century.
We were losing an average of 700,000 jobs per month and our
financial system was on
the verge of collapse.
As a result of the actions we
took in those first weeks,
we've been able to pull our
economy back from the brink.
We took steps to stabilize our
financial institutions and our
housing market.
And we passed a Recovery Act
that has already saved jobs and
created new ones; delivered
billions in tax relief to
families and small businesses;
and extended unemployment
insurance and health insurance
to those who've been laid off.
Of course, we still
have a long way to go.
And the Recovery Act will
continue to save and create more
jobs over the next two years -- just like it was designed to do.
I realize this is little comfort
to those Americans who are
currently out of work, and
I'll be honest with you --
new hiring is always one of the
last things to bounce back after
a recession.
And the fact is, even
before this crisis hit,
we had an economy that was
creating a good deal of wealth
for those folks at the very top,
but not a lot of good-paying
jobs for the rest of America.
It's an economy that simply
wasn't ready to compete in the
21st century -- one where we've been slow to invest in clean
energy technologies that have created new jobs and industries
in other countries; where we've watched our graduation rates lag
behind too much of the world; and where we spend much more on
health care than any other nation but aren't any healthier for it.
That's why I've said that even
as we rescue this economy from a
full-blown crisis, we must
rebuild it stronger than before.
And health insurance reform
is central to that effort.
This is not just about the 47
million Americans who don't have
any health insurance at all.
Reform is about every American
who has ever feared that they
may lose their coverage
if they become too sick,
or lose their job,
or change their job.
It's about every small business
that has been forced to lay off
employees or cut back on their
coverage because it became too expensive.
And it's about the fact that the
biggest driving force behind our
federal deficit is the
skyrocketing cost of Medicare
and Medicaid.
So let me be clear: If we
do not control these costs,
we will not be able to
control our deficit.
If we do not reform health care,
your premiums and out-of-pocket
costs will continue
to skyrocket.
If we don't act, 14,000
Americans will continue to lose
their health insurance
every single day.
These are the
consequences of inaction.
These are the stakes of the
debate that we're having right now.
I realize that with all the
charges and criticisms that are
being thrown around
in Washington,
a lot of Americans
may be wondering,
"What's in this for me?
How does my family stand to
benefit from health insurance reform?"
So tonight I want to
answer those questions.
Because even though Congress is
still working through a few key
issues, we already have rough
agreement on the following
areas: If you have
health insurance,
the reform we're proposing will
provide you with more security
and more stability.
It will keep government out
of health care decisions,
giving you the option to keep
your insurance if you're happy with it.
It will prevent insurance
companies from dropping your
coverage if you get too sick.
It will give you the security of
knowing that if you lose your
job, if you move, or
if you change your job,
you'll still be able
to have coverage.
It will limit the amount your
insurance company can force you
to pay for your medical costs
out of your own pocket.
And it will cover preventive
care like check-ups and
mammograms that save
lives and money.
Now, if you don't
have health insurance,
or you're a small business
looking to cover your employees,
you'll be able to
choose a quality,
affordable health plan through
a health insurance exchange --
a marketplace that promotes
choice and competition.
Finally, no insurance company
will be allowed to deny you
coverage because of a
preexisting medical condition.
I've also pledged that health
insurance reform will not add to
our deficit over
the next decade.
And I mean it.
In the past eight years, we saw
the enactment of two tax cuts,
primarily for the
wealthiest Americans,
and a Medicare
prescription program --
none of which were paid for.
And that's partly why I
inherited a $1.3 trillion deficit.
That will not happen with
health insurance reform.
It will be paid for.
Already we've estimated that
two-thirds of the cost of reform
can be paid for by reallocating
money that is simply being
wasted in federal
health care programs.
This includes over $100 billion
of unwarranted subsidies that go
to insurance companies
as part of Medicare --
subsidies that do nothing to
improve care for our seniors.
And I'm pleased that Congress
has already embraced these proposals.
While they're currently working
through proposals to finance the
remaining costs, I continue to
insist that health reform not be
paid for on the backs of
middle-class families.
In addition to making sure that
this plan doesn't add to the
deficit in the short term, the
bill I sign must also slow the
growth of health care
costs in the long run.
Our proposals would change
incentives so that doctors and
nurses are free to give
patients the best care,
just not the most
expensive care.
That's why the nation's largest
organizations representing
doctors and nurses
have embraced our plan.
We also want to create an
independent group of doctors and
medical experts who are
empowered to eliminate waste and
inefficiency in Medicare
on an annual basis --
a proposal that could save even
more money and ensure long-term
financial health for Medicare.
Overall, our proposals will
improve the quality of care for
our seniors and save them
thousands of dollars on
prescription drugs, which is why
the AARP has endorsed our reform efforts.
Not all of the cost savings
measures I just mentioned were
contained in Congress's
draft legislation,
but we're now seeing broad
agreement thanks to the work
that has done over
the last few days.
So even though we still have
a few issues to work out,
what's remarkable at this point
is not how far we have left to
go -- it's how far
we've already come.
I understand how easy it is for
this town to become consumed in
the game of politics -- to turn every issue into a running tally
of who's up and who's down.
I've heard that one Republican
strategist told his party that
even though they may
want to compromise,
it's better politics
to "go for the kill";
another Republican senator that
defeating health care reform is
about "breaking" me.
So let me be clear:
This isn't about me.
I have great health insurance,
and so does every member of Congress.
This debate is about the letters
I read when I sit in the Oval
Office every day, and the
stories I hear at town hall meetings.
This is about the woman in
Colorado who paid $700 a month
to her insurance company only to
find out that they wouldn't pay
a dime for her
cancer treatment --
who had to use up her retirement
funds to save her own life.
This is about the middle-class
college graduate from Maryland
whose health insurance expired
when he changed jobs and woke up
from the emergency surgery that he required with $10,000 worth of debt.
This is about every
family, every business,
and every taxpayer who continues
to shoulder the burden of a
problem that Washington has
failed to solve for decades.
This debate is not a
game for these Americans,
and they can't afford to
wait any longer for reform.
They're counting on
us to get this done.
They're looking to
us for leadership.
And we can't let them down.
We will pass reform that
lowers cost, promotes choice,
and provides coverage that
every American can count on.
And we will do it this year.
With that, I'll
take your questions.
And we are going to start off
with Ben Feller of Associated Press.
The Press:
Thank you, Mr. President.
Congress, as you alluded to, is
trying to figure out how to pay
for all of this reform.
Have you told House and Senate
leaders which of their ideas are
acceptable to you?
If so, are you willing to share
that stand of yours with the
American people?
And if you haven't given
that kind of direction to
congressional leaders,
are you willing to --
are you willing to explain why
you're not stepping in to get a
deal done, since you're
the one setting a deadline?
The President:
Well, before we talk
about how to pay for it,
let's talk about what
exactly needs to be done.
And the reason I want to
emphasize this is because
there's been a lot of
misinformation out there.
Right now premiums for families
that have health insurance have
doubled over the last 10 years.
They've gone up three
times faster than wages.
So what we know is that if
the current trends continue,
more and more families are
going to lose health care,
more and more families are going
to be in a position where they
keep their health care but it
takes a bigger bite out of their
budget, employers are going to
put more and more of the costs
on the employees or they're just
going to stop providing health
care altogether.
We also know that with health
care inflation on the curve that
it's on we are guaranteed to see
Medicare and Medicaid basically
break the federal budget.
And we know that we're
spending on average,
we here in the United States are spending about $6,000 more than
other advanced countries
where they're just as healthy.
And I've said this before -- if you found out that your neighbor
had gotten the same car for $6,000 less, you'd want to
figure out how to get that deal.
And that's what reform's all
about: How can we make sure that
we are getting the best bang
for our health care dollar?
Now, what we did very early on
was say two-thirds of the costs
of health care reform -- which includes providing coverage for
people who don't have it, making it more affordable for folks who
do, and making sure that we're over the long term creating the
kinds of systems where prevention and wellness and
information technologies make the system more efficient --
that the entire cost of that has
to be paid for and it's got to
be deficit-neutral.
And we identified two-thirds of
those costs to be paid for by
tax dollars that are already
being spent right now.
So taxpayers are already putting
this money into the kitty.
The problem is they're not
getting a good deal for the
money they're spending.
That takes care of about
two-thirds of the cost.
The remaining one-third is what
the argument has been about of late.
What I've said is that there may
be a number of different ways to
raise money.
I put forward what I thought
was the best proposal,
which was to limit
the deductions,
the itemized deductions, for
the wealthiest Americans --
people like myself could take
the same percentage deduction
that middle-class families do
and that would raise sufficient
funds for that final one-third.
Now, so far we haven't seen
any of the bills adopt that.
There are other ideas
that are out there.
I continue to think my
idea is the best one,
but I'm not foreclosing some
of these other ideas as the
committees are
working them through.
The one commitment that I've
been clear about is I don't want
that final one-third of the cost
of health care to be completely
shouldered on the backs of
middle-class families who are
already struggling in
a difficult economy.
And so if I see a proposal that
is primarily funded through
taxing middle-class families,
I'm going to be opposed to that
because I think there are
better ideas to do it.
Now, there are -- I have not yet seen what the Senate Finance
Committee is producing.
They've got a number of ideas,
but we haven't seen a final draft.
The House suggested a surcharge
on wealthy Americans,
and my understanding, although I
haven't seen the final versions,
is, is that there's been talk
about making that basically only
apply to families whose joint
income is a million dollars.
To me, that meets my principle
that it's not being shouldered
by families who are already
having a tough time,
but what I want to do is to
see what emerges from these
committees, continuing to
work to find more savings --
because I actually think that
it's possible for us to fund
even more of this process
through identifying waste in the
system, try to narrow as much as
possible the new revenue that's
needed on the front end, and
then see how we can piece this
thing together in a way that's
acceptable to both Democrats and
I hope some Republicans.
The Press:
Is it your job to
get a deal done?
The President:
Absolutely it's my job.
I'm the President.
And I think this
has to get done.
Just a broader point -- if somebody told you that there is
a plan out there that is guaranteed to double your health
care costs over the next 10 years, that's guaranteed to
result in more Americans losing their health care, and that is
by far the biggest contributor to our federal deficit.
I think most people
would be opposed to that.
Well, that's the status quo.
That's what we have right now.
So if we don't change, we can't
expect a different result.
And that's why I think
this is so important,
not only for those families out
there who are struggling and who
need some protection from abuses
in the insurance industry or
need some protection
from skyrocketing costs,
but it's also important
for our economy.
And, by the way, it's important
for families' wages and incomes.
One of the things that doesn't
get talked about is the fact
that when premiums are going up
and the costs to employers are
going up, that's money that
could be going into people's
wages and incomes.
And over the last decade we
basically saw middle-class
families, their incomes
and wages flatlined.
Part of the reason is because
health care costs are gobbling that up.
And that's why I
say if we can --
even if we don't reduce our health care costs by the $6,000
that we're paying more than
any other country on Earth,
if we just reduced it
by $2,000 or $3,000,
that would mean money
in people's pockets.
And that's possible to do.
But we're going to have
to make some changes.
We've got to change how health
care is delivered to --
the health care delivery system
works so that doctors are being
paid for the quality of care
and not the quantity of care.
We've got to make information
technology more effective.
We've got to have the medical
system work in teams so that
people don't go through
five different tests.
Those are all critical to
do, and we can do them.
Now, I understand that people
are feeling uncertain about
this, they feel anxious, partly
because we've just become so
cynical about what
government can accomplish,
that people's attitudes
are, you know,
even though I don't
like this devil,
at least I know it and I like
that more than the devil I don't know.
So folks are skeptical, and that
is entirely legitimate because
they haven't seen a lot of laws
coming out of Washington lately
that help them.
But my hope is, and I'm
confident that when people look
at the costs of doing nothing
they're going to say,
we can make this happen -- we've made big changes before that end
up resulting in a better
life for the American people.
David Alexander, Reuters.
The Press:
Thank you, Mr. President.
You've been pushing Congress
to pass health care reform by August.
Why the rush?
Are you worried
that if you don't --
there's a delay until the fall,
the whole effort will collapse?
The President:
A couple of points.
Number one, I'm rushed because
I get letters every day from
families that are being
clobbered by health care costs.
And they ask me, can you help?
So I've got a middle-aged couple
that will write me and they say,
our daughter just found out
she's got leukemia and if I
don't do something soon we just
either are going to go bankrupt
or we're not going to be able to
provide our daughter with the
care that she needs.
And in a country like
ours, that's not right.
So that's part of my rush.
The second thing is the fact
that if you don't set deadlines
in this town things
don't happen.
The default position is inertia.
Because doing something always
creates some people who are unhappy.
There's always going to be some
interest out there that decides,
you know what, the status quo
is working for me a little bit better.
And the fact that we have made
so much progress where we've got
doctors, nurses, hospitals, even
the pharmaceutical industry,
AARP, saying that this
makes sense to do,
I think means that the stars
are aligned and we need to take
advantage of that.
Now, I do think it's
important to get this right.
And if at the end of the day I
do not yet see that we have it
right then I'm not going to
sign a bill that, for example,
adds to our deficit; I won't
sign a bill that doesn't reduce
health care inflation so that
families as well as government
are saving money.
I'm not going to sign a bill
that I don't think will work.
And my measure of whether things
work or not are listening to the
American people but also
listening to health care experts
who have shown that
in some communities,
health care is cheaper and
delivers a better result.
I think we can achieve that.
So I'm confident that if we just
keep at it, we keep working,
we're diligent, we're honest, if
we take criticisms that are out
there and modify whatever plans
are already working through
Congress so that it meets those
concerns and those criticisms,
that we can arrive at a bill
that is going to improve the
lives of the American people.
And I'll give you
one specific example.
I think that there was
legitimate concern that we had
not incorporated all of the
measures that could reduce
health care inflation over
the long term in some of the
versions of health care reform
that were coming out of the committee.
Well, over the last week,
working with not only health
care experts but also members of
Congress who are concerned about
this, we actually have now
gotten a commitment to
incorporate an idea that has a
panel of doctors and health care
experts advising on how we can
get a better value for our money
in Medicare.
And every expert out there says
this can be a valuable tool to
start reducing inflation
over the long term.
So can I say this, though -- if we hadn't had any kind of
deadline, that change probably would have never surfaced until
who knows when.
And so I want to do this right,
but the American people need
some relief.
Chuck Todd.
The Press:
Thank you, sir.
You were just talking in that
question about reducing health
care inflation, reducing costs.
Can you explain how you're
going to expand coverage?
Is it fair to say -- is this bill going to cover all 47
million Americans that are uninsured, or is this going to
be something -- is it
going to take a mandate,
or is this something
that isn't --
your bill is probably not going
to get it all the way there?
And if it's not going to
get all the way there,
can you say how far is enough -- you know, okay, 20 million more,
I can sign that; 10
million more, I can't?
The President:
I want to cover everybody.
Now, the truth is that unless
you have a -- what's called a
single-payer system in which
everybody is automatically
covered, then you're probably
not going to reach every single
individual, because there's
always going to be somebody out
there who thinks they're
indestructible and doesn't want
to get health care, doesn't
bother getting health care,
and then unfortunately when they
get hit by a bus end up in the
emergency room and the rest
of us have to pay for it.
But that's not the overwhelming
majority of Americans.
The overwhelming majority of
Americans want health care,
but millions of them
can't afford it.
So the plan that has been -- that I've put forward and that
what we're seeing in
Congress would cover --
the estimates are at least
97 to 98% of Americans.
There might still be
people left out there who,
even though there's an
individual mandate,
even though they are required
to purchase health insurance,
might still not get it, or
despite a lot of subsidies are
still in such dire straits that
it's still hard for them to
afford it, and we may end
up giving them some sort of
hardship exemption.
But -- I'm sorry, go ahead --
so I think that the basic idea
should be that in this country, if you want health care,
you should be able to get affordable health care.
And given the waste that's
already in the system right now,
if we just redesign certain
elements of health care,
then we can pay for that.
We can pay for it
in the short term,
but we can also pay for
it in the long term.
And, in fact, there's going to
be a whole lot of savings that
we obtain from that
because, for example,
the average American family is
paying thousands of dollars in
hidden costs in their insurance
premiums to pay for what's
called uncompensated care -- people who show up at the
emergency room because they don't have a primary care physician.
If we can get those
people insured,
and instead of having a foot
amputation because of advanced
diabetes they're getting a
nutritionist who's working with
them to make sure that they are
keeping their diet where it
needs to be, that's going to
save us all money in the long term.
The Press:
Back to the politics of it.
You mentioned two Republicans
in your opening statement,
but you have 60
Democratic seats,
a healthy majority in the House.
If you don't get this, isn't
this a fight inside the
Democratic Party, and that
Republicans really aren't
playing -- you can't really blame the Republicans for this one?
The President:
Well, first of all, you haven't seen me out there blaming
the Republicans.
I've been a little frustrated
by some of the misinformation
that's been coming out
of the Republicans,
but that has to do with, as
you pointed out, politics.
You know, if you've got
somebody out there saying --
not that let's get the best
bill possible but instead says,
you know, let's try to beat
this so we can gain political
advantage -- well, that's not I think what the American people expect.
I am very appreciative that
people like Chuck Grassley on
the Finance Committee in the
Senate, people like Mike Enzi,
people like Olympia Snowe,
have been serious in engaging
Democrats in trying to figure
out how do we actually get a
system that works.
And even in those committees
where you didn't see Republican
votes, we've seen
Republican ideas.
So, for example, in the HELP
Committee in the Senate,
160 Republican amendments were
adopted into that bill because
they've got good
ideas to contribute.
So the politics may dictate that
they don't vote for health care
reform because they
think, you know,
it'll make Obama
more vulnerable.
But if they've got a good
idea we'll still take it.
And in terms of Democrats, the
fact of the matter is that
because this is a big issue, I
think that a lot of Democrats
have a lot of different ideas -- some of them have to do with
regional disparities.
For example, you've got some
Democrats who are concerned that
the Medicare reimbursement rates
in their communities are too low
and so they'd like to see the
bill incorporate higher rates
for doctors and providers in
rural communities to incentivize
good care in those communities.
That's a legitimate concern.
But the minute you bring up that
concern then that adds money,
which means that we then have
to find additional dollars.
So this is part of just the
normal give-and-take of the
legislative process.
I'm confident at the end we're
going to have a bill that
Democrats and some
Republicans support.
Jake.
The Press:
Thank you, Mr. President.
You said earlier that you wanted
to tell the American people
what's in it for them, how will
their family benefit from health
care reform.
But experts say that in addition
to the benefits that you're
pushing there is going to have
to be some sacrifice in order
for there to be true
cost-cutting measures,
such as Americans giving up
tests, referrals, choice,
end-of-life care.
When you describe health
care reform you don't --
understandably you don't talk
about the sacrifices that
Americans might have to make.
Do you think -- do you accept the premise that other than some
tax increases on the
wealthiest Americans,
the American people are going
to have to give anything up in
order for this to happen?
The President:
They're going to have to give
up paying for things that don't
make them healthier.
And I -- speaking
as an American,
I think that's the
kind of change you want.
Look, if right now hospitals
and doctors aren't coordinating
enough to have you just take one
test when you come in because of
an illness, but instead
have you take one test;
then you go to
another specialist,
you take a second test; then
you go to another specialist,
you take a third test -- and nobody's bothering to send the
first test that you
took -- same test --
to the next doctors,
you're wasting money.
You may not see it because if
you have health insurance right
now it's just being sent
to the insurance company,
but that's raising
your premiums,
it's raising
everybody's premiums,
and that money one way or
another is coming out of your
pocket -- although we are also subsidizing some of that because
there are tax breaks
for health care.
So not only is it costing
you money in terms of higher
premiums, it's also
costing you as a taxpayer.
Now, I want to change that.
Every American should
want to change that.
Why would we want to pay
for things that don't work,
that aren't making us healthier?
And here's what I'm confident
about: If doctors and patients
have the best information about
what works and what doesn't,
then they're going to want
to pay for what works.
If there's a blue pill and a red
pill and the blue pill is half
the price of the red pill
and works just as well,
why not pay half price for the
thing that's going to make you well?
But the system right now
doesn't incentivize that.
Those are the changes that
are going to be needed --
that we're going to need
to make inside the system.
It will require I
think patients to --
as well as doctors, as
well as hospitals --
to be more discriminating
consumers.
But I think that's a good thing,
because ultimately we can't
afford this.
We just can't afford what
we're doing right now.
And just to raise a broader
issue that I think has colored
how we look at
health care reform,
let me just talk about
deficit and debt,
because part of what's been
happening in this debate is the
American people are
understandably queasy about the
huge deficits and debt that
we're facing right now.
And the feeling is, all right,
we had the bank bailout,
we had the recovery package,
we had the supplemental,
we've got the budget,
we're seeing numbers --
trillions here and
trillions there.
And so I think legitimately
people are saying, look,
we're in a recession,
I'm cutting back,
I'm having to give up things -- and yet all I see is government
spending more and more money.
And that argument I think has
been used effectively by people
who don't want to change health
care to suggest that somehow
this is one more
government program.
So I just want to address
that point very quickly.
First of all, let's understand
that when I came in we had a
$1.3 trillion deficit -- annual deficit that we had already inherited.
We had to immediately move
forward with a stimulus package
because the American economy had
lost trillions of dollars of
wealth; consumers had
lost through their 401Ks,
through their home
values, you name it,
they had lost
trillions of dollars.
That all just went away.
That was the day I was sworn
in, it was already happening.
And we had 700,000 jobs
that were being lost.
So we felt it was very important
to put in place a recovery
package that would help
stabilize the economy.
Then we had to pass
a budget, by law.
And our budget had a
10-year projection --
and I just want everybody to be
clear about this: If we had done
nothing, if you had the same old
budget as opposed to the changes
we made in our budget, you'd
have a $9.3 trillion deficit
over the next 10 years.
Because of the changes we've
made it's going to be $7.1 trillion.
Now, that's not good, but it's
$2.2 trillion less than it would
have been if we had the same
policies in place when we came in.
So the reason I point this out
is to say that the debt and the
deficit are deep
concerns of mine.
I am very worried
about federal spending.
And the steps that we've taken
so far have reduced federal
spending over the next 10
years by $2.2 trillion.
It's not enough.
But in order for us to do more,
we're not only going to have to
eliminate waste in the system -- and by the way, we had a big
victory yesterday by eliminating a weapons program, the F-22,
that the Pentagon had repeatedly said we didn't need --
so we're going to have to
eliminate waste there,
we're going to have to
eliminate no-bid contracts,
we're going to have to do
all kinds of reforms in our
budgeting -- but we're also going to have to change health care.
Otherwise we can't close that
$7.1 trillion gap in the way
that the American people
want it to change.
So to all -- everybody who's out there who has been ginned up
about this idea that the Obama
administration wants to spend
and spend and spend, the
fact of the matter is,
is that we inherited
a enormous deficit,
enormous long-term
debt projections.
We have not reduced it as much
as we need to and as I'd like
to, but health care reform
is not going to add to that
deficit; it's
designed to lower it.
That's part of the reason
why it's so important to do,
and to do now.
Chip Reid.
The Press:
Thank you, Mr. President.
On Medicare, there are obviously
millions of Americans who depend
on Medicare, and when you talk
about bending the long-term cost
down, or when you talk about
cuts in the current proposal on
Capitol Hill, you talk about
cuts in Medicare and they talk
about cuts in Medicare, but
there are never many specifics.
Specifically, what kind of
pain, what kind of sacrifice,
are you calling on
beneficiaries to make?
And even if not right away,
aren't future beneficiaries
going to be getting less
generous benefits than today's?
The President:
No.
No.
The Press:
And a subsidiary question, what do you think about taking it out
of the political realm and
giving it to an outside body of
experts to take the
politics out of Medicare?
The President:
Well, on the second point, that's exactly what our
proposal is.
It -- called the MedPAC program.
By the way, it was
originally a Republican idea.
I want to give credit
where credit is due.
The Republican Congress passed
a bill that created a panel of
health care experts to make
recommendations to Congress on
how we could get better
quality, lower cost.
The problem is every year it
would just go on a shelf,
and nobody would act on it.
So what we've said is let's
give that body some power.
Let's require Congress to vote
on the proposals that they're
making every year.
Congress can still reject them,
so it's not completely removing
it from politics, but they have
to reject or accept it as a package.
And that I think would incentivize and empower
important changes.
But here's the thing I
want to emphasize, Chip.
It's not going to reduce
Medicare benefits.
What it's going to do is to
change how those benefits are
delivered so that
they're more efficient.
Let me give you a
very specific example.
You've heard that as a
consequence of our efforts at
reform, the pharmaceutical
industry has already said
they're willing to put
$80 billion on the table.
Now, why is that?
Well, the reason is, is because
there's probably even more waste
than $80 billion, in terms of
how the drug plan in Medicare is administered.
We might be able to get
$100 billion out or more,
but the pharmaceutical
industry voluntarily said,
here's $80 billion.
You know what that means?
That means that senior citizens
who right now have a so-called
doughnut hole in their plan
where after spending a certain
amount on prescription drugs
suddenly they drop off a cliff
and they've got to
pocket the entire cost,
suddenly half of that is filled.
That's a hard commitment
that we already have.
So that's a change in how
we are delivering Medicare.
But you know what, it turns out
that it means out-of-pocket
savings for seniors.
That's why AARP
has endorsed this.
Christi Parsons.
The Press:
Thank you.
During the campaign you promised
that health care negotiations
would take place on C-SPAN,
and that hasn't happened.
And your administration recently
turned down a request from a
watchdog group seeking a list of
health care executives who have
visited the White House to
talk about health care reform.
Also, the TARP inspector general
recently said that your White
House is withholding too
much information on the bank bailouts.
So my question for you is, are
you fulfilling your promise of
transparency in the White House?
The President:
Well, on the list of health care executives who've visited us,
most of the time you guys have
been in there taking pictures,
so it hasn't been a secret.
And my understanding is we just
sent a letter out providing a
full list of all the executives.
But frankly these have mostly
been at least photo sprays where
you could see who
was participating.
With respect to all the
negotiations not being on
C-SPAN, you will recall in this
very room that our kickoff event
was here on C-SPAN, and at a
certain point you start getting
into all kinds of
different meetings --
Senate Finance is
having a meeting,
the House is having a meeting.
If they wanted those to be on
C-SPAN then I would welcome it.
I don't think there are a lot
of secrets going on in there.
And the last question
with respect to TARP.
Let me take a look at what
exactly they say we have not provided.
I think that we've provided
much greater transparency than
existed prior to our
administration coming in.
It is a big program.
I don't know exactly
what's been requested.
I'll find out and I will
have an answer for you.
Julianna.
The Press:
Thank you, Mr. President.
You've said the recent bank
profits indicate that there's
been no sense of remorse on
Wall Street for risky behavior,
that we haven't seen a
change in culture there.
Do you think that your
administration needs to be
taking a harder line
with Wall Street?
And also, would you consider
going a step further than your
regulatory reform proposals
and supporting a fee on risky
activities that go beyond
traditional lending?
The President:
We were on the verge of a complete financial meltdown.
And the reason was because Wall
Street took extraordinary risks
with other people's money, they
were peddling loans that they
knew could never be paid back,
they were flipping those loans
and leveraging those loans and
higher and higher mountains of
debt were being built on loans
that were fundamentally unsound.
And all of us now
are paying the price.
Now, I believe it was
the right thing to do --
as unpopular as it is, it was
the right thing for us to do to
step in to make sure that
the financial system did not
collapse, because things would
be even worse today had those
steps not been taken.
It originated under the
Bush administration.
We continued it because whether
you're on the left or the right,
if you talk to economists, they
said that this could have the
kinds of consequences
that would --
dropped us into a deep depression and not simply a very
severe recession.
Now, one of the success stories
of the past six months is that
we really have seen a
stabilization in the financial system.
It's not where it needs to be,
but people are no longer talking
about the financial system
falling off a cliff.
We've stepped away
from the brink.
And that's important, because
what it means is there are a lot
of companies right now that can
go into the marketplace and
borrow money to fund
inventory, fund payroll,
and that will help the
economy grow as a whole.
The problem is, now that the
financial system has bounced
back, what you're seeing is
that banks are starting to make
profits again.
Some of them have paid back the
TARP money that they received,
the bank bailout money
that they received.
And we expect more of
them to pay this back.
That's a good thing.
And we also think it's a good
thing that they're profitable
again, because if they're
profitable that means that they
have reserves in place
and they can lend.
And this is America, so if
you're profitable in the free
market system then you benefit.
But what we haven't seen I
think is the kind of change in
behavior and practices on Wall
Street that would ensure that we
don't find ourselves in a fix
again where we've got to bail
out these folks while they're
taking huge risks and taking
huge bonuses.
So what do I think
we need to do?
We've got to pass financial
regulatory reform.
And this is an example
of where folks say, well,
should the Obama administration
be taking on too much?
The fact of the matter is that
if we don't pass financial
regulatory reform then banks are
going to go back to the same
things that they
were doing before.
In some ways it could be worse
because now they know that the
federal government may think
that they're too big to fail and
so if they're unconstrained they
could take even more risks.
And so there are a number of
elements of financial regulatory reform.
With respect to compensation I'd
like to think that people would
feel a little remorse and feel
embarrassed and would not get
million-dollar or
multimillion-dollar bonuses.
But if shame does not work then
I think one proposal that I put
forward is to make sure that
at least shareholders of these
companies know what their
executives are being compensated
-- and that may force
some reductions.
For banks that are still
receiving taxpayer assistance we
have a set of rules that gives
us some control on reducing
unwarranted compensation.
And in terms of the last
point that you made,
which is the possibility of fees
for transactions that we want to
discourage, that is one of
the ideas that is going to be
working its way
through the process.
I think at minimum what we want
to do is to make sure that to
the extent the federal
government is going to have to
be a backstop, just like the
Federal Deposit Insurance
Corporation, what everybody
is familiar with, FDIC,
the reason that when you put
your deposits in your bank you
can have confidence
that they're insured --
that's paid for
through bank fees.
We may need to make sure that
there is a similar mechanism in
place for some of these
other far-out transactions.
So if you guys want to do them,
then you got to put something
into the kitty to make sure
that if you screw up it's not
taxpayer dollars that
have to pay for it,
but it's dollars coming
out of your profits.
Steve Koff, the
Cleveland Plain Dealer.
The Press:
Thank you.
To follow up on Jake's
question earlier, sir,
so many Americans are
concerned that this plan,
particularly the government
insurance, the public option,
would lead to reduced
benefits or reduced coverage.
Two questions.
One, can you guarantee that this
legislation will lock in and say
the government will
never deny any services;
that that's going to be decided
by the doctor and the patient,
and the government will
not deny any coverage?
And secondarily, can you,
as a symbolic gesture,
say that you and the Congress
will abide by the same benefits
in that public option?
The President:
Well, number one, not only the public option but the insurance
regulation that we want to put
in place will largely match up
with what members of Congress
are getting through the federal
employee plan.
That's a good example of what
we're trying to build for the
American people -- the same thing that Congress enjoys,
which is they go -- there is a marketplace of different plans
that they can access, depending on what's best for their families.
Now, one of the plans that we've
talked about is a public option.
And part of the reason we want
to have a public option is just
to help keep the insurance
companies honest.
If the insurance companies
are providing good care --
and as it is, they're going to
be more regulated so that they
can't deny you care because of a
preexisting condition or because
you change jobs or because
they've decided you're too sick
and not a good risk -- with regulation there's already going
to be some improvement in
the insurance industry.
But having a public plan out
there that also shows that maybe
if you take some of
the profit motive out,
maybe if you are reducing some
of the administrative costs,
that you can get an
even better deal,
that's going to incentivize
the private sector to do even better.
And that's a good thing.
That's a good thing.
Now, there have been reports
just over the last couple of
days of insurance companies
making record profits -- right now.
At a time when everybody
is getting hammered,
they're making record profits,
and premiums are going up.
What's the constraint on that?
How can you ensure that those
costs aren't being passed on to
employers or passed on to
employees, the American people,
ordinary middle-class families,
in a way that over time is going
to make them broke?
Well, part of the way is to
make sure that there's some
competition out there.
So that's the idea.
Now, to get to your
original question,
can I guarantee that there are
going to be no changes in the
health care delivery system?
No.
The whole point of this is to
try to encourage changes that
work for the American people
and make them healthier.
The government already is
making some of these decisions.
More importantly, insurance
companies right now are making
those decisions.
And part of what we want to
do is to make sure that those
decisions are being made by
doctors and medical experts
based on evidence,
based on what works --
because that's not how
it's working right now.
That's not how it's
working right now.
Right now doctors a lot of times
are forced to make decisions
based on the fee payment
schedule that's out there.
So if they're looking -- and you come in and you've got a bad
sore throat, or your child has a bad sore throat or has repeated
sore throats, the doctor may look at the reimbursement system
and say to himself,
you know what,
I make a lot more money if I take this kid's tonsils out.
Now that may be the
right thing to do,
but I'd rather have that doctor
making those decisions just
based on whether you really
need your kid's tonsils out or
whether it might make more
sense just to change --
maybe they have allergies, maybe
they have something else that
would make a difference.
So part of what we want to do
is to free doctors, patients,
hospitals to make decisions
based on what's best for patient
care -- and that's the
whole idea behind Mayo,
that's the whole idea
behind the Cleveland Clinic.
I'm going to be visiting your
hometown tomorrow to go to the
Cleveland Clinic to show -- to show why their system works so well.
And part of the reason it works
well is because they've set up a
system where patient care
is the number-one concern,
not bureaucracy, what forms
have to be filled out,
what do we get reimbursed for.
Those are changes that I think
the American people want to see.
The Press:
And what about
yourself and Congress?
Would you abide by the
same benefits package?
The President:
You know, I would be
happy to abide by the same
benefit package.
I will just be
honest with you --
I'm the President of the United
States so I've got a doctor
following me every minute.
(laughter)
Which is why I say
this is not about me.
I've got the best health
care in the world.
I'm trying to make sure that
everybody has good health care
-- and they don't right now.
Lynn Sweet.
(inaudible)
Oh.
(laughter)
Well, I said Steve Koff --
but he just stood up, huh?
The Press:
Yes.
The President:
Well, that's not fair.
Shame on you.
(laughter)
All right, get in
there real quick.
The Press:
-- got the Cleveland connection, so I appreciate that.
You cited the Mayo Clinic and
the Cleveland Clinics as models
for the delivery of
health care in the past.
The Mayo Clinic, though, has
some problems with the House
proposal saying they're not
focused enough on patients and
on results.
What do you expect to achieve
tomorrow by going to the
Cleveland Clinic -- which
hasn't stated an opinion --
and are you expecting some
form of endorsement from the
Cleveland Clinic?
The President:
I am not expecting
an endorsement.
The Cleveland Clinic is simply a
role model for some of the kind
of changes that we want to see.
I think it's important to
note that the Mayo Clinic was
initially critical and concerned
about whether there were enough
changes in the delivery system
and cost-saving measures in the
original House bill.
After they found out that we
had put forward very specific
mechanisms for this MedPAC idea,
this idea of experts getting the
politics out of health care and
making decisions based on the
best evidence out there, they
wrote in their blog the very
next day that we actually think
this would make a difference.
Okay?
All right, I tried to make that
short so that Lynn Sweet would
get her last question in.
The Press:
Thank you, Mr. President.
Recently Professor Henry Louis
Gates Jr. was arrested at his
home in Cambridge.
What does that incident say to
you and what does it say about
race relations in America?
The President:
Well, I should say at the outset that "Skip" Gates is a friend,
so I may be a
little biased here.
I don't know all the facts.
What's been reported, though, is
that the guy forgot his keys,
jimmied his way to
get into the house,
there was a report called into
the police station that there
might be a burglary
taking place --
so far, so good, right?
I mean, if I was trying
to jigger into --
well, I guess this
is my house now so --
(laughter)
-- it probably wouldn't happen.
But let's say my old
house in Chicago --
(laughter)
-- here I'd get shot.
(laughter)
But so far, so good.
They're reporting -- the police are doing what they should.
There's a call, they go
investigate what happens.
My understanding is at that
point Professor Gates is already
in his house.
The police officer comes in, I'm
sure there's some exchange of
words, but my understanding is,
is that Professor Gates then
shows his ID to show
that this is his house.
And at that point, he gets
arrested for disorderly conduct
-- charges which
are later dropped.
Now, I don't know, not having
been there and not seeing all
the facts, what role
race played in that,
but I think it's fair
to say, number one,
any of us would be
pretty angry; number two,
that the Cambridge Police acted
stupidly in arresting somebody
when there was already proof
that they were in their own
home; and number three, what I
think we know separate and apart
from this incident is that
there is a long history in this
country of African Americans and
Latinos being stopped by law
enforcement disproportionately.
That's just a fact.
As you know, Lynn, when I was
in the state legislature in
Illinois, we worked on a racial
profiling bill because there was
indisputable evidence that
blacks and Hispanics were being
stopped disproportionately.
And that is a sign, an
example of how, you know,
race remains a factor
in this society.
That doesn't lessen the
incredible progress that has been made.
I am standing here as testimony
to the progress that's been made.
And yet the fact
of the matter is,
is that this still haunts us.
And even when there are
honest misunderstandings,
the fact that blacks and
Hispanics are picked up more
frequently and oftentime for no
cause casts suspicion even when
there is good cause.
And that's why I think the more
that we're working with local
law enforcement to improve
policing techniques so that
we're eliminating
potential bias,
the safer everybody
is going to be.
All right, thank you, everybody.
