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DEPARTMENT OF JUSTICE
2
3
PRESS CONFERENCE
4
ATTORNEY GENERAL JANET RENO
5
6
Wednesday, September lS. 1993
7
a
9th & Constitution Avenue. N.W.
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5th Floor Conference Room
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Washington, D.C. 20530
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")
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PRESS CONFERENCE
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(lO:35 a.m.)
ATTORNEY GENERAL JANET RENO
3
GENERAL .RENO:
4
We would like to welcome the
5
First Lady to the Department of Justice.
She is
6
helping -- this is her tirst visit here, and I think it is
.7
Vlonderful that you as a laW'ter have a chance to see where
.8
justice gets done in this district.
9
I would like to introduce Anne Bingaman, who is
lO
the Assistant Attorney General in charge of the Antitrust
11.
Division, who has been doing a wonderful job, and it is a
12
special privilege to introduce the Chairman ot the Federal
l3
Traas Commission, Janet Steiger.
14
to have her here, and it has been a pleasure to work with
lS
you.
It is truly a pleasure
We have Senator Howard Metzenbaum,who was the
16
17
first person to talk to me about antitrust when! arrived
l8
in Washington back in those earlier days, and the tirst
19
person 1 met in Congress, Chairman Jack ·Brooks.
20
privilege to have you here, Senator.
It is a
Americans want quality health care .. Everywhere
21
22
23
the refrain was the same from people in every walk of
24
life.
.25
)
I have gone throughout this Nation in these last 6 months,
Mrs. Clinton in this effort, we must make sure that we do
To
~chieve
that goal, to assist the President and
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our part in the Department of Justice to eliminate
2
excessive costs and delay in setting up an efficient,
3
effective health care system.
We have been asked by health care providers,
4
5
where would we stand under the antitrust laws?
What can
6
we do, what can't we do?
7
antitrust policy statement to provide clear guidance to
8
health care providers.
9
jointly by the Justice Department and the Federal Trade
We are here today to announce an
The policy statements issued
10
Commission
11
review, the first time this has been done.
incl~de
a commitment for expedited business
Requesters can expect an answer within 90 days
12
13
e)
)
after submitting the necessary information as to
14
particular situation and what can be done under the
15
antitrust laws.
This will be important.
Take some of these examples.
16
thei~
Three small
17
hospitals in Maine want to share the cost of a mobile CAT
18
scan machine.
19
.find out quickly whether the agreement would violate
20
antitrust laws.
21
so that they know where they stand.
They have not done it, because they cannot
We.want to give them the answer up front
Hospitals in another city want to know whether
22
23
chey can get together to buy amedivachelicopter.
24
Hospitals in Ohio want to buy 'furniture together.
2S
1;:0
We want
let the11", know whether they can or can't unr.;ier the
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.3ntitrust laws in an expedited way that is fair to all
2
concerned.
Doctors in another State want to know whether
3
4chey can form a preferred provider organization to
5
contract directly with insurance companies.
6
firm in Atlanta isn't sure whether it can set up a deal
7
~or
An
accounting
acute care services.
8
The speed and extent to which health care reform
9
is carried out will depend on how qyickly and how well the
lO
Government is prepared to answer those questions, and that
11
is the reason we are here today, but that is not the only
12
effort we are undertaking in health care reform.
13
?resident has asked for a larger review of health care
14
issues.
The Justice Department is currently evaluating
l5
16
17
The
measures to increase the Federal power to fight fraud and
. abuse, for example by strengthening anti-kick-back laws
l8
and making heavy penalties against defrauding the
19
\~overnment
20
nealth care system as well.
2l
enforcement plan to be an important part in the ?resident
22
and Mrs. Clinton's effort to make sure that health eare is
23
available and affordable for all Amerieans.
applicable to those who defraud the private
Those of us in law
24
The First Lady and I a=e·going to have to leave
25
early, so I want to make sure that she· has an opportunity
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to be heard first.
It is a great privilege to have her here today.
3
I met her a little over a year ago, and to watch this lady
4
in action has been one of the great opportunities.
She is
5
.a person who is dedicated to this whole Nation and day-in
6
and day-out through these first months of this first year
7elhe has truly demonstrated her commitment to America and
8
to health care reform.
9
Mrs. Clinton.
10
II
12
It is wonderful to have you here,
(Applause. )
FIRST ,LADY HILLARY RODHAM CLINTON
MRS. CLINTON:
Well, as Attorney General Reno
13
e )
said, this is my first visit to the Justice Department, a
14
place that has always had a lot of personal and
15
professional meaning for me, an with whom I have had a
16
relationship through the years with various lawyers who
17
have had the privilege Of serving
18
Itisa particularly
h~re.
spec~al
occasion for me to
19
be here, and to
20
helm, and to know how faithful and committed the many,
2l
many people in this Department are to what the words above
22
the entry say.
23
lolO\;'
that Attorney Gener.al Reno is at the
I particularly want to thank Attorney General
24
Reno and her Department for their partiCipation in our
25
health care reform
efforc~
From the very beginning,
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lawyers from the Justice Department have been involved in
2
the work that has gone on to try to analyze the many, many
3
i$s~es
4
workable solutions.
5
surrounding health care and come forward with
I want to applaud the actions taken today by the
~
Department and the Federal Trade Commission in issuing
7
these guidelines.
8
work by Anne Bingaman and Janet Steiger, by Senator
9
Metzenbaum and Congressman Jack Brooks, and their very
10 ,
They are the result of
a lot
of hard
dedicated staffs.
II
These gUidelines represent an important first
l~
step for an industry that is facing rapid change.
l3
are a good example of what health care reform' is all
14
'about.
They
They will help lower costs, maintain high quality,
15
ctnd knock down the. barriers to collaboration that
16
unfortunately are too common in our presentsy.stem,
17
The Attorney General has spelled out what the
18
problem is.
19
keeps doctors and hospitals from spending their money
20
wisely and drives up the prices that consumers and the
21
Government have to pay.
2:2
will turn this ,system the right side up.
23
We have a complex and inefficient system that
Over time, the actions
~e
take
Instead of requiring every hospita.l or doctor's
24
office to ,buy the same expensive piece of equipment, these
25
guidelines will allow them to share that equipment.
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allow physicians to get together to control costs, and
2
they allow mergers that are competitive and save consumers
3
money.
~
I
have learned many, many things about our
care syst:ern in the past monchs, but one of .t.he
5
hf~alth
6
f.i.rst ··lessons that I learned came to me fr;jffi traveling
7
around the country, when a member Of a hospital board or a
8pnysician or a hospital administrator would corne and, with
9
real poignancy say, we want to help, but we cannot even
lO
11
cfexpensive equipment in our community instead of all of
12
us feeling compelled co buy one for ourselves because ou.r
13
fit )
have a meeting to talk about how we could have one piece
lawyers tell us we cannot cooperate.
14
This is not a problem that comes from the
15
:rustice Department or the Federal Trade Corr.r:dssion or the
·16
senate or the House.
17
the grassroots of people trying to do a better job to
18
deliver quality health care.
19
This is . a problem that. comes from
These actions are pro-competition, pro
20
collaboration, and pro-consumer.
The results over time
21
will achieve tha following positive resul:s:
22
will pay less, equipment will not stand idle, it will be
consumers
.23
24
pressure on physicians to order tests to pay for the
25
)
used more frequently, hospitals will save money, the
machinery that they bought in order to be competitive will
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stop, and the highest quality tests and the latest
2
technology will still be available, and I would argue more
3
teadily available. to those who need them.
I
4
also want to thank the Attorney General and
5
the Justice Department for their ongoing and accelerating
6
t!:fforts to crack down· 00 the problem of health care fraud
7
cLOd.
S
n\ounted, consumers and businesses have paid a high price.
9
'l'he crimes have grown more sophisticated and more
abuse.
As the Nation's health care bills have
10
outrageous, and every time someone rips off the health
11
:Lnsurance system, the public, the private insurers, all of
12
IlS
13
)
pay more.
Settlements like the ones the Department has
14
recently achieved on the West Coast, and the strong
15
measures that we will have more to say about next week.
16
send a strong warning to those who would steal from the
17
American taxpayers and permit the kind of health care
18
fraud that has a damaging impact on all of us. no matter
19
who. we are.·
20
We intend to make it very clear, health care
21
fraud will not go unpunished.
22
system there will no longer be any room for the kind of
23
games that for too long have permitted the kind of fraud
24
and abuse that we are cracking down on now.
25
In a reformed health care
This is a message we must send to every American
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has health insurance and pays too much, and to every
1
wnl)
2
American who does not know if they will
3
their coverage next month or next year.
b~
able to afford
ltis a great pleasure for me to stand here in
4
5
this department with this team that has been assembled to
6
take these steps on the road to getting health care.costs
7
under con:rol and providing health care security for every
a
American.
This is the kind of example of thoughtful.
9
10
careful work that leads to a positive result that will
11
,translate into better health care for Americans in the
12
y;!ars to come.
13
14
(i\pplause. )
15
e
Thank you very mUCh.
GENERAL RENO:
16
Division is
~~ne
The leader of the Antitrust
Bingaman I one of the most dedicated and
17
. vigorous lawyers that I have met in Washington ~ . It is a
18
t.rue pleasure to have her on this team in. the Department
19
c)f Justice.
She has been working with the really dedicated
20
21
people in. that division, people who care so much about
22
ilntitrust enforcement.
23
questions. but she might have a few words for .us now.
24
Anne.
25
-
She is going to remain
(Applause. )
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ASSISTANT ATTORNEY GENERAL ANNE K. BINGAMAN
1
2
IN CHARGE OF THE DEPARTMENT OF JUSTICE'S ANTITRUST DIVISION
MS. BINGAMAN:
3
Let me just speak to you briefly,
4
because Chairman Steiger and I will remain to answer
5
detailed questions on the guidelines,
6
Let me just emphasize the extraordinary
7
CCtoperation and coordination and consultation that went on
6
jointly between the Federal Trade Commission and the
9
Dupartment of Justice in developing and issuing its
10
~lidelines.
11
h.~5
It iS
t
I believe. almost unprecedented.
It
been a wonderful experience.
12
It is exactly the kind of responsible and
13
14
j
responsive Government that we need to have, because we
recognize •• the Federal Trade Commission recognizes and
15
the Department of Justice recogni2.esthere is a problem
16
c·ut there.
17
know what the rules were.
18
People in small communities honestly didn't
As the First Lady said, you hear it over and
19
elver again.
The rules were there, but they were. in
20
gpeeches and letters and business review advisories going
21
back over a lO-year period, so that if you were a partner
22
in a major New York or Washington law firm, you knew the
23
letter issued February 18, 1985 covered such-and-such, but
24
1f you were somebody in Santa Fe, New Mexico, my home
25
town, you may not know there were such letters, and yet
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you had to give advice to your local hospital or your
2
local group of physicians as a lawyer, or if you're on a
3
hospital board, or a doctor trying to comply, you had to
4
understand what the rules were.
So this is an effort to clarify, to state in one
5
6
simple place what those rules are, and to commit to
7
ongoing review in order to provide responsible help to the
8
9
10
11
1~
13
'14
.
health care community throughout this country in a time of
enormous change which needs to occur, and we want to do
our part.
I
want to thank Chairman Steiger· and the Federal'
Trade Commission so sincerely for their enormous help.
It'
has been a great pl.easure working with them, and we look
forward to many months and years of cooperation.
15
Thank you.
16
(Applause. )
17
ATTORNEY.GENERAL RENO:
19
. 19
Chairman Steiger has set
an example for us all in terms of cooperative effort
between Government agencies that are concerned with the
20
same. jurisdiction and the same subject
2l
been a wonderful opportunity for us to work with the
22
Co(t'.mission and with Chairman Steiger, and it is a great
23
privilege to have her here today.
24
(Applause. )
2S
matte~.
It has
FEDERAL TRADE COMMISSION CHAIRMAN JANET D. STEIGER
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CHAIRMAN STEIGER:
1
Thank you.
I also will be
2
brief, since we 'are going to take· 20 questions afterwards.
3
But our thanks at the Commission for the leadership of the
4
First Lady, and the Attorney General, and, of course, Anne
5
Bingaman, for their assistance to us in this effort.
6
we cannot leave out the Senator and the Chairman, who were
7
always resources for us in these efforts.
I just want to stress that the policy statements
8
9
And
do represent a collaborative
effor~
by the two Federal
10
agencies who are entrusted.with the responsibility for
11
antitrust enforcement.
12
effort.
They also represent a bipartisan
Sound antitrust laws is not a partisan matter.
The First Lady has noted that guidance is needed
13
14
in how the antitrust laws do apply
15
care.
l6
wellbeing as people, but to our economic wellbeing as a·
·17
~o
the field of health
Health care is vital not only toourphy.sical
county.
And antitrust
enfo~cement
has historically
~layed
18
a very important role in protecting competition in the
19
health-care markets, and in lowering the cost of health
20
care for consumers.
21
. But antitrust is, as Anne Bingaman said, a very
22
23
the field of health care.
24
we believe, to the need to tell people ,dth clarity what
25
",
complicated area of the law, particularly as it applies to
kinds of activities are and are not permissible, so that
This complexity has given
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legitimate conduct is not deterred, conduct that is
2
beneficial to consumers.
3
deterred by a fear of antitrust enforcement that is not in
4
order.
We at FTC are very proud of our record in the
5
6
7
8
9
That that conduct is not
health-care area, of our record of challenging barriers to
··the development of HMO's and other innovative health-care
delivery systems.
And we are proud of our record of
. attacking conspiracies to raise prices to consumers.
antitrust enforcement efforts of this type should
10
11
and will continue.
12
to attest there are such as those we took today, to better
13
explain our enforcement intentions so that
14
)
Sou~d
misunderstandings about those intentions do not inhibit
15
activities that benefit consumers.
But at the same time it is important
I owe a special debt: of thanks to my colleagues
16
17
at the Fec:ieralTradeCommission, Commissioners Azcuenaga.
18
Starek, and Yao.
19
due to Commissioners Yao,
20
Starek.
21
and ooordination of our efforts at the FTC.
And I
m~st
wh~
add a real special thanks are
is here with"us today, and
They took the. very heavy work in the organization
22
Thank you.
23
(Applause.)
24
ATTORNEY GENERAL RENO:
2S
Senator Howard
Metzenba:o,lm is the distinguished Chairman of the Senate
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Judiciary Committee/s subcommittee which deals with
2
antitrust issues.
3
concerned with the vigorous enforcement and fair
4
enforcement of the antitrust laws of this Nation, anc we
5
az"e delighted that he cut short a meeting on the Hill to
6
bE:
No person in Washington is more
wi th us today.
7
Senator, welcome .
.8
(Applause. )
SENATOR HOWARD METZENBAUM, DEMOCRAT, OHIO
9
SENATOR METZENBAUM:
10
Jack, I hope you get the
11
12
that I feel that here are we two males, we, while these
13
)
message.
Because it is a tremendous sense of excitement
four wonderful women provided leadership.
14
C:hi;lnged in Washington and I am all for it, and I ceuld.."1' t
15
be more pleased about it.
16
(Applause. }
17
SENATOR METZENBAUM:
Governmenc has
I am also excitedaboue the
18
fact that weare going to solve a problem in the antitrust
19
field without changing one word, one comma, or one
20
semi-COlon of the antitrust laws.
21
Our antitrust laws are not to blame fer the high cost ot
~2
health care.
23
fixing and gouging.
24
never blocked a pro-competitive health care deal.
25
Ana
there is no need.
They have protected consumers from price
In fact, the antitrust laws have
We are here today to clear up confusion among
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doctors and hospitals about how these laws apply to them.
2
We want to end their uncertainty.
3
about antitrust has slowed down even one cost-cutting
"
merger or joint venture, that is one too many.
5
policy guidelines are proof positive that we can make our
6
laws work to accommodate businesses when their concerns
7
have logic and
a
9
I
If legitimate confusion
These
merit~
became cOllvinced that. the hospitals were
looking fer clarity, not loopholes, when I chaired a
10
11
huaring conducted by Senator RockefelleX" where a
12
ha.lf-dozen Senators indicated their concerns about the
13
e ;..)
hE!aring on the subject last March.
h,;)spitals trying to work together in their local
14
communities, and saying what a great problem it was, that
15
w,!: had to change the antitrusr. laws.
"t
l6
.~d
I
also attended a
that time I said we don't have to change the
17
antitrust laws;
15
culmination of those efforts, because it has been brought
19
about
20
about Changed guidelines that spell out what can andcan/t
21
be done.
withou~changing
And this is the
the antitrust laws by bringing
Together, We began to look: for resolution after
22
23
those meet.ings.
24
Ho~pital
25
e.J
we can work this out.
writing che
And thanks to the help of the Atl'.erican
Associacion, they took the extraordinary step of
Pirs~
Lady to win her support .for antitrust
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e
for hospitals.
I promised the AHA that I would
~;uidelines
2
·..,ork with the Just ice Department and the Federal Trade
3
!
1
Commission to come up with guidelines.
Today's announcement isa victory for .consumers
4
5
chat will speed health-care reform.
6
help end uncertainty about how the antitrust laws will
.7
These measures will
apply to hospital and physician deals, without creating
a
costly loopholes in those laws that could hurt consumers.
9
'they will also help hospitals and doctors to understand
10
the difference between a joint ventures that cuts costs
11
and also benefits the public and a joint venture that is
12
likely to eliminate competition and drive up prices.
I hope that we will hear from others in the
13
--
14
,
medical profession who have voiced similar concerns and
fears.
We can work these problems out together.
And
16
thanks to the magnificent leadership of the First Lady,
17
the Attorney General, Janet Reno, and Anne
18
Janet Steiger, we are here·today, and this is a victory
19
for the people of this country and I am so pleased to .
20
participate in it.
21
and
Thank you.
22
Bingama~
(Applause.)
23
ATTORNEY GENERAL RENO:
You all know Jack Brooks
24
as Chairman of the House Judiciary Committee.
25
one of the mose vigorous and most commiteed people to .
ALDERSON REPORTING COMPANY, INC.
(lO:m.89-2260 (BOO) FOR DEPO
JlIl :rOURTE.ENTH STREET. N.W. SUIrE 400 I WASHINGTON. D.C. 2000S
He is also
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1
efforts of full and fair law enforcement at all levels of
2
anybody I have met in Washington, and it is a pleasure to
3
be with him here today.
4
Mr. Chairman.
S
(Applause.)
6
CONGRESSMAN JACK BROOKS. DEMOCRAT, TEXAS
REPRESENTATIVE BROOKS:
7
a
Thank you very mUch.
am the last speaker, you'll be happy to 'Know,
(Laughter.)
9
REPRESENTATIVE BROOKS:
10
With theappoinced of
11
}~ttorney
12
Bingaman to head up the antitrust division, I have great
13
)
I
,~xpectations
l4:
i!ntit!'Ust has languished and was viewed by those in .
15
authority as the enemy,notas a guarantor .of the small
16
ousiness community and the American consumer.
17
General Reno,and ASs1stantAttorney General
for competition policy.
For 12 years
But in the past few months this administration, .
18
with the leadership of Anne
19
Anne or the Coppertone Kid -- has reaffirmed its
20
cOITh-nitment to our national competition policy, and today
21
is no exception.
22
Bing~man
-~
I call her Saint
As the Health·Care Task Force began its work in
23
earnest this spring, a nutrober Of health-care entit.ies,
24
pOSition groups, hospitals, pharmaceutical companies, came
2S
seeking relief on the Hill from the
antitr~st
ALDERSON REPORTING COMPANY, INC.
(Z02)~IIP·l160 (8OC) POR. DEPO
llli FOt.."RTEENTH S'I'RBET. N.W. SUITE 400 J WASHINGTON, p.C. 2000S
laws.
That
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18
to speak plainly , they came seeking antitrust
1
i
2
exemptions.
3
hearing such request.s.
4
clf them and use every effort we have to end the few
5
f.lxemptions that exist now on the books.
6
\tnnecessary.
7
f.eeking.
Ii..
Commit~ee
we are used to
Frankly, we don't believe in many
They are
They are harmful even to those \\Tho come
At the same time. we must acknowledge that in
S
9
At the Judiciary
the health-care area antitrust uncertainties do exist and
10
lleed to be addressed in a cooperative manner bet\o1een
II
t:nforcers and private parties.
12
such cooperation.
13
should always be the last resort.
Adversarial legislation and litigation
And very early in the health-care review
14
-- .J
There is no substitute for
15
process , I met wit.h Mrs. Hillary Rodham Clinton, our First
16
Lady. and discussed my deep-felt view that it was
17
imperative t.o avoid extreme steps in the antitrust area
18
.oecause of the many unintended consequences that: could
19
20
resu~t
in both the short and long term.
. carefully.
She listened
She was well versed in the history of
21
importance of a strong antitrust policy in this country.
22
Hers was a nearly overwhelming task, and few would have
23
been up to it.
24
25
She was.
I am very pleased today that the Clinton
administration has unveiled a plan, has chosen to reject
ALDERSON REPORTING COMPA.NY t INC.
.
(20l)2119-226O (800) fOR. DEPO
1111 FOUltl'EENTH ST.flEET. N.W. sum 400 I WASHINGTON. D.C.
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t.he exemption route in favor of the clarification rout.e ..
2
klready
3
benefits of such an approach in other critical a.nd
1&
fltrategic industries that are taking advantage of
5
I>renotification and
6
nnd development activities, and now for production joint
7
ventures.
i~
co~sultation
for a variety of research
I intend to do my share in moving the
S
9
place, already working now, we are seeing the
antitr~st
:::ection of :he health package forward in the coming
What we are witnessing today as the unveiling of .
10
months.
11
health-care antitrust guidelines is simply good medical
12
cechnique. opting for preventive
13
:Ladical surger'i".
14
welve got here, :hese women are not tough -
IS
cough.
16
'!'hey are compassionate.
17
bave a lot to be grateful.
~edicine
And I would say that the two ladies
They are higblyintelligent.
18
rather than
they are not
They are dedicated.
And for that we,
in this country,
I want to say I salute the First Lady and the
19
wonderful work of you, Janet, and your organization, and
20
the Justice Department.
Thank you.
21
(Applause. )
22
ATTORNEY GENERAL. RENO:
Ms. Bingaman and
23
Chairman Steiger will now be available to answer your
24
questions.
25
QUESTION;
I know that Se!:lator Metzer.baum said
ALDERSON REPORTING COMPANY, INC.
(202)2&9·126V (800) FOR. DEPO
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1
that this does not change the antitrust law, but it is my
2
understanding that the White House says this is the first
3
piece of the antitrust package and that legislation is to
4
follow.
5
What legislation will be coming out after this?
6
MS. BINGAMAN:
It is not my understanding that
7
there will be antitrust legislation as such.
The
8
President's package is not part of what I call this
9
package - at least in the guidelines.
But it is my
10
11
as legislation in the health care package.
l2
guidelines and policy statements and the very important
13
business review procedure which we commit to there on an
14
ongoing expedited basis.
15
who has a question, it is my understanding that that is
16
)
understanding that there will not be antitrust exemptions
clur approach.
Q'OESTIm~:
17
18
was saying that
It is certainly, for everyone
It is my understanding that Maga:iner
-
MS. BING.AMAN:
19
About. a week ago I heard people
20
!Iay -:'.1 can't address that.
2l
you what I
22
point.
23
K.i.OW,
I just can't.
And I told
and I am dOing the best I can at this
. QUESTION:
Does this mean that the petition by
24
the drug industry will probably be rejected?
25
eJ
These
they asked for any exemptions?
ALDERSON REPORTING COMPANY, INC.
(l02)l8i-226CJ (BOO) FOlt DEPO
.
1111 fOURTEENTH STlU!ET. N.W. SUlTE.roo I wASHlNGTON, D.C. 20005
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�fi'202 616 o9iu
PUBLIC AFFAIRS
21
.e
QUESTION:
1
2
Can we have her repeat the question,
Anne?
MS. BINGAMAN:
3
She
does
sai~
~his
mean that the
4
exemption for the drug industry -- this is the
5
pharmaceutical manufacturers' request -- will be rejected?
QUESTION:
Yes.
MS. BINGAMAN:
7
We have
tha~
under advisement and
8
we expect to act it in the near future.
9
want to pinpoint it.
But I would net
It does not touch on it actually as,
10
l;iUch.
There is nothing in these policy statements that
l1
directly address this -- any issue on that.
QUESTION:
12
And can you say in what
~ay
-- can
13
you tell us in what way we are going to crack down or beef
14
up your efforts to go after fraud?
MS. B!NGAr.lA.. :
~
15
fraud.
The Civil Division is in charge
16
(:If
We are the Antitrust Oivision.
17
chs Bureau of Competition does antitrust enforcement.
QUESTION:
18
And the FTC and
I understand that, but they said/ in
19
concert with this policy, these policy guidelines, there
20
~ould
bea crackdown on fraud.
MS. BINGAMAN:
21
c~se
I think yeu are aware of the San
22
23
fraud.
24
looking for cases like that, and more focus on that, in
25
\
Diego
and the ,very massive settlement involving
order to prevent high cost due to fraud.
I think what is expected is. more emphasis, more
ALDERSON REPORTING
(l02)lS9·~160 (BOO)
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INC.
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1111 FOUkTEENnJ STR..E£T. N.W. SUITE 400 I WASHlNGTON. D,C. lOOOS
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22
1
understanding.
But it is not my direct responsibility.
QUESTION:
:2
Ms. Bingaman, I have observed in the
3
p;ast a lot of complaints in Washington about that the
4
Antitrust Division in the last 12 years has largely
5
ignored big corporations and big cases, and gone after the
6
small. ones.
I trust you are going to change that policy?
MS. BINGAMAN:
7
Oh, I tell you the truth;
we
are
8
going to enforce the laws as best we can on the facts, as
9
they come before us, period.
10
11
That is what we.are going to
do.
CHAIRMAN STEIGER:
I think we are all committed,
12
clnd I certainly have been and our Commission has been, in
13
the past four years,
14
antitrust laws.
15
that point.
16
1:0
vigorous enforcement of the
And our record will speak for itself on
.QUESTION: . Can you tell us what happened to the
17
plan on the McCarren-Ferguson exemption for health
18
insurers?
19
MS. BINGAMAN:
My understanding -- again, this
20
is not my bailiwick as such, and I think it is in the
21
health care plant the draft of which is circulating
22
that McCarren-Ferguson will be modified and limited for
23
health care insurers.
24
testified before Chairman Brooks' committee about June or
25
July on behalf of the administration.
is
As some of you may be aware, I
ALDERSON REPORTING
COMP~'Y,
We favor limiting
INC.
(20l}l89-2160 (800) FOR D£PO
1111 POUR1U.lIITH STREET. N.W. SUITE 400 I WASHINGTON, D.C. 2000S
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-
1
.
the scope of McCarren-Ferguson.
We did not testify on the particulars or a
3
particular bill, but we said that we believed the
4
McCarren-Ferguson exemption should be narrowed.
QUESTION:
5
6
legislation,
But you would need
you not?
MS. BINGAMAN:
7
.B
~ould
May I follow up?
Yes, yes.
Oh, definitely.
would have to be legislation for this.
9
the particular language
10
There
It is just that
not worked through yet.
QUESTION:
II
p
the particular terms we have
Is that the only legislation
1~
l3
e )
."
involving this?
Or have you tried to answer that before?
Other than McCarren-Ferguson, are there any other aspects
14
of this that require legislation?
l5
MS. BINGAMAN:
To my understanding
r
l6
McCarren-Ferguson is what is affected in the antitrust
17
area.
18
different
If there is anyone in the room here who has a
Qt~STION:
19
20
unders~anding,
I am not aware of that.
You have a 90-day review process.
What is it currently, or is there no system for review?
CHAIRMAN STEIGER:
2l
The Justice Department has,
22
23
policy statement, has not had such a deadline system.
25 .
-.J.
would be finished in 90 days.
24
e
in the past years, promised business review letters that
we are now committed to 120 days, depending upon the
The Commission, until this
ALDERSON REPORTING COMPANY, INC.
1111
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And
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PUBLIC AFFAIRS
~025:035
24
1
s\mject matter response.
And this is a new commitrnenc for',
the FTC.
MS. BINGAMAN:
3
I might add, it is a new
4
cc:>mmitment for the Justice Department, too, in that the
5
previous policy was best efforts to answer in 90 days.
6
was not a binding, flat commitment.
It
Secondly, t'he
?previous policy, which still applies to all other
e
industries, is to answer such questions as we believe need
9
to be answered.
We retain the discretion, if we think a
10
question is trivial, unimportant and simply not wort.hy of
11
our limited resources to invest the time, to simply say to
12
the lawyer asking:
13
chat in health
Take your best shot.
We are not doing
care~
So, for the Justice Department also, this is a
14
15
new commitment for the health care industry in that we
16
commit absolutely to answer any question within 90 days,
11
ano. we retain no discre,tion to not answer any request.
16
will answer all requests in the interest of certainty and
19
clarity in this area.
QUESTION:
20
a
What about retroactive cases?
If
21
there is
22
do they take effect?
23
now underway with regard to the FTC or Juseice Department,
24
or any other agency?
25
merger pending, what are the guidelines?
We
~~d
When
what happens eo mergers that are
CHA!RMAN STEIGER:
They
ao
not apply to pending
ALDERSON REPORTING COMPANY, INC.,
(201)289-2260 (800) FO~ DEPO
1111 FOURlUN11I S'l'IWIT, N,W. sum 400' WASHINGTON, D.c.lOOO~
�'lt20: 616 090;1
PUBLIC AFFAIRS
25
1
ca.ses.
they are pending as of today?
2
QUESTION:
3
CHAIRMAN STEIGER:
4
QUEST!ON:
~f
That is right.
So all of these cases that are now in
S'the courts, will those have to be worked out?
CHAIRMAN STEIGER:
6
7
this does not apply.
a
9
If they are in litigation,
MS. BINGAMAN:
might just amplify.
As a practical matter, though, I
I do not think either one of the
10
agencies views these statements as a change from current
11
pOli~y.
12
business review letters, consent decrees and so fort.h,
l3
thCit it is an effort to simplify.
They are simply a synthesis of the multitude of
/
)
So, as a practical matter, although clearly the
14
l5
c!hairman is exactly right, these are effective today, and
16
from this day forward.
17
any practical significance to that.
I am not ,aware that there would be
18
CHAIRMAN STEIGER:
19
pOint, and I agree with it.
QUESTION~
20
I think that is an important
Just 'to clarify.
21
the 90-day review was new.
22
You just said that
Is that the only new provision?
:2 3 .
24
25
MS. BINGAMAN;
concept.
Is that the only new thing?
What else is new is the whole
There are several new things here.
Number one, neither Agency has ever issued a set
ALDERSON REPORTING COMPANY, INC.
(2.0l)189-Z260 (100) FOR PEPO
m l POURlUNTIf STIU'.Et, N.W. sum 400 I WASHINGTON. D.C...0005
�· '09 / 16'93
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26
That alone 1S-- in
1
of guidelines in a specific industry.
2
the antitrust world, somewhat earthshaking.
3.
it because Of the extreme change, the small markets and
4
what we view as the need for responsiveness.
5
one change.
6
7
We are doing
So that is
Second, there has never been a policy statement
certainly not by both Agencies.
We have had the
8
9
the Agency's enforcement intentions and to say this·
10
particular transaction, on these facts, would not be
11
challenged by this Agency at this point.
12
nl~ver
13
e,
b~siness
o:E what we call antitrust safety zones in these
14
guidelines.
15
16
17
review procedure to particular instances to state
What we have
had before is a statement'. applicable to an industry
These guidelines set up -- they are in fact
current enforcement policy, so they are not a change, out
.it.has never been stated this way before.
And for ma.ny
18
thousands of
19
there, enforcement policy can seem like a black box.
And
20
so the mere fact that: ·setting out in so ma.ny words
and
2l
we call it: an antitrust safety zone -- if you meet these
22
criteria, absent extraordinary circumstances, neither
23
1.gency will challenge your conduct.
24
25
\
la~'Yers
and health care professionals out:
And so that is new.
And then the third -- the time for the
r.:ommitment.
ALDERSON REPORTING COMPANY, INC.
(202)2119·2160 (800) FOR DEPO
1111 fOURT£EN'JlI
sTREET. N.W. sum 400 I WASHINGTON, D.C. 2000S
�'09/16:93
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27
.e
CHAIRMAN STEIGER:
1
I think it is important to
:2
stress, as Anne did earlier, that people across this
:3
cc)untry
4
~lestions
5
pJ.ace to go.
G
hilppened in the 1985 advisory panel from X or Y.
7
put it together for them.
B
current enforcement. policy.
9
d!)cument is new ~
tospital administracors and others who face
I
of a changing health care landscape. have a
They do not have to go back to see what
QUESTION:
10
We have
But it is a synthesis of
The very existence of this
Just to follow up on that.
In
taki~g
11
this different approach here, didn't you say to yourselves
12
at some point in your policy formulation, Gee, we are
13
going down a new road here, and this might seta precedent
14
in other industries?
15
your final decision?
MS. BINGAMAN:
16
l
i
And what bearing did that have on
Certainly that is a concern.
r·ecause everybody wants suidelines
I
and we have got· real
18
work to do and we cannet write guidelines for every single
19
industry in America.
20
that.
21
this document} to feel comfortable with it, and to state
22
publicly this is it:.
23
do.
24
25
We cannot spend all our time doing
:tis an enormous devotio::l to resources to turn out
This is what we will and will not
So,certainly, it was a major issue as to the
advisability of issuing industry-specific policy
ALDERSON REPORTING COMPM'Y. INC.
(lOl)l&9-2260(BOO) POR DEPO
lJ1l fOUR'l'EeN'1lI Sl'llEET. N.W. sum 400 I WASHlNGTON.
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�· 09:16/93
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28
.e
1
statements.
But it was our judgment that in the
2
extraordinary circumstances the health care
3
faces today, with massive restructuring, changes that are
4
b4!ing proposed, the crisis in cost for health care, the
5
e~ormous
6
of them with legitimate questions about what is and is not
7
permissible, all.of those factors we thought made this
8
situation unique and worthy of special attention.
comrr~nity
uncertainty that small local markets, thousands
we
CHAIRMAN STEIGER:
9
do not see these
lO
particulars anywhere else in the landscape that we are
11
looking at now.
QUESTION:
l2
Doesn't this legislation put at risk
13
t.hose smaller fringe outfits like MRI's?
14
up going out of business if bigger operacors in town are
15
. clllowed to collaborate?
16
MS. BINGAMAN:
Won't they end
17
question.
Could you repeat that?
Qu~STION:
19
r.do not understand your
the effect gOing to be on
~~atis
19
some of the smaller operators in town that may not be able
20
~o
21
collaborate with a bigger hospital?
MS. BINGAMAN:
All this does is stace what
22
23
now, the matter of sharing of expensive equipment, allows
24
hospitals jointly to purchase a piece of
2S
e ..
competition policy allcws.
And competition policy right
could not utilize·it effectively themselves.
ALDERSON REPORTIN'G
COMPAl\~,
equipmen~
INC.
{Z02)189·2Z60 (300) FOR DEPO
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if they
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�'5'202 616 0904
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PUBLIC AFF:\lRS
030/035
_ 29
1
words, if there is no need in a town for two CAT scan
2
~nachines,
3
one CAT scan machine in a particular town, the fact is,
4
r;ight now, it is permissible for hospitals to jointly
5
purchase a CAT scan machine and to jointly use it, because
6
it reduces the cost per transaction.
7
competitive and efficient.
there is only half demand by _
each hospital for
And that is pro
8
But people do not -understand that.
They think
9
that it is an antitrust violation to even speak about
10
II
equipmerit, a helicopter or whotever you want to talk
12
about.
13
)
purchasing jointly a CAT scan or some other piece of
instances in which it is permissible.
And the purpose of these is to clarify the
Now there are also instances in which it is not
14
15
permissible.
16
the rule of reason analysis for instances that do not fall
17
into the safety zone, and then we have the backup business
l8
review procedure for anyone in the country who wants to
19
ask us
20
this? -- and we will respond.
21
-~
So we have a safety zone,andthen we have
Here is my situation, can I.or can I not do·
CHAI~~
STEIGER:
I would add that neither
22
A.gency has ever challenged a jcint venture on the purchase
23
of high-tech or expensive hospital machinery.
2~
clearly within the -- as the
25
permissible activity and we do lay that out.
~Jidelines
It is
indicate -- a
A.LDERSON REPORTING COMPANY, INC.
(202)28$1-1260 (800) FOR DEPO
1111 FOURn:EN1ll STREET, N.W. sum 400' WASHINGTON. D.C.
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Pl.'BLIC AFF..HRS
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1
:2
we have been told there is ehis lingering uncertainty that
3
waS chilling effective pro-co:npetitive, .pro-consumer
4
I
spite of the fact that there has never been a challenge.
choices.
5
And this is what is in the root of the policy.
QUESTION:
Chairman Steiger l one of your
6
commissioners. Deborah Owen, dissented, and contended that
7
ehis is special interest antitrust exemption and that you
8
should do it, if you dO it at all, through legislation,
9
not through unilateral actions such as this.
10
11
Could you
speak to that point?
CHAI~~
STEIGER:
Well l I think Howard
12
13
)
Metzenbaum said it very clearly. these are not exemptions.
These are statements of current enforcement policy.
14
. are the eype of guidance that I believe we do in this
15
particular extremely dynamic and very fractionalized
16
the senseef markets
indust.ry_
17
legislation is needed.
I do not. think there are any
18
They
exemptions that we are talking about.
19
in
I do not think
We are talking about laying out groundwork so
20
that people out across this country know what 1s clearly
21
permissible.
22
23
So my answer is no.
·MR. STERN:
There are about three or four hands.
I think we will cut it off before we get too heated.
24
Over here.
25
QUESTION:
You said that these are not legal
ALDERSON REPORTING COMPANY, INC.
(102)289·2260 (800) fOR DUO
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PUBLIC AFFAIRS
31
1
exemptions.
However, you noted that the FTC case which
2
started in 1999 is still in litigation would fall into the
3
safety zone created here.
4
like that be brought again?
5
after-che-fact, de facto exemptions be antitrust?
CHAIRMAN STEIGER:
6
In light of that, would a case
And, if not, will these
I would note that - you are
7
correct - that pUblicly they indicate that the
8
statistical parameters on that fall in the safety zone.
I
9
would only add that, were a case like that to come to bat
j
10
we might still look at it to see if there were
11
extraordinary circumstances in an area in a case where we
12
would normally not or very rarely take an enforcement
13
area.
e)
14
I cannot comment as to whether such
15
circumstances exist.
16
the Clayton Act.
17
And the rarity of them I think confirms our high degree of
18
comfort with this safety zone.
19
We will decide it under section
i
of
But those challenges have been so rare.
QUESTION:
I am still not exactly clear.
Are
20
these safety zones new or have they already existed but
21
there just never was a general statement explaining that?
22
CHAIRMAN STEIGER:
They are a synthesis of our
23
experience - the economic literature and our own
24
experience over time.
25
of 40 patients per day over a three-year period.
There are two problems:
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experience reflect our experiences that these are probably
2
nc·t competitive situations.
3
he/spi tals.
4
probably a merger -- most probably a merger in these areas
5
w(}ulC1 not pose consumer injury
They are not. competitive
They are not realizing the efficiencies, and
QUEST!ON:
or an antitrust problem.
So you are saying, I think, that you
7
a:ce not creating any new safe harbors here, you are just
a
lighting them better and letting them come in faster?
9
CHAIRMAN STEIGER:
We are basically synthesizing
10
what we know in this area to the best of our ability.
11
there might be other measures that could be used.
12
QUESTION:
k~d
In the example the assistant
13
E:ecretary used about two hospitals sharing a CAT scan or
14
buying a CAT scan jointly, if those two hospitals then
15
decide to move to set price to use that CAT scan, would
16
you then challer..ge that?
17
MS. BINGAMAN:
18
QUESTION:
If the two hospitals do what?
Oecide jointly to set the price for
19
the use Of that CAT scan.
20
antitrust laws?
21
MS. BINGAMAN:
Would that run afoul of the
onder. rny understanding is that
22
under these guidelines they can jointly market.
23
believe that means they can jointly price.
24
answer is no.
25
\
QUESTION:
And I
And so the
Well, how does that enhance
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competition if they can jointly market?
MS. BINGAMAN;
2
That is what is going on risht
3
now.
It enhances competition this light.
It keeps each
4
of them from separately buying a CAT scan.
5
e:ach of them f,rom having to price it double, because in
Ei
order to recover fully on half as many procedures of a
7
~ri ven
B
l)rice has to be much, much higher than it would be if you
9
c~ould
And it keeps
piece, of extremely expensive equipment, honestly the
cut it by usage.
And so if those two hospitals have the
10
there may be a hospital across town that has a
11
l2
e
different piece of equipment that competes with it.
13
\
E~quipment,
other words, you can't look at these two hospitals in a
i4
vacuum.
15
hospitals, and there can be many of these arrangements
16
!~oing
17
with a joint venture there, or with a single' hospital that
18
has a lot of procedures on its equipment.
19
. 20
21
In
In most metropolitan areas there are many, many
on.
And
~lOU
'QUES':'ION:
can have a j oint venture here competing
Well, 'can't you separate joint
purchasing of equipment from joint pricing of the service?
MS. BINGAMAN:
That could have been done.
22
could have been done, but it was not.
23
CHAIRMAN STEIGER:
It
I think the guides make it
24
clear that the same violations remain.
25
price fixing.
Price fixing is
I think that if you read the specific
ALDERSON REPORTING COMPANY, INC.
(202)2,89-2160 (800) POR DErO
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pc,licystatement on this joint venture in purchasing it
2
dc)es answer the question.
MR. STERN:
3
4
the lady in orange.
5
QUESTION:
We will take a last question from
What is the impact of these
6
guidelines on the HHS·safe harbor provisi:lns
7
any impact?
MS. BINGAMAN:
8
9
do not know.
l
or is there
I honestly cannot answer that.
I am not aware of any.
I would give you an
lO
answer if I knew the answer, but I do not.
11
c:annot.
!
honestly
l2
-
13
)
MR. STERN:
(Whereupon, at ll:18 a.m., the press conference
14
Thank.you for coming.
was concludea.)
lS
16
·17
18
19
20
21
22
23
24
25
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Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Lissa Muscatine - Press Office
Creator
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First Lady's Office
Press Office
Lissa Muscatine
Date
A point or period of time associated with an event in the lifecycle of the resource
1993 - 1997
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36239" target="_blank">Collection Finding Aid</a>
<a href="http://catalog.archives.gov/id/7431941" target="_blank">National Archives Catalog Description</a>
Identifier
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2011-0415-S
Description
An account of the resource
<p>Lissa Muscatine first served in the Clinton Administration as a speechwriter. Within the First Lady’s Office, she served as Communications Director to the First Lady.</p>
<p>Lissa Muscatine’s records consist of materials from First Lady Hillary Clinton’s Press Office, highlighting topics such as health care, women’s rights, the Millennium Council, Hillary Clinton’s 2000 Senate campaign, and deal extensively with press interviews given by the First Lady; her domestic and foreign travel; and speeches and remarks, on a wide variety of topics, given by her before and during her time as First Lady. The records include interview transcripts, press releases, speeches and speech transcripts.</p>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
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Clinton Presidential Library & Museum
Format
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Adobe Acrobat Document
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1,324 folders in 27 boxes
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Original Format
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Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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FLOTUS Press Office Interview Transcripts Volume I 01/29/93---9/30/93 [Binder]: [09/15/93 Dept. of Justice Press Conference]
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 2
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/Systematic/2011-0415-S-Muscatine.pdf" target="_blank">Collection Finding Aid</a>
<a href="http://catalog.archives.gov/id/7431941" target="_blank">National Archives Catalog Description</a>
Creator
An entity primarily responsible for making the resource
First Lady's Office
Press Office
Lissa Muscatine
Identifier
An unambiguous reference to the resource within a given context
2011-0415-S
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
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Clinton Presidential Library & Museum
Format
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Adobe Acrobat Document
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Reproduction-Reference
Date Created
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11/26/2012
Source
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2011-0415-S-flotus-press-office-interview-transcripts-volume-i-01-29-93-9-30-93-binder-09-15-93-dept-of-justice-press-conference
7431941