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�THE WHITE HOUSE
Office of the Press secretary
Internal Transcript
september 21, 1993
INTERVIEW OF THE FIRST LADY
BY TOM BROKAW OF NBC
Q
Mrs. Clinton, as a lawyer you've handled a lot of big,
complex cases and I expect that you might have -- (inaudible)
courtroom -- anything could compare with what you're about to do here.
MRS. CLINTON: Oh, no.
I mean, this has been the most
extraordinary experience that I've ever had, or I think anybody in our
country will have by the time we finish because we're taking on such an
incredible challenge.
Q
•
Do you have butterflies?
MRS. CLINTON:
Sure. Sure.
I'm very intent upon making sure
that we do this right.
I mean, not only because it's important to the
country, but it's important to me -- important to my mother.
I mean,
you know, I really want this to work. And there's going to be a lot of
hard work ahead of us. But what we've done so far I think set the
stage.
Q
Let me ask you about your objectives here.
with coverage for everyone in America.
MRS. CLINTON:
Let's begin
Right.
Q
A lot of companies in a lot of states are already making
great progress on efficiency and on fairness.
Why not let that continue
and you just concentrate on making sure everybody gets some kind of
coverage?
MRS. CLINTON: Well, in fact, the reason that we think this is
doable is because so many companies have made such progress. They've
shown the way. Unfortunately, they are still a minority. And until we
get everybody into the system and we make it clear to even those who are
insured, they will always have health security as a right as an American
citizen, we don't think we can get the whole system to operate as
•
�'.
efficiently as some parts of it now are.
Q
A lot of people are going to wonder whether illegal
immigrants are going to be eligible for health care coverage in America.
MRS. CLINTON: They will, of course, be eligible for emergency
care and for public health reasons.
But they will not be entitled to
the health security card. And that's a decision that --we think is the
right decision, but we do want to assure people that the kind of
services currently available for undocumented workers will still
continue.
Q
For some Americans, especially those in the older
generation
this business of having the doctor of your choice is
paramount in their health care considerations.
MRS. CLINTON: And it should be. And, in fact, our plan will
increase choice. Because what happens now too frequently is that the
employer who pays for health insurance will determine who your choice
is. And more and more employers for cost reasons are limiting their
employees to one plan or two plans. And what we are proposing, the
individual makes the choice and will get to choose from among the plans
that are available. You will always be able to choose a plan where your
doctor is, because we're also saying that plans will not be able to
discriminate against doctors. So we think that we will actually be
increasing choice through this approach.
Q
But within that plan that you choose, even if your
doctor is there, isn't there a good possibility that some gate-keeper
will say he or she is not available today; we're going to be slipping
you across the street to another physician?
MRS. CLINTON: Well, of course, that happens now.
I mean, if
your doctor practices with other doctors -- they're on calli they may
not be available all the time. They may be on vacation. But in
general, we think this system will ensure that individuals get the
choice of their health plan and the doctors within that health plan.
Q
Is there a generational break in terms of preference for
a doctor? Older Americans have grown up with that system; younger
Americans who use emergency rooms and HMOs and other new systems are not
that's not as important.
MRS. CLINTON:
I think everyone wants a personal relationship
with the doctor who takes care of them. And even within the HMOs,
people develop those personal relationships. And I've talked with many
patients and physicians whose whole practice is within an HMO. They
develop their own patients. And those patients feel secure.
In fact, I
had a friend tell me just last week to assure people not to be worried.
�She's been in an HMO her entire life. She was born into it. She's had
her baby in it. And she's had the continuing care of those doctors whom
she has chosen in the HMo.
What we will need to do for them is that what is happening now
is a choice --. You know, many rural areas are losing doctors. There's
no choice for people who live in many parts of our country. Many of our
inner cities -- there's no choice, because people can't practice in
those conditions that are available there. This will improve and
increase choice for the vast majority of Americans.
And I hope that every American will study this and think on it,
but talk to their friends and neighbors who had different kinds of
experiences so that -- what is very common in California or Minnesota is
not common in Arkansas or Texasi but what we believe is that choice will
be enhanced across the nation by what we are proposing.
Q
From a doctor's point of view, physicians are often
notoriously independent. Do you think that this will discourage some
people from going into medicine because they will no longer have the
control over their lives that they've had in the past?
MRS. CLINTON: No, because I think that what has happened to
doctors in the last decade or two is they have decreasingly lost control
because of government regulations, because of insurance company
regulations. And many doctors want that autonomy back. And when they
talk about autonomy, they mean they want to make the right decisions for
their patients. They don't want to have to dial some 800 number and ask
permission to run a blood test. And what we intend to do is to remove
the kind of micromanagement and heavy regulations and paperwork that now
interferes with doctors' independence and return them back to the center
of decision-making where I think they belong.
Q
Ira Magaziner, who has been a principal advisor to you
on all of this, said that the health care industry in America is the
most inefficient industry that he has ever seen. But isn't a lot of
that driven by government regulations and by insurance regulations, and
by legal considerations?
MRS. CLINTON: Yes. A lot of our inefficiencies are the result
of decisions that we made years ago and have not changed. When you have
systems in both the public and private sectors that reimburse physicians
on how much they charge per procedure or test, then what a physician's
central concern has to be is how they can take care of their patients
and provide the right number of tests knowing, though, that the number
of tests determine how much they get paid. When you have the fear of
lawsuits hanging over physicians so that they practice defensive
medicine, that interferes with their decision-making. We really believe
-- and Dr. C. Everett Koop was here in the White House talking about
�e··
this -- we really believe there are literally tens of billions of
dollars, unnecessary procedures that will be eliminated once we clarify
the system, remove the unnecessary regulations, limit the kind of -
spread of unnecessary lawsuits, and give doctors the chance to take care
of patients as patients, not as a bundle of tests or procedures to be
performed.
Q
Almost every doctor I've talked to said, if you're going
to talk to Mrs. Clinton, ask her what she's going to do about her
profession, about the legal profession and malpractices and legal
harassment on the part of lawyers.
MRS. CLINTON: What we are going to do is propose malpractice
reforms. We are going to ask that lawyers get a certificate of merit
from an independent doctor or board before they go into court against
any doctor. We're going to ask health plans to use alternative dispute
resolutions so that we don't let a lot of these cases get into the
courts where they don't belong. We're going to limit lawyers' fees in
the malpractice arena, because we want to protect victims but we don't
want to encourage unnecessary lawsuits.
So we intend to make some
changes that we think will strike the right balance between discouraging
the frivolous and the harassing lawsuits, protecting victims, and
relieving doctors of a lot of their concerns.
Q
But you're mandating the changes for the medical
profession and you're only encouraging or asking the legal profession.
MRS. CLINTON: No, we're mandating those as well.
part of the legislation.
They will be
Q
When it comes to inefficiency, a good many people who
have looked at your plan say, listen, they're going to just set -
replace one set of bureaucracies with another. They're going to have
health alliances on a regional basis, they're going to have a national
board that's going to try to control costs, they're going to have caps
for small businesses. We're going to replace one set of paperwork just
with another blizzard of paperwork.
MRS. CLINTON: Well, we think that we're going to
replace micromanagement and much too much regulation with a system that
will set boundaries.
It has been described as the difference between a
farmer grazing a bunch of cows out in the field and keeping all of them
attached to a leash -- which is what we do now.
Instead, put up a fence.
Here's the boundaries and you make the
decisions within those boundaries. We think that's a huge difference.
No longer will we be telling doctors or hospitals, here is how you must
practice. We'll be saying, here's how much money should be available
and the insurance premiums in your region. Now you make the right
�decisions and we will judge you on quality.
the proper judgment should be.
And that's what we think
Q
You're also interested in people taking more personal
responsibility for their own health and for their health care. About
one-third of the money that I think that we spend on health care in
America is spent in the last year of someone's life --heroic care or
extending life, whatever. How do we change that?
MRS. CLINTON: We are going to encourage some of our changes
particularly by encouraging the use of advance directives and living
wills. It's a very painful moment in anyone's life. I've been there.
I know. When you have to make decisions about a loved one's medical
condition and you haven't had that conversation -- when you could have
had that conversation.
More older people tell me that when their time comes, make the
right decision, make it as humane and let nature take its course. They
want to be at home, but we don't provide support for them to be kept at
home. They may want to be in a hospice, but we don't do that. We don't
even pay for nursing home care for a lot of the acutely ill patients
that would be better off in that kind of setting. We keep people in
hospitals, we often keep them there because members of the family at
that difficult, emotional moment can't make these hard decisions.
So what I hope is that we will responsibly face up to the fact
that Dr. Koop says that all of us are going to die sometime, and we want
to provide the best medical care possible, but we also want people to
express their own wishes so that the medical care they receive can be
humane and caring treatment, but not necessarily heroic or extraordinary
if the individual and the family say that that's not what their wishes
are.
Q
Do you and the President have a living will?
MRS. CLINTON: No, but we are going to have one.
I mean, that
is something that we intend to do doing the course of this year, and I
hope it will set an example for others.
Q
It has been widely demonstrated that tobacco was a great
(inaudible) for American health care. As you very well know, there are
few stronger political lobbies and key committees on Capitol Hill. Are
you really going to be able to do something about the place of tobacco
in American --a
MRS. CLINTON: We want to tax tobacco because tobacco is,
without a doubt, the only product that if used according to its
instruction -- how you're supposed to use it -- presents a health
hazard. You don't have to overuse it or misuse it. If it's there
and
�you're using it, you're likely to damage yourself and maybe others
around you.
So we do think that that's part of our principle of
responsibility. And we also very much want to discourage the use of
tobacco among young people in this country.
Q
Do you think we'll ever get to the point where we'll
outlaw tobacco, that we'll make it illegal if it's such a threat to the
general welfare of the young?
MRS. CLINTON:
I don't know.
I don't think any country has gone
that far.
I think most countries have done what they could to point out
the dangers of tobacco and to tax it so that it would be more costly for
people.
But I doubt that we would ever outlaw it.
Q
A lot of what will occur in health care is symbolic and
it begins right here in the White House. Are you going to be able to
get the President to give up french fries?
(Laughter.)
MRS. CLINTON: Well, now, you know, french fries as an
occasional treat they're not all bad.
I mean, we don't want to go
overboard on this.
But we are, we're making lots of changes in our diet
because one of the things that we've learned as a result of this work
something I hadn't known before I got into it -- is what a role good
nutrition can play in making you healthier.
We now know, for example, that good nutrition and moderate
exercise and stress reduction, the things you hear about, will actually
reverse heart disease, not just stabilize it. So I want to encourage
better nutrition as part of the overall health care.
Q
And are you changing the President's diet?
MRS. CLINTON: Yes, we are. We are actually using the low fat
recipes that are available now.
I'm not going to tell you we do it
every day, but we're doing it the majority of days. And we have
actually changed the way we eat, and we are trying to convince ourselves
that it tastes as good as the cheeseburger and fries and we're making
progress on that -- (laughter).
Q
Does the President occasionally look down at his plate
and say, "Come on, Hillary, I've had a hard day"?
MRS. CLINTON:
and things like that.
Q
We've made a lot of progress on, you know, pasta
But tofu has been hard for us.
Not a lot of tofu fields in Arkansas?
MRS. CLINTON: But it's a good product.
until we find something we like in it.
We're keeping at it
�Q
Now we're going to switch to tomorrow -- tomorrow night.
MRS. CLINTON:
Do you eat tofu?
Have you eaten tofu?
Q
Actually, I do like it. My wife likes it a lot, and the
commercial stuff that you get in this country -- the problem is that
we've had it in Asia and there is just no comparison.
MRS. CLINTON:
Q
It's much creamier and softer in Asia.
Yes, and it's sublime.
MRS. CLINTON:
-- rubber blocks over here.
Q
But having raised three daughters, you know, we've gone
through every animal, whatever -- (laughter) -- (inaudible). But no,
tofu is a part of our life. If you can get it in Japan, it's fabulous.
strangely enough, in Nepal this year I had yak yogurt, which was the
best stuff I have ever had in my life.
MRS. CLINTON:
Q
Yak yogurt, just plain?
I don't think it will ever catch on.
(Laughter.)
MRS. CLINTON: Well, but if we don't link it to better health,
we could link it to something really -- like romance.
Q
NO, no.
It was sublime.
It was unbelievable.
The only
part of yak
MRS. CLINTON:
Eat yak yogurt and find the man of your dreams -
Q
Okay. Now the President has given his speech and we're
going on to the second part here. The President in his presentation
tried to avoid as much as possible how all of this is going to be paid
for. Almost everyone has looked at it now, Republican and Democrat
alike, and independent analysts say you just can't get there from here.
MRS. CLINTON: Well, he did talk about how it would be financed.
He didn't go into a lot of the specifics because he was making a speech
about where our destination is, what we're going to end up with. And a
lot of the details are being worked out.
But the figures that we're going with -- as the economic team at
the White House and other economists have pointed out -- they are
credible, they are based on a very clear and logical examination of what
the health care costs in the country are and how we can shift resources
around to be better utilized.
�I think there has been some confusion about what are credible,
logical numbers and what is politically feasible. For example
Q
But you can't separate the two, can you?
MRS. CLINTON: Well, you can. And I think that that's where we
need to really understand where this debate will go .. Every credible
health care reform proposal calls for reducing the rates of Medicaid
whether we talk about the Republican proposal or the proposal sponsored
by the Democrats in the House, everyone of them calls for that.
Now, which is more politically feasible -- the higher figure
that is in one bill, the slightly lower figure in another? That's what
we're going to figure out. But I don't think anybody doubts, who has
looked at this system, that costs can be contained and increases can be
decreased. What we have to decide is what will the whole package look
like, what will the tradeoffs be. And that's what starts tomorrow.
Q
One of your key allies on the Hill will be the Chairman
of the Senate Finance Committee, Senator Monihyan. He has looked at all
of this and he does agree that it comes out of the computer just fine,
but you put it in a political context and he says it is fantasy.
MRS. CLINTON: Well accurate fantasy, but we have visited with
Chairman Monihyan, as well, and he has legitimate questions undermining
the quality of care? And how will it actually be put into practice? We
have a lot of information we're looking forward to sharing -- I'm
sharing with the Chairman. The thing that is most importarit to me about
what Chairman Moynihan said is that we will have a health care plan.
And what I'm hoping is that we will get into the debate about the
details. If there are better ideas out there, we want to hear them and
we want to analyze them. That's what's really exciting, is the
bipartisan nature, the excitement on the Hill, the fact we are going to
do this to give health security to every American.
Q
And Mrs. Clinton, everybody -- every administration tip
toes up to Medicare and Medicaid very, very cautiously because it is so
politically explosive. And yet it represents 41% of our health care
budget. And you would like to slow the growth some. Why not just take
a bold step and say we're going to have means testing~ This has gotten
out of hand.
MRS. CLINTON: Well we are proposing some means testing for
certain benefits for very high income beneficiaries. But let me just
give you one example. We know that Medicare can be delivered more
efficiently in some states than other states. Minnesota, for example,
takes care of their Medicare population at one-half the cost of some of
these larger cities in the Northeast. There's no legitimate reason that
we can find why the older people in Minnesota are sicker or deserve to
�have more or less spent on them than the people somewhere else. It's
the way the system of delivering health care to Medicare patients is
constructed. And Minnesota has done a wonderful job in the last several
years lowering costs to everybody, including the Medicare population.
New Haven, Connecticut, 100 miles from Boston, has a Medicare
reimbursement rate one-half of what Boston has. So we're talking about
real world examples from around this country that we can point to when
we say we can lower the rate of growth. We're not talking about
cutting, we're just talking about instead of increasing Medicare at 11
percent a year, we will start bringing it down to 7 percent a year.
Why do we think that's possible? Because people become eligible
for Medicare at about the rate of one percent a year. If you add an
inflation rate and a little bit of a cushion there, we're in the seven,
eight, six percent range. We can't -- faster or slower But the
overriding belief is we can do better than we are doing in terms of
serving the Medicare population.
Q
One of the things that you want to do is help companies
relieve the enormous burden to them -- by taking care of people who are
retiring at younger ages. They're thrilled with the proposal that you
have that the government will pick up 80 percent of the cost. They just
don't think it's possible.
MRS. CLINTON: Well, we have run these numbers over and over
again, and we think that this can be done for about $4.5 billion. NOW,
there may very well be some adjustments made to that. We might not get
there as quickly as we think possible. We might ask the companies to
pay a little bit more over a longer period of time. But I think the
companies are right to be excited, because we burden many of our
companies with costs far beyond what their competitors have to pay, not
only for their existing work force, but for the retirees. We know we
can do better, and we know we can relieve companies from a large part of
that burden so that they can go out in a world economy and compete more.
Q
These are a couple of -- the briefing books that have
been available around Washington.
(Laughter.)
Thank you.
END
'.
�
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Lissa Muscatine - Press Office
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Lissa Muscatine
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1993 - 1997
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2011-0415-S
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<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>
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