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�. THE WHITE HOUSE
Office of the Press Secretary
For Internal Use Only
December 7, 1993
AN INTERVIEW OF THE FIRST LADY
CONDUCTED BY BOSTON GLOBE/NEW ENGLAND HEALTH CARE SERIES
BOSTON,MASSACHUSETTS
Q As I watch you run around and meet all of these
different people, I'm reminded of this sweatshirt my husband
bought me, that I believe that God put me on earth to
accomplish certain things. I'm so far behind now I will
never die.
(Laughter.)
(Inaudible) feeling as you flit from
city to city.
.
But I wonder as you leave a forum like this,
Mrs. Clinton, what do you get out of it? Some pf the stories
are heart wrenching.
MRS. CLINTON: Yes, and I keep th.ose stories in my
mind. That has been the best part of this experience, in a
personal way, for me, because I literally have this movie
running in my head, where I can.see the face of the woman who
is the dairy farmer in Vermont', or the woman who is the day
care operator in Rhode Island, the small businessman in .
upstate Maine.
"
Q Did you ever alter your thinking, then, or
(inaudible) because you (inaudible) fine tune this a little
bit?
MRS. CLINTON:
Q
Sure.
will this change anything today?
,~
,
"
MRS. CLINTON: Well, I think that there are issues
that we have to keep looking at and have to be open .to better
ideas to try to (inaudible).
Q
Did anything stand out
her~
today for you?
MRS. CLINTON: Well, I'm obviously concerned that
we don't do anything that undermines our competitiveness in
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the biotech arena, because ,it is a very important part of the
common need in many states. So I want to be sure that we
take another look at that, and that we work with people that
have good ideas.. So those are. 'the kinds of things that I .
take back.
I tak~ notes. I make notes to myself on the notes,
and then when I get back I try to' follow through .and say, you
know, how is this going to work, and·letl.s make sure we have
the best venue we can have.
Q You are wonderful at marshaling the facts and
explaining them, and. certainly focusing the country on the
go~ls here (inaudible).
There's certainly no debate on the
need and the goals, but rather the strategy. When someone
asks, you know, why reinvent the wheel, you know, how can you
be so confident that this major overhaul -- just take, for
example, the alliances, and trying to, evaluate them. Just
that part of the system is so.huge, such a'giant task, how
can you be sure it will work?
MRS. CLINTON: Because we have lots of evidence
from around the country about what works. If we ,take what we
have learned from what states and cities, what large
companies have done, we can see a pattern. For example, we
know that if we pool purchasing. power by small businesses and
individuals that they are going to. get a better price for the
health care that we would all want to be able to afford.
Q But you worry that the organization of it is
just so big, just by the sheer volume, ,certainly, some of
these programs that you're working with -- well, that you
referred to -- are such a much smaller scale. You worry
about being drowned in the administration of it, and many
others are.
MRS. CLINTON: No. No, because I think others are
looking at it from two'perspectives that need to be kind of
corrected. They're looking at it and saying to themselves,
well, gee, we've never bought insurance like this before.
But that's not really the case. I mean, if you IQok at very
large insurance purchasers, like the big pension and
retirement system in California, or a giant corporation, what
they do is pool all their resources and then go out into the
marketplace.
What we're saying is that· through a purchasing
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cooperative -- which is very
agricultural area or who buy
through volume purchasing -power together, then we will
marketplace together and buy
familiar to people in the
supplies at discounted rates
that if we put that purchasing
be able to go into the
a better deal for health care.
Q I guess part of what we -- what comes into play,
here, is that people don't trust the government to get it
done right. Certainly your husband., when he was campaigning,
alluded to the bureaucracy of this government and what had it
ever done and run correctly. You know, why would anyone
think that this, the biggest undertaking perhaps ever by the
United states government, would work?
MRS. CLINTON: It is not going to be a government
run program, it is going to be administered at the state and
local level. And remember, we ,talk about the alliance.
We're talking only about how we finance health care, not who
your doctor is, not which h,ospital you go to. There is.a
differenc,? in how we collec:;:t the moneY'and then go out and
buy what we want in health dare, and who the providers are
. that we want to pay, so tha.t the government is not going to
run either one of those.
Q
But it will collect and disburse the money?
MRS. CLINTON.: At the state level and within the
states, but not through the federal government. The federal
government will set a framework. Every American will be'
erititled to certain benefits, and that will be enforced. But
Massachusetts may decide to do it differently than Vermont
and Maine, or whatever.
.
Q That's definitely still in the plan, then, that
the states have the option to opt. out of this,. too? Is that
right?
MRS. CLINTON: Well, the states can choose how
they're going to organize this as long as they make sure
everybody in their state gets health care. Then they can
decide how, on the. ground, they think it's best to do it.
Q What about this single~payer system, that in
support of the cheap competition (inaudible) congress right
now? Why not do that?
MRS.. CLINTON:
Well, the· single-payer system has a
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lot of very stcrong features"particularly the universality of
coverage and the ability to control costs. But if you look
closely at single-payer systems.even operating in the world
today, you can seethe same trends of increasing health care
costs because they don't have any competitive delivery
system.
'They're not really able to learn from the hospital
in the next state or the doctor in the neighboring town who
is doing something differently and getting more value for the
health care dollar. So what we did was to say, any state
that wants to can pursue a single-payer plan, but we want to
t'ake the best features of single-payer,' which is making
positive that everybody gets health care, and doing it by
reducing the cost of the system, but adding to that approach
the kind of market,fqrces that we:tpink will keep everybody
on their toes, will kind of keep saying, how can we do this
better? How can we take care of more people for less money?
So what we realiy try to do is marry the single
payer goals and the kind of market approach that some have
advocated to give what is'a very American response to the
health care needs of our country.
Q Now should the single-payer system, as
represented (inaudible) put forward, pass, let's just say, in
congress, over the Clinton plan, would President Clinton sign
it?
MRS. CLINTON: I think .that that is such a
hypothetical, because in order to. pass (inaudible) you would
have to raise about $400 or 500 billion in taxes, and I don't
think that is in the cards.
Is that so, or -- there are some who would say
that not a single more dollar really would have to come out,
because you already ar,e paying insurance premiums, and you
are already paying taxes in the way of Medicare and other
federal and state taxes. And if you took all of those monies
and put them into the single-payer system, it would be -- it
would be a (inaudible).
Q
MRS. CLINTON: Well, that may be, but it would mean
turning over all ,of,your private funding'for health care to
the government~ And the concerns that you expressed earlier
in the interview that some p'eople have about alliances which
are not federal government, and not even governmental in that
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sense, would be extremely strong with those who are critics
of a single-payer system.
Because it may be that you could tell people: what
you now pay for health'care you essentialiy will just pay for
in taxes. But it would still require raising that tax money.
And. I don't think that that is something that the American
people right now are willing to do, to turn over the control
of our health system to the federal government and to raise
the taxes to do it with an open-ended kind of obligation,'
without the sort of competition that we think will produce
higher quality, better outcomes at more cost-effective ways.
Q Which of course plays into the-- the cost is so
complicated (inaudible) that we wouldn't expect you to try to
explain, nor would I ever understand it. But,even -- but you
heard people today tell you -- the small business people -
how concerned they are about the cost (inaudible) , whereas in
a single-payer system, 80 percent of the, burden would not be
on the employer. It.would be spread ,out differently, as
you've just noted.
.
I mean, how do you -- what do you say to those
small business people? I mean, it's'not ~- clearly, I'd like
it -- and my ear is,kind of to the ground, too, because of my
work here. People are reduced to tears, concerned that
they're just not going to exist anymore.
, MRS. CLINTON: Well, that is unfortunate, that
people have been scared like that, because there's no grounds
for it. You know, I looked very carefully at the single
payer sys'tem, and if you look at any of the bills that' are
pending,. there would be a payroll tax. There would be an
~ncome tax.
There would be a lot of taxes that would impact
heavily on employers as well as employees.
There-is no easy way to pay for universal coverage.
We think,though, that building on what already exists -- you
know, 100 million Americans already get their health care
from the employer system. So let's build on what works.
Let's bring down the costs for those who already pay, and
yes, let's ask everybody to pay som~thing, but let's provide
discounts to small business so that it is affordable.
Part of the reason that small business people get
so concerned now is that -- I would', too, in today's
insurance market --they know what has happened to them. We
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.
.
heard the stories today', you know, double digit increases in
their health care benefits every single year, sometimes from
month to month.
So they are rightfully cautious and concerned, but
what they have to understand is that.we are changing the
whole system. They will no longer be out there a·lone or in a
very small group that they' tried to band together in
defensive ways. They'wili be part of these big alliances.
They will have much, much lower costs, and in addition will
have protections.against the~r costs going up because of the
ceilings that 'we're putting into the' system.
So I think most small businesses, once they really
look at it, are going to find it a 'cost that they can afford
as long as they don" t get 'scared away because of what they
fear will happen, instead of the reality.
Q (Inaudible) anxiou~ (inaudible) so I'll let you
go, but I have to wonder: is there a personal level
(inaudible)? It has to be a little bit scary (inaudible). I
mean, you kno.w that (inaudible) human being, we're fallible,
as bright and knowledgeable as you are. If,you go to bed at
night'sayingto yourself (inaudible).
MRS. CLINTON: Sure, because, you know, these
stories that I heard today, every single one, whether it was,
you know., the nurse with MS, who' is desperately trying to
keep working to keep her insurance, and the, you know,
lobster ·man from Maine. who worries about whether he can pay
for his sternman -:- I.mean, I worry about all these people.
And I think carefully every chance I get
we're proposing and how it will really impact, how
better communicate what the President is trying to
because there 'is such a need for us in the country
be educated about how our health system works now.
about what
I can
do,
to really
You know, 'a' lot of people don't know Medicare is a
government system. Every time somebody says, don't have the
government involved in health care, I say, well, gee, do you
know anybody on Medicare? And of course they do --and
that's paid for by all of us on ~ payroll tax.
Q But there's only so much they can get
. (inaudible) ..
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MRS •. CLINTON: But you probably -- you've got to do
a reality check all the time, which is why I love coming and
hearing from people who tell their real stories. And then we
take that information back and we go back to the drawing
board and say, let's make sure that we think this is really
going to work.
..
.
Q
Well, everybody hopes it works·.
well.
MRS. CLINTON:
Thank you very much.
* * * * *
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Dublin Core
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Lissa Muscatine - Press Office
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First Lady's Office
Press Office
Lissa Muscatine
Date
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1993 - 1997
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<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>
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2011-0415-S
Description
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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>
Provenance
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Clinton Presidential Records: White House Staff and Office Files
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Clinton Presidential Library & Museum
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Adobe Acrobat Document
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1,324 folders in 27 boxes
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FLOTUS Press Office Interview Transcripts Volume II 10/93 - 01/28/94 [Binder]: [12/07/93 Boston Globe New England Health Series]
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Box 3
<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
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First Lady's Office
Press Office
Lissa Muscatine
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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
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11/26/2012
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2011-0415-S-flotus-press-office-interview-transcripts-volume-ii-10-93-01-28-94-binder-12-07-93-boston-globe-new-england-health-series
7431941