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THE WHITE HOUSE
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Office of the Press Secretary
For Internal .Use Only
April 25, 1994
INTERVIEW OF THE FIRST LADY
BY SABIN RUSSELL,
THE SAN FRANCISCO CHRONICLE
SAN FRANCISCO
Q
I might as well just get on with it.
MS. CLINTON:
You bet. Go right ahead because
we've got all the way to the airport.
Q A lot of people were quite impressed with your
performance on Friday and had a sense that in a sense you had
made an active effort to put this whole Whitewater thing
behind you.
I was.wondering, in light of that, do you have
sort of a post-Friday strategy to concentrate once again on
health care reform? It seemed to a lot of people it got
derailed or sidetracked somewhat by all this Whitewater
stuff.
MS. CLINTON: Well, you know, during the past three
or four months, I have traveled nonstop on health care reform
and I have been in numerous States and I've given speeches,
and I've done events, and I've always answered press
questions, but I think that was effective on the local level
but it didn't penetrate nationally because there was some
blockage. That's what I really began to realize, that I
could travel allover the country and go to as many events as
possible and I think it would have a positive effect where I
was,'but I couldn't really get the attention focused back on
what I thought was so important which was health care without
making myself available to the Washington press.
So I'm
going to try to keep those two things in balance better than
I was.
I, think I have a better understanding of what the
different roles and responsibilities are of different press
operations.
Q You talked about being rezoned.
Does that
represent a rezoning of your views of your strategy towards
health care issues in Washington in a specific way?
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MS. CLINTON: No. No,. I really meant that more in
terms of what now recognize and perhaps accept as inevitable
with respect to the demands ori people in public life, and'
particularly at ,my ,husband's level.
What I'm going to be doing is pretty much what I
have been doing, working with members of Congress, working
with interested groups and citizens, and trying to keep the
attention focused on what the principles of health care
reform should be and the different ways of accomplishing
those principles. So this speech I did today here in San
Francisco I had set up a long time ago and it was always
going to be ,about health care and it primarily was ab'out
health care, so I'm 'really going to keep doing what I have
been doing.
Q
It sounded similar to the speeches I've heard
before.
MS. 'CLINTON: But it's interesting how so many
audiences are only now really paying attention closely to the
health care debate because I have discovered that you can
make a point over and over again but people tune into it at
different stages and as you get closer and c~oser to
congressional action occurring, more and more people,
understandably, will pay attention. So you've got to keep
talking about it as a way of giving people an entrance into
the debate.
'
Q Do you feel that the health care debate does
occur in phases and if so, have we reached a different phase?
MS. CLINTON: I do think so. I believe that there
is a very strong commitment in the country to guaranteeing
health care coverage to every American. That is a big step
that has been made in the last year. So to some extent,
accomplishing that has been the first necessary achievement
on the road to health care reform. Then, I think there has
been a growing awareness of the complexities of reform that
just because you want everybody to be covered, doesn't mean
it's going to happen unless you make some hard decisions and
people beginning to understand all the tradeoffs.
What is really interesting to me is how in poll
after poll, people are asked do you support or oppose the
President's plan and a lot of people don't really know and
they are confused, and they don't like what they've heard but
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they are not sure what it means. Then if you go through the
principles of the President's plan, there is very strong
support for most of those principles. The trick is how do
you take the consensus that is developing about the need for
insurance reform, the need for comprehensive benefits, the
need to preserve choice, the elements of the health care
reform, and focus in on those so that people can really
understand what they mean. That's what is happening in the
Congress which is why I believe we are right on track because
. now the Congress is having to wrestle with those decisions.
Could I ask what is this we're passing here?
Q This is City Hall on your right and that is a
new library that is going up over·there~ This is the area
that used to be filled with homeless people, a very
politically controversial clearance of this civic center.
They are about to move out of city Hall for the earthquake
retrofit. This whole town was knocked to pieces a few years
ago. We're just starting to realize that.
MS. CLINTON:
I know.
Q If we accept the idea that maybe the message
wasn't getting through to the Washington Press Corps for
whatever their obsessions, is-there a particular message that
you feel was not getting through that you wish had gotten
through in the last couple of months? The reason why I say
this is that there does seem to be some evidence that there,
is a decreased support for health care reform in this
country. The L.A. Times poll suggested that I think it was
two-thirds of those polled said they wouldn't feel so bad if
the Congress didn't accomplish health care reform.
Polls can
be taken with a grain of salt but that one was a rather
surprising one.
Is t~ere something you feel has been lost in the
last several months?
MS. CLINTON: well, I think that part of the
challenge we've had is to deal with a well-organized and very
well-financed campaign against health care reform which has
been successful in creating confusion and sowing some
misinformation. Maybe one of the biggest concerns is that
people seem to think the President is proposing a government
health care system, which is absolutely not the 'case. So we
have to do a better job of reaching people. We don't have
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the resources that a lot of the interest groups are willing
to spend, so we pretty.much have to do the best we can
working with other groups committed to reform in getting the
message out that what the President is talking about is
guaranteed private insurance.
The ads that were run telling people that the
President's plan would take away their right to choose their
doctor were very effective and, in fact, the opposite is
true, that if the system doesn't change, people are more
likely to lose the right to choose their doctor than if we
.reform the system and guarantee the right to choose your
doctor.
I understand how in the absence of a well
organized, well~financed countercampaign to counter the
misinformation,' people have been left with some
misimpressions that we're going to have to try to dispel.
Q That kind of leads to one of the things I really
want to talk quite a bit about. Tomorrow there is going to
be in California a fair amount of press about the fact that
the single payer advocates in the State will be turning in
one miilion signatures, a little 'bit over. one million
signatures, to very likely qualify an initiative on the
California ballot to put a single payer system in place in
California.
I was wondering, first of all, are you following
.this at all. in any waYi are you aware of what the single
payer initiative says?
MS. CLINTON:
I don't know the details in the
initiative. I am aware of it, but you know, in the
President's plan, there is a single payer option for States,
so this would be in line with what the President's approach
would permit, an individual state either by legislative
action or referendum deciding that it wanted to be a single
payer state wo~ld be permissible.
Q I was talking to congressman McDermott last week
and he said that the bottom line issue for the single payer
people is that be included in the bill. How strong -- do you
think there is support or perhaps on the flip side, is there
strong opposition to that provi~ion in the Clinton plan?
MS.
~LINTON:
I don't know yet; it hasn't really
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surfaced, so I haven't seen a lot of strong opposition. The
opposition is focused on the big picture items like choice
and financing and insurance reform, so I cannot tell you how
much opposition there will be, but I do think it is a very
important featUre in the President's plan.
I'm not sure that Congress could prohibit any state
from doing that, if that's what a state wanted to do in any
event, but we would prefer that it b~ an affirmative choice
for a state.
,Q Politically, what impact do you think there will
be? If there is a single payer in California, it's likely to
be a very high profile campaign, a lot of money going into it
and a lot of publicity for the Canadian system. What sort of
impact will that have on the debate in Washington?
MS. CLINTON: Well, I can't predict exactly but I
think it might be healthy.
I want people to see grassroots
concern about our health care system and a vigorous debate
about health care 'reform and the merits of various approaches
to health care reform I think is healthy for the debate.
Q Didn't you support ,a singTe payer system in the
past in the Children's Defense Fund work?
MS. CLINTON:
I've never personally supported any
system. I think there are features of the single payer system
that I'm very supportive of -- universal coverage and
elimination of administrative costs and duplication -- but I
think there is a way for us to marry the good featUres of the
single payer system with the competitive features of the
market system that I think would be better for America, which
is what the President's plan tries to do.
Q One quality that I think t~e single payer people
have a very easy time of it when they're dealing with the
press is selling the simplicity of the single payer plan.
That seems to be one of the drawbacks that'people mention
again and again about the President's plan.
MS. CLINTON: Yes, and I don't understand that
really because the President's plan is so much closer to what
people already know and have. The President's plan would
continue what most of us already do which is to get our
insurance at our workplace; it would continue the custom of
having the employer and the employee contribute to our health
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insurance; it would improve that system by taking the choice
of health plan away from the employer and giving it to all of
us as individuals, which I would think most people would be
in favor of; it would eliminate the discriminatory practices
of. the insurance system; but it wouid preserve the choice of
health plans and Americans value choice.
I mean, they like
the choice that they could maybe save some money if they had
an HMO as opposed to a fee-for-service plan but it would be
their choice instead of their employer's choice.
I don't understand why it is so difficult, but I
believe some of the difficulty is due to the campaign against
the President's approach because if we look at the way the
Federal Government provides health insurance today for
Federal employees in the civilian work force, that's really
the model that we're suggesting every American have access to
where your employer-- in this case, the Federal Government
- pays the majority of the bill but you make a contribution
and every year, you get to choose from among the health plans
that your employer makes bargains with for health plans to
offer services. The reason the employer can get a better
deal than you can is because of their purchasing clout.
I think here in California the Calperis .(phonetic)
is another example.
I don't know why that's so
difficult for people to understand.
Syst~m
Q I think one of the reasons is it gets very
confusing very quickly.
For instance, the President's plan,
as written right now, would eliminate the Calperis System.
It would replace it with a similar system along regional
lines but the Calperis people obviously have a very simple
message, we won't exist anymore.
MS. CLINTON: But what difference does it make,
they're performing functions that would be performed by
people just like them.
From my perspective, what I care
about is who is my doctor, who is my nurse, and what hospital
do I go to.
I don't care how the money that I put up for
health care winds its way through the system.
I would like
it to be more efficiently used than it is today but I don't
want to pay for more bureaucrats, whether they are government
bureaucrats or insurance company bureaucrats than I have to.
If you look at what Calperis does in providing the
bureaucracy for what 3 million enrollees with a very small
central staff, why don't we want to do that for everybody?
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Q It's interesting that the one organization that
seems to be really pushing the government system, the Federal
employee system, is the Heritage Foundation.
I get stuff
from them all the time touting the government health care
system, s~ying this ought to be made available to everyone.
Do you see any common ground with the far right in
this health care debate right now?
MS ..CLINTON: Well, what they would like, as I
understand their proposal, is to make that available to
people but not have any requirement that people actually have
health insurance or that employers help to pay for health
insurance. They view it as something individuals could buy
into or if employers wanted to contribute, they could as
well.
That doesn't end our cost shifting problems and it
doesn't end the cost spirals that grow out of shifting costs
around from one part of the economy to the otler. So though
it does something to·recommend it, it doesn't get us to where
we need to go. We've got to get everybody covered, we've got
to get everybody in the system.
In the absence of some kind
of requirementt whether it be a tax under a single payer
system or th~ mandate on employers and employees, or an
individual mandate like some of the Republicans in Congress
want.
There has to be some way to get everybody in the
system. Only then can we begin to· contain costs and decrease
costs as we squeeze the excess bureaucracy and administrative
costs out of the system.
Q Just stepping back to that single payer
initiative in California, if you had a friend in California
who asked you how you would like her to vote on it, what
would you tell,her?
MS. CLINTON: . I'd say to follow the debate closely
and try to make sure she was as informed as possible about
what it would mean to her and her family.
I think it's a
little early to tell exactly what shape the debate will take
in the next months.
Q
Are there disadvantages to the single payer
system?
MS. CLINTON:
I think if you look at other
countries that are single payer, their cost increases have,
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in the last years, gone up significantly, particularly in
Canada which has had some real cost pressures.
They have not
had the kind of leading edge technology or pharmaceuticals or
research that we have which has been a great benefit in many
instances for Americans which is why many people from other
countries come here, for the most advanced medical care.
I think there is a very good argument that
substantively it is better to preserve incentives for private
firms, whether it be in technology or pharmaceuticals or
organizing health care, than you're permitted to do under the
single payer system.· The second point is that we start right
now from such a variation in cost levels around our country.
Medicare has struggled with this, which is a single payer
system; Medicare is a single payer system. Most Americans
don't know that but it is and Medicare has had a terrible
time figuring out how to reward efficiency and penalize
inefficiency in the financing and reimbursement of Medicare
so that you had some regions of the country where it costs
three times to take care of the same kind of patient with the
same kind of problem than it does in another region.
So if you were to layer a single payer system over
the existing inefficiencies and practice style patterns, I
don't know how you would ever ~et costs under control in our
country because you would be starting from a higher base than
anywhere in the world without any real capacity that I can
see in a single payer system to force a lot of that waste and
other excess out of the system.
If you retain incentives for
the private sector to realize benefits so that you've got a
Mayo Clinic which has cost increases below the rate of
inflation and provides the highest quality care, you then
have market driven incentives as opposed to political
pressure beginning to help squeeze out a lot of the excess
cost so that we can get to a better allocation of resources.
Those are the two things I worry about with a
single payer system coming in on top of the American system
as it is today_
Q You sound a little bit there like Alan Intovin
(phonetic) down the road whose ideas are the basis of much of
the theoretical framework but who himself finally said, after
much grumbling, that you ought to check out the plan.
Have
you had any opportunity to talk to the Jackson Hole people in
recent days or recent months? Do you see any room for common
ground with those folks anymore?
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MS. CLINTON: Well, I hope so, but you know, I'm
kind of reassured that the President's plan is criticized
from both the right and the-left and suggests that maybe
we've got it right in the correct sense of the word, because
yes, there'is a lot that was borrowed from the concepts of
managed competition, but the President believes there ought
to be some kind of mandate to get everybody in the system and
he does not believe that we ought to be driven toward the
lowest cornmon denominator so that you deprive people of any
tax preference unless they go into the lowest cost plan no
'matter what that plan is. We don't think that's good in the
long run for the quality of medical care, but many of the
other principles we support. So I can critique both the
managed competition and the single payer system and point to
the features we have borrowed from both and the changes we
have made in both which we think will be better for
Americans.
One of the big problems we've got with the Jackson
Hole approach right now is how do we get everybody into the
system and if we don't get everybody into the system with
some kind of budgetary mechanism, there is no end in sight
for the cost increases and the drain on the Federal Treasury.
The Congressional Budget Office, in attempting to cost out
the managed competition proposals is corning up with very big
deficit figures. We can't do that; we have to reform health
care in part because our State and Federal Governments can't
bear the continuing costs of health care increases. How on
earth can we aqopt a system that would increase the deficit?
Q D~ngell is trying' to bring in some votes from
all his third-year Democrats. One of the things that he
recently seems to have publicly traded away is 'the
breakthrough drug provision for biotech companies and
pharmaceutical companies, basically saying he is willing to
toss out that provision that would allow a governmental
entity to set the price of a breakthrough drug.
Can you live
with that?
MS. CLINTON:
I'm not going to comment on the
congressional process at this point.
I think it needs to
kind of proceed further and play itself out, so I don't know
what will be the butcome of a lot of work that's being done
in the committees., I think the Administration wants to wait
and get a better idea of that before it does comment.
Q
Let me
pu~sue
that a little bit though.
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is a perception, maybe it's a 3,000 mile away perception,
that in recent m'onths, the issue has really been taken away
from the White House and is in the hands of Congress among
people like Pete Stark, Dingelland others and Moynihan, who
essentially are going to just do what they want to do. How
can you continue to shape the debate at this juncture where
the decisions after all are going to be made by people in
Congress?
MS. CLINTON: Well, I think that's where the
decisions ultimately have to be made, but certainly the
members of Congress, particularly the Chairs of the major
committees, know they have to produce a bill that this
President will sign, so it's a partnership. We always knew
- in fact, counted on -- producing something that would be
broad enough that every issue was touched on but then it was
going to be the congressional responsibility to work out the
kinks in the proposal, to worry about how to get the votes in
committees, alI the things that Congress has to do.
The Administration is working every day with
members of Congress. We have a full team up there on the
Hill, we spend countless hours providing technical assistance
and information that members of Congress need, so we are
deeply involved.
I don't want anybody to have the impression
that somehow we're sitting down at the other end of
Pennsylvania Avenue and the members of Congress are not
communicating or working with us because that is not the
case, but the fact is, it is the committee responsibility and
the leadership responsibility to really fight through a lot
of these tough battles.
We presented what we thought made sense and we
really did try to look at every possible issue. There are
different ways of getting to the goals the President set, and
we respect the congressional process and want to work with it
and do everything we can to see it be successful so we can
get a piece of legislation by the end of summer.
Q Pete Stark, our local congressman, has a bill
that's quite different.
It is a single payer system. What
do you think of the Stark bill?
MS. CLINTON: Well, the President said he could
sign it because it met his number one priority, which was to
guarantee insurance for everybody, but that bill is also
going to be going through some changes in the full committee.
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We don't know what the outcome is going to be, so we want to
encour~ge members of. Congress, like the congressman you've
mentioned, to continue to work to put together the majority
that is needed to pass health care reform. What it looks
like finally is going to be something that the Congress and
the Administration ~ill work out themselves.
Q
Can you do it
~ithout
Republicans?
MS. CLINTLINTON: Well, ~e hope we don't have to
but, yes, you can, and, if necessary, will but we hope that
won'.t be necessary. We ~ant this to be bipartisan; it should
be beyond partisan politics, but it's too important an issue
to let it get diverted. So if,it is necessary, there's a
majority to be put together and we hope it will have people
from both sides of the aisle ..
Q Do you care to make a prediction about when
health care reporte~s like me will have a clear idea of what
we're going to be voting on?
MS. CLINTON:
I think by June.
Q By 'June?
MS. CLINTON: Yes. I think you'll have a much
I don't know whether it will
clearer idea than you do now.
be 'the beginning of June or the end of June but I think June
will be a very critical month.
Q Any particular congressional process that you're
talking about?
MS. CLINTON: No.
I just think that, June, a lot
of the committee work is going to start taking shape and you
will see what the options are that are out there. At least
that's what I see.
Q It·seems there may be a maxim that the amount of
work being done in Congress is inversely proportional to the
rhetoric and noise that you hear. Right now, it's very quiet
in Congress, almost too quiet.
Is there something going on
right now?
MS. CLINTON:
Yes, there is. There is a tremendous
amount of work going on. There is also a lot of education of
members going on. You know, most members who are not on the
committees of jurisdiction have not had to really l~arn this
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issue. They are learning it.
I really wish you could be
3,000 miles away because with your interest in this and your
grasp of the issue, I think you would pick up what is
happening there.
I am so excited because I've never seen
more serious, hard work and it is going to pay off,' but it's
the kind of work that doesn't grab the headlines.
It is
bonecrunching, tough work that they are doing and that's what
they should be doing.
I need to go.
Q
Ms. Clinton, -I want to thank you very much.
MS. CLINTON: Thank you.
I enjoyed talking to you.
You really have a grasp of this which is a pleasure.
(End of tape.)
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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/.
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Lissa Muscatine - Press Office
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First Lady's Office
Press Office
Lissa Muscatine
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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>
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Clinton Presidential Records: White House Staff and Office Files
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1,324 folders in 27 boxes
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FLOTUS Press Office Interview Transcripts Volume III 02/02/94 - 05/31/94 [Binder]: [04/25/94 Russell, Sabine San Francisco Chronicle]
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Box 4
<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>
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First Lady's Office
Press Office
Lissa Muscatine
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2011-0415-S
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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-iii-02-02-94-05-31-94-binder-04-25-94-russell-sabine-san-francisco-chronicle
7431941