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PHOTOCOPY
PRESERVATION
�THE WHITE HOUSE
Off,ice of the Press Secretary
For Internal Use Only
November 8, 1993
First Lady's Remarks to
Health Care Reporters
MS. CLINTON: I think it,would' be useful to spend
just a few minutes ,for me to describe where I think. we~re
and what the fundamentai issues are and will be as we move
forward in the debate.
I want ,to start by stressing that the president has
stressed and what~ll of us who, are promoting this plan have
stressed repeatedly in the last several weeks, because I
don't think it can be said too often and its implications are
sometimes overlooked or understated, and that is that the
bottom line for any health carerefo+ID that he will,signis
universal coverage with, comprehensive benefits.
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.
The'reason that I restate that and want to begin my
comments today talking about it is that I think that there
has been a lack of understanding among some people as to what
we mean by that and what the implications of our commitment
to that are.
Some people try to use the words "access" and:
"coverage" interchangeably. They'are not. There'S access
now for anybody with the money to obtain coverage, but 'tl1e're
talking about coverage, not access.. We a~e also talking ,
about coverage,including comprehensive benefits, not bare
bones benefits, and benefits that are affordable for all
Americans without the kind of barriers to care or usage that
are often constructed now through high deductibles, high
copays, high premiums, barriers that include preexisting
conditions, and the like.
. .In order, to get to universal coverage with
comprehensive benefits, there are' a number of issues that
have to be addressed, some of which can.turn out different
ways than what the president has proposed as long as they
actually achieve universal coverage with comprehensive
benefits.
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Everything in this debate is not equal.
I mean,
~hedebate over how the alliances are constructed, or their
~ize, or how they collect the money they collect is not 'on
the same plane as whether or not we achieve universal
coverage with comprehensive benefits.
I think that's important because a number of the
alternatives that have been put forward, whether in proposal
or a bill form, don't meet,this fundamental test as far as
we're concerned. The only ones that have as a goal to
achieve universal coverage are the single payer 'proposals,
the Chafee proposal, and the president's. The Graham, or
Cooper, or Michel, or (inaudible) proposals, or any other
that I'm aware of, don't even'have as a stated goal the
achieve~ent of ~niversal coverage, and do not, as a matter of
design, 'move in a directiol) that c6uldbe fairly construed as
achieving univers,al coverage within, any reasonable or even
possible period of time."
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So, as. far as we're concerned~ therefore,: in tl1e
absence of both a commitment and a structure for achieving
~niversal coverage, there really cannot be any comparison of
the president's plan with those, that do not meet that'
threshold.
-e
I think that -the other piece of this which is·,
important is that concerning ,comprehensive benefits because,
again, the description of the benefits and the actuarial
pricing of the benefitsls a precondition for determining
what kind of system' you're going to have, how much it will
cost, and what the financing mechanism has to be.
1 ,In all that, the single payer system, which
describes generally what the benefits should be, you don't
even get to that level of specificity. The other proposals
leave the benefits package to be determined at a later date
by a board to be appointed.
It's very hard to know how you
W~uld create a system that is rooted in accurate, adequate
financing if you don't know what the benefits package is.
For; some of the'proposals, it goes even a step further~:which
results in some confusion in our minds as we try to analyze
and work with the sponsors.
For example, in the Cooper
proposal you've got a national board which sets benefits
which is then keyed to an actuarlal value which insurance
companies can then alter so long as they stay within the
actuarial value.
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So when we come to look at these various proposals,
we are going into a level of analysis and scrutiny that we
would obviously make available to the press and to anyone
,e'lse interested in these issues. I think it's a very
important distinction to draw between premiums that are
specified in price so you know what, you're buying and the
AmericanptJ.blic knows what it is getting, and benefits that
are either unspecified, unpricedj or'everi when later priced
can be changed by insur~nce companies within the language of
the legislation.
'So if we 'look at where we are 'now, from our
perspective, other than the single payer bill there is no
other bill. SenatorChafee's proposal is the basis of our
comparison. But at least the Chafee single payer and the
administration bill moves us in t~e direction that we think
has to be achieved.
Now,why is that so important? Just let me just
say a few words about that. We don't see any way to
,
accomplish the cost ,savings that have to be achieved through
the'forum'in the absence of universal coverage without
benefits that are comprehensive and priced. There isn't any
way that we can think of, if you do the arithmetic or the
project~ons, that you can achieve the savings that have to be .
achieved.in order for this system to ~perate more efficiently
in the absence of universal coverage and a premium structure
with benefits that you dan assign some actuarial value to.
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You cannot stop cost shifting. You cannot deal
with the deficit. You cannot do the whoie' list'ofadditional
issues that need to be addressed through health care reform
without doing those two. So it goes for the human reasons'
that we want,everyone covered and we want to do it in a fair
way and divide quality care 'and affordable price, but also
for the economIc reasons that many of you know so well.' 'In
the absence of a commitment to universal coverage, y,ou can't
get there on the economic s,ide either. '
The second ,thing I would say in general is that we
are working very hard to disseminate ,information about this
plan, this book, which I hope you all get a copy of in the
brochure. Obviously part of that -- because we want people
:toknow: everything there is to know as, accurately as we can
communicate it about what we're doing and how we've reached
the decisions that we've,reached, because we think the more
people know about the president's proposal, the more they
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li~e it.
We've seen lots of evidence of that in the last
co:uple of weeks.
So with those sort of
happy to answer your questions.
get in in an hour, but we ought
internal agreement that not one
I'm not going to try to referee
yourself.
'
introductory comments, I'd be
I don't know how many we can
to try to have some sort of
person ask all the questions.
you. You'll have to do that
Q Since the opposition, a lot of the opposition in
your proposal tends to focus on the extent to which the
federal government ,and state government would increase their
regulations in the bealth c~re industry, could you explain
why you've come to believe that'the government, in fact,
would do a better job in making the decisions than private
interests that make them now could do it?
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, MS. CLINTON: ,Well, 'I think that that
'characterization, wpich I've certainly heard, is just off the
mark. You know, there's a lot of government regulation in
the health care business right now where they were talking
about the regulations governing medicare or medicaid,or'the
fact that it was a federal government pi~ce of legislation
that created HMOs and that still largely regulatesthem,or
whether we're talking about state government where, through
their insurance departments, at least try to keep tabso~er
the cost of premiums that insurance companies charge~
I think there's an enormous amount of government
regulation. I happen to think it's often the wrong kind,
that it is micromanagement and overly concerned about details
as opposed to setting the ground rules and then getting out
of the way~
,
,
That's really what we are proposing in this plan,
is that you would have much l~ss government regulation than
we currently have. ,You wQuldeliminate a lot of the
mic:romanagement that has driven up' costs without any
di:scernable increase in coverage or q:uality.
Through
an opportunity to
the'best possible
government is not
that are going to
level.
the creation of alliances, you would,have
peak on a much more effective basis to get
insurance price. But the federal
going to be supervisi'ng these decisions
be made at the state, local, and regional
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The alliances are going to be taking 'any qualified
plan. They are not going to be making decisions among 'these
plans as to who can or cannot offer their services. So I
think if you were to really take a list of what. we are
eliminating with respect to government regulation arid compare
it to what we think is the kind of basic framework for the
guarantee of health coverage for every American, that we are
establishing, I really don't think you could make the case
that we'have more.
'
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We have a different type of framework for both the
federal and the state governments to operate within. We have
delegated a lot of the authority to the states and have
worked very hard to limit the powers of any alliance to serve
in any way other than a kind of purchasing cooperative, which
is the original idea behind managed competition.
Q Ms. Clinton, last year Senator Moynihan and
others raised the issue of raising the tax on gun ammunition.
Are you seriously working at that? If so, how are we going
to see that?
MS. CLINTON: Well, we think there~s enough money
in the proposal that we have proposed, and I still think
there is some misunderstanding among the public about how
this is funded. Too of·ten we see people' saying well, my
gosh, o~ly a tobacco tax. That's not enough money,
. overlooking the fact we're going to, be asking everybody to
contribute to their health care for a change so that every
employer and employee will be making their contribution. So
we qon't think you need any more income revenue from any
taxes.
But as Secretary Bensen said, you know,"we're going
to consider Senator Moynihan's proposal seriously, whether
it's with respect to health care or some kind of law
.
enforcement program to try to diminish violence. I think
that will have to be looked at if the administration moves
forward with it.
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Q' Mrs. Clinton, . (inaudible).
You talked about the
link between health 'care crisis and violence. in America.
Obvious'ly you're focused on, health care right now totally. :
But at the same time, are you considering taking on this
issue of violence and crime in America as a full-time effort,
a~ajor! effort, after health care?
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MS. CLINTON: Well, I hope that we have health care
passed by the summer of 1994, which is next year. I also
hope by thEm we will have a crime bill worthy of its name,
which is what the administration is working on now. We will
have'the beginnings of 'seeing 'more police on' the streets and
alternative punishment centers like boot camps and more drug
treatment so that we will have, I hope, the beginning of a
good law enforcement structure.
I hope by next summer we will have th~ Brady bill.
We will have a bill banning assault weapons. We will have a
bill trying to control the use of guns among teenagers so
that we will have some additional legislation that will,
strengthen the hand of the additional police that we're going
to be putting on the street.
I intend to continue to speak out about it and do
whatever'I can because I think it is one of those issues that
I have described as kind of part of the security, triangle
that I've spoken about and that the president has talked
about in speeches with economic and health and personal
security. So I feel very strongly about it.
If there's a specific role when we finish the·work
we need to do on health care, and I can't really predict when
that is because once we have the 'legislation, there will be a
lot to do to make sure that it's ,implemented right, in, the
right way. But I'll continue to speak out, you know, now and
into the future.
Q Are there ,plans for a national crime summit,
coming up this year?
MS. CLINTON:
I don't have any idea.
Q Mrs. Clinton, when you talk about universal'
coverage, and you ta'lk about the safety bill,' and the
(inaudible), you invariably talk about all the drawbacks
(inaudible). Do you see or have you thought about what the
p~ssibi[ities fcir (inaudible)?
MS. CLINTON: Well, I think you've got it exactly
right. I mean, I think this conversation should take place
among the single payor advocates, the Chafee position, and
the president's posi;tion'because they are the only ones that
recognize the importance of achieving universal coverage.
I'm sure that the conversations that we have had
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with senator Chafee and his staff and the staffs of other
Republican senators, as well as the members themselves, will
continue to develop because there are a lot of, you know,
great ideas that need to be explored on both sides and ideas
that need to be analyzed.
,
I mean, part of what we have ,to begin doing in"
cooperation with Senator Chafee and others is to really put
some analysis behind their ideas sO,that we know exactly what
their assumptions are economically and with respect to
behavior.
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'! For example, we have worried 'that an individual
mandate in the absence of any employer responsibility would
leave an untold number of employers to do ,one of two things,
either shed employees they currently ensure, which would be a
tragedy for thos~ employees as well as an economic challenge
to the plan that they would have in effect, because the
second thing they might do would be to keep wage levels below
whatever the federal subsidy 'level might be.
Now we have not had time yet and we, as I said,
look forward to doing this, to really get into the level of
analysis ,that we need to be. The one thing that I can tell
you about this plan that the president has presented is that
it has been analyzed endlessly by. nearly ,'anyone you can '
imagine. We have literally millions of pieces of data to
back up everything that is in the plan. We have run as big a
projection as we can on each individual piece of the plan.
,
,We will have to do that to the same extent as we
consider any attempt to meld approaches. We don't have any
set view on that, but we're obviously pleased to be working
with people who believe as we do of the destination of
universal coverage and the test ,is 'how w~ get there.
,
Q Just a follow up on that to try and get some
(inaudible). The president (inaudiple) repeatedly
(inaudible) but that everything else is negotiable. ' ~any
people (inaudible) hip bone (inaudible). Could you g1ve us
specific examples of something either that is nature that you
ball (inaudible) change or that you see as a kind of
(inaudible) where there might be some sUbstantial numbers?
MS. CLINTON: I wouldn't. if I could, and. why would
I do that? Let me give you an example. The question about
bureaucracy and regulation that w,as inherent in, you know,
,why are you adding more government, obviously you don't think
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we are adding more government. But if there is a cleaner,
simpler way to achieve the goal of enhanced bargaining power
so that individuals, and small businesses, and medium-sized
businesses, for that matter, have the same kind of clout in
the,marketplace as the largest employers are beginning to
J:1ave, we're open to that.
;,
I mean, you know, that's not tOllS something
written in stone. We have a lot of guarantees, we believe,
in the plan for ensuring quality. If somebody ,has additional
or better ideas, we're open to that'. I mean, the princlples
that the president set forth, you know, security, and
'
savings, and simplicity, and quality, and choice, and,'
responsibility have to be met. But how we do that, you know,
we're open to discussion with people.
Q
(Inaudible)
MS. CLINTON: I mean, I don't know. I mean,
obviously we want to have the kind of coriversation that will
enable us to do so.' Let me go back to what I was just
saying. It's not enough for somebody to come to'us and say
we've got a better idea. We have to say great, sounds good,
let's,run the numbers, let's see what" you know, the best
minds think about it, let's try to figure out how it would
work,in practice, you know. So that's the nature of' the kind
of substantive discussions that we're going to have· to be
having.
But I think we absolutely mean what we said. If.
there is a way of getting financing that is sure and stable
and adequate other than the employer/employee contribution,
but is politically palatable to the majority in the ,Congress
and to the country~you know, we're open to that.
But the thing that I don't want people to
misunderstand is that by our being open and willing to
explore new-ideas, debit being number one, we will agree with
them. I mean, that is, you know, not at all the same. But
number two, if we do wait arid we make some changes in the
proposal that comes through the legislative process, we will
only do; so if we believe that they will not jeopardize the
fundamental commitment; the universal coverage, and
comprehensive benefits as soon as possible.
I began to get a little bit of a flavor in the last
week or two. People said, well, if' everything is negotiable,
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then what do, they really believe? Well, 'getting the
~niversal coverage is no easy matter.
There are only three
ways to ,get there if you're going to finance it. You're
either going to have a big tax increase and replace the
private sector investment, or you're going to figure out how
to make the individual mandate ~ork without the possible or
slippery slope effects of decreasing employer contribution,
or you're going to build on what we've got, which is the,
employer/employee system.
I don't think anybody would argue that anyone 'of
those is better or easier than any 'one of the other. It's
just that given where we are and looking at what works for
most people, we believe the best approach is the'
employer/employee. So getting to universal coverage is not a
pur~ orc;lained conclusion.
If we don~t'get there, then we
don't hilve health care reform, in our view. ,
"
, Q Can you envision~ for instance, giving ground on
a percentage that employers would have to pay from dropping
~he 80 percent down to a figure lower?
MS. CLINTON: If somebody can come up with a way to
do it that· is fair and dO,esn' t penalize either employers who
provide more or put too much of a burden on employees and can
keep the,subsidy scheme workable -- when I say I'm'open to
it, I absolutely am.
'
Part of the reason we ended up with the percentage
that we have is that we know we have to ,subsidize a number of
small busInesses and individuals in order to achieve
universal coverage within the employe:r/employee system. I·f
somebody wants to change that percentage; then if they have
to put more money into the federal subsidy pool, they're
going to have to tell us where that money comes from.
So sure, we're open to all these things if they are
workable and if they achieve our-goals without sacrificing
any, individual element that is necessary for universal '
',?overage.
Q Did you ever imagine the scenario under which
the alliances would not be mandatory?
MS. CLINTON: You know, I'm sure there are
scenarios I can't 'imagine." I'm open to anything that will
work that would'get us to where we need to go.
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Q
That's a possibility?
MS. CLINTON: I don't know. I mean, I can't answer
that blankly because I can't answer it in general.
There's
a lot of folks out there floating around saying they had, you
know, nonmandatory alliances. The problem with nonmandatory
alliances is you've got to assure you've got community
rating.' You've got to assure you've got adequate bargaining
power. You've got to assure,that everybody is in one,
"
whether they are nonmandatory or some kind of alternative
bargaining unit". So there are a lot of conditions that have
to be met before I could answer a general qu~stion like that.
Q You said that the more people know about the
plan the more they support it. 'There are polls that show
support slipping from the president's speech from the 23 of
September of yours scheduled for next week. Since then, it's
come way back down to earth. Are you concerned about all,the
attention in the past week abqut how many people would be
losers under this plan?
'
MS. CLINTON: No, because when I say that more
people know, I don't mean just an open-ended question like,
"Have you heard about the president's plan? Do you oppose it
o~' suppc;>rt it?"
I mean that if you go into focus groups
polling, as some people are now beginning to 40, or even if
you go into town meetings and you have somebody well enough
informed who understands theqplani once -- even if somebody
says they are opposed and you start to ask them questions and
you start to go into details, support rises again.
So, you know, this debate.is just beginning. The
only people who have been advertising it are people opposed
who set forth, you know, basically misleading information
about the plan. There's not been an opportunity to have a
concerted public education campaign, as there will, be. But
every time that we have looked at any forum in which accurate
information is conveyed, the more people know, the more they
like it.
'
We're in a shakedown period. I mean, this is going
to be a long process, hopefully culminating this summer.
But, you know, in politics, 24 hours is a lifetime. So we've
got a c~)Uple of months of getting this information out, and
getting: people familiar with it, and getting them to
,
understand the questions to ask. I ,think" you know, to take
the 70-30 number, I think you have a winner. I mean, once
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that. becomes well known to people -- I mean it just removes
all kinds of fears.
Once they realize the 30 percent consists of people
who basically have catastrophic insurance that's not worth
the paper it's written on, and young people'who haven't paid
their fair share, it goes off the charts. So, I'mean, it's
just a question of slowly and steadily and persistently
getting information out to people, letting them see for
themselves. Then, every time we have done that, we have
seen, you know, support grow, and I anticipate the same kind
of outcome.
Q Mrs. Clinton, are you also able to negotiate on
the range of benefits. that are included? A lot of people are
expecting mental health benefits and have to drop from their
plans -- too expensive -- and other benefits that might have
to be rolled back? Is that something that's
.
MS. CLINTON: Well, I think it's 'going to be very
difficult. 'You know, there's a lot of talk around without
looking at the numbers or without seeing the actuarial work
that has gone into the creation of the benefits package. The
mental health benefits that are in there now are reasonably
priced and we think totally credible. They ar~ not all the
folks who are advocates on behalf of mental health would have
wished for, but they make a very good statem.ent of support
for mental health benefits and establish a base that we then
can build on.
.
I think a lot of people ,are making statements or
really hypothesizing about the benefits without knowing all
the work that went into creating the actuarial underpinnings
for them. So I think that mental health should be a covered
benefit. I think the way it's' being presented in the plan
will b~ sustained as we move toward, you know, a resolution.
There will be some who will want to take it out and there
will be some who will want to add it in.
.
I think the burden should reston both of those
people. I mean, those who want to' take it out should tell us
how we're going to take care of these particular illnesses
which not only have health cost consequences but, 'you know,
homelessness, crime, et cetera •..Those who want to add are
going to have to tell us where the money is going to co~e
from.
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So I think once we get engaged in the real analysis
of the legislation,' the burden which we have basically borne,
which is we answer all your questions, you have all the
articles about us, ,we're compared to basically, you know,
some, as yet, undeveloped alternative, the more people are
going to see how much work has gone into establishing this
plan, and then the burden will shift to them. If they want
to come with an alternative, they're going to have to come
with their facts and figures and everything else to support
it.
Q How far away do you feel like you
Congressman Cooper on the universal coverage?
think that prior to an insurance market reform
virtual, ,virtual, universal coverage and' there
little (inaudible). Do you buy that or do you
at his plan, that you really are (inaudible)?
are from
He seems to
you could get
would be very
think, looking
MS. CLINTON: Well, you know, I think that --'I
don't know anyone who has looked at his plan who has really
studied it from the perspective of achieving universal
coverage who believes it achieves universal ~overage. That's
said for several reasons.
,
First of all, the insurance market reforms, there's
no indication it achieves universal coverage. Even under the
cao analysis of the version last year, ,which is not so
different from the one this year, would leave, you know, many
mill~ons of people uninsured.
What would we get for our
money, because the deficit would continue to go up? So, I
mean, I don't understand the cost benefit ratio in that kind
of approach.
The second thing is that without specifying the
benefits in the package and leaving<that to a national board,
it's very hard to know what the price would be. So how can
we determine what would be affordable for people because
there's no pricing that has been applied to benefits as; yet
undetermined.
Thirdly, as I said initially, under the legislation
as I read it, after the national board sets the benefits and,
assigns an actuarial value, insurance companies are permitted
to alter the benefits within the package so long as they
correspond to the actuarial value. So if the national, you
,know, benefits set by this national board - which I think
havin g:,lall,the benefits sets by ~ national board can be very
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d,ifficult for the American people to accept. They're going
to vote,for health care reform arid not know what they get in
return." He adds an extra layer' of uncer:tainty if insurance
companies ,are then free to say well~ as long as we stay with
the package that costs
(End of side one of tape c::me.)
MS. CLINTON:
is that unless, you buy the lowest
cost plan in your region, you don't get any tax benefits. If
that lowest cost plan is a plan that has been altered by the
insurance companies but has maintained the actuarial value so
you have to buy that plan whether or'~ot it has benefits in
it that you as a family or an individual might need,
:
otherwise anything above it you will be taxed on, I don~t see
how you do that :to a vast majority of Americans today who are
insured and think that what they want is some control over
the costs not the range of benefits. I don't know.
,1
There's a lot about it on the universal coverage
side of' it and the pricing side of it that we don't agree
with. There are other things that obviously we do agree
with, you know. The whole concept of purchasing co-ops and
the whole concept of competition and using the market, you
know, are things we all agree with. But in the absence of
universal coverage, I don't see how you get there.
Q You've tried several times today and previously
to get to the (inaudible) coalition to be developed between
what is (inaudible) motivate this whole universal coverage.
But it's also possible,that another coalition could coa~esce
around some other principles (inaudible) Chafee and Senator
(inaudible) and Cooper and some of the other plans, that they
should get together.and (inaudible). ·00 you have any .
commitment at this point (inaudible) from your cosponsors
that they also believe that·. universal coverage (inaudible)
bottom line?
.
, MS. CLINTON: I've been at several public forums
with Se'nators Chafee and Kasselbaum and Dole and Danforth in
which they all claim that that is their objective. You know,
I' have no reason to doubt them whatsoever. I think that
Senator Chafee has studied this issue for a very long time.
I think he is committed to universal coverage. I have no
r:eason to doubt that he is.
Q
Do you feel that you're not concerned about the
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p'zt.~spect that they might at some point decide (inaudible)?
MS. CLINTON: Not unless the other plans can make a
more credible case for achieving universal coverage .. You
know, there's a big, difference between insurance market'
reforms that don't achieve universal coverage and a
commitment to an individual mandate that 'will achieve
universal coverage. That is a huge leak.
,You know, that is why ,when
that are in the same ballpark as the
plan is there in terms of its stated
covera~e and its willingness to have
it.
I talk about those plans
president's, the Chafee
commitment to universal
a mechanism to achieve
You know, the individual mandate is a mechanism for
achieving universal coverage. That is very different than
insurance market reiormswith no real design for helping
p,eople make sure they're covered once those reforms, are in
effect.
Q Getting back to your (inaudible)
plan. Originally~ the task force (inaudible)
it (inaudible). It seems that (inaudibie) is
there are other types of cost controls in the
been, I think, described in (inaudible).
the president's
the pli:m called
gone,that
plan that have
Could you please confirm that there is no '
(inaudible) in the president's plan ar;d explain (inaudible)
that could or could not (inaudible) health care? (Inaudible)
what is the negotiating end (inaudible)?
MS. CLINTON: There, is no global budget. The
guaranteed benefits package will serve as the baseline for
determining what premium increases should be permitted, which
~is not so different, if you think about it, between what
large purchasers of insurance do now and what state insurance
commissioners do when insurance companies come in and ask for
increases.
I mean, I've been sort of surprised by the kind of
stir that the insurance companies have raised about this when
every day in every state they are in appearing before ' '
insurance commissioners to get increases in their rates.
That's what they do. Nobody thinks.tpat's out of the
ordinary.
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Where it hasn't worked is because you have 50
'states with " you know, hundreds and thousands of insurance
companies.
There hasn't been any capacity for
comparing apples to apples because if insurance company X
offersiO policies withdifferel'lt benefits sold to different'
kinds of businesses and insurance Yoffers 20 policies with
different benefits sold to, you know,as many different
businesses as individuals that they: can market to, there's no
way for the insurance commissioner sitting in any state to
make those determinations.
They have to go on the kind of grossest of
measurements so that, you know, you've got a situation like
Empire in New York and, you know, the insurance commissioner
doesn't know how to even evaluate whether what is being ~.:told
to them is accurate or not. When you have a comprehensive,
benefits package, which is the same benefits for everybody in
the country, WhlCh has an actuarlal valueasslgnedon the
average which then can go up or down in comparison to the
base that has been established, depending upon the region of
the country where you are, you have a much better and clearer
way of determining what is a fair, reasonable increase in
premiums. That is all we are talking about •
•
_
•
I
•
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.)
I mean, they try to make it sound like there is
some great big apparatus out there 'that is going to be, you
know, making all of these determinations. Well, what we are
attempting,to do, is to rationalize what goes on now in 50
states when insurance commissioners make these kinds of
de.terminations but can' t do it because there's no way of .
having a baseline that exists on which they can make those
jUdgments.
.
NOw, if a particular health plan is bidding for the
business of the people in a particular region, just as what
happens now when Calpers (phonetic) goes out for bids, when
the state employees in Minnesota are put out for bids, when
the federal employment planners goes out for bids, or when
your employers go out for bids, we will all know what we are
asking that. be bid upon because we will have this set of
benefits. '
There will be some historical experience that can
be looked to~
. Most regions of the country and most
health plans will not have any trouble living within whatever
the' backstop budget happens to be because there is so much
money in the system right now, and don't forget, we are going'
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to be adding money to it. Under this plan, we go from 13
percent of GOP to 17 percent of GOP within 5 to 6 years
because you've got billions of dollars flowing into the
system for new payers.
So that, you know, I don't think that these horror
stories that are trying to be created are in any way fair . .
Yes, it is true, but we are going to try to. have some .
budgetary discipline imposed upon insurance pricing practices
when it comes to premiums for the guaranteed benefits
package. There will still be an insurance market for
everything over and above the comprehensive benefits package
because we don't have a global budget.
. There wi'll be, I would imagine, a growing market
for long term care insurance because although we're going to
try to fund the infrastructure for long term care, there's no
way we can meet what will be the increasing need of an
elderly population.
"
So there's going to be a lot of insurance markets
left that will be basically back into the 'same bailiwick of
comparative pricing that we now look to states to try to
achieve on their own. We're only talking about the
comprehensive benefits package.
Q (Inaudible) of business'and the reliance
(inaudible) and the alliance (inaudible). They have the
power over the employees to deny that increase?
MS. CLINTON: Yes. They have the authority to 'say
why is it that of all the health plans ih this region, you're
the only one who can't stay within a reasonable rate of
increase? Maybe you all need to take a harder look at how
you're doing business. We think that's very appropriate.
That's what is done with, you know, insurance departments
making judgments about insurance prices alI the time. .
There are a variety of tools available to any
health plan. You know, we're not going to ordain what they
d9, but there are a number of things that have nothing to do
with delivering the. benefits or guaranteeing quality because
the benefits have to be delivered. If they cannot deliver
the benefits, then they will have to be others who will fill
that void. We expect that to happen. That's what
competition is about.
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For example, if you go into regions of the country
now where the cost of medical care is three times or two
times what it is in some other region -- compare Miami to San
Francisco. They are both metropolitan areas. They, both have
concentrations of high cost health care patients. Yet, the
medicare costs in Miami are two times what they are in San
Francisco. That says to those of us who look at this data
Miami needs to get more efficient.
,Now we're not going to come ,in and say immediately
to Miami you've got to charge what San Francisco charges. We
know there are regional differences, but over time we need to
get to a more uniform ,national standard of what it should
cost to take care of somebody in all parts of our country.
,
There is no justifiable validation for the
''
disparities in costs that have to do with matters unrelated
to medical care ~ike practice styles, for example, or, you
know, just as a custom that in some communities if you have,
you know, a temperature above a certain degree~ you go into
the hospital or whatever, when in other communities you're
taken perfectly good care of with antibiotics at home.
So those are some of the issues that the health
plans and the insurers are going to have to look at more
carefully than they, have in the past.
, Q Mrs. Clinton, do you think health care reform
needs to address the question of medical care that's given in
the very last stages of life when there's no hope that a
person can pull through, basically just keeping somebody
alive? Along those lines, how do you feel about living
wills? Do you have one yourself?
" M S . CLINTON: ,We are going to sign a living wiil.
We're looking for an opportunity actually to do it and then
to talk about it publicly. We're not going to sign it in
front of you guys, but, you know, we're going to'talk about
it. Yes, we really do believe, in that. We're trying to
encourage advance directives' in living wills because we think
they're important.
See, I think that we will be able to start having
the kinds of conversations we need to have about such issues
once everybody has health security. It's hard for me -- I
mean, I am very torn about this because anyone who has looked
at it can see that there are expenditures that are made in
situations where it'is perhaps inappropriate and is not -
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it's only prolonging the inevitable.
who has looked at these' figures.
Everybody knows,that
But'.on the other hand, there's another figure which
j-ust haunts me which is that an uninsur~d person who shows up
at the hospital with the same ailment as an insured person is
three times more likely to die. I don't know how you can
start talking about making hard decisions until everybody has
health security and., until everybodyls covered.,
I mean, universal coverage is not just 'to take 'care
of all ,of us and to do it in a way that is responsive to our
needs. It,'s not just for economic purposes and to get the
deficit down. There's a moral imperative in universal
coverage.
I mean, we should not have a country as rich as
ours with the high quality medicine that,' is available to some
but not all and that none of us is secure until all of us is
secure.; There's not one person in this room who, in good
conscience, can say you will have the 'same. health insurance
at the same price next year.
until everybody is in the· system, to have a
conversation about who'we will make judgments about strikes
me as inappropriate because who is, most' likely to be ,the
subJect-' of our judgment? Those the least powerless, those,
you know, ones that don't have access now, those who are
uninsured and walk through our doors, those who have no
family that show up and advocate for them.
But once we have health security for everybody and
once we have advance directives ,and living wills being talked
about and understood for what they are ,,' which is to try to
provide this kind of guidance"then I think we will begin to
have the kind of conversation you allude to.
; Q If I could just follow ~p: If you could just
exp'lain! why you and, I take it, the' president will sign
living wills (inaudible). What. are your reasons?
, M S . CLINTON: Because I think that it is the
fairest and most responsible action to take on behalf of
those who are going to be put in a position of being .asked
har,dquestions when a loved one is :in a comatose situat,ion,
unable to speak or act Ior him or herself.
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.
I mean, you know, many of the situations I know
about -- oftentimes it's agonizing for family members who C3.re
brought together because of a tragic ~ccident or the last
stages of a painful illness to know what they're supposed to
do. Nobody likes talking about death. But if we do it in
the context of providing guidance to help those who are left
behind make the right decisions, the decisions that you would
want made, it becomes an easier conv~rsation to have.
,
I think it is really what we need to be doing as a
nation. You know, we have this miraculous medical technology
but we ~eed now to put it into a moral and ethical and
personal context so that when it happens to all of us, as it
will at some point, we have some thinking,about it that will
help guide our decision.
,
Q Mrs'. Clinton, (inaudibl~) plan has somehow
proved to ability to pay income (inaudible) individual level.
Why not (inaudible)?
.
MS. CLINTON: ,Well, we are doing something with
Part B premiums with respect to, you know, some of the
benefits that are currently in medicare. In fact, we think
that that's appropriate. 'But I just guess I fundamentally
disagree that universal health care coverage should be means
tested •. I think that it ought to be key to ability to pay,
which is why we provide subsidies and discounts; I mean, if
you want to call that means testing.
I guess you could because clearly, you know, for
those who are low-wage employersand,employees, we are trying
,to make this affordable so they can participate and.
contribute, and the same with people who" are currently
medicaid eligible. When they go into the universal system,
under that plan, if ,they work, they Will contribute. We'
b~lieve in having people paY,their fair share.
Q You said that about younger people (inaudible)
very wealthy medicare recipients who are not paying wha~
others (inaudible) which is more than what they pay for their
health care.
MS. CLINTON: . But we're moving in that direction.
The budget plan of last year began to increase cost in
medicare for high end recipients, 'and the health plan does
too. So I mean, we're moving i~ that direction. But I mean,
I think you've got to recognize that there's a difference
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between trying to achieve community rating, which means that
you no longer discriminate against people, which is what we
have done under our existing insurance system.
The discrimination has run against the older and
the sick to the benefit of the young. I ,think that to have
insurance mean what insurance is supposed to mean in a
private system, what this will, you know, largely remain,
~hen you've got to end the discrimination.
So I don't know that as we're attempting to achieve
community rating we want, in the universal system for those
under 65, to start introducing new ways of making it possible
to discriminate against certain members of the population.
We want to get back to the old-fashioned idea of insurance
which is everybody is in the community pool.
We want to end cherry picking. We want to end
experience rating. We want to end lifetime limit. We want
to end elimination or limitation of coverage for preexisting
conditions. If you reintroduce categories that are going to
be charged more based on all kinds of other factors, we're
going to be right back down that slippery slope, in my view.
NOw, we know that rich people are going to probably buy more'
health care, just like they always have.
But if we've got a good floor below, which nobody
f#11Is, then I think we are secure in believing that we at
least have universal coverage with .comprehensive benefits for
everybody. And then if some person wants to have lO,plastic
surgeries a year, there's no local budget or other kind~of
limitation on their capacity to spend their money as they
choose.
,Q
(Inaudible)
MS. CLINTON: I think there might be some room for,
discussing the second but not the first. 'This idea that you
can postpone universal coverage is ~roubling to me because
part of; the reason why we want to achieve universal coverage
is to begin to control costs in the public sector. And one
of the great dangers we curren1;:ly face is this idea that
somehow you can cap the entitlement,s or you can have a
balanced budget amendment that will only be balanced on the
backs of health care and that means on the backs of medicaid
and medicare, and expect to achieve universal coverage
through that route. You can't do it. You can't 'even achieve
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~eal health care reform.
:' "
What you can do is to begin increasing the downward
pressure on the public program which will throw more people
under the uninsured list, which will do nothing to contiol
the cost in the private sector, which will lead to an
explosion in the deficit unless we just decide we're 'not
going to take care of people on medicaid anymore or that
we're not going to try to meet our obligations under
medicare.
,I,.
So I think this is all of a piece. I mean, until
we get universal coverage, we don't have real budgetary
discipline in the federal budget. We don't have the kind of
control·over expenditures in state and local budgets, and we
don't have the kind of focus on making our health care system
more efficient than we need in order to get the whole system
under better control.
'i'
But with respect to the rate of growth of premiums
in the future, depending upon what the negotiations during
the legislative process look like; that might be ~omething to
consider. I mean, I have said repeatedly that we think,it's
important to start with a tough target because if we don't,
we will never get ther~.
1
And if you looked at the history of health care in
this country and the amount of money that has been spent,
which has very little relation to either extending coverage
adequately or providing benefits, we can keep spending more
and more money for less and less of what we should be buying
with that money. So I think you've got to have tough
budgetary targets.
.
But we've worked with' a number of economists who
have asked. us to consider different rates of growth·after we
get the savings out of the system in the.. out years, and, you
~now, we're open to that.
Tl1at's something that -- but I
think everybody has to know the implications of what. the
impact on the deficit and the like is.
It's' imperative that if we're going to look at
budgetary targets, that we understand how you've got to do
all of this as a whole. You cannot decrease the rate of
growth in medicaid and medicare, wait for the savings to kick
in, and then :expect to get caught up in achieving universal
coverage. So we b~lieve all this has to be done at the same
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time in order to achieve what everybody claims are their .
stated goals.
QMrs •. Clinton, do you think (inaudible) the
disinformation and misinformation out there from the
insuranee industries?
MS. CLINTON: Oh, heavens no, but I expect we've
caused them to spend a whole·lot more money than they were
gqing to spend. It's interesting to me, you know, if they've
got all that money to spend on these misleading ads, I find
it hard to understand how badly they're going to be hurt by
changes in the insurance market.
Q (Inaudible) tone seems to vary from the tone ·of
"come let us work together" some weeks to a more critical
tone ~xplicitly for the size of the insuranc~ industry and
pharmaceutical companies. Does that have a conscious
strategy or is that just sort of what you happened to notice
somebody saying. (inaudible)?
MS. CLINTON: Weli, I thfnk it's .more about how I
assess what's going on from week to week. I mean, we .
absolutely mean that we intend t,o work with everybody, and
there'sta lot of division among all of these groups. I mean,
I saw the press release that the Alliance for Managed
Competition put out dumping on ~heHIAA last week. They
don't agree with them. . .
.
I mean, I just think it's important to point out
:these differences and·to make distinctions. And I think when
somebody puts on $6.5 million of advertising and it goes
unanswered, that's a ~istake.
Q
(Inaudible)
MS. CLINTON: I don't know because if you go back
and read the book which they put out, and I wish you would,
called "A Mandate for Change;" their chapter on health care
reform says you have to reach universal coverage. So you'll
have to ask them.
'
Q Are you
disappo~nted
in them?
MS. CLINTON: No, I'm not disappointed in them. I
just think that if you go back and read what they wrote as
the blueprint for their position on health care, we think
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we're ri'ght there. So I don't know quite how they got off on
this track that they're on, and we hope to have some
conversations with them in the next couple of days, maybe, to
figure it out. But, you know, maybe they just haven't gone
b'ack and read their own book lately.
Q Mrs. Clinton, you've talked (inaudible). I'm
wondering if you have (inaudible). I'm wondering if
(inaudible) when your father was ill a few months ago, right
before (lnaudible). Did you ever invite him to go over the
hospital bills and just say what would have fit-under my'
(inaudible) benefits package and what would I have missed?
Could you maybe give us your reflections on that? What was
covered for him and what not?
MS. CLINTON: My father was on medicare and we're
not chartging the medicare system.
Q
Was there any other supplementary
ins~rances?
MS. CLINTON: Yes, they had supplemental insurance
and it was mostly covered.
Q
(Inaudible)
MS. CLINTON:
Q
Sure._
(Inaudible) government regulations?
MS. CLINTON:
We'd be glad to.
We'll put that·
together.
Q (Inaudible) is making the assumption that
people's behavior will change so they'll go and get their
check-ups and their annual (inaudible) mammogram (inaudible)
illness or that they'll start going to the doctors, to the
emergency room.
How do you know people are actually going to do
that? People get really (inaudible) in their ways in dealing
wiith -the medical (inaudible). Is there any way to predict
.that this will really actually happen?
MS. CLINTON: Absolutely. There's a lot of
evidence of it. I mean, I saw .that with my own eyes. Just a
few weeks ago, I.went up to the south Bronx where they are
running a managed medicaid system and talked with patients.
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Put yourself in the position of a medicaid recipient' in the
south Bronx, the poorest congressional district in America.
You're told here is your medicaid card, go get your health
care.
Now there are a lot of providers who won't honor
medicaid cards. You've got transportation problems. You've
got language problems maybe. So you end .up at the emergency
room of ithe Lincoln Hospital, which was the sort of funnel
for everybody who was poor, which was much of the population.
They put in a managed care medicaid system.
Everybody was ,told they had a doctor. They were given a 24
hour telephone number to call. They were actually given more
visits than they could have afforded to have if they had 'gone
on a fee-per-service kind of personal journey of their ciwn.
In talking to these recipients, what struck me was that for
the first, time, their medical care was being structured for
them.
It's very difficult. I mean, it~s hard for any of
us sometimes to know where we're supposed to go to getwh~t
kind of care we might need or who's a good doctor if you move
to a new town. For the first time, the people I talked with
felt confident that their medical needs were going to be
taken care of. The way that the care was being managed,' they
were actually getting more services than were available if
they:weFe just out there on their own.
My mother told me, you know, her daughter got sick
in the middle of the night and she ,had a number to call. She
was very proud. She pulled out her card and she said, "I can
call this number. My doctor is always there." She called
this doctor and he walked her through what the problems were.
·Inthe past, she would have just grabbed the baby, gone to
the emergency room and waited a couple of hours and ,then, you
know, would have gotten whatever car~ she got at a cost less
than what was really the going rate for emergency care.
There's many examples like that allover the
country. So I think if you'Ne got the comprehensive
benefits, if they are well publicized, as they will be,if
people know what theY're available, if many of the preventive
'services that we are most concerned about people getting will
be free, as they are under this plan, utilization on the
front end of health care will go up and on· the back end
should 'start going down. I think that there's a lot, of
evidenc:e to support that.
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(Inaud~ble)
Q
,
,
MS. CLINTON: Well, like the bills that have - you
know, like the bill in ,Colorado and someothe,r plac~s that's
introducing such a bill.
Q
Is' that something, that" you would advocate?
MS.' CLINTON:' It's something I persona11y. advocate,
yes.
Q
What about (,inaudible)?
,:
"
MS. CLINTON: I think we have to look at a whole
range of proposals that are being actually considered and
legislated in the states, and try to see what might be
appropriate at the national level.
, Q Ms. Clinton, one of the concerns of Children's
Hospital, (inaudible), the same hospital, in fact, and
(inaudible) of. your plan (in~udible) providers (inaudible)
birth defect situations (illaudible). 'Is there any rule·tor
flexibility on that end that may be' given, from (inaudible)?
MS. CLINTON: I'm surprised you say that. I spoke
to the pediatricians last week. We've had constant, '
c6'nversationwith the Academy of Pediatrj,cs and with the
National Association of Children's Hospitals, and I'm not
aware of those 'concerns. I'll have to' look into them..
..
,
Q The same hospital (inaudible) will be here
tomorrow 'complaining -- well, not complaining, raising ,
questions about the plan and where they feel that they might
have some trouble on t h i s . '
concerns.
MS. CLINTON: I'll be g:J.ad to listen to, their
They didn't raise those with me.
Q I think you were talking about comparisons of
medicare costs between San Francisco and Miami, that there
shouldn't be any difference between them. "Isn't it 'a fact
that the large Miami population of the elderly who are
responsib:~:e in large measure for a la~ge medicare?
MS. CLINTON: No, because if you compare medicare
costs, which is what we "ve 'done,' thep you're taking care of
the elderly. ,There's no -- it's not just Miami and San
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Francisco; it's Boston and New Haven that -- you know, you.
could take these differences allover the country. ,Walter
Zelman (phonetic), who is here, who has be'en one of the -~
(End qf'side two of tape o.ne.)
MS.' CLINTON: --makes this point. It basically
says that some areas -- and he's a health economist at ,
Princeton who has looked at all this data. He says there's
no justification for the difference in costs in most of these
regions. Yet, the medicare system, what it has done is to
build in the inef.ficiencies. I mean, if it costs X this year
and your costs. keep going up, you get X-plus. But if your
costs g6 down because you become more efficient, you get
penalized.
'
:: j
So there has been no incentive in the existing
medicare system to make the changes that would make the
delivery system more effective. So we'll get you that piece
because,I have never quite seen it presented so clearly the
way that he did.
Walter, ,did you want to add anything?
,
Q, I think,costs vary by nature'of the population.
They vary by costs ,of inflation in different areas. You were
talking about things that are otherwise constant. The same
kinds of things will cost -~ the same procedures will cost
much more -- the same procedures will be done three or four
times (inaudible) move in one area versus another
(inaudible) •
MS. CLINTON: Somebody who hasn't asked a question
because we're getting near the ,end of O\lr time. I don't want
people to be left out. Yes?
Q Mrs. 'Clinton, the purpose (inaudible). Yet,
there has been discussion in the past of the fact that ;
medicare is (inaudible) certain other segments that are:, not
immediately (inaudible) sobriety (inaudible). I also wonder
about supplemental insurance. 'You talked about allowing
people to or allowing systems to compensate for benefits that
cannot be provided (inaudible) through supplemental plans.
, Aren't you opening a door for another level ,of complexity
(inaudible) decreasing costs, cost shared benefits? As you
know, the medicare system's real '(inaudible) supplemental
costs (inaudible).
'
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MS. CLINTON: We think tha~'s happening. I mean,
the states are getting a much better handle on it. You know,
that's beginning to sort of shake ,itself out. with this
comprehensive benefits package, there will be very few needs
that will be unmet.
Togo back to your question, I.can't think of
that is not going to be covered except the obvious
things that are left out like, you know, cosmetic surgery
and, you:know, maybe some extensive mental health benefits,
~dult dental, adult vision.
Those are things that if
'
individuals wish to buy in the open market, they're not huge
expenditures on an individual basis. So we really don't see
that that's going to in any way undermine the basic budgetary
integrity of the comprehensive package. We've looked at
that.
~nything
with respect to the supplemental market or the
elderly, that's becoming better regulated and will continue
to be better regulated to weed out the unscrupulous and to
make sure that what people are buying is what they're
getting'. So I think that that -- we've looked at that. I
think we've got that -- we have confidence that that will
work out all right..
.
Q About 40 years ago on. the same (inaudible) were
Cjlble to see (inaudible) by presenting a lot of money and
basically presenting the negative (inaudible). That seems to
be (inaudible) now. One alternative that you haven't
discussed is not doing something. In that respect,
(inaudible). How do you get the public to focus on the
positive (inaudible)?
.
MS. CLINTON: Well, I think that's what we're
engaged in right now. We're obviously disseminating this
information as broadly as possible. We're raising the level
of awareness on the part of individuals. I have no doubt
that the forces of the status quo will dig in their heels and
do everything they can while praising the potential of
reform, trying to undermine it ever being enacted.
I
,I
.
'
'.
.\
But I think that there's going to be much more
for it and there's much more insecurity now because
the costs are affecting everybody. I mean, this is a debate
about everybody's health ·security, not just about a
particular group or class of people. As. that message really
sinks in on people, I think it's going to be apparent where
pressur~
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"
their
self~interest
lies.
If the forces are weighed against the form, you
know, want a real batter in which their self-interest is
'exposed and their real agenda is made public, they'll get it
because I think there's a lot at stake.' We're going to make
sure that people are as informed as possible.
Q Mrs. Clinton, I just wanted to clarify
something, getting back to the living will. I'm just curious
abqut something. You didn't actually say ,what you would
specify as your wishes. I just wanted to ask you that.
,MS. CLINTON: Well, I don't know yet. I'm not sure
I'll ev~r tell you that. I'll' just tell you that I've done
it. I don't know that that's the kind of thing I would
publicly talk about.
Q
Okay, thank you.
Q Are you expecting' to have to fight the doctors
at some point in this? You took on the insurance industries,
the pharmaceutical industry in the spring. You took after
the insurers. Now are you going to have to come out hard
against the doctors?
MS. CLINTON: I don't think so. I don't think so.
I mean, if you looked at the major physician groups that are
already supporting us, by and large, I mean the
pediatricians, and the family physicians, and the general
practice, and the general interns, and the OB-GYNs, and a lot
o'f the other groups that have signed up and said that they
are, you know, largely supportive of what we are doing, and
they miC.;rht have a particular, issue or two that they would
like to see cha~ged~ but, you know, they are generally in
agreement.
' "
'
If you even look at the issues that we've narrowed
down with the AMAs, I don't think there's any reason to take
on physicians or any of the other health care professionals.
They all deal in universal coverage. Most ,of them -- in
fact, I can't think of one that doesn't support the
employer/employee mandate.
On the big issues, the difficult political issues
they're there. They might have,a wrinkle on what they think'
should be emphasized in a particular way, but, you know,'
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29
that's the kind of issue we're willing to work with them on.
5,0 I don't have any problem with that.
Q
(inaudible)
MS. CLINTON:'
Q
Absolutely.
(Inaudible)
MS. CLINTON: I don't know. I might take a long
trip to New Zealand. I think that this is so important.
Unless the president asks me to do something else, it's what
I·'m going to work on. .Ican't think of anything more
i'mportant or more rewarding to work on.
I feel like to some extent I have committed myself
to all of the literally thousands of people that I have met
and talked to who have shared their personal stories with me.
I have their pictures running through my head all the time,
and I don't think I could back out on them.
I think that they expect that the president will be
able to change this system and that all of us will be better
off when we do. I'agree with that. So I'm going to work as
hard as I can to make it happen.
Thank you all.
See you all later.
* * * * *
'I.
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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
A name given to the resource
Lissa Muscatine - Press Office
Creator
An entity primarily responsible for making the resource
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
An unambiguous reference to the resource within a given context
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
Extent
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1,324 folders in 27 boxes
Text
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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
A name given to the resource
FLOTUS Statements and Speeches 9/21/93 - 11/22/93 [Binder]: [Health Care Reporters 11/8/1993]
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 13
<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
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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
Publisher
An entity responsible for making the resource available
Clinton Presidential Library & Museum
Format
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Adobe Acrobat Document
Medium
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Reproduction-Reference
Date Created
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11/26/2012
Source
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2011-0415-S-flotus-statements-and-speeches-9-21-93-11-22-93-binder-health-care-reporters-11-8-1993
7431941