President Obama Holds Online Town Hall on Health Reform

By | September 1, 2019

(applause) Governor Kaine:
Thank you — thank you
and good afternoon. It’s a treat to welcome everyone
here to Northern Virginia Community College, the second
largest community college in the United States. And — (cheering and applause) And the largest trainer
of health care workforce professionals in the
Washington-Metropolitan area. I want to thank Bob Templin,
the President, and Glenn DuBois, the Chancellor of the
community college system, for being such
great hosts today. We also are joined by numerous
elected officials and I will not name them all, but we’ve
got federal, state, local; from Boards of Supervisors to U.S. Senators here on such an incredible topic, and
we’re so glad to have them. The President’s had plenty to do
in the last five months as you all know, working to bring
our American economy back, properly arrange our affairs
vis-à-vis the rest of the world, regulate credit cards, regulate
tobacco so that our kids will be safe, so many issues;
pay equity for women. But in the massive issues, he
has not failed to pay attention to Virginia. And, in fact, he’s not failed to
pay attention to Fairfax County. In February, he and I stood
together at the eastern edge of the Fairfax Parkway, a long
designed and long dreamed project that still was not done,
and we talked about the Recovery bill then pending
before Congress. And thanks to the support of our
representatives from Congress, that bill was passed,
the President signed it. And today, of the dollars going
to Virginia for transportation infrastructure from
the Recovery Act, the single largest project is
two sections of the Fairfax Parkway. That happened because
of this President. (applause) And in May, at Mt. Vernon,
I stood together with Lisa Jackson, the President’s
EPA Administrator, as she announced a first —
the first ever Presidential Executive Order about the Chesapeake Bay, coordinating all the activities of numerous federal agencies to truly save the Bay. It was a historic
day, and again, it happened because
of this President, right here in Fairfax County. So, today we’re here now to
talk about an important issue, the issue of health care. We’ve done some wonderful things
in Virginia but we’re working at the margins. Because in Virginia
and in the nation, one in seven of Americans and
one in seven Virginians don’t have health insurance, and those
that do have health insurance often find serious difficulties
in cost and access and quality and our President is joining
us today to talk about that, and it’s so great to be
able to welcome him here. I want to introduce a very
special individual who will be the moderator of the session
today as the President gives remarks and then
takes questions, both from the audience and from
previously submitted questions. Valerie Jarrett is the Senior
Advisor to the President, who is — both the Senior
Advisor and Assistant for Intergovernmental Affairs
and Public Engagement. Ms. Jarrett is a long time
friend of the President’s, who’s worked in numerous
capacities in both the corporate and philanthropic worlds in
Chicago prior to coming to Washington. But a particular
note: This topic — the need for health
care reform — is one that she
knows a lot about. She was the Chairman
of the United — of the University of Chicago
Medical Center Board of Trustees, working both on
medical school training — training of health
professionals — and Provision of Care through
the University of Chicago Hospital. So would you please join me in
giving a great Northern Virginia welcome, please,
to Valerie Jarrett. (applause) Ms. Jarrett:
Thank you, Governor Kaine, and good afternoon, everybody. We’re just delighted to have you
all here at President Obama’s health care reform ceremony — service that we’re going to have here. And we’re going to really
try to get everyone engaged. I want to first start by
thanking the people from the Northern Virginia
Community College. We have students, we
have administrators, faculty and staff; thank
you all for being here. We look forward to
your participation. Also, all of those who are here
from the Annandale community, a community that has been very
hard hit by the health care crisis that we face
here in America. So as health care reform
moves through Congress, it’s very important to President
Obama that we take the time to engage the American people. We want to engage them
and hear their questions, we want to engage them and
have the President have an opportunity to answer
their questions. And so in addition to the
people who we have here today, we are also live streaming this
session over the Internet. We want to make sure that
everybody has a chance to kind of get in the action
and participate. So we’re going to have a
multidimensional session, if you will. So, three different ways. First of all, we’re going to
have a chance to hear the video responses to the questions that
were put to us here today. Over the weekend, the President
did a YouTube video and he asked and he solicited questions, and
so we’ll have video questions first. In addition, the White
House is doing a live chat, both on our,
and we’re also doing it on our Facebook page. And my guess is that we’re going
to also have some questions coming across from Twitter. So all that’s going to be going
on while the President is asking questions. And so if you see a nice
gentleman named Macon come across the stage and hand me a
question in the course of it, it’s because we’re getting just
in time information coming across. And then, of course, we want to
hear from those of you in the audience as well. So the audience, the Facebook,
as well as the videos, all coming at us
at the same time. And so let’s get started. Without any further ado, I’d
like to introduce to you the person who’s first priority is
passing health care reform this year, please welcome to our town
hall, President Barack Obama. (cheering and applause) The President:
Good to see you guys. Thank you, everybody. Thank you. (cheering and applause) Thank you, Northern Virginia. Thank you very much. Thank you. Everybody, please have a seat. Have a seat. What a wonderful welcome. And I’m so grateful to all of
you for taking the time to be here. A couple of quick
acknowledgments. First of all, I want to
thank President Templin and Chancellor DuBois for their
wonderful hospitality. We are grateful to both of them. We’ve got some extraordinary
elected officials — a few that I want to mention. First of all, you’ve got one
of the finest governors in the country, who also is doing
a great job as DNC chair. Please give Tim Kaine a
big round of applause. (applause) Part of the reason Tim is such a
good governor is because he took notes while being lieutenant
governor to the former governor and now senator for
the state of Virginia, an outstanding public
servant, Mark Warner. (applause) And three outstanding members
of Congress: Bobby Scott, Jim Moran, and Gerry Connolly — thank you so much, guys, for the great job you do every day. (applause) So I know there’s all kinds of
stuff Valerie was explaining. Don’t worry, she’s in charge,
so she’ll organize us. I just want to give a few
remarks at the outset, and then we’ll save most
of the time for questions. First of all, it’s wonderful
to be here in Annandale, and I’m looking forward to
answering questions about what is obviously one of the most
important issues facing American families, American businesses,
and the American government. But before I begin, I just want
to say a few words about where we are as a nation and
where we need to go. We’re living through
extraordinary times — I don’t need to tell you. This generation of Americans
— our generation — has been called to confront
challenges of a magnitude that we have not seen in decades,
perhaps unlike anything we’ve seen in recent history — challenges that few generations of Americans are asked to face. In addition to the immediate
threats that we face — we’ve got two wars going on
and a very deep recession — our economy has also been
weakened by problems that have plagued us for decades: the
crushing cost of health care, the state of our schools, our
continuing dependence on foreign oil. Now, I know there are some who
say we can’t tackle all of these problems; it’s too much;
Congress can’t handle it; the President is
juggling too many things; my administration is taking
on too much too soon; we’re moving too fast. What I say is that America has
waited long enough for action on these issues. It’s not too soon to fix our
schools when we know that if our children are not prepared they
are not going to compete in the 21st century. It’s not too soon to wean
ourselves off of dirty sources of energy so that we can grab
hold of a clean energy future. We’ve been talking about clean
energy since Richard Nixon. And it’s time for us to act. And I congratulate, by the way,
the House of Representatives for beginning action this past week
on a historic clean energy bill. It’s also not too soon to
reform our health care system, which we’ve been talking about
since Teddy Roosevelt was President. We are at a defining
moment for this nation. If we act now, then we can
rebuild our economy in a way that makes it
strong, competitive, sustainable and
prosperous once more. We can lead this century the
same way that we led the last century. But if we don’t act, if
we let this moment pass, we could see this economy just
sputter along for decades — a slow, steady decline in which
the chances for our children and our grandchildren are fewer than
the opportunities that were given to us. And that’s contrary to
the history of America. One of our core ideas has always
been that we leave the next generation better off than us. And that’s why we
have to act right now. I know that people say the costs
of fixing our problems are great — and in some cases, they are. The costs of inaction,
of not doing anything, are even greater. They’re unacceptable. And that’s why this town hall
and this debate that we’re having around health
care is so important. Let me just give
a few statistics. Many of you already know these. In the last nine years, premiums
have risen three times faster than wages for the
average family. I don’t need to tell you this
because you’ve seen it in your own lives. Even if you’ve got
health insurance — and 46 million people don’t — if you’ve got health insurance, you have seen your costs double. They’ve gone up three
times faster than wages. If we do nothing, then those
costs are just going to keep on going higher and higher. In recent years, over one-third
of small businesses have reduced benefits and many have dropped
coverage altogether since the early ’90s — not because small business owners don’t want to provide benefits
to their workers, but they just simply can’t afford it; they don’t have the money. If we don’t act, that means that
more people are going to lose coverage and more people are
going to lose their jobs because those businesses are not
going to be competitive. Unless we act, within a decade,
one out of every $5 we earn will be spent on health care. And for those who rightly
worry about deficits, the amount our government spends
on Medicare and Medicaid will eventually grow larger than what
our government spends today on everything else combined — everything else combined. The Congressional Budget Office
just did a study that showed that when you look at the
rising costs of entitlement, 90% of it is Medicare
and Medicaid — it’s not Social Security — 90% of it comes from the federal share of health care costs. So if we want to
control our deficits, the only way for us to do it is
to control health care costs. Now, those are all abstractions,
those are numbers. But many of you know that
this translates into pain and heartache in a very personal way
for families all across America. I know because during the two
years that I campaigned for President every town
hall meeting I had, people would raise horrible
stories about their experiences in the medical system. And now that I’m President, I’m
hearing those same stories. I get 10 letters a day — out of the 40,000 or so that the White House receives, my staff selects 10 for me to read every single day. And at least half of them relate
to a story about somebody who has been denied coverage because
of a preexisting condition, or somebody who finds out that
what they thought was going to be a $500 bill ends up
being a $25,000 bill. I was at a town hall meeting
in Green Bay, Wisconsin, met a young woman, 36 years
old, has breast cancer that’s metastasized. She’s got two small children. Her and her husband
are both employed, both have health insurance, and yet she still has $50,000 worth of debt. And all she’s thinking
about right now is, instead of thinking about how
to get well, she’s thinking, if I don’t survive this, my main
legacy to my children may be another $50,000 worth of debt. Everybody here knows
stories like that. Some of you have experienced
them personally. So this is a problem that
we can’t wait to fix. It’s not something that we’re
going to keep on putting off indefinitely. This is about who
we are as a country. And that’s why we are going
to pass health care reform — not 10 years from now,
not five years from now; we are going to
pass it this year. (applause) That is my commitment. We’re going to get it done. (applause) Now, we’ve already started to
see some progress in Washington. Those who said we
couldn’t do it, they’re already being surprised,
because as a consequence of us pushing, suddenly the drug
companies and the insurance companies and the hospitals, all
of them are starting to realize this train’s leaving the
station, we better get on board. So just a few weeks ago, the
pharmaceutical industry agreed to $80 billion in spending
reductions that we can use to close the so-called
“doughnut hole.” Some of you know what the
“doughnut hole” is, right, where senior citizens who are on
the prescription drug plan under Medicaid, they get their drugs
reimbursed up to a certain point, and then suddenly there’s
a gap until it reaches thousands of dollars in
out-of-pocket costs. And so we’ve struck a deal
with the drug companies; they’re willing to cut those
costs for seniors in half. Already we’re seeing that when
we put pressure to reform the system, then these industries
are going to have to respond. Last month, doctors and
hospitals, labor and business, insurers and drug companies all
came together and agreed to decrease the annual rate of
health care growth by 1.5% — that would translate into $2
trillion or more of savings over the next decade. And that would mean lower
costs for everybody, for ordinary families. In the past two weeks, the
committee in the Senate, led by Senator Kennedy
and Senator Dodd, have made tremendous progress
on a plan to hold down costs, improve patient care, and
ensure that you won’t lose your coverage even if you lose your
job, or if you change your job, or you’ve got a preexisting
medical condition. But now we need
to finish the job. There’s no doubt that we have
to preserve what’s best in the health care system, and that
means allowing Americans who like their doctor and like their
health care plan to keep their plan. And that’s going to
be a priority for us. (applause) But we also have to fix what’s
broken about the system, and that means permanently
bringing down costs and giving more choice for everyone. And to do this, we’ve got
to do a couple of things. We have to build on the
investments that we’ve made in electronic medical records. We already made those
investments in the Recovery Act — because when everything is digitalized, all your records — your privacy is protected, but
all your records on a digital form — that reduces
medical errors. It means that nurses don’t have
to read the scrawl of doctors when they are trying to figure
out what treatments to apply. That saves lives;
that saves money; and it will still
ensure privacy. We need to invest in prevention
and wellness that help Americans live longer, healthier lives. We know this saves money. If we can help somebody
control obesity, they are less likely
to get diabetes. And if they are less likely to
get diabetes that means that we are going to be saving a whole
lot of money in hospital costs. The biggest thing we can do to
hold down costs is to change the incentives of the health care
system that automatically equates expensive
care with good care. Now, this is an
important concept, so I want everybody to
really focus on this. We are — we’ve been under the illusion that the more health care we get, the
healthier we become. And it turns out that every
study shows that the question is, are you getting
the right care, are you getting the best
care, the high-quality care, rather than are you having a
whole bunch of tests ordered that are unnecessary, getting
a bunch of treatments that are unnecessary, staying in
hospitals longer than may be necessary — all of which
drives up your costs, but doesn’t make you better. We have to ask ourselves why
there are places like Geisinger Health Care Systems
in rural Pennsylvania, or Intermountain Health
in Salt Lake City, that offer high-quality health
care at costs that are well below average, in some cases
30% lower than in other communities. If they can do it, there’s
no reason why all of America shouldn’t do that. We’ve got to identify the best
practices across the country; we’ve got to learn
from those successes, and then we’ve got to replicate
those successes elsewhere. And we should change the warped
incentives that reward doctors and hospitals based on how
many tests or procedures they prescribe, even if those tests
and procedures aren’t shown to actually make people better,
or if they result in medical mistakes. Doctors across this country did
not get into the profession just to be bean-counters
or paper-pushers, but more and more time that
doctors should be spending with patients are spent on
administration and worrying about how do they deal
with how they’re reimbursed. We’ve got to create
a simplified, more effective system where they
are reimbursed for quality care, as opposed to having to distort
their practices in ways that don’t actually make
their patients better. It’s also time to provide
Americans who can’t afford health insurance with
more affordable options. I believe this is a moral
imperative and it is an economic imperative. (applause) It’s a moral imperative because
in a country as wealthy as ours, if people are working
and holding up their responsibilities, they shouldn’t
be bankrupted just because they get sick. On the other hand, it’s an
economic imperative because every single one of us who
do have health insurance, our families, on average,
are paying an extra $1,000 in premiums for uncompensated care. Hospitals and doctors are adding
those costs to your premiums — insurance companies are adding
those costs to your premiums, even if you don’t know it. And if we can get a system in
which people are getting regular checkups, mammograms, all the
things that we know prevent disease from occurring
over the long term, or at least allow us to
catch those diseases early, that’s going to allow us to
drive down costs for everybody. So what we have been working on
is the creation of something called the Health
Insurance Exchange. And this is going to be a
marketplace which would allow you to one-stop-shop for health
care plans and compare benefits and prices in simple,
easy-to-understand language, and then choose the
best plan for you. None of these plans would be
able to deny coverage on the basis of a preexisting
condition. All of them would
include an affordable, basic benefit package. If you couldn’t
afford these plans, then we could provide you a
little bit of help so that you can afford these plans. I also strongly believe that one
of the options in the exchange should be a public option, in
order for us to create some competition for the private
insurers to keep them honest. If they are in fact giving
good service and providing high-quality coverage, then
that’s where people will want to go. But there should be a benchmark
there of a public plan, non-for-profit plan, that keeps
administrative costs low and is focused on providing
good service. And that way you can make the
decision which deal is going to be better for you
and your family. Now, I know one of the biggest
questions on everybody’s mind is how do we pay for all this,
how do we finance reform? And I have made a commitment,
because our deficit is a genuine problem, that whatever we
do we have to pay for it. This can’t add to our deficits. It’s got to be deficit-neutral
over the next 10 years. Here’s the good news: About
two-thirds of the costs of the reforms that we are proposing
will come from reallocating money that is already being
spent in the health care system but isn’t being spent wisely. So it doesn’t involve
more spending; it just involves
smarter spending. A lot of the money that’s being
spent in the health care system right now adds nothing to
the quality of patient care. And I’ll just give
you one example. We spend right now about
— over the next 10 years, we will spend $177 billion — $177 billion over the next decade — in unwarranted subsidies to insurance companies under something called
Medicaid Advantage — Medicare Advantage. Now, this does not
make seniors healthier. People who are signed up
for this private insurance subsidized program don’t get
any better care than those who aren’t. The subsidies don’t
go to the patients; they go to the
insurance companies. Now, think if we took that $177
billion and helped families so that they could have insurance,
and that we could have preventive care. So about two-thirds of the cost
of the reform we’re proposing is just reallocating money that’s
already in the system you, the taxpayers, are
already paying for. Now, one-third of it we’re going
to have to pay for by increased revenues. And what I’ve proposed is, is
that if we capped the itemized deductions that very
wealthy people do — the top 2% use on
their income tax — so that they’re getting the same
tax breaks as everybody else, as opposed to getting higher tax
breaks because they’ve got a bigger house, then we can
pay for the rest of reform. We’ve already identified $950
billion over 10 years — a little less than
$100 billion a year — in order to pay for reform;
two-thirds of it reallocating money, one-third of it
with increased revenues. That’s a sensible investment
for us to make in solving an intractable problem that has
been dragging down family finances, businesses, and the
federal government for far too long. Now, keep in mind, by the way,
what we’ve identified as paying for the system, that doesn’t
even include the savings that we’re going to get
from prevention, or the savings that we’re
going to get from health IT — because in using
congressional jargon, which I’m never supposed to do
because nobody understands it — it’s not scorable. And what that means is, is that
the Congressional Budget Office can’t identify exactly
how much you would save — even though everybody believes
that it will end up saving a lot of money, we can’t put
a hard number on it. So we will get additional
savings that will drive down costs. In the meantime, the costs of
reform will be paid for with hard dollars that
we’ve identified. So here’s the bottom line. Now we’re going to — I’m almost done here, but this is a big, complicated topic, so
I hope you forgive me. We’re starting to make
progress on Capitol Hill. We’re identifying ways not
only to reform the system, to make it smarter and more
efficient, more user-friendly, better for American families,
but also ways to pay for it in a way that doesn’t
bloat our deficit. But the hardest part
is yet to come — because everybody here knows
that the easiest thing to do when you’re looking at big
policy questions like health care is just to be
saying it can’t be done. And the naysayers are already
starting to line up and finding every excuse and scare tactic in
the book for why reform is not going to happen. This is going on as we speak. And what I say to
these critics is, well, what’s your alternative? Is your alternative just to
stand pat and keep on watching more and more families
lose their health care, more and more families with
higher out-of-pocket costs for less insurance; businesses
who are not able to compete internationally; a Medicare and
a Medicaid system that is run amok? Is that your alternative? What do you say to all those
families who can’t pay their medical bills? What do we tell those businesses
that are having to choose between closing their doors or
eliminating benefits for their workers? What do you say to every
taxpayer whose dollars are propping up a system that
doesn’t work and that’s driving us into debt? This isn’t just about those
Americans without health care. It’s about every American — because if we do not act to bring down costs, everybody’s health care will be in jeopardy. If you lose your job, or if
you’ve got a preexisting condition, you don’t know that
your family is going to be secure. All of us are in this together. So when it comes to energy,
when it comes to improving our schools, and when it
comes to health care, I don’t accept the status quo. And you shouldn’t either. And I don’t think that the
American people want to just stand pat. They know that
change isn’t easy. They know there are going to
be setbacks and false starts. But they also know this — that we’re in one of those rare moments where everybody is
ready to move into the future. We just can’t be scared. We’ve got to stop clinging to a
broken system that doesn’t work, and we’ve got to have the
courage to reach out for a future that’s going to be
better for our children and our grandchildren. I believe we can
accomplish it this year. But in order to make it happen,
I’m going to need ordinary Americans to stand up and
say, “Now is the time.” You are what are going to
drive this process forward — because if Congress thinks that
the American people don’t want to see change, frankly, the
lobbyists and the special interests will end
up winning the day. But when the American people
decide that something needs to happen, nothing can stop us. So I hope you’ll join me. Thank you very much, everybody. (applause) Thank you. Now, all right. Now, if I’m not mistaken, the
way this is going to work — Valerie, you are going to
be in charge of directing — you’re traffic cop. Ms. Jarrett:
I’m going to be in charge. Thank you very much,
Mr. President. So in my opening
remarks, Mr. President, I mentioned that when you
released your YouTube video over the weekend, we received
literally hundreds of video questions from all
across the country. Your staff looked through
all those questions and have selected a cross-section that
represents a broad cross-section of the kinds of
questions that came up. I want to emphasize that the
President has not seen the questions ahead of time. (laughter) Absolutely not. And so we’re going to begin with
a video question, Mr. President, if you look at the screen. The President:
All right. Video Question:
Hi, my name is Steve White. I’m in Spring Valley, New York. And my question for the
President is: Why are we considering a health care plan
which maintains the private insurance companies with
their high overhead costs, instead of a single-payer plan,
which would eliminate the high overhead costs, saving the
American taxpayer hundreds of billions of dollars, while
covering everyone in our country? Thank you. The President:
Good. Well, that’s a
terrific question. I’m not sure if
everybody could hear it, but the gist of the question is,
why have we not been looking at a single-payer plan
as the way to go? As many of you know,
in many countries, most industrialized
advanced countries, they have some version of what’s
called a single-payer plan. And what that means is
essentially that the government is the insurer. The government may not
necessarily hire the doctors or the hospitals — a lot of those may still be privately operated — but the government is the
insurer for everybody. And Medicare is actually a
single-payer plan that we have in place, but we only have it in
place for our older Americans. Now, in a lot of
those countries, a single-payer plan works
pretty well and you eliminate, as Scott, I think it was, said,
you eliminate private insurers, you don’t have the
administrative costs and the bureaucracy and so forth. Here’s the problem, is that
the way our health care system evolved in the United States,
it evolved based on employers providing health insurance to
their employees through private insurers. And so that’s still the way that
the vast majority of you get your insurance. And for us to transition
completely from an employer-based system of private
insurance to a single-payer system could be
hugely disruptive. And my attitude has been that we
should be able to find a way to create a uniquely American
solution to this problem that controls costs but preserves the
innovation that is introduced in part with a free market system. I think that we can regulate the
insurance companies effectively; make sure that they’re not
playing games with people because of preexisting
conditions; that they’re not charging wildly
different rates to people based on where they live
or what their age is; that they’re not dropping people
for coverage unnecessarily; that we have a public option
that’s available to provide competition and choice
to the American people, and to keep the insurers honest;
and that we can provide a system in which we are,
over the long term, driving down
administrative costs, and making sure that people are
getting the best possible care at a lower price. But I recognize that there are
lot of people who are passionate — they look at France or some of these other systems and they say, well, why can’t
we just do that? Well, the answer is, is that
this is one-sixth of our economy, and we’re not suddenly
just going to completely upend the system. We want to build on what works
about the system and fix what’s broken about the system. And that’s what I think
Congress is committed to doing, and I’m committed to working
with them to make it happen. Okay? Ms. Jarrett:
Now, how about a question
from the audience. The President:
All right. Ms. Jarrett:
Please, show of hands. The President:
What I always do here is
I go girl, boy, girl, boy, so that I don’t get
into trouble here. (laughter) All right, this young
lady right here — since somebody was pointing
at you, so I figured — do we have a microphone
for folks in the audience, so that everybody can
hear the question? Okay. I think there’s somebody
coming from this direction. You can just hand her the mic. Audience Member:
Good afternoon, Mr. President. I’ll try not to cry. I’m trying to figure out
what I can do currently. My situation is I had renal
cell carcinoma in ’98 that was radiated, because my dad was
dying of colon cancer at the time, and I was his health care
server on his living will, so I could not be tied up
having my kidney removed. So they did radiation procedures
to kill the tumor then. And I had insurance and
everything was taken out. But basically because of the
damage that the radiation did in things, I’m no longer able
to work and I have no health insurance. Now I have a new tumor. I have no way to pay for it. Doctors will not see you without
paying $100 or $150 to come into their office. I can get checked
into a hospital — under their program, they will
run tests and release me, but that costs a lot of money. So currently I basically — Social Security will not give me disability because renal failure is no longer a qualifying factor under Social Security currently. I cannot get Medicaid from the
state of Virginia because you have to be considered disabled
through Social Security to qualify for Medicaid in the
state of Virginia because I have no dependent children
at home — it’s just me. I get food stamps,
but that’s it. And I’m just trying to figure
out how I’m going to make it in nine years until I’m qualified
to get my regular Social Security — now that I have a new tumor and I have nowhere to turn. The President:
Well, here, come on over here. First of all, we’re
going to find out what — we’ll get your information and
we’ll see what we can do to help you. I don’t want you to feel
all — like you’re alone. (applause) You know, without knowing all
the details I’m not going to give you an answer right now
about exactly how we can help. We’re going to find out what
we can do within existing law. But — what was your name again? Audience Member:
My name is Debby. The President:
Debby. Debby is a perfect example
of somebody who we should, in a country this wealthy, be
able to provide coverage for her health care problems. And what we don’t want is a
situation where Debby gets worse and worse because she’s
not getting treatment, and then ends up having to
go to the emergency room. As I said before, all of
you will pay for it anyway; it’s just you’ll pay for it
in terms of a hidden subsidy. And she’s not getting
the best care, and we’re actually paying more
than we would have if Debby right now was getting treated on
a regular basis by a physician who knew her history. So, Debby, you are Exhibit A. And we appreciate you
sharing your story. We are going to try to find
ways to help you immediately. But the long-term problem here
is going to be how do we create a system in which Debby is
getting the preventive care that she needs and is able
to get regular checkups, is able to get treatment
in a way that is much more cost-efficient than the one
that we’ve got right now. And I’m going to make a
commitment that we’re going to get that done this year. All right? (applause) Audience Member:
Sir, July 24th
through the 26th, there’s a thing in
Wise County, Virginia, called RAM Ear and
Medical, and that is — Rural Area Medical is where
anybody who needs medical treatment can get free treatment
for those three days — the 24th, 25th, and 26th — The President:
The 24th, 25th, and 26th — Audience Member:
— of July. The President:
Well, we will help
advertise that — Audience Member:
If you would like to
showcase why there’s a need. I think they treated — Governor Warner and Kaine can say how long — but I think it’s 7,000 people get treatment there every day of those days
that it’s free. The President:
Which is a wonderful program. But I think, as Senator Warner
and Governor Kaine would agree, we can’t have a system that’s
reliant on three days of free care and 362 days in which
people don’t have health care. That doesn’t make any sense. Debby, thank you for
sharing your story. We appreciate you. Thank you. (applause) All right. Ms. Jarrett:
Thank you, Debby. So many of the questions that
are put to on the videos, Mr. President, are
also very personal. So now we’re going to take
another from a video. (Video is shown.) Small Child:
My mommy and daddy have
small businesses and we need health care. Mother:
I actually have to work for
a company so that we can get coverage because my older
daughter is an automatic decline and we’re just too small of a
business to be able to absorb the cost. How can health care
reform help us? Small Child:
(inaudible) (laughter) The President:
As somebody with two daughters, I’m a sucker for anybody who uses their daughter
in their video. (laughter) So my staff probably knew that. They figured, well, he’s going
to be a soft touch after that one. Small business owners are those
who are being, in some cases, hardest hit by the rising
cost of health care. And in some cases, they just
can’t afford to provide health insurance to their employees,
and that’s frustrating, but they’re operating
on too small a margin, or they don’t have enough
employees so they’ve got no leverage to negotiate with
the insurance companies. And so the offers that insurance
companies give them for the cost of coverage per person end up
being way higher than they would be for big companies that
have more consumer power. In some cases, though, it’s
gotten so bad that small businesses, they can’t even
afford to provide health insurance for themselves,
small business owners. And a lot of small businesses,
a huge percentage of small businesses are sole proprietorships. Maybe it’s a family business — they’ve got one or two people working for them. And so they’re like consultants
out there or self-employed individuals — they just
can’t get a good deal. This is an example of where this
health care exchange could be so helpful, because by creating
a health care exchange, part of what we want to do
is to allow small businesses, as well as people who
are self-employed, individuals whose companies
don’t provide coverage, to come to this exchange, take a
look at a menu of plans that are available, join one
of these plans — you may qualify for a subsidy
from the federal government — and you then become part of a
big pool that gives you some leverage over the drug companies
and the insurance companies to drive down costs. And that’s part of the way that
health care reform can provide direct savings to American
families right now, by giving them more leverage. Look, I am very pleased that the
drug companies decided to cough up $80 billion to help
close this “doughnut hole.” I have to be honest with you,
though: Were it not for the prospect of serious
health care reform, I don’t think they would
have given up that money. That’s just my guess. (applause) And so these same principles
apply when it comes to setting up this health care exchange. If we do it effectively, then
not only will families be able to make some very clear choices,
and small business owners make some clear choices, about here’s
the best plan available for us that fits our particular needs,
but they’re also going to be part of a broader group that
can apply some leverage in the system. And that’s essentially what
federal health care employees do. Mark Warner has a plan that all
members of Congress and federal employees have, and it’s not
Cadillac care, but it’s good, solid, decent care with
a range of options. Part of the reason that it is a
good program is because there’s so many federal employees. Well, we should provide that
same kind of leverage for the small business owner who right
now is too small on their own to be able to get the best possible
deal on the insurance market, and that’s what we want to
provide in this health care reform package. All right? Good. Ms. Jarrett:
All right, I think we’re ready to go back to the audience. The President:
All right, it’s a guy’s turn now, all right, so, ladies, keep your hands down. (laughter) All right, this
young man right here. Audience Member:
Thank you. I’ve been hearing a lot — The President:
What’s your name? Audience Member:
Jason Rosenbaum. The President:
Hey, Jason. What do you do, Jason? Audience Member:
I work for a group called
Health Care for America NOW. (applause) The President:
I think he knows something
about health care. This is like — Audience Member:
I’ve been — obviously I read the news a lot, and I’ve been hearing a lot about the price tag of health reform and how people are very concerned that it’s going to cost a trillion dollars, and we’re trying to keep it under a certain number. I’m most concerned about making
it affordable, folks like me, the American people. So what do you —
and like you said, you’re committed to
making this deficit-neutral. So I hope you could talk a
little bit about affordability and what your
plans are for that. The President:
Good. Well, look, the first thing that
I think is very important for people to do is to understand
the costs of doing nothing, because sometimes opponents of
health care reform pretend as if we’ve got this great thing
going here and the Obama administration wants to
completely upend it just because I don’t have enough to do. (laughter) And I keep on trying to
explain to people, look, I’ve got a war in Afghanistan;
we haven’t gotten the troops out of Iraq yet; I’ve got North
Korea and Iran; and H1N1 flu. So if the health care system
was really working well, I would be happy
to leave it alone. So understand where we’re at. If we don’t do anything, the
costs are going to keep on rising. I mean, some employers see
their costs going up 8, 9, 10% a year. As I said, families have seen
their health care costs double over the last nine years. So you just project out
nine years from now — your wages or incomes
aren’t going up that fast, which means that a bigger,
bigger bite is being taken out of your paycheck, even if
you’ve got health insurance. More and more employers are
saying in this very competitive atmosphere, we can’t
afford to do more. So what’s happened if
you’ve got health insurance? Your employer has
basically done what? They’ve increased deductibles;
they’ve increased premiums. Your out-of-pocket costs
have gone up by about 62%, and they’re just going
to keep on rising. And the cost of
Medicare and Medicaid, because they track
all these other costs, they’re going to
keep on skyrocketing. So our deficit will be
completely out of control. Don’t let people fool you with
this notion that somehow the reason for our deficit has
to do with, for example, the Recovery Act. The Recovery Act was designed
to make sure that local school districts didn’t lay off
teachers and firefighters and police officers —
and it’s done its job, and it’s building the kind of infrastructure that we need to be competitive in the future. But it is a tiny fraction of our
long-term deficit projections. Almost all of the long-term
deficit projections come from increases in Medicare
and Medicaid. So the reason I say all this is
because the costs are going to be there if we
don’t do anything. The deficit will grow
if we don’t do anything. Our debt will grow if
we don’t do anything. What I’m trying to do is figure
out how do we bend the curve of costs so that we’re getting
more and more efficient care, higher-quality care, at
less cost per person? How do we eliminate the $1,000
per family that’s coming out of your pocket in subsidized care,
uncompensated care at hospitals that’s going on right now? And if we can do that, then, A,
we can cover more people with the savings; and, B, we have
more leverage over the insurance companies and the drug companies
so that they give a better deal. That’s what we’re trying to do. Now, I do think that we
can’t add to the deficit; we should find ways to honestly
pay for whatever reforms we’re proposing. And I already gave you an
indication of how we would do it. About two-thirds of it would
come from reallocating money that’s currently
in the system — taxpayers, you’re
already paying for it, so this isn’t new money
coming out of your pocket; this is money that’s right now
being spent by the federal government but not spent
wisely in a way that makes you healthier. That’s two-thirds of it. One-third of it, because we’ve
got to make some initial investments up front and
a lot of the savings — remember what I told you — aren’t scorable, we’re going to have to raise some additional revenue to make sure that people are adequately covered and we’re providing some help to families who may have health insurance but are really starting to struggle right now. And I think the best way for us
to pay for it is, as I said, capping the itemized deductions
that people making over $250,000 a year, people like myself — used to be Valerie was making that, but now she’s working for
the federal government so — (laughter) — she wouldn’t be
affected by this — capping those
itemized deductions. Then we can raise enough
money to pay for a good, high-quality health care reform
proposal that will provide health care security
for everybody. And as I said before, many of
you may be satisfied with your health care now. What you’ve got
to do is project, if current trends continue, are
you still going to be happy with your health care
five years from now? Will you have health
care five years from now? A lot of people here, if you
change jobs right now but you’ve got a preexisting condition — and just about anything these days can be called a
preexisting condition — you may have trouble signing up
for health care the next time around — just because
you changed a job, set aside the situation
where you lose a job. One of the things that we did
in the Recovery Act was to help people with COBRA. Everybody knows what COBRA is? That’s the program that allows
you to get health insurance — to continue your health
insurance even when you lose your job. The problem is premiums are
so high that most people, when you lose your job,
you can’t afford it. The last thing you can do is afford suddenly a $1,000 or $1,500 in premiums. So what we did was we subsidized
people being able to keep their health insurance longer,
cutting those COBRA costs. I think that was a
pretty smart thing to do. That was the right thing to do. But we can’t just do
that indefinitely. We can’t do patchwork, piecemeal
fixes through a Recovery Act. What we need is a permanent
solution that ensures that when you lose your job
or change jobs, you can still have health
care; if you’re self-employed, you’ve still got health care. Every nation on Earth that is as
wealthy as ours is able to do that. And they don’t do
it perfectly — that’s why I say we’ve got
to find a uniquely American solution — but don’t tell me that we can’t get this done. And for those who say,
well, you know what, this is something that is very
complicated so we shouldn’t rush into it — that’s what happens in Congress all the time. They have hearings,
they write white papers, and then suddenly the lobbyists
and the special interests start going at it, and the
next thing you know, another 10 years has gone by and
we still haven’t done anything. That’s not what’s going
to happen this time. I am going to keep on pressing
until we get it done this year. All right. (applause) Ms. Jarrett:
All right, Mr. President. So Macon just slipped
me a note, and he said, right now on Facebook
and on Twitter, a lot of people are talking
about the proposal to tax health care benefits. For example, Rob
on Twitter said, “Does it really make
sense, Mr. President, to tax me on my
health care coverage?” The President:
Well, here’s — let me describe for you how this argument has evolved and where I’ve stood on it in the past and what’s being debated in Congress. Part of the reason that
employers provide health care to most American is because they
get a big tax exclusion. They don’t pay taxes on —
and you don’t pay taxes on the health care benefits
that you receive. So it’s a huge subsidy that’s
provided through the tax code for employers to
provide you coverage. Now, up until, let’s
say, a generation ago, this worked reasonably well. It’s starting to break down
because even with the tax exclusion, the cost for
employers, just out of pocket, paying the insurers, is getting
more and more expensive. Some people have said that what
we should do is just eliminate this tax exclusion so that
the federal government isn’t indirectly subsidizing
employers providing care, and that we could take that
money and then just give everybody a tax break
individually and then they could go out and shop for
their own health care. This was essentially John
McCain’s proposal during the campaign. I mean, I want to be fair to it. The idea was, you
eliminate the exclusion; the billions of dollars that
come back into the Treasury are then given out to each person in
the form of a $5,000 or a $7,000 tax credit, and then you go out and you buy your own insurance. And the thinking is that
if you do it that way, then each of you are going to be
more discriminating consumers, and you are going to go out and
get the best possible deal, and you won’t be overusing
the health care system. You won’t be going to the doctor
unnecessarily or taking drugs that you don’t really need. And you will be the — you will essentially engage in self-rationing. That’s really the
concept behind this idea. Now, in fairness,
the other notion is, is that if you don’t have your
health care tied to employers, then you’re not going to be as
worried about losing your health insurance if you change your job
because the money follows you as opposed to being
with the employer. So that’s the concept. Now, I opposed this
during the campaign, and I opposed it for a couple
of reasons: Number one, if you completely
eliminated the exclusion, there is no doubt that
what would happen is, is that a lot of employers would
stop providing health care. And so a lot of people who
currently get health care through their employers
wouldn’t be able to get it. The second thing — remember what I told you earlier about how if you are on your own shopping for health care you’ve got no leverage with
the insurance company. Well, the problem is, is that
if suddenly now you get a tax credit for $5,000 or $7,000,
you try to go buy some health insurance for your family,
and it costs $14,000, you’re a lot worse off
than you would have been. You’re out of luck. And you’ve got no leverage;
they’ve got no incentive to give you a lower price because
you’re on your own. The other problem is that when
you’re not part of a pool, the insurance companies have
every incentive to make sure that if you are older
or you are sicker, that they do not cover you. They want to cover the young,
healthy folks like Mark Warner. (laughter) That’s who they want. But if you’re older or sicker,
you are more likely to be excluded from coverage, or
they really jack up the rates. When you’re part of a pool,
then the insurers say, well, I guess we’ll take the older,
sicker folks because we’re also getting the younger, healthier
folks at the same time. So, for all those reasons, I
opposed the proposal that was put forward, because essentially
it would be, for the first time, taxing the health care benefits
that are provided by employers. Now, nobody at this point is — or not many folks are talking about taxing benefits or completely eliminating the exclusion. What they are calling for now in
Congress is to cap the exclusion so that people who have very
high-priced health care, at a certain point they can only
get a deduction up to a certain point, right? So let’s say that the average
health care cost for families — a good health care
plan costs $13,000. What they would say is the
employer and the employee get an exclusion up to $13,000, but if
you get some Cadillac plan that costs $17,000, then what we’re
going to do is you’re going to have to pay taxes
on that last $4,000. And the idea that is being
debated in Congress right now is, is that a good way to ensure
that people don’t have these big Cadillac plans but instead
have more sensible plans? Now, I don’t think — and by
the way, that also raises some money. So this has been offered as an
alternative way to pay for that extra one-third of health care
that we’re not able to pay for through simply
reallocating money. I think the better way to do it
remains the proposal I have to cap itemized deductions. I think that is a way that we
can ensure that people who currently have health care
aren’t suddenly seeing the costs go up to pay for other
people’s costs going down, but instead everybody’s costs
can go down effectively. But this is something that’s
going to be debated in the House and the Senate. Mark Warner is going to
have to weigh in on it. We’re all going to
have to weigh in on it. My bottom line, though, is that
if you’ve got health insurance right now, you shouldn’t
suddenly see your costs go up as part of health care reform. Okay? Good. Ms. Jarrett:
All right, Mr. President, I think we’re teed up for another video question. The President:
All right. Video Question:
Mr. President, as a physician,
I know the cost of defensive medicine drives
medical costs upward. Now, at your health care forum
you said that you wanted to find out what works. In my home state of
Texas, we know what works, and our Medical Justice
Act has done just that. Now, unfortunately, when you recently told the AMA you were opposed to capping
non-economic damages, even though a state like mine has proven that it does work. Now, will you reaffirm your
commitment to find out what works and then ask Congress
for its implementation? The President:
Okay. I want to make sure everybody
understands the question here. A lot of doctors have argued — and in some cases they’re justified — that their costs for medical malpractice insurance, the threat of a lawsuit if something goes wrong with a patient, even if
it’s not their fault, is so high that not only is it
increasing their out-of-pocket cost, but they’re also engaging
in what’s called defensive medicine; that they’ve got to
order five tests when one is enough just to make sure that
they’re covered so that if something goes wrong that’s not
their fault later, they can say, look, I did
everything possible — even if a lot of
that isn’t required. And so the argument is, if you
cap the pain and suffering or the liability that is awarded as a consequence of you being hurt in the hospital or by a doctor, that that would drive down everybody’s costs. Now, what I’ve said is that
I don’t like the idea of an artificial cap on somebody if
the doctor or the hospital really was negligent. And in some cases, I’ve
got to tell you, they are. I mean, there are cases where
folks leave a sponge in your gut and sew you back up, and after a
while you’re feeling worse than when you went in. And in some cases, obviously
that can cause very severe damage, and I want to make sure
that people’s pain, suffering, out-of-pocket expenses,
that those are covered. So I don’t like the idea
of just an artificial cap. I do want to work with doctors
to find ways that we can reduce their liabilities where they
haven’t done anything wrong, where they’ve
performed effectively. I want to see, are there ways
that we can reduce the constant threat of lawsuits that doctors
and hospitals experience, because I do think that that
causes defensive medicine. And so I’ve committed to working
with the AMA to see ways that we can reduce some of these
litigation costs and malpractice rates. One point that I’ve
got to dispute, though, with the gentleman who
asked me the question — he says he’s from Texas, and
that we’ve got caps in Texas, and so we’ve seen what works. Well, the fact is, is that there
was just recently an article about a town called
McAllen, Texas, where they have the highest
health care costs in the country. It’s down by the border. And even though they have caps
there, in McAllen, Texas, they spend about three times as much per person as — or not — they spend about 30% more per
person than they do in El Paso, Texas, which also is
operating under caps. So what that tells me is the
problem of rising costs doesn’t simply have to do with whether
or not liability is capped. What it really has to do with
is the incentives that are operating in various
communities. There are some places,
like the Mayo Clinic, many of you have heard of,
provides outstanding care, some of the best in the world. People fly in from everywhere
to go to Mayo Clinic to get treated. Turns out Mayo provides care
much more cheaply than a lot of other health systems, even
though it’s better care. And part of the reason is
they do some things that are commonsensical, but
unfortunately we don’t do in the health care system. For example, instead
of you going to one — your primary care physician, who
has you do a bunch of tests, then refers you to a specialist
who has you do a bunch of tests, then maybe you go to
a third specialist, another bunch of tests; go to
the hospital, they retest you. What they do is, at Mayo Clinic,
when you meet with the — your primary physician, he calls
in all the specialists all at the same time, and as a
team they evaluate you, do all the tests right there, so
you’re not duplicating a whole bunch of stuff. And that coordinated care
drives down costs tremendously. That’s the kind of common-sense
approach that we’re going to have to take. And one of the things that we’re
going to need to do in the health reform that we’re
proposing is to incentivize those kinds of smart
practices coordinating care, as opposed to what we do right
now, which is we just pay you — the more services you
provide, the more we pay you, which gives doctors and
hospitals a pretty strong incentive to test you five
times instead of one time. I’m not saying they
do it consciously, but right now we’re preventing
them from coordinating in a smart fashion because of
the ways that we reimburse. That has to be part of the
reform that we initiate. All right. Ms. Jarrett:
All right, Mr. President,
I’m getting the high sign, so how about one more question
from our wonderful audience? The President:
One more question
from the audience. Let’s see. It’s a girl’s turn, isn’t it? I think so. This young lady right here. Audience Member:
Hi, Mr. President. I’m a member of SEIU and I’m
down here in Fairfax County working on Change That Works. What can I do, as a
member of the union, to help you with
your reform bill? The President:
Well, I appreciate the question. The most important thing I think
the American people can do right now is to just be informed. Tell your friends, tell your
neighbors to get informed about what’s happening in the
health care system right now. It’s very complicated and I
don’t expect everybody to be an expert, but I want everybody to
be well enough informed that the scare tactics of those who
would oppose reform don’t work. So when you hear
somebody say this is — “Obama is proposing a government
takeover of health care” — that’s an old argument
that’s been used for years. I just want to be clear. If you’ve got a health care
plan that you get through your employer or some other private
plan, I want you to keep it. I actually think reforming the
system is the most likely way for you to keep the health
care that you’ve got. I don’t want to take it over. I think it’s great that you can
keep the care that you’ve got. All I’ve said is I want to make
sure that those things that taxpayers are paying for, that
we’re getting our money’s worth. I don’t want to provide $177
billion in subsidies to insurance companies. I don’t want to reimburse for
five tests when the evidence shows that you just getting one
test is going to be better for you because that means that the
taxpayers are saving money and I can use that to
lower your costs, or to help somebody who doesn’t
have health care at all. I do think we should have a
public plan to compete with the private plans. But these private
insurance companies, they’re always telling me what a
great deal that they give to the American consumer; if
it’s such a great deal, why are they worried about
competing against the public plan, especially when they say
government can’t do anything? (applause) So they’ll tell you that we’re
trying to take over health care. I don’t want to take
over health care. They’ll tell you that we’re
going to try to ration the system. We don’t want to get
between you and your doctor. What we do believe is that if
there’s good evidence out there that shows that the best way to
treat your illness is to give you the blue pill, and instead
right now you’re getting prescribed the red pill
that costs twice as much, I think that you and your
doctor, having that information, are probably going to decide to
go with the cheaper pill that does just as good of a job,
and that will save you money. That’s not rationing. That’s being sensible. So whenever you start hearing
these arguments about socialized medicine, government
takeover, rationing, Canada-style health care,
what I need you to do — and I need everybody here to do
and everybody who’s watching to do — is to actually pay attention to the argument, and don’t let people scare you
out of reforming a system that we know is not working. America — one of the great things about this country is we’ve got a system that’s sometimes kind of hard to change. Congress gets kind
of bogged down, and part of that is because of
the way the Constitution is designed — it’s served us well because it keeps us very stable. We don’t have coups and all
kinds of governments collapsing all the time. But the disadvantage
sometimes is, is that it’s hard for us
to make big, bold steps. But the great thing
about the system is that, every once in a while, when we
finally hit a point where things just aren’t working at all,
we are able to generate the political will to
finally get things done. That’s how we got
Social Security. After the Great Depression,
nobody had any pensions or protection, and people
started realizing, we can’t have a country where
suddenly older Americans are just on the streets, after
working hard all their lives. And finally we got
Social Security. And then people said, well, we
can’t have older Americans who don’t have any health
care, and we got Medicare. At every juncture, when we
finally need to make a change, we make a change. This is one of those times. So don’t be scared
about the future. Let’s embrace the future. Let’s go after the future. If we do, then I’m confident
that we can create a health care system that gives you choice,
allows you to keep your doctor, drives down costs, makes sure
that every American doesn’t have to worry if they lose
or change their jobs. That’s our aim. That’s our goal. We’re going to make
it happen this year. Thank you, everybody. I appreciate you. Thank you. (applause)

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