President Obama Holds Health Care Forum with Lawmakers, Health Care Professionals

CQ Transcripts Wire
Thursday, March 5, 2009 4:35 PM



[*] OBAMA: To Sir Edward Kennedy...


That's the kind of greeting a knight deserves.


It is thrilling to see you here, Teddy. We are so grateful for you taking the time to be here and the extraordinary work that your committee has already started to do, along with Mike Enzi, and I know Max Baucus and Chuck Grassley on the -- on the Senate side.

Henry, I know that you guys are gearing to go on the House side.

So I just want to, first of all, thank all of you for participating. Today was the first discussion in this effort, but it was not the last. In the coming days and weeks we'll be convening a series of meetings with senior administration officials here at the White House to further explore some of the key issues that were raised today and to bring more voices into the conversation.

But my understanding is, is that we had an extraordinarily productive set of sessions throughout the day. And I've gotten a readout from some of the breakout groups and breakout sessions, and I just want to summarize a few things that my staff thought were notable and that I thought were notable and are worth mentioning before I start taking some questions or some comments.

First of all, a clear consensus that the need for health care reform is here and now. Senators Hatch, Enzi, Congressman Jim Cooper and many agreed that we can do health care reform. Senator Hatch said that we needed leadership on both sides, and he believes that Democrats and Republicans need to put politics aside and work together to do it.

Senator Whitehouse said this isn't a Harry and Louise moment, it's a Thelma and Louise moment.


We're in the car headed towards a cliff and we must act.

Now, I just want to be clear, if you actually saw the movie, they did drive over the cliff.


So just want to be clear, that's not our intention here.


Insurers agree. Scott Serota with Blue Cross Blue Shield Association said to consider past opposition the past.

OBAMA: It is not the present. The time is ripe for action now.

The American Medical Association said that they are here to be partners and to help. Tom Donohue with the Chamber of Commerce said that in the previous debate, we knew where everyone stood. People are in different places now, including business, and that there is a vigorous understanding with all parties that improvements are needed.

And Congressman Joe Barton complimented the process we've begun and that he can agree with the principles that we've laid out. My staff thought that was a very notable statement, complimenting the process.

Melody I think slipped that one in.


With respect to the cost of care, Richard Kirsch with the Health Care for America Now said that we can't have a false dichotomy between coverage and costs, that by covering more people we can also lower costs at the same time, presumably because those who are not insured at the moment are ending up using extraordinarily expensive emergency room care.

Senator Whitehouse -- you got two quotes in here.


Senator Whitehouse pointed out that we pay more than a trillion dollars -- we pay more than a trillion dollars more than other countries for the same or lower qualities of care.

Ken Powell, the CEO of General Mills and a member of the Business Roundtable, stressed the need to preserve the role of employers and that many employers are investing in excellent prevention programs that are reducing costs and improving productivity.

And I can testify to that. I've met a lot of extraordinary companies that have really taken the bull by the horns and are doing extraordinary work.

Many participants stressed the need to invest in prevention, to lower costs and improve care, to tackle obesity, manage chronic care, invest in comparative effectiveness.

Congressman Dingell talked about the need to simplify the system to reduce costs and medical errors.

Senators Baucus mentioned the need to make investments up front, such as health I.T. and comparative effectiveness to get big savings, and that we have to align incentives toward quality.

And Congressman Waxman suggested the same point that's been made earlier, that we can't control costs unless everyone is covered.

With respect to the public plan, Congresswoman Jan Schakowsky and the AFL-CIO talked about the need to create a public option in order to reduce costs to consumers and save money within the system.

There were others who raised some concerns about the impact of a public plan limiting choices.

OBAMA: As for paying for reform, Congressman Rob Andrews challenged the group to identify additional ways to pay for reform and suggested that everyone needs to put something on the table to get reform done. And Senator Wyden raised the issue of modifying the tax inclusion for higher-income Americans.

Last set of points that we thought were notable, Senators Grassley and Hatch and Congressman Dingell all discussed the need to address medical malpractice and reduce defensive medicine as a cost- saving measure.

So that's just some of the points that were made. I know that many of you had other insights. They have all been recorded, and we are going to be generating a document coming out of this that summarizes much that was heard in these various breakout sessions.

But what I want to do is just take some time now to give all of you a chance to hear from me directly. I'm going to call on some members. I am going to call on some of the groups that were participating as well. I'm not going to be able to get to everybody.

And since he got such a weak reception when he walked in, I think that it's only fitting that we give Ted Kennedy the first question. So, we've got a microphone here. Go ahead -- or comment. It doesn't have to be a question.

KENNEDY: Thank you very much, Mr. President. I join in welcoming you, seeing all of you once again at this very special gathering.

I join with all of those that feel that this is the time, now is the time for action. I think most of us who have been in this room before have seen other times when the House and the Senate have made efforts, but they haven't been the kind of serious effort that I think that we're seeing right now.

If you look over this gathering here today, you see the representatives of all the different groups that we have met with over the period of years.

KENNEDY: I mean, you have the insurance companies, you have the medial professions, all represented in one form or another. That has not been the case over the history of the past, going all the way back to Harry Truman's time, but it is the case now.

And it is, I think, a tribute to your leadership in bringing all these people together and really a leadership of so many that are gathered here today.

Just in a very brief look around, you can see representatives of so many of the different interests. It would be hard to think of those interests being together and being as concerned and providing the leadership that they are, as they are demonstrating that kind of a commitment as we have today.

What it does is basically challenges all of us to really do the best we can. And I know that you and all of your staff -- I congratulate Max Baucus and my colleagues who have done such an extraordinary effort today, just say that I'm looking forward to being a foot soldier in this undertaking and this time we will not fail.

Thank you very much.


Let me -- I want to make sure that we are getting a good cross- section of views on this issue, so why don't I call on our Republican leader, Mitch McConnell, if you've got any thoughts or comments on the issue.

MCCONNELL: First of all, Mr. President, thank you very much for having this session today. I think it's useful, and it is significant, as Ted indicated, to have everybody in the room.

I'm also among those, as you and I have discussed before, interested in seeing us address entitlement reform.

MCCONNELL: And admittedly, Medicare and Medicaid would be a part of that, but also Social Security. I'm particularly concerned about having a mechanism in place that guarantees you get a result.

I wonder where you see yourself and the administration now, for example, in supporting something like the Conrad-Gregg proposal which would set in place a mechanism that could actually guarantee that we get a result, if not on Medicare and Medicaid, at least on Social Security?

OBAMA: Well, the -- I appreciate the question, Mitch. As you know, we had a -- I think they can hear me -- as you know, we had a fiscal responsibilities summit similar to the gathering that we've had here, although I have to say the attendance here is even greater. And what I said in that forum was that I was absolutely committed to making sure that we got entitlement reform done.

The mechanism by which we do it I think is going to have to be determined by you, Harry Reid, Nancy Pelosi, and John Boehner and the members of Congress. We've got to make certain that the various committees are comfortable with how we go forward.

But the important point that I want to emphasize today is that on Medicare and Medicaid in particular, which everybody here understands is the 800-pound gorilla, I don't see us being able to get an effective reform package around those entitlements without fixing the underlying problem of health care inflation.

If we've got 6 percent, 7 percent, 8 percent health care inflation, we could fix Medicare and Medicaid temporarily for a couple of years, but we would be back in the same fix 10 years from now.

And so our most urgent task is to drive down costs both on the private side and on the public side, because Medicare and Medicaid costs have actually gone up fairly comparably to what's been happening in the private sector with businesses and families and others have been doing. That's why I think it's so important for us to focus on costs as part of this overall reform package.

With respect to Social Security, I actually think it's easier than Medicare and Medicaid. As a consequence, I'm going to be interested in working with you, and I know that others like Senator Durbin, Lindsay Graham, have already begun discussions about what the best mechanisms would be. I remain committed to that task.

But if we don't tackle health care, then we're going to break the bank. I think that's true at the federal level. I think it's true at the state level.

OBAMA: It's certainly true for businesses, and it's certainly true for families.

Henry, do you want to just give a little feedback in terms of what you heard and any points you'd like to make?

WAXMAN: Thank you very much, Mr. President.

Let me just say that Senator Kennedy will not be a foot soldier in this battle. He has been the inspiration to all of us, all Americans who held out the dream that every American ought to have affordable, quality health care. And I want to salute him for that.


Mr. President, by bringing people together, the different stakeholders, the people representing different interest groups, the Democrats and the Republicans, all of us together, I think you've given us an opportunity not to insist that we get all that we want, but to realize that we're part of a process, and that if we don't get everything we want, the alternative is not to do nothing, as you pointed out earlier, but to make sure that we've got the best system we can develop. And that has to be a system that includes all Americans in health insurance that they'll be able to hold onto if they are satisfied with it, or to be able to access, if they don't have it at the present time.

So I think this is a very useful meeting. Our breakout session was very on point. And I think it leads all of us to recognize that we have to work together. We all need to recognize there are going to be tradeoffs, but if we don't get the tradeoff exactly the way we want it, we've got to recognize there's a broader public goal and purpose.

And your leadership I think it going to make this bill possible...

OBAMA: Good.

WAXMAN: ... to get into law.

OBAMA: Thank you. Thank you, Henry.

Is -- is Jo Ann Emerson here?


There you are. Good to see you, Jo Ann.

EMERSON: Thank you very much for having me here today. And I thank you very much for your passion on this issue.

EMERSON: Coming from a very rural poor district in southeast and south-central Missouri, I have so many constituents who have no insurance, nor do they -- not do those who have insurance necessarily have access...

OBAMA: Right. To providers.

EMERSON: ... to providers, particularly primary providers.

And so for us to be able to get together all stakeholders, members of the House, Senate, Republicans, Democrats, business, labor, you name it, I think that that's critical.

And I hope that all of us from both parties will be willing to kind of take a fresh look and say, you know, if there are laws that we had on the books before, that they need to be opened up if we need to change the system.

And I think all of us have to be willing to kind of give a little, if you will. And I thank you so very much because for me this has been a passion for all 13 years I've been in Congress. Thank you.

OBAMA: Good. Well, listen, I appreciate your point, Jo Ann. I want to amplify it.

I think it is so important that all of us make decisions throughout this process based on evidence and data and what works as opposed to what our dug-in positions may have been in the past. Because if -- if we can at least agree on a set of facts, we're still going to have tough choices, but we're more likely to make good decisions on behalf of families.

And so I want to be clear about my own position in this process. When -- during the campaign I put forward a plan for health care reform. I thought it was a excellent plan, but I don't presume that it was a perfect plan or that it was the best possible plan. It's conceivable that there were other ideas out there that we had not thought of.

If there is a way of getting this done where we're driving down costs and people are getting health insurance at an affordable rate and have choice of doctor, have flexibility in terms of their plans, and we could do that entirely through the market, I'd be happy to do it that way.

If there was a way of doing it that involved more government regulation and involvement, I'm happy to do it that way, as well.

I just want to figure out what works, and that requires us to actually look at the evidence and try to figure out, based on the experience that now's been accumulated for a lot of years, you know, how can we improve the system?

And I'm absolutely confident there's going to be some low-hanging fruit; for example, the issue of health I.T. I don't think there's any dispute between Newt Gingrich and Ted Kennedy that if we digitalize our health care system, we're going to save money over the long term and we're going to reduce error and save lives.

There are going to be some other areas that's not such low- hanging fruit and there's greater dispute about what might work.

OBAMA: But we have to keep that open mind that you called for, Jo Ann. That's going to be critical.

Let me go to Max Baucus, and then Chuck Grassley. I want to get a sense of the folks on the Finance Committee. They're going to have some influence on this process.


Just a little bit.


BAUCUS: Thank you, Mr. President.

First, we've got some real luminaries in this room -- yourself. A few hours ago, you mentioned that President Roosevelt tried to accomplish health care reform. He's over there, right there in the corner.



BAUCUS: And I think he'd be very proud of how we're doing it.


That's fine.

And the third luminary is sitting right to my right, right here. And I think in the spirit of all three of you, this is a terrific opportunity.

Second, the American public wants it. That's a no-brainer. We're at a time in American history when the American people want health care reform for all the reasons that you mentioned.

It is, as you mentioned, a moral and a fiscal imperative. There's no doubt about that.

And you've started this process, I think in pretty much the right way, namely, getting us all together, a tone and a culture and a feeling of cooperation and the constructive ways, evidence-based -- what's the science, what's worked, doesn't work, practically and pragmatically. And the real key here is for us to continue that frame of mind, continue that attitude. Keep everybody at the table. This is all encompassing. There are tradeoffs everywhere.

This is not a short-term, tactical exercise, this is a strategic, longer term plan here, that has to be a uniquely American solution -- we're not Europe; we're not Canada; we're not Japan; we're not other countries -- we're American -- with public and private participation.

And there's no doubt in my mind just tapping into the good old American, you know, can-do and entrepreneurial spirit, that we're going to find a solution.

BAUCUS: And the key here, really, is to keep abreast (ph), all stay at the table, keep an open mind, (inaudible) see how this works with that and so forth. This is clearly not going to be easy. There's a fairly steep learning curve for an awful lot of people as we get this done, but clearly the attitude is here and the frame of mind is here, the desire is here to do this in a very cooperative way.

I can't thank you enough for your brilliant (ph) leadership to help make it happen.

OBAMA: Thank you, Max.



GRASSLEY: Mr. President, thank you very much for this opportunity.

From our breakout session, you probably get the idea that it's pretty easy to get done. We know it's very difficult to get done, but without that sort of feeling starting out, nothing would get done. And I think you served with us in the Senate long enough to know that Max Baucus and I have a pretty good record of working out bipartisan things.

Neither one of us, or neither one of our parties, get everything that they want, but we've had a pretty good record. I think only two bills in eight years that haven't been bipartisan. And so we have a process in place that has hearings coming it. It has a process of getting roundtable discussions, getting stakeholders in, getting authorities in.

We expect to have work on this in the committee in June. Maybe it will sound a little ambitious, but if you aren't ambitious on a major problem like this that the country decides needs to be done, it'll never get done.

So the only thing that I would throw out for your consideration -- and please don't respond to this now because I'm asking you just to think about it -- there's a lot of us that feel that the public option, that the government is an unfair competitor, and that we're going to get an awful lot of crowd out. And we have to keep what we have now strong and make it stronger.

OBAMA: OK. Let me just -- I'm not going to respond definitively. The thinking on the public option has been that it gives consumers more choices and it helps give -- keep the private sector honest because there's some competition out there.

OBAMA: That's been the thinking.

I recognize, though, the fear that if a public option is run through Washington and there are incentives to try to tamp down costs or at least what shows up on the books, and you've got the ability in Washington apparently to print money, that private insurance plans might end up feeling overwhelmed.

So I recognize that there's that concern. I think it's a serious one and a real one, and we'll make sure that it gets addressed, partly because I assume it'll be very -- be very hard to come out of committee unless we're thinking about it a little bit. And so we want to make sure that that's something that we pay attention to.

Couple other people I want to call on. I'm going to switch gears and get some groups in here, and then come back to a couple other legislators.

Karen Inagi (ph)? Yunani (ph)? There you are.


OBAMA: Good. Why don't you wait for a mike, Karen (ph), so that we can hear you? Karen (ph) represents America's health insurance plans.

INAGI (ph): Thank you, Mr. President. Thank you for inviting us to participate in this forum. I think, on behalf of our entire membership, they would want to be able to say to you this afternoon and everyone here that we understand we have to earn a seat at the table. We've already offered a comprehensive series of proposals. We want to work with you. We want to work with the members of Congress on a bipartisan basis here. You have our commitment.

We hear the American people about what's not working. We've taken that seriously. You have our commitment to play, to contribute, and to help pass health care reform this year.

OBAMA: Good. Thank you, Karen (ph). That's good news.

That's America's health insurance plans.


And, you know, while I'm -- while I'm on it, why don't I call on Dan Danner, who's NFIB? Is Dan still here? There he is. There he is.


DANNER: Thank you. Thank you, Mr. President.

OBAMA: Give us the business perspective.

DANNER: Well, I'm honored to be here representing small business. We do think that small business has a key role in this debate. And for them, cost is still the top issue.

And we very much look forward to finding a solution together that works for America's job creators.

So we appreciate being here and thank you.

OBAMA: Good.

One thing I want to -- I want to talk about, just this whole cost issue. I can't emphasize this enough.

There is a moral imperative to health care.

OBAMA: I get 40,000 letters, I guess, every day, here in the White House. I don't read all 40,000...


... but my staff selects 10 every single day that I read and try to respond to as many of them as possible. It's a way of staying in touch with the constituencies that I had a chance to meet during the course of the campaign.

I can tell you that on average out of the 10 at least three every single day relate to somebody who's having a health care crisis. Either it's a small business that's frustrated because they can't even insure themselves, much less their employees, it's a mom who's trying to figure out how to insure their child because they make a little bit too much money so they don't qualify for SCHIP in their state. Heartbreaking stories.

So there is a moral component to this that we can't leave behind.

Having said that, if we don't address costs, I don't care how heartfelt our efforts are, we will not get this done. If people think that we can simply take everybody who's not insured and load them up in a system where costs are out of control, it's not going to happen. We will run out of money. The federal government will be bankrupt; state governments will be bankrupt.

So I hope everybody understands that for those of you who are passionate about universal coverage and making sure that the moral dimension of health care is dealt with, don't think that we can get that done without -- excuse me. This is a health care forum, so I thought I'd...


... model what happens when you don't get enough sleep.

Don't think that we can -- that's right, I'm talking to you liberal bleeding hearts out there...


... don't think that we can solve this problem without tackling costs. And that may make some in the progressive community uncomfortable, but it's got to be dealt with. And the flip side is what I would say to those who are obsessed with costs, and this goes to the issue of Medicare and Medicaid reform as well, I don't think it is a viable option as a means of controlling costs simply to throw seniors off the Medicare rolls, for example, or to prevent them from getting vital care that they need, which means, you know, we've got to balance heart and head as we move this process forward.

A couple other people I want to call on.

How about Charlie Rangel?

He has a tax committee that's important.


RANGEL: People have said that when I first came to Washington, George Washington had black hair.


But I have to tell you, Mr. President, this is one of the most exciting experiences and opportunities.

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