Thursday, February 25, 2010; 6:11 PM
OBAMA: Well, listen, this has been hard work. And I want to first of all thank everybody for being here and conducting themselves in an extraordinarily civil tone.
And, as I said, given the number of folks that were around this table, the fact that we're only an hour late, is -- it beats my prediction.
Here's what I'd like to do.
OBAMA: And I'm going to take about 10 minutes.
I want to go through where I think we agree and I want to summarize where I think we disagree. And then I'll address some of the process issues that have been brought up by a number of the Republicans.
We agree that we need some insurance market reforms. We don't agree on all of them, but we agree on some of them.
I think that, if you look at the ones that we don't agree on, since there's been a lot of reference to what the American people want, it turns out that the ones that are not included in the Republican plans right now but are included in the Democratic plans are actually very popular.
I know that there's been a discussion about whether a government should intrude in the insurance market. But it turns out, on things like capping out-of-pocket expenses or making sure that people are able to purchase insurance even if they've got a preexisting condition, overwhelmingly, people say the insurance market should be regulated.
And so one thing that I'd ask from my Republican friends is to look at the list of insurance reforms and make sure that those that you have not included in your plans, right now, are ones, in fact, that you don't think the American people should get.
Because I strongly belief in these insurance reforms. I've talked to too many families who have health insurance and find out that what they have does not provide them with the coverage they needed, and they end up being bankrupt or they end up going without care, or they get care too late, as was the case in the story that Patty Murray mentioned.
The second thing I think we agree on is the idea that allowing small businesses and individuals who are, right now, trapped in the individual market and, as a consequence, have to buy very expensive insurance and effectively, oftentimes, just go without insurance could be solved if we allowed them to do what members of Congress do, which is be part of a large group.
Again, the idea of an exchange is not a government takeover. It is how the market works, which is, if you have a lot of purchasing power, you get a better deal. That's how Wal-Mart drives its prices down, because everybody who wants to supply Wal-Mart, Wal-Mart tells them, "You give me the best deal possible."
And as a consequence, the supplier gives them a much better deal than they do the mom-and-pop shop on the corner.
Well, we should be able to give small businesses and individuals who are self-employed, who aren't able to get insurance through a large employer to have the same deal.
It sounds like we've got some philosophical difference as to whether there should be some minimum benefits in that exchange, some baseline of coverage.
Again, there's a baseline of coverage for members of Congress. And the reason we set that up is because we want to make sure that any federal employee who's part of this big pool is getting good, quality coverage -- not perfect coverage, not gold-plated coverage but adequate coverage.
It may be -- and I'd ask my Republican colleagues to look and see, is that an area that can be resolved?
There's been a lot of discussion, and one of the main tools the Republicans have offered to drive down costs is purchasing insurance across state lines. This is an idea that is embodied in the House and Senate bill, but again, the details differ.
The approach that John Boehner and some of the Republicans appear to take is to say, let's just open things up; anybody can buy anything anywhere, regardless of what state insurance laws are, and that will drive competition and cost.
The philosophical concern I have on that is that you potentially get what's been referred to as a race to the bottom.
And for people who may not be following the intricacies of the insurance market, let me give an example that people understand, and that's credit cards.
You know, in the credit card market, part of what happened was we ended up allow allowing people to get credit cards from every other -- you know, whatever state. And there were a few states that decided, you know what, we're going to have the least restrictions on credit card companies that we could have.
And what ended up happening was that every single credit card company suddenly, lo and behold, started locating in that state which had the absolute worst regulations and consumer protections and all these fees and practices that people don't like. Folks weren't happy about it.
So the question I'm going to have is, is there a way for to us to deal with the interstate purchase of health insurance but in a way that provides, again, some baseline protection. Because what we don't want is a race to the bottom. We want everybody to have the basic protections that make sense. And that's not a big government takeover. That is a standard thing that we do in almost every area of life. We protect people with respect to the food that they buy, with respect to the drugs that they purchase.
We license and regulate the medical profession because we don't think anybody should just be able to cut somebody open. We want somebody like Tom or John to actually know what they're doing before they start practicing medicine.
And the same should apply when it comes to how we think about insurance.
Medical malpractice has been mentioned. Now, look, let me be honest. This is something, historically, that Democrats have been more resistant to than Republicans. I will note that, when we had a Republican president and Republicans controlled the House and Republicans controlled the Senate, somehow it didn't happen. And I'm surprised.
(UNKNOWN): We needed 60 votes in the Senate, too, Mr. President.
OBAMA: Well, the -- see...
So -- so, as a consequence, what I have suggested is that we explore building on what we've already done, administratively, without law, asking Kathleen to help states come up with new ideas.
I've suggested, well, let's take a look at -- Tom, the suggestion you had that gives states even more incentive to start thinking about reducing defensive medicine.
I have to tell you, Joe Barton, that how you got from $5 billion to $150 billion, I didn't quite follow the math. You know, it sounded...
I'm not sure you did, either, but it's OK. But -- but here's my commitment, is that, if folks were serious about getting this done, I'd be interested in seeing if we could work on something.
I actually agree with Dick Durbin with respect to hard caps, because of the story that he told about the woman who burned her face. I think there are situations in which there is actually a very severe problem. And I would distinguish that between some of the frivolous lawsuits that are out there that really do create a defensive medical problem. And ob/gyns are the ones who get hit the hardest because people are so sympathetic when a child is born with severe disabilities. And it can just be crippling on ob/gyns.
The same is true on -- for neurologists and so forth. So there may be some ways that we can work on that.
Now, I guess what I'm saying is I've put forward, then, very substantial ideas that are embraced by Republicans.
Peter, they're not -- I forget what metaphor you used about before you popped it in the microwave, whether it was bacon bits or sprinkles or...
OBAMA: Breadcrumbs -- that was what it was.
When it comes to the exchange, that is a market-based approach. It's not a government-run approach.
There were criticisms about the public option. That's when, supposedly, there was going to be a government takeover of health care. And even after the public option wasn't available, we still hear the same rhetoric.
And it turns out that what we're now referring to is we have an argument about how much we should regulate the insurance industry.
We have a concept of an exchange, which, previously has been an idea that was embraced by Republicans, before I embraced it, and somehow, suddenly, it became less of a good idea.
With respect to the most contentious issue, I'm not sure we can bridge the gap. And that's what we're going to have to explore. And that's the issue of how do we provide coverage not only for people who don't have health insurance right now, but also for people who have pre-existing conditions and are being priced out of the market, or potentially lose their jobs and will find themselves in a situation where they don't get coverage.
OBAMA: An interesting thing happened a couple of weeks ago, and that is a report came out that for the first time, it turns out that more Americans are now getting their health care coverage from government than those who are getting it from the private sector. And you know what? That's without a bill from the Democrats or from President Obama. It has nothing to do with, quote-unquote, "Obamacare."
It has to do with the fact that employers are shedding employees from health care plans. And more and more folks, if they can, are trying to get into the Social Security system and the Medicare system earlier through disability or what have you, so that they can get some help.
The point that Tom Harkin made, the point that Chris Dodd made, the point that Henry made and a number of other people made I think is very important to understand. I did not propose and I don't think any of the Democrats proposed something complicated just for the sake of being complicated. We'd love to have a five-page bill. It would save an awful lot of work.
The reason we didn't do it is because it turns out that baby steps don't get you to the place where people need to go. They need help right now. And so a step-by-step approach sounds good in theory, but the problem is, for example, we can't solve the preexisting problem if we don't do something about coverage.
Now, it is absolutely true, and I think this is important to get on the table, because we dance around this sometimes, in order to help the 30 million, that's going to cost some money. And the primary way we do it is to say that, for example, people who currently get all their income in capital gains and dividends, they don't pay a Medicare tax, even though the guy who cleans the building for him does, on his salary or his wages.
And so what we say is you make more than $200,000, $250,000 a year, if you're a family, and your income is from those sources, then you should do -- you should have to do the same thing that everybody else has to do. Somebody mentioned the fact that we say to small businesses -- I think John, John Kyl, you said, you know, we're taxing small businesses.
Look, we exempt 95 percent of small businesses from any obligations whatsoever because we understand that small businesses generally have a tough time enough. They don't need any more government burden. What we do say is if you can afford to provide health insurance, you have more than 50 employees, meaning you're in the top 4 percent of businesses, and you're nor providing coverage and you're forcing other businesses or other individuals to pick up the tab because your employees are either going in the Medicaid system or they're going to the emergency room, we don't think that's fair. So we say you've got to pony up some. It's not an employer mandate. It just says you've got to pay your fair share, because otherwise all of us have to pick up the tab.
And that, by the way, contributes to the overall deficit that Medicaid is running. In fact, most small businesses through this program get huge subsidies by becoming members of the exchange. That's where the money's going. The money's not going to some big welfare program. The money is going to give tax credits to small businesses, tax credits to those who are self-employed to buy into this pool. And that's not a radical proposition. It's consistent with the idea of a market-based approach.
And finally, with respect to bending the cost curve, we actually have a lot of agreement here. This is an area where if I sat down with Tom Coburn, I suspect we could agree on 95 percent of the things that have to be done, because the things you talked about in terms of -- and I wrote some of them down. In terms of reducing medical errors, in terms of incentivizing doctors to coordinate better and work in groups better, in terms of price transparency, improving prevention, those are all things that not only do I embrace, but we've included every single one of those ideas in these bills.
Now, the irony is that that's part of where we got attacked for a government takeover, because what happened was when we set up the idea of a MedPAC, which is basically a panel of doctors and health care experts who would recommend ways to make the delivery system so that we can squeeze out that one-third in Medicare and Medicaid that's wasted, a Republican idea, that was part of the ammunition you all used to say that the government's going to take away your health care.
So if we're serious about delivery system reform, if we're serious about squeezing out the waste that Tom Coburn referred to, you should embrace those mechanisms that are in this bill.
I will end by saying this. I suspect that if the Democrats and the administration were willing to start over and then adopt John Boehner's bill, we'd get a whole bunch of Republican votes. And I don't know how many Democratic votes we'd get, but we'd get a whole bunch of Republican votes.
The concern, I think, that a lot of the colleagues both in the House and the Senate on the Democratic side have is that after a year- and-a-half, or more appropriately after five decades of dealing with this issue, starting over, they suspect, means not doing much, or doing the proposal that John Boehner or other Republicans find acceptable.
And that it's not possible for our Republican colleagues to move in the direction of, for example, covering more than 3 million people. It's not possible to move more robustly in the direction of dealing with the preexisting condition in a realistic way. It's not possible to make sure that we get people out of a high-risk pool and get them into a situation where, as Tom Harkin put it, healthy people, young people, rich people, poor people, old people, the sick, everybody is part of a system that works. That, I think, is the concern.
Having said that, what I'd like to propose is that I've put on the table now some things that I didn't come in here saying I supported, but that I was willing to work with potential Republican sponsors on. I'd like the Republicans to do a little soul-searching and find out are there some things that you'd be willing to embrace that get to this core problem of 30 million people without health insurance and dealing seriously with the preexisting condition issue.
I don't know, frankly, whether we can close that gap. And if we can't close that gap, then I suspect Mitch McConnell and Harry Reid, Nancy Pelosi and John Boehner are going to have a lot of arguments about procedures in Congress about moving forward.
I will tell you this, that when I talk to the parents of children who don't have health care because they've got diabetes or they've got some chronic heart disease; when I talk to small business people who are laying people of because they just got their insurance premium, they don't want us to wait. They can't afford another five decades.
And the truth of the matter is that politically speaking, there may not be any reason for Republicans to want to do anything. I mean, we can debate what our various constituencies think. I know that -- I don't need a poll to know that most of Republican voters are opposed to this bill and might be opposed to the kind of compromise we could craft. It would be very hard for you politically to do this.
But I thought it was worthwhile for us to make this effort. We've got a lot of other things to do. I don't think, Tom, that we're going to have another one of these because people don't have seven, eight hours a day to work some of these things through.
What I do know is this. If we saw movement, significant movement, not -- not just gestures, then you wouldn't need to start over because essentially everybody here knows what the issues are. And procedurally, it could get done fairly quickly.
We cannot have another year-long debate about this. So the question that I'm going to ask myself and I ask of all of you is, is there enough serious effort that in a month's time or a few weeks' time or six weeks' time we could actually resolve something?
And if we can't, then I think we've got to go ahead and some make decisions, and then that's what elections are for. We have honest disagreements about -- about the vision for the country and we'll go ahead and test those out over the next several months till November. All right?
But I very much appreciate everybody being here. Thank you for being so thoughtful. And, you know, hopefully we'll all keep our constituents in mind as we move forward. Thank you, everybody.