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Health Care Summit Transcript: Part 4 (FULL TEXT)

First Posted: 04/28/10 06:12 AM ET Updated: 05/25/11 04:40 PM ET

Hcr Summit

The White House has released the full opening remarks of President Obama, Senator Alexander, Speaker Pelosi, and Senator Reid at the bipartisan health care summit. See our live blog of the day's events here, our curated twitter list here and HuffPost's selection of expert analysis here. Remarks are continued from part 3 below.


SENATOR McCONNELL: Mr. President, Dr. John Barrasso is going to
make our opening statement on coverage.

THE PRESIDENT: And then I will call Henry Waxman, and we'll just
go back and forth.

SENATOR BARRASSO: Thank you very much --

THE PRESIDENT: And because we are short on time, let's keep our
remarks relatively brief.

SENATOR BARRASSO: Thank you very much, Mr. President. For
people who don't know me, I practiced medicine in Casper, Wyoming for
25 years as an orthopedic surgeon, taking care of families in Wyoming.
I've been the chief of staff at the largest hospital in our state.
My wife is a breast cancer survivor. Bobbi has been through three
operations, a couple of bouts of chemotherapy. We've seen this from
all the different sides of care.

And this discussion needs to be about all Americans because
everyone is affected, not just people that don't have insurance. And
I've had dozens and dozens of visits to senior centers and town hall
meetings, and visited at service clubs, and if you go to any community
in America and you ask the question, "Do you believe that this bill up
here -- that this bill, if it becomes law, do you believe you will pay
more for your health care, you personally?" Every hand goes up. And
then you say, "Do you believe if this bill becomes law, overall health
care in this spending -- its spending in the country will go up?"
Every hand goes up. And then you ask the most personal question of
all, "Do you believe if this bill becomes law, the quality of your
personal care will get worse?" Every hand goes up.

And most worried of all are the seniors, when you go to the
senior centers, because they know there's going to be $500 billion
taken away from those who depend upon Medicare for their health care,
and it's not just Medicare Advantage. It's hospitals; it's the
doctors; it's the nursing homes; it's home health, which is a lifeline
for people that are home alone; it's hospice, for people in their
final days of life. That's all going to be cut. That's why the
seniors are most concerned.

And even the White House own actuary if this goes into play, one
in five hospitals, one in five nursing homes will be operating at a
loss in 10 years. That's what we're looking at.

Now, for 25 years practicing medicine I never asked anybody if
they were a Republican or a Democrat or an independent; didn't ask if
they had insurance or not; took care of everybody. And many, many
doctors -- I know Dr. Coburn, Dr. Boustany -- do that, we take care of
everyone, regardless of ability to pay. Doctors work long hours;
nurses work long hours.

And, Mr. President, when you say with catastrophic plans, they
don't go for care until later, I say sometimes the people with
catastrophic plans are the people that are best consumers of health
care in using the way they use their health care dollars, because a
lot of people come in and say, my knee hurts, maybe I should get an
MRI, they say, and then they say, will my insurance cover it? That's
the first question. And if I say yes, then they say, okay, let's do
it. If I say, no, then they say, well, what will it going to cost?
And what's it cost ought to be the first question. And that's why
sometimes people with catastrophic problem -- catastrophic health
plans ask the best questions, shop around, are the best consumers of
health care.

But to put 15 million more people on Medicaid, a program where
many doctors in the country do not see them, as Senator Grassley said
-- you know, you say, how are you going to help those folks? And, Mr.
President, when I talk to doctors, they say, I have a way: Put all
the doctors who take care of Medicaid patients under the Federal Torts
Claim Act. That will help them, because they're not getting paid
enough to see the patients. But if Medicare -- if they accept those
patients and then their liability insurance is covered under the
Federal Tort Claims Act, I think you'd have a lot more participation
in that program.

I do believe we have the best health care system in the world.
That's why the premier of one of the Canadian provinces came here just
last week to have his heart operated on. He said, "It's my heart,
it's my life. I want to go where it's the best." And he came to the
United States. It's where a member of parliament -- a Canadian member
of parliament with cancer came to the United States for her care.
They all have coverage there, but what they want is care -- so
coverage does not equal care.

What we heard from Senator Conrad is also right. Half of all the
money we spend in this country on health care is on just 5 percent of
the people. Those are people, for the most part, that eat too much,
exercise too little, and smoke. And as a result, we need to focus on
those people. So the focus ought to be on the best possible care.
People are happy with the quality of care they get, the availability,
but they sure don't like the affordability because it's not
affordable.

And, you know, Mr. President, the first week in medical school we got
our stethoscopes and the professor of cardiology, who just died this
past year, he said, this is to listen. This is to listen to your
patients -- listen to their heart, listen to their lungs, but it's a
constant reminder to listen to them, listen to what they are telling
you. And it means to listen to the other people in the room. If
you're seeing a child, listen to what the mother is saying. If you're
with an elderly person, listen to what their adult child is saying.
And it's a constant reminder to listen.

And I have great concerns that people around this table are not
listening to the American people and are fearful of the consequences
of this large bill, which is why only one in three people in America
support what is being proposed here. And that's why so many people,
Mr. President, are saying it's time to start over.

THE PRESIDENT: Let me just -- there's one thing I've got to -- there
are a number of issues, as usual, that I've got significant difference
with. I'm just am curious. Would you be satisfied if every member of
Congress just had catastrophic care? Do you think we'd be better
health care purchasers? I mean, is that a change that we should make?

SENATOR BARRASSO: Yes, I think actually we would. We'd really focus
on it. You'd have more, as you say, skin in the game -- and
especially if they had a savings account, a health savings account.
They could put their money into that --

THE PRESIDENT: Would you feel the same way if --

SENATOR BARRASSO: -- and they'd be spending the money out of that.

THE PRESIDENT: Would you feel the same way if you were making
$40,000, or you had -- that was your income? Because that's the
reality for a lot of folks. I mean, it is very important for us --
when you say, to listen -- to listen to that farmer that Tom mentioned
in Iowa; to listen to the folks that we get letters from -- because
the truth of the matter, John, is they're not premiers of anyplace,
they're not sultans from wherever. They don't fly into Mayo and
suddenly decide they're going to spend a couple million dollars on the
absolute, best health care. They're folks who are left out.

And this notion somehow that for them the system was working and that
if they just ate a little better and were better health care consumers
they could manage is just not the case. The vast majority of these 27
million people or 30 million people that we're talking about, they
work every day. Some of them work two jobs. But if they're working
for a small business, they can't get health care. If they are
self-employed, they can't get health care.

And you know what, it is a scary proposition for them. And so we
can debate whether or not we can afford to help them, but we shouldn't
pretend somehow that they don't need help. I get too many letters
saying they need help.

And so, I want to go to --

SENATOR BARRASSO: Mr. President, having a high-deductible plan
and a health savings account is an option for members of Congress and
federal employees --

THE PRESIDENT: If -- that's right, because members of Congress
get paid $176,000 a year.

SENATOR BARRASSO: -- 16,000 employees did take advantage of that.

THE PRESIDENT: Because they --

SENATOR BARRASSO: And so, it's the same plan --

THE PRESIDENT: -- because members of Congress --

SENATOR BARRASSO: -- that the Park Rangers get in the
Yellowstone National Park.

THE PRESIDENT: John -- John, members of Congress are in the top
income brackets of the country. And health savings accounts I think
can be a useful tool, but every study has shown that the people who
use them are folks who've got a lot of disposable income. And the
people that we're talking about don't.

Let's go to Henry. Henry Waxman.

REPRESENTATIVE WAXMAN: Mr. President, I just wonder if some of
our Republican friends would like to have seniors on Medicare have
catastrophic coverage only. I'd say to the seniors in this country,
and we've heard mention of them being the people who are worried about
this Medicare -- this health care bill -- they ought to worry if we
don't do something. Because not only will we hear ideas of putting
them on catastrophic coverage only, because that will save a lot of
money -- Paul Ryan has a proposal right now to say that Medicare
recipients in the future ought to have just a little voucher, and then
they can shop for their own insurance. They could be prudent
shoppers.

Well, yesterday I had a hearing with some people who were
supposed to be prudent shoppers. They were people from California who
were told by Anthem Wellpoint that their insurance was going to go up
30 percent -- 39 percent. And could you imagine, seniors, if you have
to go shopping with your voucher and then you're told, oh, by the way,
this private policy that you're going to have to buy just went up 39
percent? And the way to save the federal government money is to shift
it on to the seniors. That's where we're going if we don't do
anything.

Now, what do we do that makes sense? We've got to hold down
health care costs. You can't -- we had some ideas that we seem to
agree about to hold down health care costs. One idea I did find
peculiar, and that's to have the medical malpractice issue at the
federal level. And the Republican proposal is to adopt the California
law. Well, the California law is in effect. It's been in effect
since the 1970s. And Californians are faced with a 39 percent
increase, so it isn't holding down their health care costs. We've got
to really look at holding down health care costs. That's hard to do,
unless we have insurance reform so we could get more people buying
health care.

I thought Tom Harkin just summed it up so well. All these issues
go together. If you don't bring more people in to be covered, segment
the groups that are covered in high-risk pools, they pay more money --
everybody else is going to get a break. Well, under the Republican
proposal, the people who get a break for insurance are the people who
are healthy. The people who have to pay more are the people who are
sick. Is that what we want in this country?

Now, I hear people all day say, Mr. President, the public doesn't
want your plan. Well, if I heard the kind of rhetoric over and over
again that I've heard from some of the Republicans, I wouldn't want
your plan either. A federal takeover of health care? That's not
what's being proposed. Somebody said that people ought to be able to
buy a policy that suits their needs. Well, how many people are going
to come forward and say, I don't want certain things covered -- and
then find out that they're sick and they need that coverage.

We need to have a market like the federal government employees, like
members of Congress. We know what we can choose. If somebody wants
to choose a health savings account, that means because they want to
put some of their money away because it's tax-free and it's a really
great deal if you got a lot of money. But most people want to know
they're going to have necessary medical coverage for the doctors and
the hospitals when they need it. And you have something that's basic
to everybody. Well, they ought to have that for people who are buying
private insurance as well.

We had three witnesses yesterday. A woman told us that in her family
she had a child with a hole in the heart. And that -- because -- that
became a preexisting condition. So she has health insurance coverage
through this individual market. But she says, "I barely use it,
because I'm just -- I'm afraid to use my health insurance." She is
now told she is going to have this 39 percent increase. She said her
health insurance is going to cost her about as much as her mortgage
payment each month. She is afraid to drop it, because she doesn't
know where she could ever get health coverage again.

Another woman had asthma, and that was considered a preexisting
condition. She was going to face a 39 percent increase, as well.
Now, if they were pooled with everybody else in that small business
and individual market, which is what our bill does, then there are
more people buying insurance and there's more -- there's more
leverage. It's spreading the cost, not making people have to pay more
of these costs.

The people who we're talking about are people in small businesses
where the small business can't get insurance because, well, they got
one employee with a real serious medical problem. So nobody in that
group is going to get coverage, the employer can't afford it. Or
women, it costs more for small businesses if they're in that
workforce, especially if they're older. They don't want to get
coverage. They don't want to give them coverage either.

We have single adults, a lot of them not very healthy, dealing with
chronic conditions, parents and families living on low incomes. They
need help from Medicaid. We have to hold down the cost by bringing
everybody into the system. Now, in Medicare, what does our bill do?
It protects the solvency of the program for an additional seven to
nine years. For Medicare, we close the doughnut hole, which means
that when seniors have to pay for those prescription drugs, they don't
have to do it all on their own.

We keep them with a Medicare policy, and we provide preventative
services and they don't have to pay for them because we know
preventive services will keep us from having to pay for more costly
care.

This bill is good for people on Medicare and if we don't get this
passed they're going to get squeezed like crazy. This bill is good
for the American working people. This bill is good for our health
care system. And for us to take the Republican proposal -- we cover
instead of 30 million people, 3 million; we wouldn't hold down the
deficit a bit; we would still have all those preexisting conditions
that would keep people from getting their insurance coverage. Maybe
if people go and pretend to be patients we could stop some of those
false claims, but I'm sure those false claims happen in the private
insurance market and not just the public insurance market.

But not only are we covering more people, we're doing innovative
ways to deliver the care that will make it less costly. And as we
develop innovative ways to deliver care, especially with chronic care,
that will hold down the costs of care and those ideas would be picked
up by the private sector. They always follow what Medicare does and
then they adopt it because they want to hold down costs.

So you can't solve any problem -- insurance reform, holding down
costs, protecting Medicare, dealing with the deficit -- unless you
deal with it all. And Mr. President, you're not going to be able to
do this piecemeal and I have doubts about whether the Republicans are
going to help you because I haven't heard a lot of willingness to come
and work with you now or did I hear it a year ago -- I hope I'm wrong.

THE PRESIDENT: Well, I'm going to be equal opportunity here and
say we're not making campaign speeches right now. And I think your
points I agree with, but I still think that there's a lot of areas of
agreement that we've discussed so far. This is an area, though, that
-- in which we do have some philosophical disagreements. And so what
I -- I think it's -- I want to go to a Republican.

The question I would ask to my colleagues, my friends on the
Republican side, would be, are there areas of coverage for people who
don't have health care that you would embrace and agree with beyond
what has been presented in Republican Leader Boehner's bill. There
may not be. I mean, that may be sort of the threshold at which all of
you think we can afford to provide help to people who don't have
coverage, but there may be some other ideas that haven't already been
presented or aren't embodied in your legislation, John, that I'd be
happy to hear about.

REPRESENTATIVE BOEHNER: I want to yield to Peter Roskam from Illinois.

REPRESENTATIVE ROSKAM: Thank you. Mr. President, thanks for
your hospitality. For the benefit of the group I want to take you for
a couple of minutes to an experience that I had with then-State
Senator Obama in the state of Illinois when he took on a very
controversial initiative regarding the death penalty situation. And
lest you think that the death penalty is sort of a junior varsity
issue -- it's not. It's crimes, it's claims of innocence, it's
penalties forever. And then-State Senator Obama approached
Republicans and said, look, let's fix this, let's recognize the
problem here, let's fix it.

But it was very different than what I sense is happening today.
What I sense is happening today is, "what is it going to take for you
Republicans to vote for our bill?" That's the subtext that I'm
getting. My sense is that this is a problem of message, it's not a
problem with the messenger. You've got an incredibly skilled
messenger who has been out these past several months in joint session
speeches and a whole host of other venues, interviews, talking --
you've all seen it, you've all participated, you've all listened --
and I think the American people, when the conversation first began
about expanding coverage, lowering cost, were actually hopeful.

And it wasn't just a bumper sticker -- I think they were actually
hopeful about what was going to be happening. And they listened and
they listened and they listened. And my sense -- now, I can't speak
for every one of your districts, but in my district they've become
increasing disappointed with what they have seen come out of this
process.

And this is not a prop -- this is the Senate bill. And my
district says, you know what, that's sure looking like just something
that's now being popped in the microwave, taken out, a little salt, a
little pepper, some Republican bread crumbs on the top, and put it
back in front of the public to say, well, do you like it now? And my
district really doesn't. I don't know, I suppose you represent some
districts that do.

And I think one of the problems, to get to this coverage issue,
is that the premise of this bill is that coverage is expanded through
Medicaid, welfare. Speaker Pelosi a couple of minutes ago -- or a
couple of hours ago, actually said that health care reform is
entitlement reform.

SPEAKER PELOSI: Yes.

REPRESENTATIVE ROSKAM: Yes. I would put a brighter light on
that and say it's entitlement expansion. Think about what we're
doing. The CBO when they wrote to Harry Reid -- wrote to Senator Reid
a couple of months ago, they said, look, there's about 15 million
people that are going to be put on Medicaid. And Medicaid is a house
of cards. Medicaid is not something that is serving the public very
well.

The state controller in Illinois -- and we all come from states
with real trauma -- the state controller in Illinois recently wrote
that as bond rating agencies continue to downgrade Illinois rankings
to the lowest in the nation, the state can't afford further
jeopardizing.

This bill, section 2001 of the Senate bill, takes away all of the
flexibility as it relates to changes in Medicaid. That is making our
states I think ultimately hidebound in how they approach these things.
This is something that in my view isn't sustainable.

Governor Brian Schweitzer of Montana said -- let me give you a
quick quote -- "One of the least effective programs in terms of health
care in the history of the country is called Medicaid. About 20
percent of America is on a Medicaid program and they would like to
shift" -- "they" meaning Washington -- "would like to shift it and
grow it to somewhere around 25 or 30 percent."

Now, Medicaid is a system that isn't working. Almost everyone
agrees. But what Congress intends to do is to increase the number of
people on Medicaid so that they can do it on the cheap. It isn't
working for anybody.

Look, the foundation of the expansion is Medicaid. And in my
view, and I think the view of folks in my district and I think many,
many people across America, it is a flawed foundation. And we can do
much, much better. A Republican proposal that's out there would
reduce the number of uninsured by 3 million people.

So, look, you heard it today in many, many forms -- this -- you
remember the old -- in closing, you remember the old game you used to
play as a kid, Etch A Sketch, and you'd start out with the Etch A
Sketch, that little thing where you try and draw something and you
dial the dials and over a period of time the more you dialed the more
crazy it looked and then finally you'd say, oh, let's just go like
that and do the Etch A Sketch.

I'll tell you what, a year's worth of work and this is what has
come up with? The American public, as far as the ones that I have
heard from, are vehemently opposed to this. And they say, look, take
the Etch A Sketch, go like this, let's start over, let's do
incremental things where there's common ground. I yield back.

THE PRESIDENT: I want to make sure that everybody gets an
opportunity to speak. But I just want to caution everybody, it's now
4:15 p.m. There are a number of folks who haven't had a chance to
speak. The question I had was, were there ideas about expansion
beyond the 3 million that that was in Leader Boehner's bill, and I
didn't get an answer on it -- so in addition to, and it may be that
the answer is that's all we can do.

I should point out this one issue about Medicaid that I think that's
important. Most of the people we'd like to be in the exchange and
giving them subsidies. And I think over time (inaudible) see as an
evolution, if you created a large enough pool, where people could
purchase it through an exchange the same way that members of Congress
do.

The problem we've got right now is that very poor people, they've
got coverage through Medicaid. And it's somewhat flawed. There are
problems with doctor reimbursements, there are problems long-term in
terms of solvency both for the state and the federal level, so all
those things need to be fixed. But the fact of the matter is if their
kid gets sick, they can go to a doctor.

The people who are really left in the cold are working families
who make too much for Medicaid and don't have anywhere to go. That's
the group that right now is getting the worst deal. They're paying
taxes, they're working, but they've got nowhere to go.

Now, for those 15 million people who've got nothing, I promise
you they would say to themselves having some coverage through Medicaid
is a pretty good deal. I'd prefer to have them in an exchange where
over time we've got everybody in a pool, similar to the pool that
members of Congress enjoyed. But that's not the situation that we
have right now. I just want to remind everybody though that the group
that is being left out, because you threw out the word "welfare,"
which is, you know, one that obviously most American people -- they
don't want to be part of welfare -- the fact of the matter is, is that
very poor people right now have coverage that is superior to what a
lot of folks who make a little more money, are working very hard
trying to support their families, do not.

Now, I know that Max has been trying to get in for a while, but
there are some other folks that haven't had a chance to speak, so I
want to call on them first. And then if I've got time, Max, I'll
allow you to wrap up.

But I'm going to go to Chris and Murray -- Chris and Patty Murray on
our side, as well as Charlie Rangel who want to speak, and what we'll
do is we'll alternate to make sure that we've got -- and I know that
Joe Barton is interested in speaking, as well, and there may be a
couple of other Republicans.

Go ahead.

SENATOR DODD: Well, thank you, Mr. President, and I'll try and keep
this brief and turn it over to Patty, so we'll take the time for one
person and divide it in two.

Let me first of all thank you as well and thank all of our colleagues
who have done this. This has been tremendously helpful I think today.

It's been said earlier -- maybe it needs to be focused, as well --
like many of you, like all of you here, in my state there are 31
hospitals, and they're terrific people. Whether or not the quality of
care is equal for everyone in this country is certainly questionable,
but certainly the quality of the people who are our health care
providers -- the nurses, the doctors, and others -- do an incredible
job every single day.

And the sense -- I was struck when the REPRESENTATIVE was talking
about the death penalty issue that was debated some time ago in
Illinois. I think most of us around this table here would agree today
that every person, if they're confronted with a legal problem has a
right to a lawyer. That's something we've accepted as a country.

It's somewhat ironic, I suppose -- and history may judge us
accordingly -- that while everyone was entitled to a lawyer,
regardless of what you've been charged with, that you don't have a
right to a doctor. And yet at the same time we acknowledge that we
provide care: If you show up in an emergency room, we take care of
you. And that's a great testimony about who we are as a people.

The problem is of course the costs associated with that. I think
there's a false assumption that that's one group of people, and
they're out there, and they have no impact on what happens to those
who have insurance today, and somehow they should be taking better
care of themselves, they should quit smoking, they should eat better,
they should get a job; that somehow the responsibility rests with
them.

If you can accept that, which I don't, the fact of the matter is that
sector of our population affects everyone else. It costs us about
$248 billion a year in lost productivity when you have increased
numbers of uninsured people in the country.

At this very hour, there's a cost with every single insured person in
this country of roughly $1,100 a year to pay for that cost of that
person showing up in that emergency room, or getting that care.
That's a hidden tax that Americans are paying today when people show
up for that kind of support.

There are -- today before we wrap up and go back to our offices and go
back to our homes this evening here in the District of Columbia,
14,000 of our fellow citizens will have lost their health care today.
And every day that we're here debating and discussing this, 14,000
Americans lose their health care. Roughly six to eight people will
have lost their lives today as we gather around this table because
they're uninsured, based on a Harvard study and National Science
Foundation study; that we lose that many people on a daily basis
because we lack -- because they lack health insurance.

So there are tremendous costs associated with this. Henry said it
well, Tom said it well, and Mr. President, you certainly encapsulize
it very well. These are not segmented issues. And while incremental
approaches are something I (inaudible) support and approach after 30
years here in dealing with major issues, but this issue defies
incremental approach. You can't get from one point to the next
incrementally unless you deal with it holistically, and that's really
what we're trying to do.

And you may disagree about whether or not we're doing too much on
mandates or too much here or there -- and that's a legitimate debate
-- but you can't get to affordability, you can't get to quality, you
can't deal with the major economic issues if you don't deal with
coverage. You just can't. There's no way to do it. You've got to
have broadening coverage if you're going to have any effort or any
successful effort in reaching those questions.

Lastly, I'll just say this to you. A guy in my state, Kevin Galvin
(phonetic) -- Kevin employs seven people, a maintenance operation in
Hartford, Connecticut. He wanted to provide health care. And like
the stories you've all heard, he lost a fellow of 24 years because the
guy had a health care issue, he finally had to take less pay, took
another job, because there was health care provided. But Kevin did
more than just tell me a story about himself, Mr. President, and what
happened to his seven employees because they couldn't get health care.

He went out in my city in Connecticut and organized 19,000 small
businesses, and they changed the law in Connecticut regarding pooling
in small businesses, because here was a small business guy who wanted
to take care of his people and watched tragically day after day what
happened to individuals because he could not provide it for them any
longer.

And I think people like Kevin Galvin exist in every district in
every state who want to provide that health care, understand how
valuable it is to them, their productivity, and of course the
importance of their employees.

But coverage is the critical issue. We know that in the next 10
years -- factually, Mr. President -- in the next 10 years every state
in this country will have a 10 percent increase in uninsured people.
We know that in 30 states in our country in that same 10-year period
there will be a 30-percent increase in the uninsured. And half the
population under the age of 65 will at one point or another in the
next 10 years be without insurance.

So it's not some isolated group out there. This is the critical
constituency that is -- this is the lynchpin that holds all of this
together. So coverage is absolutely critical.

REPRESENTATIVE BARTON: Thank you, Mr. President. I want to
commend you for asking us to come here, and I will say that never have
so many members of the House and Senate behaved so well for so long
before so many television cameras. (Laughter.) So if we ever get to
a conference committee, we may want you to be the moderator.

I do think, though, that there is a fundamental difference in the
vision that you and your friends on the majority have put forward, and
the vision that myself and those of us in the minority have put
forward. It's the fundamental role of government. We believe that we
should use free markets to empower people and give them choices. And
for the best of intentions, yourself and most of your allies in the
Democratic Party seem to believe that the government, either through a
mandate or through a regulatory requirement, knows better and will do
better for health care for most Americans. Now, whether you have a
mandate or simply give the Secretary of Health and Human Services the
ability by regulation to require something, that's a difference
without -- that's a distinction without much of a difference.

So the six commonsense ideas that various Republicans have put
out here is not incrementalism in the sense that it doesn't go
together, but it does not radically change the basic health care
system of America. If you give the ability to sell insurance across
state lines, and prevent a state from precluding it, if the insurance
company can prove that it's solvent and that it will pay the benefit,
health care costs will go down in that state and premiums will go
down.

There was a study just out that in the state of California health
care premiums would go down 50 percent if Californians could buy
insurance from Nevada or Oregon. If you create a catastrophic
high-risk pool and put the cap on it that Leader Boehner did on his
alternative on the House floor, and allow small businesses to create
the kind of pools that we've talked about, you're going to be able to
give those Americans who can't get insurance because of a preexisting
condition and want it the ability to get into those things. And their
premiums will not go up catastrophically. They will not go up
astronomically.

And one of the things that we seem to have agreement on,
according to yourself and Senator Durbin, is medical malpractice.
Now, your proposal in the House bill and the Senate bill pay lip
service to medical malpractice, but they don't really do it. Again,
if you take the Boehner proposal that was put together and put up on
the House floor, and it's based on what's happened in Texas -- in
Texas, which put in medical malpractice reform in 2003 -- premiums for
medical malpractice have gone down 27 percent.

Texas has gained 18,000 doctors since this reform was put in. There
are 55 rural counties in Texas that now have an obstetrician.

If that is extrapolated nationally, you're not going to save the
$54 billion that Senator Durbin alluded to and that yourself alluded
to. If you combine the direct savings with the indirect savings,
because the price of practicing defensive medicine goes down, you've
probably saved $150 billion a year. Now, that's real money.

So what we're saying, Mr. President -- we're not talking about
incrementalism. We're talking about, as Leader Boehner said and Mr.
McConnell -- Senator McConnell said, let's start over in the sense
that we change the vision and work together to do the things that we
agree upon, but do it in a way that doesn't destroy the fundamental
market system that's made the American health care system the best in
the world. And if we do that, we can make a deal.

Thank you, Mr. President. Thank you, Leader Boehner.

THE PRESIDENT: Joe, I'll respond to you right (inaudible)
because I think we should wrap it up.

You're right, the proposal that John Boehner has put forward doesn't
radically change the existing system. And that I think is why 3
million out of the 30 million who don't have coverage, or 40 million,
don't get coverage. The proposal that's been put forward by the House
and the Senate Democrats also doesn't radically change it in the sense
that the vast majority of people who currently have health care will
still get it, it's just they'll see it a little cheaper. People who
do not have coverage will start getting it. So that's -- it's not --
neither of these proposals are radical. The question is, which one
works best for the American people? And that's what we'll see if we
can determine.

We're running short on time. I know that some folks are going to
at some point have to get going. I am going to reserve the
prerogative of making sure that everybody who has not had a chance to
speak is allowed to speak, and then I will wrap up. That means that
we're probably going to go a little bit later than we had anticipated.
But, as I said, by the standards of Washington, we're still in the
ballpark here.

I'm going to call on Charlie Rangel first. We'll go to one of
our Republican colleagues. Patty Murray is going to have an
opportunity to speak. Again, there may be some comments -- there may
be some other Republicans who are interested in speaking. We'll go to
-- we're going to actually go to Ron Wyden first. Then, we're going
to go to another Republican. And we're going to end with John
Dingell, who was there when the idea of everybody having health care
was first introduced by his father many decades ago.

REPRESENTATIVE WAXMAN: Mr. President, why don't you just call on
Republicans who haven't talked, because some of them have talked
numerous times?

THE PRESIDENT: I agree, but I want to make sure that they may
want to respond to whatever is said. Go ahead, Ron.

SENATOR WYDEN: Thank you very much, Mr. President. And I think
this has been a very constructive session. For the last six hours, we
have essentially heard Republicans talk about incremental coverage and
Democrats talk about comprehensive or broader kind of coverage. And I
want to outline something that I think could bring both sides together
for just a couple of minutes.

First, on the incremental point, the evidence shows that
incremental reform not only does less, it costs more. And the experts
that both Democrats and Republicans rely on have found this -- the
Lewin Group, for example, that Republicans quote from, they say that
and both sides use them. Also, history. We have been doing
incremental reform in this country since 1994. Since the blowup of
the Clinton plan, that's exactly what we've been doing, and costs have
been gobbling up everything in sight in the private sector and in the
government.

So I would submit that instead of this debate about incremental
reform or comprehensive reform, we could all be for real reform. And
real reform, in effect, changes the incentives that drive the system
and particularly empower the consumer.

Mr. President, I've been very pleased that you've constantly been
coming back to the system for members of Congress. Folks, all of us
can fire our insurance company, every one of us. And as far as I'm
concerned, we've got to stay in this battle until everybody in the
United States has that right to hold the insurance companies
accountable and to fire them.

And one of the promising points you made this afternoon, Mr.
President, that I appreciate is the point on interstate shopping,
because this is another opportunity, in my view, done properly --
properly to empower the consumer. Now, colleagues, our system -- the
one that we enjoy -- already allows interstate competition for health
insurance. That's the way the federal system works right now. And
there are good consumer protections.

So, Mr. President, when you made that offer to all of us today to
work with us on this, not only am I going to follow up on what I think
is a very gracious offer to try to bring both sides together, it
allows us to build on the exchanges that we have today, which begin to
empower people with more choices and competition. And if we just keep
building on that, starting with this effort to bring both sides
together on interstate competition, looking in my view at the federal
employee system to do it, I think we can resolve a lot of our
differences. So I appreciate the opportunity to speak, Mr. President.
I want colleagues to know that I'm going to be following up with both
sides of the aisle this afternoon and your administration to bring
this group together.

SENATOR McCONNELL: Mr. President, all of my members have had a
chance to speak at least once, several of them a number of times. Jon
Kyl reminds me that the HSAs, for example, are not exactly for rich
people; that the median income of a user of a HSA is $69,000 a year.
All of us are representatives of the American people, but I have a
feeling we haven't been listening to them very carefully.

REPRESENTATIVE Roskam mentioned what the people in his district
think, and I expect all of you are experts on what the people in your
districts think. But we know from the polling that's been done in
this country how the American people feel about this 2,700-page bill.
We know how they feel about it. This is not a close call. If you
average all of the polls in America, we know that the American people
oppose this proposal by -- on an average of 55 to 37 percent.

They have also been asked -- and we keep reading in the newspaper that
where we're headed next is to the reconciliation approach. Well,
Gallup also asked that question. It explained to the American people
what it meant so they understood what this word that we use around
Washington actually means. And in the Gallup poll, the American
people were opposed using that, 52 to 39 [percent].

So this has been a fabulous discussion, Mr. President. We have a lot
of experts around the room. But I think it's really important, since
we represent the American people, that we not ignore their view on
this. They have paid attention to this issue like no other issue
since I have been in the United States Senate. Health care is a
uniquely personal issue. Obviously, you get more interested in the
subject the older you get. But every American cares deeply about the
quality of their health care, and access to health care and cost of
health care. They have followed this debate like no other, and they
have rendered a judgment about what we have attempted to do so far.

The solution to that is to put that on the shelf and to start over
with a blank piece of paper and go step by step to see what we can
agree on to improve the American health care system, which is already
-- as all of us agree -- the finest in the world.

THE PRESIDENT: I'm just going to make this remark, and then I'm going
to call on Patty Murray -- I'm going to save the two lions of the
House here for the end -- because there's been a lot of comments from
every Republican about the polls and what they're hearing from their
constituents. And, as I said, I hear from constituents in every one
of your districts and every one of your states. And what's
interesting is actually when you poll people about the individual
elements in each of these bills, they're all for them. So you ask
them, do you want to prohibit preexisting conditions? Yes, I'm for
that. Do you want to make sure that everybody can get basic coverage
that's affordable? Yes, I'm for that. Do you want to make sure that
insurance companies can't take advantage of you and that you've got
the ability, as Ron said, to fire an insurance company that's not
doing a good job and hire one that is, but also, that you've got some
basic consumer protections? Yes, we like that.

So polls I think are important in taking a temperature of the public.
If you polled people and asked them, is the system working right now
and should we move forward with health reform, they'd also say yes to
that. And my hope had been, and continues to be, that based on this
conversation there might be enough areas of overlap that we could
realistically think about moving forward without -- without a
situation in which everybody just goes to their respective corners and
this ends up being a political fight, because this is something that
really has to be solved.

We've got three people who have not had an opportunity to speak today.
If you don't mind, I will -- would like to, in the interest of time,
just go ahead and let each of them speak. If there's an intervention
that somebody on the Republican side wants to make, then I will
recognize them. Then I will allow anybody of your choice, Mitch, to
wrap things up. I think Speaker Pelosi may want to say just a quick
summary of what she's thinking. And then I will talk a little bit
about next steps. And if everybody could keep their remarks
relatively brief, that'd be very helpful.

Patty.

SENATOR MURRAY: Mr. President, thank you. And this has been I think
a very good discussion. And I think all of us come to this table
today having heard a lot of stories and talked to a lot of people and
bring their passions with us today. And I certainly am one of those.
And every time we talk about this -- every time I think about this, I
remember a little boy that I met last spring who is 11 years-old,
whose name was Marcelis (ph). And he told me that his mom, single
mom, taking care of him and his two younger sisters, was going to work
every day, had a job managing a fast-food restaurant, was doing okay
but she got sick. And when she got sick she had to take time off from
work and because she was missing so much work she lost her job. When
she lost her job, she lost her health care. And because she lost her
health care, she couldn't get in to see a doctor, and sadly,
Marcelis's mom died.

I think about him every time we talk about this bill. And what
happened to her is happening to so many Americans who when they get
sick today don't have any choices. They have nowhere to go. Either
they don't have insurance or they've been denied insurance because
they don't -- because they have a preexisting condition or they're a
small business whose premiums have gone up so dramatically that they
can no longer afford to provide it for their employees. Too many
Americans today are in a box and they don't have a choice.

Frankly, it's why so many Americans today are passionate about a
public option. It was a choice for them that they felt was important
to them. But in the bill that you have presented and that we've been
working on that is so important is it finally gets some people out of
that box of no choices -- by giving them an exchange that they can go
to, by taking care of the insurance reforms so they're not denied
coverage, by opening up community health centers so people have
choices, by making sure that we lower the cost for all Americans
because when we provide coverage for 30 million Americans it lowers
the cost of everyone who has insurance today by $1,000 a year a family
-- this is why this is so important.

And what I have listened for today is whether the alternative
proposal that has come before us gives people those choices that they
need. And that's what I'm listening for and I go back to Marcelis and
I think, will that proposal make sure that nobody loses their mom
again because they didn't have a choice? And that's why it's so
important that we move forward with what we have and open that door
for so many Americans.

THE PRESIDENT: Thank you.

SENATOR McCONNELL: Mr. President, Dr. Coburn.

SENATOR COBURN: If we don't think about what the key goal is --
the key goal is to reconnect purchase and payment so we become good
purchasers. Whether we create -- what system we do, if we don't
reconnect the mechanism of payment with purchase, we're not going to
get good value out of our health care system. And I outlined one out
of every three dollars that doesn't help anybody get well, doesn't
prevent them from getting sick. And there's enough potential there in
that pool of money that we don't have to have the government run it.
What in fact we can do is we can create and allow that money for
everybody to have the kind of access that Senator Murray wants that
individual to have.

The thing that I think is -- draws us apart is the level of
involvement in the government in making those choices. And I would
just put forward to you that we ought to have another talk like this
as we can get closer and closer on some ideas because we all want the
same thing, but how we get there, whether or not we're in charge of it
or the individual patient is in charge of it, personally making their
own choices with the asset value that is capable, based on what we're
already spending in health care. We don't need to spend a penny more
in health care in this country. What we need to do is spend it much
more wisely and much more effectively.

THE PRESIDENT: I'll pick up on some themes in my close. Charlie Rangel.

REPRESENTATIVE RANGEL: Thank you, Mr. President, and I
appreciate the fact that you saved the best for last.

THE PRESIDENT: Absolutely. (Laughter.)

REPRESENTATIVE RANGEL: I had really hoped that when we came here
that we were really going to push over the top. We are so close to
national health insurance, we are so close to allowing people that go
to work every day and don't know what can happen to them when they
lose their job and lose their health insurance. I know that they call
the Senate the upper house, but I was amazed how it seems as though
they believe the American people only listen to those from Wyoming and
Kentucky. But having said that, for my New Yorkers, even though we
have more self confidence than we need, I would want them to know that
they are Americans and that we do listen to them and that the states
that oppose this great plan, doesn't speak for all of America.

Having said that, some people have called those who oppose us as
being the "party of no." I don't think so, notwithstanding the fact
we got five Republicans from the Ways and Means Committee here at your
summit. Now, we spent hundreds of hours in three committees and Ways
and Means and there wasn't one bill before us. And I would think that
instead of taking the President's time, that this is where the House
and the Senate would take care of legislative business, especially if
we agree on 70 percent. For God's sake, then, for the 10 or 20
percent, why do you say scrap what we got unless it ends up with that
you have made up your mind that we're not going to have a health bill?

And then I would say that most all of America would find it not more
difficult to understand why the bill is so big, or why we use
reconciliation. I think one of the big problems America would have
is, why does it take 60 to get a majority? And I have to explain,
well, that's the Senate and they're different than most Americans in
understanding it.

So what I would hope would happen is that we leave here not
thinking that we're going to start all over. We can't get back those
times. This is the last year for a whole lot of people in the House
of Representatives who we believe we represent the people, too. Why
can't we take what we've agreed to? I mean, sick people, scared
people, are not Republican and Democrats. They're Americans. And
you've made it abundantly clear that you have the same sensitivity,
you recognize the fiscal crisis, you know what can happen to our
country if we're not educated, if we're not strong in a healthy way.
Have staff or somebody bring together those issues that cannot be
contradicted in terms of what you want. And I know you want more than
just 3 million people insured. You can explain why it's difficult for
you to do it. But I know you would want to achieve having most all
Americans or all Americans with the same health benefits because
that's so important.

And then, Mr. President, after we start learning to agree with
each other, and it's not a question of no but it's the Congress
working its will for the good of people, then we can work out -- and
God knows Mr. Camp and I have tried desperately hard, and Jim McCrery
before him -- to realize people aren't concerned with the debate.
They're concerned with what are we going to produce.

And I don't care what your color is, I don't care what your party
is, that if you're sick you're sick, and you don't check out the
doctor. And they're not going to check out whether or not you're
Republican or Democrat.

So I just hope that we can change this to a positive thing where
you can say let's leave here at least talking about what we agree on.
Let's stop knocking each other as who's the smartest and who's the
most patriotic. And let's really, then, confine the public argument
to where we disagree.

And rest assured, I can assure you that they won't be concerned
with how big the bill was. I have no clue as to how big the Social
Security bill was, how large, how many pages was in the Medicare bill.
And I don't really think that someone sick in the emergency room is
concerned about the size of the bill that we are trying to help them
with.

So I appreciate this.

THE PRESIDENT: John Dingell.

REPRESENTATIVE DINGELL: Mr. President, thank you. And God bless
you for your leadership in this matter. The country desperately needs
you and desperately needs this legislation. I saw the cartoon, two
people are sitting down, and one of them says, "Terrible news. Our
health care rates are going to go up 40 percent." The other guy says,
"Don't worry, good news is you're not concerned because you have
preexisting conditions." (Laughter.) This solves both problems, the
bill. And Mr. President, again, we desperately need your lead.

Now, having said that, when my dad started out on this years ago,
Harry Truman said, you know the reason people don't have health care
in this country? They can't afford it. And he was right. And it's
still the case today.

I saw this morning a statement that was made with regard to
starting over. This comes from a respected Republican leader,
Governor Schwarzenegger of California, February 23, 2010: "I think
any Republican who says you should start from scratch, I think that's
bogus talk and that's partisan talk."

I think we need to buckle down and get to the business of solving
the biggest problem that this country has coming down the road at us.
In 2025, the cost of a family's health insurance is going to double --
$25,000. I don't know anybody who can afford that. You can argue
about Cadillac plans and other nonsense. That's not going to be
important. And in 2080, the cost of all of our health care is going
to equal the gross domestic product. It's a recipe for disaster.

We have much in common, I want you to know, and I hope and pray
you will take a look. We cover young adults under their parents' --
under their parents' insurance. That's a Republican offer. We
prohibit dropping insurance coverage when the patient gets sick, but
we don't -- and the Republicans do, too, but they don't cover
preexisting conditions. Both of us prohibit annual and lifetime
limits. High-risk pools, we have and they have.

But high-risk pools carry with them some risk, because it
constitutes an incentive for a race to the bottom, whereby people will
move their insurance coverage to the place where they have the least
regulation and the least protection for the consumers.

And it also includes, and amongst the other 14 items where we're
agreed on, is the availability of health savings accounts. There are
a lot of other things here that we have and we need.

I would say that I've seen some of my friends who I knew before
they were virgins. They were pushing, for example, use of the
extraordinary budgetary mechanism, as to get this decided by 51 votes.
Seems like a great idea, if -- and I'm curious, why in the name of
common sense are we being so fussy about having the decisions in the
people's House and the people's Senate decided on the basis of a
simply majority, 51 votes? And if there's something wrong with that,
I wish somebody would tell me why we ought not give the people that
kind of representation.

I would note that also mandatory coverage, mandates. That was in
a bill introduced by my good friend Bill Thomas, Chairman of the Ways
and Means Committee, and 20 members of the U.S. Senate. They said --
and they were not fussy about that. And I think we ought to look to
see, here we have a chance to serve the people. I have people coming
to my office with tears in their eyes. They can't get coverage. They
have preexisting conditions. A young dental surgeon I knew couldn't
get health care. Why? Because she had breast cancer years before;
she couldn't get care. And I've seen a lot of other cases like that,
people who would have drive-through pregnancies or drive-through
mastectomies, and all manner of high-handed abuse by the insurance
companies.

I'm always surprised when I can find somebody that's defending the
insurance companies after the things that they do to the ordinary
people in this country. They could cancel your insurance policy while
you're on the gurney headed into the operating room. Somebody would
-- if somebody would explain that to me, I would be deeply grateful.

But the fact of the matter is, we have a chance to do something
that Dan Webster one time observed. I thought it was -- I thought it
was a very useful thing that he said. And I think we ought to -- he
said, "Let us see whether we also, in our day and generation, may not
perform something worthy to be remembered." It's on -- Madam Speaker,
as you well know, it's on the wall of the House of Representatives.
It's there for us in the House, and my colleagues in the Senate will
know it, those few who I see again and serve with us will recognize
that as something.

We have before us a hideous challenge. The last perfect
legislation that was presented to mankind was delivered to the
Israelis at the base of Mount Sinai. It was on stone tablets written
in the fingers of God. (Laughter.) Nothing like that has been
presented to mankind since. What we're going to do is not perfect,
but it's sure going to make it better, and it's going to ease a huge
amount of pain and suffering at a cost which we can afford, which has
been costed out by the Office of Management and Budget -- the
Congressional Budget Office, saying, it's budget-neutral and in fact
reduces the budget.

I beg you, my friends, let us go forward on this great task.

THE PRESIDENT: Thank you, John.

REPRESENTATIVE DINGELL: Thank you, Mr. President.

THE PRESIDENT: Speaker Pelosi wants to say a brief word. John, do
you want to say anything in closing? And then I will wrap up.

Nancy.

SPEAKER PELOSI: Thank you very much, Mr. President. As one who has
abided by the three and a half minute, I'm going to take a few seconds
more now in closing to extend thanks to you, Mr. President, for
bringing us together, for your great leadership, and without it, we
would not be so very close to affordability, accountability for the
insurance companies, and accessibility for so many more Americans to
improve their health care, to lower their cost.

Mr. President, I harken back to that meeting a year ago. At that
time, Senator Grassley said -- questioned you about the public option.
And you said, "The public option is one way to keep the insurance
companies honest and to increase competition. If you have a better
way, put it on the table."

Well, I bring that up because we come such a long way. We're
talking about how close we are on this, how far apart we are here.
But as a representative of the House of Representatives, I want you to
know that we were there that day in support of a public option, which
would save $120 billion, keep the insurance companies honest, and
increase competition.

We've come a long way to agreeing to a Republican idea -- the
exchanges. Senator Enzi has been a leader in that. Senator Snowe,
along with Senator Durbin, had legislation to that effect --
bipartisan. It caused the insurance companies opposed the public
option. They couldn't take the competition.

We have in our bill market-oriented, encouraging to the private
sector, initiatives. I think the insurance industry, left to its own
devices, has behaved shamefully. And we must act on behalf of the
American people. We have lived on their playing field all this time.
It's time for the insurance companies to exist on the playing field of
the American people.

I believe I have news for some of my colleagues, because we have
very much more in common. Senator Coburn, you had so many positive
suggestions, which I didn't hear much else of, but from you we did.
And I think you'd be pleased to know that after much debate in our
House, we came up with value not volume; others have called it quality
not quantity in terms of utilization, over-utilization. Senator
McCain, when you talk about Florida, we're talking about addressing
the regional disparities in terms of compensation and health care.

So we have addressed many of these issues in the bill. I think
it's really important to note, though, and I want the record to show
-- because two statements were made here that are not factual in
relationship to these bills. My colleague, Mr. -- Leader Boehner, the
law of the land is there is no public funding of abortion and there is
no public funding of abortion in these bills. And I don't want our
listeners or viewers to get the wrong impression from what you said.
Mr. Camp -- Mr. Camp, you said that the Medicare cuts in this bill cut
benefits for seniors; they do not. They do not.

So I want the record to show, just in those two cases, where we
may have differences of opinion and of approach and evaluation of the
value of different things, but certain things are facts about our
bills that I cannot let the opposite view stand when they are stated.

Yes, it's hard to do this. The misrepresentation campaign that
has gone on about these bills, it's a wonder anybody would support
them, as Mr. Waxman said. But the fact is this, the President said
many of these provisions on their own are largely supported by the
American people.

So this will take courage to do. Social Security was hard.
Medicare was hard. Health care reform for all Americans -- insurance
reform is hard. But we will get it done. And as we leave this debate
I think that many of the differences that we have are complicated and
they're legitimate. They're differences of opinion about the role of
government and the rest. But I think it's really clear in one point
that the American people understand very clearly, they understand that
there should be an end to discrimination on the basis of preexisting
conditions. The proposals that we have put forth end discrimination
on the basis of preexisting conditions; the Republican bill does not.

With that, Mr. President, I thank you again for the opportunity
to discuss the differences and to try to find some common ground on
this.

THE PRESIDENT: 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 -- beats my prediction. (Laughter.)

Here's what I'd like to do -- 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 there's been a discussion about whether government should
intrude in the insurance market, but it turns out that 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
believe 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

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