[Public Papers of the Presidents of the United States: William J. Clinton (1994, Book I)]
[April 7, 1994]
[Pages 617-635]
[From the U.S. Government Publishing Office www.gpo.gov]



Remarks in a Town Meeting on Health Care in Kansas City
April 7, 1994

    Wendall Anschutz. Welcome to News 5's town hall meeting with 
President Bill Clinton. Tonight the President joins us to talk about the 
health care crisis in our country and his plans to reform the health 
care system. It's a rare opportunity for people in the Midwest to talk 
face to face about their concerns. So, ladies and gentlemen, please 
welcome the President of the United States.
    The President. Thank you, Wendall, and thank you, Ann. Thank you, 
ladies and gentlemen here in Kansas City and those in Tulsa, Topeka, and 
Omaha, who are also joining us.
    I came here tonight to talk to you a little bit about my hopes for 
health care reform for America and to listen and learn from you and to 
try to answer your questions. I'd like to make a brief opening 
statement, if I might, and sort of summarize what is in our 
administration's health care proposal.
    Let me begin by saying that I have been interested in health care a 
long time. My mother was a nurse anesthetist. I grew up around 
hospitals. I watched health care change and diversify. I was an attorney 
general when I had to fight for the rights of our elderly people in 
nursing homes in my State. And then for a dozen years I was a Governor, 
when I saw, every year, our State have to pay more and more and more in 
Medicaid program--that's the Government's program for poor folks and for 
elderly people in nursing homes--oftentimes paying 2 and 3 and 4 times 
the rate of inflation for the same health care.
    I have, in the last 4 years, since long before I ever thought about 
running for President, talked to literally thousands of doctors and 
nurses and health care professionals and families who have been 
dislocated by the health care system. And I decided that we had to do 
something about it for the following reasons. And let me just try to set 
them out for you.
    First of all, our country is the only advanced country in the world 
that doesn't provide health care security for all of its citizens. All 
the countries we compete with, all the wealthier countries, provide 
health security. Only the United States does not do that. And we pay a 
dear price for it.
    We're a nation of about 255 million people. At any given time, 39 
million of us are uninsured. In every year, 58 million are uninsured. 
Eighty-one million Americans live in families where there's somebody 
with a so-called preexisting condition, where there's been a child with 
diabetes or a daddy with a heart attack or a mother that's had cancer. 
And what that means is that they can't either get insurance or they pay 
much more than anybody else, or

[[Page 618]]

they can never change jobs again, because if they change jobs they'll 
lose their insurance.
    There are so many Americans who have special problems. I met a young 
woman again at the airport here in Kansas City today, a wonderful young 
woman named Vicki Waite, a young girl that has brittle bone disease. She 
came to see me back during the campaign, and I was glad to see her 
again. Her mother gave me a letter, sort of talking about their hopes 
and their dreams and their worries about the health care system. I could 
tell you a lot of stories about that. But I think we have got to find a 
way to cover everybody.
    Another thing that you will recognize here in Missouri because you 
see it in the changing job market, people are changing jobs more than 
ever before. And it's very important that people be able to change jobs 
without losing their health care or their families losing it. Even 
though since I became President--I'm proud of this--we've had an 
economic program that passed, and our economy has created 2.5 million 
new jobs in the last 15 months, more than in the previous 4 years. But 
still, as you all know, a lot of big companies are still laying off even 
as smaller companies create jobs.
    How are we going to guarantee that people will always have health 
insurance? It's a huge problem. There are lots of other problems with 
our system: 133 million of us have health insurance policies with 
lifetime limits, which means that if any of us have children with long-
term illnesses, we can run out of health insurance just when we need it 
most. The main thing is almost no American is secure unless you work for 
big government or big business.
    Another thing I'd like to point out is most small business people 
want to provide health insurance and many do, but that rates for small 
businesses and self-employed people and farmers, on the average, are 35 
to 40 percent higher than the same insurance rates for big business and 
government, and that's not fair, either. So I think we've got to do 
something to turn this around.
    Now, let's look at what our choices are. What I want to do is to 
guarantee private insurance, not to have the Government take over the 
program, and I'll tell you why. We have basically three choices today.
    We can just do away with private health insurance all together and 
pass a tax and cover everybody through a tax, like the Medicare program 
for senior citizens. I don't favor doing that. It would be 
administratively simple, but it would put the Government in health care 
too much, I think, and we'd have less competition and therefore less 
control over prices. Or we can have more competition, but guarantee 
private health insurance to everybody. That's what I want to do, with a 
comprehensive benefit package that includes primary and preventive 
health care, with no lifetime limits and with insurance that can't be 
lost just because a worker gets older or someone in your family gets 
sick.
    I also propose in our plan to keep choice because I think choice is 
very important for quality. People should be able to choose their 
doctors or a high-quality health care plan, not employers. And insurance 
companies shouldn't be able to deny anybody coverage. Now, today, more 
and more Americans insured at work are losing their right to choose. 
Fewer than half of American workers have any choice at all over their 
doctors or their health care plan today. Our plan would guarantee that 
every year every working family would have at least three choices and 
pick among them.
    We have to make some insurance reforms. It would be illegal under 
our plan for anyone to be dropped or to have their benefits cut by 
insurance companies, for rates to be increased just because somebody in 
the family had been sick, for lifetime limits to be used to cut off 
benefits, or for older workers to be charged more than younger ones. 
This is a big deal, folks. I've met people in their late fifties and 
mid-sixties who are losing their jobs, who have to get new jobs, who are 
good and reliable workers, but employers are scared to hire them because 
their rates are higher.
    Now, let me say--we'll come back to this--the only way we can do 
this fairly is to reform the insurance market, because if you have 1,500 
separate companies writing thousands of different policies, it's hard to 
afford to be fair to small business people. The only way you can be fair 
to small business people is let small business people and self-employed 
people go into big, big pools and be insured the way big business and 
government people are.
    I want to preserve Medicare, leave it like it is--it's working for 
elderly people--except we ought to add a prescription drug benefit which 
is very important to elderly people and will save money for our health 
care system over the long run. And I think we should cover things other

[[Page 619]]

than nursing home care, including in-home care, because the fastest 
growing groups of Americans are people over 80, and we need to provide 
for their care and help their families.
    This is the most controversial part of our plan, I suppose, at least 
among organized groups. I think the benefits should be guaranteed at 
work. That is, I think employers and employees who presently aren't 
covered should contribute to their health insurance, and then the 
Government should cover the unemployed, should cover part-time employees 
when they're not working, and should help to provide discounts to small 
businesses that have low payrolls, low profit margins, and relatively 
high costs now.
    If we cover employees at work and give discounts to small business 
and have the Government help the unemployed, I think that's the fairest 
way. Why? Because 9 out of 10 Americans who have health insurance have 
it through their workplace. And 8 out of 10 Americans, believe it or 
not, who are uninsured have someone in their family who works. So I just 
want to build on what we've got now: guaranteed private insurance; 
preserve the right to choose a doctor or health care plan; change the 
insurance practices that don't work but also, don't put the insurance 
companies out of business, let them insure people in bigger pools; 
preserve Medicare; and guarantee the health benefits through the 
workplace. That's our plan.
    There may be other ideas and better ones, but let me say, I'm 
absolutely convinced if we don't do anything, we're going to continue to 
have millions of Americans in misery, millions of Americans insecure; 
we're going to pay 40 to 50 percent more than any other country in our 
income in health care and have less to show for it. I don't think that's 
an acceptable solution. So for those who don't agree with me, I hope 
they have an idea about how we can provide health security to all of our 
people. America can do it if every other country can do it.
    Thank you.
    Mr. Anschutz. The President, as you just heard, of course, has 
answered some basic questions about his plan. And I know it has raised 
some questions in the minds of our viewers as well, and that's what we 
want to get to now.
    We have in our studio about 160 people from the Kansas City area who 
have questions for the President. We also have three other cities that 
will join us in tonight's town hall meeting via satellite: From Tulsa, 
Oklahoma, and CBS station KOTV, we are joined by our host Glenda Silvy. 
From the capital city of Kansas, Topeka, and the studios of WIBW-TV, we 
are joined by host Ralph Hipp. And then from our neighbor State to the 
north, from Omaha, Nebraska, we are joined by station KMTV-TV and our 
host there, Loretta Carroll. So that is kind of the cast for tonight's 
program. Let's get on with the questioning. The first comes from here at 
home, Ann Peterson, my co-host, and she has the first lady.
    Ann Peterson. Thank you, Wendall.
    Welcome, Mr. President, to Kansas City and here to KCTV. I 'd like 
you to meet a woman who nearly lost her mother to a medical emergency. 
She didn't get the care she needed because she was worried about cost. 
What is your question to the President?

Inaction on Health Care

    Q. First of all, I would like to say, good evening, Mr. President, 
and thank you for being here. Mr. President, could you please explain 
why Washington continually fails to put the country's priorities back in 
the order in which they belong and why our officials can't or won't take 
a serious and compassionate look at our health care reform?
    Thank you.
    The President. Well, I didn't write that question for her, honestly. 
[Laughter]
    Let me try to give you an answer that's not so--that's a little more 
objective, maybe not quite so favorable to my position. This is a 
complicated issue. You wrote us a letter, didn't you? Didn't you write a 
letter to my wife?
    Q. Yes, I did.
    The President. And your mother got health care late, expensive, 
because she was afraid she couldn't afford it?
    Q. Yes, exactly.
    The President. This is something I should tell all of you, another 
point I didn't make in my opening remarks, but let me say, as all of you 
know just from common sense, most people in America who don't have 
insurance get health care if they're real sick. But they get it when 
it's too late, too expensive. They usually get it at an emergency room. 
They don't pay, and then the emergency room at the hospital has to 
decide whether they're going to pass the cost along to the rest of us, 
so that we pay more than we should, or whether they are going to absorb 
it and therefore weaken the financial

[[Page 620]]

condition of our health care providers in our communities. So I want to 
set that up.
    Now, why hasn't this been done? People have been trying for 60 years 
to do this. First of all, because America historically is very anti-
Government. We think the Government would mess up a one-car parade. 
[Laughter] And so, we are afraid for the Government to do anything 
involving health care.
    Secondly, because small business people, in general, often think 
that they cannot afford any more requirements from Government. They're 
paying a lot for worker's comp. They're paying a lot for Social 
Security. They have a lot of costs. They are worried about whether they 
can do this. And I hope we get a chance to talk about this, because I 
believe most small business people will come out ahead on our plan, and 
I'd like to explain why. That's a problem.
    Third, because the thing that's wrong with the American health care 
system is not the health care providers. We've got the best doctors and 
nurses and medical research and medical technology in the whole world. 
The thing that's wrong with our system is the way it's financed. But a 
lot of good people are employed in the way it's financed now. You know, 
we are the only country in the World with 1,500 separate health 
insurance companies writing thousands of different policies which, in 
turn, require literally hundreds of thousands of clerical workers in 
doctors' offices, hospitals, and insurance offices to figure out what's 
not covered. Right?
    It's not a good way to spend money, but there are a lot of good 
people doing it. And there are a lot of good people, independent 
insurance agencies, for example, that are doing the best they can for 
their own clients within this system. If we cut back on the 
administrative costs and spend the money on health care, we'll create 
more jobs in health care, but we'll lose jobs in the paperwork end of 
health care. We spend about $90 billion a year in the United States, 
more on administration and paperwork than any country would under any 
other system.
    So a lot of things will get changed. People are scared of change, 
skeptical of the Government. Small business is sensitive, and the health 
insurance financing system will be changed. That's what's against our 
changing the system. I think the arguments for it are much more 
powerful, but oftentimes, it's harder to change than it is to stay the 
same. That's why we haven't done it. That's why we need stories like 
your mother's story out there to remind us of the human issues at stake.
    Q. Thank you.
    Mr. Anschutz. Let's get on now to our satellite coverage of 
tonight's town hall meeting. As you know, we have three other stations 
who are involved. And let's go to the first one in Tulsa, Oklahoma, 
where Glenda Silvy is standing by.
    Hello, Glenda.
    Glenda Silvy. Hello, Wendall. Thank you.
    And Tulsa also welcomes you, Mr. President. Our first question comes 
from a man who has a question relating to rural health care.

Rural Medicine

    Q. Mr. President, I am a physician in a small town in Oklahoma. I 
wonder if the health care in the rural areas will continue to be 
provided by physicians or by other trained individuals such as 
physician's assistants, nurse practitioners, et cetera, as opposed to 
continued physician care for our patients. I think this is an important 
issue, and I'd like an idea of the Clinton approach to the plan.
    The President. Well, first, sir, I think that medical professionals 
should be able to do what they are trained and properly qualified to do. 
But what I hope we can do is to put more physicians out in rural 
America.
    Under our plan, there are some very special incentives to try to get 
more doctors to go into the rural areas and the small towns. We want to 
revive the National Health Service Corps and put another 7,000 doctors 
out paying off their medical school bills by practicing in underserved 
areas over the next 5 years.
    In addition to that, we propose to give significant tax credits to 
people as income incentives to go out and practice in rural areas, in 
shortage areas. Physicians get quite a bit, and where there's a nurse 
shortage, nurses and other health professionals can get some as well.
    And the third thing we're going to try do is to give more support to 
physicians in rural areas, do more to connect them with medical centers 
through technology, do more to provide tax incentives for them to buy 
their own equipment so they can provide high quality care.
    So my goal is to have more people like you in small towns and rural 
areas. I just came back from Troy, North Carolina, where I was talking 
to doctors there about the terrible medical shortage. And I met a woman 
who told me

[[Page 621]]

that she had worked 100 hours a week for 2 or 3 months in a row, and she 
was now down to her slow season where she was down to 80 hours a week, 
because they didn't have any more doctors. So I think that one of the 
things we have to do is to try to keep the doctors in rural America if 
we're going to keep rural America alive.
    Mr. Anschutz. Thank you, Tulsa. We go now to Topeka, up to the 
north. Ralph Hipp is there.
    Ralph, good evening.
    Ralph Hipp. Good evening, Wendall, and good evening, Mr. President. 
We're delighted to be a part of your town hall meeting here in the 
Kansas capital, home of the Menninger Foundation. And I'd like to 
introduce this gentleman, who has a special question of interest about 
that field.

Mental Health Care

    Q. Mr. President, mental health insurance coverage needs to be equal 
and at parity with physical health insurance coverage. Has Tipper Gore 
discussed the importance of this with you?
    The President. Yes. [Laughter]
    You want me to talk about it a little bit? Let me ask you, just 
curious, we're here in Kansas City, how many of you agree with what he 
said, that health insurance policies should include mental health 
coverage as well as physical coverage? How many of you agree? [Applause] 
I'm glad to see it. I think it shows our country's come a long way in 
that issue, that there are a lot of mental problems that are literally 
illnesses that can be treated, sometimes with medicine, sometimes in 
other ways. One of the things that we seek to do, sir, in this plan, and 
I want to make full disclosure here, we do cover mental health under our 
health care plan as a protected benefit. But it's not required to be put 
in all health insurance policies until the year 2000, and I want to 
explain why.
    The last thing in the world I want to do is to cost you more money 
instead of save you money by doing this. I have worked too hard to try 
to bring the Government deficit down to see it go up, for example. And 
because mental health benefits have never been provided on a 
comprehensive basis before, there is no agreement among the experts 
about what it will cost. I'll bet you this gentleman with the Menninger 
Foundation believes mental health benefits over the long run will save 
money in the health care system. I do, too. But we can't prove it. So 
we're going to have to phase the mental health benefits in. But by the 
year 2000, they will be covered just like physical health benefits in 
all comprehensive health packages for all Americans if this plan passes.
    I wish we could do it quicker, but we can't prove what the cost will 
be, and we can't put the budget at risk. So we're going to have to phase 
it in.
    Mr. Anschutz. Let's complete our circuit now by going up to Omaha, 
Nebraska, and Loretta Carroll.
    Loretta Carroll. Good evening, Wendall. An Omaha good evening, Mr. 
President. I'm here talking with this woman; she helps families who have 
family members with Alzheimer's. And Karen, you've been there yourself 
with your own dad.

Long-Term and Respite Care

    Q. Mr. President, I helped my mother at one time when she was caring 
for my father, and that was some time ago. What I'd like to ask you is 
that my experience with meeting with caregivers every week of 
Alzheimer's patients is that they do not get much relief. And they 
become prisoners in their own homes. As you know, Medicare does not 
cover Alzheimer's care in the home because it doesn't have much rehab 
potential. What will the new health care plan do to help these 
caregivers so they can have some relief?
    The President. I think probably almost everybody understood that 
question, but let me try to put it in a larger context. Alzheimer's is 
growing very rapidly in our country as our population ages. But a lot of 
other infirmities are growing as well. Today, Medicare, the Government's 
program for elderly people, normally doesn't cover any kind of in-home 
care unless it's part of a rehabilitation program, she said.
    There are limited coverages for nursing home care under Medicare. 
Most of our older people who get any help from the Government in nursing 
homes have to spend themselves into poverty so they can get into the 
Medicaid program.
    If you look at the fact that people over 65, and within that group, 
people over 80, are the fastest growing group of our population in 
percentage terms. We want to encourage people to stay at home. We want 
to encourage people who want to, to become as independent as they can. 
But what that means is, if children are

[[Page 622]]

willing to take care of their parents and save society a whole lot of 
money that they could cost the rest of us just by spending their parents 
into poverty and putting them in a nursing home, we should give them a 
little bit of help in terms of respite care and help when they're 
providing help in their homes or in the community.
    So under our plan, we would, just like mental health care, which--we 
would phase in over the next few years a long-term care benefit so that 
for children who are taking care of their parents in the home, to use 
your example, who have Alzheimer's or who have had a stroke, for 
example--I met a couple taking care of the lady's mother for 9 years 
after she had a stroke, the other day--they would be able to get some 
relief, someone to come in and watch the parent, take care of the parent 
on a regular basis while they took some time off, got to go do errands 
or do whatever needed to be done, so that we would encourage these 
families staying together. It would save our country a lot of money over 
the long run. And I think it recognizes what's happening to our 
population.
    Thank you.
    Mr. Anschutz. Thank you, Omaha, for the question, and we'll get back 
to you in a few minutes. Now back to our own studio audience, Mr. 
President, and Ann has another question.
    Ms. Peterson. Mr. President, I'd like you to meet a woman who is a 
cancer survivor, and she is also surviving changes in the health 
insurance plan. Would you explain?

Choice of Physician

    Q. Yes. Welcome, President Clinton. My surgery was delayed for 
approximately 2 months because originally I'd gone to my OB that I'd 
gone to for 18 years. He sent me to a surgeon and then the mammograms 
and so forth. And then when you find out that you're going to have to 
have surgery, to then stop--they were off-plan, by the way, with my 
insurance carrier, which is provided by my employer--to have to stop and 
choose doctors that you know nothing about--and the disease is 
devastating, but then to choose another doctor is just as devastating. 
And what I wanted to know is how can you 100 percent ensure or guarantee 
that under your health plan and the plan that my employer would choose, 
that we would have the choice of our own doctors?
    The President. I want to make sure everyone here and everyone in our 
other studios understood what she said. She said her previous doctor, 
her personal choice, was off-plan. Why don't you explain to everybody 
what that means, in case they don't know.
    Q. Off-plan? It can either be off-plan where they don't pay anything 
at all, or they pay quite a bit less, either 50, 60, 70 percent.
    The President. So, in other words, your employer chose an insurance 
plan for you that did not permit you to keep the doctor that you had 
been dealing with----
    Q. Correct.
    The President. ----which, when you have a serious condition like 
cancer, is terrifying to have to go to a new doctor.
    Q. Correct.
    The President. That's what you're trying--I just want to make sure 
everybody understands that, because one of the charges that's been 
leveled against our plan which is absolutely untrue is that I'm trying 
to restrict the choice of the American people. The American people are 
having their choices restricted now. Now, let me just say something very 
briefly. In defense of your employer and many others, a lot of times the 
employer says, ``Hey, that's all I can afford is an HMO, and I'm doing 
the best I can, and I think they'll provide quality care.''
    Here's how our plan works. Under our plan, your employer would have 
an obligation to contribute a certain amount to your insurance, and it 
would not change, no matter what plan you chose. Then every year, your 
employer would be part--unless you have more than--unless it's a very 
large employer.
    Q. It's a small company.
    The President. If it's a small employer, the small company, then, 
would be part of a big buyer's co-op to guarantee lower rates and 
choices. And you would be given, through this cooperative, at least 
three choices. You'd be able to buy into an HMO like the one you've got 
here. But you'd also be able to pay a small premium so if you wanted to, 
you could opt out and get the services from the doctor of your choice 
with exactly the same contribution, no more if you bought the premium. 
You could buy fee-for-service medicine on your own, just keep your 
doctor. You'd pay a little more. Or you could--you'd always have to have 
at least one third choice.

[[Page 623]]

    And under our bill, if it passes, every year you'd be able to revise 
that. You'd be able to reconsider it. But you would always have the 
right to choose. And even though you might pay a little more for fee-
for-service medicine, your employer would not be disadvantaged, he'd pay 
the same, regardless, and you would pay less than you would now because 
your small business would be part of a big buyer's pool.
    So even if you took the most expensive choice, it would be in all 
probability less than you're paying now because you'd be part of a big 
pool.
    Q. That would be wonderful.
    Thank you.

Small Business

    Mr. Anschutz. And the small business would pay less?
    The President. It depends. Most people in America, if our plan 
passed, would get the same or better health care for the same or lower 
costs. Some small businesses would pay more. It depends on what they're 
paying. I'd have to know. Let me just tell you briefly how it works.
    The average business in America today pays 8 to 9 percent of payroll 
for health insurance. Under our system, everybody would pay a maximum of 
7.9 percent. Small businesses with fewer than 70 employees and average 
wages of under $24,000 a year or less, average wages, would be eligible 
for discounts going down to as low as 3.5 percent of payroll on a 
sliding scale. That's how it would work.
    Mr. Anschutz. That answers your question?
    Q. Yes. Thank you.
    Mr. Anschutz. Thank you. And now back to the television monitors, 
another circuit here. We'll go back to Tulsa, Oklahoma.

Part-Time Workers

    Q. Mr. President, I'm a full-time college student. I have a part-
time job, and I have no health insurance. How will your plan help me? 
And how will I be able to pay for it?
    The President. How many hours a week do you work?
    Q. I work 25 to 30 hours a week, sir, and I'm currently taking 13 
hours at a college here in town.
    The President. Good for you. When you get your degree, you'll be 
glad that you worked for it like that, if you can get it, and I think 
you can.
    Under our plan, the cost of insuring part-time workers would be 
shared between the employer, the employee, and the Government. So if you 
work--let's just say you work 20 hours a week, which is half-time, your 
employer would pay half the premium that the employer would pay if your 
worked 40 hours a week. And you would similarly pay your obligation, 
then the difference would be made up with help from the Government. But 
you would have to pay, and so would your employer, if you work more than 
10 hours a week, but you would be eligible to get health care coverage.
    Let me say that one of the most interesting and controversial parts 
of any health care plan is how you treat younger workers. And here's a 
young man who wants health care coverage. But there are a lot of young 
folks who don't, who don't want to be forced to pay anything because 
they say, ``Hey, I'm young, and I'm healthy, and I'm not married and I 
have no responsibilities to anybody, and I ought to have the right not 
to pay.'' And you can say that, but the truth is if they have a car 
accident or a skiing accident or they, God forbid, get sick, they still 
go to the hospital and then the rest of you still have to pay if they 
don't have any insurance. So I think this is the fair way to do it, and 
you would be able to be insured under our plan.

[At this point, the television stations took a commercial break.]

    Mr. Anschutz. Once again, Mr. President, it's a pleasure to have you 
here at our town hall meeting. And our next question is via satellite 
again from Topeka.
    Mr. Hipp. Thank you, Wendall. And, Mr. President, we'd like for you 
to meet this young woman. She is a single mother with a small child. And 
she simply could not find a doctor. Now, you've reconciled with your 
husband, right about that? So, you'll be covered by his insurance in 
May. And your question has to do with access to health care and the 
problems you've had. Why don't you tell the President about those.

Medicaid Patients

    Q. Right. Mr. President, my daughter and I were on State assistance 
for 10 months. And when you're on assistance, you get the medical

[[Page 624]]

card to help you out if you have to go to the doctor for anything. And 
when my daughter got sick, I had a hard time finding a doctor in the 
Topeka area that would accept her because she was on the medical card. 
And I was told by a caseworker that it was just unfortunate because we 
came onto the system at a very bad time, and that usually it isn't this 
way. But unfortunately, there just aren't any doctors that are accepting 
new patients with that type of coverage.
    And my question to you is, what can you do to help low-income 
families get better access to health care? Not just people that have 
jobs and don't have insurance because of their jobs, but perhaps people 
that don't have jobs at all through some unknown circumstances that they 
couldn't control.
    The President. I want to make sure everyone who's listening to us 
understands this. I mean, I understand it very well, but I want to make 
sure all of you do. For awhile, she was on public assistance. If you're 
not employed and you're on public assistance, you're eligible for health 
insurance from the Government under the Medicaid program. In almost 
every State in the country, the Medicaid program reimburses doctors at 
less than their cost of providing the service. And it's a paperwork 
hassle, so a lot of doctors don't take Medicaid patients. You can 
understand it from the doctor's point of view. But when you see a young 
woman with a baby like that, it makes you sick; it makes you want to 
cry. So what she's asking is, ``Okay, I had insurance, but nobody took 
me anyway; how are we going to fix that?''
    The answer is that under our program people on Medicaid would be 
covered under the same plans that people who are privately employed 
would. So, for example, we would put Medicaid folks in with others into 
these big buying pools, and they would get exactly the same services on 
exactly the same terms. And because the doctors would be reimbursed in 
exactly the same way, the physician might not even know whether the 
person was on public assistance or had a job, because the plans would be 
the same. And what happened to you, ma'am, would not happen again in the 
future if this plan were to pass. And I think it's quite important.
    Mr. Anschutz. We're glad that question came up tonight. Thank you in 
Topeka. Go up to Omaha.
    Ms. Carroll. Thanks, Wendall. Mr. President, Tuesday in North 
Carolina we talked about the cost of health care reform for service 
industries, specifically restaurants. Here with me now is this 
gentleman, the CEO of Godfather's Pizza. He has some concerns about 
that.

Small Business

    Q. Thank you very much. Mr. President, thank you very much for this 
opportunity. And I would first like to commend you on making health care 
a national priority. In your State of the Union Speech, you indicated 
that 9 out of 10 Americans currently have health care insurance 
primarily through their employers. And tonight you indicated that out of 
those people who do not have insurance, 8 out of 10 of them work for 
someone. And your plan would force employers to pay this insurance for 
those people that they currently do not cover. I would contend that 
employers who do not cover employees, do not for one simple reason, and 
it relates to cost.
    Now, I have gone through the rigors of calculating the impact of 
your plan on my business, which has about 525 units throughout the 
country, and we employ in total over 10,000 employees. I have also 
talked with hundreds of other business people, and they've also 
calculated the cost impact on their businesses.
    I believe that this is something that we should and can fix. But for 
many, many businesses like mine, the cost of your plan is simply a cost 
that will cause us to eliminate jobs. In going through my own 
calculations, the number of jobs that we would have to eliminate to try 
and absorb this cost is a lot greater than I ever anticipated. Your 
averages about the impact on smaller businesses, those are all well 
intended. But all of the averages represent a wide spectrum in terms of 
the businesses impacted.
    On behalf of all those business owners that are in a situation 
similar to mine, my question is quite simply, if I'm forced to do this, 
what will I tell those people whose jobs I will have to eliminate?
    The President. Let's talk a minute about what you would have to do. 
Are any of your employees insured now?
    Q. Yes, sir. Approximately one-third of my employees are insured 
now.
    The President. And of the one-third that are insured now, what 
percent of payroll does their insurance cost?

[[Page 625]]

    Q. My insurance costs, at the present time, run about 2\1/2\ percent 
of payroll.
    The President. And what do you provide them? Do they share the cost 
50-50 or something like that?
    Q. Cost 75 percent paid for by my company and 25 percent paid for by 
the employee. Now, two-thirds of my employees are part-time or short-
term workers that fall into the class that you identified earlier.
    The President. Okay. And if they are part-time or short-term 
workers, they wouldn't add all that much. You wouldn't have to pay the 
whole 7.9 percent for them because they don't work all the time.
    All right, let me ask you this--on average, food service businesses' 
payroll is about one-third of the total cost of doing business. Is that 
about what it is?
    Q. That is an adequate estimation, yes sir.
    The President. So, suppose, since you have part-time workers and 
some wouldn't have to be covered, so you wouldn't go from 2\1/2\ percent 
of payroll to 7.9 percent. You might go to something like 6 percent. If 
you had 6 percent of payroll, let's just say, instead of 2\1/2\. Let's 
say 6\1/2\ percent, that's a good even number. You have 4 percent of 
payroll. And that's one-third of your total costs, so you would add 
about 1\1/2\ percent to the total cost of doing business.
    Would that really cause you to lay a lot of people off if all your 
competitors had to do it too? Only if people stop eating out. If all 
your competitors had to do it, and your cost of doing business went up 
1\1/2\ percent, wouldn't that leave you in the same position you are in 
now? Why wouldn't they all be in the same position, and why wouldn't you 
all be able to raise the price of pizza 2 percent? I'm a satisfied 
customer. I'd keep buying from you. [Laughter]
    No, I'm serious. This is a very important--let me say--this is a 
very important question because a huge number of Americans are involved 
in the food industry; 40 percent of the American food dollar is spent 
eating out now, 40 percent. So this is not an idle question. This man is 
raising a very important question in terms of employment.
    What if all your competitors were just like you? Wouldn't you be 
able to do it, then?
    Q. Okay, first of all, Mr. President, with all due respect, your 
calculation on what the impact would do, quite honestly, is incorrect.
    Let's take, for example, the fact that after I went through my 
calculations, your calculation or your example of the 6 percent or the 
7.9--and in my case, it works out to 7.9 percent. Now, let's suppose 
that 30 percent of my costs are labor costs, 7.9 times that would be the 
2 to 2\1/2\ percent that you are referring to. The problem with that 
calculation, sir, is the fact that those, most of those 30 percent of 
the people currently have zero. So when I calculate in the fact that I 
have to go from no coverage on those employees to full coverage at the 
7.9 percent rate, it actually works out to be approximately 16 percent.
    Now, your other point about having to pass it on to my customers in 
the competitive marketplace, it simply doesn't work that way because the 
larger competitors have more staying power before they go bankrupt than 
a smaller competitor. They have more staff that they could simply do 
without until the marketplace reestablishes itself.
    So what I'm saying and suggesting is that the assumptions about the 
impact on a business like mine are simply not correct because we are 
very labor intensive, we have a large number of part-time and short-term 
employees that we do not cover for one simple reason: We can't afford 
it. My bottom-line net profit for the last 2 years was less than 1.5 
percent of my top-line sales. When we calculate the cost just for my 
company, under your plan, it equates to 3 times what my bottom line 
profitability is.
    What is one of the biggest misconceptions, sir, is the fact that a 
company like mine only makes between 1 and 3 percent of top-line sales. 
And because we have a large population of employees that we would like 
to cover, but simply the dynamics of our business will not allow us to 
do that under your proposed plan.
    The President. Let me ask you a favor. Would you send to me 
personally your calculations? Because I know we've got to go on to other 
questions, but let me remind you, if it added 4.5 percent to the cost of 
doing business and his labor costs were only one-third of his total 
costs, then all you have to do is multiply it by three, it would have to 
be 13.5 percent of payroll. And that maximum is 7.9 percent. So it's 
just--we can't get there. Send it to me; we'll work on it.
    Mr. Anschutz. I'm sure a lot of this health care reform debate is 
going to be over numbers.
    The President. That's right.

[[Page 626]]

    Mr. Anschutz. Maybe that will all come out in the wash. That's 
what----
    The President. Let me also just say, for those who are listening to 
us, on part-time employees, you don't pay the full premium unless the 
employee works 30 hours a week or more. Anything less, the employer pays 
a smaller percentage of the premium.
    Ms. Peterson. Mr. President, this gentleman is helping his son and 
daughter-in-law pay for skyrocketing medical bills to help them so that 
they don't go under financially. Why don't you explain.

Preexisting Conditions

    Q. Mr. President, we have a daughter-in-law with complications from 
two back surgeries. She's at a point now that she cannot work, and she's 
losing her job and, therefore, her insurance. Her husband's insurance 
won't pick it up because it's preexisting conditions. My son's income is 
$1,080. And just to give you an idea of how this cost reflects, Sharon 
has therapy three times a week for 15 to 20 minutes, physical therapy. 
Each session costs $438.
    Right now they're over $12,000 in debt, and it's climbing. What can 
you tell a family like this? What kind of hope do they have?
    The President. Let me ask you a question. Your son has insurance?
    Q. Yes.
    The President. But they won't pick up the family because of your 
daughter-in-law's preexisting condition?
    Q. It wouldn't pay the preexisting conditions, so----
    The President. How big is the company for which your son works?
    Q. Well, it's the largest--first or second largest company in my 
town, a very large business.
     The President. See, even for a large business, it's difficult. I 
want to explain why--it's not so many--the bad in this is the way the 
financing is organized, not necessarily the company. Under our plan, 
your son would have a right to insure his family at any place of work, 
now and in the future. But the private insurance company who provides 
the insurance would not go broke even with your daughter-in-law's 
problems, because they would be in a very large pool.
    So to go back to the gentleman who was on television here with the 
pizza company, insurance companies would make money the way Blue Cross 
originally did and the way food stores do now or large eating 
establishments, a little bit of money on a lot of sales, a lot of 
people. And that's how we would do it. But your son under our plan would 
have a right to have his family insured at this job or at any other. But 
the company wouldn't go broke trying to provide the employer's share of 
the premium, and the insurance company wouldn't go broke, because they'd 
be in a very big pool, and the risk would be broadly spread.
    Mr. Anschutz. Mr. President, let's move on to Tulsa, Oklahoma, again 
if we can.
    Ms. Silvy. Mr. President, this gentleman is an internist with a 
managed care organization here in Tulsa, and his question relates to 
medical technology.

Medical Technology

    Q. Thank you. This will be a piece of pizza compared to Omaha. 
[Laughter]
    President Clinton, my question has to do with medical technology. 
Organizations like the one I work for, and we insure working folks and 
Medicare recipients, we deal on a daily basis with tough decisions about 
medical technology. There was a letter to a medical director of an 
insurance company to your wife in a well respected medical journal not 
long ago. And you probably saw that letter. And hospitals and other 
health care organizations struggle with this as well. Part of it is 
wrapped up in tort issues and malpractice concerns that payer 
organizations have, that hospitals have.
    And the question I have for you is in looking at new and emerging 
medical technologies and technologies that are diffused in our country, 
throughout our country. And those technologies are oftentimes applied to 
folks who are at the end of their life who have really no meaningful 
hope of recovery, and yet there's a compulsion really to continue to do 
things. And I'm really wondering how your health plan addresses that 
issue.
    The President. Well, let me mention--let me talk about this from two 
or three different points. This is a big issue, and it's an issue that 
I'm very sensitive to now. As you know, I just lost my mother a few 
months ago. My father-in-law died last year. My family's been through 
this personally. And I would like to say three or four things about it.
    First of all, on balance, we like having the best medical technology 
in the world, and we

[[Page 627]]

want to have access to it if we need it. And our plan actually continues 
a commitment to invest more, for example, in academic medical centers 
which have this technology and in medical research, generally, and I 
think we should. On the other hand, we don't want to have a lot of money 
spent on technology if it's totally useless. Let me just mention three 
things which the present system does, and he alluded to two of them.
    One is, a lot of doctors are worried about malpractice claims so 
they may do tests whether they think the patient needs it or not, just 
so later on they can say they did it in case they get sued. That costs 
all of us a lot of money if there's no reason to do it. What's the 
answer to that? Our plan would require the national professional 
associations to promulgate medical practice guidelines that then the 
doctors could use, and if they use these guidelines, those guidelines 
would, in effect, be a first line of defense in a malpractice case. It 
would at least raise the presumption that the doctor had not been 
negligent.
    Problem number two, hospitals get to competing with one another, and 
they're afraid--if one has an MRI, the other hospital's afraid it won't 
get any patients unless it gets an MRI. So a town needs one MRI and 
winds up with two so everybody can compete with one another. We try to 
make sure that there's equal access to technology, but that hospitals 
don't feel like they have to do that, double the cost of technology to 
everybody, when the facilities could be properly shared.
    Point number three is the really difficult one, and that is the 
question of when should people in their last months, or their last year, 
give up expensive technology? My own view of that is that a lot of 
people have made that decision for themselves, but they don't formalize 
it. And so one of the things we're trying to encourage people to do is 
to make sensible living wills, to make these decisions. I think that's a 
lot better than having medical professionals try to get between a grief-
stricken child and a parent on life support, or sometimes a grief-
stricken parent and a child on life support. So I think what we should 
do is to try to encourage the use of living wills, encourage families to 
talk about this in honest ways. And I think America will move to this 
and save the money that can be saved and still keep the benefits of 
technology.
    Mr. Anschutz. Thank you, Mr. President. As we told you earlier, 
we're talking with four communities, not only ours but Tulsa, Topeka, 
and Omaha. At this point, we're ready to go back to Topeka.
    Mr. Hipp. Okay, Wendall. Mr. President, this gentleman has lived in 
the capital of Kansas for 18 years. And Paul doesn't have a lot of 
faith, frankly, in the Government's ability to administer health care, 
and he's got a question about that for you, sir.

Managing the System

    Q. Mr. President, good evening. In view of the Government's past 
poor performance, i.e., Social Security, welfare, Federal budget, the 
deficit, and pork barrel spending, can you explain to us how the Federal 
Government can manage health care, another socialistic program, in an 
economical and efficient manner?
    The President. Well, I have two things to say about it. Number one 
is, the Federal Government's not going to manage this program. Under our 
program, if my program passes, the private sector will manage it. The 
only thing the Federal Government will do is two things basically. We 
will require everybody to have health insurance and employers and 
employees to share responsibility for it. That includes good primary and 
preventive benefits.
    We will then say that insurance has got to be what it used to be 
when it started: You can't cut people off because somebody in the family 
got sick; you can't charge old folks too much if they're still working 
and they're healthy; and small business people and farmers and self-
employed people have the right to be in big buying groups so that they 
can get the same kind of deal that Government employees and that big 
business employees get today. That's not a big Government business 
program.
    Let me give you one example, sir. The State of California just set 
up a small business buying group with 40,000 businesses in it. And the 
businesses that entered actually got a reduction in their health 
insurance costs by going into the buying pool. And there was no big 
Government bureaucracy. They hired 13 people to run the insurance buying 
and handle the paperwork for these 40,000. So I don't want the 
Government to run it.
    Q. Is there going to be less paperwork, instead of more?

[[Page 628]]

    The President. Absolutely. Right now we've got the most expensive--
right now, sir, we have the most expensive system in the world in 
America. We have 1,500 separate companies writing thousands of different 
policies, and then the two Government programs for older people and for 
poor people on top of that. So we've got more bureaucracy and more 
paperwork and more money spent on that and less on health care than any 
other country in the world. So I don't want the Government to run the 
health care system. I just want to make sure the system works for the 
benefit of everybody.
    Mr. Anschutz. Well, we hope that answered your question. We're 
moving on to Omaha now.
    The President. But I'm not going to let Social Security get in 
trouble, either. And the deficit's coming down, not going up. Go ahead.
    Mr. Anschutz. Go ahead, Loretta.
    Ms. Carroll. This gentleman was diagnosed as having full-blown AIDS 
back in 1991. He is now disabled, and he has really had a tough time 
with the current health care system.

AIDS

    Q. Thank you, Mr. President. As she said, I'm a person who's living 
with full-blown AIDS. When I was first diagnosed HIV-positive in 1989, I 
was part of an HMO program of which I had to fight tooth and nail to get 
to an infectious disease doctor. I was forced to see a family practice 
doctor who was not educated or interested in treating my symptoms of the 
illness. I'd like to know from you, with health care reform, we've 
already voted to reform Medicaid in Nebraska to start charging patients 
for copayments. Will health care reform enhance, or is it going to 
restrict, the availability of quality care, the availability of low-cost 
prescriptions, and the access to doctors who are educated and interested 
enough to treat HIV infections without having caps on expenditures and 
those sorts of services that we need to survive?
    The President. Health care reform will enhance the quality and range 
of services you can get. It will require everybody to pay something, but 
it will place limits on that something. Let me just say, one of the 
things that people who are HIV-positive or people who have AIDS will get 
out of this program is that we will cover for the first time, in all 
health care plans, prescription medicines. And there will be a copay and 
a deductible, but there will also be an annual limit.
    So for someone like you who has very expensive medical bills for 
medicine, you would benefit enormously from that because of the very 
reasonable copay and deductible and annual limit. Let me say something 
in your behalf. All the rest of us would gain, too, for this reason: A 
lot of people, like this gentleman, who have AIDS can't get health 
insurance anymore and are forced out of the workplace. And all of us are 
better off if everybody in his position can work as long as possible, 
can be independent as long as possible, can be self-supporting as long 
as possible. And we need a health care system where employers can afford 
to properly and fully ensure their employees without going broke so that 
they can live as long and as well as possible.
    But you would be much better off under our plan because you get 
choice of doctor, adequate care, and prescription medicine would be 
covered after a modest effort required on your part.
    Q. But with all due respect, with my disability check and having to 
pay rent and utilities and food and everything else, I am left with $20 
a month, and I do not think that that's enough to have to pay copayments 
to go to the doctor or pay for prescriptions.
    The President. No, I'm talking about not now. At your income level 
now, you probably have no responsibility at all. But I'm talking about 
back when you were working; suppose you needed medicine to maintain your 
condition. Even then, every health insurance package would have had to 
cover medicine with a modest copay to help people stay as independent as 
long as possible. With your present income, those responsibilities would 
be dramatically less. And if your income is what you say, you wouldn't 
have any copay responsibility.
    Q. If I could not pay, would I be denied services?
    The President. No. Nobody who cannot pay would be denied services. 
But people who can pay will have to pay something.
    Mr. Anschutz. Okay, we'll have to move on now. I hope we answered 
your question, sir. We will continue with our town hall meeting with 
President Clinton in just a moment. But first, this time out.

[The television stations took a commercial break.]

    Mr. Anschutz. We've been going for about an hour so far with 
questions. It doesn't seem

[[Page 629]]

that long, does it, Mr. President? About a half hour left, and I know we 
have a lot of questions to go. So let's return to our studios.
    Ms. Peterson. Mr. President, I'd like you to meet a doctor from 
Children's Mercy Hospital. She's very concerned about the toll violence 
is taking on our health care industry and our Nation as a whole and 
especially our young people.

Violence and Health Care

    Q. Good evening, President Clinton, and thank you for taking the 
time to come and meet with us in Kansas City. Over the years I've seen 
many changes in my practice as a pediatric emergency medicine physician. 
By far and away, the most frightening is the escalation of violent 
injuries involving our children, both as victims and as witnesses. My 
question for you is this: Are we going to be able to provide these 
children the acute care, the rehabilitation, and the mental health 
services they need, both the victims and the witnesses, under your plan 
for health care reform?
    The President. The short answer is yes. The long answer is what I 
said earlier about mental health benefits. We phase them in, and we 
don't fully have them covered until the year 2000. So that, except in 
extreme circumstances, they wouldn't all be covered under all health 
insurance practices.
    Now, some children's hospitals will be eligible for certain payments 
that will permit that to be done. But the short answer is yes, the 
comprehensive services will be provided, but we won't have full mental 
health coverage until the year 2000 under the plan as it is presently 
drawn.
    But let me just say to all of you--I know we're running out of time, 
and I want to be quick, but violence is one of the biggest health 
problems we have. And you need to know that even though I believe we can 
bring down the cost of health care in terms of things that we're out of 
line with other countries on, principally in paperwork and unnecessary 
procedures and undue fear of malpractice, as long as we are the most 
violent country in the world and we've got more kids getting shot up and 
cut and brutalized, we're going to have higher medical costs than other 
countries and busy emergency rooms.
    It's a human problem. It's also a horrible public health problem, 
which is why I hope we can pass this crime bill and do some other things 
that will drive down the rate of crime and violence in our country 
because it is swallowing up a lot of your health dollars as well as 
tearing the heart out of a lot of your children.
    Q. And a lot of the doctors.
    Thank you, Mr. President.
    The President. Thank you. Thank you for doing it, though.
    Mr. Anschutz. Mr. President, Glenda Silvy in Tulsa has another 
question to ask you. And Glenda, I would ask you in the interest of 
time--we're getting toward the end, and we have a lot of ground we'd 
like to cover, so if we could kind of keep it fairly condensed.
    Ms. Silvy. Mr. President, this is a woman with a question about 
services to the elderly.

Services for the Elderly

    Q. Mr. President, I'd like to ask you about the transportation for 
the frail elderly because it has become a very serious problem in Tulsa 
and other cities. Limited personal resources rule out hiring taxis to 
take people in for doctors appointments and dialysis and also adult day 
care centers and other therapeutic activities. Does the plan address 
this growing problem?
    The President. I have to tell you the truth. I'm not sure what's 
covered and what's not with transportation. And what I will do is, after 
this is over, I'll get your name and address, and I'll get you an 
answer. And I wish I could give you an answer on the air, but I don't 
want to say the wrong thing, and I don't want to mislead you. So, I will 
write you as soon as I find out. I'm sorry, I don't remember.
    Q. I'll look for it, Mr. President. [Laughter]
    The President. I'll sure get it then.
    Mr. Anschutz. I'm sure she'll get it. Let's move on to Topeka. 
Ralph.
    The President. I wish I had her in my office, that's for sure. 
[Laughter]
    Mr. Anschutz. Yes, she's pretty sharp. Are you ready, Ralph?
    Mr. Hipp. Yes, Wendall and Mr. President. We have a short question 
from a girl who is 9 years old, goes to Central Grade School up in 
Holton, Kansas, and has a question of concern to people her age.

Immunizations

    Q. Mr. President, I would like to know how your new health care 
program will help to make sure that all children get their 
immunizations.
    Mr. Anschutz. Good question.

[[Page 630]]

    The President. That's a great question. It will help in two ways. 
First of all, immunizations will be covered under everybody's health 
insurance policies for families so that children's immunizations will be 
covered under the family health insurance policy.
    The second thing we will do under our plan is to make sure that the 
public health offices all over the country, which do a lot of 
immunizations for children, have enough money to do them without 
overcharging the parents. In my State of Arkansas, for example, 85 
percent of our children, 85 percent, including children from well-off 
families, get their shots in the public health offices. So we do it in 
those two ways. And a lot more children will be immunized if this plan 
passes.
    Thank you. Great question.
    Mr. Anschutz. Thank you. Up to Omaha.
    Ms. Carroll. Thanks. This woman is with Mutual of Omaha, which 
employs 6,000 people here in Omaha, 4,000 agents nationwide.

Insurance Companies

    Q. Mr. President, thank you so much for the opportunity tonight for 
us to provide input. We wanted to let you know that we do support 
universal coverage as well as universal and comprehensive health care 
reform. Given our agreement on so many basic issues, I have to say that 
we're disappointed in--our 6,000 employees who work very hard at Mutual 
of Omaha--in the personal attacks that we felt by the administration and 
the fact that they're doing the best job that they can.
    My first question is, why have you taken this approach? And 
secondly, as we try to build consensus with your team and other teams in 
Congress, will you acknowledge the positive steps that we've taken to 
reduce costs as well as the fact that we support many of your basic 
goals as well?
    The President. Yes, but let me try to defend myself first. Tonight, 
how many times tonight did I go out of my way to explain this problem 
from the insurance companies' point of view? A lot, right? And let me 
further say, I went to Connecticut the other day, which is the other big 
center of health insurance companies, where five of the six biggest 
companies in Connecticut refused to join in this health insurance 
association multi-million dollar attack on our health care reform 
efforts. And I complimented those companies for what they're trying to 
do. So I believe that we have a lot in common. And I believe most 
insurance companies support universal coverage. And I would be more than 
happy to continue to work with them.
    What I have tried to do is to answer the attacks on our plan by the 
ads, the multi-million-dollar ad campaign, that I don't have the money 
to answer in paid ads yet--I hope I do someday--from the health 
insurance association. Nothing would please me more than to tone down 
the rhetoric, to sit around like we're doing now in private and 
recognize that a lot of companies, particularly a lot of the bigger 
companies, have done a lot to help control heath care costs.
    I guess what I want to do is to try to take the initiatives that 
you've already taken and that you've proved we can take to help larger 
companies, to help Government employees, to help others control health 
care costs and make those available to all Americans, first with 
coverage and first with affordable rates for people who have small 
businesses.
    I can't believe we can't reach agreement on this. I think we can. 
And nothing would please me more than to have this conversation with you 
and everybody in your business all over America. And I thank you for 
what you said.
    Q. We'll take you up on that.
    Mr. Anschutz. Okay. Thank you in Omaha. And now to our studio.
    Ms. Petersen. Mr. President, this gentleman is with Marion Merrill 
Dow, a major pharmaceutical company based here in Kansas City. What is 
your question for the President?

Drug Prices

    Q. Mr. President, good evening. I appreciate the chance to visit 
with you. I'd like to begin by saying that I applaud your efforts to 
bring health care to the top of the national agenda. I think that's very 
important.
    Let me say that, at the same time, I'm somewhat concerned about some 
of the provisions of the bill, particularly some of the provisions that 
relate to Government control and intervention in the business, things 
like the committee that would discuss the appropriateness of new drug 
prices. I believe that that's the function of the open market, and I'm 
very concerned about the implications there.
    It appears that the investment community is also concerned about 
that. The market has taken the value of pharmaceutical stocks and bio-


[[Page 631]]

technology stocks down by many billions of dollars over the past 18 
months. And there's been a considerable loss of jobs in our industry.
    My question is, what assurances can you give the American people 
that your bill will not permanently damage this industry which is so 
helpful and brings cures to so many people, and allows us to continue 
the research that we're doing to solve the many diseases that we've 
heard spoken about here tonight?
    The President. First of all, let me explain what he was talking 
about to the rest of you. The pharmaceutical industry in America is very 
important to all of us, not only because we want to get the best in 
emerging prescription drugs, it's also a big part of our high-tech 
economy. We have clearly the dominant pharmaceutical industry in the 
world. It provides enormous numbers of jobs in America and helps us to 
sell our products overseas.
    As you know, all around the world, sometimes you can sell products 
in other countries quicker than you can here because of the Government 
regulation, which I'm trying to speed up.
    Under the health care plan as it is presented, a committee would be 
able to decide whether or not the price of a given drug was excessive. 
The reason that provision was put in there is because there are so many 
drugs that are made in America, where Americans have paid in all kinds 
of ways for the research to be done, which costs much less in other 
countries than they do in America.
    What the pharmaceutical industry, however, is legitimately concerned 
about is that they have to go out and raise huge amounts of money in the 
biotechnology area to raise money to develop new ground-breaking drugs, 
and they believe those drugs ought to be able to charge for the enormous 
cost of their development in the first place, which I agree with.
    And what I think we have to do, sir, is to work that out. You know, 
last year the biotechnology industry asked me to give special incentives 
in terms of capital gains taxes for investment in that area. We did. I 
was trying to build them up, and I've been as disturbed as you have by 
what's happened to the markets.
    So what we have to do is enter into some sort of understanding so we 
can protect the right to develop and market new drugs. I'm very 
concerned about it myself. I do not want to do anything to hurt it. And 
it's a very important part of our economy.
    But let me also say that generally, pharmaceuticals will do well 
because so many more people are going to have drug coverage. That's why 
the Pharmacists Association strongly endorses our health plan. We can 
work this out.
    Mr. Anschutz. Let's move along now and get back to the satellites in 
Tulsa.
    Ms. Silvy. This woman has a question about Native American health 
care.

Native American Health Care

    Q. Mr. President, I have Medicare and insurance benefits from 
retirement, but I'm real concerned about the Native Americans living in 
our city, in the city that I live in that do not have the benefits that 
I have. What will happen to their urban clinics that they go to now for 
medical care?
    The President. For the people at all the other places, Native 
Americans have a Native American health service funded through Federal 
funds. It's a separate health service, sort of like the Veterans 
Administration network is separate. Our plan, ma'am, will put more 
resources into that network, will strengthen it, will enable Native 
Americans to choose to use the Native American network and to bring 
whatever insurance policies and support they have to that network in 
addition to taking the extra money we put in it.
    So the Native American network, we believe, will be better off if 
our plan passes. And I have committed that to the leaders of tribes all 
over the country. We're going to keep working on it until they're 
absolutely satisfied that that's what's going to happen. That is an 
obligation we have. We cannot break it.

[The television stations took a commercial break.]

    Mr. Anschutz. Welcome back. We have about another 15 minutes on the 
program, and we want to cover as much ground as we can. President 
Clinton, so far, how do you feel about the questioning? Has it been----
    The President. I think the people have done a good job. And we've 
gotten a broad range of questions.
    Mr. Anschutz. Some agree, some argumentative, but that's the kind of 
thing we want.
    The President. It's a complicated issue. We should have an argument.

[[Page 632]]

    Mr. Anschutz. Okay, I think we have Omaha next. Is that right? 
Topeka. Let's go to Topeka and Ralph Hipp. Ralph.
    Mr. Hipp. Wendall and Mr. President, this is a woman who lost her 
daughter last year to complications from a bone marrow transplant from 
an unrelated donor that cost $350,000. And if there's any bright spot 
about you losing your daughter last year, it's been that you have become 
an advocate for other transplant families. So at least there's something 
going on that you are continuing to work with this. And you did have 
insurance for that operation. Why don't you tell the President about 
your situation and your question.

Transplants

    Q. Thank you, Mr. President, for your gift of time this evening.
    Fortunately, our daughter's insurance provided coverage for her 
transplant. But we also realize there are many patients facing organ 
transplants. And their insurance companies do not provide coverage for 
them, nor do they provide coverage for the donor's expenses which is 
also part of the transplant process. My question to you, Mr. President, 
is: What will be in your health care program that will help provide 
coverage for all patients needing bone marrow transplants and also for 
their donor's expenses?
    The President. Transplants are covered when they are appropriate. 
When it's an appropriate medical procedure and the doctor decides it's 
appropriate, it gets recommended, the transplant will be covered. And 
there are no lifetime limits on our policies, keep in mind, unlike most 
policies now. Three out of four policies now have lifetime limits. So 
that would not be a problem.
    I have to tell you, I don't know about the donor's expenses. I'll 
have to check on that. I can't answer that. But when it is an 
appropriate medical recommendation, it would be covered. It's a normal 
thing that would clearly be warranted by the treatment and by the 
doctor's treatment of the patient. And I think it should be. And again, 
there are no lifetime limits on the policy, so that won't be a problem.
    Mr. Anschutz. Thank you, Topeka. We go by satellite now to Omaha, 
Nebraska.
    Ms. Carroll. Thanks Wendall. This gentleman is a veteran, and he's 
very healthy right now, but he's also concerned about what's happening 
at the local VA hospitals and other hospitals just like it.

Veterans Health Care

    Q. Mr. President, Commander, all veterans, as well as the employees 
of all the VA hospitals, are very concerned on what is happening at the 
hospitals. They keep reducing the budget, keep pushing the employees out 
the door. Consequently, that is reducing the care for the veteran. How 
will your new plan affect the VA?
    The President. I'm glad you asked that, because we were talking 
about it during the last break. And let me thank you for your service, 
for wearing your cap tonight. You look fine, and I appreciate you asking 
the question.
    Let me also back up and tell the rest of you, the veterans hospital 
network has been suffering in recent years because we have had a 
reduction in the number of patients going into these hospitals, leading 
to a reduction in the budget, which means that those who are left behind 
don't have and oftentimes the quality or the range of care that they 
want.
    One real problem is that the veteran can go in and qualify to be 
cared for in the veterans hospital. But the only money the hospital gets 
is whatever the budget is from the Government, so that a veteran has 
another hospital policy, an insurance policy, or is covered by Medicare 
or whatever, that money can't flow to the hospital. So what we have 
done, sir, is to make sure that veterans on a priority basis, then their 
family members, can be cared for through the veterans health care 
network, and that all sources, including this insurance policy, can go 
in income to the hospitals and to the doctors in the veterans health 
care network so that they can get adequate funds.
    And the Veterans Administration is quite excited about this, the 
veterans health care network, because they think they are going to be 
able to get these veterans into these hospitals and that finally they're 
going to be able to be reimbursed in an appropriate way just as any 
other hospital would be able to. So we don't want to continue to cut 
their budget; we want to give them access to other different funds. And 
I think it's going to be the salvation of the veterans health care 
network myself.
    Mr. Anschutz. Does that answer your question, sir?
    The President. Do you understand? I mean, like if you have Medicare 
or if you have an

[[Page 633]]

insurance policy or CHAMPUS whatever now, none of that money flows to 
the hospital now. Under our plan, you'd be able to go there, take your 
insurance policy, and get the hospital reimbursed that way, as well as 
through whatever budget we get directly from the hospitals through the 
Congress.
    Mr. Anschutz. Quickly your follow-up, sir.
    Q. Thank you, Mr. President.
    Mr. Anschutz. Okay, good. Let's move back to our studios here at TV 
5.
    Ms. Petersen. Mr. President, I'd like you to meet this woman. She is 
16 years old and has lost six of her adoptive relatives to smoking-
related illnesses. What is your question?

Smoking

    Q. As a high school student, I see the heightening use of tobacco 
among my age range. And I feel it's not only the responsibility of the 
Government to help those that have existing health complications but 
also to prevent it. So my question tonight is why do we continue to use 
subsidies to help support tobacco growers when tobacco is harmful to us?
    The President. We don't use direct Government subsidies to support 
tobacco. We do organize the market with non-taxpayer funds actually to 
keep growers out of the market. It keeps the prices higher and does 
provide an income for the people who are in tobacco farming now. I think 
if you abolish the present Federal program--I want to talk about what 
we're trying to do to reduce smoking in a minute--but I think, if you 
abolish the Federal program, what would happen is the big tobacco 
companies would come in and actually plant more tobacco at lower prices 
and try to make it more readily available.
    Now, what we are doing is, the only tax we propose to raise in this 
program is a 75 cent tax on tobacco to pay for the medical care of the 
unemployed uninsured. And we ask big companies that get a big windfall, 
that is whose insurance rates will drop way down, to pay a little bit, 
too. We have proposed in Federal buildings totally smoke-free areas 
unless the rooms are separate and completely separately ventilated. The 
Food and Drug Administration is conducting an investigation, even as 
we're here tonight, on the nicotine content of cigarettes and whether 
there's been any direct attempt to increase the nicotine content so that 
it has a more addictive effect on people who smoke.
    We are doing our best to be aggressive in trying to tell young 
people that they should not smoke, that there are dangers to smoking, 
and that those who are around smokers in closed spaces can also be 
exposed. A few thousand people a year die from lung cancer induced by 
smoke, even though they're nonsmokers. This is a very serious problem, 
and we're taking some strong steps in that direction. And I appreciate 
you raising the issue.
    Mr. Anschutz. Mr. President, we're going to try for one more round-
robin of our remote stations. We go again to Tulsa.
    Ms. Silvy. This gentleman has a question about public health.

Public Health Services

    Q. Good evening, Mr. President. As you know, public health 
departments provide preventive health services to millions in our great 
land. And as you well know, the preventive health services are much more 
cost-effective to give than treating an illness. How will your health 
care plan affect the provision of our services related to public health?
    The President. When the young lady a few moments ago asked the 
immunization question, I alluded to this. In our plan, there is 
provision for the expenditure of I think it's around a billion dollars a 
year more of Federal funds to public health units all around the 
country, every year, than we're providing now to try to expand the 
preventive and primary services provided.
    As I said, I know in my State, we relied very heavily on public 
health clinics. And in a lot of rural areas and in underserved inner-
city areas, they are very important. And in many places, everywhere they 
provide the immunizations for kids. So we'll continue to support them at 
a higher level than we are now if the plan passes as it is.
    Mr. Anschutz. Thank you, Tulsa. And, Glenda Silvy, we thank you very 
much for participating tonight. If we don't get back to you, thanks 
again.
    Now, let's go on to Topeka and Ralph Hipp.
    Mr. Hipp. Thanks again, Wendall, and this is probably our final 
question. Mr. President, we've enjoyed being with you here in Topeka, 
Kansas, tonight. A doctor has our next question.

[[Page 634]]

Lifestyles

    Q. Mr. Clinton, unhealthy lifestyles contribute to a majority of the 
medical diseases we treat today. How would the medical savings plan 
encourage each of us to become more responsible and to follow a more 
healthy lifestyle?
    The President. Well, there's nothing in this plan that would mandate 
diets, for example. But I think--[laughter]--no, don't laugh, this is a 
very serious question. This man has said something that is quite 
important. And I'd like to know what you think we can do other than 
requiring people to pay a portion of their own health insurance.
    A lot of employers themselves are providing such incentives. What we 
have done is to organize this in the hope that each State and each 
health group within the State, each of these health alliances, will 
themselves undertake incentives to encourage employers, for example, to 
provide exercise facilities, to encourage healthy lifestyles, to do 
health education, instead of having national mandates, but to give these 
alliances the incentives to do it to keep the cost of health care down. 
It is a very, very important thing to do.
    We have not mandated specific things in here. But I think the 
incentives for the groups within State by State to do it will be 
overwhelming to try to keep the cost of health care down in the future. 
And he has asked a very important question. I'm glad you brought it up 
before we got off the air.
    Mr. Anschutz. Ralph, thank you for being with us in Topeka tonight. 
We appreciate your--there's a large crowd there and all the questions 
that we've had. We also appreciate from Omaha. Unfortunately, we don't 
have time to return to them for one last question. But I think we've 
covered a lot of ground tonight. It's certainly been an interesting 
discussion. And I'm sure that all of our viewers have learned quite a 
bit from what they've heard tonight because a lot of ground has been 
covered.
    Before we close, Mr. President, do you have some final words you'd 
like to say?
    The President. Just that I hope that all of you who are listening 
tonight and all of you who asked questions and had questions that 
weren't asked, will agree with me that this is an issue we ought to deal 
with now, not that anybody has all the answers or that there aren't some 
tough decisions to be made. If there weren't some hard decisions to be 
made, this crisis would have been dealt with a long time ago. We've been 
trying to do this for 60 years.
    But I would just urge you to urge your Members of Congress, without 
regard to party, to face this issue this year, to discuss these issues, 
to deal with the problems that have been raised tonight, the questions 
people have about my proposal, but to act this year to finally provide 
private guaranteed health insurance for all Americans. We will not solve 
a lot of the problems that were mentioned here tonight or bring costs in 
line with inflation or provide real security to working families, ever, 
until we do this. We will not do it.
    It is important for our economy, but it's most important for who we 
are as a people and what kind of life we're going to have as families 
and as working people as we move into the next century. So please urge 
your Members of Congress, not necessarily to agree with me on every 
detail, but to seize this moment to do something profoundly important 
for the American people and guarantee health security to all of us and 
to our children.
    Thank you.
    Mr. Anschutz. I want to thank the President again. And we thank all 
of you who came, and we apologize to everyone who we couldn't work in to 
this small studio, this small amount of time, because so many people 
have questions about health care in our country. And I think the main 
thing is that they do have questions.
    We asked President Clinton to come here this evening because he has 
a health plan. We didn't say it's the right plan. That wasn't the idea. 
The idea was to give him a forum so that he could tell us everything he 
could about his health plan in a fairly large amount of time so that you 
could get a grasp of it. Then we are asking you to go weigh what he has 
had to say and look at all of the other alternatives that are out there 
so that you can make an informed opinion when it comes time to express 
how you feel.
    We invite you to send your questions and your opinions to your 
Congressmen, to your U.S. Senator, and make those opinions known. Right, 
Mr. President?

[[Page 635]]

    The President. If anybody has any questions that weren't answered 
tonight, write us, and we'll answer them.

Note: The town meeting began at 7:05 p.m. in the KCTV television 
studios.