    [Public Papers of the Presidents of the United States: William J. Clinton (1995, Book II)]
    [July 29, 1995]
    [Pages 1174-1178]
    [From the U.S. Government Publishing Office www.gpo.gov]

    Question-and-Answer Session With Senior Citizens on Medicare
    July 29, 1995

        The President. Yes, Sarah [Sarah McClendon, McClendon News].
        Q. What's your strategy? What's going to be the Democrats' strategy?
    We can't live with this present condition like this. We can't do it.
    People are dying every day because they don't have preventive health
    care. And what's going to be the strategy of the Democrats to overcome
    this?
        The President. Well, first of all, we're going to try to win as many
    of the fights as we can as they come up. You know, yesterday we won a
    really important victory in the House of Representatives where, really,
    the first time since the new majority took over, over 50 Republicans
    bolted and voted to protect the environment, a very important issue in
    States like Florida and other States around the country. The House had a
    bill before it that would literally strip the Federal Government of its
    power to protect the environment. So that--and 50 Republicans joined
    with almost all the Democrats and said, no, we're not going to do that.
        So I think that we've got a chance now, a real chance to build a
    sensible, common-sense, common ground majority. And that's what we're
    going to try to do. I don't know that these Medicare cuts can pass the
    Congress. And I'm certainly going to do what I can to defeat them.
    That's our first strategy.
        The second thing, to follow up on what you said, is that we believe
    that if we're going to slow the rate of growth in Medicare spending
    dramatically, without imposing great new costs on seniors and making the
    system work, we ought to take a little of that money we're going to save
    and put it into preventive care, to try to help people take care of
    their parents or their grandparents outside of institutions, outside of
    nursing home care. I think it would save money over the long run. It
    wouldn't cost a

    [[Page 1175]]

    lot of money to start, and we'd sure find out over the next 2 or 3
    years.
        And in my budget, we take some of that money to put into home health
    care. We've put some of that money into respite care for people with
    Alzheimer's. We do some other things with it, and we'll be able to
    monitor over the next 2 or 3 years whether it saves money or not. I
    think it will, and it doesn't have anything to do with stabilizing the
    trust fund. So that's our strategy.
        And I'm encouraged by yesterday's vote on the environment that there
    may be some Republicans willing to brave the pressure, the enormous
    pressure they've been under to toe the line, to do what's right for
    America. So I'm encouraged.
        Q. Mr. President----
        Q. Larry, let's go do the discussion first and then we'll----
        The President. Larry, what were you going to say?
        Q. I'm sorry.
        The President. I want to hear from all of you first, and then we'll
    take the press questions.

    [At this point, Mayor Norman Abramowitz of Tamarac, FL, asked the
    President to continue the fight to protect Medicare and Medicaid and
    asked if he would address the concerns of the younger generation and
    their desire for change.]

        The President. Well, you tell--first of all, tell them I won't give
    up the fight. We've just begun the fight. But I think, to be fair, the
    young people of our country are worried about their own future. And it's
    an amazing time in our country. We've got--just since I've been
    President, we've brought the deficit down, we've got 7 million new jobs,
    we've got a record high stock market, we've got a record number of new
    businesses. But a lot of people, including a lot of young people, are
    working harder for less. They feel more and more powerless. And so a lot
    of them think, well, maybe the answer is to turn against everything
    we've done in the past, turn against programs like Medicare, turn
    against the elderly, walk away from everything that's been done.
        And the problem with that is, all they will do is make themselves
    and their parents and their own future worse. We have to properly
    analyze what's the matter, and we have to get the kind of change we
    want. We do need to raise incomes as well as create jobs, just like we
    need to stabilize the Medicare trust fund. People are living longer and
    longer, so there are more people drawing Medicare. And the older you
    are, on balance, the more you use the health care system. So the cost
    per person goes up as people get over 80, let's say. But the answer is
    to fix it in a way that won't break it and that won't bankrupt the
    seniors of this country.
        And I think it's--you know, I'm glad you mentioned Medicaid. A lot
    of people think Medicaid is exclusively a program for young, poor people
    on welfare. And two-thirds of Medicaid money goes to the elderly and
    disabled. That's what funds the parents of middle class America who have
    to go into nursing homes, for example. And if you look at the nature of
    the Medicaid cuts, we're going to see a lot of middle class Americans
    who will no longer be able to afford to send their kids to college
    because they'll be paying for their parents in nursing homes if they can
    afford to do that.
        So, the answer--I think you ought to tell these young people, we are
    in a period of change. And we have to change our Government policies to
    be prepared for the 21st century. But the answer is to enable everybody
    to make the most of their own lives, not to pit one generation against
    another or one group of Americans against another. That is a dead loser
    for this country. That is a really foolish thing to do. It helps a lot
    of politicians win elections when they can pit people against one
    another, but it doesn't help the country much. And we have never
    progressed doing it. You look back in the whole history of America, we
    have never taken one step forward by pitting one group of Americans
    against another one, and we never will.

    [A participant described a recent illness she suffered and explained
    that she had been very concerned that Medicare would not cover the
    expenses. She stated that she was fortunate that she had daughters to
    help provide care for her but that the average older person could not
    afford the expense of a serious illness and the nursing care required.]

        The President. But you know, your story illustrates a point that the
    mayor just made. I mean, first of all, for about 10 years now, the
    elderly in our country have had a lower poverty rate than very young
    people. And that's a wonderful thing. And two things did it, the cost of
    living

    [[Page 1176]]

    on Social Security and Medicare. That's what did it.
        Now, if we put another half a million older Americans in poverty
    with this program, is that going to lift any little children out of
    poverty? No. Is that going to help that young worker? No. All you're
    going to do is take more money out of the incomes of middle class
    working people who are working harder for less.
        So the answer is to raise their incomes and increase their security.
    The answer is not to make this swap. And who would get the benefit of
    this, this tax cut? I want to emphasize again, this money is not
    necessary to fix the Medicare trust fund. They don't have to make this
    much savings.
        And an enormous amount of this huge tax cut is going to people who
    don't even need it, and many of them, frankly, don't want it. Many of
    them do not want it. I've had a lot of upper income people tell me that
    they do not want--they want to balance the budget, take care of
    Medicare, invest in education, get this country going. So I--this is a
    battle we have to win.
        Yes, ma'am. Go ahead.

    [A participant described a letter the President sent her about
    Medicare.]

        The President. Bless you.
        Q. And I know you want it because you wouldn't have done it. You
    wouldn't have done this today. You didn't have to sit here.
        The President. Thank you.
        Go ahead.

    [A participant stated that if Medicare and Medicaid were cut, a great
    number of disabled and elderly people would fall below the poverty
    line.]

        Hillary Clinton. One of the concerns we have--and I think one of the
    reasons the President wanted to do this, to go back to Sarah's question,
    is there's a lot of misinformation out there. And I think, Mayor, that's
    what some of the young people are responding to. And we're now seeing
    ads being run that are trying to scare people and trying to say that,
    you know, if we don't do what the majority in Congress wants to do, then
    there won't be any Medicare--a lot of real scare tactics. And I think we
    have to get the information out to people.
        For example, there's a difference, as you know, between Part A and
    Part B of Medicare. And what the President has proposed in his budget
    will improve the Trust Fund. But the beneficiary cuts and the additional
    costs that the majority in Congress want older people to have to pay out
    of their own pockets have nothing to do with the Trust Fund.
        The President. Nothing to do with the Trust Fund.
        Mrs. Clinton. See, this is one of those shell games. Remember when
    you'd walk down the street and you'd see how fast people could do all
    that, and I never could figure it out--well, it's going on again. But
    it's going on in a much more serious way, trying to really keep the
    balls moving so fast that they think that they'll fool people, and not
    just fool older people but fool the children and grandchildren, so that
    people will think, well, all they're trying to do is to fix the Medicare
    Trust Fund, and so if people have to pay more--not remembering that 75
    percent of the people on Medicare make less than $25,000 a year--so
    where are they going to get the $2,000, the $5,000 to pay more? And it
    has nothing to do with the Part B cuts, with the Part A Trust Fund.
        So that's one thing that we have to keep explaining to people. And I
    think the truth, as is often the case, is one of our most effective
    arguments.
        The President. A lot of people, like a lot of young people, don't
    know. They'll see these ads, and they think, well, they're trying to fix
    the Trust Fund. But I just want to remind--look, we need to do a little
    history here. When--1993, when I gave the State of the Union Address and
    I became President, I said, look, we've got to fix the Trust Fund. In
    1994, I said, we have to fix the Trust Fund. When I presented health
    care reform, I said, we have to fix the Trust Fund. A lot of these same
    people, now, who are alarmed about the Trust Fund said, ``There's no
    real problem, there's no health care crisis, what's he talking about?''
        Then when a report comes out this year and it shows we've actually
    improved things for the Trust Fund but we still have to fix it, they
    say, ``Oh, we have to fix the Trust Fund, and that's why we need to load
    all these costs on the seniors.'' But the costs--I want to say again
    what the First Lady said--the costs being loaded on the individual
    seniors do not go against the Trust Fund. They're being used to finance
    an excessively large tax cut and to balance the budget at the arbitrary
    date of 7 years.

    [[Page 1177]]

        And, you know, it is just not fair. I have never seen a time when
    the seniors of this country were not willing to bear their fair share,
    were not willing to make their own contributions. You know as well as I
    do, modest changes have been made in Medicare and Social Security over
    the years. That's not what this is about. This is about just what Mr.
    Flemming said; it's about taking the heart out of this program, to
    drastically change the way the Government's priorities are. And it is
    wrong. And you and your children, your grandchildren, in some cases your
    great-grandchildren, you've got to stand up against it.

    [A participant stated that she resented claims that the President and
    the Vice President were scaring older people.]

        The President. I'm not trying to scare anybody. But I am trying to
    arouse----
        Q. I'm defending you----
        The President. I am trying to arouse the citizens of this country.
    I've seen scare tactics. I've had them used against me and what I was
    trying to do. I saw a couple hundred million dollars worth of scare
    tactics last year when I was trying to secure your health care future.
    So I know all about scare tactics. I'm not trying to scare you, but I
    think it's wrong for people to go around with this little plan to mess
    with your Medicare and try to keep the details of it secret until the
    11th hour, then pop it through and have it all gone. And I think we need
    to--this is like a covey of quail. We need to flush it--[laughter]--get
    it out there and see what's going on here.
        Go ahead, what were you going to say, ma'am?

    [A participant said that she was concerned that Medicare cuts could
    affect the number of older women who get mammograms.]

        Mrs. Clinton. Well, I'm glad you raised that because we've got the
    experts back there who run this program, and we know that one of the
    barriers to older women getting regular mammograms is cost. And if we
    make the cost of Medicare even more expensive for older people in
    general, but particularly women, then the preventive health care that
    they need--which will save us all money if people take care of
    themselves and get those tests--will be lost as well.
        And I want to say one other thing because I think this is part of
    the--sort of the scare tactics as well that are being used. A lot of
    people say, ``Well, families should take care of each other and families
    should be there for each other and the Government shouldn't do it.'' The
    majority leader has said, you know, he doesn't want any part of
    Medicare; it shouldn't be a program in any free country, and everybody
    should take care of themselves.
        Well, I think everybody in this room certainly and most people I
    know around the country do everything they can to help their parents.
    Your daughters came to take care of you, and you're grateful that they
    could. And we will continue to do that, financially, emotionally, in
    every way we can. But there are two, I think, realities we have to look
    at. There are a lot of older people who don't have those children and
    those grandchildren. There are a lot of older people who have outlived
    their children, who don't live anywhere near their children or their
    grandchildren, who are in no position to be able to get any help. What
    we are going to do with them, particularly all these older women who are
    on their own?
        And the second thing is that because a lot of young people are
    struggling very hard for themselves I have no doubt they would make the
    sacrifice if they had to, but with the cost of medical care, my
    goodness, we will drive more young people into poverty if they have to
    spend all of their assets to try to help take care of their parents and
    their grandparents. That's why what we're talking about here is
    something that doesn't just affect older Americans. It affects every
    single American, no matter what our age. And I hope that people will
    understand that more.

    [A participant suggested that the President should express his plan to
    reform Medicare very clearly to avoid confusion about the differences
    between his proposal and the Republican proposal.]

        The President. That's what the First Lady said. These personal costs
    that are going to be loaded on the individual seniors under their plan
    do not make a contribution to stabilizing the Trust Fund. They are not
    necessary to stabilize the Trust Fund, and we don't have to do it.
        I know we've got to break up. We'll hear from one more person.

    [[Page 1178]]

    [A participant expressed concern about the impact on minorities living
    in poverty if Medicaid were no longer an entitlement, especially in view
    of cutbacks in assistance at the local level.]

        The President. It's a mistake. Let me just say this. Just look at
    the--you know, of course, the main Medicaid benefit to seniors is
    nursing home care. And you know, most States have more people in nursing
    homes under Medicaid than Medicare, way more.
        But let's just talk about the next generation. Let's talk about the
    children. We've all got a big stake in seeing how well they do. Medicaid
    is the program that provides health insurance to really poor children in
    this country. Now, you tell me what's going to happen if you block-grant
    Medicaid and you don't require the States to come up with their portion.
    And the next time the State legislature meets in Florida--let's take
    Florida, a State I know quite a bit about. You know, Hillary and I
    have--her family live there, two of her brothers. Let's just take
    Florida. And it's a fast-growing State. And they come in and we have a
    legislature, and the people say, we don't have enough money for the
    schools. And they're telling the truth, because it's fast-growing. And
    then they say, we've got all these new communities, and we don't have
    enough money for the water systems we need or the sewer systems we need.
    And they'll be telling the truth. Or we don't have enough money for the
    road systems we need. And they'll be telling the truth.
        Now, then let's say the seniors have a strong enough lobby to come
    in and save the money for the nursing homes. What happens? They'll cut
    off all the aid to the poor children. And then what happens if you take
    the health care away from the poor children? Then all of us will be
    paying for them when they're either really sick or they don't develop
    mentally and physically as they should 5, 10, 15 years down the road.
        This is not a good idea. This is a bad idea. Not all change is good.
    We've got to have the right kind of change. And you're absolutely right.
    And I hope you will fight for it. And I will fight for it. And we just
    need to tell the American people about it. We can prevail.
        Thank you. You guys have been great.
        Q. Mr. President, just to give you a chance to respond to,
    undoubtedly, what the Republican response will be. They say that you
    have not offered a really detailed proposal of your own for changes with
    Medicare----
        The President. Have they? Have they? What I have done--I have done
    what's important. I have said, we are not going to accept the
    beneficiary increases that they are. I have said that we can fix the
    Medicare Trust Fund without requiring the kind of cost increases on
    these folks that they are recommending to pay for their tax cut. That is
    a huge change.
        Secondly, I have said that we don't have to do as much on the
    provider side into the health care system as they want to do, because I
    want to balance the budget in 10 years instead of 7. So, any set of
    options I adopt, they will have to adopt more severe options, which is
    why they want to go into the August recess with their plan a secret and
    why they allegedly apparently have plans to come back here and drop this
    thing out right before the fiscal year begins and allow about 2 days
    debate on it and then roll it through.
        Now, I have proved--when I had responsibility for the budget, I did
    that. We made the Medicare Trust Fund better, with no help, I might add,
    from them. Not a single vote. We made it better. They denied that there
    was a problem with the Trust Fund. Then when they won the majority in
    the Congress, what happened? All of a sudden they discovered this
    problem in the Trust Fund, and they used it as a pretext to raise costs
    on Medicare beneficiaries so much so they could pay for the big tax cut
    they promised and meet the 7-year balanced budget deadline they
    promised.
        If you want to talk about--am I willing to work with them on
    Medicare reform to fix the Medicare Trust Fund? Absolutely, I am. Why
    did I present a balanced budget and alternative? So I could reach out my
    hand in good faith to work with them. So far that has not been an
    option. So far they have been proceeding down their own course. All I'm
    saying is, I am serving notice that I will not support what they are
    attempting to do to the seniors.
        Now, we can fix the Medicare Trust Fund. It doesn't have anything to
    do with what we've been talking about here today.

    Note: The President spoke at 10:12 a.m. in the Oval Office at the White
    House. In his remarks, he referred to Arthur Flemming, chair, Save Our
    Security.