    [Public Papers of the Presidents of the United States: WILLIAM J. CLINTON (1999, Book II)]
    [July 22, 1999]
    [Pages 1326-1329]
    [From the U.S. Government Publishing Office www.gpo.gov]

    Interview With Mike Cuthbert of ``Prime Time
    Radio'' in Lansing, Michigan
    July 22, 1999

        Mr. Cuthbert. Hi. I'm Mike Cuthbert in Lansing, Michigan; welcome
    back to ``Prime Time Radio.'' As we promised you, we'll present full and
    indepth discussion of the proposed changes in our health care system,
    with particular focus on Medicare, as the year 2000 campaign begins. But
    the discussion of Medicare has not waited for the campaign to start, as
    you know.
        With us here in Lansing, Michigan, is President Clinton, who just
    finished having a discussion with folks from Michigan on Medicare. Mr.
    President, welcome to ``Prime Time Radio.''
        The President. Thank you. I'm glad to be here.

    Health Care Reform and Medicare

        Mr. Cuthbert. Back in 1992, in a long discussion about health care
    reform, you stopped the proceedings and you said, very firmly, ``Without
    wholesale health care reform, we have no hope of a stabilized, long-term
    economic recovery.'' The economic recovery has been long, but health
    care reform didn't happen. How does that impact on the Medicare plans?
        The President. Well, the one thing that I didn't believe that has
    happened that was good is that we had--I didn't believe that we could
    get health care inflation down to the general rate of inflation without
    moving to universal coverage. And I think what happened was we got all
    the benefits of managed care in the early years--and we were very
    fortunate to do so--but now we're also living with the burdens, as you
    hear all the horror stories that prompted me to push the Patients' Bill
    of Rights.
        So I think where we are now is--where I am, at least, is I'm trying
    to extend health insurance coverage to discrete groups that don't have
    it, to try to improve the way the system works and do more preventive
    care, and try to modernize and stabilize the Medicare program. For
    example, we, 2 years ago, provided for funds to cover 5 million children
    who don't have health insurance. In this Medicare reform package, we
    have a proposal to allow people between the ages of 55 and 65 who don't
    have insurance to buy into Medicare.
        But the most important thing we can do now is to stabilize Medicare
    financially by putting some more cash into it over the next 10 years, by
    adopting the most modern practices, and by providing more preventive
    services free, like testing and screenings for osteoporosis and cancer
    and other things, and adding a prescription drug benefit that we can
    afford.
        So I think that this will be a very good, balanced package. It's
    completely voluntary. It gives seniors another choice on Medicare. But
    the most important thing is it stabilizes Medicare for 27 years, and
    that's very, very important, because all the baby boomers start retiring
    in--well, they'll start retiring sooner, but the baby boomers start
    turning 65 in 2011. The oldest baby boomers are already in the AARP.
    That seems impossible to me, but there it is. [Laughter]
        So to me, it's very, very important that we not spend too much of
    this surplus on a tax cut before we do the first things first, before we
    stabilize Social Security, stabilize Medicare

    [[Page 1327]]

    and reform it. And incidentally, my proposal, if it's adopted as I sent
    it to Congress, would also make America debt-free in 15 years, for the
    first time in 160 years. So that would be a good thing to do, as well.

    Link Between Medicare, Social Security, and Education

        Mr. Cuthbert. One thing I noticed you have done since this focus
    began--and you did it again here in Lansing--was you always mention
    Medicare and Social Security and you never fail to mention education.
    This program talks a lot about ``sandwich generation'' issues. What do
    you see, and what should the American people see, as the importance of
    that link between Medicare, Social Security, and education, which seem
    to me to be appealing to two different audiences?
        The President. Well, I think that they tie families together, and
    they tie the future together. For example, younger people should care a
    lot about stabilizing Social Security and Medicare, not just for
    themselves but so that they will not be financially burdened by their
    parents' aging. The number of people over 65 is going to double in 30
    years--double. People over 80 are the fastest growing group of
    Americans.
        So if you're going to be--in 10 years from now, if you're going to
    be 45 years old and have kids going to college, you ought to be
    interested in this because you ought to want our programs to be strong
    so that your parents can support themselves with their own retirement
    from the Social Security, and you'll be free to raise your parents'
    grandchildren. So it is an intergenerational thing.
        If you look at the education issue, the ability of America to
    sustain our economic dominance long term will rest increasingly on the
    ability of America to educate all American kids to world-class standards
    so they can occupy tomorrows with jobs. And so the older people have a
    big vested interest in education, apart from generally caring about how
    their grandchildren are going to do in the world, because it will
    stabilize and strengthen America. And we should look at America as a
    whole. We ought to--we've got to deal with the aging of America; we've
    got to deal with the challenges to the children of America; and we've
    got to make sure we can keep the economy going. If you do those three
    things, I think we'll solve a lot of the other problems just on our own.

    Budget Surplus

        Mr. Cuthbert. Critics of the surplus debate have said that nobody
    can guarantee the economic growth that is at the bottom of your plan. It
    seems to me--and I wish you to comment on this--that that may be the
    most important part of that education you're talking about, that without
    that education, that economic growth underlying this whole thing and the
    surplus isn't possible.
        The President. Absolutely. Let me say though, to people who say that
    you can't be absolutely certain the surplus will be there as projected
    for 10 years or 20 years, to me that's an even stronger argument not to
    go out and give it away before it materializes with a big tax cut. At
    least if you adopt my plan, you know that we're going to be saving the
    lion's share of it for Social Security and Medicare and paying the debt
    down. So if it doesn't all materialize, at least you're going to be
    making headway.
        But I should say a little something about economic forecasting,
    because it relates to what you said about education. When we say the
    surplus will be such and such over 10 years, based on the economists'
    forecasts, it doesn't mean that we think every year will always be
    better than the next and there will never be a recession or never be an
    economic slowdown. What these economists do is they factor the patterns
    of economic performance over a long period of time and they say, ``If
    you assume the average number of downturns and the average number of
    upturns and the economy performs as it has been performing for the last
    10 to 20 years, then this is what the surplus will be.''
        In other words, we have eliminated the so-called structural deficit.
    We never really had a big permanent deficit in America until 1981, you
    know, in peacetime, just a permanent deficit. And we quadrupled the debt
    in 12 years. We have gotten rid of that. So now if we had--God forbid--a
    big downturn next year or the year after next, we might even run a
    little deficit because there would be fewer people working and more
    people getting tax money. But over the 10 year period, the surplus
    estimate is almost certainly right.

    Nursing Homes

        Mr. Cuthbert. Can we turn for a moment to nursing homes? They've
    been running ads recently in major papers across the country

    [[Page 1328]]

    about the effects of the Balanced Budget Act amendment cuts, some $2.6
    billion. My mother is in a nursing home, and I can see the effects on
    her--less exercise periods, more difficulty getting service, more
    turnover in staff. How would your Medicare reforms and stabilization
    affect that problem, which appears to be growing?
        The President. Let me, first of all, describe what the problem was.
    When we passed the Balanced Budget Act, we agreed with the Republicans,
    we would try to achieve a certain level of savings in the Medicare
    program, which funds nursing homes and hospitals and home health and all
    that. We then produced, from our health care experts who deal with all
    the providers, the list of changes we thought were necessary to achieve
    that level of savings. The congressional budget people said they thought
    it would require more changes than that. So under the law, we had to do
    it. They didn't do this on purpose. What happened was they cut more than
    was necessary; they realized much bigger savings than they estimated. To
    that extent, our surplus is larger than it otherwise would be.
        And we believe that it is mostly because we did too much that some
    of our nursing homes and hospitals and other programs are in trouble.
    And what I have done in extending, in taking the savings of the Balanced
    Budge Act for '97 out another 10 years, we have taken out of that some
    of the things we put in last time. And we have also set aside a fund of
    $7.5 billion that can be allocated by Congress to the hospitals and the
    nursing homes that have been particularly disadvantaged by this, to try
    to alleviate this quite difficult financial situation a lot of them
    found themselves in.

    Prescription Drug Coverage

        Mr. Cuthbert. Much of the discussion here in Lansing concerned the
    prescription program that so featured part of your Medicare
    stabilization program. I have not, in all my reading and listening, been
    able to discern too much opposition to that. Have you?
        The President. Well, I think there's opposition. The only opposition
    I'm aware of now is there are some in the Congress who are opposed to
    it, who say that--mostly the Republicans who want to use the money for
    the tax cut--they basically say, ``Well, two-thirds of our seniors
    already have drug coverage.'' But as I pointed out today--we produced
    our report today--only about 24 percent have really good private sector
    drug coverage related to their former employment. The other coverage--
    either they don't have coverage at all, a third of them don't have any
    coverage; and the rest of them have coverage that's too expensive and
    too unreliable and is shrinking every year. Some of them have coverage
    that has $1,000 ceiling. And the most rapidly growing drug coverage has
    a $500 ceiling. Well, for people with drug problems, you know, if they
    have $2,000, $3,000, $4,000 worth of bills every year, that's not much
    coverage.
        So we think that--this is a purely voluntary program, but we think
    that people ought to have another choice. They ought to have the option
    to have more adequate drug coverage at a considerably lower price than
    you get in the Medigap policy. Medigap is just too expensive. And it
    also goes up as people get older. And the older you get, the less able
    you are to pay, normally, and the higher the premium is. So I feel that
    this is quite a good thing to do.
        Mr. Cuthbert. Speak to the fears of the people who say, ``If this
    prescription drug program comes in, my company will cut drug
    prescription benefits.''
        The President. Well, we were concerned about that, because the 24
    percent that have this drug coverage already, some of them actually have
    programs that are more generous than the one we're offering, and we
    don't want to mess that up. So we have offered, as a part of this
    program, quite generous subsidies to employers to continue such
    programs. And I think, actually, it might be that more employers will be
    willing to provide this coverage.
        What's happening now is these employers are dropping this coverage
    like crazy right now; they're dropping it anyway. And so what we want to
    do is to give incentives for them to keep it, and then to add it back if
    they've dropped it. This will not aggravate this problem; this will make
    that problem better. However bad or good it is, it'll be better after
    this because it's totally voluntary. But the employers will have no
    financial incentives to drop it and put their people on the Medicare
    program because they're going to get direct subsidies from Medicare to
    keep what they've got.

    [[Page 1329]]

    President's Future

        Mr. Cuthbert. As we'll hear in just a moment, we're going to hear
    from some of the folks who were at this meeting in Lansing, the people
    from the audience and their stories. As you said in the presentation,
    those who criticize stories as ineffective don't know America. We are a
    collection of stories.
        It seemed to me that since this is your last year in the
    Presidency--and, as you say, you're not running for anything--President
    Carter had the Habitat for Humanity; what are the chances that President
    Bill Clinton, after he's President, will focus on health care reform and
    health care issues as your next job?
        The President. Well, I think it's one of the things that I will do.
    I've tried to bring this country together politically, economically,
    socially, across racial and religious lines. And one of the things that
    I expect I will be doing is to use the center that I will establish at
    my library to try to find ways to close the gaps in the fabric of our
    American community, including the health care gaps. You know, I care a
    lot about it.
        But I think it's very important that we recognize we can do a huge
    amount in the one year and 5 months I have left. It would be a big
    mistake for us to all check out here--or a year and 6 months we've got
    left.
        Mr. Cuthbert. You don't seem to be checking out.
        The President. No, I think we ought to bear down. I tell my friends
    in the Congress all the time, I say, you know, we still get a check
    every 2 weeks. People are paying us. We need to show up for work. There
    will be an election, and time will take care of all the rest of this,
    and then we'll all go on about our business and do other things.
        But it's funny, sometimes the pressure of an election--a lot of
    people have forgotten this, but in 1996 we passed welfare reform with
    overwhelming bipartisan majorities in both Houses; we passed an increase
    in the minimum wage; we did two or three other big things in '96. In
    '98, at the very end of the 11th hour, we passed a budget that provided
    for a downpayment on 100,000 teachers to take class size down to 18 in
    the first 3 grades. And we've already funded almost a third of them. I
    mean, this was a huge deal. So if we all just stay in harness here and
    focus and show up for work everyday, good things can happen.
        Mr. Cuthbert. You said here in Lansing that you want the debate to
    be harmonious; you want it to be civil; you want it to be intelligent;
    and we hope it will remain this way on this program.
        We thank you for contributing to that atmosphere and the information
    and inspiration you've given us today. Thank you very much for being on
    ``Prime Time.''
        The President. Thank you very much. I'm delighted to be here. Thank
    you.

    Note: The interview was recorded at 2:20 p.m. in Room 252 of the Dart
    Auditorium at Lansing Community College for later broadcast. ``Prime
    Time Radio'' is a production of the American Association of Retired
    Persons. The interview was released by the Office of the Press Secretary
    on July 27.