[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.