    [Weekly Compilation of Presidential Documents Volume 30, Number 12 (Monday, March 28, 1994)]
    [Pages 601-609]
    [Online from the Government Publishing Office, www.gpo.gov]

    <R04>
    Remarks in a Health Care Roundtable With Small Business Leaders

    March 22, 1994

        The President. Ladies and gentlemen, first let me thank all of you
    for coming here. We have several Members of the United States Congress
    up here in the front. We're very glad to see all of them, and we thank
    them for their presence. And we have small business people here from all
    over America, and we thank you for your presence. We're here primarily
    to hear from the small business people who are here on the panel, and
    perhaps some others if time permits.
        I just want to make a couple of comments. First of all, I very much
    appreciate the work that Erskine Bowles has done as Director of the
    Small Business Administration. I am proud of the fact that I was able to
    appoint someone to this job who was not just someone who had run
    unsuccessfully for office or was otherwise looking for a patronage
    appointment. This man has spent 20 years helping to finance small
    business creations and expansions. And therefore, he has a clearer
    understanding and grasp of what small businesses are really up against
    and the difference between the rhetoric of supporting small business and
    the reality of it than perhaps anyone who has held this job in a very
    long time. Secondly, I want to thank my good friend Congressman LaFalce
    for his leadership on small business issues.
        Finally, let me say that everybody, I think, understands that one of
    the reasons that the United States has not succeeded in providing health
    security for all its people while every other advanced economy has done
    so is the

    [[Page 602]]

    difficulty posed by the greatest strength of our economy, which is that
    an inordinate percentage of our workers work for small business people,
    very small business, and increasingly, more and more of the new jobs are
    created by small businesses.
        So that presents us with a dilemma. However, we also know if we look
    at the real facts that almost all the job creators among small business
    are making some effort to provide health insurance, and that those which
    do tend to have more stable work forces and higher productivity and
    greater success.
        Just this week I had a good friend of mine up here with his family.
    He's a car dealer in my home State, and he was talking about how he'd
    always insured all of his employees and none of his competitors had. And
    in the last 20 years, three of them had come and gone, and he was still
    there. And one reason was, he never had any employee turnover because he
    always took care of his employees and their health care problems, but
    the struggle to get a bigger pool of insured people so that he could get
    his insurance cost down was a continuing one for him.
        Anyway, that just brings me to this point: This administration could
    not in good conscience have advocated, and I could not support a plan
    that I thought would be, on balance, bad for small business. I believe
    this plan is, on balance, good for small business. If I didn't I
    wouldn't be supporting it. And I will not sign any bill passed by the
    Congress that I do not believe is good for the small business economy,
    because we have to create more jobs in this country.
        Our plan builds on the system we have now, guaranteed private
    insurance. It provides more choices to employees than they now have
    under most health care plans, at least three a year, every year. It
    contains real insurance reforms that are very important to small
    businesses--no discrimination for preexisting conditions, or based on
    the age of the work force. It protects Medicare. It does provide both
    for Medicare people and for the work force and their families,
    prescription medicine benefit and a phased-in, long-term care benefit
    for service at home, for example, for disabled people or elderly people,
    as well as in institutional settings. And it does have an employer
    mandate, but with strong discounts for small businesses with modest
    payrolls and modest profit margins.
        Now, there will be countless discussions about what the proper
    details of that should be, but it seems to me that that is the only
    approach that has a reasonable chance of being successful in this
    environment. And as I said, there are people who will propose variations
    on it, but that, it seems to me, is what we ought to be doing.
        My purpose today is to show that there is a great difference in the
    rhetorical pronouncements of some organized groups and the real life
    experiences of a lot of business people. And we have here people who
    have been affected by the present health conditions. And I am frank to
    say that while most of the people who are on this panel who are
    providing health insurance today would actually pay less under our plan,
    some would pay more, and they know it. But they also know that for the
    first time their competitors would as well, putting them on a more even
    footing.
        So let's get in to the panelists, hear their stories, and give them
    a chance to comment.
        I'd like to start with Mona Castillo who founded Monarch Graphics, a
    trophy and plaque manufacturer in Chicago and who was the Chamber of
    Commerce national minority entrepreneur of the year award winner in
    1993. And I'd like to ask Mona to talk a little bit about her
    difficulties in providing coverage for her employees and finding an
    insurance company who will do it.
        Mona.

    [At this point, Mona Castillo, chief executive officer, Monarch
    Graphics, Chicago, IL, discussed difficulties presented by having
    uninsurable employees; Betty Hall, owner, Hall Manufacturing Co., Inc.,
    Brookline, NH, discussed loss of coverage by Blue Cross/Blue Shield,
    limiting her company's options for health care coverage; and Spence
    Putnam, chief operating officer, Vermont Teddy Bear Co., Shelburne, VT,
    discussed difficulties providing coverage for employees.]

        The President. Thank you very much.
        Let me just try to emphasize a couple of the points that were made
    here, because they are different issues. Mr. Putnam wants to insure all
    of his employees; today can only insure about two-thirds of them. So he
    would

    [[Page 603]]

    actually pay more if our plan passed, but he'd get to insure all of his
    employees and they would also have more primary and preventive care than
    they have now and lower deductibles. But he would be, again, on an even
    scale with his competitors.
        Betty Hall talked about--I wanted to make sure you understand what
    she meant when she talked about her situation in New Hampshire, because
    she doesn't have Blue Cross options for her business but does have the
    matching Thornton option. She has an HMO option. And the HMO has a very
    good reputation in New Hampshire and throughout New England; I think
    everybody would admit that. But the individuals who work for her now
    don't have the choice that, if our plan passed, every year her employees
    would get to choose either the HMO or one of two other options. And
    under our plan, she would pay the same no matter what. But if the
    employee wanted to pay a little more for fee-for-service medicine, the
    employee would have that right. So that's how that would work.
        If you go back to what Mona said about two of her employees being
    uninsurable, it's important here, I think, to recognize a certain truth
    about the insurance business itself. While certainly I have been
    critical of insurance practices of which I do not approve, I think it is
    also important for us to understand that given the organization of the
    insurance business today, it is economically impossible for a lot of
    these health insurance companies to do other than they do because they
    are dealing with a very small pool of people.
        So if you insure, let's say, an employee unit the size of her
    company and two of them are really sick or they have two kids who have
    been really sick, then that can double the cost of whatever your annual
    premiums are in a year which is why we have worked so hard to find a
    mechanism--and I'll say more about this in a minute--to let insurance
    companies insure people the way grocery stores make money, a little bit
    of money on a lot of people. And that's what all this--and I'm going to
    say more about this toward the end of the hour because I don't want to
    interrupt the flow of the people talking, but that's the dilemma we face
    about whether there should or should not be a health alliance, a buyer's
    co-op or something.
        You've got to have these folks able to go into big enough pools so
    that the insurance companies themselves do not go broke. They're in
    business, too. And the economics have to work out. And the only way the
    economics can work out is if the risks which all small businesses are
    subject to can be widely spread over a bigger pool. So we'll come back
    to that.
        I want to introduce now Murray Horowitz who currently covers his
    employees today but has had to take some pretty strong steps to keep
    covering them. Murray would you like to speak about that?
        Murray Horowitz. As a pawnbroker, I represent one of the most
    misunderstood industries in the country.
        The President. Want to come to work up here? [Laughter]

    [Murray Horowitz, owner, City Pawn Shop, Baton Rouge, LA, discussed
    increasing costs, increasing deductibles, and employees who are
    uninsurable because of preexisting conditions.]

        The President. Same thing--81 million Americans have preexisting
    conditions of some kind or other. This is not a small problem; this is a
    big problem. Those who are in families that are insured through
    government or larger employers are okay now except that most of them
    couldn't change jobs and go to work for any of you or couldn't start
    their own business. You know, a lot of people, that's a lifetime dream
    to start their own business. It takes enough courage, as all of you
    know, to do that if you don't have to worry about this.
        So you've got 81 million Americans, some in the situation of your
    employee who can't get insurance, others who pay very much higher rates,
    and millions and millions--no one knows exactly how many, but literally
    tens of millions--who are locked in the jobs they are now in because
    they can't afford to give them up and lose in coverage. So it's a
    significant issue. Congressman, would you like to say something about
    any of this? I haven't heard from you since the beginning.

    [Representative John J. LaFalce, discussed town hall meetings in which
    constituents de-

    [[Page 604]]

    scribed dramatic cost increases, increasingly limited choice, and
    increases in deductibles and copayments.]

        The President. We have someone here from your home State, Elaine
    Stone, of American Aviation in New York, who has gone to extraordinary
    efforts to cover her employees at very high cost. I'd like to ask her to
    explain her situation and what the consequences have been.

    [Elaine Stone, owner, American Aviation International Corp., New York,
    NY, discussed her desire to provide coverage for all employees and
    described her current self-insured plan which splits funding between the
    corporation and the insurance company.]

        The President. Thank you very much.
        Let me say because of the unique, sort of, semi-self-insured system
    that Elaine has, and because she's had some significant illnesses in her
    work force, she would actually, at least based on the last year or two's
    experience, pay considerably less than she is paying because of the self
    insurance schemes kicked in. It works, again, like everything else--it
    may work very well for large employers, but for someone with a couple of
    dozen employees, it is a very high-risk strategy that can work real well
    until it doesn't anymore.
        I'd like to now talk about people who are kind of the other side of
    that equation, people who would like to cover all their employees but
    can't, and therefore, only cover a portion of them, or have had to give
    up coverage. And I'd like to begin with Judith Wicks who owns the White
    Dog Cafe in Philadelphia. Because, as I'm sure all of you know, the
    people in the restaurant business have been among those most concerned
    about this health care plan because there are so many people who work
    for restaurants and delis and other eating establishments who are young,
    who are single, who don't have health insurance, and who are still
    willing workers there. But there are an awful lot of people who very
    much want to cover folks.
        And the press will remember, we were in an establishment in
    Columbus, Ohio, just a couple of weeks ago, where by accident--we didn't
    plan to go there for health care, but where we had a whole health care
    seminar because only half the employees were covered, and the person
    covering them wanted to cover them all.
        So Judith, why don't you talk a little bit about your situation?

    [Judith Ann Wicks, owner, White Dog Cafe, Philadelphia, PA, discussed
    her ability to provide insurance coverage for only a small percentage of
    her employees and indicated that the health care plan would provide full
    coverage for only a small increase in cost and place all restaurants on
    an equal competitive footing. Representative LaFalce discussed sources
    of opposition to the health care plan indicating that instituting the
    plan would place all restaurants in the same competitive positions.]

        The President. Do you think he feels strongly about that? [Laughter]
        Thank you.
        Erskine Bowles. Mr. President, we also have another restauranteur
    here, who runs the Burrito Brothers chain here. They're three Mexican
    fast food restaurants. Eric's also experienced some of these same
    problems that small businesses face in trying to provide health care
    coverage. And Eric, you might want to comment on how you would react if
    it was a level playing field and you could provide reasonable coverage
    at reasonable cost.
        Eric Sklar. First let me say that, what Judy said notwithstanding, I
    hope jobs are lost to Mexican food. [Laughter]
        The President. Well, if I'm setting the pace, you've got a good
    chance of achieving that objective. [Laughter]

    [Mr. Sklar, owner, Burrito Brothers, Washington, DC, discussed how the
    health care plan would be good for the restaurant business, citing the
    advantage to businesses of having employees with health care coverage,
    and indicated a willingness to pay more to secure health care for
    employees.]

        The President. Thank you. I just want to say that Eric and Judy
    represent an interesting thing that we have seen basically around the
    country with people who really are trying to do the right thing by their
    employees. If you are in the restaurant business and you insure part of
    your employees, you are in the worst of all worlds. You're still at a
    competi-

    [[Page 605]]

    tive disadvantage to people who don't insure anybody, and you feel
    terrible that you can't insure everybody. That's basically what they
    face.
        Administrator Bowles. Mr. President, unfortunately some of the small
    businesses in this country have experienced such absolutely skyrocketing
    costs and the cost of health care, experiencing these 20 to 50 percent
    annual rises in health care, that they simply just no longer can afford
    it. Garth Sheriff is here from Los Angeles. I know Garth has had to drop
    his coverage a couple of years ago when the cost just went so high you
    couldn't afford it.

    [Garth Sheriff, owner, Sheriff Associates, Los Angeles, CA, discussed
    the dilemma he confronted of having to choose between keeping an
    employee or keeping health insurance for his firm, the difficulties
    presented by an aging group of workers in terms of insurance costs, and
    concluded with a strong endorsement of the health care plan.]

        The President. Thank you. Thank you very much.
        I'd like to, first of all, thank you and thank your group and thank
    you for sharing your painful experience with us. I'd like to go on and
    sort of pursue this theme a little more and call on Brian McCarthy, who
    owns the McCarthy Flowers, a large florist in Scranton, and ask him to
    tell us a little about his situation.
        Brian.

    [Brian McCarthy, owner, McCarthy Flowers, Scranton, PA, discussed the
    problem of attracting unskilled workers from welfare when the workers
    would lose health care coverage from Medicaid for their families and
    also attracting skilled managers who would not take positions without
    adequate health care coverage.]

        The President. Thank you very much. I just want to emphasize one
    comment Brian made, and if I might go back to what our restauranteurs
    also said there. One of the arguments that the Restaurant Association
    makes against our doing this is they say, ``Well, you know we have a lot
    of young single workers that are healthy. They're strapping. They don't
    want insurance, or if they do have it, they ought to be able to get it
    much more cheaply than older workers,'' because young single workers
    will pay higher per person premiums under our plan. That's what
    community rating is all about. If you put people in large pools with
    older people and with families with a lot of kids and the kids have been
    sick, you average it out. So they will pay a modestly greater amount,
    and therefore, the employer contribution for them will be modestly
    greater.
        I'd like to make two arguments in response to that. One is one Brian
    made. A lot of the young single people we want to be workers in this
    country are on welfare. They all have health insurance for themselves or
    their children through the Medicaid program which is as generous as most
    health insurance programs. And yet, we want them to move from welfare to
    work and take jobs in our small businesses and give up health insurance
    for their children so they can then start paying taxes to pay for the
    health care of people who made the other decision to stay on welfare.
        I mean, it's just a--we cannot reform this welfare system unless we
    fix this problem. So there are a lot of young single potential workers
    out there we cannot even get in the workplace unless we deal with this.
        The second point that I'd like to make is that the fastest growing
    group of people in America are older Americans. And people are going to
    be working later and later and later in their lives. Indeed, the gradual
    phase-up of the Social Security retirement age starts in a couple of
    years as a result of the Social Security Reform Act of 1983, raising
    retirement age by a month a year over several years to go up to 67. And
    if you don't want discrimination, if we need older people, if we know
    they're very good employees and they're very reliable and you don't want
    discrimination against them in the workplace, one sure way to avoid it
    is to make sure that their health insurance premiums are not
    discriminatory.
        I see a lot of older people who work in eating establishments, too,
    So this thing, I think, will balance out and is ultimately fair. I
    especially thank Brian for his statement because he does cover all his
    employees today.

    [[Page 606]]

    And it shows you, I think he really is thinking towards the future.
        Administrator Bowles. Mr. President, we also have here Chris Maas,
    who has experienced some of these same problems of trying to compete for
    labor with absolutely skyrocketing costs in health care.
        Chris, do you want to talk about it a second?
        Chris Maas. We're a small computer consulting firm here in
    Washington. We do most of our work with Washington area lawyers, and we
    need professional help. And the one competitive advantage that we have
    as a little firm--[laughter].
        The President. Every one of you has a one-liner for that, don't you?
    [Laughter]

    [Mr. Maas, owner, Potomac Consulting Group, Arlington, VA, discussed the
    problems he confronted in hiring older employees because of the health
    insurance issues that arise. He concluded by stating that his associates
    see the health care issue as a business issue rather than a political
    issue.]

        The President. Good for you. Believe you me, nothing would make me
    happier than to do exactly what you've said. It should not be a partisan
    political issue. And if you get beyond the fog of rhetoric to the hard
    facts of what people's actual individual circumstances are, it's very
    much easier for it not to be a political issue.
        Thank you very much. That was very impressive.
        I want to talk a little bit--by giving these folks a chance to talk
    about how we give small business people the ability to have competitive
    prices in the insurance market.
        And I'd like to start with Stephen Hightower of the Hi-Mark
    Corporation in Franklin, Ohio, and talk about how the absence of that
    has affected his business and his family.
        Stephen.

    [Stephen Hightower, president, Hi-Mark Corp., discussed the difficulty
    keeping employees with the corporation without offering health care
    benefits and emphasized the link between welfare reform and health care
    reform.]

        The President. I'd like to now to go to a small family business.
        Kathleen Piper who owns the Pied Piper Flower Shop in Yankton, South
    Dakota.
        I first met her a little over a year ago when she represented small
    business at the economic conference we held in Little Rock shortly
    before I assumed the Presidency. I'd never met her before, and I didn't
    know anything about her, but I was deeply impressed by the comments she
    had to make, and we asked her to come back here today because of her own
    experience on health care.
        Kathleen.

    [Ms. Piper discussed how she was no longer able to provide health care
    insurance for her employees. She thanked the Small Business
    Administration for its work in educating small business owners on the
    health care plan.]

        The President. Yesterday when I was in Miami, I met, as I often do
    when I'm traveling around the country, with some children and their
    families from these Make-A-Wish programs, where the kids are desperately
    ill and one of the things they want to do is meet the President. And I
    met with a family, a very impressive family of three children, two sons
    and a daughter, where both sons had a very rare and apparently
    genetically transmitted propensity to have a very rare form of cancer.
    And this family has a lifetime limit on their policy, as three out of
    four Americans do. Three out of four Americans have lifetime limits. And
    they're in a real pickle, because they are going to run up against the
    limit long before the second child--assuming that both the boys survive,
    and they've done pretty well so far, but if they do both survive their
    illness and they're plugging along--then they'll run up against their
    limit long before the second child is out of the house. And then they
    have a third, youngest child and, thank goodness, the young child so far
    has not contracted the disease, and of course, they hope she won't. But
    if she does, then you can just double whatever their problem is.
        Again, I would say--I want to emphasize, though, the only way this
    works with the private health insurance business is that you have to
    find a way not to bankrupt private

    [[Page 607]]

    health insurance. And a lot of these things--I've had a lot of
    employers--I had a restaurant owner I mentioned in Columbus, Ohio, who
    was very complimentary of her personal health insurers. She said,
    ``These people are doing the best they can for me under the
    circumstances given the way their business is organized and the way the
    market is organized.'' That's why you have to reorganize the market and
    put people into larger units and insure people on a community basis.
        One of the most controversial things--I just want to mention this--
    one of the most controversial aspects of our plan has been the provision
    for small and medium sized businesses to be in these big buying
    alliances. People have treated it as if it were some big new Government
    bureaucracy.
        I have seen it, quite the contrary, as a way of enforcing community
    rating. That is, there are some States--New York State has a law
    mandating community rating. But if you don't have the system within
    which the little guys can buy together, the law itself won't guarantee
    community rating.
        And yesterday--I just want to read you something--yesterday in the
    Los Angeles Times, there is this article, ``State Alliance Gives Workers
    Health Clout. Forty thousand workers at small California businesses will
    get an extraordinary piece of good news on Tuesday.'' That's today. ``At
    a time when health insurance costs in the country are climbing at 6 to 8
    percent a year, their premiums will actually be reduced, starting July
    1st. These fortunate few are members of the State's unheralded health
    alliance, a purchasing agency that gives companies with between 5 and 50
    workers an opportunity to band together and achieve the same buying
    clout the health care market gives to giant corporations. Even as
    President Clinton's proposal for alliances is being denounced in
    Washington as a blueprint for a menacing new bureaucracy, a staff of
    just 13 State workers in Sacramento has put together a working alliance,
    the first in the Nation, and the customers seem delighted.''
        And in Florida they've got now buying pools of small businesses--
    Congressman Gibbons is here. And the Governor told me last night that
    most small businesses that joined these alliances had experienced
    declines in premium costs of between 5 and 40 percent.
        So I say this not to be combative, but just to ask this question: As
    this bill moves through the Congress, if they don't like the way we
    structured the alliances, you've got to find some ways to give the
    little guys big buying power.
        Administrator Bowles. Mr. President, all these buying groups do--and
    I wish to goodness we'd called them buying groups instead of alliances,
    but all these buying groups do----
        The President. I do, too. They liked it when we called NATO an
    alliance. [Laughter]
        Administrator Bowles. ----is, truly, they shift the power of the
    marketplace. They change that supply and demand equation from favoring
    the supplier of health care to favoring us, the consumer and the small
    business owner. It's just identical to what Mr. McCarthy was here saying
    about what happens in the flower business. It gives us, the small
    business owner, some market muscle so that we can cut a good deal for
    our employees. That's what it does.
        Q. Could I ask a question? One of the big arguments that I have
    heard in talking to other businesses is that everybody is concerned
    about the quality of health care, what's going to happen. They're
    afraid. Right now they may have choices; they have certain choices, and
    that's sort of the unknown out there. How is the quality of health care
    going to change?
        The President. I think there are two concerns about the quality of
    health care that I've heard. One is, are you going to cut down on how
    much you spend on health care so much that there won't be enough for
    medical research, for technology, for things to progress? The other is,
    if you deprive people of choices, isn't that a backdoor way of
    undermining quality?
        I mean, in America I think people equate--we all like to make our
    own decisions. So people equate choice with quality. To that I would
    respond in two ways: Number one, if you don't do anything, if we just
    let this alone, if we walk away from here and don't do anything, you
    will see dramatic re-

    [[Page 608]]

    ductions in choice. And many of you in this room will contribute to that
    because you will have no choice.
        That's what happened to our friend from New Hampshire here. She
    wished to give her employees the choice between being in the HMO or
    insuring with fee-for-service medicine through Blue Cross. Now she has
    only the HMO option. She is now in the majority of employers in America
    who cover their employees. Now, a slight majority does not provide any
    choice for the employee but, in fact, makes the choice for the employee
    because they have no choice. You know, Mr. Sheriff here, if he were able
    to get back into the health insurance market, probably would have to
    just make the best deal he could, and the employees would have to take
    it or leave it.
        So on the question of quality in terms of choice, under our plan,
    again because of marketing power, we would give-- your obligation as an
    employer would be constant. You would pay the same no matter what. But
    your employees every year, because of the cooperative buying power,
    would be able to choose from among at least three programs.
        And we estimate that in most places they would always have access to
    an HMO. And as I said, many of them are very good, but they'll be better
    if they have competitive pressure. Then, probably there would be a PPO--
    that is a professional group where doctors get together and they
    organize health care delivery, and normally those have many more doctors
    and sometimes let people in who are willing to provide the service for
    an approved price, so you get even more choice--and the fee-for-service
    medicine. And that would come up every year. So that's my answer.
        And the second thing is, if you do nothing, you will continue to see
    a squeeze on the quality of medicine in terms of what goes into the
    teaching hospitals and medical research. Why do I say that? I was in
    Boston last week, and I met with the heads of all the teaching hospitals
    after which they came out and endorsed our plan. And they said--every
    one of them said, ``If we don't do anything, we're going to get less and
    less money because the people who come into our hospitals are
    increasingly in managed care plans where they put the squeeze on us, and
    they cut down on the money we get for patient care.'' So under our plan,
    we increase medical research; we increase support for teaching
    hospitals, and that's what we have to do.
        So my argument is quality will suffer if we do nothing. Choice will
    be restricted if we do nothing. If we move, we can increase quality and
    choice in a fair and balanced way.
        I know we've got to wrap up. We have one more person to hear from,
    and the Congressman wants to make a comment.

    [Representative LaFalce indicated that the health care plan offered
    better quality care with its emphasis on preventive medicine and pointed
    to the Hawaii system as a model of success.]

        The President. I'd like to hammer that home because a lot of people
    say, ``Well, Bill, everybody goes to Hawaii on vacation. It's a rich
    State.'' Hawaii has a very, very large percentage of people in its
    health care system who are low income people, native islanders, people
    come in from surrounding islands, about a 20 percent load there, quite a
    high load. So the health outcomes for Hawaii include a very large number
    of people who have to be paid for in traditional ways who aren't even in
    the employment system. So you just can't make that argument. I'm just
    trying to reinforce what he said.
        Our last speaker is John Sorenson, from the WECO Supply Company, in
    Fresno, California. He wrote to me about one of his employees. And I
    thought it would be good to kind of let him close because of the concern
    that this employer had for his employee and how it affected his
    business.

    [John Sorenson, owner, WECO Supply Co., Fresno, CA, told the story of an
    employee who, because of job changes and changes in the WECO company
    insurance plan, was not covered for the birth of two premature children,
    incurred the full cost of their treatment, and ultimately suffered
    bankruptcy, loss of credit rating, loss of his job, and separation from
    his wife. He concluded that the preexisting conditions caused the
    problem.]

        The President. It was.
        Q. And if you can accomplish that, you've got my vote for the next
    20 times.

    [[Page 609]]

        The President. Well, let me tell you, the votes that really matter
    here--first of all, let's give him a hand. I think that was quite a
    moving thing. [Applause]
        I wanted to end with that because I was so moved by the letter that
    he wrote to Hillary. And it seemed to sort of capture so many of these
    things that we talk about in kind of esoteric terms: preexisting
    conditions; people falling in between the gaps; why you can't change
    jobs; all that kind of stuff. And you hear a story and you realize that
    this is the business of America.
        But the votes that really matter here are the votes of the Members
    of Congress. So before we leave, I'd like to ask the Members of Congress
    who sat through this entire panel to please stand and be recognized. I
    see Congresswoman DeLauro there and Congresswoman Eshoo there, who are
    standing, so they can't stand; and Congressman Serrano's in the back.
    Would all the Members of Congress who are here please stand so you can
    see them?
        Thank you, Mr. Bowles. Thank you, Congressman. And thank you most of
    all to these fine members of our small business family in America.
        Thank you. We're adjourned.

    Note: The President spoke at 10:46 a.m. in Room 450 of the Old Executive
    Office Building.