THE WHITE HOUSE
Office of the Press Secretary (Miami, Florida) _________________________________________________________________ For Immediate Release March 21, 1994
REMARKS BY THE PRESIDENT AND THE FIRST LADY IN HEALTH CARE FORUM Century Village East Deerfield Beach, Florida
1:23 P.M. EST
THE PRESIDENT: Thank you very much. (Applause.) Thank you, ladies and gentlemen. Thank you for that sign back there. Can you hear me in the back? Good. Everybody sit down and relax now.
Hillary and I are delighted to be back here at Century Village. We liked it the first time; we like it better this time. (Applause.)
I want to thank Larry Smedly for that introduction; Joanne Pepper for here support of health care; your fine, fine Congressman Harry Johnston for his leadership and support of our efforts in Congress. (Applause.) And my good friend, Governor Lawton Chiles for his kind remarks and his strong leadership. (Applause.)
I also want to note the presence here in the audience today of Congressman Peter Deutsch and Congressman Alcee Hastings. (Applause.) A host of state officials, including your Lieutenant Governor Buddy McKay, Attorney General Bob Butterworth, and many others -- legislators and other state officials. (Applause.) I want to thank the Mayor, Mayor Albert Catellini, for giving me a cap. If I put it on in a few minutes, I'll be just like most of you, protecting myself from the sun. I want to thank Mr. and Mrs. Leavy for having us here at Century Village and recognize my good friends Michael and Kitty Dukakis who are here with us today. (Applause.) Thank you for being here. (Applause.)
Ladies and gentlemen, two years ago Hillary and I came here when I was running for President. We sought the support of the people of Broward County and South Florida and all of this state. We did extremely well here on Super Tuesday -- much better than anyone predicted that we would. And we nearly carried this heavily Republican state in November, and I haven't given up on it for next time. (Applause.)
I believe it happened because Americans were sick and tired of their politics and their headlines being dominated every day by distraction, by division, by destruction. I said that I wanted to get away from distraction and focus the American people on the real problems that we face and our real opportunities; that I wanted to go beyond division to bring our people back together again across the lines of race and age and region and income and party; and that I was tired of destruction. I thought it was time we started building again. Americans are real good when we work on building things and getting together and moving forward. We're absolutely unstoppable.
Even though I'm kind of a mediocre golfer and not a very good baseball player at all, I'm glad I'm here in Florida for spring training, because while the baseball players are working on their swings, I came to tell you that I'm still in Washington going to bat for you, and I will every day I am the President of the United States. (Applause.)
You heard the Congressman mention a little of this, but I want to take just a minute to give you a progress report. When I took office, we had seen the four slowest years of economic growth since the Great Depression, almost no job growth. People said our deficit was going to be over $300 billion a year. It is now commonly agreed that the first year of this administration was the most productive in a generation -- 2.1 million new jobs in 13 months; the highest growth rate in 10 years in the fourth quarter of last year; dramatic increases in sales of cars and homes; an economic program that led to lower interest rates and higher investments and more jobs and opportunity.
We have done something for your grandchildren and your children -- we've reformed the college loan program to lower the interest rates and make the repayment terms better. (Applause.) We passed the national service program that this year will provide 20,000 young Americans and two years from now 100,000 young Americans a chance to earn their way through college by serving their communities at the grass roots level to make our streets safer, our people healthier, our people smarter and stronger. (Applause.)
We finally passed the family leave bill after seven years of trying to make sure that people don't lose their jobs if they have to take time off from work when a baby's born or a parent is sick and needs the help of a child. (Applause.) And after seven years we passed the Brady Bill, to begin the work of making our streets safer. (Applause.)
This year the Congress is up there right now working on a comprehensive crime bill to put another 100,000 police officers on the street; to take automatic weapons and semiautomatic weapons off the street; to provide alternative punishment to young people and drug treatment for people who need it; and a three strikes and your out law so we don't parole people who are serious dangers to society. (Applause.)
They're working on a welfare reform law to make welfare a second chance not a way of life. They're working on a campaign finance reform law that Governor Chiles worked his heart out on as a Senator. We're finally going to get it this year. And most important, we are working on doing something that started 60 years ago -- finally, finally providing health care security for all Americans that can never be taken away. (Applause.)
Many of you in this audience remember when Franklin Roosevelt led the struggle to create Social Security. You were there when John Kennedy and Lyndon Johnson fought to create Medicare, a solemn pact with our senior citizens. Many of you also remember, I hope, that Franklin Roosevelt and Harry Truman and Lyndon Johnson and Jimmy Carter, and yes, even President Nixon all tried and failed in the face of special interest opposition to guarantee health security for all Americans. But we can do it this year, and we must. (Applause.)
There are those who say there is no health care crisis. Well, as always happens when we get up to the brink on health reform, inflation has dropped a little in the cost of health care. That's one thing our health care reform has already done -- brought the rising cost of health care into the point where it's rising more slowly. But you let them kill it this time, and it'll go right back to the way it was for the last 12 years -- going up at two and three times the rate of inflation.
Even now, 2 million Americans lose their health insurance every month -- 100,000 of them for good forever; 58 million Americans are without health insurance at some time during every year in a country of 255 million; 81 million Americans have a preexisting condition in their family so that they can never change the job they have because they couldn't get new insurance or they have to pay higher rates for the insurance they have, or they can't get insurance at all. And 133 million Americans, a majority of us, have lifetime limits on our health coverage so that when we need it the most, we can run out of health insurance.
Now, I believe that qualifies as a crisis. I also know that everybody in this country who is still working for living, who does not work for the federal government or a very big and completely secure corporation, can lose their health insurance even if they've got it. I also know that because of the cost of health care going up at two and three times the rate of the inflation, there are other plans in the Congress that seek to cut Medicare or cut Medicaid increases without doing one thing to try to help our senior citizens, and without proposing a comprehensive plan that guarantees you that Medicare services will not be cut. I am here to tell you, that we're not going to mess up what's right about American health care. Medicare works; our doctors, our nurses, our hospitals, our medical research works; and we're going to keep them intact and improve our support for them. That's what we ought to do. (Applause.)
My fellow Americans, if we want everybody in this country to have health care, we've only got three choices -- we can guarantee coverage through the workplace through private insurance; we can pass a tax and cover everyone; or we can decide what a lot of the special interest groups and the Congress, people in the Congress hope we'll decide, which is one more time, we just can't figure out how to do it.
Every other advanced country with which we are competing for the future has figured out how to give all their people health care security. We have not been able to figure out how to do it. You know why. It's because the people who are making a killing on the financing of the system don't want us to figure it out. I say, give it to the people (Applause.)
I want to tell you what I think we should do. We ought to have guaranteed private insurance; we ought to keep the choice of doctors and health care plans in the hands of consumers -- people who are actually having to deal with the care, not their employers or the insurance companies; we ought to outlaw insurance abuses like charging older people more than younger people for their insurance or eliminating people with preexisting conditions; we ought to guarantee those health benefits at work; and we ought to protect Medicare and improve it.
First, I believe that guaranteed health coverage is important because if you don't do it, you're never going to bring costs under control, and all the rest of us will be suffering from medical inflation from now until kingdom come. And a lot of you are going to deal with the fact that your children and grandchildren are facing bankruptcy because they don't have the kind of security you have under Medicare.
I also believe the benefits package has to be a good one. If it doesn't include primary and preventive care, you will have children who are sicker than they ought to be. You'll have women who ought to have access to mammographies and men who ought to have cholesterol tests and things of that kinds that you won't have. This is very important. And people have got to know that this is going to be there and can never be taken away. (Applause.)
The second thing -- I want to be very clear on this -- the second thing that our plan does is to preserve, indeed to expand, the right of the American people to choose their doctor or their health care plan. Now, if you're on Medicare, you can choose your doctor. But slightly more than half the people in the country who are insured at work already today have lost their right to choose their health care plan and their doctor. They don't have it today. And if we don't do anything, the rising cost of medical care will force more and more and more employers to take from their employees the right to choose their doctor or their health care plan.
Under our system, every American in the work force will get three choices: They can choose their doctor individually; they can choose a given health care plan; or they can choose another plan. They'll have at least three choices. And if they don't like the choice they made, every year they get to make another one. That's the way we ought to do it. That will guarantee the highest quality. (Applause.) It will protect the interest of our doctors and nurses. (Applause.) It will be the right thing to do. (Applause.)
The third thing we've got to do is stop some of these insurance company abuses. We have got to stop people from dropping their insured people. We've got to stop people from cutting benefits to the bone. We can't have people with their rates going up just because they get sick. After all, you have insurance because you might get sick. So when you get sick, which is the reason you bought the insurance in the first place, should you have to have higher rates? Of course, not. We shouldn't have lifetime limits. Insurance ought to mean what it used to mean back when it was started by Blue Cross during the Depression -- pay a fair price for security, and when you're sick your health care benefits are there for you. That's what insurance used to mean, and it can mean that again. (Applause.)
Now, I think the easiest way to do this is just to expand coverage at the work place. Why? Because eight out of 10 Americans who have no insurance are working or are in working families. And nine out of 10 Americans who have private insurance get it at the work place. So the simplest way is to say that employers and employees who aren't covered should purchase insurance and to provide discounts for small businesses who can't afford it otherwise. That is the simplest way to do it.
The government should provide the discounts for the small business and cover the unemployed. This approach builds on what works. It's easy, it's simple, it will make sure that everyone is covered.
Why are some people fighting it? They say it's bad for small business. Let me tell you something folks -- 70 percent of the small business people in this country cover their employees. What about them? They're at an unfair competitive disadvantage to those people in the same business they're in who don't cover their employees. (Applause.) And I'll tell you something else -- I meet small business person after small business person who says, I'm embarrassed that every year I have to raise the copay and the deductible because my rates are 35 or 40 percent more expensive than the people in the government are paying or the people from big business are paying. We are going to change that. That's what Governor Chiles has tried to do here in Florida; that's what we're going to do for America. (Applause.)
And let me say finally that no health care reform can pass any true test unless it is good for older Americans. Dr. Arthur Flemming, a former U.S. Commissioner of Aging and a fighter for older Americans in the tradition of Claude Pepper, has called my proposal, and I quote, "The best thing for older Americans since Medicare." That's why so many senior groups have said that our approach is the best option for senior citizens and why I was so proud that Larry Smedly of the National Council of Senior Citizens would come here today to endorse our efforts and give you all those caps to keep you from expiring in this heat. (Applause.)
Under our approach, if you get Medicare, you keep it. Your choice of doctor is protected. I know that's important, because every older American deserves the security of quality health care. But under our approach you get more. I want to expand benefits. We want to have coverage for prescription drugs which costs older Americans more than anything today. (Applause.)
Since I started running for President, the number one complaint I have heard from people who are on Medicare is that they are not poor enough to be on Medicaid; they don't want to be that poor; but they are not rich enough to pay their outrageous drug bills. We want to do something about it, and that's why our plan covers prescription medicine for senior citizens. (Applause.)
We also begin to provide coverage for long-term care where you want it -- at home or in your community. I want to thank the wonderful "We Care" volunteers for greeting us today and for walking Hillary and me in here. (Applause.) I understand they help many of you get medicine or get a little bit of help to stay at home. But not everybody is lucky enough to have a "We Care." Believe me, I know -- I meet people who don't every week. That's why we need to make a start in helping people to afford care where they prefer it -- in their homes or in communities like this one. It's not right to force people into nursing homes when they could do just fine at home if they had a little help from their friends. (Applause.)
Let me also say that I know we can strengthen Medicare and make some savings in the Medicare program, but only -- listen to me -- only if we cover everybody and if everyone has medical inflation go down. Under our plan we still expect Medicare spending to go up at twice the rate of inflation, not three times the rate of inflation, which is what's going to happen if we don't do something to change. Medicare goes up at three times the rate of inflation, your premiums under Medicare go up more for the same health care. Under our plan, less inflation, and we use the savings for prescription drugs and for health care at home or in the community. It is a good deal for the senior citizens of America. (Applause.)
Let me make one other point. We must also invest more and more, not less and less, in medical research, into all kinds of problems, but especially one which I know concerns many of you in this audience today, and that's Alzheimer's disease; and the new drug therapies to treat Alzheimer's; into things which cause cancer; and to the causes of osteoporosis; into what we can do to prevent heart disease. America leads the world in cutting edge research. And under our plan we actually increase the funds going to medical research. (Applause.)
The opponents of our plan have tried to confuse the issue by making it seem complicated. They ignore the fact that the system we have today is the most complicated on the face of the Earth. The principles of our plan are simple: guarantee private insurance to every American; let you choose your doctor and your health plan; outlaw insurance company abuses; guarantee health benefits at work for everyone who works; preserve and strengthen Medicare for older Americans by adding the prescription drugs and long-term care benefits. That's our approach, and that's our opportunities.
But let me say this: There are a lot of people who are making money out of this system today who don't want it to change, even though we can change it and improve, not weaken, health care. One group of health insurers has already spent 14 million on health care ads to scare you about the cause of health care reform.
And what are the special interests saying? Led by the extreme right of the Republican Party, they are warning of a grim future. I say that because we do have some good Republicans who want health care reform, and we hope they'll be at least free to vote with us in the Congress as we work toward it. That's a message to their leaders. (Applause.)
These guys that -- no kidding, they're up there saying all over again -- they say, this is socialized medicine; this is rationing. This is private health insurance. This is what every other economy with an advanced standard of living in the world has done but the United States; that's what it is. It's the same old thing they said when Roosevelt tried to do health care reform, when Kennedy fought for Medicare.
Listen to this, when Kennedy fought for Medicare back in 1962, a movie actor in California who later became the governor of his state and the leader of our country -- listen to this -- urged listeners to oppose Medicare. He said, if you don't do this, one of these days you and I are going to spend our sunset years telling our children and our children's children what it was once like in America when men were free.
Now, to his credit, by the time he became President, Mr. Reagan didn't try to totally dismantle the Medicare system. But they're using the same rhetoric today. Once we've put it in, they won't try to take it out. They'll try to take credit for it just like they do with Social Security and everything else. (Applause.)
Make no mistake about it -- the guardians of gridlock, the people who liked our national politics when it was about distraction, division and destruction, are doing everything they can to stop health care reform. If you will help me, it will be good for your health because we won't let them, if we stay together. (Applause.)
My fellow Americans, I cannot outspend the opponents of health care reform. They have more money than I can possibly raise, especially if I'm working for you every day. But I can fight, and you can fight with me, and we can keep working, and we can support congressmen like your Congressman who believe that the time has long since past when America should be able to continue making excuses for no prescription drugs, no long-term care in the home or in community and not even providing decent, basic coverage to the working families of this country. We can do better, and with your help, we will.
Thank you very much and God bless you all. (Applause.)
MRS. CLINTON: Thank you all so much. It is so great to be back here with all of you. I'm just grateful, and I've seen so many of you that I saw when I was first here and it's just great to see you all looking so good. I'm really glad to be back.
I just want to say a very few words about what the personal dimensions of this health care reform battle are, because -- didn't my husband do a wonderful job? (Applause.)
Well, he outlined what his health care approach is like and what it will do and talked about how we need to guarantee private insurance and outlaw the discriminatory insurance practices and guarantee choice of doctor and to provide health care at the workplace and to preserve and strengthen Medicare.
Now, those ideas didn't come out of nowhere. They came from literally thousands and millions of Americans who have helped us and worked with us over the past years. And I have been so privileged to travel around our country and to meet thousands of Americans who have shared their stories with me. I've said to my friends that I feel like I have a movie running in my head with all of the faces of all of the people who have told me why they need health care reform.
And I've also been privileged to receive nearly a million letters from people who took their time to sit down to right to tell us what goes on in their lives. And I want all of us here, and I want everybody in Washington, to remember that what's really at stake in this health care reform debate are people -- people, their lives, their futures; people like the woman I met in New Orleans who worked hard every day who tried to take care of herself, who went to see her doctor; he found a lump in her breast; he referred her to a surgeon; the surgeon said to her, if you had insurance, I would biopsy the lump; because you do not, we will just watch it; people like the families I have met in children's hospitals all across the country, maybe some of them your children, grandchildren or great-grandchildren.
But of all whom I have met, nothing was said that made a bigger impression than one day in Cleveland when I was in their fine children's hospital. And a husband and a wife, a mother and a father were there with their three children. Their first child had been born healthy. Their second two had a chronic disease. They both worked hard. They made a very good living, but they could not insure their two little girls who needed constant medical care. And the mother looked at me and said, I finally realized how futile it was when I was talking to an insurance agent explaining our medical problems with our daughters and he looked at me and he said, you don't understand; we don't insure burning houses.
And I sat there listening to that mother tell me that and saying, there, but for the grace of God go any of us. We were lucky to have a healthy daughter. Suppose she had been born with a congenital disease like these little girls and somebody had said that to me. There are so many stories and so many people's faces. I want to share two from Florida with you.
I want you to meet two people who wrote to me. The first is Jeanne Linley. Jeanne is from Fort Lauderdale, and here is what she wrote to me:
"Dear Mrs. Clinton, I would like to ask you take health care assistance into consideration in the health care reform." Jeanne says, "I am a 64-year old daughter taking care of my 93-year old mother. My husband is 70. I am trying to not to use public funds to care for my mother, who has Alzheimer's disease. She has lived with us for over eight years. My husband and I have raised six wonderful, successful children. Our funds are limited. We are using up our funds for our old age to care for my mother. It is getting harder to cope every day. If we could just have some respite care for her or just a little help, we could continue the arrangement. But respite care in the home costs $52 for a four- hour minimum. This is more than we can afford." "I am sure other families have similar predicaments. More people would care for their relatives in their homes instead of putting them in nursing homes on Medicaid at $2,000 to $3,000 a month if only they got help." "This is a real tragedy," Jeanne wrote, "it would save the government millions of dollars and help families at the same time." Jeanne, you were right then, and you are right now.
Thank you so much for what you are doing. (Applause.)
Don't we want a country where children take care of their parents when they're ill and sick? Don't we want a country where people can stay at home if they get the help that they need to be able to do that? Don't we want more people like Jeanne Linley in our society? (Applause.)
Under the President's health care reform, we will begin to be able to give help to Jeanne and the millions of Americans like her who want to take care of their mothers and their fathers and their other older relatives because they will get a little bit of help. And people say to me all the time, how are you going to save money? I'll tell you how we'll save money, we'll give more home health aid to people like Jeanne so we don't have to spend so much on nursing homes for their relatives. (Applause.)
And I want to share one other letter. This is from Joe Crankshaw from Stuart, Florida, who wrote to me last year. He said something that really made an impression:
"Dear Mrs. Clinton, the American health care system is designed to have only good results or death. Anything in between doesn't exist. Custodial patients, such as my wife, usually cannot do anything for themselves." His wife, "Jean suffered a stroke almost nine years ago. It left her paralyzed, aphasic and unable to make any reasoned decisions beyond whether to use a fork or spoon or which color dress to wear. She needs help all day long, and she needs it 24 hours a day." "If Jean were in a nursing home, where they won't accept her because she is a custodial patient, it would cost the insurance companies or the taxpayers more than $2,600 a month." But Joe keeps his wife at home. "The doctors say that her quality of life is better and she's happier because she's at home. They attribute her past nine years to the fact she's at home and not in an institution." It costs Joe $1,600 a month. It all comes off the
top of his income, leaving him barely enough to meet his mortgage and usual bills. He has spent more than $165,000, and that was as of last year when he wrote me, taking care of his wife. The number is probably closer to $200,000 because she needed nurses around the clock.
But then their daughter, Jean Marie, gave up her job as a school teacher to help care for her mother. And that brings up another problem. Since Jean Marie quit her job to become the full-time caregiver along with her father, she no longer has health insurance. She's a 27-year-old girl and does not have enough money nor does her father, Joe, make enough money to buy health insurance for her. And as Joe says, already caring for his wife, "God only knows what will happen if his daughter becomes seriously ill."
I saw Joe, it was before I came in, and I asked him how his wife was; and I asked how Jean Marie was; and he reported that they were both doing well. As well in his wife's case as could be expected. But what has Joe had to do, and what has Jean Marie had to do in order to be able to tell me that today? Joe has had to deplete his savings. He has only a small retirement nest egg left. And his daughter has had to live precariously with the hope that nobody rear-ends her; that she doesn't slip and fall; that no disease is discovered.
I want you to meet Joe Crankshaw. (Applause.)
The way I was raised, and I think the way most of you were raised, it's people like Jean and Joe and their families who keep this country going; who reach out and take care of each other and themselves; who put their families ahead of instant gratification; who try to be there when times are tough. And yet we have a financing system for health care. We have a bureaucracy in the insurance industry and in the government that doesn't give much help to supporting those kinds of values.
If we do nothing else, when we pass health care reform, it will not be just about getting our health care less expensively and spreading it around more equitably and making sure we preserve the high quality, it will be a statement of values, about what kind of people we are.
I think this is a great debate not just because it's about health care, but it's about what kind of families we have, what kind of people we are, and what kind of country we will be. And I am an optimist. And I'm betting we're going to give us all the right answer in the next year. (Applause.)
Thank you all very much. (Applause.)
MRS. CLINTON: We have time for some questions. I was supposed to announce that, but forgot.
Q Do you want a question?
MRS. CLINTON: Yes, we've got the questions. And we've got our first question right over here. Can you all hear? Okay, just a minute.
Q (inaudible) -- about the 28 millions veterans in this -- what about -- can you hear me?
MRS. CLINTON: Let me repeat -- let me repeat this gentlemen's question. His question is, what about the 28 million veterans?
Well, the President's still visiting --
Let me say that the President's health care reform has been endorsed by all of the major veterans' service organizations because it is the only one that tries to preserve and strengthen the veterans health system. And there's a very specific way we offer to do that. Those of you who are veterans, and I imagine there are many of you in this crowd -- if you are like my father was, that was one of the most important parts of your life. And he never could understand as he got older why he could not take his Medicare and go to a VA hospital, as he chose to do so. And we've heard that from many veterans.
Under the President's health care reform plan, if you're a veteran with Medicare or Medigap or other insurance, you can use the VA system. You will no longer be locked out of the system that is there for veterans. (Applause.)
Now, veterans with service connected disabilities and low-income veterans will always retain their preference, because we have to take care of them first. But there are many facilities around our country that can accommodate millions of our veterans who can bring their Medicare and insurance dollars. So we are going to take care of our veterans.
Thank you. (Applause.)
Q Mrs. Clinton, will -- if this program is put into effect -- this reformed health plan -- will the congressmen and senators assume the same payments as we do?
MRS. CLINTON: Yes, and the President, too. We are going to have one health care system for everybody, including Congress and the President. (Applause.)
Q I'm President of the Florida Nurses Association. And you have made it clear that you will veto any health care reform bill that does not guarantee coverage for all Americans. Will you make a commitment to veto any bill that doesn't also include tough and effective cost controls? And could you comment on the role of advanced practice nurses in the health care reform?
THE PRESIDENT: She said that -- this lady is the from the nurses association here in Florida. (Applause.) Give her a hand. (Applause.) And the American Nurses Association have been among the strongest supporters of our plan. I appreciate that. She said I said that I would veto any bill that didn't provide universal coverage; would I also veto a bill that didn't have cost controls? And would I comment on the role of advanced practice nursing.
Let me answer the second question first. We have achieved so much support among nurses in part because our plan permits the widest possible use of nurses for things -- to do things that they are properly trained to do anywhere in the country. And secondly, it's not as easy to say yes or no on that. I think there have to be cost controls in the plan. If there aren't cost -- if there aren't some guarantees of controlling costs, we won't be able to prove to the Congressional Budget Office how much the plan costs, and we won't be able to pass it. So as a practical matter, no plan will pass and come to my desk unless there are clear, disciplined measures to make sure that costs are held down. It can't happen. But I don't want to get into a fight about what kinds of measures we'll accept or not accept.
Q I want you to know that we love you. (Applause.) And the reason we love you is because you've shown by words and more important by deeds that you love us, too. (Applause.)
THE PRESIDENT: Thank you.
Q I have two questions. Why do we need those parasites known as the insurance business? And I have one more question -- and the other question is, can we end up with 50 alliances instead of say, 5,000? If you want real competition, why not one allowance or two for the more populous states? That should be the real competition, because we'll show the industry where we come from.
THE PRESIDENT: Let me answer the insurance question, and I'll let Hillary answer the alliance question. Okay? We'll split it up, because a lot of you have single-payer signs up, and I want to talk about that.
There are basically, obviously, two ways to get universal coverage. You can do it through a single-payer system, or you can do it through an employer-employee shared cost system for private insurance.
Here is why I think our plan is better and why I wouldn't eliminate all the insurance companies. First of all, I feel compelled to tell your, sir, that there are some insurance companies, believe it or not, who have not contributed to that television ad campaign against our plan, because they do favor universal control -- I mean, universal coverage for all Americans.
Now, here's why I think it's -- our plan is better. First of all, I think that it's clear that some of the insurance companies, particularly bigger ones, do a good job of trying to manage the health care system and manage costs. And if you have enough people in a big insurance pool, they can get their administrative costs down almost as low as you have in the Medicare program -- if the pools are big enough. That's the second question you asked.
And they really have acquired quite a lot of expertise. Secondly, as a practical matter, there are a lot of awfully good people who are working in this industry. And I don't think we should throw them all out of work. The problem is that in our system you've got 1,500 separate companies writing thousands of different policies, so you have to hire all these people to figure out who's not covered. If we had a rational private insurance system, the insurance companies can make a valuable contribution without bankrupting the system.
I also believe as a practical matter, based on -- we have members of Congress here who may have a different opinion, but my reading of the Congress is that we have a better chance to pass guaranteed private insurance than the single-payer system, because I think it's simpler, easier and less disruptive. But I also think on the merits it's the right thing to do.
Now, let me let Hillary answer the question about the alliances.
MRS. CLINTON: Well, I think that if you have the states making the decisions, some states will only have one; some will only have two; some of the larger ones may need more than two. But it's not going to be thousands. It will only be probably 100 or 120 at the most, the way we look at the population. So I don't think that will be a problem.
And the other thing about single payer is in the President's plan, each state has the right to be a single-payer state if they so choose. And so that is something we want local people to make a decision about. (Applause.)
Q Hillary and Mr. President, to quote you about "we'll watch it" -- that happened to my wife. I died because the doctor we'll watch -- she died because a doctor said we'll watch it.
Now, as a little aside, Mr. President, our honorable Governor will concur, we do have the best health care in the world right here in Florida. Our number two industry is citrus -- oranges and grapefruit -- has the best health care for Florida at the moment. Thank you.
THE PRESIDENT: Go ahead.
Q Thank you, sir. Do you all know that a third of homeless -- (inaudible) -- are mentally ill -- (inaudible). You've never been able to provide quality health insurance in the private sector. There's either been a cap or there's been a limit. You know this; I know that -- a third of the homeless are mentally. That's a fact. Most of the people in law enforcement, they're on the street, they have no place to put them, they go to jail. They're out in 24 hours, and they're back on the streets. We know what happens when a family that has funds has a mentally ill child. They can't afford -- (inaudible) -- they wind in the state institutions.
How will your health plan -- I know you're starting; I've been watching it very closely -- (inaudible) -- running for office two years ago. My wife shook your hand, and you -- (inaudible) -- going to be there for eight years, and Gore's going to be there for eight years more if we have anything to do with -- (inaudible). (Applause.)
How are you going to -- (inaudible) -- get insurance for cancer; you can get insurance for heart disease, but you can't get insurance for mental illness. Thank you very much.
MRS. CLINTON: I wish that this gentleman had the microphone so you could have heard. He made the point that a third of the people who are homeless have mental health problems. Many people in our prisons have mental health problems. And many Americans have mental health and substance abuse problems. We want to begin covering mental health problems. And in the benefits package the President has proposed, that will begin because it is not fair to turn our backs on mental illness like schizophrenia or clinical depression and not treat it like a disease. And, in fact, if we began to treat it, it will actually help more people and save us all money. And so we're going to start doing that and beginning to treat mental health right. (Applause.)
Q Mr. President. (Applause.) And to Hillary -- Hillary, I know you've been pushing the primary physician. And even though I'm on a board with a lot of hospitals and doctors, how are you going to get rid of all these specialists who charge millions and millions of dollars for IRS, salary, MRI's and scans? We need primary health care. Will you push that, please?
MRS. CLINTON: Yes, we do need more primary health care physicians, and we're going to try to create more and also advanced practice nurses and physician assistants because we really need a team of doctors and nurses and other health care professionals to work together on primary care so that our specialists, then, can get the good referrals that they need to take care of people.
THE PRESIDENT: Don't let -- let me just say this: Don't let anybody tell you, scare you, into saying that we are for undermining the American people having enough specialists. That's a load of hooey. Right now we've got enough specialists for 30 years, but we don't have enough primary care physicians in most states in the country. So we'll take care of the specialists, but we have to have or primary physicians first.
Q? Mr. President, I realize that you're trying to redo the medical program. The problem that I'm facing, and I might be the youngest one in the crowd, is I have somebody at home who has applied for Medicare disability and should be eligible. And what is happening to this person is over a year ago or a year and a half ago, this person was denied it twice. It has gone to federal court. We have an honorable lawyer, and the judges are writing one thing and saying another. And what I'd like to do -- and I made myself a promise I was going to do this today, I'll be glad to pass it on to you -- I would like you to look at -- may I come forward?
THE PRESIDENT: I'll have somebody come get it.
Q Well, I could come forward.
And I have to say to you, that while you are fixing or re-doing a new prescription for medicine, I think you need to look at this documentation and talk to -- I'm very disappointed, but I know Senator Graham who I have been working with on this has the whole file. And I think there are a lot of disabled people -- I might be one of them next -- that need help and need a system that's ethical and moral.
And I thank you for listening to me, and I wish you good luck because we need it.
THE PRESIDENT: Thank you very much.
Q Mr. President, I'd like to tell you what happened to my mother. She needed a operation and was told to go to a doctor to get this operation. The doctor said, yes, you need a gallstone operation, but my price is $5,000. My father says, I can give you my life savings of $1,000;I don't have $5,000. He said, Mr. Segal (phonetic), if you don't have money to go in a taxi, you ride in a subway. And he left.
THE PRESIDENT: I think what you said speaks for itself. And thank you for having the courage to tell us. Thank you.
Q Mr. President, a lot of the people here know me. I've been coordinating your health care plan for South Florida since the inauguration. And I just want to comment that it's really a pleasure to do so. But I'd like to ask you what's asked of me when I give speeches around. They say, Mr. Brodin (phonetic), how does this lower or lessen their bureaucracy? If anything, you're going to create another level of bureaucracy. Could they hear it from your lips, that I prize your words greatly, and explain to them as I have tried, how it will not, only not multiple it, but it will actually significantly lessen it.
And by the way, it's a pleasure to work with you too.
THE PRESIDENT: Here's why it will lessen the bureaucracy. Look what -- what runs the bureaucracy up today? Talk to any doctor or nurse. Talk to these nurses here. You have 1,500 separate health insurance companies writing thousands and thousands of different policies, each of them with different coverages or different co-pays or different deductibles. Once you standardize the benefit package, and standardize the coverage, then you make it possible for every person to spill out one form. The insured person can fill out one form, a simple form; the nurse at the hospital or the clinic can fill out one form. You will drastically cut the paperwork, the insurance people will be processing one form.
So I want to -- the people -- you will need fewer jobs in clerical work in hospitals, clinics and insurance companies. You will need more jobs in providing home health care, community-based health care and doing other things. But it will be, from a pure paperwork point of view, it will be much simpler because of the reform of the insurance packages.
Now, what that means is the little insurance companies will either have to resort to selling supplemental policies, or go into cooperative arrangements so they can insure people in big pools and make money the way grocery stores do, a little bit of money on a lot of people instead of a lot of money on a few people.
But that's why it will be much simpler. The central benefit package in the common system, and everybody carries a little card around like that card up there, and just files for the health care.
Q Thank you. That's my most frequently asked question --
Q (inaudible) -- dedicated state employee. My name is -- and I've been deprived of all my state benefits for the past two years. My dad in Cleveland has had to pay for my Blue Cross-Blue Shield for me. And I just -- (inaudible) --grave injustice. And I'm just asking for help from you and also from the Governor, because I've calling his office for the last two years to help me, and no one has helped me. And I was a devoted state employee, and the only girl in my office in Broward County, and I don't deserve it -- the Division of Hotels and Restaurants.
MRS. CLINTON: Thank you. We will look into that. But your concern and your feeling obviously goes far beyond your own case because people lose their jobs, then they lose their health care benefits.
Q But I was a loyal --
MRS. CLINTON: And they can be loyal, hard-working people. And you don't deserve it. And when I think about that --
Q (inaudible) -- and they crucified me for no reason.
MRS. CLINTON: We'll look into that, thank you.
But what we are going to try to do is eliminate the problem. The problem should be eliminated so that when you lose your job, you still have insurance; you don't have to worry about it anymore.
THE PRESIDENT: Medical overbilling, there's a special provision in the plan that will enable us to do that.
Again, if you have everybody covered in the uniform system, it will be much easier to see whether there is overbilling than there is now.
Q Your health care plan is great -- great for people who have existing problems; also, good for my grandma and her contemporaries. But what about my generation and my mom's. Will there still be enough money for these funds for our security?
THE PRESIDENT: Absolutely. Here's the thing. If we don't do something now, then there may not be enough money for adequate health care because we can't have another 10 years when the cost of health care goes up at two and three times the rate of inflation, so people pay more money for the same health care.
And also, keep in mind, our plan covers things for your generation that aren't covered now like medicine and preventive care, and mental health coverage -- things that aren't covered now. So the answer to your question is your generation has a lot better chance if you pass a plan and we slow the growth of health care cost.
We could stay here tomorrow at dawn. You've been great being out here in all this hot weather. Thank you so much.
MRS. CLINTON: Thank you all, and if you have a question we didn't get to answer, if you will address it to the White House and get it to your congressman, he will get it to us and we will answer your letters just like we have tried to do in the past.
Thank you all.
END2:22 P.M. EST