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                  Office of the Press Secretary
                     (Minneapolis, Minnesota)
For Immediate Release                               April 8, 1994
                     REMARKS BY THE PRESIDENT
                      Minneapolis, Minnesota

7: P.M. CDT

MS. ASTORE: Welcome to the Twin Cities and our town hall meeting. And thank you for this unique opportunity to answer questions about your health care program.

THE PRESIDENT: Well, thank you for giving me the chance to do it. And I want to thank the people who are joining us from Milwaukee and Detroit and Sioux Falls, too.

MS. ASTORE: We'd like you to start off the program perhaps with some opening remarks.

THE PRESIDENT: I'll do that.

MR. MEIER: We turn it over to you.


First, let me say, I came here to Minneapolis late last night, and I started the day off with a rally for health care sponsored by the Nurses Association of Minnesota. Over two million nurses in the Nurses Association have endorsed our health care plan. And that's especially important to me because I started out my interest in health care because my mother was a nurse.

And then, many years ago when I started out in public life, I was an attorney general, and one of my jobs was to try to ensure good care within our nursing home system in my state. Then as a governor, I had to worry about health care for the poor through the Medicaid program, something Minnesota and every other state has wrestled with.

About four years ago, a long time before I even thought I'd be running for president, I agreed to take a look at the health care system for the nation's governors to see what we could do about it. And at that time, I talked to literally 900 health care providers -- doctors, nurses, hospital administrators, paramedical workers of all kinds. And a lot of businesspeople and health care consumers, people in every kind of medical problem you can imagine. I became convinced then that unless we had a national solution to a lot of our health care problems, we wouldn't be able to solve them; that no state, even the most progressive state, could solve all the problems of the health care system without a national solution.

And let me just briefly say what I think the issues are -- and a lot of them will be represented by people who are in our four audiences tonight.

First of all, 39 million Americans don't have health insurance at all, ever, during the year. And about another 100,000 a month are losing their health insurance permanently. Secondly, at any given time in this nation of about 260 million people, 58 million people won't have health insurance at sometime during the year. Third -- and it gets worse as we go along here -- about 81 million of us live in families with so-called preexisting conditions -- a child with diabetes, a mother with cancer, a father who had a heart attack early but still had to go back to work. Those families either can't get insurance, pay very high rates, or can never change their jobs because if they change jobs they won't be able to get insurance in their new jobs.

Fourth, small businesspeople and self-employed people who have health insurance pay on the average 35 percent more than those of us who are insured, who are government workers or who work for bigger business. And 133 million of us have health insurance policies with lifetime limits, which means that if someone in our family should get real sick, we could run out of our insurance just at the time we need it the most.

In addition to that, we're spending 40 to 50 percent more of our national income on health care than any other country in the world. The cost of health care to state and government and to the federal government is exploding at two and three times the rate of inflation. All the things I'd like to do for you as President, in terms of investing more in education and training and new technologies for the 21st century, are limited by how much we have to put into health care every year to pay more for the same health care.

There are lots of other problems. We have tens of millions of Americans with disabilities -- some of them are here -- who could work, who could be self-supporting, who get no help for long-term care in their homes and who can't get health insurance if they go to work. We have older people on Medicare who need help with their medical bills and if they could get medicine, they could stay out of hospitals and save us money and have a better quality of life; but that's not covered. So the question is, what are we going to do about this? Let me very briefly tell you what I think we should do, then we'll open the floor to questions.

First of all, I'm convinced that we can't solve any of our problems until we deal with the basic one. We can no longer be the only advanced country in the world that doesn't provide health care security to all of our citizens all of the time. If you want to do that, there are only two ways to do it. You either have to have a system where you get rid of insurance all together and have the government fund it, the way Canada does; or you have to have a system of guaranteed insurance, the way Germany does and several other countries. I advocate -- and I'll explain why later -- I think we should have a system of guaranteed private insurance with comprehensive benefits including primary and preventive care, which saves a lot of money in the long run; with no lifetime limits; and insurance that you can't lose.

I believe that our system should maintain something that's very important to Americans, which is the choice of doctors and health care plans. More and more Americans are insured in plans that deprive them of any choice of their doctors; and that can be a serious problem. I believe there are ways to control costs and protect choice. Our plan would guarantee you at least three choices every year.

Third, we have to change insurance practices. We have to make it illegal for people to have their coverage dropped or benefits cut, for rates to be increased just because there's someone in the family with a preexisting condition who's been sick, for lifetime limits to cut off benefits, or for people who are older to be charged more. This is a big deal. The average person's going to change jobs eight times in a lifetime. A lot of people are losing their jobs in their 50s and 60s and have to get new jobs and can't get jobs because no one will give them insurance because their rates are higher.

Fourth, I want to preserve Medicare, which keeps the choice of doctors. But I also want to have Medicare begin to cover prescription drugs, which it doesn't now, and phase in a long-term care program not only for the elderly, but for Americans with disabilities.

Finally, I think these health benefits should be guaranteed in private insurance at work. Why? Because it's the simplest way to get to universal coverage from where we are now. Nine out of ten Americans with private health insurance are insured through the workplace. Eight out of ten Americans who don't have any insurance at all are in working families. So the simplest way to cover this is to say, the employed uninsured should have their insurance paid for by the employers and the employees. The government should pay for the unemployed uninsured, and should raise a pool of money to provide discounts to small businesses who otherwise couldn't afford health insurance. That's essentially our plan -- guaranteed private insurance, the choice of the doctor, reform insurance procedures, preserve Medicare, have health benefits guaranteed at work.

One last thing -- you have to find a way if you want to reform the insurance practices to make it possible for insurance companies to do these things, which means they have to insure all of us in very large pools; and we have to let small business people and self-employed people band together in co-ops so they can bargain for the same good prices that those of us who are insured through big businesses or government get. That's essentially what we're trying to do in the Congress this year.

MS. ASTORE: Mr. President, we're going to start with a couple of questions from our Twin Cities audience.

MR. MEIER: Our first question comes from this gentleman from St. Paul.

Q Welcome to Minnesota. It's indeed an honor. I'd like to talk philosophically -- a philosophical basis for universal health coverage. I'll go first, then I'd like to hear your philosophical arguments in support.

I've got an interest in ethics and redistribution. I firmly believe that the redistributionist policy undermines the basic sense of personal responsibility by transferring authority for decisions -- crucial life decisions --from the individual to the state. When a do-everything government assumes control of a person's most personal responsibilities, we lose faith in our capacity to make our own decisions. And we've seen the deleterious effects of dependency upon -- of dependency upon an institution such as --

MR. MEIER: Go ahead and ask your question.

Q Okay. My question is, is you plan really a health plan or is it a power grab? I'd like the philosophical arguments in support of your plan. I do not want to hear compassion. I want something more concrete.

THE PRESIDENT: Well, compassion is part of my philosophy. But anyway, philosophically, I don't believe the government can solve all the problems for people; and I don't think you should rob people of their personal responsibilities or their personal choice. That's why I don't have a government-run plan. It's private insurance. And people who don't have insurance have the responsibility to provide it for themselves.

But I believe philosophically it is wrong for people not to assume responsibilities for themselves and let other people do it. And what's happening today -- let me just give you two examples. Self-employed person x decides, well, I'm not going to have any insurance. The they get in a wreck; they show up at the emergency room; they can't pay. They could have had insurance, but they didn't do it. That's fine for them, except they get the care. Nobody let's them die; and nobody thinks they should; and then the rest of us pay for it. And that is irresponsible.

Another example: restaurant x and restaurant y next together -- one covers the employees, the other doesn't. One is fulfilling a responsibility not only to himself and the employees, but to the rest of society by not asking us to bear the risk of anybody getting sick; the other isn't. The other has a competitive advantage in business. I don't think that's right.

And the system we have is not an individual responsibility system, it's an irresponsibility system. I don't plan to take over the health care system. I don't want the government to run it. I think the government should help to organize the markets so that small business people and selfemployed people can afford to have insurance, and so that they are not disadvantaged as compared with big business and government. And I think it is irresponsible for people not to provide for their own health care and irresponsible for the government not to make it possible for people to do it not matter what their station in life.

MS. ASTORE: Mr. President, this woman is a school principal from St. Paul, and she's concerned about losing certain benefits.

Q Good evening, President Clinton. I have been real concerned about the health policy. I've followed it along since your beginning presidency. I wondered about you and Hillary's true concerns. I've been concerned that it might be a political issue with you, and I wondered how it will affect all Americans. Will we really receive better service? I wondered about the people who have insurance. Will we have to pay more? Will we get less then? Will we have less choice of doctors or less of choice of hospitals? Will the doctors have less choice of the services that they can provide? Will we have more government debt? Will we have more taxes? I'm wondering if your program is about controlling rather than better service. And I realize that we in Minnesota are ahead of many states, but I do have real concerns.

THE PRESIDENT: Well, let me try to answer two or three of those questions -- you asked me ten at once so -- (laughter.) The only real tax we have in this plan -- we have to raise funds to pay for the unemployed uninsured which we're all paying for any way, folks. When they get sick, they wait until it's too late, it's too expensive, they show up at the emergency room and we pay.

Under our plan we would raise a fund to pay for them and to pay for the discounts on small business from two sources -- one, a tax on cigarettes, and the other, a modest assessment on the biggest American companies that will get the biggest windfall from this. That is, most big companies are paying way too much in insurance now to subsidize the rest of us. They'll get a windfall. We ask for a portion of that back to create a fund for discounts for small business and for the unemployed uninsured.

There will be more choice under our plan. This idea that every American today has a choice of doctors is a myth. More than half the American people who are insured in the workplace today don't have a choice. They get one plan and that's it. Ninety percent of the American people who are insured in small businesses with 25 or fewer employees have no choice. Under our plan there will be more choices.

That's one of the reason why so many medical groups have endorsed this plan -- not just the nurses, but the family practitioners, the pediatricians. Any number of other medical groups have endorsed our plan because they know it guarantees more choice.

Now, if you have a plan today that is better than the one in our bill, you can keep it. In other words, if you have a plan today where your employer pays 100 percent of your health insurance, not 80 percent, and you continue to do that, that's perfectly alright. We don't change that at all.

Q individual when you go for universal coverage. If I already have a policy, isn't it true that it will cost people that now pay for insurance more?

THE PRESIDENT: No, if you don't pay your premium, if your employer pays all of your insurance now --

Q They don't pay all of my insurance, I carry family coverage.

THE PRESIDENT: Well, the question is whether it will cost you more. It depends on a lot of factors. In all probability, you won't. All the -- not our studies, but all the nonpartisan studies that have been done show that more than half the people will get the same or better insurance for the same or lower cost.

By and large, the people who will pay more are people who aren't paying anything now, people who have only very bare-bones coverage now, and young single workers will pay more so that older people can pay less and we can have a large community rating. Otherwise, most other people will pay the same or less.

But if you have a better plan than we require, what this does is put a floor under you. We've got -- keep in mind -- I don't know where -- I mean, I understand, I saw those ads putting out all that propaganda, "this is just politics," "this is just a power play," and all that. Tell that to these people who are disabled who can't get insurance. Tell that to these old people who choose between medicine and food every month. Tell that to the 100,000 Americans a month who lose their health insurance. Tell that to the farmers and the small businesspeople who insure at 35 and 40 percent higher rates.

I mean, this is a bunch of hooey. If people don't agree with me, let them come forward and contest me with their ideas. But I am sick, and I think a lot of you must be sick, of all this hot air rhetoric and all these pay television ads and all these hit jobs from people who are making a killing from the insurance business that we have today. It is wrong and we should change it. (Applause.)

Let me just tell you something -- I don't go around -- I don't mind doing this; I'll do this all night. But it never gets -- one of the things I've learned in 20 years of public life is you don't get very far questioning other people's motives. Most people I've met -- contrary to what you read, most of the people I've met in public life are honest, well-meaning. They're not crooks and they're trying to do the right thing. We have differences of opinion. But this health care debate, in my judgment, has really been retarded -- in more ways than one -- (laughter) -- by all this motive throwing around we've had.

If I had wanted to take on a tough issue I could have found something else to do with my time. I believe we have to do this. And if we don't do it you're going to have more people without insurance, more people that can't afford what they've got, and a terrible situation in this country. And that's why I did it. That doesn't mean I'm right, but let's argue about what should or shouldn't be done and not talk about other people's motives. I've even tried to convince the insurance industry I don't want to attack their motives. I just want us to argue about what we should do.

MR. MEIER: Mr. President, I want to direct you to this side of the floor where you can look at that large monitor. I want to give our live satellite audiences a chance to join in. Let's go first to WDIV TV in Detroit, and Carmen Harlan.

Q Thank you, Randy. They were living the American Dream. The Bertolones had two healthy children, a nice home, and their own business. But in a matter of months, their dream life changed.

(Film is shown.)

Three years later, Tony Bertolone lost his wife to cancer. The family's last year together was spent battling the disease and the insurance company.

(Film continues.)

That's when the battle began. Linda, Tony, and the organization That's What Friends Are For began a letter-writing campaign. Seven weeks later, the company changed its mind. But the cancer had spread.

(Film continues.)

And to talk more about that pressure, Tony is with us tonight. We used that video tribute that Tony made in his story to his wife. It is a legacy for her children and for her family. And as I said, Tony Bertolone is with us in the studio with a question for the President.

Good evening, and welcome. What is your question?

Q My wife had advanced breast cancer. She was told by a leading bone marrow transplant unit in the country that they had a 25 percent chance of prolonged life extension if she would receive the transplant. Our insurance company deemed the procedure experimental and would not cover the expense. Would women in a similar situation be told the same under your health care plan?

THE PRESIDENT: It's an issue I'm very familiar with. As you may know, my mother had breast cancer, and so I've learned a lot about this issue. What we would cover under this health care plan -- transplants of all kinds as long as the doctors thought it was an appropriate procedure.

Now, there are some people who still believe bone marrow transplants for breast cancer are experimental, although there's a lot of evidence that it can prolong life among younger women, especially women 50 and under. And the truth is that it will depend upon the doctor's belief that it should be the appropriate course of medical care. But what we're trying to do is to give these decisions back to doctors and their patients who believe it's an appropriate course of medical care. And I think that it is clear that we're moving to the point where most physicians believe that there are circumstances under which it is an appropriate thing to do to give women with breast cancer bone marrow transplants.

But I'm not trying to give you an evasive answer, I'm trying to give you the standard that will be used in the insurance policy -- is it appropriate medical care? Will the doctor believe that? I think that more and more doctors do believe that so, in most cases, I think you can look forward to that kind of procedure being covered. Thank you.

MS. ASTORE: Let's bring the audience in Milwaukee into the discussion now.

Q Thank you very much. It's been most interesting thus far. Will Vanessa Donovan please come up? I'd like to have you ask your question if you are here. Vanessa's coming over now to -- step right this way, Vanessa, if you will and I'll meet you sort of halfway here.

We are -- it will be interesting for the audience here to know, they can't hear us in Minneapolis, which is more than we've been able to say for much of the program. What was your question for the President?

Q Okay, my main question is, a year ago, my insurance was perfect. Shortly after your reform came into the public eye, my insurance company notified us that in order to keep our insurance the same, it would cost us $1440 more per year. There's three doctors that I see on a regular basis -- they're specialists. I went Wednesday, and a big sign on his desk said, in order -- you must have a current referral every day -- I mean every appointment. And also I called my insurance company and they said --

Q Can you get to the point of the question?

Q The question is if I have to pay for two doctors' appointments, how is that cost effective?

Q Okay, thank you. Mr. President?

THE PRESIDENT: Well, first of all, let me say that a lot of that referral business is probably because of requirements that the insurance companies have put on the doctors treating this lady. If you talk to any doctor, they'll tell you that more and more and more, they're having to call insurance companies and get permission to practice medicine in advance of doing what they think has to be done anyway. Last night I was down in Kansas City and I had three doctors in our group there, and that's all they talked about was how much time they were spending getting the approval of insurance companies to do what they knew to do anyway.

You talked about how much your insurance had gone up. Let me say, one of the best things about having a national reform is that you can charge people the same price for an individual policy and a higher price for a family policy, but you would pay that price even if you had to use the doctor enough. That's what insurance used to be.

I mean, when Blue Cross first got organized, everybody was lumped in a great big pool, everybody paid the same amount. Some people got sick and the rest of us paid for that as well as a hedge against ourselves getting sick. Now we have 1500 separate insurance companies, thousands of different policies, hundreds of thousands of people working in doctors' offices and hospitals and insurance offices figuring out who's not covered for what. So if you're in a little pool, and this lady -- you heard what she said, she has an illness -- your rates can go way up. If we're all insured in large pools, then your rates would not go up unduly -- just more or less at the rate of inflation -- just because you had an illness. That's one of the -- this woman would be dramatically advantaged if we had national insurance reform -- health care reform.

MR. MEIER: Mr. President, I'd like you to meet this 46-year-old man from Milwaukee. He is HIV positive, the father of two grown children. He is an unemployed factory worker, soon to be without insurance. What is your question for the President.

Q Mr. President, I want to say thank you for bringing this to the forefront and Mrs. Clinton. My question is, why can't the best of what the Canadian health care has and the German health care have be brought to us as a package for the American people?

THE PRESIDENT: Well, that's kind of what we're trying to do. The Canadian system -- in Minnesota, for example, where you're close to Canada, or in Michigan, or any of the states that are in our program tonight, there are a lot of people who would like to see the single-payer system that the Canadians have.

The problem is twofold. One is, it would be very difficult to get Congress to agree, in effect, to put all the health insurance business in America out of business and substitute it with a tax. And a lot of people like the lady who asked the second question here would wonder what that would do to their health care plans. Secondly, the Canadian system, in my judgment, has not had quite as much success at controlling costs as the German system has, where all the people pay something, assume some responsibility directly for their health care, and therefore negotiate more vigorously on an ongoing basis to try to hold down the costs of health care.

But let me say from my point of view, sir, to you, there are lots of people in America who are HIV positive who could be working; who could be making a contribution and paying taxes; who have difficulty doing that because they can't get health insurance. But if they were insured in very large pools, they would be able to do so.

So I think that one of the most important beneficiaries of this policy will be people who have very serious illnesses that still may permit them to work for long periods of time and be active if they can provide for their own health care needs.

MS. ASTORE: Thank you, Milwaukee. We have one more live location to bring into our town hall meeting tonight on health care.

Q Mr. President, we have with us tonight a person who has perhaps slightly a nontraditional type of view of how this might impact the health care industry. We have with us this gentleman who is a chiropractor here in Sioux Falls. Your question for the President.

Q Mr. President, 34 percent of the office visits to practitioners according to the New England Journal of Medicine are to nontraditional practitioners, such as chiropractors, acupuncturists, massage therapists and nutritionists. How will we be covered in your new health care plan?

THE PRESIDENT: Well, what we do in the health care plan is to require certain kinds of care to be covered. And then that care can be provided in a variety of different ways by anybody who is qualified to provide it. What will happen is that the people who band together in these purchasing alliances will be given any number of choices from which the consumers of health care can choose what kind of health care plan they want. So all consumers will have the option, if they wish, to choose plans that have different kinds of providers including alternative providers, as you mentioned, to provide various health services. We have to have -- everybody by law has a right to have three different kinds of plans -- kinds of plans. But what you'll have in most places is the kind of choices that now, for example, federal employees have.

You know, a lot of federal employees can choose between two dozen different plans. It's amazing. And as a consequence of that, you have all different kinds of options and a lot of providers, including chiropractors, have a chance to provide services to people. That's the way ours would be set up.

Let me go right to the heart of the question because I've got a lot of friends who are chiropractors who have asked me this. We do not specify in the bill as it is presently drawn the services of chiropractors, osteopaths, nurse practitioners or neurosurgeons for that matter. What we do instead is say, here are the kinds of health care services that have to be ordered, let people organize themselves and offer them to the consumers of America.

MR. MEIER: In South Dakota we're in an area that's a lot more rural than the other areas represented in this program. Tonight we have with us a woman who is a physician's assistant in one of those rural areas.

Q Good evening, Mr. President. As a practicing physician's assistant, I see significant increase in the cost of health care as physicians, physician's assistants and nurse practitioners practice defensive medicine in a litigious society. Providers are obligated to order extensive tests and treatments to protect themselves from potential malpractice suits. If health care costs are to be reduced, attention must be directed at health care, at tort reform. Will you health care plan address this problem as health care reform becomes a reality?

THE PRESIDENT: Our plan does that in two ways. Let me also mention, since we're talking to South Dakota and you've got a lot of rural population, although we do here in Minnesota, too, and in Michigan, the other states that are represented and in Wisconsin.

Another big problem that we have in my rural state where I'm from is that more and more general practitioners out in the country are reluctant to do things like deliver babies and set simple fractures because of the malpractice problems.

Our bill does two things: one is it sets a limit on the percentage of a malpractice judgment that can be taken by a lawyer, a percentage of the contingency fee; the second thing it does, which I am convinced will have a far more positive impact on insurance rates, is it sets up a system in which the professional associations set up medical practice guidelines for various kinds of cases. And then if the physicians can demonstrate that they follow the guidelines, there is a presumption that the physician was not negligent.

Now, that presumption can be overcome, but it is much harder. And if that happens, we believe, that there will be a substantial reduction in the number of frivolous cases in the malpractice area, and therefore, malpractice insurance rates will go down.

That's been tried in a rural state, Maine, with some considerable success. And I think that it's the best way to go to guarantee lower malpractice fees and still give people a right to go into court when they've genuinely got a gripe.

MS. ASTORE: We're going to take this opportunity to give the President a breather. So relax, we're going to take a short break, and we'll be right back.

MS. ASTORE: Welcome back everyone to "Health Care in the Heartland", our town hall meeting in the Twin Cities with the President.

MR. MEIER: Coming up we have a profile of a person. One of the scariest scenarios we've heard over and over again from callers here in the Twin Cities is, what happens when someone loses their health insurance during a time when they really need it. And here's one such story.

( A film is shown.)

Q Mr. President, health care is certainly a difficult issue and one that has many components to it. Can you address how the new plan would handle insurance as you go from one employer to another; and also how changes in the economy as well as profitability of companies could handle and affect the funding of the health plan.

THE PRESIDENT: Thank you very much. You know, this is so interesting. Of all these forums that I've done, you're the first person that's asked me that question. And let me try to explain how it would work.

First of all, under our plan, companies would be free to self-insure if they were above a certain size. We now have 5,000 and above. There are some in Congress who think it should be smaller. But what we have is complete portability of benefits so that no family can never be without benefits. So that if your company goes down and you don't have another job, you just carry your benefits. And for the period in which you're between jobs, this reserve fund that I talked about that we'll set up, the government basically would provide the reserve to guarantee that your coverage would continue just as if you were still working at the other company. So you would not have been put in the position that you're in now.

And it's very important. In addition to people who are in the position that you're in, where your company went broke and you got left with all those bills, there are an awful lot of people who just want to change jobs, but they have to wait for months and months and months, even after they change jobs, before they actually get coverage. So this is a big issue.

We need to guarantee -- the term of art is portability -- complete portability of policies through jobs and through employers. And our system would provide that.

Thank you.

MS. ASTORE: Mr. President, this gentleman is from North St. Paul, and he's concerned about benefits to immigrants to this country. Your question.

Q Mr. President, in your health care plan, you say you want all Americans to get involved in the process of planning so that all American citizens will benefit from the plan. However, there are -- adult literacy surveys indicate there's 21 to 23 percent of adult or 40 to 44 million adults were less skilled level. And 25 percent of adult or 10.5 million adults were immigrant with limited English skills. And I ask, what is your plan to insure or access to your health plan system for this unique American citizen and alien resident?

THE PRESIDENT: Most of those folks, even with very limited English capacity, have jobs. So they would get -- at the job site -- a card, a health care card, just like everyone else; which they then would be able to present to their doctor. They would have the opportunity either at work or at a local health clinic to have explained to them what their choices are of the health care plan, and then they would just -- they wouldn't have to keep up with a lot of paper or anything, just one card for the family that they could present at the health care clinic when they needed it, or at the hospital. So I think that's the way it will work.

Now, in many places where there are a very large number of people whose first language is not English, we will have to expand the outreach activities of the public health clinics for people who are not employed, and where there's no one in the family who is employed. And we understand that we're going to have to do that and make some provision for doing that. Thank you.

MR. MEIER: Mr. President, we're going to join our satellite audience one more time in Detroit and station WDIV.

Q And first we want to apologize for the audio problems that we've been experiencing here in Detroit. We are working very closely with the people in Minneapolis to get that corrected, we ask that you do be patient and stay with us.

Right now we're going to take a question for the President from this woman who is the Secretary for the National Association of Engineering Companies. And what is your question for the President tonight?

Q Mr. President, I would like to know how prescription coverage will be affected under the plan outside of Medicare?

THE PRESIDENT: Under our plan, every health policy would have to have a prescription drug component which would have the following characteristics: There would be a $250 deductible. In other words, you have spend up to $250 of your own money on medicine before it would trigger in. And then after that, every prescription would require a 20 percent co-pay. But there would be a ceiling beyond which you could not spend -- it's about 1,000. If your expenditures went over $1,000 a year, then the insurance policy would cover all the prescription drugs that your doctor would require and that your health would require.

So it's a pretty good policy, because -- now, if you have a better policy now, you can keep it. Keep in mind, if the coverage is better now, you can keep it. But almost no one has coverage that good today in their health care policy for prescription drugs. And there are a lot of national studies which show that the adequate provision of prescription medicine can actually save money by reducing hospital stays and emergency room visits.

MS. ASTORE: Okay, now, since we got that question out, we've got another one for you, Mr. President. It's from this woman who is an American citizen living in Windsor. And what is your question for the President tonight?

Q I wonder if he knows about Ontario's latest plan that preventage of medicine consists of community health centers run by the community, staffed by salaried practitioners, concentrating on long-term health problems within each community. They're running 49 such centers at a cost approximately the same as a large hospital.

MS. ASTORE: And that's in Canada.

Q This is in Ontario.

THE PRESIDENT: I think that one of the things that will happen if we pass this bill is that you will have more and more health care provided in that way by community-based clinics or comprehensive health centers that have salaried professionals, including doctors. Interestingly enough, we're here in Minneapolis -- that's what you have at the Mayo Clinic, right? Everybody concedes that there is no finer health care in the world. And yet I have many people who have been patients at the Mayo Clinic tell me that it is less expensive than they what they paid back home for other kinds of care.

So I think that you will see a lot more of that in this country once the health insurance market is organized so that people know they will always be reimbursed for the services they provide. That then permits people to organize these kinds of associations and know that they'll be able to run them without going broke, because they know they'll always have reimbursement.

Q why this woman moved there to begin with, right?

Q That's true. It was an unexpected bonus.

MS. ASTORE: We're going to go back now to our Milwaukee audience.

Q Thanks. There are people in Milwaukee who have already taken health care reform into their own hands. With me now is this doctor. And the clinic he works in is a model for the Clinton health plan, and is already making a difference here in Milwaukee.

(A film is shown)

Q Dr. Sanchez, what is your question for the President?

Q Mr. President, do you feel it is important to preserve the established network of community health centers across the country? And if so, how do you address this in your health plan?

THE PRESIDENT: Yes, I do. Not only for the reasons we just saw in the fine practice you have, but because the community health centers are increasingly providing services to large numbers of people who used to not use them at all. For example, in many of the southern states of this country, including mine, over 80 percent of all the children in the states get their immunizations through community health centers, because a lot of regular doctor's offices don't do it anymore because of the malpractice problems that were mentioned earlier.

So I think it's very important. And our plan has a special provision for funding community health centers at a higher level to try to make sure that these kind of comprehensive services can be provided.

And let me emphasize, too, that in the inner city and in rural areas -- we've got South Dakota here, remember, on this television program -- if it weren't for community health centers there would be no access to health care; so that people might have insurance but they still wouldn't have any place to go with their insurance. So it's very important.

Thank you for practicing there.

MR. MEIER: Our next question's from this gentleman, who is a cigarette and grocery supplier. And you have a question with regard to the tax on cigarettes, which is being discussed in regard to this.

Q Mr. President, this country was based on tobacco farmers exporting their product overseas. Today it's been proven that the people least likely to afford cigarette smoking are the ones that are left smoking today. Why would you place such an unfair burden on one group of people and one industry to pay for all this?

THE PRESIDENT: Well, as I said, first of all, let me say if I could figure out how to get enough savings out of this program to pay for it without any tax, that's what I would do. We are going to get dramatic savings out of this program, mostly by having a single form, simpler administration, which will save the taxpayers a lot of money; and those of you who aren't taxpayers who have private insurance, by drastically cutting the amount of administrative overhead in the system.

We cannot, however, provide enough money to do the things that we've been discussing without raising some money. Obviously, I think it is fair to ask the companies that will have the biggest drop in their insurance premiums to give a small portion of that to the fund for small business discounts and for unemployed people.

The reason that I think that the cigarette tax is a legitimate place to get funds is that cigarette smoking is the only activity that we know of in our society that there is no know safe margin for doing. That is, it's not like alcoholic consumption where if you're not prone to be an alcoholic there are safe margins of consumption. We know of no safe measure of smoking. And we also know that several thousand people year get lung cancer from subsidiary exposure to smoke, when they don't do it themselves. We also know that our society bears a health care burden and cost as a result of the health care consequences of smoking far in excess of the money raised from the cigarette tax. So for all those reasons, I thought since we had to raise some money, that was the fairest way to do it.

MS. ASTORE: There are millions of Midwest residents who live in rural areas who have some unique issues when it comes to health care. Mr. President, we're going to take another break; we'll talk about that when we come right back. (Applause.)

MR. MEIER: And welcome back to "Health Care in the Heartland," our town hall meeting in the Twin Cities with President Bill Clinton, obviously.

We're going to toss it out to Sioux Falls, South Dakota, where we have more questions for you from the heartland. Mr. President.

Q South Dakota is among the most rural states in the nation. We have several hundred thousand people spread out over the entire state, not just in one city. Small business people, the self-employed and those with existing medical problems all have a big stake in the health care reform problems.

(A film is shown.)

Q We're back now and we have with us a farmer from South Dakota, and he has a question for the President.

Q Do you have it built into your plan to encourage more organ donation amongst -- to get more organs available and when they do become available, to use for transplants? That's my question.

THE PRESIDENT: Yes, sir. We support transplants as I said, let me restate -- particularly organ transplants. We support transplants when they are the recommended medical procedure, and we try to provide ways to make sure that we facilitate that.

Now, let me also say to you since you were introduced in a slightly different way -- as a farmer who's selfemployed, who has already had a medical problem, who has folks working for you on the farm. Farmers, in my opinion, may be the biggest winner in the proposed reform we have because today, believe it or not, self-employed people who buy health insurance, number one, pay exorbitant rates anyway because they're not in big pools. If they've been sick, they pay lots more. And if you're self-employed, you can only deduct 25 percent of your cost of the premium from your income taxes whereas a business can deduct 100 percent.

Under our plan, you'd be able to buy on an equal basis with others in a much bigger pool and you would be able to deduct 100 percent of your self employed premium which means in almost every case in the country, farmers would be able to insure their farm hands for the time they work for them and their families for less than they're paying just for family insurance today. And you certainly would because of your preexisting condition.

But, let me just say this, I will try to get some more information on the specific question you asked me about encouraging and organizing the whole market for transplants. And I will make sure that we get back to you in the next day or two with a more specific answer to your question.

Q Mr. President, also joining us today is the president of the South Dakota's Farmers Union.

Q Thank you. It's nice to have you around, Mr. President. It was nice to have your wife here previously. It was an excellent opportunity for the people of South Dakota.

One of the things that concerns many of us is, number one, to maintain the farmers out there, but as the farmers are maintained, to require them or have the ability to have the infrastructure in the small towns. As I understand it, this plan will provide monies to develop that infrastructure. Would you please elaborate?

THE PRESIDENT: Yes, I'd like to talk about that a little bit. And I'd like to say, first of all, my wife had a wonderful time out there. And I want to thank Senator Daschle for doing such a good job and working on this rural health care issue.

Let me try to explain how this would work, and let me say for the rest of you, a lot of people who live in small towns in rural areas don't even have a doctor in their town anymore. I met in rural North Carolina earlier this week a doctor who told me she was working 110 hours a week and had been several weeks, but she had just come to her slow season when she could work 80 hours a week. Now, that's a doctor who's going to need a doctor pretty soon, right? (Laughter.)

Here's what we try to do. Let me briefly run through the things that are in this plan for rural areas. Number one, revive the National Health Service Corps where young doctors can pay for their medical education which normally leaves them with a big debt by serving in underserved areas -- 7,000 doctors over the next few years doing that.

Number two, give doctors and other health care providers who go into underserved areas significant income tax credits as incentives to do it -- $1,000 a month for doctors, $500 a month for nurses and other medical professionals for up to five years. That's a huge incentive. Number three, give doctors faster write-offs, tax write-offs when they buy modern equipment to put into their clinics in rural areas.

And number four, make sure that we've got the technology, the computer technology to connect rural clinics with urban medical centers so doctors can feel good about the quality of their practice when they're out there and feel like they're giving their patients the kind of care they need.

Those are the things that we think will get a lot more doctors and nurses and other into rural America and make a big difference.

Q Mr. President, we also have another farm group in South Dakota that is quite large, the South Dakota Farm Bureau. And we have along with us tonight Gayle Brock from the Farm Bureau.

Q Mr. President, I would like you to ask you to comment on Medicare and Medicaid. They are often underreimbursed in the rural areas for those that provide care in the rural areas. And how can these providers then be adequately compensated and still save over $100 billion, as you have outlined in your financing proposal on these two programs?

THE PRESIDENT: Well, for one thing, Medicare and Medicaid are going up right now at two and three times the rate of inflation -- by far more than inflation and population growth -- because primarily of the way the Medicaid program is organized. Under our plan, Medicaid recipients would be put into big insurance pools along with all other -- along with small businesspeople, self-employed people, and larger business people. In other words, they'd be put in these big community pools. And doctors, for the first time, would be reimbursed at the same rate whether or not they had a Medicaid patient or someone who was privately insured. It would be exactly the same reimbursement. And that would make a huge difference to the physicians.

Secondly -- and how would we do that and still save money? Because you'll have competition; you'll have managed competition, which we've seen already in Minnesota with the work that's been done here. You had dramatic drop-off in the increase in medical costs here as people have organized themselves into larger groups.

Secondly, under Medicare, we leave it the way it is because so many of the people that I have talked to in the AARP and the other groups believe Medicare works and want it left alone. But we do add a prescription drug benefit and we add a long-term care benefit.

How will rural doctors be able to deal with this? They won't have any more uncompensated care. One of the things that makes Medicare and Medicaid a bigger burden in rural areas is there are an awful lot of uncompensated care in rural areas. Now doctors will be paid something by everybody they treat. And I believe that that will make a big difference to the quality and rewards of the practice of medicine in rural areas.

We can save this money -- to go back to your question -- by the way we organize the health care markets and by making sure that everybody is reimbursed for all the services that are provided. Then we'll be able to lower the rate of inflation.

Keep in mind, we don't propose to cut Medicare and Medicaid, ma'am. Medicare and Medicaid under our proposal would go up at twice the rate of inflation, instead of three times the rate of inflation, which it's going to do if we don't pass national health care reform.

MS. ASTORE: Back here in the Twin Cities, Mr. President, we have a question from a woman of St. Paul. She's concerned about the importance of mental health care under your program.

Q Mr. President, initially, mental health care seemed to be an important part of health care reform. But recently I haven't heard much about its inclusion within the reform package. My question is, is mental health care an important part of health care reform; where and how is it going to fit in?

THE PRESIDENT: Yes, it is a very important part of health care reform. We have -- under our plan, some mental health benefits would be included from the beginning of national health reform. That is, whenever -- all the states would have until the end of '97 to provide universal coverage. Each state would have that time. From the beginning of the time everybody was covered, there would be significant mental health benefits, much more than most people have under their policies today --both in-patient and out-patient care.

There would not, however, be complete parity. And if you're interested in mental health, you know -- parity between the mental health benefits and the physical health benefits until the year 2000. And that's because we don't have accurate cost estimates on how much it will cost and we have to phase it in. To go back to what some other people had said earlier, we have to know that when we put these things in that we can pay for them and we're not going to cost the Treasury more than we have.

But there will be quite a significant mental health benefit from the very beginning and much more than most people have today. I think it's very important. I think it's one of the best things about our plan, and I personally believe it will make us a healthier country and will cut down on long-term medical costs if we have proper kind of mental health.

MR. MEIER: Mr. President, if I could have you do an about-face -- (laughter) -- and direct your attention right up here. We had a lot of questions about costs of a national health care when we organized this forum. Brian Malloy is from Minneapolis, and I believe he'd like to ask you a question on that topic.

Q Mr. President, we already have Minnesota Care in this state and we've enrolled 30,000 Minnesotans in this plan. Are we going to lose money under a federal plan? Would we be better off to continue with Minnesota Care independent of a federal initiative?

THE PRESIDENT: No, you won't lose money because -- and I commend what you've done; I think it's important. But you won't lose money. We estimate that both private insurers and the government will save money if we go on with national health care reform. And what will happen is if we have the national plan, we'll be able to do some things that at least you're not now doing.

First, everybody will be able to be insured. And, secondly, in addition to holding costs down, we'll be able to hold costs down with more choices for health care consumers than you're going to be able to provide unless we have a national plan which reorganizes the insurance markets. So my judgement is, you'd be -- I would urge you to keep going with you reforms here to do the best you can and go full out until the Congress acts. But I believe you'd be much better off when the Congress acts.

MS. ASTORE: Mr. President, another question from Minneapolis.

Q Mr. President, untreated addiction is a huge factor in the rising cost of health care. The American Medical Association tells us that about 40 percent of hospital days and over 50 percent of emergency room visits are for alcohol or other drug-related causes, illness or accidents. I'd like to know with your benefit for a substance abuse treatment which, as you mentioned, is there now -- along with the mental health -- you've been taking a lot of flack on the cost. But we know that treatment cuts medical utilization in half immediately not only for addicted persons, but for their whole family members. Can you do a better job of defending that? And how far are you going to go to keep this benefit in the final legislation on health care reform?

THE PRESIDENT: I don't know if I can do a better job of defending it. Some days I don't think I do such a hot job. (Laughter.) I did my best when we started tonight, but I'm going to try. Let me say -- I think you may know this -- but I have a brother who is an addict, who is a recovering addict. I know the treatment works.

And we have done two things in our administration. One is to require that drug treatment be a part of the benefits, as a part of a general approach to preventive health care. I believe in preventive health care, folks. We spend a ton of money after the cow's already out of the barn door in our health care system. And I like -- I mean, I like the fact that we have the best technology in the world. I like the fact that we can get it. But we can save so much money if we just invest in prevention generally, whether it's mammograms for women or cholesterol tests for people or substance abuse treatment.

In addition to that, although I just presented a budget to the Congress that cuts defense and cuts discretionary domestic spending -- that is, not Medicare, Medicaid or Social Security -- for the first time since 1969. We increase in our regular budget drug treatment funds by, oh, about 8 or 10 percent, just because I think it is so important. And I will fight very hard for it. I think it would be a big mistake for us to back off of this. There's still an awful lot of people who have alcohol and drug abuse, substance abuse problems in this country. And we can save a bunch of money and a lot of people, more importantly, if we stay with it.

MR. MEIER: Before we move on, we want to apologize to our satellite audiences. We understand they've been experiencing some technical difficulties. We know how important this forum is. And we apologize for that.

In the meantime, let's move onto Detroit for another audience there.

Q All right. I know from Detroit, we really do thank you for that. With me is this woman, and she's been waiting patiently for quite awhile. She's a mother of five, a grandmother of one. You've lived in Detroit for 30 years, you work with senior citizens. What's your question for the President tonight?

Q My question, Mr. President, is, will there be coverage for seniors for medication, and full coverage, in fact, for those people who are most likely to need it?

I work in an office where I see seniors who are going to doctors maybe three, four times per month, and they can hardly afford to eat if they buy their medication. Will there be some type of relief or help with medications for those people.

THE PRESIDENT: Yes, ma'am. Let me explain this again for the benefit of all of our participants here. Older people who are at or below the poverty line are eligible for coverage under the Medicaid program, the government's program for poor folks. If you're under Medicaid, then you have a prescription drug benefit. But if you're a senior citizen eligible for Medicare --that is, the regular elderly person's health care program -- and you haven't spent yourself in poverty, you don't get any prescription drug benefit. But we know that older people are four times as likely to use medicine as younger people. And we also know that we save money in our health care system if people who need medicine get it and can therefore stay out of hospitals. I mean, you can spend a year's worth of medicine in three days in a hospital.

So what our plan does is to add to Medicare a prescription drug benefit, which has a $250 deductible, a 20 percent co-pay and, I think, a $1,000 ceiling -- it has a ceiling and I think it's $1,000. That is, after you spend $1,000 out of pocket, your insurance then will cover all your medicine from then on.

MS. ASTORE: Okay, our next question comes from a health economist at the U. of M. School of Public Health -- the University of Michigan. Welcome, and what's your question for the President?

Q Well, my question is, one of the important principles behind health care reform is that an increasing reliance on competition to control costs. However, what we see in many markets already is consolidation of insurers and providers into larger and larger groups. My question is, what steps would you advocate to ensure that, in a situation that seems to be evolving to even very large cities having two or three big players in the health insurance market -- what steps do you advocate to ensure the competition will remain viable in the long term?

First, let me say, I think there has to be some consolidation of the insurance market. To be fair, I've tried to say this over and over again -- and sometimes not so well -- but, I don't think there are any bad people in this drama. We have the best health care in the world -- we have the best doctors, the best nurses, the best medical technology, the best medical research. We have the worst health care financing system in the world. It is the world's most expensive; it's estimated by nearly everybody that studies it that we spend about $90 billion a year -- which is pretty good money -- in clerical work, simply because of the way we're organized.

I think there should be and will be, inevitably, some sort of insurance consolidation. How do we guarantee competition? By requiring that in every group of buyers, every consumer in America have access to at least three different kinds of plans -- a fee-for-service plan, a health maintenance organization, a professional provider organization.

They may have access to 24 specific plans -- as I said, the way the federal government employees often do today -- but we will guarantee that every person always has access to at least three different kinds of plans, including fee-for-service in the old-fashioned way. When you do that, you're going to ensure that there will be more competition than there will be. If we do nothing, the move toward competition, in my judgement, will be just exactly what you say -- there will be more and more concentration, more and more managed care, but less choice, less quality and less competition.

MS. ASTORE: Now, we've heard from an American who moved to Canada. Our next question comes from a Canadian who has moved here to America. You owns a small business, and what is your question for the President?

Q Mr. President, you have said that I will not have to give up my doctor. Right now, my family uses several doctors. Under your plan, what if these doctors work for different alliances in my area? Won't I be forced to choose which alliance I want to join and thereby give up one of the doctors I now see?

THE PRESIDENT: No. But let me answer your question directly. First of all, one option you will always have, ma'am, is to continue to pay your doctors as you would now, on a feefor -service basis. Your premiums might be slightly higher, but they probably still would be as low, if not lower, than they are today because of the way the markets are organized.

In addition to that, you can also join a certain plan -- like a certain health plan -- and maybe all your doctors aren't members of it, let's say three are but one of your specialists aren't. You can buy a small premium, which would not be very expensive, which would give you the right also to use that doctor, who would then get reimbursed from your plan at the same rate other doctors in the same specialty or the same area would.

So you would be able to keep all your doctors. That would be one of the things you'd have to do. You might have to pay slightly more to do it than you would otherwise pay. But you could keep them all and, in all probability, based on our studies, it would be for the same or less money than you're paying now.

Q I think we should mention that we have one of the friendliest --

THE PRESIDENT: If you have a comprehensive plan.

Q international borders, probably, in this country between Detroit and Windsor, Ontario, Canada. Back to you in Minneapolis.

MS. ASTORE: Thank you. We'd like to go now to our Milwaukee audience at WISN-TV.

Q Thanks, she is a 29-year-old college graduate. She is the mother of three, she is bilingual, she wants to work, she can't find a job and begins to think that maybe we're approaching the wrong problem first.

Q Yes. Mr. President, my concern is welfare reform. As it is true with any reform effort, the basic purpose for welfare reform is to increase and expand the opportunities and benefits for the people on it to enable them to be selffunctionable. Therefore my question, Mr. President, how does your proposed welfare reform program expand and increase the opportunities for myself -- a welfare recipient who has went to high school, has received a high school diploma; who has attended and graduated a state-accredited four-year university, has received a Bachelor of Arts degree in Communication, bilingual in Spanish; who has also acquired computer proficiency in WordPerfect, Work Express, Wendalls, Lotus --

Q Now we know what job she's looking for. What's your answer Mr. President? (Laughter.)

THE PRESIDENT: My guess is we've already done it. I'll bet you'll have four job offers tomorrow since you've been on television. (Laughter.) I imagine we probably solved your problem. But let me give you a more general answer. I hope somebody who's watching you will call you and offer a job tomorrow.

First of all, quite apart from welfare, we have to create more jobs in this country. In the last 15 months, our economy has produced two and a half million new jobs -- 90 percent of them in the private sector, more than in the previous four years. So we're creating more jobs. That's the first thing.

Secondly, with regard to welfare, how do you move people from welfare to work? You have to make work more attractive. We, this year, starting in this calendar year, we are lowering income taxes for 16.6 percent, one-sixth of American workers who make lower wages to make sure that work will always be more attractive than welfare by saying, if you work for modest wages, you'll get an income tax cut.

The third thing we are trying to do is to reform the welfare system itself by helping to create jobs ultimately for people who have training and are able to go to work, if necessary, with some sort of public funding. But let me say, it doesn't apply to you.

But the biggest problem we've got with welfare for a lot of people is that -- remember, if you're poor on Medicaid and on welfare, your children get health care. If you take a minimum wage job in a business that doesn't have health insurance, you have to give up your kid's health care to go to work. Then you work for a minimum wage and you pay taxes so people on welfare can have health care. It doesn't make any sense. So, the health care issue is an important part of welfare reform.

The answer to this lady's question is she should be able to get a job in a healthy market economy. So we have to create more jobs. Ultimately, for people on welfare who are willing to go to work, if they can't find jobs within a certain specific time, in my judgment, the government is going to have to work with the private sector to give extra incentives for people to go to work. It's better to have work than be on welfare even if you have to give extra incentives to create the jobs.

Q Our next person who would like to ask you a question is this gentleman. He's 17 years old, still in high school, has done a great deal of research on this entire project, and has drawn the conclusion that it will not work. (Laughter and applause.)

Q Good evening, Mr. President. I don't know if that's exactly correct, but how will you nationwide health care program affect the American free enterprise system as we know it? Will it simply be a case of government stepping in and improving the status quo while maintaining the private business -- private health care industry? Or is it more like a reinvention of the American health care -- improving conditions for Americans, but hurting the private business sector?

THE PRESIDENT: I think it will do much more good than harm. There will be some job loss in some areas, and there will be some job gain in some areas. And let me explain how and why I think it's the right thing to do.

First of all, the system is entirely private. We require people to purchase insurance. We keep private insurance. We do not abolish insurance and substitute taxes. Secondly, all the health care providers that are now private will continue to be private. So we leave that alone. But if you go to a comprehensive benefit program where you have a single form that the doctor has to fill out, a single form that a hospital has to fill out, a single form that a patient has to fill out, and everybody is clearly covered by producing a card, then all those people who are busily at work trying to figure out who's not covered under what health insurance policy; or why the health insurance policy needs to be cut off; or why a small pool can't anymore support a person who's got a sick child -- those jobs will go down in number dramatically. But we'll have a big increase in jobs in health care providers -- people who work in home health, for example.

Some small businesses will pay more because they don't pay anything now or they have very limited policies now. But on average, it will add 1 to 2 percent to their cost of doing business, and all their competitors will have to do the same thing. And within a few years they'll all be saving so much more because medical inflation will be less.

The Congressional Budget Office is a nonpartisan group that did a study on this. They estimate that on average, within five years we'll be creating many more jobs in the small business sector because we'll lower medical inflation and all small business people will be on equal competitive terms.

So I think there will be some job loss, more job gain in the short run in health care, and big job gains over the long run by bringing health costs in line with inflation.

MR. MEIER: Thank you, Milwaukee. Thank you, Mr. President. We want to now go to Sioux Falls, South Dakota.

Q Mr. President, our next participant is not looking for work. He provides jobs. He is providing also the prospective of tonight's program of the small business person in small town America. This gentleman is an auto dealer in Platt, South Dakota, a town of about 1,300 people. Your question for the President.

Q Good evening, Mr. President. Most big businesses in corporate America provide health insurance for their employees and also millions of retirees with pretax dollars. My concern is the cost this is going to probably have on your plan. If the Clinton plan becomes law, would this release of the liability of businesses from providing health insurance to retirees, and if so who does pay for it?

THE PRESIDENT: It would relieve them of some of their responsibilities for paying for the early retirees. And they would be in the retiree pool in our health care program. But I still believe it's good economics, because a lot of these companies are paying now 15, 16, 17, 18 percent of their payroll as compared with the national average of 8 to 8.5 percent of payroll for health care. And that is undermining their ability to reinvest money and to create more jobs and to make our economy stronger.

Most of those companies that are severely affected by this are companies like automobiles and steel, which had to have huge layoffs through early retirement all during the 1980s to be competitive. In other words, it wasn't a decision they made, it was necessity. And they had contracts which required them to carry these health burdens.

We believe for relatively modest cost we can generate a huge amount of money in these sectors, which are now prospering, to create more jobs and help strengthen the American economy. So we think that it'll be about a wash that we can well afford.

Let me say, sir, that we have had the cost of our plan evaluated by any number of people, including groups that are composed largely of folks that were active in the previous two Republican administrations. And all of them say more or less the same thing -- that over the 10-year period, our numbers are right. The differ from year to year sometimes, but I think that the cost figures in my plan are good because we've bent over backwards, we've contacted 10 different medical actuarial firms and also had a lot of outsiders look at it. I think the numbers are right.

MS. ASTORE: Thank you, Sioux Falls. Mr. President, we have time for one final question here in the Twin Cities. And we'd like you to pick a member of the audience to ask that final question. (Laughter.)


MR. MEIER: Wait, wait, wait, wait. I've got to pull a Donahue here and get up there. (Laughter.)

THE PRESIDENT: Maybe we'll do two if you can do it real quick.

MR. MEIER: Tell us your name and what your question is.

Q I'm from Dayton, Minnesota. And one word I haven't heard the whole time I've been listening to the news programs about the plan is dental. And I'm a person whose teeth have not been kind to me. And that's my major medical budget in my household for myself is teeth. And I'm really concerned about that. Is there going to be any thought or any kind of provision at all for that type of medical care, because that can affect your health.

THE PRESIDENT: Yes -- we're running out of time. I can't give you the whole details. But the short answer is yes. You'll have to pay some of it, and I'll get you the details.

Go ahead, what's your question? Thank you.

MS. ASTORE: Hurry, Randy.

THE PRESIDENT: We can do it. We can do it.

MR. MEIER: I'm getting there. Here we go. Your name, and what your question is.

Q Thank you, Mr. President. I have a handicapped daughter. She grew up with severe handicap. And as she's getting older -- she's out on her own right now -- but she cannot get any type of medical help whatsoever from anywhere. I'd like to know what your plan has that will help her to be able to succeed in life and do what she wants to do and still have coverage.

THE PRESIDENT: What's her handicap?

Q Right now it's a form of scoliosis. She's got a severe curvature; she's had a back spinal fusion amongst other things.

THE PRESIDENT: Your daughter would be able to buy insurance as an individual once she be becomes an adult on the same terms as anybody.

Now, the only way we can do that is if we organize the insurance markets and the buyers so that they're big insurance pools and large numbers of buyers so we can spread the risk of some future illness or problem of hers across a large number of people.

I do want to make full disclosure, because one of the first questions I got was who would pay more under this plan. We would ask young single workers to pay a little more per month than they would otherwise pay so that we'd be able to insure people like your daughter and older workers on affordable terms. I think, again, that's a fair thing because young, single workers want to be older some day, number one; and they're going to be married, they're going to have children, and they might have children that have health problems.

So I think it's a fair thing to do. But that's the way it would work. That's the way, by the way, other countries do it. And your daughter would be able to get insurance.

MS. ASTORE: President Clinton, we're coming to the end of our town hall meeting. We'd like to give you this opportunity to offer some closing remarks.

THE PRESIDENT: I just want to make two points after I say, thank you to all of you. Thank you to those of you who asked questions and those who couldn't get your questions asked.

For those of you in the other sites, if you had a question that didn't get answered, send it to us and we'll answer it. And those of you that are here, I'll just gather them up while I'm here. (Laughter.)

I want to make two points if I might. We can differ about the details of this, but the one thing that we have to decide on as a people is, are we going to continue to be the only advanced economy in the entire world that can't figure out how to provide health insurance for all of its people so that we insure people and pay for them if they are on welfare, but we punish working people. Or are we going to solve this problem after talking about it for 60 years now?

The second thing I want to say is this -- to go back to a point I made at the beginning. This is a complicated issue. I've tried to shoot straight with you and tell you what the problems are with it. I respect people who have differences of opinion with me on exactly how we should do it.

But what I want to ask you to do is to try to communicate to your members of Congress, without regard to party, that Republicans and Independents and Democrats all get sick, all have kids, all have parents, all have hopes, all have fears; and that it's okay for us to disagree about this in terms of the details, but it is not okay to let another year go by and not deal with it.

And what I ask you to do is not so much to say, Bill Clinton's right about everything. But to say, this is a serious problem, we have to deal with it, please act now. We will not know any more about this next year than we do this year. It's just going to be like an ingrown toenail. It will get worse, not better, if we don't move.

So that is what I plead with you to do. Ask your members of Congress to act now and to work in the spirit of humanity, bipartisanship and common sense and let's get this done.

Thank you very much. (Applause.)

MR. MEIER: Thank you, Mr. President. I'm sure we've all enjoyed this opportunity to meet with you tonight. It's a very important issue, and I thank we all learned something here tonight.

MS. ASTORE: We hope by getting together tonight, we've helped to shed some light on this complicated issue for our live audiences and our viewers on the satellites.

Thank you for joining us, everyone. Good night.

END8:30 P.M. CDT