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Office of the Press Secretary

For Immediate Release August 18, 1994
                            PRESS BRIEFING
                          The Briefing Room 

1:23 P.M. EDT

SECRETARY SHALALA: These briefings will never leave you. You could change your jobs -- (laughter) -- actually, you could not make me unhappy today with any question. I just got to have lunch with Nolan Ryan.

Good afternoon. The protection and security of people in this country has always been our top priority, and I came to talk with my colleagues today about the Mitchell bill and about the Gephardt bill to see if we can get back to the basics, the things that are in the bill, that are absolutely critical for everyone in this country if we're going to give them the kind of health security that the President promised during the campaign and as part of our overwhelming effort.

And while everybody's been getting hot under their collars as we've gone on with the debate, I think it's very important that we get back to the basics and talk about the fundamentals.

I'm afraid that some of the debate and some of our understanding of what's in all of these bills recommended by the Democratic leadership has been lost in the bickering of partisan politics. And so I think that Senator Mitchell has laid before the Senate a proposal that we think would significantly strengthen the American health care system. It's going to preserve what's right about the current system while repairing what's wrong with that system. And one of the points we want to keep making to everyone here is, for the 85 percent of the public that already have the insurance, what the Mitchell bill does, what the Daschle bill does is to lock in and protect those of us that have good health insurance to make certain that it will never go away.

Some of the Mitchell plan's benefits have been lost in the discussion, and I think these charts make those points in a more straightforward manner. First, the Mitchell bill provides real protection for the 85 percent of Americans who have insurance, but could lose that coverage tomorrow.

This health care debate is not simply about working people who don't have health insurance. Obviously, we believe that 80 percent of those who don't have health insurance, we know that they're working people. We very much want to make sure that they have health insurance at the end of this debate. But, fundamentally, what we're trying to do is to protect those who have health care insurance already.

What the Mitchell bill does, what the Daschle bill does is eliminates any possibility that insurance companies can take away coverage because of preexisting medical conditions. It ends the roller coaster pattern of annual insurance premium increases that have averaged 20 percent a year over the last couple of years. And that's important, as my two colleagues here will tell you, to stabilize American businesses' ability. They need a predictability in their health care costs if they're going to be competitive around the world.

So it's very much locking in and protecting the 85 percent has a great deal to do with the American economy and strengthening the American economy. It locks in our right to choose our own health care plan, our right to choose our own doctors and other health care professionals who care for us in this country. Again, I've talked to numerous people in the media, and I always ask you what's happened to your health care. And everybody's got a story about their company reorganizing their own health care, shoving them just into one HMO, limiting their choices. That's happening to hundreds of thousands of Americans from one end of this country to the other.

As health care costs, as companies try to stabilize their health care costs, they start limiting choices, they start reducing the kinds of benefits that are available for people who have insurance. And the point here is that people who have insurance are at risk.

The Mitchell plan also guarantees every American who has insurance a well-tested set of comprehensive benefits. And there has been a lot of discussion on the Floor of Congress about these benefits and about giving the Secretary of HHS too much power over these benefits.

I have to tell you, the comprehensive set of benefits that we're talking about is a standard package designed by health care professionals and by insurance companies over a generation in this country. There's not a huge debate about what's in that standard package. Everybody operates off the same language and the same package. The only thing that we have done, the only thing the Democratic leadership has done is added the prevention piece --again, a standard piece.

Not very complicated, it talks about breast cancer screenings, it talks about immunizations for kids. Again, it's the experts -- the pediatricians and those who are specialists in prevention who have put these packages together and who have a standard way of determining what ought to go under something that's called "preventive services." That extra piece that has been added on since the beginning of this debate, very much accepted by the American people, is key to this new health care system.

We're not talking about just locking in the old health care system, we're trying to improve it. The test 30 years from now is going to be whether the American people are healthier, and the prevention piece is very much a part of that as having real benefits. What good does it do to fight through a new way of financing and of stabilizing the financing of the American health care system if the package itself isn't any good, if what we get isn't any good? So the standard benefit package, combined with the addition of prevention is absolutely key.

We're obviously interested, finally, in preserving the existing Medicare program. Everybody loves Medicare. I think they don't realize it's a government program. Because when I get out and people say, well, we don't want the government to run the health care system. And I say, what about Medicare? Should we get rid of Medicare? No, no, no. That's pretty well run.

In fact, name one American health care company, one American insurance company that could run as large a program as the Medicare program for three percent overhead. Because that's essentially the administrative costs of the Medicare program, and I submit to you that Americans are happy, senior citizens are happy with their Medicare program. We intend to keep it; and, in fact, to improve it with a prescription drug benefit, a new home care program. The Mitchell bill and the Gephardt bills obviously have the drug benefit, the home care program that allows people to keep their loved ones at home.

Again, what we're talking about is stability of the existing system, making sure that we have it forever, the package of benefits because we want to talk about health in the end and about improving our health and stabilizing by making certain that older Americans get their Medicare program and are protected in the future in terms of their health care and adding the pieces that modern science has given us -- keep people at home, not in hospitals, not in nursing homes unless it's absolutely necessary. Keep them at home and give their families some help to be able to keep them at home. And that's what home care is all about.

Finally, let me say that Hubert Humphrey taught us the measure of a just society is how it treats its citizens who are in the dawn of life who are, of course, our children; those who are in the twilight of life who are our elderly; and those who are in the shadows of life -- the sick, the needy and the disabled. I would argue that Senator Mitchell's bill, Congressman Gephardt's bill, in fact, meet that very high standard provided by former Vice President Humphrey.

SECRETARY BROWN: We have just heard Secretary Shalala lay out all the reasons why the Mitchell plan should be supported. I think the legitimate and appropriate question after that eloquent discourse would be why isn't the Senate moving. The Senate isn't moving because we are faced with a lot of disinformation, a lot of misinformation, downright lies about the content of the Mitchell bill. We've been faced with a bunch of myths which we have to explode.

Some have said that this Mitchell bill sets up a whole new set of bureaucracies. That is just downright false. The fact is that what the Mitchell bill relies on is private health insurance for every American. It moves toward privatization. It takes Medicaid, for example, and privatizes Medicaid. It brings now a public program, a government program into our private sector health delivery system. The Mitchell bill makes sense. It embodies the very essence of the President's original proposals -- private health insurance for every American that can never be taken away. It can't be taken away if you lose your job; it can't be taken away if you change jobs; it can't be taken away when you get sick; it can't be taken away when you get old. Those are very simple, basic principles.

We are fighting hard, as I think is demonstrated by everything the President and First Lady have done over the last 18 months, everything we and the in the administration have been doing over that same period of time and have accelerated in recent days. It's very important that we not allow obstructions, that we not allow petty politics to keep the Congress of the United States from doing what it should do.

There is some debate now that is really beginning to start. There is some useful dialogue and discourse. I believe that the Congress of the United States cannot leave Washington next fall without passing meaningful health care reform. The American people want it. The country needs it.

Why do I, as Secretary of Commerce, care so much about this legislation? First of all, I care deeply about the 38 million Americans who have no health insurance and the 22 million who are underinsured. We're the only industrialized country in the world that doesn't provide universal health care coverage to our people We've got to do better.

Now what does that do to us economically? Frankly, if we don't get everyone into the system, we will not be able to control costs. Let me tell you why costs are out of control. They're out of control because people who do not have health insurance, people who are underinsured, don't go to the doctor until they are very, very sick. They don't go get preventive care. They don't get prenatal care. They don't immunize their children -- because they can't afford to do so. So they seek medical services when the costs are the highest, when they are really sick.

Now, some people think that those people who are uninsured really get health care and they get it free; they don't get it free. If they walk into a public hospital, into an emergency room, we taxpayers pay that bill. If they walk into a private hospital, we will have health insurance pay that bill through higher premiums.

The plans that are on the table now stop that kind of cost-shifting. They create a fair and equitable system, and they allow us to control costs.

Now, I know that when you see these charts that the opponents use on the Floor of the Senate, and you see all these boxes saying, oh, my goodness, look at all these new bureaucracies, have you looked at what those boxes are? Patients, doctors, nurses, prescription drugs, early retirees -- people who either deliver health care services, or need health care services. That's not bureaucracy, that is trying to deal with a real problem in America.

We've got the best doctors, the best medical technology. We've got the best hospitals and the best medical research in the world. We have a health care delivery system that is not working. The Mitchell bill fixes that. It makes it work, it incorporates the essence of the President's original proposals. The Senate needs to stop inaction. The Senate needs to stop obfuscation. The Senate needs to stop these delaying tactics.

Opponents of the legislation need to stop the campaign of disinformation and misinformation, and get on with passage of legislation that's good for the United States, that's good for the American people. I believe it's going to happen, because we have a President of the United States who has been willing to take on all the special interest groups, that has been willing to take on all the tough issues, that has been willing to display the courage and spend the political capital that is required if you're going to provide leadership in America today.

That's what he's doing on crime. That's what he's doing on health care. That's what he did on deficit reduction. That's what he's done on all the major challenges that America is facing. And that's why I'm increasingly confident that we're going to win on crime, we're going to win on health care, we're going to do what is right for America.

Thank you.

SECRETARY REICH: Let me just say that as Secretary of Labor, Secretary of the American work force, the question to be addressed here fundamentally is very simple: Are we going to have universal health care, or are we not? Even the Republicans now are willing to accept the proposition that we have a health care problem, a health care crisis. Six months ago some were saying, no, there's no problem at all; we should do nothing. The real debate going on now is between those who say we've got to make sure that everybody is insured, we've got to aim for universal coverage, and those who say partial measures are sufficient.

Now, I, like my colleagues, am optimistic. And I'm optimistic for two reasons: Number one, because this week we're seeing some momentum, we're seeing some action. There's actually -- the issues are being squared in the Senate. Finally there are amendments, there is discussion, there is deliberation. The democratic process is moving forward.

I'm also optimistic because these members of Congress have got to face their voters in the fall -- every member of the House, one-third of the Senate. Nobody wants to come back emptyhanded, because the public also understands that there is a crisis.

The Mitchell plan, the Mitchell plan targets funds to ensure that universal coverage -- universal coverage -- is extended to as many of the currently nine million uninsured children right from the start. And this is the beginning point -- it's children. Directly ensuring that our future generations get the health care they need. We're not doing it right now. Subsidies are targeted earlier to children.

Number two, the Mitchell bill then goes on to ensure that 95 percent of our citizens are covered. If 95 percent of our citizens are not covered, then there is right away, by 2000 -- if 95 percent coverage is not achieved by 2000, employers and employees will split insurance costs or other universal coverage legislation will kick in. This builds on the present system -- the present system of employer and employees sharing the burden.

This is not a radical departure. For firms over 25 employees, 90 percent already offer shared responsibility, already provide some health insurance. Even if the 95 percent goal is met under the Mitchell bill, a commission will recommend how to cover those who are uninsured. The goal here, as with the Gephardt bill, is 100 percent, is complete universal insurance.

The Dole plan, by contrast, leads nowhere. It does not accomplish the fundamental purposes that the President and the American public want. That is, universal health care that cannot be taken away.

The Dole plan leaves an estimated 6.2 million currently uninsured children with no coverage -- this is out of 9 million children. With the Dole plan, you still have 6.2 million out of the 9 million children without coverage -- they continue to live without coverage.

Now, you and I and all of us know when we say without coverage, all that means is they don't see doctors regularly, they don't get preventive care, the end up in emergency rooms at expensive rates, some of them with extraordinary chronic conditions that are costing society and their families enormously.

Number two, the Dole bill will leave over 30 million Americans without coverage in 1997. That's out of 38 million who now longer -- who now, at any given point, don't have coverage. In other words, it doesn't do the trick. It doesn't come close to doing what needs to be done.

There is no commitment to universal coverage. Preexisting conditions are still going to be a problem for many Americans under the Dole bill. If you're uncovered for a year, preexisting conditions, you can't be -- so you can't get insurance for a year if you have a preexisting condition.

It protects the insurance industry; it does not protect consumers. It does not guarantee individuals a choice. What's happening now is the choices are being rapidly constricted. Economists call it "adverse selection." As more and more of the responsibility is put on the few firms -- the relatively fewer firms that are offering health insurance right now, and as 100,000 fewer Americans who are working, are getting health insurance every month, why is that? Because more and more of the costs are being shifted to the firms that are offering health insurance.

Adverse selection means that the trend is going to continue to spiral downward. As these firms find that they're picking up the bill for other members of the family who are not being covered by other employers, and they're picking up emergency room bills, those firms are going to continue to restrict coverage. They're either going to drop, or they're going to demand that their employees have more copayments, more deductibles, or they're simply going to offer less choice. And that's the direction we're seeing now.

The Dole bill does not correct this. The Dole bill goes down exactly the same road to less and less choice, more and more adverse selection. There's nothing for prescription drugs. There's no guarantee of long-term care.

We are at a turning point here. We're at a turning point with health care, much as we're at a turning point with crime. America is about to make a decision. We've debated this for 60 years. And the question we are going to address, the question that is being addressed -- and the choice is very clear: Are we going to guarantee all Americans that they have universal health care that can't be taken away? Not substituting the government for private health insurers, but not substituting the government for private health providers, not substituting government bureaucracy, but rearranging the market so that everybody is covered.

The President, Congressman Gephardt, Senator Mitchell are all aiming for the same goal. That is universal coverage, and that is what Americans are -- average working Americans want and need, because the present trend is simply unacceptable.

Q Why is there so much resistance? What is the main stumbling block now?

SECRETARY REICH: Let's take your questions and have my colleagues take your questions.

Q What is the main stumbling block now to selling this to the Senate?

SECRETARY REICH: Let me offer my view. I don't think there is, right now, much of a stumbling block in the sense that we're moving forward. We're seeing amendments. In fact, the --

Q One hundred amendments are going to be --

SECRETARY REICH: Well, this is the democratic process. There is momentum here. I think what was of concern was when there was a complete logjam. But now there is momentum, there is deliberation. Yes, there are going to be amendments, yes, there's going to be a lot of discussion, but we're moving forward. That's good.

Q What's your analysis of the compromise bill, the Chafee-Durenberger bill that's just being introduced? Does that meet the standards which --

SECRETARY SHALALA: We actually don't know yet, because no one has seen the the details of the Chafee-Durenberger-Conrad -- I mean, the list. And they're just starting to have their conversations with CBO. We obviously look forward to being able to review it, and it is a thoughtful group of Democrats and Republicans that really care about getting a health care plan this year. So we look forward to being able to review it along at the same time with the other members of the Senate.

Q On the Mitchell bill, how much would the average currently covered worker's health care costs go up annually?

SECRETARY SHALALA: If the Mitchell bill works, as the designers expect it to -- and that is for the market, giving people more choices, moving people to universal coverage, what we will do is slow down the growth of health care costs, and at the same time, obviously what everybody is after is to start slowing down growth to something near the cost of living, plus whatever modern technology -- and to squeeze out the uncompensated care costs out of the present health insurance plan by making sure that everybody who now walks into an emergency room for primary care gets coverage.

The goal here has always been to slow down growth and to squeeze out the extra coverage that all of us have built into our premiums to cover those that don't have health insurance. So one could not say exactly what will happen to your insurance premium, but what we can say is, with the Mitchell bill, with the Daschle bill, the goal there -- and everybody believes that there will be good market effects -- will be to squeeze out the extra coverage that we're all picking up, plus slowing down the growth rate.

Q You were very exact, however, about over the last couple of years health costs have grown about 20 percent a year. So you can't be exact about what the Mitchell bill would, in fact, do.

SECRETARY SHALALA: Well, because what the Mitchell bill attempts to do is to change market behavior. In fact, all of this, including the Daschle bill, is an attempt to get the market organized in a way so that the consumer, using their power of choice, begins to get price and quality into the system and holds down and squeezes down and slows down both the growth of health care costs.

If we let the system just continue under its present rate, we will both squeeze more people out of the system, and at the same time because they won't be able to afford health care and their businesses won't, so that we'll have less people with health insurance, and at the same time all of us that have health insurance will be paying more and more for those that can't cover their own costs and walk into emergency rooms.

Q Didn't CBO say that the cost of health care under the Mitchell bill would increase over a ten-year period?

SECRETARY SHALALA: Well, CBO -- are you answering CBO questions or am I?

SECRETARY BROWN: I'll do it if you want. With regard to the CBO, the CBO found that the Mitchell bill was deficit-neutral. In fact, in the out years there will be savings. The CBO also found -- and this is very important -- that it could not estimate, based upon present information, the additional savings that would come about because of standardized benefit packages and the competition, the competition that would come about because there are standardized packages. So the CBO, we simply -- we think the CBO, even the CBO's estimate, was conservative in terms of the potential savings, benefits and the slowdown in increased costs that will come about.

I want to emphasize that the standard benefit package here enables consumers to do comparison shopping. Right now, the average consumer of health care is very varied, has a difficult time of understanding what he or she is buying. You have been through the experience. We've been through the experience, my family. It's like comparing apples and oranges. With a standardized package, you can actually see what you're buying. You can compare what you're getting from providers. And that, along with the preventive aspects, are very important. But the CBO did not specifically score that aspect.

SECRETARY REICH: Let me say something about process for a moment, because there have been a lot of questions about momentum and is this going any where. I think there's a lot of reason for optimism. Yesterday I believe we saw some significant breakthroughs. We saw breakthroughs the day before when some real debate started.

Senator Mitchell was very well received when he met with Republicans and Democrats trying to -- at least some of them --trying to work with him on making sure the Senate can act this year. Those who want to delay clearly have political motivations. The fact is, people who say we haven't had time enough just aren't telling the truth. This has been a debate that has been going on in America for half a century.

When President Clinton was elected President of the United States, the American people engaged on the issue of health care reform. The President and the First Lady have been around this country talking about this issue, engaging the American people. Literally thousands of people have been engaged in shaping the original proposals. The Senate has been working on these matters in committee for months and months and months. To talk about an unreadiness cannot be a suggestion made in good faith.

Q Secretary Shalala, Senator Nickles this morning said that he sent to you at your request a paper detailing 17 or 18 new taxes he says had to be unburied. Did you receive it? Did you read it? Can you comment on this?

SECRETARY SHALALA: No, I actually -- what I was trying to find out and the reason I asked -- the Republicans was they were running around saying there were 17 new taxes. And since in my reading of the bill I couldn't find 17 new taxes, as it turns out, what they were calling taxes were things that they certainly didn't call taxes -- like adjustments in the Medicare program in terms of the premiums and income testing the Medicare program -- they certainly didn't call them taxes when they were introduced Ronald Reagan and by George Bush. So they have a bunch of things on the list.

I was also trying to find out whether they really were counting cigarette taxes more than once. That is, counting the rolls of paper and cigars separately from other things. I appreciated him sending it over because no one could figure out how he got 17 taxes. I certainly didn't find 17 taxes. And as all the plans introduced by the Democrats, none of the have broad-based taxes. All of them focus on adjustments in the Medicare program on subsidies provided through cigarette taxes and through other kinds of mechanisms.

Q broad-based taxes --

Q The premium tax is on every health insurance premium. How is that not a broad-based tax?

SECRETARY SHALALA: Well, you know, we're going to get into an argument about whether it's a tax or it's an assessment on the premium because it's not income-based and we have conceded that there are in fact revenue raisers that are often measured as taxes in our bill. I was trying to find out whether there were all 17 of them, and I didn't find 17.

             Q    How many did you find?
             Q    The White House has previously said the Mitchell 

bill, with its goal of 95 percent coverage by whatever year the CBO says it will get there, is the minimum it will accept. This socalled moderate group's bill is likely to be less than that. You said you haven't reviewed, you're not sure where you stand on it. Is it possible that the White House could accept something like that? Have you changed your line in the sand about what the minimum White House will accept is?

SECRETARY SHALALA: First, we have never changed our line in the sand. We have always said that what we want to see in place is a system that leads us to every American getting health care, getting into the health insurance system in this country so that what we've been debating as people have put 95 or 85 or 92 is triggers or ways of evaluating the system once you get to that point, but all of the efforts have been to get everybody coverage. And our bottom line has always been we want to see a system in place that gets us to 100 percent coverage.

Q I don't believe anybody's claimed that the socalled moderate group would be coming forward with a bill that will get you to universal coverage. Isn't it your understanding that the bill would fall somewhat less than universal coverage?

SECRETARY SHALALA: We'll see when we see the details of the plan. Many of those moderates have always wanted to design a plan that would offer everyone the opportunity to get health insurance. There may be breaks along the way, and I really --

Q Does that mean you're --

SECRETARY SHALALA: Like at 95 percent we're going to take a look and see how we get to 100 percent, either with a commission or with some kind of a financing mechanism kicking in.

All of the discussions, every time someone has laid out a number, what we have asked is how do you plan to get to 100 percent. Do you intend to stop, take a look, have a recommendation to Congress? What is the process by which we will get to 100 percent. The problem of not having a system that will get every American covered is the rest of us who are covered pay for those who aren't in an inefficient way, and therefore, getting everybody covered in a fair way is important so that we don't end up paying for those who don't have coverage.

After all, the American health care system covers everyone now. It's just that some of us pay and some of us don't pay. And we've got to figure out a way in which all of us make a fair-share contribution.

Q If you talk about momentum, it looks like the House might be going home for a couple of weeks until after Labor Day, and maybe they'll hear from people that maybe they should go slower. Are you worried that if they go out they'll lose momentum?

SECRETARY BROWN: We have never said that the Congress is going to finalize its work before the summer recess. What we've said is we wanted them to make substantial progress before the recess so they can finalize their work this year. That is still our position. And, again, I think that there is reason for some optimism. I think we've seen some movement in the Senate, clearly slower than we would like it to be. Senator Mitchell has put a proposal on the table that we support. We would like to see it enacted into law. We believe that the House is going to be watching very closely what the Senate is doing, as its leadership has already announced. And we think that this can and should and must happen this year.

Q Secretary Brown, do prospects for passage of the health care reform improve and deteriorate the closer you get to the November election?

SECRETARY BROWN: Well, I think it's going to happen. That is, I believe that they improve as that pressure builds. I don't believe that the Congress of the United States can go home at the end of this session without taking a specific action to enact health care reform for all the American people.

Q Why do you feel that way when polls show that Americans are very split about this?

SECRETARY BROWN: There is a new poll every day. The American people have been subjected to the kind of misinformation and disinformation campaign, the likes of which we have seldom seen on any issue. Tens of millions of dollars being spent --

Q Who are the purveyors --

SECRETARY BROWN: -- tens of millions of dollars being spent by those who have a vested interest in the status quo. We all know that the status quo isn't good enough any more.

Q Why do you feel that there would be this pressure on them when they go home? Why do you think --

SECRETARY BROWN: Because I believe that every time they go home, people tell them at home that they want a health care delivery system that works for them. There are too many people in America who are scared to death about losing health care coverage, who don't take new jobs because they're afraid that they're going to lose their health care coverage, that sees the devastation that can come to the economics of a family because of our present inadequate system, and know that it has to be changed, and know that we must do better as a nation.

Q Mr. Secretary --

Q But aren't they also expressing fear that if it's done this year that might not be done right?

SECRETARY SHALALA: Look at it from our perspective. Look how far we've come already. For 60 years we have not been able to get to the Floor of Congress on major health care reform. We are on the floor of both Houses of Congress. The Senate is moving along. The House is waiting for CBO numbers, but intends to get to the floor.

If our perspective is longer than two weeks, then our perspective has to be that we've come an extraordinary way over the last 18 months and we're within, literally, a couple of months of a victory unlike any that we've had in this century on social policy or on health policy. So from our perspective, given where we started and where this country started, where we've been in the last 60 years, we are within a breath of enacting health care reform.

Q Por favor, listen to me. I want to ask you a question. Do you have confidence that when the people know the facts, know the policy in connection with the issue or the Mitchell bill and they know the people -- uncovered, the senior citizen, they are going to react. And the will of the people shall prevail and then the bill is going to pass. What is your opinion of that? And what role does Congress have in this situation? And do you believe that your trip to China is going to improve the calamitous situation of the people of the United States.

SECRETARY SHALALA: My answer is C, I don't know what -- (laughter.) I didn't get the -- I'm not going to China.

SECRETARY BROWN: Obviously, we feel very optimistic about the future. We think when the American people learn the facts, and one of the things that was our purpose today was to present some of the facts about the Mitchell bill -- Secretary Shalala did that, supported by Secretary Reich and myself -- we want to get those facts out, we want to explode the myths, we want to clear away the cloud of disinformation and misinformation, we want to take on the lies. And there have been some direct lies told about the Mitchell plan.

We think when the American people learn the truth, they will support the Mitchell bill and the similar Gephardt bill. On the final question, yes, obviously we wouldn't be going to China next Friday if we didn't think it was good for the American economy, good for American workers, and that the United States exports equal United States jobs.

Q Who is lying? The Republicans?

SECRETARY BROWN: I think many of the things -- when you look at a chart and you see that that chart is represented by those who are pointing at it as a sign of an immense federal bureaucracy, calling this some kind of federalized, nationalized system, that is a lie, that is not true. And any person who engages in that kind of distortion is not telling the truth to the American people.

I hope that you have looked at that chart and seen what the boxes say. And I tried to describe what some of those boxes say. They say things like "early retirees." That's a bureaucracy? They say "patients, nurses." They say, "prescription drugs." They say "doctors." And that is supposed to represent this new, gigantic bureaucracy. That is misleading, that is not telling the truth to the American people; it's as simple as that.

Q So some Republicans are lying?

SECRETARY BROWN: Some who oppose the legislation. Whether they be in the House or the Senate, or whether they be among these special interest groups who have a vested interest in keeping the system the way it is.

SECRETARY SHALALA: You know, the only bills that are out there being debated now are obviously -- in particular, Senator Mitchell -- I've now decided that we used to have this front-rudder status problem for people that were running for office. Now we have the front-rudder status problem of bills that are moving through -- that if you're out there, you get pounded on. And we think the Mitchell bill is solid, we think the Daschle bill is solid because it has the elements of comprehensive health care reform that the President started this effort with, and we will look at all of the other bills that come up as we see them, with those kinds of high standards, because that's what the American people expect.

Thank you very much.

Q Madam Secretary, how much help can Governor Chiles expect in Florida with the -- he is begging for federal help. Can I just get you to step up here?

SECRETARY SHALALA: I think that question really has to go to the Office of Management and Budget in terms of what additional programs are available. We are reviewing our refugee programs now to see -- with an extra number of people that are coming. But I think you should get a complete answer from Alice Rivlin on that question specifically.

Q But he's asking for help, because a lot of those people, thousands of people may be coming here are going to need health and human services.

SECRETARY SHALALA: That's right. Yes, I know, but it's an OMB question. I'm not trying to dodge the question, but it will be coordinated by the Office of Management and Budget.

Q How much are seeking? Can't you even tell us that? I mean, what's the need?

SECRETARY SHALALA: What the Governor's need is?

Q What does it need to be, yes.

SECRETARY SHALALA: Let's back up here. When you're in the federal government, or any other government, there are always going to be emergencies, whether it is the number of people that are coming to this country illegally, or trying to escape a government like Cuba, or whether you have a natural disaster. We have an organized way of responding to that. We obviously do not have huge cushions in our budget to do that, we often have to go to Congress. That's organized by the Office of Management and Budget.

And I have nothing but sympathy for the Governor of Florida for his concerns. And he's made a request that we look very carefully to see whether we can give him some additional help because he, clearly, as the Governor of Texas, the Governors of New York and Illinois and California -- they have overwhelming needs in terms of what's happening. We do have an initiative in relationship to that that Leon Panetta has discussed on a number of occasions with them. We do have a task force. But the specific question about this Governor's request, I simply will ask you -- and we'll provide a response from the Office of Management and Budget.

THE PRESS: Thank you.

END2:10 P.M. EDT