Bob Dole, Bill Clinton and Dave Durenberger on health care reform

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Senate Minority Leader Bob Dole and President Bill Clinton speaking before the Plenary Session of the National Governors Association Convention in Boston's Hynes Convention Center. Speeches highlighted differing views on proposals for federal health care coverage. The biggest debate is the issue of universal coverage. Following speeches, MPR’s Dan Olson interviews Dave Durenberger, Minnesota U.S. Senator (I-R), who provides commentary about legislative health care reform.

Read the Text Transcription of the Audio.

From National Public Radio in Washington, this is special coverage of speeches by Senate minority leader, Bob Dole and President Bill Clinton on proposals for federal health care coverage. I'm Frank stay show both men spoke earlier today before the national Governors Association Convention in Boston. This exchange comes as Congress prepares to press out some form of compromise from among the many plans now under consideration the biggest gap between the president's plan and that is Senator Dole is the issue of universal coverage, which the President says is essential to Health Care legislation, Senator Dole Is steadfastly opposed Center. Was first to address the convention the governor's convention in Boston Hynes Convention Center.They let me in the gate. That we're meeting here in a city. That's home a lot of early American leaders. I mean the founding fathers put together our constitution. They often understood that state and local governments are much in a much better position to respond to the needs of the people and sometimes the federal government. And unfortunately the past many many years. The relationship between federal and state government is almost turned into one way street. With Washing DC dictating what you can and cannot do in forcing you to pick up the tab on the end of string of unfunded mandates. The cost of those mandates are devastating financially and devastating and turn the blocking your ability to develop Innovative programs and solutions. If there's one thing that Congress could do to restore balance in the federal state relationship of weed to pass s 993 the kempthorne Glenville, which is now awaiting action on the senate floor. the legislation the legislation that you know was compromised slightly in the committee, but it's still a big step in the right direction. And I listen to Center to Mitchell and he was Siri said that the chance of bringing it up depends whether or not Republicans behave properly. Those are his words in other debates. But I certainly respect Senator Mitchell but to use a Tiramisu may be familiar with there is no need to keep s99 3 waiting in the on-deck circle because a bill has overwhelming support and it could be passed very quickly tomorrow. For example wouldn't be much debate. I think it has a lot of support bipartisan support. So the federal-state relationship is also at the core of the Congress on going to Bates Healthcare welfare reform in crime and let me touch upon those issues now. As I look around the room, I note the absence of a few Governors notably. Governor Edgar and as you know Jim underwent emergency bypass surgery week ago. I spoke to him last week and he's not on the way to recovery. Jim learned firsthand with Governor Casey all solar not long ago. And that's the fact that America's healthcare system is the best in the world performing near Miracles every day. and when we began this debate on a bipartisan basis Democrats and Republicans alike share the same goal doing all we could ensure that every American had access had access to that Healthcare System that best healthcare system in the world. That was surprising skull that was my goal. That was your goal as well. But in reaching that goal, we always had to keep certain things in mine rather important things. We had to keep in mind the cost of healthcare, which is I understand may have been the reason the bill didn't pass in Vermont because of the cost. The price of healthcare reform should not be the complete takeover of 1/7 the economy by the federal government and a new burden on middle-class Americans. We also knew the price of healthcare reform should not be the loss of millions of jobs has been estimated minute and a half to a million some 3 million jobs. the price of healthcare should not be bankrupting states are bankrupting our children by simply talking on Untold billions the national debt and I must say as Executives you understand the importance of least having some idea what something may cost. And at this point we're not certain because we don't have estimates on many of the major bills. Andy cost of healthcare reform should not be the destruction is what I've called the best Healthcare delivery system in the world. No, no doubt about it there. We're in the final stages this year of the health-care debate. It was a debate that began as a bipartisan manner in a bipartisan manner. And I think despite the ratcheting up of the rhetoric by the White House and the Democratic National Committee. And I might I guess the Republican Penny had allowed to we don't have the money but we do the best we can. But I think the seeds of a bipartisan plan still exist if the administration's want to come our way. And I believe it's very important. When I say come our way and I say the seeds of the bipartisan plan, where did I go to get those seeds? Why went to the call to action? You should buy the governor's Democrats and Republicans last January. Much of which is contained in your prose proposal. Is in the proposal put forward by Senator Packwood in myself. And we didn't put the proposal forward as a republican plan or is an opposition plan to present Clinton as you know, they're at least 5 6 7 8 plants in Congress and probably more than that, but five or six I've got that out of committees. Ours hasn't gotten out of Committee of the be offered probably is a substitute for opiate time. We call our plan the American Auction not a republican. Option the American option. We've been in contact with nearly a dozen Democratic senators. We met a number of times that the congressman and dr. Roy rolling the Democrat from Georgia and Congress and Mike Della Rocca's who had the Rolling Rock is building a house that about 75-80 co-sponsors about an equal number of Democrats and Republicans. So I want to make it clear that we're looking for a bipartisan solution. Just as I believe the governor's are looking for a bipartisan solution. And we hope that it's out there somewhere. And a lot of things we agree on a lot of things you agree on and again, I guess how you've already made these reforms affordability and pre-existing condition reforms don't maybe affects all the states, but it was in the call to action. But we think Insurance reforms dealing with issues like portability and pre-existing condition that was in the call to action. We think that was a good idea State Design and run voluntary purchasing Co-op to get was in the call to action your call to action. We we listen we heard we could we got the message. It's in our package. A core benefit package and subsidies for low-income Americans that's in the call-to-action. That's an r package. Medical malpractice, which I think is very very important. We want doctors that spend more time with their patients instead of more times with defensive medicine trying to avoid a future lawsuit and we have a strong Provisions as you suggested in the call to action. Really fat man. I trust statutes administrative simplification is all of these were contained in your call to action. All the help the so-called middle-class and all these can be found in what we call the American option the door Packwood proposal. I think it's fair to say it. They've all been in politics for some time that in our business of politics. We never say that someone is against us. Either they're for us or they're undecided. And I have noted that there is one key issue in the door pack would proposal on which the governor's are undecided. That of course is a cap on Medicaid and I put you all down as undecided. We knew going in you'd be undecided on this issue and we assume that you still are on the side. We also understand to make it work. As I've said in every appearance that I made you got to work with a Governor's you got to give the governor's flexibility. They are the Laboratories. They are the innovators and we need to listen to drivers Governor's regardless of party. And so we've already started in fact started long before somebody raised it in rather distorted article in New York Times on Sunday. We started negotiating with members of the governors Association on how can we change it? How can we make it work? So there's some pressure on both of us and both on on the stage. So we don't spend a lot of money. So you can be sure that we understand first of all, we understand your concerns about being left holding the bag and I believe we can work together to settle our differences. How we going to do that? But if you got real technical, I'll have to go to bend, twist up here, but I just say generally. We're flushing out. What ideas to give the states the option of buying in all afdc and non-cash recipients into the private sector program? So the large majority of low-income individuals whether they're the working for or not working for is Gunnar gamble Mansion. We don't think there would be class distinction here are treated the same and we don't believe the non-working fluoride have better benefits than the Working Poor. And as yours yourself suggested to the greatest extent possible. The low-income population receive is Healthcare through the same delivery mechanism as the rest of the population again, no class distinction. That's not the American way and that's not our proposal. So we're going to continue. our efforts In addition to propose Medicaid cab could well be replaced or some variation of the maintenance of effort that's in the finance committee bill that make certain it's in your interests and ours and negotiate the most reasonable rates will the insurance plans for those low-income individuals. So I wanted to say it at that point. We know that you have a problem with Medicaid cat. I didn't come as any great shocked and take a rocket scientist to figure out that might be a problem for Governors, but our door is open will be open. We think we can resolve it and we're anxious to continue our discussions because we want to get health care bill pass a bill passed this year. And I need not remind you that the administration bill as also far from perfect in regards to Medicaid. In both the administration building in the fan finance committee proposal would phase out the Medicaid disproportionate share payments something. We're very much opposed to and that's a big big ticket item in a lot of the big States lot of the other states, New York, California particular. It's okay. We don't have that in our bill. That's about a 50 billion dollar item over 5 years at the states would like to continue that we made got it back just a bit, but we don't cut it out. We don't face it up. So I guess the question is where do we go from here? But I think the president will agree. I'm not certain what he's going to say. I think we have to get back to the issues that matter the most. And notwithstanding what the medium a report or what happening on whatever. This issue is not about Bill Clinton vs. Bob Dole or the Republicans versus Democrats or republican Governors or Democratic Governors versus some other group or the poor verse is the middle class. I think the healthcare is too important to be turned into class Warfare was a political Battle of personalities. And again like men in this room. I'm a living example of somebody who's had a lot of healthcare. I become the prostate pin-up boy in Washington DC is one example, and that's only the latest episode. And I understand a little about affordability and accessibility. His many many years ago and I got out of World War II and all the good doctors have gone. I want to go to some private doctor, but I didn't have the money. So I might have a counter Russell County Kansas a password on a cigar box and raised $1,800 so I could go to Chicago. So I think I know a little about accessibility and I know a little about affordability. And I believe that we're just as sensitive as anybody else on any side of this issue and it's not politics. Politics. And I don't think the television commercials organized attacks on Pizza Hut which app is be headquartered in Kansas or others who would dare speak out against the the administration's proposal? helps a process one bit I think we need to move past the rhetoric or the press and say that's morning on television. He spoke yesterday in Miami. I think it's time for a second opinion. And I think we all ought to be ready for a second opinion. We're dealing with a very important issue and it's just going to pack every American. And if we start the class Warfare game the poor the not the Working Poor not working poor the middle-class the rich then I were going to be right back in the same old Battle of same old rhetoric. Am I view the American people have heard the debate? Hey if you're going to town meetings as you have. And they got in record numbers and they call our office in record numbers Nick all talk shows a written letters. And maybe someone say well they just don't understand it. I think they understand it. But like most consumers when something is so complicated. And an Arab you so bureaucratic weather at the state level or federal level when you don't understand that you don't buy the product as a consumer. And maybe that's why the news CNN USA Today Gallup poll today said there's about 55% opposed 40% support. So what are you going to do about it? We're going to keep trying to push and push and push have it all. We got to have it all. every Gardener app support employer mandates That's a big problem States like ours is the governor knows where most of our people employers have 10 or fewer employees, but 87% most at five or six. We're not a big state and there a lot of small states represented. The Congress is everybody here knows. So it just seems to me we have we need a reality check. We need a second opinion. And the Healthcare System may not be perfect. But it is the best in the world. It does need repair, but I'm not certain needs a complete and total overhaul. I'm not certain. Of complete and total take over by the federal government and somebody wants to tell me what universality is. Would be happy to listen. How do you get there? And how much does it cost? Is a 91% 92% 95% Is it Ivory soap? What is it? I think access universal access. I have no brother. Everybody being covered in America. Got to figure out how we do it. How much does it cost? And I guess between getting it done right and getting it done fast many of us like to get it done, right? So I we shouldn't be setting artificial deadlines. We've been told if we're good boys and girls in the Congress and eat our vegetables and pass Healthcare we go to recess. We could care less about the recess. This is a very important issue if it takes all of August and all of September and all of October to debate this issue. We all have that debate. I remind you that even in Social Security, we don't have universality that by 95% We didn't cover agricultural workers lot of other workers the first phase of social security. So this idea to the everybody has to be covered immediately in my view is going to be very tough sell, but we're prepared to do whatever the leadership in the Congress and they say we're going to do it going to do it. But keep in mind. We're about to create the largest. single entitlement program ever created in history and we've been talkin a federal that we've got a commission in the Senate on how to reduce entitlement programs. We got to go after entitlements. We're going to deal with a budget and while we're doing that. We're about to create a new entitlement. We do it in our program to don't misunderstand me. We create a new entitlement a hundred billion dollars over five years for low-income. Ours is small compared to others. So we need to legislate a language. We need the details. There is my Governor it would take up or satellite just flashing your legislature. We did have some idea what it's going to cost. I didn't know what was in it. Didn't know what the options were. And I think we remember in our business. We never get everything we want. A real Health Care reform in my view is still possible. Let me quote from the store in the Wall Street Journal on July 8th that I think it'll be required reading by everybody in Congress and a concern Health River Health Care reform in Minnesota. And it says and I quote. Last year Minnesota held itself up as a state that could teach the rest of us how to overhaul the healthcare system in a hurry in a hurry. This year reform-minded states such as Minnesota have a new message. The new message is don't try to fix everything at once. And the State Health commissioner said our buzzword this year is sequential reform doing things one step at a time. I hope that the federal level people will do the same. I mean that's pretty good advice. And I hope we do the same. Let me just move them quickly dude couple of issues then I'll conclude. I think welfare reforms another issue not certain going to pass this year going to be hearing Late July or maybe an effort. Somebody even said suggest you just put welfare reform on the health-care bill have an Omnibus Bill that would really create a lot of excitement and probably take us a few days, but it's has crossed the minds of a few so it's another place. We got to get out of your way wherever we can. Because again, we think the states are much closer to the problem at a lot better ideas. while listening to mourn mandate less Nike the most important things I said is getting out of the way I know that. Governor Engler, I think to ask Mitchell about language in the Advil the bar States from receiving new USDA approved waivers convert food stamps to cash benefits or wage subsidies. and I think the and I hope And I think Center Mitchell to support it. But there's a McCain amendment to do just that which may be offered today in the Senate. And I believe this is another example of State flexibility. Let the states have the flexibility. What are we afraid of at the federal level? And we hope that the amendment will drive go sponsored will will pass today or tomorrow finally on crime. Is that a past a bipartisan crime Bill 94 to 4? It's pretty good. Margin. Make the forward Euler goes into conservatives who didn't think it went far enough for one too far or whatever. There is 8 months later. We still have nothing to show for their efforts. And what are the sticking point is this so-called racial Justice act and who could be opposed to racial Justice? I called you look at the title. No one that I know of be opposed to racial Justice. But this is a part of the long tradition of giving bad legislation a great sounding name. We do that in Congress frequently and a lot of the things that sound the best probably the worst. And although more than 30 State Attorney General Democrats and Republicans of urge Congress to drop the ACT. Bring it would sound the death knell for their state definitely loss. President Clinton and attorney general so far. It's our remained neutral on it. And I think if we could break this logjam, we could probably move on get a crime bill, but I must say there are other things in the crime bill, at least we ought to take a look at it. We got all kinds of spending programs and I'm not going to list them all but I just really want to back to the card billions and billions of dollars in new spending programs. Nobody thinking about hearings on we even have one program for a program to coordinate programs, which probably doesn't surprise anybody here. This is about the federal government. We have local Partnership Act youth employment drug treatment, residential substance-abuse midnight Sports gets 40 million. We got everything you ever wanted and you all going to get money. So I assume maybe you're all for it, but it's going to cost a lot of money. And some of us, please. It's the wrong direction certainly ought to be treatment certainly ought to be opportunities for young people. But a lot of people that's going to be worried about the victims and I'm certain everybody here is worried about the victors. So they're all these 12 13 billion dollars and all these new social engineering programs. I think you could at least some Americans believe. That some prevention may make sense. And we want to do it. We want to do it, right. But I think it's a prison cell rather than the pork barrel. That's the most effective and we hoped it in the conference. They can cut out some of those spending programs. And that's where the federal grabbing can and should make a real difference. By providing you the states with the resources to ensure that violent criminals are kept behind bars where they belong. a lot of Statistics out there, but one is pretty Bulletproof is a fact if you're locked up, you're not out committing violent crimes. If you do the time is everybody here knows my red quotes and something the governor has to do the time you do the do the crime you do the time. What we're suggesting at least in truth in sentencing, if you have violent offenders, then you ought at least to 85 or more percent of the time 13 billion dollars were talking about we don't want to siphon all that often some of these good sounding programs cuz I think that would not be helpful at all. That'll grab it also can be more of a hindrance to help in your own efforts the war on crime. Gunner symington 5 Simonton tried to get pornography out of the Arizona Prison System only be overruled by a federal judge. In other states federal judges to decide of the prisoners liking access to television and basketball courts Upper cruel and unusual punishment. And federal prison caps orders that led to the early release of violent versus criminals. And as Governor, is it by Wilson? Well pointed out of the David Brinkley show just on Sunday. Federal judges are too often acted as legislators. Create an exclusionary rule on the establishing elaborate system Criminal Appeals all of the name of habeas corpus and the result of more delays more expense and more frustration. And it seems to me that's not the way we ought to go. That's not what the American people want us to go. So, let me conclude by this. We heard the call to action getting back to health care. We responded to the call to action by Democratic and Republican governors. We know when your pastor greeted that call to action. It was done in good faith. Not a bipartisan basis and that still were coming from and we're still prepared to go back and take a look at that call to action if there are other questions that somebody wants to race on the Medicaid cap. I believe that can be resolved. And I just hope in the next 30 days because we're down to that 30-day. No. We're going to have Healthcare this year is probably going to come at least the next 30 next 40 days. if we go beyond the August recess if there is an August recess come back after Labor Day That September 9th a lot of people running for re-election this year want to get reelected that would only leave 30 days to do all the other things plus health care because I think best guess is we'll adjourn sometime October 6th through the 10th. That's why I just believe the governor's can have a very important impact. If you want to go all the way. Sorry that you're right. I've been set of Peace day. Is it going to be the good doll or the bot bad though? I don't know which is which my going to try to work this out or try to destroy. I'm just trying to respond to what I have heard across the country Republicans and Democrats alike. We can still get it done. And I hope that's the same message. The presents will deliver when he comes here sometime later this morning. I'll be happy to have somebody has a question if there are questions. Senator Robert Dole speaking earlier today before the plenary session of the national Governors Association Convention in Boston a short time after Senator Doles speech President Clinton to dress the governor's you discuss the number of issues and owing to time constraints. We will restrict our coverage to the president's remarks on health care, of course the most politically difficult and politically charged this you were facing today is the issue of healthcare. It shouldn't be surprising for 60 years. The American people have seen their leaders periodically try to provide coverage to all Americans and reform the Healthcare System only to fail the most encouraging thing perhaps it has happened to today so far is the comment that the senator Dole made that now is the time to act and he is willing to work all through August and September and October to get something done. That is what we ought to do. We ought to do whatever it takes and work. However long it takes on whatever days it takes. To get something done. I would like to set this again into some context you gave me the privilege of coming and speaking with you about this last year and I don't want to be just going over old ground, but I think it's important when we decide what it is. We should do or shouldn't do to talk again about what the problem is. First of all and the United States. We are the only country in the world with an advanced economy that doesn't provide functional full coverage. That is somewhere, you know, 96-97 98% social security has 98% You always got a few people just walking around out there. So there's it's impossible to have 100% coverage of anything. but all other major Nations do this We don't secondly in spite of the fact that we don't we spend 40% more of our income on Healthcare than anybody else this year. We're at about 14.2% of our income going to healthcare Canada is at 10 Germany as at 8 and a half. And Germany is you know as a very fine pharmaceutical industry, very fine research industry in high quality Healthcare as well. Because healthcare costs have been going up faster than the rate of inflation. They've been eating up and ever larger percentage of both National and state budgets. You know, there's a lot of you who served for sometime have seen your budget every year ago more and more and more for health care less and less and less for education for economic development for tax relief or whatever else you might wish to do. If you look at the chart of the federal budget, it's absolutely stunning. Now. If you do take start next year and string it out to the end of the decade. We are pretty flat in all discretionary spending the fence is coming down and I would argue is coming down just as much as it can and it should not be cut more. And health care costs are exploding. The job of being a congressman or a senator then for 5 years will amount to showing up in Washington right in healthcare Jackson going home. Unless we do something to reverse these trends. And yet in spite of the fact that we're spending much more money. We are the only nation in the world is going in reverse and coverage 10 years ago 88% of the American people were covered today 83% are now You may say well that's just one in six. What that's good 83% recovered. The problem is 16% is a lot of folks for one thing 17% secondly and perhaps more importantly the number of people who are at risk of losing their coverage is far greater. Who's locked into coverage? Who's locked in if you're on Medicaid if you're very for your locked in? If you have Medicare you're locked in. You're in jail. You're locked in you get coverage. If you're very wealthy you're locked in cuz you can buy if you're a politician. Are you work for government? You're locked in and you get it. Almost everybody else is at risk of losing their Healthcare. And keep in mind you have pushed for lifetime learning you have because you recognize that younger workers are going to change jobs seven times in a lifetime. Now, how are we going to provide that kind of security? And let me say there is a human face behind this. I don't want to class Warfare. But let's look at the facts over 80% of all the people without insurance in America are people who work for a living. They're working people this morning. I had coffee with a man named Jim Bryant and his wife Mary and their two children because I read about him in the Boston Globe. You work 60 hours a week and don't have any health insurance. And I talked about how much they worked and said they had a good life and all the extra money. They had that were put away for their kids college education, but they'd be ruined if they ever had an illness. And I asked him if he could afford to pay something. He said sure I said would you like to know how much I pay a month for Health Care is the president knighted states are members of Congress or members of the federal government. He said yeah. I said we pay about $100 a month. and our employer you FaZe $300 a month and he said I could play that easy. He said I could pay twice that. I was in Western Pennsylvania Governor Casey state. By the way, I appreciate your support for reform in your attempt to resolve the abortion issue gum Acacia, but I was in Western Pennsylvania, Greensburg, Pennsylvania to women got up and spoke before me. I don't know if they were Republicans Or democrats don't have any idea who they voted for. One of them was a Dairy Farmer. 62 years old and you know, that's about the hardest farming areas. You got to work 7 days a week cuz you can't tell a cow's to quit producing milk. 62 years old and finally had to give up Health Care at the time. She needed it Most Wanted then she and her husband cuz he just couldn't afford it anymore. And then after that a woman spoke who was a mother of five children, and she introduced her husband. She had had cancer and he had had to change jobs and then to have health insurance. And there are a lot of people out there like that. We're talking millions of people not just a few. Savannah issue is not just them but it's everybody else. It could be in that position. Now. The reason I'm bringing this up is that it is important to understand what the problem is when you analyze what the solution should be and the problem is not just at 160 American people don't have Healthcare and at the cost of running out of control, but that many many more Americans are at risk of losing their Healthcare. So the question is, what should we do? I recommended a system of private insurance participated in by everybody. with a break for small business They give them lower-cost and allows them to buy insurance small business and self-employed people in farmers in big groups. The way government something employees do employers do. maintaining consumer choice, but with cost constraints like Managed Care And then I went around the country and listen to people and listen to y'all. Tell me what you thought was wrong with it. And we came back with modifications that had less bureaucracy fewer boards and commissions more flexibility for the states. Less burden on small business then we originally proposed more choices for the American people in healthcare and a longer facing. Because there is always a law of unintended consequences and everything. So everybody in this debate agrees. We have to face this in No One Believes we can do it next year everybody believes. This has to be a multi-year phase-in. Now that's what we offered and you can find that in some form or fashion. in the bills which are working their way through the Congress. Now, what is the alternative? If you want to cover everybody or nearly everybody there are near as I can. Tell there only three ways to do it. You can do it the way Canada does and the way we do for seniors through Medicare by having attacks. It does it. That didn't seem to me to be feasible abolishing all Private health insurance and replacing it with the tax. Although you could do it for even less money than we're spending the day and cover everybody. You can do it. The way Hawaii does in the way Germany does and the way most of us do it by just extending the system we have now and asking employers to pay some portion of their employee health insurance and ask. Can you please pick up the rest? You can ask the employees who don't have insurance to cover their own insurance and give them a break at their low-income people to do it. Probably that obviously is whether you would encourage everybody who's on the margin the doctor employees. There might be some other way to do it, but I'm not sure what that would be. You could get close to that maybe by a system of subsidies to middle class and lower middle-class people and by putting all the small businesses giving them at least a chance to be in Byers Co Ops and doing something like what doesn recorder and others have done with the Medicaid Program to put it in some sort of Managed Care situation so you can save some money and provide some money to cover others. But I asked you to look at the evidence more than forty-five states have passed some sort of partial Health Care reform Insurance reform the last few years, but State spending is continue to go up business spending on health Care's continue to go up and coverage has continued to go down and eat in a study. I recently saw only 10 states actually had reduce the number of uninsured people after all their reforms were implemented in five of them only had reduce the number of uninsured working people mostly states that it provided very generous benefits for people who would move from welfare to work. So what are we to do? It was a recent Wall Street Journal article, which said that even in States that had Insurance reform for that Universal coverage quote fewer people have coverage then under the old system. Why is this? Why is this? because the system we have encourages waste and inefficiency and responsibilities under the system. We have people who cover their employees pay for those who don't Indirectly because people who don't have coverage when they get real sick show up the emergency room. They get Healthcare in the cost or pass along because of the system we have without more people and managed competition environment the more you do the more you earn. Whether it's needed or not, Pennsylvania has had a very valuable reform in this regard by simply publishing the cost of various procedures across the state of Pennsylvania and the results showing that there is not necessarily a correlation between the most expensive care and the best results care that something could be done everywhere. And finally it's very expensive because we're the only country in the world that has 1500 separate companies riding thousand different policies so that every doctor's office every hospital every insurance company has to hire a slew of clerical people to figure out who's not covered for what and we pay for all that. That's 4.2% difference in America and Canada. Let me just give you an idea about how much it is. That's about 250 billion dollars a year. That's not chicken feed. Some of that money is because of medical technology and high quality Care some of that money is because of violence and illness and age but a lot of that money is just pure old-fashioned inefficiency. And so we have to ask ourselves. What should we do? You have already said no to an alternative proposal that would cap the federal share of Medicaid. Cut Medicare without giving any extra benefits of senior citizens use money to help the poor and do nothing for the middle class. I think it is important to take the rhetoric out of this and ask what will work. I heard again. The Litany of things that people have said that we don't want a government takeover 1/7 of our economy know we don't that's why I propose doing what who why did Hawaii's not in control of the healthcare system. Are you governor? Private insurance not a government takeover. We don't want job loss of congressional budget office SLB job gain, if you stop all this car shifting over a 10-year. And wise experience indicates that there will be job game. We do not want to bankrupt the states. And we don't want to buy Krupp the federal government. That's why we have to have hard cost estimate. At least we have them on our plan. now I read your Proposal and we have made some changes in our plan to reflect your proposal to make it more flexible respect State and issues more have less regulation don't have mandatory alliances. But the question is what are we going to do? That works just yesterday the Catholic Health Association release the study conducted by Lewin vhi which says that if you have insurance reforms and low-income subsidies without having coverage for everybody middle-class people earning between 20 and $29,000 a year will wind up paying $484 a year more for their insurance. Why is it? Because if you require everybody to be covered and you say they can take it from job to job, but you don't have everyone covered. There are more single individuals who think they'll be healthy and live forever won't buy health insurance more small businesses on the margin will drop it and the cost will rise for everybody that's left. So I say to you, you know, it was Senator Chaffey a distinguished Republican senator from Rhode Island who said that you can't have these Insurance reform for that Universal coverage. He said that I didn't said it was difficult to conceive of how you can have a right of people to carry their insurance policy from job to job to job unless you had some system in which virtually everybody was covered. now if you look at the Hawaii experience They have had a program based on employee employee shared responsibility since 1974 two years after it was first proposed by President Nixon and Senator Packwood. They have had it. What's happened infant mortality is down by 50% The number of people without insurance and shrunk dramatically unemployment has fallen. The cost of living is higher in Hawaii than almost any place else in America with small business premium to 30% below the national average. Why does everybody participate nobody wants anybody else out of it and everybody's in Big Pine pools? now What are we going to do? I will say again we have to do something that works. We have to do something that works for families like Jim Bryant his wife and two kids something that work for the people that are out there and all of your State's who are working who are not. I was in Columbus Ohio the other day and I talked to a woman who ran a delicatessen. She had 20 full-time employees 20 part-time employees and she had cancer five years ago, and she said I'm in the worst of all worlds. I cover my 20 full-time employees and we pay too much cuz I'm a small business person and I've got a pre-existing condition. And I'm at a disadvantage with all my competitors. But I feel guilty that I don't cover my part-time employees if you had a system where I could buy insurance at a rate competitive with government and big business and where my competitors had no advantage over me. I would gladly do it. So again, I say I am open to any solution to this. And I believe the states are to be the Laboratories of democracy and I want you to have more flexibility, but at a certain time I heard Governor rumors coming earlier. We have to look at the evidence. and so I say if you imagine what the world will be like when the century turns and we start a new millennium if you imagine what it would be like in America and what you wanted to be like and what you worked so hard for it to be like you want us to have a competitive economy. You want our deficit to be under control. You wanted a debt to be a smaller percentage of our income. You want us to have a system of lifetime learning you want us to have a trading system where we can grow in the world economy. You do not want every governor and every president of both parties in the future to spend all their time writing checks where they're paying more every year for the same Healthcare and they haven't solved the problem which has been solved elsewhere. All I ask in these closing weeks of this debate is it we take the political air out of the balloon and ask ourselves. What will work for ordinary Americans now? Let me close. How many clothes just by asking everyone if you read this letter that was published in the Boston Globe this morning? Because one thing I think every democrat or republican every independent America agrees, is that for people who have it? We have the best Healthcare in the world. We are the finest medical schools of finest Medical Center has the best medical research. Everybody agrees on that Senator Dole and I agree on that everybody does. This is a letter from the people who are providing it in this area. They are part of the 100 people who came to the White House the other day representing academic medical centers. Who said if you want to keep what is best about American Health Care, you will have to fix what doesn't work about it. You will have to find a way to cover all Americans because we are being hurt now. We used to pass our cost on everybody else but states are controlling their cost the federal government controlling their cost these big companies that used to send their employees to our Medical Center. They're controlling their costs and we are left holding the bill for all the poor people we have to care for and all the middle-class people with horrible problems that show up without insurance. And please give us Universal coverage. If you want the medical schools of America to continue to work read this. All I have tried to do folks is to consult with everybody from Doctor poop who was President Reagan Surgeon General to the heads of our biggest medical school to the heads of our biggest corporations that can't deal with her medical problems to the small businesses that want to buy insurance. You can't to come up with something that works. I have no pride of authorship and no proud of details. I just want to do what will work for people like Jim brightness wife and kids and I think you do too if we'll keep that attitude will find a solution of the next three To the problem of healthcare. Thank you. And God bless you all in Boston at the meeting of the national Governors Association and before him you heard Senator Bob Dole the Senate Majority Leader on the line with us from Washington. DC is Minnesota. Senator Dave durenberger. Thank senator for joining us at the pleasure. Thank you for having me Senator you serve on the finance committee and on the labor committee, I believe I have that right both taking a look at the various proposals is that snow are both the funding of healthcare reform and then the essential philosophy of the reforms still big obstacles for members of Congress or have major elements of one of the other been essentially decided already. I think the the healthcare reform elements have been virtually decided there still a difference in how we approach the whole issue of national rules for local markets. The the labor committee Bill the the president's is still in Tucson premium controls price controls and and I employer mandates on the other side Bob Dolan Lottery public under insisting that we we use Medicare and Medicaid savings to empower Americans who are at work to buy catastrophic plans and him by their own doctor Services button, but a lot of the other issues Insurance reform reforming the way markets are going to work at 8 rust medical liability reform. A lot of those issues have been dealt with it's the the fact that you can't talk Universal coverage unless you're willing to raise taxes or the deficit or or something else and nobody's willing to do that. That's the problem. I gather from your answer if we've gotten by the main obstacle then of of the issue of who gets and who loses power in this reform in this in the reforms, We need now is for that the president and the Congress to decide. What do they mean by Universal coverage the sort of a the who gets covered by a health plan on how we going to pay for it if if they would get off that issue or resolve that issue. We could tie up the last ten per-cent on on the reforms the rules for the way markets. Are you heard the president? He said he had the coffee with the Boston family and they talked about the fact they don't have health coverage and that they could afford to pay $100 maybe even double that amount out of their pocket each month to pay for some kind of Health Care coverage. What's your personal take on how much a citizen should have to pay out of his or her pocket for coverage? And then how much the employer pick up is? Is there some kind of racial you've come to I think the NBA she really is. What are you buying it if we could ever decide for you people can understand what it is. They were buying then they could make judgments about what the pay for it. That's the best difficult far. We've got one third of our people the elderly disabled and low-income people that are forced into a government run programs like Canadian programs in the middle of the United States people at work don't have a choice of Health Plans, even if they're even a lot of people have employers who say this is the plan we got here this take-it-or-leave-it basis of health plans and how they've been going to be covered. You can't take a dollar amount say this is all I'm going to pay a people get value for their money. They're willing to contribute if they don't if they see that their discriminated against in some way somebody works for one come to get the same product for a lot less money than somebody has different one of the movement of healthcare reform proposals to Congress. Is there a lot of stuff being attached to the Health Care reform proposals that maybe a members pet ID our project but may not be germane and his results holding a Progress. Well, that's a good question. But at this stage that's not been our problem. That's that's a problem that comes along when you get near the end and when you get in the conference committees, and when the political Powers come out in the end the reformers try to get overwhelmed by the pain, we have been successful through the two to have you know, really big deal with what it is that makes a more informed consumer and a better provider of care and I ain't hyeh Builders relationships. How do you have nice clean rule that everybody can understand without serving a variety of The Selfish interests that are served by the current system. We've been able to beat off these interests in one way or another and and I just hope that I hope that holds all the way to the end of the ball game because the consumer interest can only be served if we can keep that special interest playing by the same rules that everybody else has to play by one of the scare messages if you will that is being put forth by some of the players in the Health Care reform debate is that we are going to lose the very desirable very cutting-edge kind of medical technology experimental medical development in the healthcare reform process of reforms are enacted. What what it what is your take on that? What I think it's a it's a very real concern to raise that that we in Minnesota or I mean, I just talked this morning to a dad of a of a of a young woman who with leukemia, you know, who just thank God that that we made the kind of Investments not only in in technology but in the in the oncologist and the the wonderful people at this hospital that are that are saving This Woman's life we could use to that a Minnesota. We also get used to the fact that it doesn't cost us an arm and a leg compared to what it doesn't some other states have to put that at risk. In fact, in fact if we're so good at what we do in Minnesota and it cost a little by comparison then everybody ought to be coming from these high cost less less. Appropriate Healthcare Statham coming to Minnesota. You can't do that under the current under the current system. And so only up only a system where it where you can tell what quality is, you know, what payoff comes with results there is responsibility on the part of the consumer and there's accountability on the part of the the the the producers personal relationships things like that. Cuz the system can you bring the cost down on this system medical technology, for example of the cost saver get on an airplane, you know when it's full of Technology, but it had saved you could save your money and get you get you a safer ride to get you there quicker and all that sort of thing in the same thing is true and Healthcare, but only if you the healthcare Market government doesn't know how to use technology government doesn't know how to get quality up in price is down and that's worth fighting for a we're fighting or real markets that really work briefly Senator up. What are you hearing about the effects of any health care? Or mayhap on small business is there enough detail that has emerged to really say much about that at this point. I'd let them learn in Minnesota that that if small businesses and individuals can buy with the same buying power that General Mills are the health care action group for 3M of those folks can buy with you can turn the system on its head and get better quality for lower-priced. We just need to find the ways to enable those small business people to buy into the system at the same rates in the same quality in the same value. We call him coops a present to call them alliances. We think they oughta be a private entities like the co-op's we've all grown up with. I don't think they ought to be more semi-governmental, but in the end the point is give the small business people the same power the same price break the same adjusted Community rating that that you give to a large employer buyers you're going to turn this market around very very quickly in right-center to thank you very much Senator Dave durenberger joining us from Washington, DC.


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