Return to Transcripts main page
THE SITUATION ROOM
Roadblocks to Health Reform; Dow Hits 12-Year Low; President Obama Hosts White House Summit on Health Care Reform
Aired March 5, 2009 - 15:59 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
WOLF BLITZER, CNN ANCHOR: Happening now, America's troubled health care system under examination. We're standing by to hear directly from President Obama about a high-powered brainstorming session that's going on at the White House right now.
Plus, bold and unprecedented attacks deep inside a critical airbase in Afghanistan. This hour, the danger and what it could mean for U.S. troops on the ground.
And fighting foreclosure, how one jobless man and his family might be helped by the bailout company threatening to take his home.
I'm Wolf Blitzer. You're in THE SITUATION ROOM.
But we begin with breaking news this hour. Once again, the Dow plunging almost 300 points on this day, as stock prices descend into territory not seen since the late 1990s. It's an added shot of economic misery for this nation.
Right now, President Obama is addressing another key source of pain, the soaring health care costs. We're standing by to hear live from the president of the United States as he wraps us this day, a summit on the life and death issue over at the White House.
Let's go to our White House correspondent, Dan Lothian. He's standing by with more on this part of the story.
Dan, we expect to hear from him fairly soon. Is that right?
DAN LOTHIAN, CNN WHITE HOUSE CORRESPONDENT: That's right, fairly soon he will be coming up to the mike and talking about everything that has happened today. The focus, of course, has been health care reform.
The president says the reason that he held this summit is because he wants to get health care reform done in a year. The White House admits that this is an ambitious timeline, but they're essentially saying that this patient is in critical condition and needs help now.
LOTHIAN (voice-over): President Obama says the high cost of health care is bankrupting American families, so he's pushing for reform and signaling that his ideas aren't set in stone.
BARACK H. OBAMA, PRESIDENT OF THE UNITED STATES: In this effort, every voice has to be heard, every idea must be considered, every option must be on the table. There should be no sacred cows.
LOTHIAN: The White House says this summit is the beginning of a conversation. Nurses, doctors, pharmaceutical reps taking part in five breakout sessions led by the president's top economic advisers and his newly appointed health czar.
The ultimate goal, helping nearly 46 million uninsured Americans and others who have insurance, but can barely afford it. People like optometrist Jim Matthews, whose health problems forced him to sell a successful practice.
JIM MATTHEWS, OPTOMETRISTS: I've entered into the perfect storm. I've hit the 55-year-old mark. I'm self-employed. I have health issues. And if you find that you're in that -- a category, health insurance is just incredibly expensive.
LOTHIAN: And there's laid-off public health nurse Terry Arsenault.
TERRY ARSENAULT, LAID-OFF PUBLIC HEALTH NURSE: I can worry about health insurance just like my patients.
LOTHIAN: The Clinton administration pushed hard for health care reform 15 years ago, but failed. John Podesta was an adviser in that White House and now has the ear of this administration.
LOTHIAN: The White House has some lofty goals, but so far, the plan lacks any real details. But critics say that the fine points will place a heavier tax and financial burden on some Americans -- Wolf.
BLITZER: Dan, stand by. I want to get back to you as soon as the president starts speaking. We're standing by for that.
There's no doubt that there will be opposition to the president's vision for health care reform, even though he has brought a lot of folks from all political persuasions into the White House for this summit meeting today.
Let's get more on what is likely to happen in the immediate period ahead. Our National Political Correspondent Jessica Yellin is watching this part of the story.
What are you seeing, Jessica?
JESSICA YELLIN, CNN NATIONAL POLITICAL CORRESPONDENT: Well, Wolf, it's fascinating. The president, instead of delivering a health care bill to Congress like the Clintons did last time, says he's going to work with Congress to develop a plan that members can be on board with. So, as you can imagine, there's already a gathering storm of groups preparing to spend, they say, up to $55 million this year to influence what reform will look like.
Now, already on the right, there's a group called Conservatives for Patients' Rights. They're fighting to limit government's role in health care. The group is run by a health care entrepreneur named Richard Scott.
(BEGIN VIDEO CLIP)
RICK SCOTT, CONSERVATIVES FOR PATIENTS' RIGHTS: If we want costs to come down, which will make it easier for everyone to buy insurance, to afford insurance, and we want affordable health care, it clearly has to be the free market.
(END VIDEO CLIP)
YELLIN: Now, ,on the left, there are a number of groups ready to push back against that. They want to craft a bill that expands coverage and protects consumers.
And Wolf, they're convinced that the insurance industry, while they say they're on board now, might object to whatever Congress does, and they're organized to fight back if there's another Harry and Louise type ad.
BLITZER: And we remember from '93, '94, early in the Clinton administration, they tried to reform health care. Hillary Clinton obviously leading the charge at that time.
What's different now, as opposed to then?
YELLIN: Right. And the Obama team, President Obama's team, is emphasizing this.
First of all, as I mentioned, the president says he'll collaborate with Congress on a bill. Second, there's really no need now to convince Americans that the health care industry needs to be fixed. Folks aren't necessarily happy with their insurance as they were 15 years ago.
There's wide consensus among the same groups that fought health care last time, like insurance industries. Now they're saying they're on board. So, if they stay on board, that's a huge change.
And finally, in case those groups don't like the final legislation and do end up fighting it, well, there are a number of well-funded supporters. They say they're prepared to fight for President Obama's vision with a $35 million ad campaign.
BLITZER: Yes. So they've learned some of the lessons from Hillary Care. Now, they're trying to move forward. We'll see how they do.
BLITZER: Stand by.
I want to get back to the breaking news we're following right now in the markets. Another horrible day up in New York.
Susan Lisovicz is standing by.
Give us all the details, Susan.
SUSAN LISOVICZ, CNN BUSINESS CORRESPONDENT: Well, Wolf, you know, one trader said to me today, "When there's no clarity, there's no confidence. And when there's no confidence, there's no buying."
And that is an understatement today, because we saw another huge sell-off. The Dow hitting fresh 12-year lows below 6,600, closing below that level. The S&P 500, a broader gauge, closing at levels that we last saw in 1996.
So just a huge sell-off. To see a 284-point may not seem like a lot to viewers, but remember, at 14,100, just in October of 2007, that would have been a 650-point drop. Huge.
BLITZER: Stand by, Susan. I'm going to get back to you as well.
We're getting ready to hear the president of the United States, but let's check in with Jack Cafferty right now for "The Cafferty File" -- Jack.
JACK CAFFERTY, CNN ANCHOR: There are some Democrats, Wolf, calling on President Obama to veto a $410 billion spending bill because it's too expensive and includes too much pork. Senators Russ Feingold and Evan Bayh both say they're going to vote against the measure. The bill, which would keep the federal government running through the fiscal year, includes $7.7 billion in more than 8,000 pet projects or earmarks or pork.
Bayh says the bill "requires sacrifice from no one, least of all the government." He calls the measure tone deaf and points to a disconnect between the belt-tightening average Americans are going through and what the government is doing. Feingold said, "Mr. Obama should veto the bill, tell Congress to clean it up do it over."
But other Democrats have defended the bill, saying it's necessary to counter the economic downturn and restore budget cuts made by President Bush. House Majority Leader Steny Hoyer defended earmark requests, calling them "the congressional initiative process."
Meanwhile, President Obama is expected to sign the bill once it gets to his desk. The White House says the legislation needs to be passed in order to "finish last year's business," and that the president will work with Congress to reduce earmarks in the future. At a meeting last week, the president reportedly urged Democratic leaders to limit future earmarks.
So here's the question: Should President Obama veto the $410 billion spending bill in order to remove $7.7 billion worth of pork?
Go to cnn.com/caffertyfile. You can post a comment on my blog.
The $7.7 billion, Wolf, is a small percentage of the overall bill, but it's the principle of the thing. Barack Obama campaigned on the idea that there wouldn't be any more of this stuff going on. BLITZER: It's a lot of money, $7.7 billion.
And here's the president. He's wrapping up a day of talks over at the White House on health care reform.
Let's listen in.
OBAMA: It is thrilling to see you here, Teddy. We are so grateful for you taking the time to be here, and the extraordinary work that your committee has already started to do, along with Mike Enzi and Max Baucus and Chuck Grassley on the Senate side.
Henry, I know that you guys are gearing to go on the House side.
So I just want to first of all thank all of you for participating.
Today was the first discussion in this effort, but it was not the last. In the coming days and weeks, we'll be convening a series of meetings with senior administration officials here at the White House to further explore some of the key issues that were raised today, and to bring more voices into the conversation. But my understanding is, is that we had an extraordinarily productive set of sessions throughout the day. And I've gotten a readout from some of the breakout groups and breakout sessions, and I just want to summarize a few things that my staff felt were notable and that I thought were notable and are worth mentioning before I start taking some questions or some comments.
First of all, a clear consensus that the need for health care reform is here and now. Senators Hatch, Enzi, Congressman Jim Cooper and many others agreed that we can do health care reform. Senator Hatch said that we needed leadership on both sides, and he believes the Democrats and Republicans need to put politics aside and work together to do it.
Senator Whitehouse said this isn't a "Harry and Louise" moment, it's a "Thelma and Louise" moment.
We're in the car headed towards a cliff, and we must act.
Now, I just want to be clear. If you actually saw the movie, they did drive over the cliff.
So I just want to be clear. That's not our intention here.
Insurers agree. Scott Serota with Blue Cross/Blue Shield Association said to consider past opposition the past. It is not the present. The time is right for action now.
The American Medical Association said that they are here to be partners and to help. Tom Donohue, with the Chamber of Commerce, said that in the previous debate, we knew where everyone stood. People are in different places now, including business, and that there is a vigorous understanding with all parties that improvements are needed.
And Congressman Joe Barton complimented the process we've begun and said that he can agree with the principals that we've laid out. My staff thought that was a very notable statement, complimenting the process. Melody (ph) I think slipped that one in.
With the respect to the cost of care, Richard Kirsch, with the Health Care for America Now, said that we can't have a false dichotomy between coverage and costs. That by covering more people, we can also lower costs at the same time, presumably because those who are not insured at the moment are ending up using extraordinarily expensive emergency room care.
Senator Whitehouse, you've got two quotes in here.
Senator Whitehouse pointed out that we pay more than a trillion dollars more than other countries for the same or lower qualities of care.
Ken Powell, CEO of General Mills, and a member of the Business Roundtable, stressed the need to preserve the role of employers and that many employers are investing in excellent prevention programs that are reducing costs and improving productivity. And I can testify to that. I've met a lot of extraordinary companies that really take the bull by the horns and are doing extraordinary work.
Many participants stressed we invest in prevention (AUDIO GAP) to tackle obesity, chronic care (AUDIO GAP) effectiveness.
Congressman Dingell talked about the need to simplify the system, to reduce costs and medical (AUDIO GAP). Senator Baucus mentioned the need to make investments up front such as health IT and compared effectiveness to get big savings, and that we have to align incentives towards quality.
And Congressman Waxman suggested the same point that's been made earlier, that we can't control costs unless everyone is covered.
With respect to the public plan, Congresswoman Jan Schakowsky and the AFL-CIO talked about the need to create a public option in order to reduce costs to consumers and save money within the system. There were others who raised some concerns about the impact of a public plan limiting choices.
As for paying for reform, Congressman Rob Andrews challenged the group to identify additional ways to pay for reform and suggested that everyone needs to put something on the table to get reform down.
And Senator Wyden raised the issue of modifying the tax exclusion for higher-income Americans. The last set of points that we thought were notable, Senators Grassley and Hatch and Congressman Dingell all discussed the need to address medical malpractice and reduce defensive medicine as a cost- saving measure.
So that's just some of the points that were made. I know that many of you had other insights. They have all been recorded, and we are going to be generating a document coming out of this that summarizes much that was heard in these various breakout sessions.
But what I want to do is just take some time now to give all of you a chance to hear from me directly, and I'm going to call on some members. I'm going to call from some of the groups that were participating as well. I'm not going to be able to get to everybody.
And since he got such a weak reception when he walked in, I think that it's only fitting that we give Ted Kennedy the first question.
So we've got a microphone here. Go ahead.
Or comment. It doesn't have to be a question.
SEN. EDWARD KENNEDY (D), MASSACHUSETTS: Thank you very much, Mr. President.
I join in welcoming or seeing all of you once again at this very special gathering.
I join with all of those that feel that this is the time, now is the time for action. I think most of us who have been in this room before have seen other times when the House and the Senate have made efforts, but they haven't been the kind of serious effort that I think that we're seeing right now.
If you look over this gathering here today, you see the representatives of all the different groups that we have met with over the period of years. I mean, you have the insurance companies, you have the medical professions all represented in one form or another. That has not been the case over the history of the past, going all the way back to Harry Truman's time, but it is the case now.
And it is, I think, a attribute to your leadership in bringing all these people together, and really a leadership of so many that are gathered here today.
Just in a very brief look-around, you can see representatives of so many of the different interests. It would be hard to think of those interests of being together and being as concerned, and providing the leadership that they are, as they are demonstrating that kind of a commitment as we have today. What it does is basically challenges all of us to really do the best we can.
And I know that you and all of your staff -- I congratulate Max Baucus and my colleagues who have done such an extraordinary effort today, just say that I'm looking forward to being a foot soldier in this undertaking. And this time, we will not fail. Thank you very much.
OBAMA: Let me -- I want to make sure that we are getting a good cross section of views on this issue, so why don't I call on our Republican leader, Mitch McConnell.
If you've got any thoughts or comments.
SEN. MITCH MCCONNELL (R), MINORITY LEADER: First of all, Mr. President, thank you very much for having this session today. I think it's useful, and it is significant, as Ted indicated, to have everybody in the room.
I'm also among those, as you and I have discussed before, interested in seeing us address entitlement reform, and admittedly, Medicare and Medicaid would be a part of that, but also Social Security. I'm particularly concerned about having a mechanism in place that guarantees you get a result.
And I wonder where you see yourself and the administration now, for example, in supporting something like a Conrad Greg proposal which would set in place a mechanism that could actually guarantee that we get a result, if not on Medicare and Medicaid, at least on Social Security.
OBAMA: Well, the -- I appreciate the question, Mitch.
As you know, we had a -- I think they can hear me.
As you know, we had a Fiscal Responsibility Summit similar to the gathering that we've had here, although, I have to say, the attendance here is even greater. And what I said in that forum was that I was absolutely committed to making sure that we got entitlement reform done.
The mechanism by which we do it, I think, is going to have to be determined by you, Harry Reid, Nancy Pelosi, and John Boehner and the members of Congress. We've got to make certain that the various committees are comfortable with how we move forward, but the important point that I want to emphasize today is that on Medicare and Medicaid in particular, which everybody here understands is the 800-pound gorilla, I don't see us being able to get an effective reform package around those entitlements without fixing the underlying problem of health care inflation.
If we've got six, seven, eight percent health care inflation, we could fix Medicare and Medicaid temporarily, for a couple of years, but we would be back in the same fix 10 years from now. And so our most urgent task is to drive down costs both on the private side and on the public side, because Medicare and Medicaid costs have actually gone up fairly comparably to what's been happening in the private sector, what businesses and families and others have been doing. That's why I think it's so important for us to focus on costs as part of this overall reform package. With respect to Social Security, I actually think it's easier than Medicare and Medicaid. And as a consequence, I'm going to be interested in working with you. And I know that others like Senator Durbin, Lindsey Graham, have already began discussions about what the best mechanisms would be. I remain committed to that task.
But if we don't tackle health care, then we're going to break the bank. I think that's true at the federal level, I think it's true at the state level. It's certainly true for businesses and it's certainly true for families. OK?
Henry, do you want to just give a little feedback in terms of what you heard and any points you'd like to make?
Thank you very much, Mr. President.
REP. HENRY WAXMAN (D), CALIFORNIA: Let me just say that Senator Kennedy will not be a foot soldier in this battle. He has been the inspiration to all of us, ,all Americans who held out the dream that every American ought to have affordable, quality health care. And I want to salute him for that.
Mr. President, by bringing people together, the different stakeholders, the people representing different interest groups, the Democrats and the Republicans, all of us together, I think you've given us an opportunity not to insist that we get all that we want, but to realize that we're part of a process. And that if we don't get everything we want, the alternative is not to do nothing, as you pointed out earlier, but to make sure that we've got the best system we can develop.
And that has to be a system that includes all Americans in health insurance that they'll be able to hold on to if they are satisfied with it, or to be able to access if they don't have it at the present time. So I think this is a very useful meeting.
Our breakout session was very on point, and I think it leads all of us to recognize that we have to work together. We all need to recognize there are going to be tradeoffs, but if we don't get it the tradeoff exactly the way we want it, we've got to recognize there's a broader public goal and purpose.
And your leadership I think is going to make this bill possible.
OBAMA: Good. Thank you. Thank you, Henry.
Is Jo Ann Emerson here?
There you are. Good to see you, Jo Ann.
REP. JO ANN EMERSON (R), MISSOURI: Thank you very much for having me here today. And thank you very much for the passion on this issue. Coming from a very rural, poor district in southeast and south- central Missouri, I have so many constituents who have no insurance, nor do those who have insurance necessarily have access...
OBAMA: Right, to providers.
EMERSON: ... to providers, particularly primary providers.
And so for us to be able to get together, all stakeholders, members of the House, Senate, Republicans, Democrats, business, labor, you name it, I think that that's critical. And I hope that all of us from both parties will be willing to kind of take a fresh look and say, you know, if there are laws that we had on the books before, that they need to be opened up if we need to change the system. And I think all of us have to be willing to kind of give a little, if you will.
And I thank you so very much, because for me, this has been a passion for all 13 years I've been in Congress.
OBAMA: Good. Well, listen, I appreciate your point, Jo Ann, and I want to amplify it.
I think it is so important that all of us make decisions throughout this process based on evidence and data and what works, as opposed to what our dug-in positions may have been in the past, because if we can at least agree on a set of facts, we're still going to have tough choices, but we're more likely to make good decisions on behalf of families. And so I want to be clear about my own position in this process.
During the campaign, I put forward a plan for health care reform. I thought it was a excellent plan, but I don't presume that it was a perfect plan or that it was the best possible plan. It's conceivable that there were other ideas out there that we had not thought of.
If there is a way of getting this done where we're driving down costs and people are getting health insurance at an affordable rate, and have choice of doctor, have flexibility in terms of their plans, and we could do that entirely through the market, I'd be happy to do it that way. If there was a way of doing it that involved more government regulation and involvement, I'm happy to do it that way as well.
I just want to figure out what works. And that just requires us to actually look at the evidence and try to figure out, based on the experience that's now been accumulated for a lot of years, you know, how can we improve the system? And I'm absolutely confident that there's going to be some low-hanging fruit. For example, the issue of health IT, I don't think there's any dispute between Newt Gingrich and Ted Kennedy that if we digitalize our health care system, we're going to save money over the long term, and we're going to reduce error and save lives. There are going to be some other areas that's not such low-hanging fruit, and there's greater dispute about what might work. But we have to keep that open mind that you called for, Jo Ann. That's going to be critical.
Let me go to Max Baucus and then Chuck Grassley. I want to get a sense of -- the folks on the Finance Committee, they're going to have some influence on this process. Just a little bit.
SEN. MAX BAUCUS (D), MONTANA: Thank you, Mr. President.
First, we've got some real luminaries in this room. Yourself.
A few hours ago, you mentioned that President Roosevelt tried to accomplish health care reform. He's over there in the corner. And I think he'd be very proud.
OBAMA: There's Teddy. The other Teddy.
BAUCUS: And I think he'd be very proud of what we're doing. That's right.
And the third luminary is sitting right to my right, right here. And I think in the spirit of all three of you, this is a terrific opportunity.
Second, the American public wants it. That's a no-brainer.
We're in a time in American history the American people want health care reform for all the reasons that you mentioned. This is, as you mentioned, a moral and a fiscal imperative. There's no doubt about that.
And you've started this process, I think, in very much the right way. Namely, getting us all together -- a tone, and a culture, and a feeling of cooperation and the constructive ways, evidence-based, what's the science, what works, what doesn't work practically and pragmatically.
And the real key here is for us to continue that frame of mind, continue that energy, to keep everybody at the table. This is all- encompassing. There are tradeoffs everywhere. This is a not a short- term tactical exercise. This is a strategic, longer-term plan here.
But it has to be a uniquely American solution. We're not Europe, we're not Canada, we're not Japan, we're not other countries. We're Americans, with public and private participation.
And there's no doubt in my mind, it's tapping into the good old American "can do" and entrepreneurial spirit that we're going to find a solution. And the key here really is to keep abreast -- all stay at the table, keep an open mind, as we're seeing how this works with that and so forth. This is clearly not going to be easy. There's a fairly steep learning curve for an awful lot of people to get this done, but clearly, the attitude is here, and the frame of mind is here, the desire is here to do this in a very cooperative way.
And I can't thank you enough for your leadership to help make all that happen.
OBAMA: Thank you, Max.
SEN. CHARLES GRASSLEY (R), IOWA: Mr. President, thank you very much for this opportunity.
From our breakout session, you'd probably get the idea that it's pretty easy to get done. We know it's very difficult to get done. But without that sort of feeling starting out, nothing would get done.
And I think you served with us in the Senate long enough to know that Max Baucus and I have a pretty good record of working out bipartisan things. Neither one of our parties get everything that they want, but we've had a pretty good record. I think only two bills in eight years that haven't been bipartisan.
And so we have a process in place that has hearings coming up. It has a process of getting roundtable discussions, getting stakeholders in, getting authorities in. And we expect to have work on this in a committee in June. Maybe it will sound a little ambitious, but if you aren't ambitious on a major problem like this that the country decides need to be done, it will never get done.
So the only thing that I would throw out for your consideration -- and please don't respond to this now, because I'm just asking you just to think about it -- there's a lot of us that feel that the public option, that the government is an unfair competitor, and that we're going to get an awful lot of (INAUDIBLE). And we have to keep what we have now strong and make it stronger.
OBAMA: OK. Well, let me just -- I'm not going to respond definitively.
The thinking on the public option has been that it gives consumers more choices and it helps give -- keep the private sector honest, because there's some competition out there. That's been the thinking.
I recognize, though, the fear that, if a public option is run through Washington and there are incentives to try to tamp down costs or at least what shows up on the books, and you've got the ability in Washington apparently to print money, that private insurance plans might end up feeling overwhelmed.
So I recognize that there's that concern. I think it's a serious one and a real one, and we'll make sure that it gets addressed, partly because I assume it'll be very -- be very hard to come out of committee unless we're thinking about it a little bit. And so we want to make sure that that's something that we pay attention to.
Couple other people I want to call on. I'm going to switch gears and get some groups in here, and then come back to a couple other legislators.
Karen Ignagni? Ignagni? There you are.
Good. Why don't you wait for a mike, Karen, so that we can hear you? Karen represents America's Health Insurance Plans.
KAREN IGNAGNI, AMERICA'S HEALTH INSURANCE PLANS: Thank you, Mr. President. Thank you for inviting us to participate in this forum. I think, on behalf of our entire membership, they would want to be able to say to you this afternoon and everyone here that we understand we have to earn a seat at the table. We've already offered a comprehensive series of proposals. We want to work with you. We want to work with the members of Congress on a bipartisan basis here. You have our commitment.
We hear the American people about what's not working. We've taken that seriously. You have our commitment to play, to contribute, and to help pass health care reform this year.
OBAMA: Good. Thank you, Karen. That's good news.
That's America's health insurance plans.
(CHEERING AND APPLAUSE)
OBAMA: And, you know, while I'm -- while I'm on it, why don't I call on Dan Danner, who's NFIB? Is Dan still here? There he is. There he is.
DAN DANNER, NATIONAL FEDERATION OF INDEPENDENT BUSINESS: Thank you. Thank you, Mr. President.
OBAMA: Give us the business perspective.
DANNER: Well, I'm honored to be here representing small business. We do think that small business has a key role in this debate. And for them, cost is still the top issue.
And we very much look forward to finding a solution together that works for America's job creators.
So we appreciate being here and thank you.
One thing I want to -- I want to talk about, just this whole cost issue. I can't emphasize this enough. There is a moral imperative to health care.
I get 40,000 letters, I guess, every day, here in the White House. I don't read all 40,000...
OBAMA: ... but my staff selects 10 every single day that I read and try to respond to as many of them as possible. It's a way of staying in touch with the constituencies that I had a chance to meet during the course of the campaign.
I can tell you that on average out of the 10 at least three every single day relate to somebody who's having a health care crisis. Either it's a small business that's frustrated because they can't even insure themselves, much less their employees, it's a mom who's trying to figure out how to insure their child because they make a little bit too much money so they don't qualify for SCHIP in their state. Heartbreaking stories.
So there is a moral component to this that we can't leave behind.
Having said that, if we don't address costs, I don't care how heartfelt our efforts are, we will not get this done. If people think that we can simply take everybody who's not insured and load them up in a system where costs are out of control, it's not going to happen. We will run out of money. The federal government will be bankrupt; state governments will be bankrupt.
So I hope everybody understands that for those of you who are passionate about universal coverage and making sure that the moral dimension of health care is dealt with, don't think that we can get that done without -- excuse me. This is a health care forum, so I thought I would...
OBAMA: ... model what happens when you don't get enough sleep.
Don't think that we can -- that's right, I'm talking to you liberal bleeding hearts out there...
OBAMA: ... don't think that we can solve this problem without tackling costs. And that may make some in the progressive community uncomfortable, but it's got to be dealt with.
And the flip side is what I would say to those who are obsessed with costs, and this goes to the issue of Medicare and Medicaid reform as well, I don't think it is a viable option as a means of controlling costs simply to throw seniors off the Medicare rolls, for example, or to prevent them from getting vital care that they need, which means, you know, we've got to balance heart and head as we move this process forward.
A couple other people I want to call on.
How about Charlie Rangel?
He has a tax committee that's important.
REP. CHARLES RANGEL (D-NY), HOUSE WAYS AND MEANS COMMITTEE CHAIRMAN: People have said that when I first came to Washington, George Washington had black hair.
RANGEL: But I have to tell you, Mr. President, this is one of the most exciting experiences and opportunities.
It hasn't been a year that we haven't talked about this, and you have brought all of these different stakeholders to read from the same page to show how important it is to our country. I'm excited about it.
The speaker has made it abundantly clear that there may be a lot of people to blame, but it won't be your committee people. It won't be those of us who have jurisdictions. There's nothing that we would rather do than be able to say that we helped for you to fulfill not just a campaign obligation, but a moral obligation. We all are indebted.
So Senator Kennedy, this is a fantastic day. There hasn't been a time we haven't hoped that we could do this. And so we know that there's going to be a lot of problems, but we also know what you've created is a group of missionaries who make our political job easier, so that when we have the problems, they won't have to say "what are they doing in Congress."
They can go to our union leaders, our business people, Advocate for Children, those that do want public programs, and at least we would know that we're moving in the direction that our country wants us to do, collectively so.
I'm proud to be on the team.
OBAMA: Good. Thank you.
Is your counterpart on your committee here?
RANGEL: Yes, he is.
OBAMA: Come on, Dave.
RANGEL: Me and David work so closely together. If we can keep the disagreements down, we'll be a hell of a team.
OBAMA: What I meant, Charlie, was let's give him the mike.
(LAUGHTER) (CHEERING AND APPLAUSE)
REP. DAVE CAMP (R), MICHIGAN: It's tough on the minority, let me tell you.
CAMP: You do lose the microphone when you're not in the majority.
But thank you, Mr. President. Thank you so much for bringing us all together. I think much of what has been said I can agree with. And I think particularly the idea that we have an American solution, and certainly in America the idea that a patient and physician make the health care decisions that affect them is certainly something we need to protect.
I just appreciate the opportunity to be here, look forward to working with you. There are so many things that we talked about that we had in common in terms of health information technology, wellness. But we are going to have to figure out, you know, just how much of our economy is devoted to health care, and that's going to be a big issue we have to face.
And there's cost-shifting that goes on between public and private health care dimensions. Those are challenging things, but I look forward to working with you and your team. Thank you.
OBAMA: You raise a couple of important points. Number one, doctors -- and I'm assuming that we've got somebody, and I'm going to call on them in a second, but I have got a lot of very close friends who are doctors. And the enormous pressure and strain that the medical profession is now feeling from a whole variety of sources is something that we've got to attend to in this reform process.
We're not producing enough primary care physicians, because the costs of medical education are so high that people feel they have got to specialize. The issue of malpractice insurance is real, and if you're an OB/GYN that is enormous pressure that you're having to deal with.
One of the things that we've done in this budget that we're presenting is to finally surface what had been the fiction that we weren't going to give doctors higher reimbursements. We always did it in the end. We just didn't budget for it and caused enormous stress for them.
Now, the flip side of it is, if we're going to do more for doctors, part of what we've also got to say is if there are states like Minnesota that are providing as good or better care than other states, and yet are keeping their costs lower, and Medicare and Medicaid reimbursements are better controlled, shouldn't we be learning from what those states are doing, and then making that more generally applicable.
And there may be some resistance on the part of providers to say, well, our circumstances are different in this state or that state. But this is what I mean when I say that data and evidence have to drive the process. If we can find better practices, then doctors have to be willing to learn from the experience of others in terms of controlling costs.
They have got to be part of the solution as well.
So, since I'm talking about doctors, we've got Ted Epperly of the American Academy of Family Physicians. Is Ted around here somewhere?
There you go. Go ahead.
TED EPPERLY, AMERICAN ACADEMY OF FAMILY PHYSICIANS: Well, first, Mr. President, what an honor to be here, and to be with all of you.
Speaking on behalf of over 100,000 doctors, we're ready to do our part. We very much believe that we need to expand coverage in this country to everyone, and we need to fix the work force, sir, so that all those patients have a place to go.
We'll roll up our shirtsleeves and do everything possible to make this work. Because it is the right thing to do, and I applaud you and this body for doing this today, to do it this year. And we must do it. Thank you.
(CHEERING AND APPLAUSE)
OBAMA: Good. OK, before we break up -- because we've been using some time, and I'm starting to get Reggie Love signalling over there. Whenever he stands...
OBAMA: ... since he's 6'5'', I see him and I know that...
OBAMA: ... we're running out of time.
Are there some people I did not call on that have a critical question or point that they would like to make?
REP. LOIS CAPPS (D), CALIFORNIA: Mr. President, thank you very much.
I'm Lois Capps, and I will love to follow the doctor. I also want to say to Senator Kennedy, this is the time.
As one of three nurses in the U.S. Congress, the proposals you are putting forward resonate.
Nurses do provide quality care. They help reduce costs through increased preventive care, and they deliver cost-effective primary care, along with physicians, especially in the underserved areas.
But we have a huge shortage of nurses of today. And the estimates are that the U.S. will be lacking over 500,000 nurses in the next seven years.
Our nursing schools are only able to admit a tiny fraction of applicants. The great -- greatest bottleneck for educating more nurses comes from the lack of nursing school faculty.
You've done a great job by proposing an increase in nursing education in your 2010 budget and by including nurse education funding in the recovery act.
I would love to your thoughts, if not -- if there's no time today, I would love to pursue this -- there are other nurses in the room -- on how we can further advance nursing education and faculty training, because they're going to be essential to our overall efforts to contain costs while expanding and improving care.
CAPPS: Thank you very much.
OBAMA: Well, let me respond to this right away, because it's not that complicated.
OBAMA: Nurses provide extraordinary care. I mean, they are -- they are the front lines of the health care system. And they don't get paid very well. Their working conditions aren't as good as they should be. And when it comes to nurse faculty, they get paid even worse than active nurses.
So what happens is, is that it is very difficult for a nurse practitioner to go into teaching, because they're losing money.
The notion that we would have to import nurses makes absolutely no sense. And for people who get fired up about the immigration debate, and yet don't notice that we could be training nurses right here in the United States, and there are a lot of people who would love to in that helping profession, and yet we just aren't providing the resources to get them trained, that's something that we've got to fix.
That should be a no-brainer. That should be a bipartisan no- brainer, to make sure that we've got the best possible nursing staffs in the country.
(CHEERING AND APPLAUSE)
UNIDENTIFIED MALE: Thank you, Mr. President.
I know you stress the cost efficiencies, and that is certainly important, and it was an important part of our breakout session.
But I also want to commend you for also being honest and saying that there has to be a new source of funding as well, because in your reserve fund you mentioned a new source of funding dealing with deductions, whatever, for people over a certain income. And I do notice that there is a tendency to think that we can somehow expand heath insurance and achieve coverage for everyone just with the existing money in the system, and I don't think that's true.
So I want to commend you for that, and I want everyone to keep in mind the fact that we have to come up with a new source of funding, either what you proposed or perhaps others, because even as you said in your budget message, that this only pays this reserve fund for about half the costs if we're going to cover everyone, and that's an important part of this as well.
OBAMA: Let me -- I want to make an important distinction, though, between short-term costs and long-term costs.
I don't think that we can expand coverage on the front end, without some money. By definition we will not have changed the system sufficiently to drive down costs in order to pay for new people being part of the system.
Now, keep in mind, we're already paying for those folks. Every single person at home, the average family is paying $900 per family in additional premiums because of the care that people are receiving in emergency rooms.
So we're paying for it, but it's -- it's oftentimes hidden.
But capturing those savings will take some time.
Health I. T. is going to save money, but it's not going to save money in year one or year two. It'll save money in year 10, year 11, year 15 and year 20.
If we're doing a good job on prevention and are reducing rates of obesity -- if we went back to the obesity rates that existed back in 1980, we'd save the system a trillion dollars, but we're not doing to do that overnight; it's going to take some time.
So what we constantly have to think about is short-term costs versus even higher long-term costs. And what I'm trying to do in this debate is make sure that we're focused not just on year one and year two, but on year 10, year 20, year 30 and year 50, and making sure that our children are not bankrupted.
Now that creates a very difficult political task. Nothing is harder in politics than doing something now that costs money in order to gain benefits 20 years from now.
It's the single hardest thing to do in politics, and that's part of the reason why health care reform has consistently broken down.
There -- there should be enough money in the system. We spend more per capita than any nation on Earth. And to find that American solution that mixes public and private, but also says we shouldn't have such an inefficient system and we should make investments today to ensure that we're saving money down the road, you know, that's going to be our challenge. OK, I have got time for maybe a couple more questions.
The gentleman right here, and I will catch folks back here as well.
LAWRENCE A. MCANDREWS, NATIONAL ASSOCIATION OF CHILDREN'S HOSPITALS AND RELATED INSTITUTIONS: Mr. President, my name is Lawrence McAndrews. I represent the National Association of Children's Hospitals.
First, I would like to thank you for your leadership with CHIP. Extending coverage to 4 million children is just fantastic.
OBAMA: Thank you.
(CHEERING AND APPLAUSE)
MCANDREWS: Second, as your leadership in CHIP has illustrated, perhaps children can lead the way. And I think we in the pediatric community, children represent 25 percent of the population, 10 percent of the health care costs.
And we, I think, are a small enough community, cohesive enough, the doctors and the hospitals working together, we know each other, that perhaps we can offer an opportunity to be another leading edge in your plan for change. And we would work with you in the implementation of any quality measures, any new incentive structures.
And I think children's hospitals can be a disrupter in cost (INAUDIBLE) because they take care of 40 percent to 50 percent of the market, and we can -- and they're the most expensive kids. Working with you, we can make the biggest down payment, the Willie Sutton principle, so to speak -- where the money is, we can help you manage that.
Thank you very much.
OBAMA: Good. That's a great point. That's a great point.
(CHEERING AND APPLAUSE)
OBAMA: I'm going to make this -- oh, suddenly everybody raised their hand.
OBAMA: I'm going to take two more questions. This young lady right here and then this gentleman right here. Just 'cause they had their hands up a little bit earlier.
UNIDENTIFIED FEMALE: Thank you so very much, Mr. President. And it's quite an honor for you having all of us here today.
You've created a network among us that we didn't even know exists. We are more alike than we are different.
And I would ask that all of us help to make sure that the elimination of racial and ethnic health disparities be a core component of whatever health care reform legislation may look like that you enact.
And I thank you again.
(CHEERING AND APPLAUSE)
OBAMA: Well, I think that's important. I think that's important.
And that's an example of where, you know, there is some data out there that's pretty indisputable that even when you account for incomes and levels of insurance, that you're still seeing problems in the African-American community, in the Latino community, Native American communities, in terms of quality of care and outcomes.
And part of what we should be doing is to think about, based on this evidence and this data, are there ways that we can close those gaps? And to the extent that that is reflected in this reform, I think that will ultimately save everybody money.
UNIDENTIFIED FEMALE: Thank you so much.
Just one really quickly.
UNIDENTIFIED FEMALE: If you will give us some marching orders before we leave.
IRWIN REDLENER, PRESIDENT, THE CHILDREN'S HEALTH FUND: Mr. President, I'm Irwin Redlener, a pediatrician at Columbia University's Mailman School of Public Health and president of the Children's Health Fund.
And I also just want to underscore how extraordinarily important this meeting was. It launches health care in a way that I don't think we've seen before in this country. And we all, I know, congratulate you deeply about that.
And I wanted to say just a couple of words about prevention, which has been mentioned a few times.
Prevention needs to be bolstered by a strong American public health system, as well. And we cannot forget about the public health infrastructure as we're building and strengthening our health care system in general.
So the public health schools are often the places where the research is done that tell us and guide us what kinds of preventive interventions actually work, and what works is really going to be important.
I also wanted to underscore what Larry McAndrews said about the importance investing in children. They are not only a compelling moral issue for us, but they are compelling fiscally, as well. America's going to be depending on its children to be fully functional, to function in school, to succeed in ways that can only happen if their health is protected and guarded.
And the final point is that I don't think we've mentioned yet the role of individual citizens. Every since American has a role to play in making us healthier as a nation. And your inspiration, and hopefully the inspiration of others here will make sure that individuals know that their choices of healthy lifestyle decisions and making sure they get the prevention that they need will bolster our ability to provide quality health care and reduce the costs of care that could have been avoided if we had thought about prevention in the first place.
OBAMA: And those are all great points.
(CHEERING AND APPLAUSE)
OBAMA: Let me just -- let me just close by saying this, because somebody asked for marching orders.
Number one, all of the groups here need to stay involved. And I know you will.
Number two, we will generate a report or a summary of the comments in the various breakout session that will be distributed to all the participants.
Number three, I know that Nancy Pelosi, Harry Reid, Mitch McConnell, John Boehner, and the other leadership are interested in moving a process forward.
And so, unlike the fiscal responsibility summit, where I think we have to have some discussion about mechanisms, and how do we make it work so that it takes?
I think, here, you've got a bunch of committees that are eager and ready and willing to get to work.
And so I just want to make sure that I don't get in the way of all of you moving aggressively and rapidly.
I have got some very strong ideas, and the White House will be providing some guideposts and guidelines about what we think we can afford to do, how we think it's best to do it.
But we don't have a monopoly on good ideas. And to the extent that this work is being done effectively in these various committees, then I assure you that we are going to do everything that we can to work with all of you, Democrat and Republican.
But the one thing that I have got to say here -- there's been some talk about the notion that maybe we're taking on too much, all right, that we're in the midst of an economic crisis and that the system is overloaded, and so we should put this off for another day.
Well, let's just be clear. When times were good, we didn't get it done. When we had mild recessions, we didn't get it done. When we were in peacetime, we did not get it done. We were at war, we did not get it done.
There is always a reason not to do it. And it strikes me that now is exactly the time for us to deal with this problem.
The American people are looking for solutions. Business is looking for solutions, and government -- state, federal and local -- need solutions to this problem.
So for all of you who have been elected to office, or those of you who are heading up major associations, I would just say what better time than now, and what better cause for us to take up. Imagine the pride when we go back to our constituencies next year and say, "You know what? We finally got something done on health care."
That's something that's worth fighting for and I hope all of you fight for it. Thank you.
(CHEERING AND APPLAUSE)
WOLF BLITZER, CNN ANCHOR: Walking over to Senator Ted Kennedy, who showed up at the Twitter today for this historic meeting kicking off the president's desire to get health care reform enacted this year.
Let's talk about what we have just seen.
Joining us, our senior political analyst Gloria Borger, Elizabeth Cohen, our senior medical correspondent, and Ed Henry, our White House correspondent.
Ed, I was struck at how open the president says he is. He doesn't have a monopoly on the best ideas. He wants to hear from everyone and then come up with a -- a plan. That was pretty extraordinary, I think.
ED HENRY, CNN WHITE HOUSE CORRESPONDENT: That was striking, Wolf, because, on the positive side, that can suggest this president is ready for solutions and is not going to pretend that he has the monopoly on all the good ideas, and he is going to leave it in Congress, in part, to work with these groups that are in the room, whether it's insurance companies, whether it's children's hospitals, et cetera, to work out the details.
On the negative side, though, as we saw with the stimulus plan play out, sometimes, when you leave the details to Congress, they can start adding all kinds of provision that pull you away from your core mission.
In the end, on the stimulus, the president won, but, as you know, he only got three Republicans on board. There were a lot of very controversial provisions in there. But he would say that, in the end, he got a good, strong final product. So, he may follow a similar path once again.
I think the other thing to pay very close attention to, when we talk about solutions, moving forward, is funding. That was something that came up near the end, when Democratic Congressman Frank Pallone congratulated the president on bringing up a tax in his budget by -- by basically changing deductions for wealthy people in America.
That's going to be the key point moving forward. The president, on the campaign, talked about, you know, basically making sure insurance companies -- companies cover preexisting conditions, require large employers to cover more of their employees. That's going to take money. It's going to take funding.
BLITZER: All right.
HENRY: And how is he going to do that? That's going to be a big, big challenge ahead.
BLITZER: I was also struck, Gloria, that this was open, open to the press, sort of different than during Hillarycare, as it was called, in '93, '94, where so many of the preliminary meetings were all held behind closed door.
GLORIA BORGER, CNN SENIOR POLITICAL ANALYST: I think that's what was unspoken in this long session.
You -- you had a group that was gathered out in the public. Everyone was included, both people who are likely to support President Obama on this and some folks who -- who might oppose him on this, all out in the open, meeting together.
And that was the problem 15 years ago with Hillarycare, which is that she just presented Congress with a piece of legislation, which they proceeded to rip apart.
BLITZER: And, you know, it was interesting, Elizabeth, as well, that a lot of doctors and nurses, they were there, as well, not the just inside-the-Washington-Beltway political crowd.
ELIZABETH COHEN, CNN MEDICAL CORRESPONDENT: That's right.
And you also saw insurance companies. And I have got to tell you, Wolf, from where I sit, doctors and insurance companies often do not get along. And there they were, joining hands, so to speak.
They called themselves missionaries for this cause to reform health care. They asked the president for marching orders. It's interesting. There's a lot of support for this -- for this concept. Will there be as much support when the details of the plan come out?
BLITZER: All right, stand by, guys. We're going to get back to you.
We're going to have a lot more on this story.
But I want to check back with Jack Cafferty right now for "The Cafferty File" -- Jack. .
JACK CAFFERTY, CNN ANCHOR: Just like the Bush administration, right, transparency in government.
This is great stuff that he's doing, these open forums on these big issues.
The question this hour: Should President Obama veto the $410 billion spending bill in order to remove almost $8 billion in pork?
Janne writes: "He ought to if he wants to keep any credibility with the American people. All I have heard from him is change and accountability, but I have yet to see him produce either."
J.D. in North Carolina: "So, the pork amount to almost 2 percent of the overall budget. The other 98 percent is more urgently needed than more partisan bickering and posturing. Ignore the so-called fiscal conservatives."
Jim in Wisconsin: "Yes, but allow the sponsors of the pork to apply for funding of their projects out in the open in a subsequent bill and support those that create jobs or stimulus with money from the stimulus package."
Marc in Orlando writes: "Congress chastises bankers for wasting stimulus money on extravagant parties and bonuses. Then they do the same thing and disregard the public trust by wasting money on earmarks meant to do nothing more than keep them in office."
Vinnie in Islip, New York: "Due to our failing economy post-Bush, it is not the right time for President Obama to play the tough guy and veto this porky spending bill. The pork projects will help create jobs across the country."
And Mike writes: "Cream puff question, Jack. Of course he ought to veto the bill. Otherwise, he is just like all the other politicians he has been complaining about."
Didn't see your e-mail here, go to my blog, CNN.com/caffertyfile, and spend the rest of your day looking for it there.
BLITZER: A lot of people will, Jack. Thank you.