

			 THE WHITE HOUSE

		  Office of the Press Secretary
		     (Kansas City, Missouri)
______________________________________________________________
For Immediate Release                          April 7, 1994     

	     
		     REMARKS BY THE PRESIDENT
			       IN 
	     POTUS TOWN HALL MEETING WITH PRESIDENT CLINTON 
	     
	     
		     KCTV Television Studios
		      Kansas City, Missouri



7:05 P.M. CDT
	     
	     
	     MR. ANSCHUTZ:  Welcome to News 5's Town Hall Meeting 
with President Bill Clinton.  Tonight the President joins us to 
talk about the health care crisis in our country and his plans to 
reform the health care system.  It's a rare opportunity for 
people in the midwest to talk face to face about their concerns.
	     
	     So, ladies and gentlemen, please welcome the 
President of the United States.  (Applause.)
	     
	     THE PRESIDENT:  Thank you, Wendall, and thank you, 
Ann.  Thank you, ladies and gentlemen here in Kansas City and 
those in Tulsa, Topeka, and Omaha, who are also joining us.
	     
	     I came here tonight to talk to you a little bit 
about my hopes for health care reform for America, and to listen 
and learn from you and to try to answer your questions.  I'd like 
to make a brief opening statement, if I might, and sort of 
summarize what is in our administration's health care proposal.
	     
	     Let me begin by saying that I have been interested 
in health care a long time.  My mother was a nurse anesthetist.  
I grew up around hospitals.  I watched health care change and 
diversify.  I was an attorney general when I had to fight for the 
rights of our elderly people in nursing homes in my state.  And 
then, for a dozen years, I was a governor when I saw, every year, 
our state have to pay more and more and more in the Medicaid 
program -- that's the government's program for poor folks and for 
elderly people in nursing homes -- oftentimes paying two and 
three and four times the rate of inflation for the same health 
care.
	     
	     I have, in the last four years, since long before I 
ever thought about running for President, talked to literally 
thousands of doctors and nurses and health care professionals and 
families who have been dislocated by the health care system.  And 
I decided that we had to do something about it for the following 
reasons.  And let me just try to set them out for you.
	     
	     First of all, our country is the only advanced 
country in the world that doesn't provide health care security 
for all of its citizens.  All the countries we compete with, all 
the wealthier countries, provide health security.  Only the 
United States does not do that.  And we pay a dear price for it.
	     
	     We're a nation of about 255 million people.  At any 
given time, 39 million of us are uninsured.  In every year, 58 
million are uninsured.  Eighty-one million Americans live in 
families where there's somebody with a so-called preexisting 
condition, where there's been a child with diabetes or a daddy 
with a heart attack or a mother that's had cancer.  And what that 
means is that they can't either get insurance, or they pay much 
more than anybody else, or they can never change jobs again, 
because if they change jobs they'll lose their insurance.  
	     
	     There are so many Americans who have special 
problems.  I met a young woman again at the airport here in 
Kansas City today -- a wonderful young woman named Vicki White, a 
young girl that has brittle bone disease.  She came to see me 
back during the campaign, and I was glad to see her again.  Her 
mother gave me a letter, sort of talking about their hopes and 
their dreams and their worries about the health care system.  I 
could tell you a lot of stories about that.
	     
	     But I think we have got to find a way to cover 
everybody.  Another thing that you will recognize here in 
Missouri because you see it in the changing job market, people 
are changing jobs more than ever before.  And it's very important 
that people be able to change jobs without losing their health 
care, or their families losing it.  Even though since I became 
President -- I'm proud of this -- we've had an economic program 
that passed and our economy has created 2.5 million new jobs in 
the last 15 months, more than in the previous four years.  But 
still, as you all know, a lot of big companies are still laying 
off even as smaller companies create jobs.
	     
	     How are we going to guarantee that people will 
always have health insurance?  It's a huge problem.  There are 
lots of other problems with our system -- 133 million of us have 
health insurance policies with lifetime limits, which means that 
if any of us have children with long-term illnesses, we can run 
out of health insurance just when we need it most.   The main 
thing is almost no American is secure unless you work for big 
government or big business.
	     
	     Another thing I'd like to point out is most small 
business people want to provide health insurance and many do, but 
that rates for small businesses and self-employed people and 
farmers, on the average, are 35 to 40 percent higher than the 
same insurance rates for big business and government; and that's 
not fair, either.  So I think we've got to do something to turn 
this around.  Now, let's look at what our choices are.
	     
	     What I want to do is to guarantee private insurance, 
not to have the government take over the program, and I'll tell 
you why.  We have basically three choices today.  We can just do 
away with private health insurance all together and pass a tax 
and cover everybody through a tax, like the Medicare program for 
senior citizens.  I don't favor doing that.  
	     
	     It would be administratively simple, but it would 
put the government in health care too much, I think, and we'd 
have less competition and therefore less control over prices.  Or 
we can have more competition, but guarantee private health 
insurance to everybody.  That's what I want to do with a 
comprehensive benefit package that includes primary and 
preventive health care, with no lifetime limits and with 
insurance that can't be lost just because a worker gets older or 
someone in your family gets sick.  
	     
	     I also propose in our plan to keep choice because I 
think choice is very important for quality.  People should be 
able to choose their doctors or a high-quality health care plan, 
not employers.  And insurance companies shouldn't be able to deny 
anybody coverage.  Now, today, more and more Americans insured at 
work are losing their right to choose.  Fewer than half of 
American workers have any choice at all over their doctors or 
their health care plan today.  Our plan would guarantee that 
every year every working family would have at least three choices 
and pick among them.  
	     
	     We have to make some insurance reforms.  It would be 
illegal under our plan for anyone to be dropped or to have their 
benefits cut by insurance companies; for rates to be increased 
just because somebody in the family had been sick; for lifetime 
limits to be used to cut off benefits; or for older workers to be 
charged more than younger ones.  This is a big deal, folks.  I've 
met people in their late 50s and mid-60s who are losing their 
jobs, who have to get new jobs, who are good and reliable workers 
but employers are scared to hire them because their rates are 
higher.
	     
	     Now, let me say, we'll come back to this.  The only 
way we can do this fairly is to reform the insurance market, 
because if you have 1500 separate companies writing thousands of 
different policies, it's hard to afford to be fair to small 
business people.  The only way you can be fair to small business 
people is let small business people and self-employed people go 
into big, big pools and be insured the way big business and 
government people are.  
	     
	     I want to preserve Medicare, leave it like it is; 
it's working for elderly people.  Except we ought to add a 
prescription drug benefit which is very important to elderly 
people and will save money for our health care system over the 
long run.  And I think we should cover things other than nursing 
home care, including in-home care, because the fastest growing 
groups of Americans are people over 80 and we need to provide for 
their care and help their families.  
	     
	     This is the most controversial part of our plan, I 
suppose, at least among organized groups.  I think the benefits 
should be guaranteed at work.  That is, I think employers and 
employees who presently aren't covered should contribute to their 
health insurance; and then the government should cover the 
unemployed, should cover part-time employees when they're not 
working and should help to provide discounts to small businesses 
that have low payrolls, low profit margins and relatively high 
costs now.
	     
	     If we cover employees at work and give discounts to 
small business and have the government help the unemployed, I 
think that's the fairest way.  Why?  Because nine out of ten 
Americans who have health insurance have it through their 
workplace.  And eight out of ten Americans, believe it or not, 
who are uninsured have someone in their family who works.  So I 
just want to build on what we've got now -- guaranteed private 
insurance; preserve the right to choose a doctor or health care 
plan; change the insurance practices that don't work  but also, 
don't put the insurance companies out of business, let them 
insure people in bigger pools; preserve Medicare; and guarantee 
the health benefits through the workplace.  That's our plan.  
	     
	     There may be other ideas and better ones, but let me 
say, I'm absolutely convinced if we don't do anything, we're 
going to continue to have millions of Americans in misery, 
millions of Americans insecure; we're going to pay 40 to 50 
percent more than any other country in our income in health care 
and have less to show for it.  I don't think that's an acceptable 
solution.  So for those who don't agree with me, I hope they have 
an idea about how we can provide health security to all of our 
people.  America can do it if every other country can do it.  
Thank you.  (Applause.)
	     
	     MR. ANSCHUTZ:  Mr. President, as you just heard of 
course, has answered some basic questions about his plan.  And I 
know it has raised some questions in the minds of our viewers as 
well, and that's what we want to get to now.
	     
	     We have in our studio about 160 people from the 
Kansas City area who have questions for the President.  We also 
have three other cities that will join us in tonight's town hall 
meeting via satellite:  From Tulsa, Oklahoma, and CBS station 
KOTV, we are joined by our host Glenda Silvy.  From the capital 
city of Kansas, Topeka, and the studios of  WIBW-TV, we are 
joined by host, Ralph Hipp, a man from our neighbor state to the 
north 
from Omaha, Nebraska.  We are joined by station KMTV-TV and our 
host there, Loretta Carroll.  So that is kind of the cast for 
tonight's program.  Let's get on with the questioning.  The first 
comes from here at home, Ann Peterson, my co-host, and she has 
the first lady.
	     
	     MS. PETERSON:  Welcome, Mr. President to Kansas 
City, and here to KCTV.  I'd like you to meet a woman who nearly 
lost her mother to a medical emergency.  She didn't get the care 
she needed because she was worried about cost.  What is your 
question to the President?
	     
	     Q    First of all, I would like to say, good 
evening, Mr. President, and thank you for being here.  Mr. 
President, could you please explain why Washington continually 
fails to put the country's priorities back in the order in which 
they belong, and why our officials can't or won't take a serious 
and compassionate look at our health care reform?
	     
	     THE PRESIDENT:  Well, I didn't write that question 
for her, honestly.  (Laughter.)  Let me try to give you an answer 
that's not so -- that's a little more objective, maybe not quite 
so favorable to my position.  This is a complicated issue.  You 
wrote us a letter, didn't you?  Didn't you write a letter to my 
wife?
	     
	     Q    Yes, I did.
	     
	     THE PRESIDENT:  And your mother got health care 
late, expensive, because she was afraid she couldn't afford it?
	     
	     Q    Yes, exactly.
	     
	     THE PRESIDENT:  This is something I should tell all 
of you -- another point I didn't make in my opening remarks, but 
let me say, as all of you know just from common sense, most 
people in America who don't have insurance get health care if 
they're real sick.  But they get it when it's too late, too 
expensive.  They usually get it at an emergency room.  They don't 
pay, and then the emergency room at the hospital has to decide 
whether they're going to pass the cost along to the rest of us so 
that we pay more than we should or whether they are going to 
absorb it, and therefore, weaken the financial condition of our 
health care providers in our communities.  So I want to set that 
up.
	     
	     Now, why hasn't this been done?  People have been 
trying for 60 years to do this.  First of all, because America 
historically is very antigovernment.  We think the government 
would mess up a one-car parade.  (Laughter.)  And so, we are 
afraid for the government to do anything involving health care.
	     
	     Secondly, because small business people, in general, 
often think that they cannot afford any more requirements from 
government.  They're paying a lot for worker's comp; they're 
paying a lot for Social Security; they have a lot of costs.  They 
are worried about whether they can do this.  And I hope we get a 
chance to talk about this, because I believe most small business 
people will come out ahead on our plan and I'd like to explain 
why.  That's a problem.
	     
	     Third, because the thing that's wrong with the 
American health care system is not the health care providers.  
We've got the best doctors and nurses and medical research and 
medical technology in the whole world.  The thing that's wrong 
with our system is the way it's financed.  But a lot of good 
people are employed in the way it's financed now.  You know, we 
are the only country in the world with 1,500 separate health 
insurance companies writing thousands of different policies 
which, in turn, require literally hundreds of thousands of 
clerical workers in doctor's offices, hospitals and insurance 
offices to figure out what's not covered.  Right?
	     
	     It's not a good way to spend money, but there are a 
lot of good people doing it.  And there are a lot of good people, 
independent insurance agencies, for example, that are doing the 
best they can for their own clients within this system.  If we 
cut back on the administrative costs and spend the money on 
health care, we'll create more jobs in health care, but we'll 
lose jobs in the paperwork end of health care.  We spend about 
$90 billion a year in the United States, more on administration 
and paperwork than any country would under any other system.
	     
	     So a lot of things will get changed.  People are 
scared of change, skeptical of the government.  Small business is 
sensitive, and the health insurance financing system will be 
changed.  That's what's against our changing the system.  I think 
the arguments for it are much more powerful, but oftentimes, it's 
harder to change than it is to stay the same.  That's why we 
haven't done it.  That's why we need stories like your mother's 
story out there to remind us of the human issues at stake.
	     
	     Q    Thank you.
	     
	     MR. ANSCHUTZ:  Let's get on now to our satellite 
coverage of tonight's town hall meeting.  As you know, we have 
three other stations who are involved.  And let's go to the first 
one in Tulsa, Oklahoma, where Glenda Silvy is standing by.
	     
	     Hello, Glenda.
	     
	     Q    Hello, Wendall.  Thank you.  And Tulsa also 
welcomes you, Mr. President.  Our first question comes from a man 
who has a question relating to rural health care.
	     
	     Q     Mr. President, I am a physician in a small 
town in Oklahoma.  I wonder if the health care in the rural areas 
will continue to be provided by physicians or by other trained 
individuals such as physician's assistants, nurse practitioners, 
et cetera, as opposed to continued physician care for our 
patients.  I think this is an important issue, and I'd like an 
idea of the Clinton approach to the plan.
	     
	     THE PRESIDENT:  Well, first, sir, I think that 
medical professionals should be able to do what they are trained 
and properly qualified to do.  But what I hope we can do is to 
put more physicians out in rural America.
	     
	     Under our plan, there are some very special 
incentives to try to get more doctors to go into rural areas and 
to small towns.  We want to revive the National Health Service 
Corps and put another 7,000 doctors out paying off their medical 
school bills by practicing in underserved areas over the next 
five years.  
	     
	     In addition to that, we propose to give significant 
tax credits to people as income incentives to go out and practice 
in rural areas, in shortage areas.  Physicians get quite a bit.  
And where there's a nurse shortage, nurses and other health 
professionals can get some as well.  
	     
	     And the third thing we're going to try to do is to 
give more support to physicians in rural areas, do more to 
connect them with medical centers through technology, do more to 
provide tax incentives for them to buy their own equipment so 
they can provide high quality care. 
	     
	     So my goal is to have more people like you in small 
towns and rural areas.  I just came back from Troy, North 
Carolina, where I was talking to doctors there about the terrible 
medical shortage.  And I met a woman who told me that she had 
worked 100 hours a week for two or three months in a row, and she 
was now down to her slow season where she was down to 80 hours a 
week, because they didn't have anymore doctors.  So I think that 
one of the things we have to do is to try to keep the doctors in 
rural America if we're going to keep rural America alive.
	     
	     MR. ANSCHUTZ:  Thank you, Tulsa.  We go now to 
Topeka, up to the north.  
	     
	     Q    Good evening, Wendall.  And good evening, Mr. 
President.  We're delighted to be a part of your town hall 
meeting here in the Kansas capital, home of the Meninger 
Foundation.  And I'd like to introduce this gentleman, who has a 
special question of interest about that field.
	     
	     Q    Mr. President, mental health insurance coverage 
needs to be equal and a parity with physical health  insurance 
coverage.  Has Tipper Gore discussed the importance of this with 
you?
	     
	     THE PRESIDENT:  Yes.  (Laughter.)  You want me to 
talk about it a little bit?  Let me ask you, just curious, we're 
here in Kansas City -- how many of you agree with what he said --
that health insurance policies should include mental health 
coverage as well as physical coverage?  How many of you agree?  
(Applause.)
	     
	     I'm glad to see it.  I think it shows our country's 
come a long way on that issue -- that there are a lot of mental 
problems that are literally illnesses that can be treated, 
sometimes with medicine, sometimes in other ways.  One of the 
things that we seek to do, sir, in this plan -- and I want to 
make full disclosure here -- we do cover mental health under our 
health care plan as a protected benefit.  But it's not required 
to be put in all health insurance policies until the year 2000, 
and I want to explain why.  
	     
	     The last thing in the world I want to do is to cost 
you more money instead of save you money by doing this.  I have 
worked too hard to try to bring the government deficit down to 
see it go up, for example.  And because mental health benefits 
have never been provided on a comprehensive basis before, there 
is no agreement among the experts about what it will cost.  I'll 
bee you this gentlemen with the Meninger Foundation believes 
mental health benefits over the long run will save money in the 
health care system.  I do, too.  But we can't prove it.  So we're 
going to have to phase the mental health benefits in.  But by the 
year 2000, they will be covered just like physical health 
benefits and all comprehensive health packages for all Americans 
if this plan passes.
	     
	     I wish we could do it quicker, but we can't prove 
what the cost will be; and we can't put the budget at risk.  So 
we're going to have to phase it in.
	     
	     MR. ANSCHUTZ:  Let's complete our circuit now by 
going up to Omaha, Nebraska.
	     
	     Q    Good evening, Wendall.  An Omaha good evening, 
Mr. President.  I'm here talking with this woman.  She helps 
families who have family members with Alzheimer's.  And, Karen, 
you've been there yourself with your own dad.
	     
	     Q    Mr. President, I helped my mother at one time 
when she was caring for my father, and that was sometime ago.  
What I'd like to ask you is that my experience with meeting with 
care-givers every week of Alzheimer's patients is that they do 
not get much relief.  And they become prisoners in their own 
homes.  As you know, Medicare does not cover Alzheimer's care in 
the home because it doesn't have much rehab potential.  What will 
the new health care plan do to help these care-givers so they can 
have some relief? 

	     
	     THE PRESIDENT:  I think probably almost everybody 
understood that question, but let me try to put it in a larger 
context.  Alzheimer's is growing very rapidly in our country as 
our population ages.  But a lot of other infirmities are growing 
as well.  Today, Medicare, the government's program for elderly 
people, normally doesn't cover any kind of in-home care unless 
it's part of a rehabilitation program, she said.  
	     
	     There are limited coverages for nursing home care 
under Medicare.  Most of our older people who get any help from 
the government in nursing homes have to spend themselves into 
poverty so they can get into the Medicaid program.  
	     
	     We believe -- if you look at the fact that people 
over 65, and within that group, people over 80, are the fastest 
growing group of our population in percentage terms -- we want to 
encourage people to stay at home.  We want to encourage people 
who want to, to become as independent as they can.  But what that 
means is, if children are willing to take care of their parents 
and save society a whole lot of money that they could cost the 
rest of us just by spending their parents into poverty and 
putting them in a nursing home, we should give them a little bit 
of help in terms of respite care and help when they're providing 
help in their homes or in the community.
	     
	     So under our plan, we would, just like mental health 
care, which we would phase in over the next few years a long-term 
care benefit so that for children who are taking care of their 
parents in the home -- to use your example -- who have 
Alzheimer's or who have had a stroke, for example -- I met a 
couple taking care of the lady's mother for nine years after she 
had a stroke the other day -- they would be able to get some 
relief, someone to come in and watch the parent, take care of the 
parent on a regular basis while they took some time off, got to 
go do errands or do whatever needed to be done -- so that we 
would encourage these families staying together.  It would save 
our country a lot of money over the long run.  And I think it 
recognizes what's happening to our population.  Thank you.
	     
	     MR. ANSCHUTZ:  Thank you, Omaha, for the question, 
and we'll get back to you in a few minutes.  Now back to our own 
studio audience, Mr. President, and Ann has another question.
	     
	     Q    Mr. President, I'd like you to meet a woman who 
is a cancer survivor and she is also surviving changes in the 
health insurance plan.  
	     
	     Would you explain?
	     
	     Q    Yes.  Welcome, President Clinton.  My surgery 
was delayed for approximately two months because originally I'd 
gone to my OB that I'd gone to for 18 years.  He sent me to a 
surgeon, and then the mammograms and so forth.  And then when you 
find out that you're going to have to have surgery, to then stop 
-- they were off-plan, by the way, with my insurance carrier, 
which is provided by my employer.  
	     
	     To have to stop and choose doctors that you know 
nothing about, and the disease is devastating, but then to choose 
another doctor is just as devastating.  And what I wanted to know 
is how can you 100 percent ensure or guarantee that under your 
health plan and the plan that my employer would choose, that we 
would have the choice of our own doctors?
	     
	     THE PRESIDENT:  I want to make sure everyone here 
and everyone in our other studios understood what she said.  She 
said her previous doctor, her personal choice, was off-plan.  Why 
don't you explain to everybody what that means, in case they 
don't know.
	     
	     Q    Off-plan?  It can either be off-plan where they 
don't pay anything at all, or they pay quite a bit less -- either 
50, 60, 70 percent.
	     
	     THE PRESIDENT:  So, in other words, your employer 
chose an insurance plan for you that did not permit you to keep 
the doctor that you had been dealing with; which, when you have a 
serious condition like cancer, is terrifying to have to go to a 
new doctor.
	     
	     Q    Correct.
	     
	     THE PRESIDENT:  That's what you're trying -- I just 
want to make sure everybody understands that because one of the 
charges that's been leveled against our plan which is absolutely 
untrue is that I'm trying to restrict the choice of the American 
people.  The American people are having their choices restricted 
now.  Now, let me just say something very briefly.  In defense of 
your employer and many others, a lot of times the employer says, 
hey, that's all I can afford is an HMO, and I'm doing the best I 
can and I think they'll provide quality care.  Here's how our 
plan works.  
	     
	     Under our plan, your employer would have an 
obligation to contribute a certain amount to your insurance, and 
it would not change, no matter what plan you chose.  Then every 
year, your employer would be part -- unless you have more than --
unless it's a very large employer.
	     
	     Q    It's a small company.
	     
	     THE PRESIDENT:  If it's a small employer, the small 
company, then, would be part of a big buyer's co-op to guarantee 
lower rates and choices.  And you would be given, through this 
co-operative, at least three choices.  You'd be able to buy into 
an HMO like the one you've got here.  But you'd also be able to 
pay a small premium so if you wanted to, you could opt out and 
get the services from the doctor of your choice with exactly the 
same contribution -- no more -- if you bought the premium.  You 
could buy fee-for-service medicine on your own, just keep your 
doctor; you'd pay a little more.  Or you could -- you'd always 
have to have at least one third choice.  
	     
	     And under our bill, if it passes, every year you'd 
be able to revise that, you'd be able to reconsider it.  But you 
would always have the right to choose.  And even though you might 
pay a little more for fee-for-service medicine, your employer 
would not be disadvantaged -- he'd pay the same, regardless --and 
you would pay less than you would now because your small business 
would be part of a big buyer's pool.
	     
	     So even if you took the most expensive choice it 
would be, in all probability, less than you're paying now because 
you'd be part of a big pool.
	     
	     Q    That would be wonderful.  Thank you.
	     
	     MR. ANSCHUTZ:  And the small business would pay 
less?
	     
	     THE PRESIDENT:  The small business -- it depends.  
Most people in America, if our plan passed, would get the same or 
better health care for the same or lower costs.  Some small 
businesses would pay more, it depends on what they're paying; I'd 
have to know.  Let me just tell you briefly how it works.  
	     
	     The average business in America today pays eight to 
nine percent of payroll for health insurance.  Under our system, 
everybody would pay a maximum of 7.9 percent.  Small businesses 
with fewer than 70 employees and average wages of under $24,000 a 
year or less -- average wages -- would be eligible for discounts, 
going down to as low as 3.5 percent of payroll on a sliding 
scale.  That's how it would work.
	     
	     MR. ANSCHUTZ:  That answers your question?
	     
	     Thank you.  And now back to the television monitors, 
another circuit here.  We'll go back to Tulsa, Oklahoma.  
	     
	     Q    Mr. President, I'm a full-time college student.  
I have a part-time job and I have no health insurance.  How will 
your plan help me?  And how will I be able to pay for it?
	     
	     THE PRESIDENT:  How many hours a week do you work?
	     
	     Q    I work 25 to 30 hours a week, sir.  And I'm 
currently taking 13 hours at a college here in town.  
	     
	     THE PRESIDENT:  Good for you.  When you get your 
degree, you'll be glad that you worked for it like that --
(laughter) -- if you can get it; and I think you can.
	     
	     Under our plan, the cost of insuring part-time 
workers would be shared between the employer, the employee and 
the government.  So if you work -- let's just say you work 20 
hours a week, which is half-time, your employer would pay half 
the premium that the employer would pay if you worked 40 hours a 
week.  And you would similarly pay your obligation, then the 
difference would be made up with help from the government.  But 
you would have to pay, and so would your employer, if you work 
more than ten hours a week; but you would be eligible to get 
health care coverage.
	     
	     Let me say that one of the most interesting and 
controversial parts of any health care plan is how you treat 
younger workers.  And here's a young many who wants health care 
coverage.  But there are a lot of young folks who don't, who 
don't want to be forced to pay anything because they say, hey, 
I'm young and I'm healthy and I'm not married and I have no 
responsibilities to anybody; and I ought to have the right not to 
pay.  And you can say that, but the truth is if they have a car 
accident or a skiing accident or they, goodness God forbid, get 
sick, they still go the hospital and then the rest of you still 
have to pay if they don't have any insurance.  So I think this is 
the fair way to do it, and you would be able to be insured under 
our plan.
	     
	     MR. ANSCHUTZ:  Mr. President, even at a town hall 
meeting, the wheels of American commerce keep rolling, so if 
you'll excuse us, we'll break for a commercial break and we'll be 
right back.  (Applause.)
	     
			     * * * * * 
	     
	     MR. ANSCHUTZ: Once again, Mr. President, it's a 
pleasure to have you here at our town hall meeting.  And our next 
question is via satellite again from Topeka. 
	     
	     Q    Thank you, Wendall.  And, Mr. President, we'd 
like for you to meet this young woman.  She is a single mother 
with a small child.  And she simply could not find a doctor.  
Now, you've reconciled with your husband, right about that?  So 
you'll be covered by his insurance in May.  And your question has 
to do with access to health care and the problems you've had.  
Why don't you tell the President about those.
	     
	     Q    Right.  Mr. President, my daughter and I were 
on state assistance for 10 months.  And when you're on 
assistance, you get the medical card to help you out if you have 
to go to the doctor for anything.  And when my daughter got sick, 
I had a hard time finding a doctor in the Topeka area that would 
accept her because she was on the medical card.  And I was told 
by a caseworker that it was just unfortunate because we had -- we 
came onto the system at a very bad time, and that usually it is 
isn't this way.  But unfortunately, there just aren't any doctors 
that are accepting new patients with that type of coverage.  
	     
	     And my question to you is, what can you do to help 
low-income families get better access to health care?  Not just 
people that have jobs and don't have insurance because of their 
jobs, but perhaps people that don't have jobs at all through some 
unknown circumstance that they couldn't control.
	     
	     THE PRESIDENT:  I want to make sure everyone who's 
listening to us understands this.  I mean, I understand it very 
well, but I want to make sure all of you do.  For awhile, she was 
on public assistance.  If you're not employed and you're on 
public assistance, you're eligible for health insurance from the 
government under the Medicaid program.  In almost every state in 
the country, the Medicaid program reimburses doctors at less than 
their cost of providing the service.  And it's a paperwork 
hassle, so a lot of doctors don't take Medicaid patients.  
	     
	     You can understand it from the doctor's point of 
view, but when you see a young woman with a baby like that it 
makes you sick; it makes you want to cry.  So what's she's asking 
is -- okay, I had insurance, but nobody took me anyway; how are 
we going to fix that?
	     
	     The answer is that under our program people on 
Medicaid would be covered under the same plans that people who 
are privately employed would.  So, for example, we would put 
Medicaid folks in with others into these big buying pools, and 
they would get exactly the same services on exactly the same 
terms.  And because the doctors would be reimbursed in exactly 
the same way, the physician might not even know whether the 
person was on public assistance or had a job, because the plans 
would be the same.  And what happened to you, ma'am, would not 
happen again in the future if this plan were to pass.  And I 
think it's quite important.
	     
	     MR. ANSCHUTZ:  We're glad that question came up 
tonight.  Thank you in Topeka.  Go up to Omaha.
	     
	     Q    Thanks, Wendall.  Mr. President, Tuesday in 
North Carolina we talked about the cost of health care reform for 
service industries, specifically restaurants.  Here with me now 
is this gentleman, the CEO of Godfather's Pizza.  He has some 
concerns about that.
	     
	     Q    Thank you very much.  Mr. President, thank you 
very much for this opportunity.  And I would first like to 
commend you on making health care a national priority.  In your 
State of the Union speech, you indicated that 9 out of 10 
Americans currently have health care insurance primarily through 
their employers.  And tonight you indicated that out of those 
people who do not have insurance, eight out of 10 of them work 
for someone.  And your plan would force employers to pay this 
insurance for those people that they currently do not cover.  I 
would content that employers who do not cover employers, do not 
for one simple reason, and it relates to cost.
	     
	     Now, I have gone through the rigors of calculating 
the impact of your plan on my business, which has about 525 units 
throughout the country, and we employ in total over 10,000 
employees.  I have also talked with hundreds of other business 
people, and they've also calculated the cost impact on their 
businesses.
	     
	     I believe that this is something that we should and 
can fix.  But for many, many businesses like mine, the cost of 
your plan is simply a cost that will cause us to eliminate jobs.  
In going through my own calculations, the number of jobs that we 
would have to eliminate to try and absorb this cost is a lot 
greater than I ever anticipated.  Your averages about the impact 
on smaller businesses, those are all well intended.  But all of 
the averages represent a wide spectrum in terms of the businesses 
impacted.  
	     
	     On behalf of all of those business owners that are 
in a situation similar to mine, my question is quite simply, if 
I'm forced to do this, what will I tell those people whose jobs I 
will have to eliminate?
	     
	     THE PRESIDENT:  Let's talk a minute about what you 
would have to do.  Are any of your employees insured now?
	     
	     Q    Yes, sir.  Approximately one-third of my 
employees are insured now.
	     
	     THE PRESIDENT:  And of the one-third that are 
insured now, what percent of payroll does their insurance cost?
	     
	     Q    My insurance costs, at the present time, run 
about two and one-half percent of payroll.
	     
	     THE PRESIDENT:  And what do you provide them?  Do 
they share the cost 50-50 or something like that?
	     
	     Q    Cost 75 percent paid for by my company and 25 
percent paid for by the employee.  Now, two-thirds of my 
employees are part-time or short-term workers that fall into the 
class that you identified earlier.
	     
	     THE PRESIDENT:  Okay.  And if they are part-time or 
short-term workers, they wouldn't add all that much.  You 
wouldn't have to pay the whole 7.9 percent for them because they 
don't work all the time.
	     
	     Alright, let me ask you this -- on average, food 
service businesses' payroll is about one-third of the total cost 
of doing business.  Is that about what it is?
	     
	     Q    That is an adequate estimation, yes sir.
	     
	     THE PRESIDENT:  So, suppose, since you have part-
time workers and some wouldn't have to be covered, so you 
wouldn't go from two and one-half percent of payroll to 7.9 
percent.  You might go to something like six percent.  If you had 
six percent of payroll -- let's just say -- instead of two and 
one-half.  Let's say six and one-half percent, that's a good even 
number.  You have four percent of payroll.  And that's one-third 
of your total costs, so you would add about one and one-half 
percent to the total cost of doing business.
	     
	     Would that really cause you to lay a lot of people 
off if all your competitors had to do it too?  Only if people 
stop eating out.  If all your competitors had to do it, and your 
cost of doing business went up one and one-half percent, wouldn't 
that leave you in the same position you are in now?  Why wouldn't 
they all be in the same position, and why wouldn't you all be 
able to raise the price of pizza two percent?  I'm a satisfied 
customer.  I'd keep buying from you.  (Laughter.)
	     
	     No, I'm serious.  This is a very important -- let me 
say -- this is a very important question because a huge number of 
Americans are involved in the food industry; 40 percent of the 
American food dollar is spent eating out now -- 40 percent.  So 
this is not an idle question.  This man is raising a very 
important question in terms of employment.
	     
	     What if all your competitors were just like you?  
Wouldn't you be able to do it, then?
	     
	     Q    Okay, first of all, Mr. President, with all due 
respect, your calculation on what the impact would do, quite 
honestly, is incorrect.
	     
	     Let's take, for example, the fact that after I went 
through my calculations, your calculation or your example of the 
six percent or the 7.9 -- and in my case, it works out to 7.9 
percent.  Now, let's suppose that 30 percent of my costs are 
labor costs, 7.9 times that would be the two to two and one-half 
percent that you are referring to.
	     
	     The problem with that calculation, sir, is the fact 
that those, most of those 30 percent of the people currently have 
zero.  So when I calculate in the fact that I have to go from no 
coverage on those employees to full coverage at the 7.9 percent 
rate, it actually works out to be approximately 16 percent.
	     
	     Now, your other point about having to pass it on to 
my customers in the competitive marketplace -- it simply doesn't 
work that way because the larger competitors have more staying 
power before they go bankrupt than a smaller competitor.  They 
have more staff that they could simply do without until the 
marketplace reestablishes itself.
	     
	     So what I'm saying and suggesting is that the 
assumptions about the impact on a business like mine are simply 
not correct because we are very labor intensive, we have a large 
number of part-time and short-term employees that we do not cover 
for one simple reason -- we can't afford it.  My bottom line net 
profit for the last two years was less than 1.5 percent of my 
top-line sales.  When we calculate the cost just for my company, 
under your plan, it equates to three times what my bottom line 
profitability is.  
	     
	     What is one of the biggest misconceptions, sir, is 
the fact that a company like mine only makes between one and 
three percent of top-line sales.  And because we have a large 
population of employees that we would like to cover, but simply 
the dynamics our business will not allow us to do that under your 
proposed plan.
	     
	     THE PRESIDENT:  Let me ask you a favor.  Would you 
send to me personally your calculations?  Because I know we've 
got to go onto other questions; but let me remind you, if it 
added 4.5 percent to the cost of doing business and his labor 
costs were only one-third of his total costs, then all you have 
to do is multiply it by three, it would have to be 13.5 percent 
of payroll.  And that maximum is 7.9 percent.  So it's just -- we 
can't get there.  Send it to me, we'll work on it.
	     
	     Q    I'm sure a lot of this health care reform 
debate is going to be over numbers.  
	     
	     THE PRESIDENT:  That's right.
	     
	     Q    Maybe that will all come out in the wash.  
That's what --
	     
	     THE PRESIDENT:  Let me also just say, for those who 
are listening to us -- part-time employees, you don't pay the 
full premium unless the employee works 30 hours a week or more.  
Anything less, the employer pays a smaller percentage of the 
premium.
	     
	     Q    Mr. President, this gentleman is helping his 
son and daughter-in-law pay for skyrocketing medical bills to 
help them so that they don't go under financially.  Why do you 
explain.
	     
	     Q    Mr. President, we have a daughter-in-law with 
complications from two back surgeries.  She's at a point now that 
she cannot work, and she's losing her job, and therefore her 
insurance.  Her husband's insurance won't pick it up because it's 
preexisting conditions.  My son's income is $1,080.  And just to 
give you an idea of how this cost reflects, Sharon has therapy 
three times a week for 15 to 20 minutes -- physical therapy.  
Each session costs $438.  
	     
	     Right now they're over $12,000 in debt, and it's 
climbing.  What can you tell a family like this?  Why kind of 
hope do they have?
	     
	     THE PRESIDENT:  Let me ask you a question.  Your son 
has insurance?
	     
	     Q    Yes.
	     
	     THE PRESIDENT:  But they won't pick up the family 
because of your daughter-in-law's preexisting condition.
	     
	     Q    It wouldn't pay the preexisting conditions, so 
--
	     
	     THE PRESIDENT:  How big is the company for which 
your son works?
	     
	     Q    Well, it's the largest, first or second largest 
company in my town -- a very large business.
	     
	     THE PRESIDENT:  See, even for a large business, it's 
difficult -- I want to explain why -- it's not so many -- the bad 
in this is the way the financing is organized, not necessarily 
the company.  Under our plan, your son would have a right to 
insure his family at any place of work, now and in the future.  
But the private insurance company who provides the insurance 
would not go broke even with your daughter-in-law's problems, 
because they would be in a very large pool.  
	     
	     So to go back to the gentleman who was on television 
here with the pizza company, insurance companies would make money 
the way Blue Cross originally did and the way food stores do now 
or large eating establishments -- a little big of money on a lot 
of sales, a lot of people.  And that's how we would do it.  But 
your son under our plan would have a right to have his family 
insured at this job or at any other.  But the company wouldn't go 
broke trying to provide the employer's share of the premium, and 
the insurance company wouldn't go broke, because they'd be in a 
very big pool, and the risk would be broadly spread.
	     
	     MR. ANSCHUTZ:  Mr. President, let's move on to 
Tulsa, Oklahoma, again if we can.  
	     
	     Q    Mr. President, this gentleman is an internist 
with a managed care organization here in Tulsa, and his question 
relates to medical technology.
	     
	     Q    Thank you.  This will be a piece of pizza 
compared to Omaha.  (Laughter.)  President Clinton, my question 
has to do with medical technology.  Organizations like the one I 
work for, and we insure working folks and Medicare recipients.  
We deal on a daily basis with tough decisions about medical 
technology.  There was a letter to a medical director of an 
insurance company to your wife in a well respect medical journal 
not long ago.  And you probably saw that letter.  And hospitals 
and other health care organizations struggle with this as well.  
Part of it is wrapped up in tort issues and malpractice concerns 
that payer organizations have, that hospitals have. 
	     
	     And the question I have for you is, in looking at 
new and emerging medical technologies and technologies that are 
diffused in our country, throughout our country, and those 
technologies are often times applied to folks who are at the end 
of their life who have really no meaningful hope of recovery; and 
yet there's a compulsion really to continue to do things.  And 
I'm really wondering how your health plan addresses that issue.
	     
	     THE PRESIDENT:  Well, let me mention -- let me talk 
about this from two or three different points.  This is a big 
issue, and it's an issue that I'm very sensitive to now.  As you 
know, I just lost my mother a few months ago; my father-in-law 
died last year.  My family's been through this personally.  And I 
would like to say three or four things about it.
	     
	     First of all, on balance, we like having the best 
medical technology in the world and we want to have access to it 
if we need it.  And our plan actually continues a commitment to 
invest more, for example, in academic medical centers that have 
this technology and in medical research, generally; and I think 
we should.  On the other hand, we don't want to have a lot of 
money spent on technology if it's totally useless.  Let me just 
mention three things which the present system does, and he 
alluded to two of them.
	     
	     One is, a lot of doctors are worried about 
malpractice claims so they may do tests whether they think the 
patient needs it or not, just so later on they can say they did 
it in case they get sued.  That costs all of us a lot of money if 
there's no reason to do it.  What's the answer to that?  Our plan 
would require the national professional associations to 
promulgate medical practice guidelines that then the doctors 
could use; and if they use these guidelines, those guidelines 
would, in effect, be a first line of defense in a malpractice 
case.  It would at least raise the presumption that the doctor 
had not been negligent.
	     
	     Problem number two, hospitals get to competing with 
one another and they're afraid if one has an MRI they're afraid 
that -- the other hospital's afraid it won't get any patients 
unless it gets an MRI.  So a town needs one MRI and winds up with 
two so everybody can compete with one another.  We try to make 
sure that there's equal access to technology, but that hospitals 
don't feel like they have to do that -- double the cost of 
technology to everybody -- when the facilities could be properly 
shared.
	     
	     Point number three is the really difficult one, and 
that is the question of when should people in their last months, 
or their last year, give up expensive technology?  My own view of 
that is that a lot of people have made that decision for 
themselves, but they don't formalize it.  And so one of the 
things we're trying to encourage people to do is to make sensible 
living wills, to make these decisions.  I think that's a lot 
better than having medical professionals try to get between a 
grief-stricken child and a parent on life support, or sometimes a 
grief-stricken parent and a child on life support.  So I think 
what we should do is to try to encourage the use of living wills, 
encourage families to talk about this in honest ways.  And I 
think America will move to this and save the money that can be 
saved and still keep the benefits of technology.
	     
	     MR. ANSCHUTZ:  Thank you, Mr. President.  As we told 
you earlier, we're talking with four communities; not only ours, 
but Tulsa, Topeka and Omaha.  At this point, we're ready to go 
back to Topeka.
	     
	     Q    Okay, Wendall.  Mr. President, this gentleman 
has lived in the capital of Kansas for 18 years.  And Paul 
doesn't have a lot of faith, frankly, in the government's ability 
to administer health care and he's got a question about that for 
you, sir.
	     
	     Q    Mr. President, good evening.  In view of the 
government's passed poor performance, i.e., Social Security, 
welfare, federal budget, the deficit and pork barrel spending, 
can you explain to us how the federal government can manage 
health care, another socialistic program, in an economical and 
efficient manner?
	     
	     THE PRESIDENT:  Well, I have two things to say about 
it.  Number one is, the federal government's not going to manage 
this program.  Under our program, if my program passes, the 
private sector will manage it.  The only thing the federal 
government will do is two things basically.  We will require 
everybody to have health insurance, and employers and employees 
to share responsibility for it.  That includes good primary and 
preventive benefits.  
	     
	     We will then say that insurance has got to be what 
it used to be when it started -- you can't cut people off because 
somebody in the family got sick; you can't charge old folks too 
much if they're still working and they're healthy; and small 
business people and farmers and self-employed people have the 
right to be in big buying groups so that they can get the same 
kind of deal that government employees and that big business 
employees get today.  That's not a big government program.  
	     
	     Let me give you one example, sir.  The state of 
California just set up a small business buying group with 40,000 
businesses in it.  And the businesses that entered actually got a 
reduction in their health insurance costs by going into the 
buying pool.  And there was no big government bureaucracy -- they 
hired 13 people to run the insurance buying and handle the 
paperwork for these 40,000.  So I don't want the government to 
run it.
	     
	     Q    Is there going to be less paperwork, instead of 
more?
	     
	     THE PRESIDENT:  Absolutely.  If you have -- right 
now we've got the most expensive -- right now, sir, we have the 
most expensive system in the world in America.  We have 1500 
separate companies writing thousands of different policies, and 
then the two government programs for older people and for poor 
people on top of that.  So we've got more bureaucracy and more 
paperwork and more money spent on that and less on health care 
than any other country in the world.  So I don't want the 
government to run the health care system.  I just want to make 
sure the system works for the benefit of everybody.
	     
	     MR. ANSCHUTZ:  Well, we hope that answered your 
question.  We're moving on to Omaha now.
	     
	     THE PRESIDENT:  But I'm not going to let Social 
Security get in trouble, either.  And the deficit's coming down, 
not going up.  Go ahead.
	     
	     Q?     This gentleman was diagnosed as having full-
blown AIDS back in 1991.  He is now disabled, and he has really 
had a tough time with the current health care system.
	     
	     Q    Thank you, Mr. President.  As she said, I'm a 
person who's living with full-blown AIDS.  When I was first 
diagnosed HIV-positive in 1989, I was part of an HMO program of 
which I had to fight tooth and nail to get to an infectious 
disease doctor.  I was forced to see a family practice doctor who 
was not educated or interested in treating my symptoms of the 
illness.  I'd like to know from you with health care reform, 
we've already voted to reform Medicaid in Nebraska to start 
charging patients for co-payments.  Will health care reform 
enhance, or is it going to restrict, the availability of quality 
care, the availability of low-cost prescriptions and the access 
to doctors who are educated and interested enough to treat HIV 
infections without having caps on expenditures and those sorts of 
services that we need to survive?
	     
	     THE PRESIDENT:  Health care reform will enhance the 
quality and range of services you can get.  It will require 
everybody to pay something, but it will place limits on that 
something.  Let me just say, one of the things that people who 
are HIV-positive or people who have AIDS will get out of this 
program.  We will cover, for the first time, in all health care 
plans, prescription medicines.  And there will be a co-pay and a 
deductible, but there will also be an annual limit. 
	     
	     So for someone like you who has very expensive 
medical bills for medicine, you would benefit enormously from 
that because of the very reasonable co-pay and deductible and 
annual limit.  Let me say something in your behalf.  All the rest 
of us would gain, too, for this reason -- a lot of people, like 
this gentleman, who have AIDS can't get health insurance anymore 
and are forced out of the workplace.  And all of us are better 
off if everyone in his position can work as long as possible, can 
be independent as long as possible, can be self-supporting as 
long as possible.  And we need a health care system where 
employers can afford to properly and fully insure their employees 
without going broke so that they can live as long and as well as 
possible.  
	     
	      But you would be much better off under our plan 
because you get choice of doctor, adequate care and prescription 
medicine would be covered after a modest effort required on your 
part.
	     
	     Q    But, with all due respect, with my disability 
check and having to pay rent and utilities and food and 
everything else, I am left with $20 a month, and I do not think 
that that's enough to have to pay more payments to go to the 
doctor or pay for prescriptions.
	     
	     THE PRESIDENT:  No, I'm talking about not now.  At 
your income level now, you probably have no responsibility at 
all.  But I'm talking about back when you were working -- suppose 
you needed medicine to maintain your condition.  Even then, every 
health insurance package would have had to cover medicine with a 
modest co-pay to help people stay as independent as long as 
possible.  With your present income, those responsibilities would 
be dramatically less.  And if your income is what you say, you 
wouldn't have any co-pay responsibility.
	     
	     Q    If I could not pay, would I be denied services?
	     
	     THE PRESIDENT:  No.  Nobody who cannot pay would be 
denied services.  But people who can pay will have to pay 
something.
	     
	     MR. ANSCHUTZ:  Okay, we'll have to move on now.  I 
hope we answered your question, sir.  We will continue with our 
town hall meeting with President Clinton in just a moment.  But 
first, this time out.  (Applause.)
	     
			    * * * * *
	     
	     MR. ANSCHUTZ:  We've been going for about an hour so 
far with questions.  It doesn't seem that long, does it, Mr. 
President?  About a half hour left and I know we have a lot of 
questions to go.  So let's return to our studios.
	     
	     MS. PETERSON:  Mr. President, I'd like you to meet a 
doctor from Children's Mercy Hospital.  She's very concerned 
about the toll violence is taking on our health care industry and 
our nation as a whole, and especially our young people.
	     
	     Q    Good evening, President Clinton, and thank you 
for taking the time to come and meet with us in Kansas City.  
Over the years I've seen many changes in my practice as a 
pediatric emergency medicine physician.  By far and away, the 
most frightening is the escalation of violent injuries involving 
our children both as victims and as witnesses.  My question for 
you is this:  Are we going to be able to provide these children 
the acute care, the rehabilitation, and the mental health 
services they need -- both the victims and the witnesses -- under 
your plan for health care reform?
		  
	     THE PRESIDENT:  The short answer is yes; the long 
answer is what I said earlier about mental health benefits.  We 
phase them in and we don't fully have them covered until the year 
2000.  So that, except in extreme circumstances, they wouldn't 
all be covered under all health insurance practices.
	     
	     Now, some children's hospitals will be eligible for 
certain payments that will permit that to be done.  But the short 
answer is:  Yes, the comprehensive services will be provided, but 
we won't have full mental health coverage until the year 2000 
under the plan as it is presently drawn.
	     
	     But let me just say to all of you.   I know we're 
running out of time, and I want to be quick.  But violence is one 
of the biggest health problems we have.  And you need to know 
that even though I believe we can bring down the cost of health 
care in terms of things that we're out of line with other 
countries on -- principally in paperwork and unnecessary 
procedures and undue fear of malpractice -- as long as we are the 
most violent country in the world and we've got more kids getting 
shot up and cut and brutalized, we're going to have higher 
medical costs than other countries and busy emergency rooms.
	     
	     It's a human problem.  It's also a horrible public 
health problem which is why I hope we can pass this crime bill 
and do some other things that will drive down the rate of crime 
and violence in our country because it is swallowing up a lot of 
your health dollars as well tearing the heart out of a lot of 
your children.
	     
	     Q    And a lot of the doctors.  Thank you, Mr. 
President.
	     
	     THE PRESIDENT:  Thank you.  Thank you for doing it, 
though.
	     
	     MR. ANSCHUTZ:  Mr. President, Glenda Silvy in Tulsa 
has another question to ask you.  And Glenda, I would ask you in 
the interest of time -- we're getting toward the end and we have 
a lot of ground we'd like to cover -- so if we could kind of keep 
it fairly condensed.
	     
	     Q    Mr. President, this is a woman with a question 
about services to the elderly.
	     
	     Q    Mr. President, I'd like to ask you about the 
transportation for the frail elderly because it has become a very 
serious problem in Tulsa and other cities.  Limited personal 
resources rule out hiring taxis to take people in for doctors 
appointments and dialysis and also adult day care centers and 
other therapeutic activities.  Does the plan address this growing 
problem?
	     
	     THE PRESIDENT:  I have to tell you the truth.  I'm 
not sure what's covered and what's not with transportation.  And 
what I will do is, after this is over, I'll get your name and 
address, and I'll get you an answer.  And I wish I could give you 
an answer on the air, but I don't want to say the wrong thing, 
and I don't want to mislead you.  So, I will write you as soon as 
I find out.  I'm sorry, I don't remember.
	     
	     Q    I'll look for it, Mr. President.  (Laughter.)
	     
	     THE PRESIDENT:  I'll sure get it then.
	     
	     MR. ANSCHUTZ:  I'm sure she'll get it.  Let's move 
on to Topeka -- Ralph.
	     
	     THE PRESIDENT:  I wish I had her in my office, 
that's for sure.  (Laughter.)
	     
	     MR. ANSCHUTZ:  Yes, she's pretty sharp.  Are you 
ready, Ralph?
	     
	     Q    Yes, Wendall and Mr. President, we have a short 
question from a girl who is nine years old, goes to Central Grade 
School up in Holton, Kansas, and has a question of concern to 
people her age.
	     
	     Q    Mr. President, I would like to know how your 
new health care program will help to make sure that all children 
get their immunizations.
	     
	     MR. ANSCHUTZ:  Good question.
	     
	     THE PRESIDENT:  That's a great question.  It will 
help in two ways.  First of all, immunizations will be covered 
under everybody's health insurance policies for families so that 
children's immunizations will be covered under the family health 
insurance policy. 
	     
	     The second thing we will do under our plan is to 
make sure that the public health offices all over the country, 
which do a lot of immunizations for children, have enough money 
to do them without overcharging the parents.  In my state of 
Arkansas, for example, 85 percent of our children -- 85 percent, 
including children from well-off families -- get their shots in 
the public health offices.  So we do it in those two ways.  And a 
lot more children will be immunized if this plan passes.
	     
	     Thank you.  Great question.
	     
	     MR. ANSCHUTZ:  Thank you.  Up to Omaha.  
	     
	     Q    Thanks.  This woman is with Mutual of Omaha, 
which employs 6,000 people here in Omaha, 4,000 agents 
nationwide.  
	     
	     Q    Mr. President, thank you so much for the 
opportunity tonight for us to provide input.  We wanted to let 
you know that we do support universal coverage, as well as 
universal and comprehensive health care reform.  Given our 
agreement on so many basic issues, I have to say that we're 
disappointed in our 6,000 employees who work very hard at Mutual 
of Omaha in the personal attacks that we felt by the 
administration and the fact that they're doing the best job that 
they can.
	     
	     My first question is, why have you taken this 
approach?  And secondly, as we try to build consensus with your 
team and other teams in Congress, will you acknowledge that the 
positive steps that we've taken to reduce costs as well as the 
fact that we support many of your basic goals as well?
	     
	     THE PRESIDENT:  Yes, but let me try to defend 
myself, first.  Tonight -- how many times tonight did I go out of 
my way to explain this problem from the insurance companies' 
point of view?  (Applause.)  A lot, right?  And, let me further 
say, I went to Connecticut the other day, which is the other big 
center of health insurance companies, where five of the six 
biggest companies in Connecticut refused to join in this health 
insurance association multi-million dollar attack on our health 
care reform efforts.  And I complimented those companies for what 
they're trying to do.  So I believe that we have a lot in common.  
And I believe most insurance companies support universal 
coverage.  And I would be more than happy to continue to work 
with them.  
	     
	     What I have tried to do is to answer the attacks on 
our plan by the ads, the multi-million dollar ad campaign, that I 
don't have the money to answer in paid ads yet -- I hope I do 
someday -- from the health insurance association.  Nothing would 
please me more than to tone down the rhetoric, to sit around like 
we're doing now in private and recognize that a lot of companies, 
particularly a lot of the bigger companies, have done a lot to 
help control health care costs. 
	     
	     I guess what I want to do is to try to take the 
initiatives that you've already taken and that you've proved we 
can take to help larger companies, to help government employees, 
to help other control health care costs and make those available 
to all Americans -- first with coverage and first with affordable 
rates for people who have small businesses.
	     
	     I can't believe we can't reach agreement on this.  I 
think we can.  And nothing would please me more than to have this 
conversation with you and everybody in your business all over 
America.  And I thank you for what you said.
	     
	     Q    We'll take you up on that.
	     
	     MR. ANSCHUTZ:  Okay.  Thank you in Omaha.  And now 
to our studio.
	     
	     Q    Mr. President, this gentleman is with Marion 
Merrill Dow, a major pharmaceutical company based here in Kansas 
City.  What is your question for the President?
	     
	     Q    Mr. President, good evening.  I appreciate the 
chance to visit with you.  I'd like to begin by saying that I 
applaud your efforts to bring health care to the top of the 
national agenda.  I think that's very important.  
	     
	     Let me say that, at the same time, I'm somewhat 
concerned about some of the provisions of the bill, particularly 
some of the provisions that relate to government control and 
intervention in the business.  Things like the committee that 
would discuss the appropriateness of new drug prices.  I believe 
that that's the function of the open market, and I'm very 
concerned about the implications there. 
	     
	     It appears that the investment community is also 
concerned about that.  The market has taken the value of 
pharmaceutical stocks and biotechnology stocks down by many 
billions of dollars over the past 18 months.  And there's been a 
considerable loss of jobs in our industry. 
	     
	     My question is, what assurances can you give the 
American people that your bill will not permanently damage this 
industry which is so helpful and brings cures to so many people, 
and allows us to continue the research that we're doing to solve 
the many diseases that we've heard spoken about here tonight?
	     
	     THE PRESIDENT:  First of all, let me say -- let me 
explain what he was talking about to the rest of you.  The 
pharmaceutical industry in America is very important to all of 
us, not only because we want to get the best in emerging 
prescription drugs, it's also a big part of our high-tech 
economy.  We have clearly the dominant pharmaceutical industry in 
the world.  It provides enormous numbers of jobs in America and 
helps us to sell our products overseas. 
	     
	     As you know, all around the world, sometimes you can 
sell products in other countries quicker than you can here 
because of the government regulation, which I'm trying to speed 
up.
	     
	     Under the health care plan as it is presented, a 
committee would be able to decide whether or not the price of a 
given drug was excessive.  The reason that provision was put in 
there is because there are so many drugs that are made in 
America, where Americans have paid in all kinds of ways for the 
research to be done, which costs much less in other countries 
than they do in America   .  
	     
	     But what the pharmaceutical industry, however, is 
legitimately concerned about is that they have to go out and 
raise huge amounts of money in the biotechnology area to raise 
money to develop new ground-breaking drugs, and they believe 
those drugs ought to be able to charge for the enormous cost of 
their development in the first place, which I agree with.
	     
	     And what I think we have to do, sir, is to work that 
out.  You know, last year the biotechnology industry asked me to 
give special incentives in terms of capital gains taxes for 
investment in that area.  We did.  I was trying to build them up 
and I've been as disturbed as you have by what's happened to the 
markets.
	     
	     So what we have to do is enter into some sort of 
understanding so we can protect the right to develop and market 
new drugs.  I'm very concerned about it myself.  I do not want to 
do anything to hurt it.  And it's a very important part of our 
economy.
	     
	     But let me also say that generally, pharmaceuticals 
will do well because so many more people are going to have drug 
coverage.  That's why the Pharmacists Association strongly 
endorse our health plan.  We can work this out.
	     
	     MR. ANSCHUTZ:  Let's move along now and get back to 
the satellites in Tulsa.
	     
	     Q    This woman has a question about Native American 
health care.
	     
	     Q    Mr. President, I have Medicare and insurance 
benefits from retirement, but I'm real concerned about the Native 
Americans living in our city.  I live -- in the city that I live 
in that do not have the benefits that I have.  What will happen 
to their urban clinics that they go to now for medical care?
	     
	     THE PRESIDENT:  For the people at all the other 
places?  Native Americans have a Native American health service 
funded through federal funds.  It's a separate health service, 
sort of like the Veterans Administration network is separate.  
Our plan, ma'am, will put more resources into that network, will 
strengthen it, will enable Native Americans to choose to use the 
Native American network and to bring whatever insurance policies 
and support they have to that network in addition to taking the 
extra money we put in it.
	     
	     So the Native American network, we believe, will be 
better off if our plan passes.  And I have committed that to the 
leaders of tribes all over the country.  We're going to keep 
working on it until they're absolutely satisfied that that's 
what's going to happen.  That is an obligation we have; we cannot 
break it.
	     
			    * * * * * 
	     
	     MR. ANSCHUTZ:  Welcome back.  We have about another 
15 minutes on the program, and we want to cover as much ground as 
we can.  President Clinton, so far, how do you feel about the 
questioning?  Has it bee --
	     
	     THE PRESIDENT:  I think the people have done a good 
job.  And we've gotten a broad range of questions.
	     
	     MR. ANSCHUTZ:  Some agree.  Some argumentative.  But 
that's the kind of thing we want.
	     
	     THE PRESIDENT:  It's a complicated issue.  We should 
have an argument.
	     
	     MR. ANSCHUTZ:  Okay, I think we have Omaha next.  Is 
that right?  Topeka.  Let's go to Topeka and Ralph Hipp.  Ralph 
--
	     
	     Q    Wendall and Mr. President, this is a woman who 
lost her daughter last year to complications from a bone marrow 
transplant from an unrelated donor that cost $350,000.  And if 
there's any bright spot about you losing your daughter last year, 
it's been that you have become an advocate for other transplant 
families.  So at least there's something going on that you are 
continuing to work with this.  And you did have insurance for 
that operation.  Why don't you tell the President about your 
situation and your question.
	     
	     Q    Thank you, Mr. President, for your gift of time 
this evening.
	     
	     Fortunately, our daughter 's insurance provided 
coverage for her transplant.  But we also realize there are many 
patients facing organ transplants.  And their insurance companies 
do not provide coverage for them, nor do they provide coverage 
for the donor's expenses which is also part of the transplant 
process.
	     
	     My question to you, Mr. President, is:  What will be 
in your health care program that will help provide coverage for 
all patients needing bone marrow transplants and also for their 
donor's expenses?
	     
	     THE PRESIDENT:  Transplants are covered when they 
are appropriate.  When it's an appropriate medical procedure and 
the doctor decides it's appropriate, it gets recommended, the 
transplant will be covered.  And there are no lifetime limits on 
our policies, keep in mind, unlike most policies now.  Three out 
of four policies now have lifetime limits.  So that would not be 
a problem.
	     
	     I have to tell you, I don't know about the donor's 
expenses.  I'll have to check on that.  I can't answer that.  But 
when it is an appropriate medical recommendation, it would be 
covered.  It's a normal thing that would clearly be warranted by 
the treatment and by the doctor's treatment of the patient.  And 
I think it should be, and again, there are no lifetime limits on 
the policy, so that won't be a problem.
	     
	     MR. ANSCHUTZ:  Thank you, Topeka.  We go by 
satellite now to Omaha, Nebraska. 
	     
	     Q    Thanks Wendall.  This gentleman is a veteran, 
and he's very healthy right now, but he's also concerned about 
what's happening at the local Va hospitals and other hospitals 
just like it.  
	     
	     Q    Mr. President, Commander, all veterans, as well 
as the employees of all the VA hospitals, are very concerned on 
what is happening at the hospitals.  They keep reducing the 
budget, keep pushing the employees out the door.  Consequently, 
that is reducing the care for the veteran.  How will your new 
plan affect the VA?
	     
	     THE PRESIDENT:  I'm glad you asked that, Jack, 
because we were talking about it during the last break.  And let 
me thank you for your service, for wearing your cap tonight.  You 
look fine, and I appreciate you asking the question.
	     
	     Let me also back up and tell the rest of you, the 
veterans hospital network has been suffering in recent years 
because we have had a reduction in the number of patients going 
into these hospitals, leading to a reduction in the budget, which 
means that those who are left behind don't have and oftentimes 
the quality or the range of care that they want.  
	     
	     One real problem is that the veteran can go in and 
qualify to be cared for in the veterans hospital.  But the only 
money the hospital gets is whatever the budget is from the 
government.  So that a veteran has another hospital policy, an 
insurance policy, or is covered by Medicare or whatever, that 
money can't flow to the hospital.  So what we have done, sir, is 
to make sure that veterans on a priority basis, then their family 
members, can be cared for through the veterans health care 
network, and that all sources, including this insurance policy, 
can go in income to the hospitals and to the doctors in the 
veterans health care network so that they can get adequate funds.  
	     And the Veterans Administration is quite excited 
about this, the veterans health care network, because they think 
they are going to be able to get these veterans into these 
hospitals and that finally they're going to be able to be 
reimbursed in an appropriate way just as any other hospital would 
be able to.  So we don't want to continue to cut their budget; we 
want to give them access to other different funds.  And I think 
it's going to be the salvation of the veterans health care 
network myself.
	     
	     MR. ANSCHUTZ: Does that answer your question, sir?
	     
	     THE PRESIDENT:  Do you understand -- I mean, like if 
you have medicare or if you have an insurance policy or --
whatever now, none of that money flows to the hospital now.  
Under our plan, you'd be able to go their, take your insurance 
policy, and get the hospital reimbursed that way, as well as 
through whatever budget we get directly from the hospitals 
through the Congress.
	     
	     MR. ANSCHUTZ:  Quickly your follow-up, sir.
	     
	     Q    Thank you, Mr. President.
	     
	     MR. ANSCHUTZ:  Okay, good.  Let's move back to our 
studios here at TV 5.
	     
	     Q    Mr. President, I'd like you to meet this woman, 
she is 16 years old and has lost six of her adoptive relatives to 
smoking-related illnesses.  What is your question?
	     
	     Q    As a high school student, I see the heightening 
use of tobacco among my age range.  And I feel it's not only the 
responsibility of the government to help those that have existing 
health complications, but also to prevent it.  So my question 
tonight is why do we continue to use subsidiaries for -- to help 
support tobacco growers when tobacco is harmful to us?  
(Applause.)
	     
	     THE PRESIDENT:  We don't use direct government 
subsidies to support tobacco; we do organize the market with non-
taxpayer funds actually to keep growers out of the market.  It 
keeps the prices higher and does provide an income for the people 
who are in tobacco farming now.  I think if you abolish the 
present federal program -- I want to talk about what we're trying 
to do to reduce smoking in a minute -- but I think if you 
abolished the federal program what would happen is the big 
tobacco companies would come in and actually plant more tobacco 
at lower prices and try to make it more readily available.
	     
	     Now, what we are doing is, the only tax we propose 
to raise in this program is a 75 cent tax on tobacco, to pay for 
the medical care of the unemployed uninsured.  And we ask big 
companies that get a big windfall -- that is whose insurance 
rates will drop way down -- to pay a little bit, too.  We have 
proposed in federal buildings totally smoke-free areas unless the 
rooms are separate and completely separately ventilated.  The 
Food and Drug Administration is conducting an investigation, even 
as we're here tonight, on the nicotine content of cigarettes and 
whether there's been any direct attempt to increase the nicotine 
content so that it has a more addictive affect on people who 
smoke.
	     
	     We are doing our best to be aggressive in trying to 
tell young people that they should not smoke -- that there are 
dangers to smoking -- and that those who are around smokers in 
closed spaces can also be exposed.  A few thousand people a year 
die from lung cancer induced by smoke, even though they're 
nonsmokers.  This is a very serious problem, and we're taking 
some strong steps in that direction; and I appreciate you raising 
the issue.
	     
	     MR. ANSCHUTZ:  Mr. President, we're going to try for 
one more round-robin of our remote stations.  We go again to 
Tulsa.
	     
	     Q    Good evening, Mr. President.  As you know, 
public health departments provide preventive health services to 
millions in our great land.  And as you well know, the preventive 
health services are much more cost-effective to give than 
treating an illness.  How will your health care plan affect the 
provision of our services related to public health?
	     
	     THE PRESIDENT:  We have -- when the young lady a few 
moments ago asked the immunization question, I alluded to this.  
In our plan, there is provision for the expenditure of I think 
it's around a billion dollars a year more of federal funds to 
public health units all around the country -- every year -- than 
we're providing now to try to expand the preventive and primary 
services provided.  
	     
	     As I said, I know in my state, we relied very 
heavily on public health clinics.  And in a lot of rural areas 
and in underserved inner-city areas, they are very important.  
And in many places, everywhere they provide the immunizations for 
kids.  So we'll continue to support them at a higher level than 
we are now if the plan passes as it is.
	     
	     MR. ANSCHUTZ:  Thank you, Tulsa.  And, Glenda, we 
thank you very much for participating tonight.  If we don't get 
back to you, thanks again.
	     
	     Now, let's go on to Topeka and Ralph Hipp.
	     
	     Q    Thanks again, Wendall, and this is probably our 
final question.  Mr. President, we've enjoyed being with you here 
in Topeka, Kansas, tonight.  A doctor has our next question.
	     
	     Q    Mr. Clinton, unhealthy lifestyles contribute to 
a majority of the medical diseases we treat today.  How would 
medical savings plan encourage each of us to become more 
responsible and to follow a more healthy lifestyle?
	     
	     THE PRESIDENT:  Well, there's nothing in this plan 
that would mandate diets, for example.  But I think --(laughter.)  
No, don't laugh, this is a very serious question.  This man has 
said something that is quite important.  And I'd like to know 
what you think we can do other than requiring people to pay a 
portion of their own health insurance.    
	     
	     A lot of employers themselves are providing such 
incentives.  What we have done is to organize this in the hope 
that each state and each health group within the state, each of 
these health alliances, will themselves undertake incentives to 
encourage employers, for example, to provide exercise facilities, 
to encourage healthy lifestyle, to do health education -- instead 
of having national mandates, but to give these alliances the 
incentives to do it to keep the cost of health care down.  It is 
a very, very important thing to do.
	     
	     We have not mandated specific things in here.  But I 
think the incentives for the groups within state by state to do 
it will be overwhelming to try to keep the cost of health care 
down in the future.  And he has asked a very important question.  
I'm glad you brought it up before we got off the air.
	     
	     MR. ANSCHUTZ:  Ralph, thank you for being with us in 
Topeka tonight.  We appreciate your -- there's a large crowd 
there and all the questions that we've had.  We also appreciate 
from Omaha.  Unfortunately, we don't have time to return to them 
for one last question.  But I think we've covered a lot of ground 
tonight.  It's certainly been an interesting discussion.  And I'm 
sure that all of our viewers have learned quite a bit from what 
they've heard tonight because a lot of ground has been covered.
	     
	     Before we close, Mr. President, do you have some 
final words you'd like to say?
	     
	     THE PRESIDENT:  Just that I hope that all of you who 
are listening tonight and all of you who asked questions and had 
questions that weren't asked will agree with me that this is an 
issue we ought to deal with now.  Not that anybody has all the 
answers or that there aren't some tough decisions to be made.  If 
there weren't some hard decisions to be made, this crisis would 
have been dealt with a long time ago.  We've been trying to do 
this for 60 years.
	     
	     But I would just urge you to urge your members of 
Congress, without regard to party, to face this issue this year, 
to discuss these issues, to deal with the problems that have been 
raised tonight, that the questions people have about my proposal, 
but to act this year to finally provide private guaranteed health 
insurance for all Americans.  We will not solve a lot of the 
problems that were mentioned here tonight or bring costs in line 
with inflation or provide real security to working families, 
ever, until we do this.  We will not do it.
	     
	     It is important for our economy, but it's most 
important for who we are as a people and what kind of life we're 
going to have as families and as working people as we move into 
the next century.  So please urge your members of Congress, not 
necessarily to agree with me on every detail, but to seize this 
moment to do something profoundly important for the American 
people and guarantee health security to all of us and to our 
children.
	     
	     Thank you.  (Applause.)
	     
	     MR. ANSCHUTZ:  I want to thank the President again.  
And we thank all of you who came, and we apologize to everyone 
who we couldn't work in to this small studio, this small amount 
of time, because so many people have questions about health care 
in our country.  And I think the main thing is that they do have 
questions.
	     
	     We asked President Clinton to come here this evening 
because he has a health plan.  We didn't say, it's the right 
plan.  That wasn't the idea.  The idea was to give him a forum so 
that he could tell us everything he could about his health plan 
in a fairly large amount of time so that you could get a grasp of 
it.  Then we are asking you to go on, weigh what he has had to 
say, and look at all of the other alternatives that are out there 
so that you can make an informed opinion when it comes time to 
express how you feel.  
	     
	     We invite you to send your questions and your 
opinions to your congressmen, to your U.S. senator, and make 
those opinions knowns.  Right, Mr. President?
	     
	     THE PRESIDENT:  If anybody has any questions that 
weren't answered tonight, write us and we'll answer them.
	     
	     MR. ANSCHUTZ:  Good.  There you are.  We can't do 
better than that.  Again, thank you, Mr. President.  (Applause.)  
Thank you all for being here tonight.  And thank you for joining 
us via television.  Good night everyone.  (Applause.)

			       END8:28 P.M. CDT

