News from 1600 Pennsylvania Ave.

– Press briefing with Robert Gibbs, Wednesday, July 1, 2009
– Pool report on Obama health-care town hall
– Remarks of President Barack Obama at Health Care Town Hall in Annandale, Va., Wednesday, July 1, 2009
– Q-and-A from the health-care town hall
– Vice President Biden launches broadband initiative  


Press briefing with Robert Gibbs, Wednesday, July 1, 2009

BEGIN 12:27 P.M. EDT

MR. GIBBS: Ms. Sidoti, you’ve got poor attendance on the front row, but we’ll start.

Q Thanks, Robert.

MR. GIBBS: Here comes Chuck.

Q Still getting dressed. (Laughter.)

MR. GIBBS: Fix your collar, there — just trying to help you out there.
Go ahead.

Q What’s the White House’s sense of the situation in Honduras at this point? Are we on the cusp of a true meltdown? It seems to be spiraling.

MR. GIBBS: Well, I think it’s best for me to characterize what actions have happened here. Assistant Secretary Tom Shannon, who deals with the Western Hemisphere at the Department of State, and Dan Restrepo from the National Security Council, met yesterday at the OAS with President Zelaya. I think you’ve seen the OAS take some actions and set some deadlines for the restoration of President Zelaya before actions kick in, and I think that’s where we are.

Q But with the Pentagon suspending joint military operations, how far-reaching is that and are there next steps that are under consideration as well?

MR. GIBBS: Well, we continue to monitor the situation and will respond accordingly as events transpire. But, again, as I said, we’re watching closely what’s going on.

Yes, sir.

Q Another kind of meltdown, this one California. The legislature there failed to agree on a balanced budget plan and they’re on the verge of having to take the extraordinary step of issuing IOUs to their creditors. How concerned is the administration about this development in California — and possibly in other states, as well — and what, if anything, will the federal government do to help them out of it?

MR. GIBBS: Well, I think the biggest step the federal government can do we have done, as it related to the recovery plan. I think about $144 billion is the amount of money in the recovery plan for states, as many of them struggle with the downturn in the economy and how it affects each of their state budgets.

As you mentioned, there are a number of states that find themselves at the end of the fiscal year and required to pass budgets. We’re certainly watching — I know in California’s instance they had sought many weeks ago a designation under TARP, which I think the Secretary of Treasury said, based on the law, wasn’t possible.

But I think the major contribution from the federal government has been an increase in Medicaid and education money to go to helping to close some of those fiscal gaps.

Q But that really has only been a drop in the bucket for the problem they have. The stimulus plan hasn’t really given them enough to make ends meet. Is the administration considering anything further than that?

MR. GIBBS: Well, let me — I forget the exact number of budgetary shortfall, but understand $144 billion represents a pretty large chunk of total state budget shortfall. It’s not the whole thing, but I think it’s an important step that we took, understanding that an economic recovery had to include individual state governments. And we’ve certainly taken, I think, important steps to cushion as much as possible that blow.

Q Does it concern the administration that the largest state is about to start issuing IOUs and what kind of message that sends to international credit markets?

MR. GIBBS: Well, again, we continue to watch the situation, and we’ll see as it develops.

Yes, sir.

Q Robert, I know you don’t like polls, and tend not to like —

MR. GIBBS: Depends. (Laughter.)

Q You like the positive polls, but any negative polls typically are dismissed. But in this new CNN poll, when it comes to health care —

MR. GIBBS: Some CNN polls —

Q We actually like those and think they’re quite credible. But it shows that there is some resistance among the public for the President’s plan. They believe that their health care costs will go up under the President’s plan, and only a bare majority, 51 percent — 45 percent approve of the plan. Any concern at all that there’s some resistance, perhaps, among the public to the President’s plan on health care?

MR. GIBBS: Well, again, you might elicit a different answer if the poll was 45-51, rather than 51-45. So —

Q But to the question, then, of concern that their health care costs will go up.

MR. GIBBS: Well, look, I think that’s why we have to do — continue to do the job of telling people what will happen if we change the rate of spending on health care; that if we seek greater efficiency, seek treatments not simply — when we approach people’s health care, we seek to treat them, not simply to provide more and more treatments. That’s certainly one of the things that the President has talked about. Changing the way we spend money on health care is extremely important. That’s obviously something the President has dedicated a lot of time to doing.

Millions and millions of Americans right now are paying a premium every day for the millions of people that don’t have health insurance but have to seek medical treatment in an emergency. There are tons of hidden costs in our health care system that have to be addressed through comprehensive health care reform.

I think yesterday, though, there was some important developments relating to this, right? The nation’s largest employer, Wal-Mart, is supportive of aspects of our health care plan because they understand, as a business, they are seeing the crushing effects of skyrocketing health care costs — just as families are, just as state governments are, just as the federal government is.

So I think the President you’ll see today continue to describe for the American people the positive aspects of health care reform and the reason why doing nothing just isn’t an option.

Q So then — is it an issue, then, of the President having to better explain himself to the American people? Perhaps they’re not —

MR. GIBBS: Or the news media. No, I’m just kidding.

Absolutely. The President — I mean, I don’t think the President — one of the reasons the President is out there today is for people to get a better understanding of what his health care plan will do, how it will help and impact them, what it will do to change the cost for their family or for their small business. All of those are aspects of what the President will seek to do — has done and will do, certainly later today in Virginia.

Q Just one more point on that, though. But does he have to change anything at all? I mean, he’s been talking about holding town hall meetings, and now, of course, going online, interactive. But does anything have to change to sort of ramp it up, to better explain it to the American people if, at this juncture, there’s still some confusion perhaps, they’re not buying into it?

MR. GIBBS: My sense is a lot of this is frequency, and I think that’s why you’ve seen us frequently do more events on health care.

Q Follow up on Wal-Mart. What did Rahm Emanuel say to Wal-Mart’s people on Tuesday to get them to issue that letter yesterday?

MR. GIBBS: I don’t — I think this was something that — I think Rahm would appreciate you denoting that he might have twisted or broken an arm, but I don’t think that’s the case.

What happened was this is something that I think the nation’s largest employer, as well as one of the nation’s — if not the nation’s largest union — I think they both understand the same thing. They’re watching skyrocketing health care costs.

There was a — I wish I would have brought it out — there was a great quote in the Wall Street Journal by the head of the retail association who said that he was surprised that Wal-Mart had traded — had abandoned their previous position on an employer mandate for the promise of health care savings. The ridiculous notion that a business would make a business decision; that a business that’s suffering the crushing cost of health care increase year after year after year might eventually year after year after year come to the conclusion that the status quo was unacceptable. That’s precisely where the President has come to.

I think a lot of the American people have come to that conclusion and I think that’s why Congress is making significant progress on health care reform.

Q Can I follow on that, Robert?

MR. GIBBS: Sure.

Q In its letter, Wal-Mart said the commitment to rein in health care costs must be the strongest possible and endorsed the idea of a trigger mechanism that would automatically enforce reductions in medical expenditures. What’s the White House position on the concept of a trigger in the ultimate health care reform legislation?

MR. GIBBS: I don’t know if what that is explaining — and I’ll find out from Nancy-Ann — I don’t know if what that is talking about are some of the MedPAC recommendations that the White House has also endorsed. I think you’ve heard Peter and others talk about this notion that — set up as a result of, I think, the balanced budget agreement of 1997 — there is a board that considers options to rein in unnecessary health care costs from the government — from the government’s perspective.

And each and every year, almost en bloc, these recommendations are gathered and moved aside. Obviously the President and his team believe that this is a key component of health care reform; that ensuring — and again, I want to make sure that these two things are similar, but —

Q They specifically mentioned the Baker/Daschle/Dole approach to this, which may be different than MedPAC, I think it’s a slight variation on that.

MR. GIBBS: Let me check on the differences. I mean, again, I think the President — to underscore —

Q There are some Democrats who are not in favor of this at all, and that’s why I wanted to get the specific —

MR. GIBBS: Sure. Again, I think you’ve heard the President say that — remember this isn’t a bill for a bill’s sake, this isn’t reform for reform’s sake. This has to be something that’s meaningful. One of the meaningful aspects of any of this legislation has to be something that significantly reins in the costs of health care. We can’t — if all we do — right, if all we do is take what’s happening now with those skyrocketing exponential costs and simply add to that, you’re just creating a system that can’t sustain itself. Obviously we’ve got to change the arc of health care spending.

Q But, Robert, what about the smaller businesses? I mean, obviously Wal-Mart is the largest employer in the country. What does an employer mandate really look like and what level could be able to opt out? What does the White House want to —

MR. GIBBS: Well, I mean, obviously there’s going to have to be discussion on this. This is not — without having the details in front of me, this is not something that is going to be — there are certainly going to be exemptions for business size in this. There’s no doubt about that.

Q So, ideally, what size?

MR. GIBBS: Well, I’ll leave that up to some health care negotiators rather than picking a number here. But I think, again, I think what’s important is — you know, I think this represents a pretty big mindset change on behalf of the nation’s largest employer, and it’s a recognition first and foremost of the notion that health care costs are increasing at a rate that cannot be sustained even by the largest employer. So you can imagine the crushing impact that it has on people that are not seeing gross revenues like they are.

Q But those same people say that this will crush them even more.

MR. GIBBS: Who says that?

Q I mean, the smallest businesses having some kind of a mandate like that.

MR. GIBBS: Well, again, that’s why the smallest business is not going to fall under that scenario. There’s obviously going to be some carve-out as it relates to that.

Q Can I ask you just one — on a lighter note, Sarah Palin in an interview with Runner’s World said that in a one-on-one with the President she thinks she has more endurance. Would he consider going for a run with the Alaska Governor?

MR. GIBBS: That’s an interesting question. How’s her jump shot? I guess it depends on where they were going to run. Maybe there’s a terrain advantage in a place like Alaska. But I will certainly ask him if he’s got any free time in his summer to do that.

Q At today’s town hall meeting, questions coming in on YouTube and Twitter and such — who decides what questions will be asked?

MR. GIBBS: I think a group over at New Media is shuffling through questions. I think if you go on — I did not do this today, but I think if you go on our Web site you’ll see some of those questions. And I think, Chip, at the end of the day, when you — I think the questions that will be read to the President — obviously he’ll take some questions from the audience there — I think will be a representative sample of the issues in this debate that we’re dealing with.

Q And the audience is all preselected, right?

MR. GIBBS: No, we usually just generally hand out tickets on a first come, first serve basis.

Q Well, I think in this case, the people were invited either by the White House or by the university — I mean, invited by this community college, as it was explained to us.

MR. GIBBS: Well, if the university is —

Q It just feels very tightly controlled. It feels — I mean, the concept of a town hall I think is to have a open public forum, and this sounds like a very tightly controlled audience and a list of questions. Why do it that why? Why not open it up to the public?

MR. GIBBS: How about we do this — how about you can ask me that question tomorrow based on what questions were asked rather than preselecting your question based on something that may or may not come through.

Q But why pre-select? Why not just open it up for people and allow any question to come in?

MR. GIBBS: Well, Chip, I think if you get on your computer from your e-mail address —

Q I have. I have.

MR. GIBBS: Have you sent in your question?

Q I think that would be inappropriate. This is for the public.

MR. GIBBS: I’m sorry, I’m confused — are you not a member of the public?

Q Well, I think if you were going to allow questions from the press you’d have us in a prominent position over there and allow us to ask questions — you haven’t done that.

MR. GIBBS: Let’s not get into the notion of where you’d be sitting — (laughter) — if I let you ask a question, but —

Q Well out of shouting range.

MR. GIBBS: Well, but you could e-mail.

Q Would you put my question in there? I don’t think so.

MR. GIBBS: Maybe. Have you e-mailed?

Q I mean, this is a town hall.

MR. GIBBS: It’s a little — if you haven’t e-mailed.

Q This is an open forum for the public to ask questions, but it’s not really open.

MR. GIBBS: I couldn’t agree more.

Q But it’s not open.

MR. GIBBS: Based on what?

Q Based on the information that your staff gave us on how the audience and the questions are being selected.

MR. GIBBS: The questions are being selected by people that e-mail on Facebook and Twitter.

Q Well, they’re not deciding what questions actually get in.

MR. GIBBS: Well, Chip, I appreciate, again —

Q It just feels completely controlled —

MR. GIBBS: I appreciate, again —

Q — in a way unlike his town meetings all the campaign and —

MR. GIBBS: I appreciate the pre-selected question on your part.

Q Will there be dissenting views —

Q Yes, how about that?

MR. GIBBS: I think that’s a very safe bet. But, again, let’s — how about we do this? I promise we will interrupt the AP’s tradition of asking the first question. I will let you ask me a question tomorrow as to whether you thought the questions at the town hall meeting that the President conducted at Annandale —

Q I’m perfectly happy to —

Q That’s not his point. The point is the control —

Q Exactly.

Q — we have never had that in the White House. And we have had some, but not —

Q This White House.

MR. GIBBS: Yes, I was going to say, I’ll let you amend her question.

Q I’m amazed — I’m amazed at you people who call for openness and transparency and —

MR. GIBBS: Helen, you haven’t even heard the questions.

Q It doesn’t matter. It’s the process.

Q You have left open —

Q Even if there’s a tough question, it’s a question coming from somebody who was invited or was screened, or the question was screened.

Q It’s shocking. It’s really shocking.

MR. GIBBS: Chip, let’s have this discussion at the conclusion of the town hall meeting. How about that?

Q Okay.

MR. GIBBS: I think —

Q No, no, no, we’re having it now —

MR. GIBBS: Well, I’d be happy to have it now.

Q It’s a pattern.

MR. GIBBS: Which question did you object to at the town hall meeting, Helen?

Q It’s a pattern. It isn’t the question —

MR. GIBBS: What’s a pattern?

Q It’s a pattern of controlling the press.

MR. GIBBS: How so? Is there any evidence currently going on that I’m controlling the press — poorly, I might add. (Laughter.)

Q Your formal engagements are pre-packaged.

MR. GIBBS: How so?

Q Well, and controlling the public —

Q How so? By calling reporters the night before to tell them they’re going to be called on. That is shocking.

MR. GIBBS: We had this discussion ad nauseam and —

Q Of course you would because you don’t have any answers.

MR. GIBBS: Well, because I didn’t know you were going to ask a question, Helen.

Go ahead.

Q Well, you should have.

Q Thank you for your support.

MR. GIBBS: That’s good. Have you e-mailed your question today?

Q I don’t have to e-mail it. I can tell you right now what I want to ask. (Laughter.)

MR. GIBBS: I don’t doubt that at all, Helen. I don’t doubt that at all.

Q Actually, could you pass along a question to the President from all of us, is he going to support a tax increase on the middle class?

MR. GIBBS: I will — if you get on your computer you can ask him that yourself.

Q I think you’re a more direct pipeline than —

MR. GIBBS: I don’t know. I was just told that you guys have a pretty good — go ahead.

Q So, ADP, private employers, they’ve released their estimates on what the job loss figures on private payrolls — they have it at 492,000 for June. Obviously we know we’re going to get the public number tomorrow. Worse than expected. Wall Street just concluded — stock market just concluded its first positive quarter. I know we hear all this time that unemployment —

MR. GIBBS: Lagging indicator.

Q Lagging indicator on this stuff. But it is just such a stark contrast: Wall Street recovering; Main Street, not. I mean, there it is. What do you say?

MR. GIBBS: I think we’ve probably had this discussion more than virtually any other. And I think I have long said, despite your questions, that I don’t equate what’s going on necessarily each and every day in the economy to the ups and downs of the stock market. I never have.

Q A full quarter they had positives, though, which means they’re on an uptick, so —

MR. GIBBS: Right.

Q — but it goes to this concern that somehow that you’ve done a lot to help Wall Street with the financial bailouts, and it hasn’t trickled down to Main Street.

MR. GIBBS: Well, again, I think you can go back to any number of your questions about what was going on as it related to the recovery and what was going on in Wall Street. I wasn’t the one making that connection — many of you were. So I’ll leave that largely aside.

This is not — as I’ve said before, this is not going to happen overnight. This is not something that we got into recently. This is a recession that I think statistically dates back to December of 2007, and I think if you look at the job loss figures, specifically in the last six months, you see a real change in the number of figures — a real jump in the size of those figures.

Q But it’s clear the number is not moving the way I think you guys thought it was going to —

MR. GIBBS: No, no, no, we’ve always said this was going to take time. I said last week that I would — I think that either this month or next month we’ll hit 10 percent. I think if you go back and look at economic forecasts around November, December, and January, you’ll find that a lot of people were surprised at what we ultimately learned in November and December, which was the level of growth — I forget the numbers — were less than — we were contracting at less than a percent, and then all of the sudden, I think the ultimate revised figure for the last quarter in 2008 was negative 5.5 percent growth.

Q Should the public feel better? They should feel better, we’re going to have — shed a half-million — another half-million jobs? But Wall Street —

MR. GIBBS: Well, I’m going to wait for —

Q I understand the statistics stuff, but, I mean —

MR. GIBBS: I’m going to wait for —

Q — should the public feel better about this?

MR. GIBBS: I think that the public rightly, as the President will be, rightly anxious until we see job creation, not job loss; positive economic growth, not negative economic growth. I think that’s going to take some time — not simply because it’s a lagging indicator, but I think for the economy to turn around from the depth that it has been in is not going to happen over the course of one or two months but the course of many, many, many months.

Q Sixty Senate seats — your party has them.


Q The no excuse — Republicans saying no excuses now, everything is on the Democrats, everything is on this White House, you know, if you fail to get something it’s because you can’t get unity in your own party. Is that fair?

MR. GIBBS: Well, it’s a little — I don’t know who said that, but it’s a little odd from — it’s a little odd if —

Q The Chairman of the — I think Michael Steele said it. I just set you up — (laughter.) That’s okay. There are others saying it, it’s not just Steele. It’s Republicans saying, hey —

MR. GIBBS: Wasn’t he complaining last week about bipartisanship?

Q Don’t ask me.

Q He wanted to meet with the President about health care last week.

MR. GIBBS: Well, apparently it’s all on us. Why does he need to meet with us?

Q But is that fair? I mean — but you have the 60 Senate seats. You have a huge majority in the House. You have the White House. Your agenda — it is in your — it’s in your party’s hands, correct?

MR. GIBBS: Look, there’s no doubt — I don’t know that 60 — I don’t know that the seating of one senator changes the notion that Democrats control both Houses of Congress and the White House. I hope the implication by Chairman Steele is not that addressing America’s problems isn’t the priority of all Americans that serve in government, it’s not simply one party. That is a follow-up you could ask him. This President is going to continue to pursue the policies that he believes are important to turn our economy around, to lay that foundation for long-term economic growth, to change our image throughout the world, and continue to reach out to Democrats and Republicans to make that agenda happen.

Q You say it’s one senator. I have heard from plenty of — from you, from others — 60 senators — understand how the Senate works; if you don’t have 60 votes, you don’t have it. Well, you now have — your party has 60 seats, and I understand that it’s still always difficult to get the 60. You don’t have that excuse anymore, though.

MR. GIBBS: Well, again, there’s math, there’s — look, I will say this, as I’ve said many times, I think we don’t get everybody from every party on every vote. That includes the Democratic Party. But where we’ll continue to make progress — I think that — I think all of us, Democrat or Republican, have a unique responsibility serving in government in times like this to work as much as we can together to address and solve these problems. I don’t think one party can simply say, okay, it’s all yours. That certainly doesn’t seem to be the message, again, in prior weeks about making sure that they’re part of the solution. I think that’s the outreach that the President will continue to do in order to restore our economic growth and get this country back on track.


Q Are you saying you don’t see 60 votes as a rubber stamp in the Senate?

MR. GIBBS: Well, I think you can — I assume there’s about 60 U.S. senators that would confirm that for you, yes.

Q Has the President changed his mind about sending more troops to Afghanistan?

MR. GIBBS: Changed his mind how?

Q Well, when he has spoken about Afghanistan, he has spoken about upping the U.S. military presence. Yesterday on Iraq he said forces that come out of Iraq could be used in Afghanistan. And yet General Jones is making it sound that your emphasis will be on economic development in Afghanistan rather than military victory.

MR. GIBBS: Well, I think there are several hundred years of evidence that military might alone is not likely to solve all of your problems in that country or that region of the world. Understand that the troop increases that the President ordered upon coming into office are in the process of phasing in. Not all of that has been done. The President was concerned about the security situation in Afghanistan, as were commanders on the ground, and additional troops have been approved in order to stabilize the security situation as we head into those important elections.

But I think the important point that General Jones was making on that trip throughout the region in Afghanistan and Pakistan and India is, in order to — and I made this point yesterday in Iraq — in order to stabilize that country, to get it back on track and to solve some of the long-term problems, you’re going to have to have more than just military might. You’re going to have to have more than military power. The onus is also going to have to be on the Afghans to improve their security situation, which is why a portion of the additional troop increases go for training the Afghan police and the Afghan military, which is tremendously important.

But if we don’t get good governance and improvement in governance, if we don’t get an increase in development and a change in the economy, I think the President, and I think General Jones would agree, that no amount of troops are going to leave that country in a situation that is sustainable.

Q Can I follow up on that, please?

MR. GIBBS: Hold on, let me finish. Yes, you can. But I think that’s the point, much as the point I made yesterday on a couple of questions as it related to Iraq. I think it’s pretty clear that an increase — or I should say a decrease in the amount of violence, and in some ways an increase in troops to change the security environment, while extremely important, isn’t going to get us all the way until there in Iraq is political reconciliation, until you see a government that is able to economically create jobs and things like that in order to promote sustainability and security there.

So I think this is — the President strongly believes this is something that, as he said before, this isn’t either/or. It’s not military or economic. It has to be both.

Q President Obama, in his remarks yesterday on the community solutions agenda, he was commenting on Iraq, and he said that by 2011, that all of the U.S. troops will be out of Iraq. Did he mean all, there will be zero, not one troop left in Iraq, especially since in legislation that he sponsored before as a senator, said that we need to leave some amount of troop presence there to protect civilians, to fight terrorism, et cetera.

MR. GIBBS: Well, understand there’s two different deadlines I think that we’re talking about here. The plan that the President has and that commanders on the ground and commanders here are implementing is in about 14 months, you’d see the removal of all combat brigades from Iraq. There would be trainers and a residual force that’s left. But understand, when the President says all our troops will be out of Iraq, that’s in accordance with the deadline established in the Status of Forces Agreement negotiated by the previous administration and signed by the sovereign government of Iraq.

So I think —

Q Is there flexibility on that? Does it mean that there could be troops there after 2011?

MR. GIBBS: I think the agreement — I think there’s an agreement that’s been signed between two countries that denote the end of military involvement at the conclusion of 2011.

Yes, sir.

Q Concerning the trip next week, has the President spoken with Medvedev since he met with him in London in April?

MR. GIBBS: Yes. They spoke yesterday about the importance of the upcoming summit and in making progress on issues that will be on their agenda.

Q And we have the briefing at 3:30 this afternoon — that’s on the record, right?

MR. GIBBS: I think it is. We have Denis, Michelle Gavin, Mike Froman, and Mike McFaul, who will walk you guys through each aspect of the three stops.

Q Could you elaborate a little bit on that phone conversation?

MR. GIBBS: Just to say that they spent a few minutes discussing the issues that they’re going to discuss in the upcoming summit.

Q What issues —

MR. GIBBS: The reduction of nuclear weapons.

Q The arsenal stuff?


Q Iran?

Q Missile defense, could that come up?

MR. GIBBS: Only in relation to the notion that will be discussed next week.

Q Robert, for a couple of weeks now, the internal report from the CIA put together by its inspector general on the interrogation techniques of that agency has been delayed. There are concerns among those — specifically, the ACLU has been fighting to get this — that it will be dumped late this week or right before the holiday weekend and sort of missed or lost. What is the status of that report? Why is it being delayed? And will it meet or exceed what you have set as a standard of transparency on this particularly sensitive national security topic?

MR. GIBBS: My standard or Helen’s standard?

Q The administration’s.

MR. GIBBS: I think — here’s what I know of the report, and I would refer you to DOJ because I think part of this is obviously based on Freedom of Information Act litigation involving the ACLU and in some ways an outcropping of what you saw in the OLC memos that were released earlier this year in the President’s term.

It’s my understanding that the interagency review of the document and what can be released is continuing and I don’t anticipate that that’s going to be released today.

Q Today? This week?

MR. GIBBS: It’s my understanding that it’s doubtful that it will be released this week.

Q Doubtful. And this interagency review process, is part of it to increase the amount of information that’s available? Obviously the first report was almost thoroughly redacted. Is part of that process, part of the delay, to make this as transparent as possible or is it principally legal issues —

MR. GIBBS: Well, I would say it’s a — in some ways, it’s a combination. Obviously part of this report, as I said, is an outcropping of that Freedom of Information Act litigation that resulted in the release of the OLC memos. Obviously some of the information that’s out now can — you can go back now through the older IG report — in a sense, I don’t know if this is a word, “unredact” some of that material. That’s what — I think that’s a decent part of what’s going on interagency-wise right now.

Q Quickly, the Iranian police has conducted an investigation into Neda’s death and concluded it was staged. I don’t know if you had a chance to look at that, if you have any reaction to that?

MR. GIBBS: Well, I think that is the ongoing campaign of misinformation about what’s going on. I think the notion that the death of an innocent woman would be staged is — even with them it’s shocking that that would be what would come out.

Q Follow-up on Iran? Follow-up on Iran, Robert?


Q Mousavi earlier today put out a statement in which he called for protests to continue. He also said that he considered the government now to be illegitimate. He demanded the release of political prisoners. Does the President have a reaction yet to that statement? And has the President himself talked to the release of people who’ve been detained in Iran?

MR. GIBBS: Let me check and see if that’s something that we’ve done or not. Obviously, David, you’ve heard the President speak on a number of occasions that the President strongly believes in the right for people to gather in protest without fear or harm or violence. Obviously there are still a lot of questions that surround the most recent election. And I think I’ll leave it at that.

Q On Honduras? One of the triggers of the coup was President Zelaya’s attempt to alter the constitution to allow for reelection. Does the White House believe that the President — that President Zelaya shares an element of blame in his ouster, and what message does the White House have to other leaders in Latin America who seek to alter the constitution to further their political ambition?

MR. GIBBS: You know, let me get a little guidance on that. I don’t know, except to say — let me just say that obviously we were working in order to prevent what happened from happening. And I think — I don’t want to stray too far from just the notion that obviously at OAS there’s an inter-American charter that establishes rights, rules, and responsibilities as it relates to democratic governance. That’s obviously something that’s been violated. And the OAS, with the help of the United States, has reacted to that. But let me get some more guidance on the other question.

Q A quick follow-up? Was one of the — did you ask President Zelaya, in your attempts to stop this from happening, to not hold — to not proceed with —

MR. GIBBS: We’ll reach out to those guys —

Q On Honduras? Just to clarify, Micheletti, the (inaudible) President has said that he’s planning to send some representatives to Washington to talk with the U.S. government. Is the White House or the State Department planning to talk with them?

MR. GIBBS: Not that I’m aware of, no.

Q Micheletti has also said that if Zelaya returns to Honduras, he’s going to be put in jail. Do you have any comments to that?

MR. GIBBS: No, except I think, again, I would simply reiterate that I think the OAS has laid down some fairly strong conditions and a timeline that we’re supportive of and think that should be met in order to restore the democratic rule of law.

Q Why hasn’t the President seen him — having deplored the coup?

MR. GIBBS: I think he’s in Panama.

Q With regard to the health care debate, obviously this is going to be controlled more by Congress than the White House, but does the White House have a good sense now of the pace at which things will proceed, the pace at which each chamber will probably have a bill, and the pace at which, on the calendar, negotiations will proceed?

And as a follow-up, the President, during the campaign and since taking office, has emphasized his desire to have the policymaking play out in the public eye. And so far there have been sort of town halls or a meeting at the White House with cameras and a transcript. But in terms of how the actual policy is being crafted, that’s going on in Congress behind closed doors. What can you do to make sure that he’s able to have this play out in public as he’s promised, as things go forward?

MR. GIBBS: Well, look, I don’t want to interject too heavily into the committee process, but, I mean, obviously — and I’ve been asked about them on any number of occasions, reactions to different aspects of bill mark-ups, obviously that are done in a very public way. I think what the President has talked about and I think what — particularly what the step taken by Wal-Mart demonstrates is that as I’ve talked about a lot this week is unlike previous attempts to reform our health care system in a way that is comprehensive and brings down costs, those players are still at the table, those players are actively participating in working in finding a solution. And the President thinks that’s how we’re going to get enduring comprehensive reform to an issue that we’ve been debating for 40 years.

Q But do you think the sausage-making part is public enough? For example, one of these questions that —

MR. GIBBS: For me? Yes. (Laughter.) I’ve been asked about it I don’t know how many times. I think it’s — I seem to be dealing with it — yes.

Q — issues such as the possible partial taxation of insurance benefits and these sort of things, which are yet to be determined. The way legislation often works is everybody says, well, we’ll talk about it when we get there, and then like, you know, suddenly it’s done and it’s in the bill. And I know that’s something you’re trying to avoid in this process. How will you make sure that this is done publicly?

MR. GIBBS: Since I’ve been asked about it about 10 times in the last two weeks, if it’s being done in secret, somebody is doing an awfully poor job of keeping it that way.

Q I’m doing a poor job of asking my question.

MR. GIBBS: I don’t want to render an opinion on that.

Go ahead, yes.

Q Well, first off, for the record, I did submit a question through the Web site today about public options, so —

MR. GIBBS: Excellent. Well, I’ll —

Q But my question today is about — the Justice Department didn’t appeal a ruling in this discrimination case involving a potential Library of Congress hire who was planning a gender change. Why not, and is that part of the President’s promise that he made during the LGBT meeting last —

MR. GIBBS: That I don’t have any — let me find something on that. I don’t have anything on that.

Q Then another health care one then. How does the President feel about some of the liberal groups like MoveOn targeting Senator Kay Hagan and Senator Mary Landrieu on public option, the fact that they said they won’t support that in the bill?

MR. GIBBS: Well, I don’t know that I — the President has much to say about what the groups are doing, except to reemphasize the principle that he has that — of the importance of providing that public option to give those that are not able to buy insurance through their workplace or that are having trouble in the normal health insurance market go through a health insurance exchange that will provide greater choice, greater transparency, and more competition in a way that we believe will be effective and cost-effective.

So I think — I mean, obviously the President is a big believer in an option — in that option.

Q Are these ads helpful when you’ve got senators who — he was trying to convince them to support what you just said, and you’ve got these groups that are saying we’re going to withhold your money, we’re going to pressure you with your citizens back home to support —

MR. GIBBS: I’m not sure how much money Mary gets from MoveOn. But I don’t have any general reaction to that.

Q Thanks, Robert.


Q Thank you, Robert. Medicaid is a big part of the health care problem, and I think it’s costing $300 billion a year, and that’s a big reason the states need help. Last year the state of Rhode Island became the first and so far only state to get a waiver on Medicare. And of course —

MR. GIBBS: Medicaid?

Q Medicaid, sorry, on Medicaid. As it is, they’ll allow Washington to put a cap on Medicaid funding and, in turn, if they can determine eligibility, put limits down and reform the system. Allowing states to have waivers on Medicaid, is that something that’s on the table with the President now?

MR. GIBBS: Let me talk to the health team. I don’t know the degree to which that’s something that — how much they’ve gotten involved in that. Obviously, I think you mentioned Medicaid represents a growing fiscal component for states, especially in harder economic times, and that obviously is something that has to be looked at and addressed in anything that’s comprehensive.

But again, I think that also strengthens the argument for changing the way health care is done and ensuring that it’s done in a way that’s affordable, again, not just for families and small businesses but for state governments, as well.

Thanks, guys.

END 1:11 P.M. EDT


Pool report on Obama health-care town hall

President Obama talked up the Health Insurance Exchange at a town hall forum at Northern Virginia Community College that included questions from the audience and also submitted via Facebook, Twitter and YouTube.

Valerie Jarrett, acting as moderator, made a point of saying the president was not given the questions in advance.

“I want to emphasize that the president has not seen the questions ahead of time, absolutely not,” Jarrett said.

They were chosen by the president’s staff.

The biggest “moment” came when the president solicited his first question from the audience and singled out a woman with her hand up, noting that “somebody was pointing at you, so I figured…”

According to information provided by the White House, she was Debby Smith, 53, of Appalachia, Va.

Fighting tears, Smith told Obama she had renal cell carcinoma in 1998. The tumor was treated with radiation but she was no longer able to work, and now has no health coverage. “Now I have a new tumor,” Smith told the president.

She can’t get it treated, can’t get disability from Social Security, can’t get Medicaid, has dependent kids at home.

The president listened intently, gazing at Smith with a slightly furrowed brow.

“Come on over here,” Obama said.

As she made her way out of the seats and to his side, the president promised to get her information and try to help her. He hugged her and said she is a “perfect example” of why health care reform is needed.

“You are Exhibit A,” he told her.

Please see transcript for full rundown. He also got questions about why no single-payer, how health care reform will help employees of small business, one from a guy who works at Health Care for America Now who was wondering if Obama would talk about “affordability,” and another from an SEIU member asking what she can do to help pass health care reform. Rep. Mike Burgess, R-TX, asked about malpractice insurance.

Uneventful motorcades to and from event. Back at White House shortly after 3 pm. POTUS this afternoon is meeting with regional press, including Sacramento, Modesto, Cincinnati, Portland and several others.

– Filed by Julie Mason, The Washington Examiner


Remarks of President Barack Obama at Health Care Town Hall in Annandale, Va., Wednesday, July 1, 2009

It’s great to be here in Annandale, and I’m looking forward to answering questions from the folks here with us today as well as the Americans who’ve submitted questions online.

But before I begin, I just want to say a few words about where we are as a nation and where we need to go.

We are living through extraordinary times. This generation of Americans – our generation – has been called to confront challenges of a magnitude unmatched in recent history – challenges that few generations of Americans have ever been asked to confront. In addition to the immediate threats we face – two wars and a deep recession – our economy has also been weakened by the failure to solve problems that have plagued us for decades: the crushing cost of health care, the state of our schools, and our dependence on foreign oil.

Now, I know there are some who say that in tackling all these problems, my administration is taking on too much at once – that we’re moving too fast, too soon.

Well I say that America has waited long enough. It’s not too soon to fix our schools when we’re already behind other nations in graduation rates and achievement. It’s not too soon to wean ourselves off dirty sources of energy when we’ve been talking about our oil dependence since Richard Nixon was president. It’s not too soon to reform our health care system when we’ve been talking about fixing it since Teddy Roosevelt was president.

We are at a defining moment for this nation. If we act now, we can rebuild an economy that is strong, and competitive, and prosperous once more. We can lead this century as we lead the last. But if we don’t act – if we let this moment pass – we could see this economy sputter along for years, if not decades. We could see our children inherit a world that is poorer and more dangerous than the one we found. I know that people say the cost of fixing our problems is great, but I can assure you – we have reached a point where the cost of doing nothing is far greater.

Nowhere is that more true than when it comes to the cost of health care in America. In the last nine years, premiums have risen three times faster than wages. If we do nothing, they will rise even higher. In recent years, over one third of small businesses have reduced benefits and many have dropped coverage altogether since the early 90s. If we do not act, more will lose coverage and more will lose their jobs. Unless we act, within a decade, one out of every five dollars we earn will be spent on health care. And for those who rightly worry about deficits, the amount our government spends on Medicare and Medicaid will eventually grow larger than what our government spends today on everything else combined.

The stories behind these numbers are real and they are heartbreaking. For over two years, I’ve heard them in town halls just like this one. I read them in letters every day. And so many of you have asked questions and talked about your struggles on our website,

I still remember the story of the young mother I met in Wisconsin a few weeks back. She has bone cancer and two young children. She’s thirty-five years old. She had a job, her husband has a job, and even though they’ve got insurance, their medical bills have still landed them in deeply in debt. And now, instead of worrying about how she’ll get well, all this mother can think about is whether she’s going to be leaving that debt to her husband and her children if she doesn’t survive.

This is not a problem we can wait to fix. This is not something we can keep putting off indefinitely. This is about who we are as a country. And that’s why we’re not going to pass health care reform ten years from now, or five years from now, or even one year from now. The United States of America will have health care reform in 2009. We will get it done.

We have already made great progress in Washington. In the last few weeks, the pharmaceutical industry to agreed to $80 billion in spending reductions that will make prescription drugs more affordable for our seniors. Last month, doctors and hospitals, labor and business, insurers and drug companies all came together and agreed to decrease the annual rate of health care growth by 1.5 percentage points — saving $2 trillion or more over the next decade. That will mean lower costs for all of us.

And in the past two weeks, a committee in the Senate led by Senator Kennedy and Senator Dodd has been making tremendous progress on a plan that would hold down costs, improve patient care and ensure that you will not lose your coverage if you lose your job, change your job, or have a pre-existing medical condition.

But now we need to finish the job. There is no doubt that we must preserve what is best about our health care system, and that means allowing Americans who like their doctors and their health care plans to keep them. But we also have to fix what’s broken about health care in America – and that means permanently bringing down costs for everyone.

To do this, we have to build on the investments in electronic medical records that we’ve already made in the Recovery Act – records that will reduce medical errors, save lives, save money, and still ensure privacy. We need to invest in prevention and wellness programs that help Americans live longer, healthier lives. And the biggest thing we can do to bring down costs is to change the incentives of a health care system that automatically equates expensive care with better care.

We have to ask why places like the Geisinger Health system in rural Pennsylvania or Intermountain Health in Salt Lake City can offer high-quality care at costs well below average, but other places in America can’t. We need to identify the best practices across the country, learn from the success, and replicate that success elsewhere. And we should change the warped incentives that reward doctors and hospitals based on how many tests or procedures they prescribe, even if those tests or procedures aren’t necessary or result in medical mistakes. Doctors across this country did not get into the medical profession to be bean counters or paper pushers. They became doctors to heal people. And that’s what we must free them to do. This has to be about the best care, not just the most expensive care. It has to be about treatments that work, not just more treatments.

It’s also time to finally provide Americans who can’t afford health insurance with more affordable options. This is a moral and economic imperative, because we know that when someone without health insurance is forced to get treatment at the ER, all of us end up paying for it – to the tune of about $1,000 per person.

So what we’re working on is the creation of something called a Health Insurance Exchange – a marketplace which would allow you to one-stop shop for a health care plan, compare benefits and prices, and choose the plan that’s best for you. None of these plans would be able to deny coverage on the basis of a pre-existing condition, and all should include an affordable, basic benefit package. And if you can’t afford one of the plans, we should provide a little help to make sure you can. I also strongly believe that one of the options in the Exchange should be a public insurance option – an option funded by premiums, not the government. This public option is important because if the private insurance companies have to compete, it will keep them honest and help keep prices down.

Now, I know one of the biggest questions on everyone’s mind is how to finance reform. And that’s why we’ve committed to paying for this without adding to our deficit over the next decade.

About two-thirds of the cost will be covered by reallocating money already in our current health care system. Much of this money adds nothing to quality of care for patients – it fattens the bottom lines of insurers and other health care providers. As an example, we’re on track to spend $177 billion over the next decade in unwarranted subsidies to insurance companies that add nothing to the quality of care. $177 billion. Those are your tax dollars, and you deserve better in return. That’s why we’ll redirect those resources toward lowering costs, expanding coverage, and improving quality for all Americans.

In fact, between slashing wasteful spending, cost savings, and identifying new sources of revenue, we’ve already put almost $950 billion on the table to help pay for reform without adding to our deficit. And that doesn’t even include the savings that these reforms could achieve – savings that will reduce our deficit over the long-term.

So we are making progress on health care reform and we are identifying ways to pay for it. But the hardest part is yet to come – because that’s the part when the naysayers and cynics use every excuse and scare tactic in the book to stop reform from happening. And it’s already happening as we speak.

If you hear this criticism, ask the same question that I always ask: “What’s your alternative? What do you say to all those families whose medical bills have driven them into bankruptcy? What do we tell those businesses that are choosing between closing their doors and letting their workers go? What do we say to every taxpayer in America whose dollars are propping up a system that is driving us further and further into debt?”

This isn’t just about those Americans without health care. This is about every American – because if we do not act to bring down costs, every American’s health care will be in jeopardy. All of us are in this together.

When it comes to health care, or energy, or education, the naysayers seem to think that we can somehow just keep doing what we’ve been doing. But everywhere I go, I meet Americans who know that we can’t. They know that change isn’t easy. They know that there will be setbacks and false starts. But they also know this:

We are at a rare moment when we have been given the opportunity to remake our world; a chance to seize our future. And as difficult as that sometimes is, what is inherent about the American spirit is the fact that we do not cling to the past in this country. We always move forward. And that movement doesn’t begin in Washington – it begins with Americans from every corner of this country who stand up and face that future unafraid. And if we do that now – with health care, with energy, with education – then someday we will look back at this moment as the time when we did what’s necessary to leave our children an America that is as bold, ascendant, and imaginative as the America we inherited from our parents. And with that, I’ll turn it over to my friend and advisor Valerie Jarrett, who will take your questions.


Q-and-A from the health-care town hall

MS. JARRETT: I’m going to be in charge. Thank you very much, Mr. President.

So in my opening remarks, Mr. President, I mentioned that when you released your YouTube video over the weekend, we received literally hundreds of video questions from all across the country. Your staff looked through all those questions and have selected a cross-section that represents a broad cross-section of the kinds of questions that came up.

I want to emphasize that the President has not seen the questions ahead of time. (Laughter.) Absolutely not.

And so we’re going to begin with a video question, Mr. President, if you look at the screen.


VIDEO Q Hi, my name is Steve White. I’m in Spring Valley, New York. And my question for the President is: Why are we considering a health care plan which maintains the private insurance companies with their high overhead costs, instead of a single-payer plan, which would eliminate the high overhead costs, saving the American taxpayer hundreds of billions of dollars, while covering everyone in our country? Thank you.

THE PRESIDENT: Sure. Well, it’s a terrific question. I’m not sure if everybody could hear it, but the gist of the question is, why have we not been looking at a single-payer plan as the way to go?

As many of you know, in many countries, most industrialized advanced countries, they have some version of what’s called a single-payer plan. And what that means is essentially that the government is the insurer. The government may not necessarily hire the doctors or the hospitals — a lot of those may still be privately operated — but the government is the insurer for everybody. And Medicare is actually a single-payer plan that we have in place, but we only have it in place for our older Americans.

Now, in a lot of those countries, a single-payer plan works pretty well and you eliminate, as Scott, I think it was, said, you eliminate private insurers, you don’t have the administrative costs and the bureaucracy and so forth.

Here’s the problem, is that the way our health care system evolved in the United States, it evolved based on employers providing health insurance to their employees through private insurers. And so that’s still the way that the vast majority of you get your insurance. And for us to transition completely from an employer-based system of private insurance to a single-payer system could be hugely disruptive. And my attitude has been that we should be able to find a way to create a uniquely American solution to this problem that controls costs but preserves the innovation that is introduced in part with a free market system.

I think that we can regulate the insurance companies effectively; make sure that they’re not playing games with people because of preexisting conditions; that they’re not charging wildly different rates to people based on where they live or what their age is; that they’re not dropping people for coverage unnecessarily; that we have a public option that’s available to provide competition and choice to the American people, and to keep the insurers honest; and that we can provide a system in which we are, over the long term, driving down administrative costs, and making sure that people are getting the best possible care at a lower price.

But I recognize that there are lot of people who are passionate — they look at France or some of these other systems and they say, well, why can’t we just do that? Well, the answer is, is that this is one-sixth of our economy, and we’re not suddenly just going to completely upend the system. We want to build on what works about the system and fix what’s broken about the system. And that’s what I think Congress is committed to doing, and I’m committed to working with them to make it happen. Okay?

MS. JARRETT: Now, how about a question from the audience.


MS. JARRETT: Please, show of hands.

THE PRESIDENT: What I always do here is I go girl, boy, girl, boy, so that I don’t get into trouble here. (Laughter.) All right, this young lady right here — since somebody was pointing at you, so I figured — do we have a microphone for folks in the audience, so that everybody can hear the question? Okay. I think there’s somebody coming from this direction. You can just hand her the mic.

Q Good afternoon, Mr. President. I’ll try not to cry. I’m trying to figure out what I can do currently. My situation is I had renal cell carcinoma in ’98 that was radiated, because my dad was dying of colon cancer at the time, and I was his health care server on his living will, so I could not be tied up having my kidney removed. So they did radiation procedures to kill the tumor then. And I had insurance and everything was taken out.

But basically because of the damage that the radiation did in things, I’m no longer able to work and I have no health insurance. Now I have a new tumor. I have no way to pay for it. Doctors will not see you without paying $100 or $150 to come into their office. I can get checked into a hospital — under their program, they will run tests and release me, but that costs a lot of money.

So currently I basically — Social Security will not give me disability because renal failure is no longer a qualifying factor under Social Security currently. I cannot get Medicaid from the state of Virginia because you have to be considered disabled through Social Security to qualify for Medicaid in the state of Virginia because I have no dependent children at home — it’s just me. I get food stamps, but that’s it. And I’m just trying to figure out how I’m going to make it in nine years until I’m qualified to get my regular Social Security — now that I have a new tumor and I have nowhere to turn.

THE PRESIDENT: Well, here, come on over here. First of all, we’re going to find out what — we’ll get your information and we’ll see what we can do to help you. I don’t want you to feel all — like you’re alone. (Applause.)

You know, without knowing all the details I’m not going to give you an answer right now about exactly how we can help. We’re going to find out what we can do within existing law. But — what was your name again?

Q My name is Debbie.

THE PRESIDENT: Debbie. Debbie is a perfect example of somebody who we should, in a country this wealthy, be able to provide coverage for her health care problems. And what we don’t want is a situation where Debbie gets worse and worse because she’s not getting treatment, and then ends up having to go to the emergency room. As I said before, all of you will pay for it anyway; it’s just you’ll pay for it in terms of a hidden subsidy. And she’s not getting the best care, and we’re actually paying more than we would have if Debbie right now was getting treated on a regular basis by a physician who knew her history.

So, Debbie, you are Exhibit A. And we appreciate you sharing your story. We are going to try to find ways to help you immediately. But the long-term problem here is going to be how do we create a system in which Debbie is getting the preventive care that she needs and is able to get regular checkups, is able to get treatment in a way that is much more cost-efficient than the one that we’ve got right now. And I’m going to make a commitment that we’re going to get that done this year.

All right? (Applause.)

Q Sir, July 24th through the 26th, there’s a thing in Wise County, Virginia, called RAM Ear and Medical, and that is — Rural Area Medical is where anybody who needs medical treatment can get free treatment for those three days — the 24th, 25th, and 26th —

THE PRESIDENT: The 24th, 25th, and 26th —

Q — of July.

THE PRESIDENT: Well, we will help advertise that —

Q If you would like to showcase why there’s a need. I think they treated — Governor Warner and Kaine can say how long — but I think it’s 7,000 people get treatment there every day of those days that it’s free.

THE PRESIDENT: Which is a wonderful program. But I think, as Senator Warner and Governor Kaine would agree, we can’t have a system that’s reliant on three days of free care and 362 days in which people don’t have health care. That doesn’t make any sense.

Debbie, thank you for sharing your story. We appreciate you. Thank you. (Applause.)

All right.

MS. JARRETT: Thank you, Debbie.

So many of the questions that are put to on the videos, Mr. President, are also very personal. So now we’re going to take another from a video.

(Video is shown.) SMALL CHILD: My mommy and daddy have small businesses and we need health care.

MOTHER: I actually have to work for a company so that we can get coverage because my older daughter is an automatic decline and we’re just too small of a business to be able to absorb the cost. How can health care reform help us?

THE PRESIDENT: As somebody with two daughters, I’m a sucker for anybody who uses their daughter in their video. (Laughter.) So my staff probably knew that. They figured, well, he’s going to be a soft touch after that one.

Small business owners are those who are being, in some cases, hardest hit by the rising cost of health care. And in some cases, they just can’t afford to provide health insurance to their employees, and that’s frustrating, but they’re operating on too small a margin, or they don’t have enough employees so they’ve got no leverage to negotiate with the insurance companies. And so the offers that insurance companies give them for the cost of coverage per person end up being way higher than they would be for big companies that have more consumer power.

In some cases, though, it’s gotten so bad that small businesses, they can’t even afford to provide health insurance for themselves, small business owners. And a lot of small businesses, a huge percentage of small businesses are sole proprietorships. Maybe it’s a family business — they’ve got one or two people working for them. And so they’re like consultants out there or self-employed individuals — they just can’t get a good deal.

This is an example of where this health care exchange could be so helpful, because by creating a health care exchange, part of what we want to do is to allow small businesses, as well as people who are self-employed, individuals whose companies don’t provide coverage, to come to this exchange, take a look at a menu of plans that are available, join one of these plans — you may qualify for a subsidy from the federal government — and you then become part of a big pool that gives you some leverage over the drug companies and the insurance companies to drive down costs.

And that’s part of the way that health care reform can provide direct savings to American families right now, by giving them more leverage.

Look, I am very pleased that the drug companies decided to cough up $80 billion to help close this “doughnut hole.” I have to be honest with you, though: Were it not for the prospect of serious health care reform, I don’t think they would have given up that money. That’s just my guess. (Applause.) And so these same principles apply when it comes to setting up this health care exchange. If we do it effectively, then not only will families be able to make some very clear choices, and small business owners make some clear choices, about here’s the best plan available for us that fits our particular needs, but they’re also going to be part of a broader group that can apply some leverage in the system.

And that’s essentially what federal health care employees do. Mark Warner has a plan that all members of Congress and federal employees have, and it’s not Cadillac care, but it’s good, solid, decent care with a range of options. Part of the reason that it is a good program is because there’s so many federal employees. Well, we should provide that same kind of leverage for the small business owner who right now is too small on their own to be able to get the best possible deal on the insurance market, and that’s what we want to provide in this health care reform package. All right? Good.

MS. JARRETT: All right, I think we’re ready to go back to the audience.

THE PRESIDENT: All right, it’s a guy’s turn now, all right, so, ladies, keep your hands down. (Laughter.) All right, this young man right here.

Q Thank you. I’ve been hearing a lot —

THE PRESIDENT: What’s your name?

Q Jason Rosenbaum.

THE PRESIDENT: Hey, Jason. What do you do, Jason?

Q I work for a group called Health Care for America NOW. (Applause.)

THE PRESIDENT: I think he knows something about health care. This is like —

Q I’ve been — obviously I read the news a lot, and I’ve been hearing a lot about the price tag of health reform and how people are very concerned that it’s going to cost a trillion dollars, and we’re trying to keep it under a certain number. I’m most concerned about making it affordable, folks like me, the American people. So what do you — and like you said, you’re committed to making this deficit-neutral. So I hope you could talk a little bit about affordability and what your plans are for that.

THE PRESIDENT: Good. Well, look, the first thing that I think is very important for people to do is to understand the costs of doing nothing, because sometimes opponents of health care reform pretend as if we’ve got this great thing going here and the Obama administration wants to completely upend it just because I don’t have enough to do. (Laughter.) And I keep on trying to explain to people, look, I’ve got a war in Afghanistan; we haven’t gotten the troops out of Iraq yet; I’ve got North Korea and Iran; and H1N1 flu. So if the health care system was really working well, I would be happy to leave it alone.

So understand where we’re at. If we don’t do anything, the costs are going to keep on rising. I mean, some employers see their costs going up 8, 9, 10 percent a year. As I said, families have seen their health care costs double over the last nine years. So you just project out nine years from now — your wages or incomes aren’t going up that fast, which means that a bigger, bigger bite is being taken out of your paycheck, even if you’ve got health insurance. More and more employers are saying in this very competitive atmosphere, we can’t afford to do more.

So what’s happened if you’ve got health insurance? Your employer has basically done what? They’ve increased deductibles; they’ve increased premiums. Your out-of-pocket costs have gone up by about 62 percent, and they’re just going to keep on rising. And the cost of Medicare and Medicaid, because they track all these other costs, they’re going to keep on skyrocketing. So our deficit will be completely out of control.

Don’t let people fool you with this notion that somehow the reason for our deficit has to do with, for example, the Recovery Act. The Recovery Act was designed to make sure that local school districts didn’t lay off teachers and firefighters and police officers — and it’s done its job, and it’s building the kind of infrastructure that we need to be competitive in the future. But it is a tiny fraction of our long-term deficit projections. Almost all of the long-term deficit projections come from increases in Medicare and Medicaid.

So the reason I say all this is because the costs are going to be there if we don’t do anything. The deficit will grow if we don’t do anything. Our debt will grow if we don’t do anything. What I’m trying to do is figure out how do we bend the curve of costs so that we’re getting more and more efficient care, higher-quality care, at less cost per person? How do we eliminate the $1,000 per family that’s coming out of your pocket in subsidized care, uncompensated care at hospitals that’s going on right now?

And if we can do that, then, A, we can cover more people with the savings; and, B, we have more leverage over the insurance companies and the drug companies so that they give a better deal. That’s what we’re trying to do.

Now, I do think that we can’t add to the deficit; we should find ways to honestly pay for whatever reforms we’re proposing. And I already gave you an indication of how we would do it. About two-thirds of it would come from reallocating money that’s currently in the system — taxpayers, you’re already paying for it, so this isn’t new money coming out of your pocket; this is money that’s right now being spent by the federal government but not spent wisely in a way that makes you healthier. That’s two-thirds of it.

One-third of it, because we’ve got to make some initial investments up front and a lot of the savings — remember what I told you — aren’t scorable, we’re going to have to raise some additional revenue to make sure that people are adequately covered and we’re providing some help to families who may have health insurance but are really starting to struggle right now.

And I think the best way for us to pay for it is, as I said, capping the itemized deductions that people making over $250,000 a year, people like myself — used to be Valerie was making that, but now she’s working for the federal government so — (laughter) — she wouldn’t be affected by this — capping those itemized deductions. Then we can raise enough money to pay for a good, high-quality health care reform proposal that will provide health care security for everybody.

And as I said before, many of you may be satisfied with your health care now. What you’ve got to do is project, if current trends continue, are you still going to be happy with your health care five years from now? Will you have health care five years from now?

A lot of people here, if you change jobs right now but you’ve got a preexisting condition — and just about anything these days can be called a preexisting condition — you may have trouble signing up for health care the next time around — just because you changed a job, set aside the situation where you lose a job.

One of the things that we did in the Recovery Act was to help people with COBRA. Everybody knows what COBRA is? That’s the program that allows you to get health insurance — to continue your health insurance even when you lose your job. The problem is premiums are so high that most people, when you lose your job, you can’t afford it. The last thing you can do is afford suddenly a $1,000 or $1,500 in premiums. So what we did was we subsidized people being able to keep their health insurance longer, cutting those COBRA costs.

I think that was a pretty smart thing to do. That was the right thing to do. But we can’t just do that indefinitely. We can’t do patchwork, piecemeal fixes through a Recovery Act. What we need is a permanent solution that ensures that when you lose your job or change jobs, you can still have health care; if you’re self-employed, you’ve still got health care.

Every nation on Earth that is as wealthy as ours is able to do that. And they don’t do it perfectly — that’s why I say we’ve got to find a uniquely American solution — but don’t tell me that we can’t get this done. And for those who say, well, you know what, this is something that is very complicated so we shouldn’t rush into it — that’s what happens in Congress all the time. They have hearings, they write white papers, and then suddenly the lobbyists and the special interests start going at it, and the next thing you know, another 10 years has gone by and we still haven’t done anything.

That’s not what’s going to happen this time. I am going to keep on pressing until we get it done this year. All right. (Applause.)

MS. JARRETT: All right, Mr. President. So Macon just slipped me a note, and he said, right now on Facebook and on Twitter, a lot of people are talking about the proposal to tax health care benefits. For example, Rob on Twitter said, “Does it really make sense, Mr. President, to tax me on my health care coverage?”

THE PRESIDENT: Well, here’s — let me describe for you how this argument has evolved and where I’ve stood on it in the past and what’s being debated in Congress.

Part of the reason that employers provide health care to most American is because they get a big tax exclusion. They don’t pay taxes on — and you don’t pay taxes on the health care benefits that you receive. So it’s a huge subsidy that’s provided through the tax code for employers to provide you coverage.

Now, up until, let’s say, a generation ago, this worked reasonably well. It’s starting to break down because even with the tax exclusion, the cost for employers, just out of pocket, paying the insurers, is getting more and more expensive.

Some people have said that what we should do is just eliminate this tax exclusion so that the federal government isn’t indirectly subsidizing employers providing care, and that we could take that money and then just give everybody a tax break individually and then they could go out and shop for their own health care. This was essentially John McCain’s proposal during the campaign. I mean, I want to be fair to it. The idea was, you eliminate the exclusion; the billions of dollars that come back into the Treasury are then given out to each person in the form of a $5,000 or a $7,000 tax credit, and then you go out and you buy your own insurance.

And the thinking is that if you do it that way, then each of you are going to be more discriminating consumers, and you are going to go out and get the best possible deal, and you won’t be overusing the health care system. You won’t be going to the doctor unnecessarily or taking drugs that you don’t really need. And you will be the — you will essentially engage in self-rationing. That’s really the concept behind this idea.

Now, in fairness, the other notion is, is that if you don’t have your health care tied to employers, then you’re not going to be as worried about losing your health insurance if you change your job because the money follows you as opposed to being with the employer. So that’s the concept.

Now, I opposed this during the campaign, and I opposed it for a couple of reasons: Number one, if you completely eliminated the exclusion, there is no doubt that what would happen is, is that a lot of employers would stop providing health care. And so a lot of people who currently get health care through their employers wouldn’t be able to get it.

The second thing — remember what I told you earlier about how if you are on your own shopping for health care you’ve got no leverage with the insurance company. Well, the problem is, is that if suddenly now you get a tax credit for $5,000 or $7,000, you try to go buy some health insurance for your family, and it costs $14,000, you’re a lot worse off than you would have been. You’re out of luck. And you’ve got no leverage; they’ve got no incentive to give you a lower price because you’re on your own.

The other problem is that when you’re not part of a pool, the insurance companies have every incentive to make sure that if you are older or you are sicker, that they do not cover you. They want to cover the young, healthy folks like Mark Warner. (Laughter.) That’s who they want. But if you’re older or sicker, you are more likely to be excluded from coverage, or they really jack up the rates. When you’re part of a pool, then the insurers say, well, I guess we’ll take the older, sicker folks because we’re also getting the younger, healthier folks at the same time.

So, for all those reasons, I opposed the proposal that was put forward, because essentially it would be, for the first time, taxing the health care benefits that are provided by employers.

Now, nobody at this point is — or not many folks are talking about taxing benefits or completely eliminating the exclusion. What they are calling for now in Congress is to cap the exclusion so that people who have very high-priced health care, at a certain point they can only get a deduction up to a certain point, right? So let’s say that the average health care cost for families — a good health care plan costs $13,000. What they would say is the employer and the employee get an exclusion up to $13,000, but if you get some Cadillac plan that costs $17,000, then what we’re going to do is you’re going to have to pay taxes on that last $4,000. And the idea that is being debated in Congress right now is, is that a good way to ensure that people don’t have these big Cadillac plans but instead have more sensible plans?

Now, I don’t think — and by the way, that also raises some money. So this has been offered as an alternative way to pay for that extra one-third of health care that we’re not able to pay for through simply reallocating money.

I think the better way to do it remains the proposal I have to cap itemized deductions. I think that is a way that we can ensure that people who currently have health care aren’t suddenly seeing the costs go up to pay for other people’s costs going down, but instead everybody’s costs can go down effectively.

But this is something that’s going to be debated in the House and the Senate. Mark Warner is going to have to weigh in on it. We’re all going to have to weigh in on it. My bottom line, though, is that if you’ve got health insurance right now, you shouldn’t suddenly see your costs go up as part of health care reform.

Okay? Good.

MS. JARRETT: All right, Mr. President, I think we’re teed up for another video question.


VIDEO Q Mr. President, as a physician, I know the cost of defensive medicine drives medical costs upward. Now, at your health care forum you said that you wanted to find out what works. In my home state of Texas, we know what works, and our Medical Justice Act has done just that.

Now, unfortunately, you recently told the AMA you were opposed to capping non-economic damages, even though a state like mine has proven that it does work. Now, will you reaffirm your commitment to find out what works and then ask Congress for its implementation?

THE PRESIDENT: Okay. I want to make sure everybody understands the question here. A lot of doctors have argued — and in some cases they’re justified — that their costs for medical malpractice insurance, the threat of a lawsuit if something goes wrong with a patient, even if it’s not their fault, is so high that not only is it increasing their out-of-pocket cost, but they’re also engaging in what’s called defensive medicine; that they’ve got to order five tests when one is enough just to make sure that they’re covered so that if something goes wrong that’s not their fault later, they can say, look, I did everything possible — even if a lot of that isn’t required.

And so the argument is if you can cap the pain and suffering or the liability that is awarded as a consequence of you being hurt in the hospital or by a doctor, that that would drive down everybody’s costs.

Now, what I’ve said is that I don’t like the idea of an artificial cap on somebody if the doctor or the hospital really was negligent. And in some cases, I’ve got to tell you, they are. I mean, there are cases where folks leave a sponge in your gut and sew you back up, and after a while you’re feeling worse than when you went in. And in some cases, obviously that can cause very severe damage, and I want to make sure that people’s pain, suffering, out-of-pocket expenses, that those are covered.

So I don’t like the idea of just an artificial cap. I do want to work with doctors to find ways that we can reduce their liabilities where they haven’t done anything wrong, where they’ve performed effectively. I want to see, are there ways that we can reduce the constant threat of lawsuits that doctors and hospitals experience, because I do think that that causes defensive medicine. And so I’ve committed to working with the AMA to see ways that we can reduce some of these litigation costs and malpractice rates.

One point that I’ve got to dispute, though, with the gentleman who asked me the question — he says he’s from Texas, and that we’ve got caps in Texas, and so we’ve seen what works. Well, the fact is, is that there was just recently an article about a town called McAllen, Texas, where they have the highest health care costs in the country. It’s down by the border. And even though they have caps there, in McAllen, Texas, they spend about three times as much per person as — or not — they spend about 30 percent more per person than they do in El Paso, Texas, which also is operating under caps. So what that tells me is the problem of rising costs doesn’t simply have to do with whether or not liability is capped. What it really has to do with is the incentives that are operating in various communities.

There are some places, like the Mayo Clinic, many of you have heard of, provides outstanding care, some of the best in the world. People fly in from everywhere to go to Mayo Clinic to get treated. Turns out Mayo provides care much more cheaply than a lot of other health systems, even though it’s better care. And part of the reason is they do some things that are commonsensical, but unfortunately we don’t do in the health care system.

For example, instead of you going to one — your primary care physician, who has you do a bunch of tests, then refers you to a specialist who has you do a bunch of tests, then maybe you go to a third specialist, another bunch of tests; go to the hospital, they retest you. What they do is, at Mayo Clinic, when you meet with the — your primary physician, he calls in all the specialists all at the same time, and as a team they evaluate you, do all the tests right there, so you’re not duplicating a whole bunch of stuff. And that coordinated care drives down costs tremendously.

That’s the kind of common-sense approach that we’re going to have to take. And one of the things that we’re going to need to do in the health reform that we’re proposing is to incentivize those kinds of smart practices coordinating care, as opposed to what we do right now, which is we just pay you — the more services you provide, the more we pay you, which gives doctors and hospitals a pretty strong incentive to test you five times instead of one time. I’m not saying they do it consciously, but right now we’re preventing them from coordinating in a smart fashion because of the ways that we reimburse. That has to be part of the reform that we initiate.

All right.

MS. JARRETT: All right, Mr. President, I’m getting the high sign, so how about one more question from our wonderful audience?

THE PRESIDENT: One more question from the audience. Let’s see. It’s a girl’s turn, isn’t it? I think so. This young lady right here.

Q Hi, Mr. President. I’m a member of SEIU and I’m down here in Fairfax County working on Change That Works. What can I do, as a member of the union, to help you with your reform bill?

THE PRESIDENT: Well, I appreciate the question. The most important thing I think the American people can do right now is to just be informed. Tell your friends, tell your neighbors to get informed about what’s happening in the health care system right now. It’s very complicated and I don’t expect everybody to be an expert, but I want everybody to be well enough informed that the scare tactics of those who would oppose reform don’t work.

So when you hear somebody say this is — “Obama is proposing a government takeover of health care” — that’s an old argument that’s been used for years. I just want to be clear. If you’ve got a health care plan that you get through your employer or some other private plan, I want you to keep it. I actually think reforming the system is the most likely way for you to keep the health care that you’ve got. I don’t want to take it over. I think it’s great that you can keep the care that you’ve got.

All I’ve said is I want to make sure that those things that taxpayers are paying for, that we’re getting our money’s worth. I don’t want to provide $177 billion in subsidies to insurance companies. I don’t want to reimburse for five tests when the evidence shows that you just getting one test is going to be better for you because that means that the taxpayers are saving money and I can use that to lower your costs, or to help somebody who doesn’t have health care at all.

I do think we should have a public plan to compete with the private plans. But these private insurance companies, they’re always telling me what a great deal that they give to the American consumer; if it’s such a great deal, why are they worried about competing against the public plan, especially when they say government can’t do anything? (Applause.)

So they’ll tell you that we’re trying to take over health care. I don’t want to take over health care.

They’ll tell you that we’re going to try to ration the system. We don’t want to get between you and your doctor. What we do believe is that if there’s good evidence out there that shows that the best way to treat your illness is to give you the blue pill, and instead right now you’re getting prescribed the red pill that costs twice as much, I think that you and your doctor, having that information, are probably going to decide to go with the cheaper pill that does just as good of a job, and that will save you money. That’s not rationing. That’s being sensible.

So whenever you start hearing these arguments about socialized medicine, government takeover, rationing, Canada-style health care, what I need you to do — and I need everybody here to do and everybody who’s watching to do — is to actually pay attention to the argument, and don’t let people scare you out of reforming a system that we know is not working.

America — one of the great things about this country is we’ve got a system that’s sometimes kind of hard to change. Congress gets kind of bogged down, and part of that is because of the way the Constitution is designed — it’s served us well because it keeps us very stable. We don’t have coups and all kinds of governments collapsing all the time. But the disadvantage sometimes is, is that it’s hard for us to make big, bold steps. But the great thing about the system is that, every once in a while, when we finally hit a point where things just aren’t working at all, we are able to generate the political will to finally get things done.

That’s how we got Social Security. After the Great Depression, nobody had any pensions or protection, and people started realizing, we can’t have a country where suddenly older Americans are just on the streets, after working hard all their lives. And finally we got Social Security. And then people said, well, we can’t have older Americans who don’t have any health care, and we got Medicare. At every juncture, when we finally need to make a change, we make a change. This is one of those times.

So don’t be scared about the future. Let’s embrace the future. Let’s go after the future. If we do, then I’m confident that we can create a health care system that gives you choice, allows you to keep your doctor, drives down costs, makes sure that every American doesn’t have to worry if they lose or change their jobs. That’s our aim. That’s our goal. We’re going to make it happen this year.

Thank you, everybody. I appreciate you. Thank you. (Applause.)


Vice President Biden launches broadband initiative

Vice President Biden today announced the availability of $4 billion in American Recovery and Reinvestment Act loans and grants to help bring broadband service to un-served and underserved communities across America. This is the first round of Recovery Act funding aimed at expanding broadband access to help bridge the technological divide and create jobs building out Internet infrastructure.

Vice President Biden was joined today by Agriculture Secretary Tom Vilsack, Commerce Secretary Gary Locke, Federal Communications Commission Chairman Julius Genachowski and Congresswoman Kathy Dahlkemper at Seneca High School, the first stop on the President’s National Rural Tour.

“Today’s announcement is a first step toward realizing President Obama’s vision of a nationwide 21st-century communications infrastructure – one that encourages economic growth, enhances America’s global competitiveness and helps address many of America’s most pressing challenges,” said Vice President Biden.

The Recovery Act provided a total of $7.2 billion to the Commerce Department’s National Telecommunications and Information Administration (NTIA) and the U.S. Department of Agriculture’s Rural Utilities Service (RUS) to accelerate broadband deployment in areas of the country that have been without the high-speed infrastructure. Of that funding, NTIA will utilize $4.7 billion to deploy broadband infrastructure in un-served and underserved areas in the United States, expand public computer center capacity and encourage sustainable adoption of broadband service. RUS will invest $2.5 billion to facilitate broadband deployment in rural communities.

“The Commerce Department’s Broadband Technology Opportunities Program will reach the last frontiers of America’s information landscape, and the investments it makes in inner-city neighborhoods and rural communities will spur innovation and pave the way for private capital to follow,” Secretary Locke said. “This first wave of funding will help create jobs, jumpstart additional investment and provide model projects that can better inform our national broadband strategy.”

“The funding we’re announcing today will carry out President Obama’s goal to expand broadband to communities that lack access to it,” Secretary Vilsack said. “The President is committed to bringing the educational and economic benefits of the Internet to all communities.”

“Access to high-speed Internet is no longer a luxury, but an essential tool to compete in this 21st-century economy. The availability of this technology is critical to attracting the business and development that will create the good paying jobs that stay in the United States,” said Congresswoman Dahlkemper. “I am so pleased that Vice President Biden and the administration chose Western Pennsylvania to announce this critical broadband initiative – a region that will benefit from this strategic investment.”

NTIA and RUS will be accepting applications for loans, grants and loan/grant combinations to be awarded by each agency under a single application form. This collaborative approach will ensure that the agencies’ activities are complementary and integrated, make the best use of taxpayer funds and make it easier for applicants to apply for funding. This is the first of three rounds of funding the Agriculture and Commerce Departments will provide.

Vice President Biden also announced today that Commerce and USDA officials will host public workshops in July to share information about the funding availabilities and the application process. Forums will be held in Boston, Mass.; Charleston, W.Va.; Minneapolis, Minn.; Memphis, Tenn.; Lonoke, Ark.; Birmingham, Ala.; Billings, Mont.; Albuquerque, N.M.; and Los Angeles, Calif.

Applications will be accepted beginning July 14, 2009, through 5:00 p.m. EDT on August 14, 2009. The complete details of this Notice of Funding Availability are available at

The American Recovery and Reinvestment Act of 2009 was signed into law by President Obama on February 17, 2009. It is designed to jumpstart the nation’s economy, create or save millions of jobs, and put a down payment on addressing long-neglected challenges so our country can thrive in the 21st century. The act includes measures to modernize our nation’s infrastructure, enhance energy independence, expand educational opportunities, preserve and improve affordable health care, provide tax relief and protect those in greatest need.

More information about efforts regarding the Recovery Act is available at, and

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