News from 1600 Pennsylvania Ave.
Monday, Aug. 17
– Remarks by President Obama at VFW convention, Phoenix, Ariz.
– Remarks by President Obama at Grand Junction, Colo., health-care town hall
– Press gaggle by Press Secretary Robert Gibbs
Remarks by President Obama at VFW convention, Phoenix, Ariz.
THE PRESIDENT: Thank you. Please, be seated. Thank you so much. Commander Gardner, thank you for your introduction and for your lifetime of service. I was proud to welcome Glen and your executive director, Bob Wallace, to the Oval Office just before the 4th of July, and I look forwarding to working with your next commander, Tommy Tradewell.
I want to also acknowledge Jean Gardner and Sharon Tradewell, as well as Dixie Hild and Jan Title and all the spouses and family of the Ladies Auxiliary. America honors your service as well.
Also Governor Jan Brewer is here, of Arizona; and Mayor Phil Gordon, our host here in Phoenix. I want to acknowledge President — Dr. Joe Shirley, Jr., President of the Navajo Nation. And this wasn’t on my original card, but this is just an extraordinary story and you may have already heard from her, but I just want to publicly acknowledge and thank Ms. Helen Denton the secretary to Dwight Eisenhower — (applause) — who typed up the orders for the Normandy invasion and is here today, and what an extraordinary story that is. (Applause.)
Members of the Veterans of Foreign Wars, I am honored and humbled to stand before you as Commander-in-Chief of the finest military the world has ever known. (Applause.) And we’re joined by some of those who make it the finest force in world — from Luke Air Force Base, members of the 56th Fighter Wing. (Applause.)
Whether you wear the uniform today, or wore it decades ago, you remind us of a fundamental truth. It’s not the powerful weapons that make our military the strongest in the world. It’s not the sophisticated systems that make us the most advanced. The true strength of our military lies in the spirit and skill of our men and women in uniform. And you know this. (Applause.)
You know this because it’s the story of your lives. When fascism seemed unstoppable and our harbor was bombed, you battled across rocky Pacific islands and stormed the beaches of Europe, marching across a continent — my own grandfather and uncle among your ranks — liberating millions and turning enemies into allies.
When communism cast its shadow across so much of the globe, you stood vigilant in a long Cold War — from an airlift in Berlin to the mountains of Korea to the jungles of Vietnam. When that Cold War ended and old hatreds emerged anew, you turned back aggression from Kuwait to Kosovo.
And long after you took off the uniform, you’ve continued to serve: supporting our troops and their families when they go to war and welcoming them when they come home; working to give our veterans the care they deserve; and when America’s heroes are laid to rest, giving every one of them that final fitting tribute of a grateful nation. We can never say it enough: For your service in war and in peace, thank you VFW. Thank you. (Applause.)
Today, the story of your service is carried on by a new generation — dedicated, courageous men and women who I have the privilege to lead and meet every day.
They’re the young sailors, the midshipmen at the Naval Academy, who raised their right hand at graduation and committed themselves to a life of service. They’re the soldiers I met in Baghdad who have done their duty, year after year, on a second, third or fourth tour. They’re the Marines of Camp Lejeune, preparing to deploy and now serving in Afghanistan to protect Americans here at home. They’re the airmen, like those here today, who provide the close air support that saves the lives of our troops on the ground. They’re the wounded warriors — at Landstuhl and Walter Reed and Bethesda and across America — for whom the battle is not to fight, but simply to speak, to stand, to walk once more. They’re the families that my wife Michelle has met at bases across the country. The spouses back home doing the parenting of two, the children who wonder when mom and dad may be coming home; the parents who watch their sons and daughters go off to war; and the families who lay a loved one to rest — and the pain that lasts a lifetime.
To all those who have served America — our forces, your families, our veterans — you have done your duty. You have fulfilled your responsibilities. And now a grateful nation must fulfill ours. And that is what I want to talk about today.
First, we have a solemn responsibility to always lead our men and women in uniform wisely. And that starts with a vision of American leadership that recognizes that military power alone cannot be the first or only answer to the threats facing our nation.
In recent years, our troops have succeeded in every mission America has given them, from toppling the Taliban to deposing a dictator in Iraq to battling brutal insurgencies. At the same time, forces trained for war have been called upon to perform a whole host of missions. Like mayors, they’ve run local governments and delivered water and electricity. Like aid workers, they’ve mentored farmers and built new schools. Like diplomats, they’ve negotiated agreements with tribal sheikhs and local leaders.
But let us never forget we are a country of more than 300 million Americans. Less than 1 percent wears the uniform. And that 1 percent — our soldiers, sailors, airmen, Marines and Coast Guardsmen — have borne the overwhelming burden of our security. In fact, perhaps never in American history have so few protected so many.
So the responsibility for our security must not be theirs alone. That is why I have made it a priority to enlist all elements of our national power in defense of our national security — our diplomacy and development, our economic might and our moral example, because one of the best ways to lead our troops wisely is to prevent the conflicts that cost American blood and treasure tomorrow.
As President, my greatest responsibility is the security and safety of the American people. As I’ve said before, that is the first thing I think about when I wake up in the morning, it’s the last thing that I think about when I go to sleep at night. And I will not hesitate to use force to protect the American people or our vital interests. (Applause.)
But as we protect America, our men and women in uniform must always be treated as what they are: America’s most precious resource. As Commander-in-Chief, I have a solemn responsibility for their safety. And there is nothing more sobering than signing a letter of condolence to the family of servicemen or women who have given their lives for our country.
And that’s why I have made this pledge to our armed forces: I will only send you into harm’s way when it is absolutely necessary. And when I do, it will be based on good intelligence and guided by a sound strategy. I will give you a clear mission, defined goals, and the equipment and support you need to get the job done. That’s my commitment to you. (Applause.)
Which brings me to our second responsibility to our armed forces — giving them the resources and equipment and strategies to meet their missions. We need to keep our military the best-trained, the best-led, the best-equipped fighting force in the world. And that’s why, even with our current economic challenges, my budget increases defense spending.
We will ensure that we have the force structure to meet today’s missions. And that’s why we’ve increased the size of the Army and the Marine Corps two years ahead of schedule and have approved another temporary increase in the Army. And we’ve halted personnel reductions in the Navy and Air Force. And this will give our troops more time home between deployments, which means less stress on families and more training for the next mission. (Applause.) And it will help us put an end, once and for all, to stop-loss for those who’ve done their duty. (Applause.)
We will equip our forces with the assets and technologies they need to fight and win. So my budget funds more of the Army helicopters, crews, and pilots urgently needed in Afghanistan; the intelligence, surveillance, and reconnaissance that gives our troops the advantage; the special operations forces that can deploy on a moment’s notice; and for all those serving in Afghanistan and Iraq, including our National Guard and Reserve, more of the protective gear and armored vehicles that save lives. (Applause.)
As we fight in two wars, we will plan responsibly, budget honestly, and speak candidly about the costs and consequences of our actions. And that’s why I’ve made sure my budget includes the cost of the wars in Iraq and Afghanistan.
In Iraq, after more than six years, we took an important step forward in June. We transferred control of all cities and towns to Iraq’s security forces. The transition to full Iraqi responsibility for their own security is now underway. This progress is a testament to all those who have served in Iraq, both uniformed and civilian. And our nation owes these Americans — and all who have given their lives — a profound debt of gratitude. (Applause.)
Now, as Iraqis take control of their destiny, they will be tested and targeted. Those who seek to sow sectarian division will attempt more senseless bombings and more killing of innocents. This we know.
But as we move forward, the Iraqi people must know that the United States will keep its commitments. And the American people must know that we will move forward with our strategy. We will begin removing our combat brigades from Iraq later this year. We will remove all our combat brigades by the end of next August. And we will remove all our troops from Iraq by the end of 2011. And for America, the Iraq war will end.
By moving forward in Iraq, we’re able to refocus on the war against al Qaeda and its extremist allies in Afghanistan and Pakistan. That’s why I announced a new, comprehensive strategy in March — a strategy that recognizes that al Qaeda and its allies had moved their base from the remote, tribal areas — to the remote, tribal areas of Pakistan. This strategy acknowledges that military power alone will not win this war — that we also need diplomacy and development and good governance. And our new strategy has a clear mission and defined goals: to disrupt, dismantle, and defeat al Qaeda and its extremist allies.
In the months since, we have begun to put this comprehensive strategy into action. And in recent weeks, we’ve seen our troops do their part. They’ve gone into new areas — taking the fight to the Taliban in villages and towns where residents have been terrorized for years. They’re adapting new tactics, knowing that it’s not enough to kill extremists and terrorists; we also need to protect the Afghan people and improve their daily lives. And today, our troops are helping to secure polling places for this week’s election so that Afghans can choose the future that they want.
Now, these new efforts have not been without a price. The fighting has been fierce. More Americans have given their lives. And as always, the thoughts and prayers of every American are with those who make the ultimate sacrifice in our defense.
As I said when I announced this strategy, there will be more difficult days ahead. The insurgency in Afghanistan didn’t just happen overnight and we won’t defeat it overnight. This will not be quick, nor easy. But we must never forget: This is not a war of choice. This is a war of necessity. Those who attacked America on 9/11 are plotting to do so again. If left unchecked, the Taliban insurgency will mean an even larger safe haven from which al Qaeda would plot to kill more Americans. So this is not only a war worth fighting. This is a — this is fundamental to the defense of our people.
And going forward, we will constantly adapt to new tactics to stay ahead of the enemy and give our troops the tools and equipment they need to succeed. And at every step of the way, we will assess our efforts to defeat al Qaeda and its extremist allies, and to help the Afghan and Pakistani people build the future that they seek.
Now, even as we lead and equip our troops for the missions of today, we have a third responsibility to fulfill. We must prepare our forces for the missions of tomorrow.
Our soldiers, sailors, airmen, Marines, and Coast Guardsmen adapt to new challenges every day. But as we know, much of our defense establishment has yet to fully adapt to the post-Cold War world, with doctrine and weapons better suited to fight the Soviets on the plains of Europe than insurgents in the rugged terrain of Afghanistan. Twenty years after the Cold War ended, this is simply not unacceptable. It’s irresponsible. Our troops, and our taxpayers, deserve better. (Applause.)
And that’s why — that’s why our defense review is taking a top-to-bottom look at our priorities and posture, questioning conventional wisdom, rethinking old dogmas and challenging the status quo. We’re asking hard questions about the forces we need and the weapons we buy. And when we’re finished, we’ll have a new blueprint for the 21st-century military that we need. And in fact, we’re already on our way.
We’re adopting new concepts — because the full spectrum of challenges demands a full range of military capabilities — both the conventional and the unconventional, the ability to defeat both an armored division and the lone suicide bomber; the intercontinental ballistic missile and the improvised explosive device; 18th-century-style piracy and 21st-century cyber threats. No matter the mission, we must maintain America’s military dominance.
So even as we modernize our conventional forces, we’re investing in the capabilities that will reorient our force to the future — an Army that is more mobile and expeditionary and missile defenses that protect our troops in the field; a Navy that not only projects power across the oceans but operates nimbly in shallow, coastal waters; an Air Force that dominates the airspace with next-generation aircraft, both manned and unmanned; a Marine Corps that can move ashore more rapidly in more places.
And across the force, we’re investing in new skills and specialties, because in the 21st century, military strength will be measured not only by the weapons our troops carry, but by the languages they speak and the cultures that they understand.
But here’s the simple truth: We cannot build the 21st-century military we need, and maintain the fiscal responsibility that America demands, unless we fundamentally reform the way our defense establishment does business. It’s a simple fact. Every dollar wasted in our defense budget is a dollar we can’t spend to care for our troops or protect America or prepare for the future.
You’ve heard the stories: the indefensible no-bid contracts that cost taxpayers billions and make contractors rich; the special interests and their exotic projects that are years behind schedule and billions over budget; the entrenched lobbyists pushing weapons that even our military says it doesn’t want. The impulse in Washington to protect jobs back home building things we don’t need has a cost that we can’t afford.
This waste would be unacceptable at any time, but at a time when we’re fighting two wars and facing a serious deficit, it’s inexcusable. It’s an affront to the American people and to our troops. And it’s time for it to stop. And this is not a Democratic issue or a Republican issue. (Applause.)
This is not a Democratic issue or a Republican issue — it’s about giving our troops the support that they need. And that’s something that all Americans should be able to agree to. So I’m glad I have as a partner in this effort a great veteran, a great Arizonan, and a great American who has shown the courage to stand and fight this waste — Senator John McCain. (Applause.) And I’m also proud to have Secretary of Defense Robert Gates, who has served under eight Presidents of both parties, leading this fight at the Pentagon.
So already I’ve put an end to unnecessary no-bid contracts. I’ve signed bipartisan legislation to reform defense procurement so weapons systems don’t spin out of control. And even as we increase spending on the equipment and weapons our troops do need, we’ve proposed cutting tens of billions of dollars in waste we don’t need.
Think about it. Hundreds of millions of dollars for an alternate second engine for the Joint Strike Fighter — when one reliable engine will do just fine. Nearly $2 billion to buy more F-22 fighter jets — when we can move ahead with a fleet of newer, more affordable aircraft. Tens of billions of dollars to put an anti-missile laser on a fleet of vulnerable 747s.
And billions of dollars for a new presidential helicopter. Now, maybe you’ve heard about this. Among its other capabilities, it would let me cook a meal while under nuclear attack. (Laughter.) Now, let me tell you something, if the United States of America is under nuclear attack, the last thing on my mind will be whipping up a snack. (Laughter and applause.)
So this is pretty straightforward: Cut the waste. Save taxpayer dollars. Support the troops. That’s what we should be doing. (Applause.) The special interests, contractors, and entrenched lobbyists, they’re invested in the status quo. And they’re putting up a fight. But make no mistake, so are we. If a project doesn’t support our troops, if it does not make America safer, we will not fund it. If a system doesn’t perform, we will terminate it. (Applause.) And if Congress sends me a defense bill loaded with a bunch of pork, I will veto it. We will do right by our troops and taxpayers, and we will build the 21st century military that we need. (Applause.)
Finally, we will fulfill our responsibility to those who serve by keeping our promises to our people. We will fulfill our responsibility to our forces and our families. That’s why we’re increasing military pay. That’s why we’re building better family housing and funding more childcare and counseling to help families cope with the stresses of war. And we’ve changed the rules so military spouses can better compete for federal jobs and pursue their careers.
We will fulfill our responsibility to our wounded warriors. For those still in uniform, we’re investing billions of dollars for more treatment centers, more case managers and better medical care so our troops can recover and return where they want to be — with their units. (Applause.)
But as the VFW well knows, for so many veterans the war rages on — the flashbacks that won’t go away, the loved ones who now seem like strangers, the heavy darkness of depression that has led to too many of our troops taking their own lives. Post-Traumatic Stress and Traumatic Brain Injury are the defining injuries of today’s wars. So caring for those affected by them is a defining purpose of my budget — billions of dollars more for treatment and mental health screenings to reach our troops on the frontier — on the frontlines and more mobile and rural clinics to reach veterans back home. We are not going to abandon these American heroes. We are going to do right by them. (Applause.)
We will fulfill our responsibility to our veterans as they return to civilian life. I was proud to co-sponsor the Post-9/11 GI Bill as a senator. And thanks to VFW members across the country — and leaders like Arizona’s Harry Mitchell in Congress — it is now the law of the land. (Applause.) And as President, I’m committed to seeing that it is successfully implemented.
For so many of you, like my grandfather, the original GI Bill changed your life — helping you to realize your dreams. But it also transformed America, helping to build the largest middle class in history. We’re saying the same thing to today’s post-9/11 veterans: You pick the school, we’ll help pick up the bill. (Applause.)
And as these veterans show — start showing up on campuses, I’m proud that we’re making this opportunity available to all those who have sacrificed, including Reservists and National Guard members and spouses and children, including kids who’ve lost their mom or dad. (Applause.) In an era when so many people and institutions have acted irresponsibly, we choose to reward the responsibility and service of our forces and their families.
Whether you’ve left the service in 2009 or 1949, we will fulfill our responsibility to deliver the benefits and care that you earned. And that’s why I’ve pledged to build nothing less than a 21st-century VA. And I picked a lifelong soldier and wounded warrior from Vietnam to lead this fight, General Ric Shinseki. (Applause.)
We’re dramatically increasing funding for veterans health care. This includes hundreds of millions of dollars to serve veterans in rural areas, as well as the unique needs of our growing number of women veterans. We’re restoring access to VA health care for a half-million veterans who lost their eligibility in recent years — our Priority 8 veterans.
And since there’s been so much misinformation out there about health insurance reform, let me say this: One thing that reform won’t change is veterans’ health care. No one is going to take away your benefits — that is the plain and simple truth. (Applause.) We’re expanding access to your health care, not reducing it. (Applause.)
We’re also keeping our promise on concurrent receipt. My budget ensures that our severely disabled veterans will receive both their military retired pay and their VA disability benefits. (Applause.) And I look forward to signing legislation on advanced appropriations for the VA so the medical care you need is never held up by budget delays. (Applause.)
I’ve also directed Secretary Shinseki to focus on a top priority — reducing homelessness among veterans. (Applause.) After serving their country, no veteran should be sleeping on the streets. (Applause.) No veteran. We should have zero tolerance for that.
And we’re keeping our promise to fulfill another top priority at the VA — cutting the red tape and inefficiencies that cause backlogs and delays in the claims process. (Applause.) This spring, I directed the Department of Defense and Veterans Affairs to create one unified lifetime electronic health record for the members of the armed forces — a single electronic record, with privacy guaranteed, that will stay with them forever. Because after fighting for America, you should not have to fight over paperwork to receive the benefits that you’ve earned. (Applause.)
Today, I can announce that we’re taking another step. I’ve directed my Chief Performance Officer, my Chief Technology Officer and my Chief Information Officer to join with Secretary Shinseki in a new reform effort. We’re launching a new competition to capture the very best ideas of our VA employees who work with you every day.
We’re going to challenge each of our 57 regional VA offices to come up with the best ways of doing business, of harnessing the best information technologies, of cutting red tape and breaking through the bureaucracy. And then we’re going to fund the best ideas and put them into action, all with a simple mission: cut those backlogs, slash those wait times, deliver your benefits sooner. (Applause.) I know you’ve heard this for years, but the leadership and resources we’re providing this time means that we’re going to be able to do it. That is our mission, and we are going to make it happen. (Applause.)
Now, taken together, these investments represent a historic increase in our commitment to America’s veterans — a 15 percent increase over last year’s funding levels and the largest increase in the VA budget in more than 30 years. And over the next five years we’ll invest another $25 billion to make sure that our veterans are getting what they need.
These are major investments, and these are difficult times. Fiscal discipline demands that we make hard decisions — sacrificing certain things we can’t afford. But let me be clear. America’s commitment to its veterans are not just lines on a budget. They are bonds that are sacred — a sacred trust we’re honor bound to uphold.
These are commitments that we make to the patriots who serve — from the day they enlist to the day that they are laid to rest. Patriots like you. Patriots like a man named Jim Norene.
His story is his own, but in it we see the larger story of all who serve. He’s a child of the Depression who grew up to join that greatest generation; a paratrooper in the 502nd Parachute Infantry Regiment of the 101st Airborne; jumping in a daring daylight raid into Holland to liberate captive people; rushing to Bastogne at the Battle of the Bulge where his commanding general — surrounded by the Germans and asked to surrender — declared, famously, “Nuts.”
For his bravery, Jim was awarded the Bronze Star. But like so many others, he rarely spoke of what he did or what he saw — reminding us that true love of country is not boisterous or loud but, rather, the “tranquil and steady dedication of a lifetime.”
Jim returned home and built a life. He went to school on the GI Bill. He got married. He raised a family in his small Oregon farming town. And every Veterans Day, year after year, he visited schoolchildren to speak about the meaning of service. And he did it all as a proud member of the Veterans of Foreign Wars. (Applause.)
Then, this spring, Jim made a decision. He would return to Europe once more. Eighty-five years old, frail and gravely ill, he knew he might not make it back home. But like the paratrooper he always was, he was determined.
So near Bastogne, he returned to the places he knew so well. At a Dutch town liberated by our GIs, schoolchildren lined the sidewalks and sang The Star-Spangled Banner. And in the quiet clearing of an American cemetery, he walked among those perfect lines of white crosses of fellow soldiers who had fallen long ago, their names forever etched in stone.
And then, back where he had served 65 years before, Jim Norene passed away, at night, in his sleep, quietly, peacefully — the “tranquil and steady dedication of a lifetime.”
The next day, I was privileged to join the commemoration at Normandy to mark the day when the beaches were stormed and a continent was freed. There were Presidents and prime ministers and veterans from the far corners of the earth. But long after the bands stopped playing and the crowds stopped cheering, it was the story of a departed VFW member that echoed in our hearts.
Veterans of Foreign Wars, you have done your duty — to your fallen comrades, to your communities, to your country. You have always fulfilled your responsibilities to America. And so long as I am President of the United States, America will always fulfill its responsibilities to you.
God bless you. God bless all our veterans. And God bless the United States of America. Thank you very much. (Applause.)
Remarks by President Obama at Grand Junction, Colo., health-care town hall
THE PRESIDENT: Thank you. Thank you. Hello, Grand Junction! (Applause.) Thank you so much. Thank you. Everybody please have a seat. It is good to be back in Southwest Colorado. (Applause.) Last time I was here I had some really good peaches. (Laughter.) Somehow, though, Michelle and the girls got to go pick peaches — and I’m hoping they bring some back for me.
It is nice to take a break from the back and forth in Washington. I want to especially want to thank Nathan for his introduction and sharing his story. (Applause.) It’s not easy to talk about an illness in the family. It’s not easy to talk about such a painful experience. Because it’s important that we understand what’s at stake in this health care debate he’s been willing to share it with us. And so I’m very grateful to him.
We’ve got a couple of other special guests that I want to acknowledge. First of all, I stole him from you to make him what I believe will be the best Secretary of the Interior in the history of the United States, Ken Salazar. (Applause.) But I left things in good hands with the outstanding congressman and brother of Ken, John Salazar. (Applause.)
Your outstanding governor of this great state, Bill Ritter, is here. (Applause.) As well as the extraordinary First Lady of the state, Jeannie Ritter is here as well. (Applause.)
Two of the finest young senators that we’ve got in Washington right now: Senator Mark Udall. (Applause.) And Senator Michael Bennet. (Applause.)
I want to thank the hospitality of Grand Junction Mayor Bruce Hill. (Applause.) And finally I want to thank Tillie Bishop for the invocation. (Applause.) And I want to thank the Central High students Elise Beckstead, Crystal Rossman, Axel Urie and Amelia LyBarger for their National Anthem and Pledge of Allegiance. Thank you, guys. (Applause.)
Oh, and Central High principal Jody Diers is here. (Applause.) And it turns out school starts in two days. (Laughter.) You know, when I was going to school we always had until Labor Day. (Laughter.) It’s rough for kids these days. But it’s important for us to be able to compete internationally, so it’s great to see dedicated educators like we have here at Central High. (Applause.)
You know, Nathan’s story is the kind of story that I’ve read in letters and heard in town halls all across America. And on Tuesday I was in New Hampshire talking about people denied coverage because of preexisting conditions. Yesterday, I was in Montana talking about people who’ve had their insurance policies suddenly revoked, even though they were paying their premiums, just because they got sick. Today we’re talking about people like Nathan and his family who have insurance but are still stuck with huge bills because they’ve hit a cap on their benefits or they’re charged exorbitant out-of-pocket fees.
And when you hear about these experiences, when you think about the millions of people denied coverage because of preexisting conditions and the thousands who have their policies cancelled because of an illness, the countless people like Nathan, I want you to remember one thing: There but for the grace of God go I. (Applause.) This is something that sometimes we’ve forgotten during the course of this health care debate. These are ordinary Americans. They’re no different from anybody else. They’re working hard, they’re meeting their responsibilities, but they’re held hostage by health insurance companies that deny them coverage, or drop their coverage, or charge fees that they can’t afford for care that they desperately need.
It’s hurting too many families and businesses. It’s wrong. And we’re going to fix it when we pass health insurance reform this year. (Applause.)
Now, this is obviously a tough time for the families in Colorado and all across America. I just want to rewind the clock a little bit, because sometimes people have forgotten what’s transpired over the last seven, eight months. Just six months ago, we were in the middle of the worst recession of our lifetimes. We were losing about 700,000 jobs each month. Economists from the left and the right, liberals and conservatives, feared the second coming of the Great Depression. I don’t know if everybody remembers that. That was six months ago. That’s why we acted as fast as we could to pass a recovery plan to stop the freefall. And there’s been a lot of misinformation about that, so let me just talk briefly about what it is that we did.
The recovery plan was divided into three parts. One-third of the money — one-third of the money in the Recovery Act, the stimulus plan — went to tax cuts that are already showing up in the paychecks of nearly 2 million working families in Colorado, including right here in Grand Junction. (Applause.) So I just want everybody to be clear: One-third of it, tax cuts — not tax increases — more money in your pockets to spend as you wish.
We also cut taxes for small businesses on the investments that they make, and hundreds of Colorado small businesses have qualified for new loans backed by the Recovery Act — including 11 businesses in Grand Junction alone. (Applause.)
So that was one-third of it.
Now, another third of the money in the Recovery Act is for emergency relief for folks who’ve borne the brunt of this recession. So we’ve extended unemployment benefits for more than 150,000 Colorado citizens. (Applause.) We’ve made health insurance 65 percent cheaper for families who are having to use COBRA because they lost their jobs and they’re out there looking for work. (Applause.) And for states facing historic budget shortfalls, we provided assistance that has saved the jobs of tens of thousands of workers who provide essential services, like teachers and police officers. And Governor Ritter will tell you, if we had not had some of that money in, then Colorado would have had to make much more painful job cuts in vital services and might have had to put in place some very painful state and local tax increases. So that was the second third of the Recovery Act.
Now, the last third of the Recovery Act is for investments that are already putting people back to work. There are almost 100 shovel-ready transportation projects already approved in Colorado which are beginning to create jobs. Not far from here, for example, there’s a project to pave and add lanes to State Highway 92. Most of the work is being done by local businesses, because that’s how we’re going to create jobs and grow this economy again.
And by next month, projects will be underway at more than 100 national parks all over America, including Colorado. (Applause.) Now these are — these are projects restoring trails, improving infrastructure, making park facilities more energy efficient. Earlier today, some of you may know, I toured Yellowstone with Michelle and the girls. We saw Old Faithful — I hadn’t seen it since I was 11 years old. It’s still going strong. (Laughter.) Tomorrow we’re going to be visiting the Grand Canyon.
And I recently signed into law a public lands bill that designates the Dominguez-Escalante Canyon as a National Conservation Area here in Colorado. (Applause.) These are national treasures — symbols of how much we owe to those who came before us, and the fact that we’re borrowing this earth from those who will follow us. And I want to thank especially Ken Salazar, because he’s been leading the way on these vital issues, especially in the West. (Applause.)
As we grapple with enormous challenges — like health care — the work of generations past reminds us of our duty to generations yet to come.
So there is no doubt that the recovery plan is doing what we said it would: putting us on the road to recovery. It’s not solving all problems. Unemployment is still way too high. But we just saw last week that the jobs picture is beginning to turn. We’re starting to see signs that business investment is coming back. But that doesn’t mean we’re out of the woods. Even before this extraordinary financial crisis we had an economy that was working pretty well for the wealthiest Americans — working pretty well for Wall Street bankers, for big corporations — but it wasn’t working so well for everybody else. It was an economy of bubbles and busts. It was an economy in which the average worker, their wages and incomes had flatlined for a decade. It was an economy that rewarded recklessness over responsibility. So we can’t go back to that kind of economy.
If we want this country to succeed in the 21st century, we’ve got to lay a new foundation for lasting prosperity. And health insurance reform is a key pillar of this new foundation. (Applause.) Because this economy — this economy won’t work for everyone until folks like Nathan and his family aren’t pushed to the brink of bankruptcy by medical expenses; until companies aren’t slashing payrolls and losing profits to pay for health insurance; until every single American has the security and peace of mind of quality, affordable health care.
And health care touches us all in profound ways — which by the way means that it’s only natural this debate is going to be an emotional one. There’s a lot at stake. And I know there’s been a lot of attention paid to some of the town hall meetings that are going on around the country — especially those where tempers have flared, and TV really likes that. You can have 20 really great town hall meetings, and if there’s one where somebody loses their temper, that’s the one TV wants to cover.
What you haven’t been seeing are the constructive meetings going on all over the country. That doesn’t mean people agree with me on every single issue, but it means that we’ve been trying to figure out how do we solve what we know is an unsustainable problem in our health care system. (Applause.)
So just yesterday — just yesterday I held a town hall in Belgrade, Montana, and we had a pretty good crowd. Some were big supporters of reform. Some had concerns and questions. Some were completely skeptical. And I got tough questions. But even though Montanans have strong opinions, they didn’t shout at one another. They were there to listen. And that reflects the American people and what our democracy is about, a lot more than what’s been covered on TV these last few days. And that’s why I thank all of you, whether you’re for or against health care reform, for being here today. (Applause.)
Now, I’m going to take a bunch of questions, but before I do, I want to just talk about what health insurance reform will mean for you, because there’s a lot of misunderstandings out there.
First of all, what we’re proposing is a common-sense set of consumer protections for people with health insurance, people with private insurance. I expect that after reform passes, the vast majority of Americans are still going to be getting their insurance from private insurers. So we’ve got to have some protections in place for people like Nathan, people like you.
So insurance companies will no longer be able to place an arbitrary cap on the amount of coverage you can receive or charge outrageous out-of-pocket expenses on top of your premiums. That’s what happened to Nathan and his wife. Their son was diagnosed with hemophilia when he was born. The insurance company then raised the premiums for his family and for all his coworkers who were on the same policy. The family was approaching their cap.
And so on top of worrying about taking care of their son, they had the added worry of trying to find insurance that would cover him — plus thousands and thousands of dollars in out-of-pocket costs. Nathan and his wife even considered getting a divorce so that she might possibly go on Medicaid.
Now thankfully, Colorado’s law doesn’t allow coverage for small businesses to permanently exclude preexisting conditions like his son’s, so eventually they found insurance. But they’re paying increasing premiums and they still have to face the prospect of hitting their new cap in the next few years.
Those are the stories I hear all over the country. I heard from a teenager in Indiana diagnosed with leukemia. The chemotherapy and intensive care he received cost hundreds of thousands of dollars. His family hit their lifetime cap in less than a year. They had insurance. So the insurance wouldn’t cover a bone marrow transplant and the family couldn’t afford all the money that was needed. The family turned to the public for help, but the boy died before he could receive that transplant.
If you think that can’t happen to you or your family, think again. Almost 90 percent of individual health insurance policies have lifetime benefit limits. And about a third of family plans in the individual insurance market have lifetime limits under $3 million. If you or your spouse or your child gets sick and you hit that limit, it’s suddenly like you have no insurance at all.
And this is part of a larger story, of folks with insurance, paying more and more out of pocket. In the past few years, premiums have nearly doubled for the average American family. Total out-of-pocket costs have increased by almost 50 percent — that’s more than $2,000 per person. And nobody is holding these insurance companies accountable for these practices. And by the way, your employer is paying even more, and you may not even see the costs of it except for the fact that’s why you’re not getting a raise — (applause) — because it’s going into your health care instead of your salary and income.
So we’re going to ban arbitrary caps on benefits. We’ll place limits on how much you can be charged for out-of-pocket expenses. No one in America should go broke because they get sick. (Applause.)
Now, insurance companies will also be stopped from cancelling your coverage because you get sick or denying coverage because of your medical history. (Applause.) Again, if you think this has nothing to do with you, think again. A recent report found that in the past few years, more than 12 million Americans were discriminated against by insurance companies because of a preexisting condition. When we get health insurance reform, those days will be over. And we will require insurance companies to cover routine checkups and preventive care, like mammograms and colonoscopies. That saves money; it saves lives. (Applause.)
At the same time — I just want to be completely clear about this; I keep on saying this but somehow folks aren’t listening — if you like your health care plan, you keep your health care plan. Nobody is going to force you to leave your health care plan. If you like your doctor, you keep seeing your doctor. I don’t want government bureaucrats meddling in your health care. But the point is, I don’t want insurance company bureaucrats meddling in your health care either. (Applause.)
So just to recap here, if you’re one of nearly 46 million people who don’t have health insurance, you will finally have quality, affordable options. If you do have health insurance, we will help make that insurance more affordable and more secure. Under the reform proposals that we’ve put out there, roughly 700,000 middle-class Coloradans will get a health care tax credit. More than a million Coloradans will have access to a new marketplace where you can easily compare health insurance options; 87,000 small businesses in Colorado will be aided by new tax benefits, so when they’re doing the right thing for their employees, they’re not penalized for it. (Applause.) And we will do all of this without adding to our deficit over the next decade, largely by cutting waste and ending sweetheart deals for insurance companies that don’t make anybody any healthier. (Applause.)
Now here — if you don’t — I know there’s some skepticism: Well, how are you going to save money in the health care system? You’re doing it here in Grand Junction. (Applause.) You know — you know that lowering costs is possible if you put in place smarter incentives; if you think about how to treat people, not just illnesses; if you look at problems facing not just one hospital or physician, but the many system-wide problems that are shared. That’s what the medical community in this city did, and now you’re getting better results while wasting less money. And I know that your senator, Michael Bennet, has been working hard on legislation that’s based on putting the innovations that are here in Grand Junction into practice across the system, and there’s no reason why we can’t do that. (Applause.)
So the fact is, we are closer to achieving reform than we’ve ever been. We have the American Nurses Association, we have the American Medical Association on board, because America’s doctors and nurses know how badly we need reform. (Applause.) We have — we have broad agreement in Congress on about 80 percent of what we’re trying to achieve. We have an agreement from drug companies to make prescription drugs more affordable for seniors — $80 billion that can cut the doughnut hole that seniors have to deal with on prescription drug plans in half. (Applause.) The AARP supports this policy, and agrees with us that reform must happen this year.
But look, because we’re getting close, the fight is getting fierce. And the history is clear: Every time we’re in sight of reform, the special interests start fighting back with everything they’ve got. They use their influence. They run their ads. And let’s face it, they get people scared. And understandably — I understand why people are nervous. Health care is a big deal. In fact, whenever America has set about solving our toughest problems, there have always been those who’ve sought to preserve the status quo by scaring the American people.
That’s what happened when FDR tried to pass Social Security — they said that was socialist. They did — verbatim. That’s what they said. They said that everybody was going to have to wear dog tags and that this was a plot for the government to keep track of everybody. When JFK and then Lyndon Johnson tried to pass Medicare, they said this was a government takeover of health care; they were going to get between you and your doctor — the same argument that’s being made today.
These struggles have always boiled down to a contest between hope and fear. It was true when Social Security was born. It was true when Medicare was created. It’s true in today’s debate. (Applause.)
But whether you have health insurance or you don’t have health insurance, we all know we can’t continue down this path. Costs are rising far faster than wages. Cuts — the system works a lot better for insurance companies than it does for America’s families. To maintain what’s best about our health care system, for you to keep what you’ve got if you’re happy with it, is going to require change.
We’ve got to keep what’s good about the system, especially the relationship between doctors, nurses, and their patients, while fixing what’s broken — because for all the scare tactics out there, what’s truly scary is if we don’t do anything. We will continue to see 14,000 Americans lose their health insurance every day. Premiums will continue to skyrocket, going up three times faster than your wages. The deficit will continue to grow because most of it is Medicare and Medicaid. Medicare will go into the red in less than a decade. And insurance companies will continue to profit by discriminating against people just because they’re sick.
So if you want a different future — a brighter future — I need your help. (Applause.) I need you to stand for hope. I need you to knock on doors. I need you to spread the word, because we are going to get this done this year. Thank you, Grand Junction. Thank you. (Applause.)
Thank you. Thank you. All right. Now, I’ve got time for a bunch of questions. We’ve got a bunch of people in the audience with microphones. Hold up your microphones, guys. All right. Now, the way we’re going to do this is, I’m just going to go around the room. Raise your hand. To be fair I’m going to make sure it’s girl, boy, girl, boy. (Laughter.) If you can introduce yourself and ask your question or make your comment, if you can keep your question or comment relatively brief, I will try to keep my answers relatively brief, and that way we can make sure that we get through more questions during the course of this event. All right? Okay. Let’s see hands. And I’ll start with this young lady right here in the pink blouse. Oops, hold on, the mic doesn’t — can you check that mic? Is it working? Does it work?
Q Good afternoon, Mr. President. My name is Polly. I work at Rocky Mountain Orthopedics here in Grand Junction. On behalf of our CEO, I would like to extend an invitation for you to visit our successful practice to see how we provide excellent health care at a lower average cost to our patients.
My question is, the original health care House bill included funding for federally qualified health centers whose future budget would be based on expenses plus inflation. If private physicians, hospitals, and other providers are going to be given incentives to reduce waste and cost, what will be done to ensure the government programs will do the same?
THE PRESIDENT: Well, it’s an excellent question. Part of what’s so important about reform is that right now the way Medicare and Medicaid operates, if it’s starting to go over budget, we basically have two choices. Either we raise taxes and just keep on paying more and more, and health care inflation is going up at least twice as fast as inflation on everything else, or what we do is we just tell the providers, we’re going to give you less money — period. We’ll reimburse you 80 cents or 90 cents for every dollar of services that you provide. And then what happens is that the providers, they end up just charging people with private insurance to make up for the difference. So that drives everybody’s costs up.
Now what’s been done here in Grand Junction, in other outstanding health programs like Mayo, is they started to change the delivery system so that you’re actually getting more bang for your health care dollar.
Let me give you an example. Right now if you go to your doctor and you get a test, a lot of times that test won’t be forwarded to the next doctor or specialist that you have to see. You have to take another test. You might have to take three or four or five tests by the time your treatment is all completed. That’s a waste of money. And if we can incentivize the provider to say, do one test and then e-mail the results to everybody who might be providing treatment, or the patient might be referred to, that right there saves a lot of money.
So what we want to do is to do this in Medicare and Medicaid, which will incentivize a lot of health systems around the country to start using some of the smart practices that you’re using. Frankly, Medicare and Medicaid is — they provide a lot of care for a lot of patients, particularly seniors, and so if they hear from Medicare, can you start doing things smarter, they have an incentive to do it, and once they put a smarter system in place, the benefits spill over to the private insurance market, as well. So we want to do it through Medicare and Medicaid, but we also want to see in the private insurance market that health providers start thinking smarter and providing better care, which often turns out to be lower-cost care.
Now, it’s not going to happen overnight, because a lot of these systems have been put in place for a long time. And if you’re in Grand Junction or Mayo Clinic or Geisinger or other of these really good health care systems, what they’ve done is each year they are continually comparing notes, they’ve got a peer review process where doctors are exchanging ideas, and they’re continually making the system better and better, smarter and smarter, and over time what we can do is bend the cost curve so that instead of having inflation go up a lot faster on health care than everything else, it matches everything else.
And if we could do that, if we could just get health care inflation to match the inflation on food and other items, all of our deficit — long-term deficit problems would be solved. Just that alone. If we could just reduce the amount of health care inflation, our long-term debt and deficit problems would be solved.
So this is the most important thing we can do for deficit reduction. And I want everybody to remember that, because in this debate you’ve heard a lot of people saying, “We can’t afford to do this because our deficit and debt are too high.” The biggest driver of our deficit and debt is health care. And if we don’t change delivery systems and adapt some of the innovations that are being used where you work and in really good health care systems around the country, then we’re going to be in red ink forever.
Okay. Thank you so much for the question. (Applause.)
All right. Gentleman in the red shirt back there. Wait for the mic so everybody can hear you.
Q Thank you, Mr. President, for taking my question, for one. I’ve got a bunch, but — my name is Randy Piper (phonetic) and I have been in the health insurance business for over 25 years. I’m also a big Steelers fan, as well.
THE PRESIDENT: I like that in you. (Applause.) Are you allowed to confess that though here, where — (laughter.)
Q I can take it. (Laughter.)
THE PRESIDENT: All right, all right. Go ahead.
Q You have asked many times why insurance companies are so afraid of competing with a public plan option of coverage. And I understand insurance companies need to get spanked every now and again for sure, but if the public plan option reimburses on average 55 cents by contract of every dollar of care to the provider, and the private insurance plans by contract reimburse an average of 85 cents per dollar of care, how can it be considered fair competition? And thank you for being here today. (Applause.)
THE PRESIDENT: No, I think it’s a good question. Thank you. For those of you who have not been following the debate as closely, let me just describe what this issue of the public plan is all about. And to do so, I’ve got to describe how we’re looking to provide health insurance for people who currently don’t have it. I spent most of my time talking about what we would do for folks who have health insurance, but we’ve still got 46 million uninsured and I think it is the right thing to provide them with some help. Most of them work. Most of them are responsible. But their employer — maybe they work for a small business — their employer just can’t afford it because they don’t have the bargaining power to get low enough rates to cover all their employees. That’s a big category of the uninsured.
So what we’ve said is, let’s set up what’s called a health insurance exchange. It’s essentially a marketplace where you could go online and you’d have a menu of options, most of them private insurers — Aetna, BlueCross BlueShield — insurance companies that wanted to participate, and they would list a range of plans just like when Mike and Mark want to get health insurance as members of the Senate, they go on to this exchange for federal health care — for federal employees, and they select which plan works best for their families.
So we want everybody to be able to access that and choose which plan works best for them. And if they can’t afford it, even though we’d have a lot of bargaining power, we’d be able to get the same kinds of rates that really big companies are able to get or the federal system is able to get, some people will still not be able to afford it, and then we would provide some subsidies. And there would be certain rules governing any insurance company that’s participating: You couldn’t exclude for preexisting conditions; you couldn’t have a lifetime cap; you’d have to limit out-of-pocket expenses. So all the insurance rules that I talked about, that would be part of the deal if you as an insurer wanted to sell insurance through this exchange.
So far, so good. The argument around public option is, should one of the choices — not the only choice — but one of the choices on that exchange be a public option? And the idea here would be that a government-run non-for-profit would have its own option that people could sign up for — they wouldn’t have to, but they could sign up for it — and if it could keep its costs lower and provide a good-quality service and good benefits, then that would help keep the insurance companies honest — (applause) — because the idea being — the idea being that as a non-for-profit, potentially with lower administrative costs, they could do a good job.
Now, the insurance companies have come back and said, well, that’s not fair, because nobody can compete against the government. They have a legitimate point if, if what’s being done is the government is either subsidizing that government plan — essentially taking taxpayer money and saying, here, we’ll just keep on spending money regardless of whether you run a good operation or not, then it’s hard for insurance companies to compete against that. And by the way, it would be wildly expensive for taxpayers.
So I’ve already said a public option can only work if they have to collect premiums just like a private insurer and compete on a level playing field. That’s point number one.
The second argument that’s been made is the one that you just made, which is, if public option is reimbursing at Medicaid rates that are substantially lower than what private insurers have to negotiate for, then eventually, over time, private insurers might be run out of business. So that’s the second argument.
Now, what’s happened in the House bill, that as it’s been modified, is they’ve actually said we’re going to negotiate rates, they won’t be Medicaid rates. So that actually solves the problem that you’re addressing, because now this would be a negotiated process and prices would not be set just to Medicaid. All right?
Now, there’s a third argument against the public option, and this is the one, really, that you’ve been hearing mostly about, and that is just this idea that we shouldn’t have government involved at all, that government is part of the problem, not part of the solution, to quote Ronald Reagan. (Applause.) We’ve got some supporters of that view. And I guess the only — look, I think you can have a legitimate position just saying you don’t want to see more government involvement. I understand the argument. The only thing I would point out is, is that Medicare is a government program that works really well for our seniors and has protected people — (applause) — hold on one second, let’s not start yelling.
It’s true that it’s expensive, but the truth is that actually the cost of Medicare inflation has actually gone up at a slower rate than private insurance. So it’s not because it’s mismanaged; it’s because of what was referred to in the first question — the whole health care system is out of whack and way too expensive. It’s not government, per se. It has to do with the fact that the health care system itself, the delivery systems, are not working the way they should.
So if you just believe the government shouldn’t be involved in anything, or shouldn’t be involved in health care, period, then you’re right that you can’t support the kind of reform that we’re proposing. The only thing I want to make sure of, though, is you’ve got to — you make an honest argument, because nobody is talking about government takeover of health care. There’s a difference between what we’re proposing, which has some government involvement, versus this idea that somehow government is going to take over everything and get between your and doctor. That’s not what we’re proposing.
So we can have an honest disagreement, but I just want to be clear on what the debate is about. It’s about this narrow issue of the public plan. It’s not about somehow eliminating private insurance. Everybody who has currently private insurance that works for them will be able to keep private insurance under the proposals that have been made in Congress. All right? (Applause.)
Okay, it’s a woman’s turn. It’s a young lady’s turn. Let me — right there with the vest. Yes, that’s you. (Laughter.)
Q Hello, Mr. President, and thanks for being here.
THE PRESIDENT: Thank you.
Q My name is Jamie and I am a nursing student at Mesa State. (Applause.)
THE PRESIDENT: Outstanding.
Q Being as I am a potential health care provider in the health care system, there are a few things in the plan that I read about that I wanted to understand more —
THE PRESIDENT: Sure.
Q — as far as providers being required to report — what was the words — preventable medical errors in the health care system. Now, as far as health care systems are concerned, we are required to report every error we see. So I kind of want a clarification of how much you’re expecting from providers in this system.
THE PRESIDENT: Well, different states have different rules. So we got kind of a patchwork. I don’t — I confess I don’t know exactly what the rules are here in Colorado. But about 100,000 people die every year from preventable diseases and illnesses in hospitals. Some of the ways that we could solve this are so simple. There’s actually a doctor who’s put together a protocol — washing your hands, a lot of just basic stuff that costs no money — that has been shown repeatedly to cut these preventable illnesses and deaths down drastically — by a magnitude of 50 percent, 75 percent reductions in preventable deaths just by applying these things that don’t cost any money.
So the question then becomes, how do we get more hospitals, more doctors, more health systems, to adopt these systems. And the best way to do it is to make sure that not only are they reporting these preventable errors, but that they’re also available to consumers — the American people — so that if they’ve got too many of them, after a while they start getting embarrassed. Right? I mean, if you found out that there are two hospitals here in this city and one hospital has half the preventable deaths of the other hospital, you’d want to know that, wouldn’t you?
The problem is right now oftentimes it’s very hard for consumers to get that information directly. So the idea is simply to make sure that that information is packaged in a way where you can comparison shop, and your employer — if you’re getting health insurance from your employer — could comparison shop. So we’re putting some competitive pressure to improve quality across the system. That’s what we’re talking about. (Applause.)
By the way, thank you for being a nurse, because we need more nurses. That’s important. (Applause.)
All right, gentleman right here in the t-shirt. Hold on one second, we got a mic coming.
Q Thank you for coming to Colorado. It’s a great place.
THE PRESIDENT: It’s a great place. (Applause.)
Q You touched on this. I would like you to expand a little more. This problem with misinformation in our country, it seems to me that it’s not only just hurting health care reform, health insurance reform, it’s dividing our country. (Applause.) Is it not maybe time — I think we all know where it’s coming from. Is it not time that something can be done — okay, I got to watch what I’m saying, but —
THE PRESIDENT: Well, look, let me — let me just — let me address this. You know, health care is really hard. I mean, this is not easy. I’m a reasonably dedicated student to this issue. I’ve got a lot of really smart people around me who have been working on this for months now. We’ve got really fine public servants like Senators Bennet and Udall who are working on this and thinking about it a lot.
And the truth is — I want to be completely honest here — there is no perfect, painless silver bullet out there that solves every problem, gives everybody perfect health care for free. There isn’t. I wish there was. I wish I could just say, you know what, we’re going to change the system, everybody will get as much care as they want any time they want, everybody will have it, and it won’t cost anything. And doctors will be happy and nurses will be happy, hospitals will be happy, insurance companies will still make a lot of profits, drug companies will be able to charge as much as they want. I can’t do it. Nobody can.
What I can do is try to sort through what are all the options available, be realistic about where we’re going on health care, say to myself, if we keep on doing what we’re doing, we are in a world of hurt. We can’t afford what we’re doing right now. More people are going to lose health insurance. More employers are going to drop coverage or push more coverage onto their employees with higher premiums and higher deductibles. Medicare and Medicaid will go broke. State budgets and federal budgets will be unsustainable.
And then we’re going to have to make some really bad decisions where we had no good options — even worse options than we have right now. And what’s going to end up happening is — mark my words — if we do nothing, at some point Medicare in about eight to nine years goes into the red. Somebody mentioned it’s going broke — yes, it is going broke.
So here’s what’s going to happen if we don’t change the delivery systems and change some of the incentives — we’ll have a choice. We’ll either have to cut Medicare, in which case seniors then will bear the brunt of it, or we’ll have to raise taxes, which nobody likes. And we still will be paying about $5,000 to $6,000 more than any other advanced country in the world and not get better health care for it. Now that doesn’t make sense.
So in terms of misinformation, there is — because there’s no perfect solution, we can have legitimate debates about the public option that we just had. That was a good, serious debate, and you can make a plausible argument as to why we shouldn’t have a public option. Now, I believe that we should on balance. It’s not perfect. It’s not going to solve every problem, but I think it actually would keep the insurance companies more honest. You can have a honest disagreement with me on that.
What you can’t do — or you can, but you shouldn’t do — is start saying things like, we want to set up death panels to pull the plug on grandma. I mean, come on. (Applause.) I mean, I just — first of all, when you make a comment like that — I just lost my grandmother last year. I know what it’s like to watch somebody you love, who’s aging, deteriorate, and have to struggle with that. So the notion that somehow I ran for public office, or members of Congress are in this so that they can go around pulling the plug on grandma? I mean, when you start making arguments like that, that’s simply dishonest, especially when I hear the arguments coming from members of Congress in the other party who, turns out, sponsored similar provisions.
Here’s what this was about. Here was the genesis of this little piece of information. We had a provision in the House bill that would give the option — the option — of somebody getting counseling on end-of-life care or hospice care, and have it reimbursed by Medicare; the option — voluntary — so you’d have more information about how to deal with these situations.
Turns out the biggest proponent of this was a Republican congressman who is now a senator and a colleague of Mr. Udall and Mr. Bennet. Turns out in Medicare Part D, which was passed by a Republican Congress, they had the exact same provision.
So when I have people who just a couple of years ago thought this was a good idea now getting on television suggesting that it’s a plot against grandma or to sneak euthanasia into our health care system, that feels dishonest to me. And we’ve got enough stuff to deal with without having these kinds of arguments. (Applause.)
All right, so it’s — all right, it’s a woman’s turn here. Yes, I sort of neglected this area right here. Young lady right there, blond hair, black blouse — white dress. Yes, right there. Go ahead.
Q Hi, my name is Julie, and I’m a small business owner from Colorado Springs. I am also a Republican that voted for you.
THE PRESIDENT: Thank you.
Q You’re welcome. (Applause.)
THE PRESIDENT: What’s your business?
Q We make software.
THE PRESIDENT: Excellent. We need that.
Q I hope so. (Laughter.) So I grew up in a blue-collar family, and my husband and I work very hard at our small business. We’ve always treated our employees like family, given them great benefits, any time off they need with their family. I volunteer in my professional community. I volunteer at my children’s schools. And that’s still not enough, because us small business owners that are on that cusp between middle class and the rich are going to bear the brunt of a lot of what this is going to cost. Why is what I do now not enough? (Applause.)
THE PRESIDENT: Let me — I think it’s a good question. Let me talk about both cost and what this would mean for small businesses, because both issues would affect you.
First of all, remember what I said, I can’t come up with a perfect solution that is completely free. It is absolutely true that in order for us to provide help to those who have no insurance at all, that’s going to cost some money. It’s going to cost some money. We can’t do it for free. They’ve got no health insurance right now; we’re going to help them. It’s 46 million people. That’s going to cost some money.
Now, what I’ve proposed is going to cost roughly $900 billion — $800 billion to $900 billion. That’s a lot of money. Keep in mind it’s over 10 years. So when you hear some of these figures thrown out there, this is not per year, this is over 10 years. So let’s assume it’s about $80 billion a year. It turns out that about two-thirds of that could be paid for by eliminating waste in the existing system.
So I’ll give you — let me give you one particular example. We right now provide $177 billion over 10 years — or about $17 billion, $18 billion a year — to insurance companies in the forms of subsidies for something called Medicare Advantage where they basically run the Medicare program that everybody else has, except they get an extra bunch of money that they make a big profit off of. And there’s no proof, no evidence at all that seniors are better off using Medicare Advantage than regular Medicare. If we could save that $18 billion a year, that is money that we can use to help people who right now need some help.
So about two-thirds of what we’re talking about is paid for through the existing health care system, money that’s already being paid by taxpayers — does not require additional taxes. But that still leaves one-third.
Now, in order to pay for that, there have been a lot of proposals out there. One of them that I proposed, I still think is the best idea. You may disagree, because I don’t know what your income bracket is. My proposal was that for people making more than $250,000 a year — people like myself — that we should, instead of getting the full itemized deduction of what our highest tax bracket is, we should just cap out our itemized deduction at 28 percent, which is what the average American gets. So — because my attitude is, I shouldn’t get a bigger tax break if I write a check to my local church than if the janitor down the street writes a check to their local church. We should get the same tax break. If we were willing to do that, just that alone would pay for what we’re talking about. (Applause.)
Now, some members of Congress disagree with that and they’ve got other proposals, and that’s going to be worked out in September.
I do want to make the point, though, that I have not proposed any plan that would put the burden on middle-class families in order to deal with this. So when you hear people talking about I’m raising your taxes, the only tax policies I’ve implemented for middle-class families is a tax cut for 95 percent of working families.
Now, let me talk about small businesses. I don’t know your particular situation, whether you’re providing health insurance right now to your employees. If you are, then you stand to benefit from this plan because every proposal, both in the House and the Senate, that’s been put forward, provides a huge number of subsidies to small business owners that are doing the right thing by their employees. (Applause.)
So it is very likely — you know, obviously we’d have to look at the calculation; I’d have to figure out how many employees you have, what kind of health insurance plan you had, et cetera — but it is very likely that you would actually make money, gain from this plan, because you’re already providing health insurance to your employees and we would give you some help.
The only category of folks who might not like this plan are employers who can afford to provide health insurance to their employees but aren’t doing so, because what we would then say to them, what we’d say to them is, look, we’re giving you affordable options; you are going to be able now to be part of a bigger pool. You can buy your health insurance through that exchange that I was explaining to that gentleman there. So you’ll be able to get premiums and prices that are comparable to what big companies, Xerox or IBM, are getting for their employees, and we’ll give you some help doing it.
But if you refuse to provide any health insurance for your employees at all, then we are going to ask you to make a contribution to help make sure those employees have health insurance, because by the way, it turns out if you as an employer are not providing that health insurance, the rest of us are, because those folks are going on Medicaid, or they’re going to the hospitals for uncompensated care, and that’s not fair. (Applause.)
So the bottom line is this: If you are a small business person who is providing health insurance for your employees, I am very sure that you would actually benefit from this. But the problem is — again, this is where the information has not been going out in as clear a fashion as possible, which is why I’m glad you asked the question.
All right? Okay. (Applause.)
All right, I’m going to call on this gentleman because he’s been waving — and he’s shouted at me a couple of times, so I just want to — I just want proof here that I’m happy to get a good debate going.
Q How are you doing, Mr. President?
THE PRESIDENT: I’m good. What’s your name?
Q My name is Zack Lane (phonetic). I’m a student at the University of Colorado in Boulder.
THE PRESIDENT: Good to talk to you, Zack. What do you study?
Q Political science and business marketing.
THE PRESIDENT: Fantastic. All right, what’s your question?
Q My question is this. And also, I’d love to have a debate, just all out, anytime, Oxford-style, if you’d like. (Laughter.) I understand — I’m willing to do that. But my question is this. We all know the best way to reduce prices in this economy is to increase competition. How in the world can a private corporation providing insurance compete with an entity that does not have to worry about making a profit, does not have to pay local property taxes — (applause) — they do not have to — they’re not subject to local regulations? How can a company compete with that? And I’m not looking for anything — I don’t want generalities. I don’t want philosophical arguments. I’m just asking a question.
THE PRESIDENT: That’s a great question. Thank you for the question. (Applause.)
Now, I just want to point out that I partially answered the question earlier by explaining that certainly they can’t compete if the taxpayer is standing behind the public option just shoveling more and more money at it, right? That’s certainly not fair. And so I’ve already said I would not be in favor of a public option of that sort because that would just mean more expenses out of our pockets and we wouldn’t be seeing much improvement in quality.
It is true that there are certain costs associated with a private business that a government would not have to worry about; you mentioned a couple of them. It’s not just, by the way, property taxes; it’s also things like just the cost of capital. In terms of the cost of borrowing, a public option — insurance companies have to have a lot of money on hand and it’s conceivable that a private entity that’s having to pay a certain interest rate for their money would be really undermined if the government is able to get money much cheaper implicitly because Uncle Sam backs this operation.
So that’s why I say, this is actually a legitimate debate. I think that we can craft a system in which you’ve got a public option that has to operate independently, not subsidized by taxpayers — it would be nonprofit, but we’ve already got nonprofits out there like BlueCross BlueShield — that they would have to go on the market and get a market price for capital, so they wouldn’t be able to just have the Federal Reserve write them a check. I think there are ways that we can address those competitive issues. And you’re absolutely right, if they’re not entirely addressed, then that raises a set of legitimate problems.
But the only point I wanted to make was the notion that somehow just by having a public option you have the entire private marketplace destroyed is just not borne out by the facts. And in fact, right now you’ve got a lot of private companies who do very well competing against the government. UPS and FedEx are doing a lot better than the post office. (Applause.) No, they are. And so — but the larger point I want to make — and it’s good to see a young person who’s very engaged and confident challenging the President to a Oxford-style debate, I think this is good. (Applause.) You know, the — this is good. You know, I like that. You got to have a little chutzpah, you know.
This is a legitimate debate to have. All I’m saying is, though, that the public option, whether we have it or we don’t have it, is not the entirety of health care reform. This is just one sliver of it, one aspect of it. And by the way, it’s both the right and the left that have become so fixated on this that they forget everything else, like the fact that we can help Nathan make sure that he doesn’t suddenly find himself — (applause) — completely broke in trying to treat his son.
So we are working on a series of proposals to address the questions that you’re raising. I believe that we can work them out. But those are specific questions as opposed to broad, philosophical questions about whether government ever has a role to play or not.
Keep in mind, finally — and this is the last point that I’ll make — that you have a bunch of countries that have systems in which government is involved but you still have a thriving private insurance market — The Netherlands being a good example. Everybody is covered. Everybody has care. The government has regulations in there. But it does not somehow take over the entire private insurance market. So I just want people to understand nobody is talking about a government takeover of health care. I want to repeat that one last time.
All right. I’ve got — I’ve got one last — I’ve got time for one last question. I’m going to call on this young lady right here. Oops, she just lost her question. Go ahead. Who’s got a microphone? Right here, right here.
Q I cannot believe that we have the President of the United States of America in Grand Junction, Colorado! (Applause.)
THE PRESIDENT: Good to be here.
Q We are so proud of you.
THE PRESIDENT: Thank you. (Applause.)
Q My name is Marie Elena, and I live in the Western Slope in Montrose, Colorado. And I am a naturalized citizen, and I am proud to be an American in this beautiful land. (Applause.)
THE PRESIDENT: Thank you.
Q As a child I had polio, and I had a series of surgeries, 52 of them, to correct my poor structure of bones — between here, Denver, Montrose, and the Mayo Clinic in Phoenix, Arizona. I have been blessed with a good insurance, generally excellent doctors and care. However, my major concern in cost, even with good — even with a good insurance, the cost has been high, practically when I have been gone out of the network. Why should our doctor treatment choice be limited by a geographic area or the state? What kind of competition is this, Mr. President? (Applause.)
THE PRESIDENT: Okay, all right.
Q Thank you.
THE PRESIDENT: This raises an important question, because it goes to the overall debate that’s taking place out there right now. When we talk about reform, you hear some opponents of reform saying that somehow we are trying to ration care, or restrict the doctors that you can see, or you name it. Well, that’s what’s going on right now. It’s just that the decisions are being made by the insurance companies.
Now, in fairness, we probably could not construct a system in which you could see any doctor anywhere in the world anytime, regardless of expense. That would be a hard system to set up. So if you live in Maine, you know, we’re going to fly you into California, put you up. I mean, you can see — and I’m not trying to make light of it — you can just see the difficulty.
So any system we design, there are going to have to be some choices that have to be made in terms of where you go to see your doctor, what’s going on, et cetera. That’s being done currently in the private marketplace.
All we’re trying to do is to make sure that those decisions that are being made in the private marketplace aren’t discriminating against people because they’re already sick; that they are making sure that people get a good deal from the health care dollars that they are spending.
So let’s make sure, for example, that if you go to a hospital, you get one of those operations that you discussed, and it turns out that two weeks later you’ve got to be readmitted because they didn’t do it right the first time, that the hospital has to pay some penalty for that, or at least they’re not being reimbursed as much as a hospital who gets it right the first time. That’s an example of changing incentives that can save us money.
The more that we make those kinds of changes that improve quality, reduce cost, the more likely it is that more Americans have more options and that they are not being jerked around. It doesn’t mean that everything is going to be perfect, but it does mean that consumers will have more choices, better options, more security, more protection.
That’s all we’re trying to accomplish here and we’re trying to do it in a way that over time reduces costs overall for families, whether you’re getting Medicare or you’re getting Medicaid or you’ve got private insurance through your employer or you’re a small business owner. That’s what we’re trying to accomplish.
And I am confident that we can accomplish it — but we’re going to have to work hard to do it, and we’re going to have to overcome some of the wrong information, and we’re going to have to have an honest debate. Nothing is going to be perfect. We’re going to have to make sure — this is something, by the way, that people need to understand: Even if everything goes perfectly and we pass legislation, let’s say, in October, we’re still going to have another three months of debate about this, then we’re still going to have several years of implementation. It’s not going to happen overnight. We’re going to have to set up these reforms and these processes, and we’re going to have to give insurance companies the chance to adjust, because, for example, if we don’t have everybody covered, we can’t construct a system that prevents insurance companies from discriminating against preexisting conditions. I hope everybody understands that.
We can’t tell insurance to take everybody if, on the other hand, you’ve got a whole bunch of people who are healthy and young who choose not to get insurance at all, because what ends up happening is then insurance companies are just going to take the people when they get sick. Somebody won’t buy insurance until they find out that they’re sick. Then they go into the insurance office and they say, give me insurance so I can go pay my bill. Insurance companies would lose money pretty quick that way.
So if we’re going to eliminate the preexisting conditions problem, we’ve got to also — have the coverage problem, and that’s why this is going to have to be phased in over a number of years.
Last point I want to make, and this has to do with the budget issues, because we’ve got a huge deficit right now and a huge debt, and I think that that’s coloring how people view the debate. I hear a lot of people say, how can we afford this right now? We’ve got to reduce our deficit.
First, I want everybody to understand the source of our deficit, because if you don’t understand that, then my argument won’t make sense. When I walked into the White House, I had gift-wrapped, waiting for me at the door a $1.3 trillion deficit — $1.3 trillion. Now, I say that — (applause) — I just want to — I just want to — I just want to — I say that — this was not — and this is not, by the way, entirely the previous administration’s fault. The financial crisis was so bad that revenues plummeted and all this money was spent in making sure that the banking system did not completely collapse. So all the actions that have been taken — the bank bailout, the auto bailout, all that stuff — that did spike the deficit.
But the problem actually is not that — you know, the extraordinary steps that we’ve taken over these last one or two years. The real problem is much longer. Even if we had had no fiscal crisis whatsoever, we have a structural deficit. We’re spending more money than we are taking in. We’ve been doing it for the last eight years. When we passed the prescription drug benefit for Medicare, by a Republican Congress, they didn’t pay for it. They didn’t want to raise taxes, but they wanted to get the benefit. That just was red ink. That just went into our structural deficit.
When we fought the Iraq war, we made that decision. We didn’t pay for it. When we cut taxes on some of the wealthiest Americans, we did not compensate by making cuts in programs that were comparable. So what that has all added up to is, we’ve got a structural deficit that over the course of the next 10 years is about $9 trillion.
Now, I say that because I just want everybody to understand, if we’re going to tackle that problem, the only way we can do it in an intelligent way is if we get control of Medicare and Medicaid spending in some realistic way. If we don’t do that — if we don’t do that, we can’t simply cut our way out of the problem or tax our way out of the problem.
I ask sometimes, when I’m in audiences, what people think the amount of federal budget is devoted to foreign aid. And people will say, 25 percent; if we could just cut that out, we could eliminate the deficit. Foreign aid is 1 percent of our budget — 1 percent. People think, well, it’s all these pork projects and earmarks that everybody is getting. One percent. Almost all of our spending is Social Security, Medicare, Medicaid, interest on the national debt, defense spending — things that are very hard to cut.
Only about — only about 30 percent of the overall budget, somewhere between 25 and 30 percent is non-defense discretionary spending. That’s everything for national parks, for education, you name it. Every single program that you think of that you think of as a government program, that is only about 25 percent of the budget. The rest of it is all Social Security, Medicare, and Medicaid. And what’s really going up fastest is Medicare and Medicaid.
So I just want everybody to understand, if you are a fiscal hawk, if you are — if you are a deficit hawk and you are tired of this crazy spending in Washington and you want to finally make sure that we are looking out for the next generation, then you, more than anybody, should want to reform the health care system — because if we don’t do it, we can’t solve that problem. (Applause.)
Thank you, Grand Junction. Love you. (Applause.)
Press gaggle by Press Secretary Robert Gibbs
MR. GIBBS: Good morning.
MR. GIBBS: I know, it’s not really morning. I’m pretty sure my schedule will be completely messed up by the time we get home.
Q Public option — is it dead or not?
MR. GIBBS: I got to tell you, this is one of the more curious things I’ve ever seen in my life. I was on a Sunday show, I said the same thing about a public option that I’ve said for I don’t know how many weeks. The Secretary reiterated what the President said the day before, and you’d think there was some new policy.
Q The language appeared to be —
MR. GIBBS: The language “appeared” to be?
Q Well, the language on Saturday — the President made — saying that the public option was only a sliver, and whether it’s in it or it isn’t in it seems to move the ball a little bit from where you guys were. No?
MR. GIBBS: No. I think you can go back and find the President saying — look, the President has said that’s his preference, but the President has also said I don’t know how many times if the goals are choice and competition, right, the reason you have a public option is because you have an insurance market that doesn’t have choice or competition. If somebody is trying to seek private insurance on — private health insurance on a private market and only has — because this happens in some areas or in some states where there’s one insurance company that does business in that region, that that is — that doesn’t ensure the type of affordability and quality that you’d want to see in a health insurance system.
So you have some competition that provides some choice, so that if a family of four might have different insurance needs than a single person or a couple that’s married with no children or what have you. The goals are choice and competition. His preference is a public option. If there are other ideas, he’s happy to look at them. Because I think his — I think this is true not only for the issue of health care, but for virtually every other issue that he’ll ever deal with in public life is he has goals about what he wants to accomplish and he’s not necessarily wedded to one — only one way of getting there. I think he’s said that a hundred times.
Q Just to be completely clear, has anything changed on the public option?
MR. GIBBS: No. I challenge you guys all to go back and see what we’ve said about this over the course of many, many, many, many months, and you’ll find a boring consistency to our rhetoric.
Q The rhetoric, as you say, might be consistent, but the movement on the ground, so to speak, toward legislation hasn’t been. Is there any recognition now that a public option is looking less likely to be part of a final deal?
MR. GIBBS: Let me make sure I understand your question, because I want to know if it’s — is this predicated on legislative developments since Congress has been out of session, or are we trying to match the stampede of a series of stories to if not the consistent language that we’ve all been saying to some now legislative vote?
Q It’s just looking more and more likely that a public option is not going to be part of the final bill. I’m wondering if the White House is —
MR. GIBBS: I do think — can I just — I want to point out the — how do I phrase this — massive irony that I don’t know that I saw any of your stories denote the fact that this might be — that you’re surmising now this was a political reality rather than —
Q That’s what we’re asking.
MR. GIBBS: I understand, but did you think from the phrasing of Julianna’s question that we might be coming to justify a series of stampeding stories in one direction based on something different than what we’ve always said?
Q But you guys have — you haven’t exactly come out publicly since Sebelius’ statement yesterday, come in front of the cameras to speak to us, to downplay —
MR. GIBBS: Because nothing has changed.
Q But you haven’t downplayed the remarks and the coverage either.
MR. GIBBS: No, no, I think many people talked to you all yesterday. I think people sent e-mails. David Axelrod called people.
MR. GIBBS: I didn’t get an e-mail from you. Nothing has changed. I mean, we can go out and say nothing has changed, but that seems sort of silly since nothing has changed.
Look, in terms of the political realities, obviously there’s a public plan — or public option in the House bill. There is a public option in the HELP bill. I don’t know what the Senate Finance Committee will come out with.
Q When the President talks about the special interests and railing against the special interests on health care, who is he referring to — criticized special interests, lobbyists, and —
MR. GIBBS: Well —
Q Specifically, those you’re referring to. What constituencies?
MR. GIBBS: Interest groups that are aligned to keep the status quo either because it benefits them or they have a vested interest in — or because they have a vested interest in it not changing.
Q So he would include drug makers in that, or not?
MR. GIBBS: Drug makers, if you’re a member of PhRMA, you’ve come to an agreement about health care reform happening this year.
Q So he’s referring to special interests who are not on board with reform?
MR. GIBBS: Well, I mean, to be critical of somebody who’s not for reform, you typically would have to be opposed to the President’s plan.
Q Right, but it seems that there are actually a lot of special interests that are in favor of reform. So —
MR. GIBBS: I guess I’m confused at where you’re heading here.
Q Well, I’m — he gets up there, he rails against special interests, but yet there are special interests who are allies of the White House, as well.
MR. GIBBS: But let’s be clear. You can rail against special interests that are for — it’d be sort of odd to go to a town hall meeting and rail against interest groups that are supporting reform — right — who have acknowledged that it’s time for health care reform; acknowledged that the system as we currently have it either isn’t working for patients or doctors or nurses or seniors or young people or budgets or the government.
Q Well, then, specifically, who? Can you give me a couple examples of —
MR. GIBBS: I think the President mentioned the other day that there are insurance companies that are for the status quo.
MR. GIBBS: Well, I think we’ve produced a list. I’ll try to find that for you. There’s groups that have run commercials, right? Dick Armey’s group has been out there. I’d point you to Dick Armey’s comments on Medicare today, as well. But Dick Armey’s group is out there actively getting people to go to town halls and yell at members of Congress. The Conservatives for Patients’ Rights, the gentleman who has in his list of lifetime accomplishments, “receiving the largest Medicare fine in the history of the entire program,” who spent millions of dollars to go on TV and criticize health care reform. I think that’s a list of people that are special interests who oppose a change and reform in health care.
Q Switching topics —
Q Wait, can I ask one more health care question?
Q What was the President’s message to Chairman Baucus regarding the public option during their meetings on Friday?
MR. GIBBS: I don’t know the degree which that particularly came up. I think they were talking more about the global process, about trying to get consensus in the Finance Committee.
Q Would that have to involve public option of some sort?
MR. GIBBS: Well, I mean, obviously they’ll make a decision about it. He didn’t talk to me about whether or not that specifically came up.
Q Swapping topics a little bit to tomorrow. What does the President hope to achieve with his meeting with Mubarak?
MR. GIBBS: Look, again, I think this is continuing our outreach in the Middle East. Again, I don’t want to get ahead of what the President will tell Mubarak. But I think obviously each country in the region on either side of this issue has certain responsibilities to uphold as we make progress toward a lasting peace in the Middle East. And without a recognition of those responsibilities it’s going to be hard to move forward. So I think the President will take some time to talk through that.
Q Anything else specifically that he wants to discuss?
MR. GIBBS: Well, let me — let me just leave at that, then we’ll have — you guys will have a chance to talk to them tomorrow afternoon.
Q More broadly, sort of six months from sort of starting his Middle East peace push, how does the President feel things are sort of developing? It seems we’ve gone to a situation now where the Arabs are telling the Israelis, you’ve got to go first, and the Israelis are telling the Arabs, you’ve got to go first. Is there any way you can sort of unblock that situation?
MR. GIBBS: Well, look, I think — I think most Middle East observers will tell you that progress on this issue is not going to be made unless or until there’s sustained involvement by the United States; that if we look back at progress that has been made, it’s generally been with the involvement of the United States, because we all understand it’s in our national interest.
I think the President talked throughout — has talked throughout his time in public life as saying that most of all, what we have to have is have that sustained engagement that allows the two parties to work with each other and make progress. And without it, what happens, we tend to see — we tend to see the absence of that progress.
And I think instead of — instead of waiting until the end of a certain term or a certain time to have that engagement, the President’s plan is to — was to do that from the very beginning, and I think you saw that in the phone calls that he made the very first full day — his very first full day in office. We’ll continue to do that.
Q Has he spoken to Mubarak since the June meeting?
MR. GIBBS: I don’t believe he has but I will double-check. I don’t believe he has since then. They haven’t — I mean, they haven’t spoken on the phone, I should say.
Q How else —
MR. GIBBS: Well, they could communicate.
Q He’s got the e-mail address.
MR. GIBBS: You could write a letter.
Q Does he have the BlackBerry —
Q Does he have the e-mail address?
MR. GIBBS: Not that I’m aware of, no. Just by letter.
Q So you’ll let us know if any communication has —
MR. GIBBS: Yes, well, I’ll double check with those guys.
Q Is there a change in the schedule for the rest of the week?
MR. GIBBS: Not that I’m aware of, though I have to admit, having been out West, I’m a bit out of the — I’m happily out of the scheduling loop for a couple days. But we’ll try to update you tomorrow morning or tomorrow afternoon in the briefing if any events have been added. I’m sure there have, just as they have been fleshed out.
Q And the reason that we moved the schedule up earlier today — was there any special reason?
MR. GIBBS: No, just he was — he was up a little earlier, and the VFW could take us a little earlier, and I think he’s probably anxious to get back over — to get back out East, much to our chagrin.
Q What’s the format for tomorrow, is it — with Mubarak? Is it the usual one-on-one, expanded delegations, lunch, that kind of thing?
MR. GIBBS: I believe so. I don’t — I have not seen the full itinerary, but I don’t know why that would be different. And then I don’t know where we’re doing the spray with the questions, but we’ll have all that information out for you guys either in tonight’s guidance or first thing tomorrow morning.
Q With the budget mid-session review coming out in the next few weeks, are you guys expecting good news or bad news?
MR. GIBBS: Well, look, I think obviously the biggest driver in a budget right now is the state of the economy. I think it’s pretty safe to assume that the economy over the course of the first six months, particularly that first three months that the President was in office, we’ve talked about numerous times deteriorated at a rapid pace unlike anything anybody imagined. So I think in many ways it has only sharpened our budget challenges. I’ve not seen the final documents or things like that, but I don’t think there’s any doubt the challenges remain to get our fiscal house in order.
I think you’ve heard the President at town hall meetings talk about the importance of making sure that health care reform is paid for. I think he, at the end of — particularly at the end of the Colorado town hall meeting, you know, he talked about, you know, Congress — and the President added an expensive drug benefit through Medicare that we didn’t pay for. We went to war in Iraq that we didn’t pay for. We made a lot of cognitive decisions that we knew would be expensive, and we made them knowing we weren’t going to pay for them.
The President has a different idea about that — that reform has to be something that we pay for because we have to get our fiscal house in order, we have to change the cost curve for Medicare and Medicaid. Families can’t afford health care to continue to skyrocket at this rate. Neither, quite frankly, can the government.
All right, enjoy your flight home. Thanks, guys.
Q Thanks, Robert.