obama healthcare bill

- ladies and gentlemen,please welcome former secretary of stateof the united states, hillary rodham clinton. [applause] >> mrs. clinton:good afternoon, everyone. well, thank you. thank you very much. i have the great pleasure tointroduce our next two speakers, who are about tohave a conversation

concerning health care. and i thought hard about howto introduce these two men. [laughter] and the morei thought about it, the more i realizedhow much they have in common. they are both left-handed. they both love golf, a game that does notoften reciprocate the love they put into it.

they both arefanatic sports fans and go to great lengthsto be in front of the tv or on the side ofthe court or the field. they both aremaster politicians. each of them has onlylost one election. they are both democrats. they have fabulous daughters. they each marriedfar above themselves. [laughter and applause]

and they eachlove our country. and so pleasejoin me in welcoming number 42 and number 44, bill clintonand president barack obama. >> president obama:mr. president. >> president clinton:are you interviewing me? >> president obama:that would be bad. i've been talking a lot today. >> president clinton:i want to thank youfor giving hillary a job.

that was a good thing you did. thank you for coming. >> president obama:well, it is wonderfulto be back. and let me start justby saying to all the people who have for years now supportedthe incredible efforts of cgi, thank you. because wherever we travel,all across the globe, we see the impact thatit's making every single day. and we're very proudof what you all do.

and let me saythat we still miss our former secretary of state. and i should add thatthere's nothing she said that was not true, particularly the partabout us marrying up. >> president clinton:well, that brings me tomy first health care comment. this is going to be aconversation about domestic and international health,and america's role in it. but i want tobegin by telling you

that i think the first ladyhas done a great job in this fight againstchildhood obesity. we have been honoredat our foundation to be asked to representher effort in 18,000 schools where we've loweredthe calories in drinks being served inschools by 90 percent. but she has beengreat on that one. the other thing i think isthat i was a little upset -- and, as you know, called oneof your administration members

when you got to africa -- when i read an articlethat said that you didn't have a big initiative in africa. and i said -- i can't sayexactly what i said -- -- but i saidthat is inaccurate. that's the sanitizedversion of what i said. because when the presidenttook office, our program, begun underpresident bush, pepfar, was giving antiretroviralmedicine to 1.7 million people.

because of an agreement thati made with president bush to use generic drugs thatwere approved by the fda, about half our drugs werebeing purchased in that way. under president obama,we've gone to 99 percent. we are treating morethan 5.1 million, three times as manyfor less money. that is a stunning legacy -- so that more money has been putinto malaria medicine, bed nets, so you saved a lot of money andsaved more lives while doing it.

and i'm very proud of that. and i want to thank you for it. it's important. now, maybe at the end of thisconversation we can get back to some of your currentglobal health initiatives. but let's talk a littleabout the health care law, because we're aboutto begin on october 1st open enrollment for six months. and i'd like to give youa chance, first of all,

to tell them why --when you took office, we were teetering onthe brink of a depression. you had to avert it. you had to startthe recovery again. why in the midstof all this grief did you also take onthis complex issue? many people were saying,why doesn't he just focus on the economyand leave this alone? so tell us why you did it.

>> president obama:well, first of all, i think it'simportant to remember that health care is the economy. a massive part of our economy. and so the idea that somehowwe can separate out the two is a fallacy. second of all,the effort for us to deal with amultifaceted health care crisis has been going on for decades.

and the person who justintroduced us, as well as you, early in your presidency,had as much to do with helping to shape theconversation as anybody. the fact is that we havebeen, up until recently, the only advancedindustrialized nation on earth that permits largenumbers of its people to languish withouthealth insurance. not only is therethe cruelty of people who are unableto get health insurance

having to use the emergencyroom as their doctor or their health service, but -- we're also more efficientthan anybody else and so when we talk about,for example, our deficit -- you know this betterthan anybody -- the reason that we havenot only current deficits but also projectedlong-term deficits -- the structural deficit thatwe have is primarily based on the fact that wehave a hugely inefficient,

wildly expensivehealth care system that does not producebetter outcomes. and if we spent the same amountof money on health care that canada or franceor great britain did, or japan, or any otherindustrialized country, with the same outcomesor better outcomes, that essentially would removeour structural deficit, which would then free updollars for us to invest in early-childhood educationand infrastructure

and medical researchand all the other things that can make surethat we're competitive and growing rapidlyover the long term. so my view wheni came into office was we've gotan immediate crisis -- we've got to getthe economy growing. but what wealso have to do is to start tackling someof these structural problems that had beenbuilding up for years.

and one of the biggeststructural problems was health care. it's what accountsfor our deficit. it's what accounts for our debt. it causes pain and miseryto millions of people all across the country. it is a huge burdenon our businesses. i was out at a fordplant out in missouri, making the f series out there,

and this isa big stamping plant. ford is now the biggestseller in the united states. we took that lead backfrom the japanese automakers. but we are stillburdened by the fact that every u.s. automobilethat is manufactured requires a couple of thousand dollarsin added health care costs that our foreigncompetitors don't have to pay. so this has everythingto do with the economy, in addition to what i considerto be the moral imperative

that a mom should nothave to go bankrupt if her son ordaughter gets sick; that a family who'sdealing with a layoff and is already strugglingto pay the bills shouldn't also be wondering whether they're one illnessaway from losing their home. and i think mostamericans agree with that. >> president clinton:so first of all, folks, for those of you whoare from the united states,

that's about as good an overviewas you're ever going to hear of what this economic issue is. but you remember the presidentsaid our structural deficit would disappear if we had acomparable health care system in terms of costto the french and germans that are consistentlyrated the highest. it's abouta trillion dollars a year, and somewhere around44 percent of that money is government-funded money.

so you just run the numbers. think -- over half of ourdeficit has already disappeared because of economic growth and the revenues you raisedand the spending we cut. and you pretty muchget rid of the rest of it if we just hada comparably expensive system to any other country. before you took office, we lost a car company thatwanted to locate in michigan

that went instead to canada, and they announced --they said, look, we're a car company thatprovides health care benefits to an employee;were not a health care company that sells carsto cover our bills. we have to go to canada. and it was one ofthe few companies willing to go onrecord and say this. so thank you for doing it.

so let's talk about this. what does this openenrollment mean? how are people goingto get involved? when you have universalenrollment you can manage your costs betterand cut inflation down. i'll give the presidenta chance to talk about all the goodstuff that's happened, but i just want youto know one thing. in the last three years,just as we started doing this,

inflation in health care costshas dropped to 4 percent for three years in a row forthe first time in 50 years. fifty years. before that,the costs were going up at three times the rateof inflation for a decade. so now what? what are you goingto do on october 1st? tell them how thishas got to work. >> president obama:well, let me give folks justa little bit of background

about what's already in place and then what happenson october 1st. when we passed theaffordable care act, there were a numberof components to it. a big part of itwas essentially providing a patient's bill of rightsthat americans and advocates have been fightingfor for decades. so what we wantedto do was make sure if you already havehealth insurance

that you get a fair deal, that you're being treatedwell by your insurers. so we eliminated, prohibited insurance companiesfrom imposing lifetime limits, which oftentimes ifa family member really got sick, they thought they were covered until suddenlythey hit that limit and now they're outhundreds of thousands of dollars with no way of paying.

we said to insurance companies, you've got to use at least80 percent of your premium that you're receivingon actual health care -- not on administrativecosts and ceo bonuses. and if you don't,you've got to rebate anything that you spentback to the consumer. so there aremillions of americans who've received rebates. they may not knowthat they got it

because ofthe affordable care act -- or "obamacare" -- but they're pretty happyto get those rebates back, because it made surethat the insurance companies were treating folks fairly. we said that any young person who doesn't havehealth insurance can stay on theirparent's health insurance until they're 26 years old.

and as a consequence,what we've seen is steadily the rateof uninsured for young people dropping over the last threeyears since the bill passed and obviously providinga lot of relief to a lot of parents out there because a lot of youngpeople, as they've been entering into the job market at atime when jobs are tough to get and oftentimesbenefits are slim, this is providingenormous security

until they getmore firmly established in the labor market. we provided additional discountsfor prescription drugs for seniorsunder the medicare program. and so seniors havesaved billions of dollars when it comes to theirprescription drugs. so there have beenover the last three years a whole arrayof consumer protections and savings for consumers

that result directlyfrom the law that we passed. and for those who say thatthey want to repeal it, typically whenyou ask them about, what are all these variousbenefits, they say, well, that one is good, andthat one is pretty good, and we'd keep that. and you pretty muchgo down the list, and there's not toomuch people object to. you will recall also atthe time that part of the way

that we paidfor the health care bill was we said medicareis wasting a lot of money without makingseniors healthier. and there wasa lot of hue and cry about how we weretaking money out of medicare -- well, it turns outthat we were right, that we could change how doctorsand hospitals and providers were operating,rewarding them for outcomes, as opposed to simply how manyprocedures that they did.

you started seeingpractices change among millionsof providers across the country. medicare rates have actuallyslowed in terms of inflation. seniors have saved money. folks are healthier. and some of those savings we'vebeen able to use to make sure that people who don'thave health insurance get health insurance. now, this bringsme to october 1st.

the one partof the affordable care act that required severalyears to set up, but a critical part, was how do we provide healthinsurance for individuals who don't get healthinsurance through the job? it's a historical accident thatin this country health care is attached to employers. and part of the problemis if you're out there shopping for healthinsurance on your own,

you're not part of a big pool, well, there's no aggregationof risk taking place for the insurers. so they're basicallygoing to say, let's see, you're 50 years old. you got high blood pressure. and we just look atthe actuarial tables and we figure you'regoing to get sick, so we're goingto charge you $1,500 a month

for health insurance, which the average personhas no way of affording -- because there'sno pooling of risk. so what we said was we needto set up a mechanism to pool people who currentlydon't have health insurance so that they havethe same purchasing power, the same leveragethat a big companies does when they're negotiatingwith the insurance company. and essentially whatwe've done is we've created

what we're callingmarketplaces in every state across the countrywhere consumers are now able to be part of a big pool. insurershave to bid, essentially compete for the business of that pool. and what we now have setup are these marketplaces that provide high-quality healthcare at affordable prices, giving people choicesso that they can get the health insurancethat they need and they want.

and the premiums aresignificantly lower than what they wereable to previously get. i'll take the exampleof new york state. the insurersput in their bids to participate inthese marketplaces. it turns out that their ratesare up to 50 percent lower than what wasavailable previously if you just wenton the open market and you tried to gethealth insurance.

fifty percent lowerin this state. california --it's about 33 percent lower. in my home state of illinois, they just announcedit's about 25 percent lower. so just by poolingand creating competition so that insurers haveto go after people's business the way they goafter a group plan, we have drasticallyreduced premiums and costs. on top of that, what we're nowdoing is we're saying

if with the better deal that yougot you still can't afford it, we're going to give you taxcredits to essentially subsidize your purchase ofhealth insurance. and here's the net result. we'll be continuing to rollout what the actual prices are going to end up being, but i can tell youright now that in many states across the country,if you're, say, a 27-year-old young woman,don't have health insurance,

you get on that exchange, you're going tobe able to purchase high-quality health insurance for less thanthe cost of your cellphone bill. and because all the insurerswho participate are required to, for example, providefree preventive care, free contraceptivecare, that young woman, she may make up whatshe's spending on premiums just on her monthlyuse of health care. so this is goingto be a good deal

for those who don'thave health insurance. those who alreadyhave health insurance get better health insurance. and the best part ofthe whole thing is, because of these changeswe initiated in terms of how we're paying providers,health care costs have grown, as you pointed out,mr. president, at the slowest rate in 50 years. we are bending the cost curveand getting at the problems

that are creating our deficitsin medicare and medicaid. >> president clinton:i should point out that,so far, in most states, one of the good things that at least i didn'tknow whether it would happen is when we beganthis in the united states, more than 80 percent ofthe american states had only one or two companiesproviding health insurance who had more than80 percent of the market. so there was, in effect,no price competition.

so what i was terrifiedof was we'd open these things and there would only be onecompany show up and bid, and this whole thing, we'd behaving an academic conversation. instead, it's actually ledto the establishment of more companiesdoing more bidding. and i think part of it is theyhave greater confidence that they can deliver healthcare at a more modest cost. so, so far, it's good. but i think it's importantfor you to the tell the people

why we're doingall this outreach -- because this only works, for example,if young people show up. and even if they buytheir cheapest plan, then they claimtheir tax credits, so it won't cost themmuch -- 100 bucks a month or so. we got to havethem in the pools, because otherwise all theseprojected low costs cannot be held if older peoplewith preexisting conditions

aredisproportionately represented in any given state. you've got to haveeverybody lined up. so explain what kind of -- all the work you'vebeen doing on the outreach for the opening on october. >> president obama:i think president clintonmakes a really important point. and the way poolswork, any pool, is essentially those of uswho are healthy subsidize

somebody who is sickat any given time. we do that becausewe anticipate, well, at some point we'll get sickand hope the healthy person is in our pool so those costsand those risks get spread. that's what insuranceis all about. and what happens isif you don't have pools that area cross-section of society, then people whoare already sick or more likely to get sick, they'llall rush out and buy insurance.

people who are healthy,they say, you know what, i won't bother. and you get what'scalled adverse selection. essentially what happensis that the premiums start going higher and higherbecause the risks aren't spread broadly enoughacross the population. so you want to get a goodcross-section in every pool. that's why big companieshave an easier time getting good rates for theiremployees than small companies,

because if you only havefive employees and one person is stricken withbreast cancer, let's say, your rates potentially shoot up. but if it's athousand employees, then it gets spread out. so on october 1st,open enrollment begins. all these folks can startsigning up for the marketplace. and what we want to makesure of is that everybody, in every category,in every age group,

understands why healthinsurance is important, understands whythey should sign up, understands the choices that aregoing to be available to them. they're going to be ableto go to a computer, tap on the web page and they'regoing to be able to shop just like you shoppedfor an airline ticket or a flat-screen tv, and see what's thebest price for you, what's the plan that'sbest suited for you,

and go ahead and signup right there and then. and that the open enrollmentperiod will last from october 1stuntil the end of march and so there will besix months for folks to sign up. normally, this would bepretty straightforward. a lot of people don'thave health insurance. a lot of people realize theyshould get health insurance. but let's face it,it's been a little political, this whole obamacare thing.

and so what you've hadis an unprecedented effort that you've seen ramp upover the last month or so in which thosewho have opposed the idea of universal healthcare in the first place and have fought thisthing tooth and nail through congress and throughthe courts and so forth have been trying to scareand discourage people from getting a good deal. and some of you may have seen

some of the commercials outthere that are a little whacky. and the main message we have -- and we're using social media,we're talking to churches, we're talking tovarious civic groups -- and what we're sayingto people is, look, just go to the website yourself. go to healthcare.gov; take a look at whetherthis is a good deal or not and make your own decision

about whether thisis good for you. because what we are confidentabout is that when people look and see that theycan get high-quality, affordable health care for lessthan their cell phone bill, they're going to sign up. they are going to sign up. and part of whati think the resistance that we've seen ramp up particularly overthe last couple of months

is all about is the opponentsof health care reform know they're going to sign up. in fact, oneof the major opponents, when asked, well, why is itthat you'd potentially shut down the government at thispoint just to block obamacare, he basically fessed up. he said, well,once consumers get hooked on having healthinsurance and subsidies, then they won'twant to give it up.

i mean, that's --you can look at the transcript. this is one of the majoropponents of health care reform. it is an odd logic. essentiallythey're saying people will like this thing too much and then it will bereally hard to roll back. so it is very importantthat people just know what's out there,what's available to them, and let peoplemake up their own minds

as to whetherit makes sense or not. now, one last thingi want to say, because i do think sometimes -- people come upto me and they say, well, if this issuch a good deal, how come the pollsshow that it's not popular? well, one of the thingsyou and i both know is that when youcome to health care, there's no more personal andintimate decision for people.

i mean, this is somethingthat people really care about. and frankly,the devil you know is always better thanthe devil you don't know. and that's what"harry and louise" was all about backin the '90s, right? it was scaring people withthe prospect of change. and so part of our goal hereis just to make sure people have good information. and there has beenbillions of dollars spent

making people scaredand worried about this stuff. and rather than tryingto disabuse people of every single bitof misinformation that's been out there, what we're saying isjust look for yourself. take a look atit and you will discover that this isa good deal for you. >> president clinton:well, first of all, i completely agree with that.

i think we've got to justdrive people to the websites. the states thatare participating -- the supreme court decisionthat upheld the health care law said that states didn't haveto set up these marketplaces if they didn't want to, but if they didn't the federalgovernment would set it up. they also said that states didn't have toexpand medicaid coverage to help people whose incomes

are up to 138 percent ofthe federal poverty level buy health insurance. there are some states,believe it or not, that want the marketplacebut don't want the medicaid. and that's going tolead to a cruel result, and there's nothingthe president can do and it's not his fault. that's what thesupreme court said. so we can have this bizarresituation where, let's say,

a business with60 employees can -- or an individual goinginto the individual market will get the benefitof tax credits for everybody withincomes of 138 percent of the federal povertylevel or above, but they won't get it for people who are between100 and 138 percent. so lower-income people who desperately needthe health insurance --

we would have the cruelest ofall situations in those states. and there's nothing thepresident can do about it because of thesupreme court decision. so we have to persuadethe states to come on. but more and more stateswith republican governors, republican legislaturesare doing it. tell them about arkansas, because we're doingwell down there. >> president obama:a little hometown bias,there's nothing wrong with that.

a couple of thingsthat are happening that i think arevery interesting. first of all, look,i'm sympathetic to some of theserepublican governors who are under a lot ofpressure because the whole issue of whether you'refor obamacare or not has become a litmus testin the other party. so some of them,politically it's been tough; sometimes state legislatures

that refuse to allow governorsto go ahead and implement. but as you indicated, what we've seen is thatwhen republican governors take a look at the dealthey're getting where, in addition to these exchanges, we're also providinga much more significant match, much more federal moneyto provide health insurance -- from the state's perspective,they're not paying; the federal governmentis picking up the tab --

and this is helping thembecause people are no longer going to the emergency room andthey now have good health care, they're now gettingpreventive care. you're seeing some republicangovernors step up and saying, i may not like obamacare, but i'm going to go aheadand make sure that my people are benefiting from this plan. so that's one goodthing that's happening. the second thingthat's happening

is there area couple of states -- arkansas is a good example; kentucky is anothergood example; idaho, interesting example -- these are stateswhere i just got beat. i mean, i do not have a bigconstituency in these states. well, i take that back. you know what, 40 percentis still a lot of people -- but i'm losing by 20 percentin these states.

but the governorswere still able to say we're going to set upour own state exchanges, their own marketplaces. and each state is justusing their own name for it. so i had a meet --i had a conference, a video conference withall the state directors of all the marketplaces, and i'm talking to thedirector in kentucky and idaho. and in kentucky, it's calledlike, kentucky connect.

and in idaho, it's called theidaho health care exchange. and there's a story that cameout of kentucky where some folks were signing people upat a county fair somewhere. some guy goes up and hestarts looking at the rates and decides he'sgoing to sign up. and he turns to his friend andsaid, this is a great deal. this is a lot betterthan obamacare. right? which is fine.

because we -- i don't have prideof authorship on this thing. i just want the thing to work. and arkansas justcame out with its rates, and as has been true invirtually every single state, not only are premiumslower than they were, they're a lot lower than even the mostoptimistic predictions were about how low they would be. and once these marketplacesare up and running,

it turns out thatwhat has traditionally been a prettyconservative principle, which is competitionand choice work, well, in the insurance market,competition and choice work. and what we're seeing is thatpeople are going to be able to get the kind of health care that they have neverbeen able to get before. states are goingto benefit from it because they'regoing to save money.

and one thingthat all of you -- there are probablyvery few people in this room who don't have health insurance, although if you don't, you should sign upstarting on october 1st. one of the things thatmany people don't realize is that the subsidy that allof you provide for the uninsured is about $1,000 per family. you pay $1,000 -- everybody herewho has got health insurance

pays about $1,000 morefor your families' insurance than you otherwise would have,because hospitals are mandated, they are required to provideservice to anybody who shows up. and so what happens iswhen you've got 15 percent of the populationwithout health insurance, they end up showing up atthe emergency room typically at a point whenthey're much sicker than if they had beengetting regular checkups and preventive care.

so you pay for the mostexpensive care there is, because hospitals have gotto recoup that money somewhere. and the way they do itis to charge higher prices. and people who have healthinsurance end up picking it up. so part of what willhelp reduce the increase in health care costsis making sure that that hidden subsidyno longer exists. >> president clinton:let's talk a littlebit about business, because we're out of time,

but i think it'sreally important. as you pointed out, most people who haveinsurance work for a living, or somebody intheir family does, and they get their insurancethrough their workplace. the law says that allemployers have to participate if they have50 employees or more. many employers withfewer than 50 employees already voluntarily providesome health insurance.

both the companies with50 or more and the companies with fewer than 50are somewhat concerned. and the employees thathave to be insured are those who work30 hours a week or more. so there were manypeople who speculated that when thislaw came into place that it would add to the cost and there would bea lot more part-time workers instead of full-time workers.

i'll save the president the timein the interview on this -- so far, that's not true. the overwhelming number ofpeople who have been hired coming out of thisrecession have been -- they have been hiredat lower wages, but they have beenfull-time employees. there has not beenan increase in the percentage of our employmentin part-time work. there has been an increase inrelatively lower-wage new jobs.

but that means they needhealth insurance even more. so explain very briefly tothem how this is going to work, how private employers are helpedto buy their insurance and the requirements. >> president obama:well, first of all,if you're a large employer or an employer withmore than 50 employees, you're already providinghealth insurance, you don't have to do anythingother than just make sure that you can show that you'reproviding health insurance.

and there was a lot of newsrecently about how we delayed the so-called employermandate for a year -- because under the law, what it says is if youhave more than 50 employees, you're not providing healthinsurance to your employees, then you're going topay a penalty to help pay for the fact that we,the taxpayers, are going to have toprovide your employees with health insurance --which, by the way, is only fair.

a lot of the controversyaround the affordable care act had to do with theseso-called mandates, both an employer mandateand an individual mandate. and the employermandate says, if you don't meetyour responsibilities by your employees, and they end up getting medicaid or they're ending upin the emergency room, you're basically dumpingthose costs onto society.

that's not fair. so we're going to charge youa couple thousand dollars to help pay for health carefor those employees. to the individuals,what we said was we're going to makehealth insurance so affordable, so cheap for you, so heavily subsidized if you'renot making a lot of money, that if you're notgetting health insurance then it's because you justdecided you don't want to,

you don't need to. and in that circumstance, what happens when you get hitby a bus, heaven forbid, or somebody in yourfamily gets sick, and you hadn't had them covered? well, we're going to end uphaving to pay for you anyway because we're not going tojust let somebody bleed in front of the emergency room. so what we've said is you'vegot to take responsibility,

and so there's a small penalty if you don't gethealth insurance. this is where a lotof the controversy and unpopularity came in, because people generallydon't like to be told, "you've got to gethealth insurance," and employersdon't like be told, "you've got to give youremployees health insurance." but, as a society,what we cannot do is to say,

you have noresponsibilities whatsoever, but you've gotguaranteed coverage. and this raises the whole issueof preexisting conditions, which we haven't talked a lotabout but is really important. one of the centralcomponents of this law, one of the main perversitiesof the health care system before this law passed wasthere were millions of people around the country who,if you had gotten sick before, if you had had a heartattack, if you had had cancer,

if you had diabetes; let's say, when it firsthappened you had a job, you got cured;then you lose your job or you're trying tochange jobs or you're trying to start a business, you try to go outand get health insurance, the health insurance companynot only could deny you but had everyincentive to deny you. because, basically, they'drather have healthy people

who are paying premiums andnever asking for a payout. they don't wantsomebody who actuarially they can anticipatemight get sick. and so, keep in mind that a hugepercentage of our society has some sort ofpreexisting condition, and they can be locked out. you can do everythingright, work hard, build a strongmiddle-class life, but if you've been sickand then you lose your job

or something happens, you may suddenly be lockedout of the insurance market, or the premiums may beso high that only somebody fabulously rich could afford it. so what we said is,all right, you know what, insurance companies,you can no longer bar somebody from getting health insurance just because they've gota preexisting condition. but the only way that works isif everybody had a requirement

to get health insurance. because think about what happensif you don't have that rule. well, all of us --not all of us, but a lot of us who were trying to figureout how to save some money would say, well, i'm notgoing to worry about it until i get sick, and then rightwhen i'm diagnosed with something that'sgoing to be expensive i'll go to the insurancecompany and say,

you can't prevent me fromgetting health insurance just because i've gota preexisting condition. so they could potentially gamethe system and it wouldn't work. so now what we've done is said you've got to providehealth insurance to anybody, all comers -- that's the deal. the flipside of it is everybodyhas got some responsibility and we'll help you pay for itto get health insurance. and that's where a lotof the misunderstandings,

the frustrations abouthealth care reform came in. i should add, by the way, thatthis was the same proposition that was set up in massachusetts under a governornamed mitt romney that's working really well. ninety-nine percent ofthe people in massachusetts have coverage. and that same principlewas, ironically, considered a very smart republicanconservative principle.

but it was the right one. the economics of it are true. so, just to finishup the question, when it comes to businesses, if you're alreadyproviding health insurance for your employees,that's great. you don't have do muchother than just make sure that you show us thatyou've got health insurance for your employees.

if you have morethan 50 employees, and you're not providinghealth insurance for them, you now have theopportunity to join a pool of small businessesto get a better price and a better dealon health insurance. you're eligible for tax credits in providing healthinsurance to your employees. up to 35 percent ofthe premiums for each employee will be a tax benefit --

a tax credit fromthe federal government. but if you still aren'tproviding health insurance for your employees after that, then we're going to go aheadand penalize you for it. and i can understandwhy some businesses wouldn't want to pay for it. if they're not currentlyproviding health insurance for their employees,what that means is that they'd ratherhave those additional profits

than make surethat their employees are getting a fair deal. in some cases,they may be operating under some very small margins. but keep in mind,since people are -- companies are exempted, the average small businesswith five employees, mom-and-pop shop, 10 employees, they're not underthat requirement.

so i'm not thatsympathetic to a company, typically, if it's gotmore than 50 employees and generating somesignificant revenue, we're making it affordable forthem to provide health insurance for their employees. they should do the right thing. >> president clinton:i agree with that. we have to close, but i thinkthere's one last issue we ought to deal with.

the most importantthing obviously is just to get peopleenrolled in this. we'll work throughit as we go along. but you just heardthe president say that so far in virtuallyevery state, the actual prices ofthe insurance are coming in quite a bit lower than theywere originally estimated to. with the originalprice estimates and with thegovernment obligated

to provide subsidies -- which costs money onthe budget, right? -- it was, nonetheless, estimatedthat in the first 10 years, this would keep the nationaldebt $110 billion lower than it otherwisewould have been, which means ifwe come in at even less, we can bring the debt down more, or we can subsidizemore small businesses and get more smallbusinesses into this loop.

a lot of people comeup to me and say, now, you sound like the peopleyou used to criticize who say we couldcut taxes all day long, increase spendingand balance the budget. don't give me that; this sounds too good to be true. so i think before you leave, you should tell peoplehow we can spend more -- not so muchin direct spending,

but in tax credits -- and still wind up reducingoverall federal spending by $110 billionduring this decade. >> president obama:well, a couple of things just in terms of howthis whole thing got paid for. first of all, i think it'sreally important to point out here that the total cost of theaffordable care act to provide health insurance for everyamerican out there at an affordable rateis costing about the same amount

over the course of 10 years as the cost of theprescription drug bill that president bush passed --except that wasn't paid for. we felt obligedto actually pay for it and not just add to the deficit. so what we did -- it's paidfor by a combination of things. we did raise taxeson some things. we, for example, said that forhigh-end income individuals, you can pay a slightlyhigher medicare rate --

medicare tax. so we bumped thatup a little bit. we said that for employerswho are currently providing a so-called cadillachealth care plan, where there are so manybells and whistles, there's no incentiveto actually spend wisely when it comes to health care -- we're actually goingto penalize you for that -- not only to raisea little bit of money,

but also to say you'reencouraging the worst aspects of a health care systemwhere you spend a lot of money, you don't get better outcomes. i mentioned to you medicare. we basically said -- there'sa program in medicare called medicare advantage that providessome additional options for medicare recipients aboveand beyond standard medicare. and it's very popularwith a lot of seniors. you get eyeglassesand other benefits.

but it turned outthat it was so uncompetitive that we were providingtens of billions of dollars of subsidies tothe insurance companies under thismedicare advantage plan without getting better outcomes,health outcomes for seniors. so what we said waswe'll keep medicare advantage and we'll givethem a small premium if they're providingbetter services for seniors, but we're going to makeyou compete for it a little bit.

and we're going to savetens of billions of dollars in the process, and that will go into payingfor the affordable care act. so the bottom line is, throughthese various mechanisms we raised enough money to payfor providing health insurance for those who don't have it, to provide thesetax credits in the marketplace, and at the same time, because we'redriving down costs,

we actually end upsaving a little money. it is a net reductionof our deficit. the ironyof those who are talking about repealing obamacarebecause it's so wildly expensive is if they actuallyrepealed the law, it would add to the deficit. it would addto the deficit. now, there have been a coupleof republicans in the house who have been smartenough to say,

we're going to repealall the benefits so that 25, 30 million peopledon't get health insurance, but we're going to keepthe taxes that obama raised, we just won't talk about that. and then, that way we cansay we reduced the deficit. but obviously, you're doingsome funny business there with the budget. but, look, nothing is free. the bottom line, though,is do we want to continue

to live in a societywhere we've got the most inefficienthealth care system on earth, leaving millions of peopleexposed to the possibilities that they could lose everythingbecause they get sick? or we've got littlechildren and families going to the emergencyroom once a week because they've got asthmaand other preventable diseases, because their familiesaren't linked up with a primary care physician

who is providingthem regular care? where the costs to societyfor reduced productivity, illnesses, et cetera,all burden our businesses? is that the kind ofsociety we aspire to? and i think the answer is no. and the notionthat we would resist, or at least some would resistas fiercely as they have, make this theirnumber-one agenda, perpetuating a systemin which millions of people

across the country, hardworking americansdon't have access to health care i think is wrong. >> president clinton:we have to close. but i will close with a story. i told you all thismorning that the employee that our health access programlost in the kenya mall shooting was a dutch nurse. and we spend a lot oftime in the netherlands;

we get a lot of support there. oxi is one of the biggestinsurance companies in europe. they're one ofour partners here. i went to celebrate their200th anniversary with them. they started as a fire insurancecompany with 39 farmers, 200 years ago. and we were out there in thisbig farm field in a tent in the shadow of a 13th centurychurch and a big dutch windmill. and i asked the chairmanof the company, i said,

do you write health insurance? because in the netherlands there's no medicareand no medicaid, everybody is onan individual mandate and you just subsidizepeople based on their incomes. he said, yes,i write it; we all do. and he looked at me and he said, but we don't makeany money on it. and he said, we shouldn't.

this guy is running a huge -- can you imagine somebodysaying that in america? he said, we shouldn't. if i can't make moneyon this business doing traditional insurance business, i've got no businessin the work. he said, look,health care is a public good and you've got to find a wayto finance it for everybody. and he said, it's justan intermediary function

that somebody has to handle. but in the end, it's how it'sdelivered, how it's priced, and how healthy youcan keep your people. so the first lady is tryingto keep us all healthier, and you're trying to changethe delivery and the pricing. and you have to covereverybody to do it. i think this is a bigstep forward for america. this will, over the next decade,not only make us healthier, but it will free up in theprivate sector largely funds

that can then be reinvested inother areas of economic growth, and give us a much morewell-balanced economy. but, first, we've got toget everybody to sign up. >> president obama:everybody, sign up. go to healthcare.gov.