Bill Clinton: “We've run a little longer than I thought we were going to, but I'm glad actually we got this question, even though I've…”

“We've run a little longer than I thought we were going to, but I'm glad actually we got this question, even though I've got to stop now, because this is a very important thing. Enrollment by physicians in the Medicaid program is totally voluntary, and a lot of doctors won't treat Medicaid patients, by and large because in most States they are reimbursed at below the cost of service but the cost of dealing with the paperwork of the program is greater even than some of the insurance company paperwork, so it is a bigger hassle for a lower return. A lot of people don't do it. One of the important aspects of the health care plan that we have presented is that people on Medicaid would be treated just like everybody else and would be mixed in with everybody else in these big groups. So if you got a security card, you'd have it whether you were an employee of a big company or a self-employed person or someone on Medicaid, and you would be involved in one of these big care networks which would give you the bargaining power to get the highest quality care you can at the most reasonable price. Again, this is largely the way it is done in several other countries, especially in Germany, and it works pretty well. There is no reason we should have a separate Government system which then the providers can elect to participate in or not. Under this system, if it were in existence when you had your situation, it would have been totally immaterial whether you were on Medicaid or not because you would have the same reimbursement, the same paperwork coming from the same source. As a matter of fact, depending on how they set it up, the physicians and the hospitals might not even have known you were a Medicaid patient because the Government funds will go to the health care unit you would be a part of, and they would pay the bill. Let me talk about the freedom of choice issue very briefly. First of all, I want to say something I don't think is clear to everybody. If we pass this program--and for all the people who have better benefits, like for anybody who is in a work unit where the employer is paying 100 percent of the premium, the employer can go right on paying it. In other words, this does not require anybody--what we try to do is set some floors on coverage not ceilings. So if an employer wants to continue to pay 100 percent of the premium and have fee-for-service medicine and let people choose their doctor, they can all do that under this system. They can go right on doing that. As a matter of fact, if anything, it will be easier for them to do it. If we can lower the medical rate of inflation closer to the regular rate of inflation, it will be easier for them to do it because their premiums won't go up as much. But under this system, people who don't have choices now will be guaranteed them. And let me explain why. Most employees in the employer- based health system we have now are losing their choices every year as the employers try to better manage the exploding cost of health care. For example, about 10 years ago 47 percent of the employees in an employer-financed health care system had some choices of plans. Now, it's down to about one in three. So under our plan every employee would have three options with comprehensive benefits. One, you could join an HMO. And on today's facts, it would probably be the least expensive, that is, for you. And your employer pays a flat amount regardless. If you did that, you would pay a certain amount every year and then you would get those comprehensive services, but you would deal with the doctors in the HMO unless you needed a specialty help that was from a doctor not in the HMO. Second option is, you get a lot of doctors together and they form something called a preferred provider organization. I have a friend who is a doctor in Nevada, who is in a PPO with 700 doctors--lots of choice. And they have kept their prices in the range of 2 to 3 percent up or down in the last 5 years. So big choice, big quality, low price increase. The third option is fee-for-service medicine, which from today's facts would be more expensive, but it would be your choice and still much less. Again, 63 percent of the people in this country with health insurance would pay the same or less for the same or better coverage, if you did that. I think even that will go down in price because of the incentives in our plan to enable doctors to get together, even on a fee- for-service basis, and compete for this business. But most Americans would have more choices than they have now under this plan. Americans who have more choices than the minimums in this plan could keep them. But there's a limit to what could be taken away. You listened to all these people talk today, you know, a lot of this stuff can be taken away from you that you think you have. All that we're doing is limiting what can be taken away. Thank you very much. This has been great. I appreciate it.”