Wednesday, August 26, 2009

I received this press release from Massachusetts Health Connector Executive Director Jon Kingsdale and thought it might be of interest to those with an open mind about health insurance reform. Kingsdale debunks some common misconceptions about the Massachusetts system.

1. Commonwealth Care cost the state $1.3 billion in FY 2009 and has risen 85% faster than projected.
False.  The legislative conference committee that ironed out the landmark health care reform law in 2006 estimated spending for the Commonwealth Care program at $725 million during FY 2009. Commonwealth Care actually cost about $800 million in FY 2009, about 10% over the 2006 projection.
Some critics of Massachusetts healthcare reform continue to cite a higher figure, using a worst-case scenario from a state bond prospectus that was issued nearly a full year before the completion of fiscal year 2009. This figure of $1.3 billion is incorrect.
The main reason for the increased spending on Commonwealth Care is higher-than-expected enrollment. (Premiums per enrollee have actually increased less than 5% a year since inception of the program.) In FY 2008, program costs grew more rapidly than projected because the state was working with estimates of the eligible population, based on 2006 survey data, which turned out to be low. The Connector enrolled the larger pool of eligible uninsured individuals faster than anticipated.  As a result, costs grew in concert with the rapid enrollment, not because of medical inflation.  As of August 1, 2009, enrollment is about 179,000.
2. Massachusetts health reform is unaffordable.
False.  Against the new costs of Commonwealth Care and some expansion of MassHealth (Medicaid), there have also been offsets from reduced government spending under health reform on uncompensated charity care, such that the full, net new cost of reform to government is probably less than $800 million. A recent report by the independent Massachusetts Taxpayers Foundation concludes that total, net government spending on Massachusetts health reform, since it began in FY 2007, will be $707 million in FY10.[i][1] About half of this increased government spending on reform is offset by federal matching payments, so the net cost to state government in FY 2010 is a little more than one percent of its entire annual budget.
3. Health care premiums have increased dramatically since (and because of) reform.
False.  Commercial insurance premiums have risen annually in Massachusetts at a slightly slower pace since 2006 than before, as they have nationally.  A recent report by the Commonwealth Fund found that the average family health premium offered by employers in Massachusetts is the highest in the nation.[ii][2] Massachusetts had high premium costs before reform, so this is not surprising news and is no reflection on the reform law. It does, however, underscore the need for payment reform, and Massachusetts is now taking action to put cost controls in place.
One exception is that reform did bring substantial rate relief to the non-group market in Massachusetts. The merger of the non-group and the small group markets, implementation of a requirement that individuals who can afford it purchase insurance, and the development of an insurance exchange have reduced premiums substantially for Massachusetts residents who buy insurance directly (non-group).[iii][3] Their premiums for comparable coverage dropped on average about 20% in 2007, and in 2008 the Connector held the average premium increase for commercial, non-group Commonwealth Choice plans to 5%. This is significant progress in a market that had typically experienced double-digit annual premium increases.
4. Reform has caused a shortage of primary care physicians and waits to see PCPs are excessively long.
False.  The diminishing supply of primary care physicians is a national problem. (Massachusetts has more physicians per capita than any other state and more than the average number of primary care physicians.)  While there are waiting times in parts of the state, recent surveys have found that over 90% of individuals reported having a primary care provider and only 5% said there was a time in the past year that they needed medical care, tests or treatment that they did not get.[iv][4]  Access to care is far better in Massachusetts than nationally: for 2007, about 20% of the U.S. population reported not getting or delaying needed medical care at some point in the previous 12 months.[v][5]
Moreover, Massachusetts reform has stimulated creative approaches to further improve access.  In 2008, the state and private sector partners developed a loan repayment program for medical and nursing students who make a two- to three-year commitment to practice primary care in Massachusetts after graduation. Some 92 primary care clinicians, able to care for some 140,000 patients, have been recruited or retained because of the new incentive program designed to make coverage expansion work for patients.  Additionally, the state's decision in 2007 to allow (carefully regulated) development of primary care nursing services in commercial pharmacies is also expanding access for minor ailments.
5. The number of uninsured in Massachusetts remains high, despite the reform law.
False.  According to the latest comprehensive survey, completed for the state Division of Health Care Finance and Policy by the Urban Institute, Massachusetts has an insured rate of over 97%.[vi][6] "Near-universal" insurance is a historic accomplishment, which compares very favorably with the U.S. rate of over 15% uninsured (and probably climbing during the recession of 2008 and 2009).[vii][7]  
6. The only real coverage expansion is Medicaid-like, free government coverage.
False. Of the 428,000 newly insured as of Dec. 31, 2008, about 163,000 were enrolled in the subsidized Commonwealth Care program, 76,000 were receiving MassHealth (Medicaid), and 190,000 were enrolled in private commercial insurance through their employers, the Commonwealth Choice program or because they purchased directly from a carrier.[viii][8]  The 44% who are enrolled in private, commercial health insurance plans represent the first significant increase in such coverage in Massachusetts in decades. 
Moreover, 57 percent of the new 428,000 enrollees contribute significantly toward their monthly premiums, whether they pay all of it - as do some 41,000 direct buyers - or part. In addition to 41,000 new direct purchasers, 149,000 new enrollees contribute to their employer's offer of insurance, and 55,000 enrollees in government-subsidized Commonwealth Care contribute toward their monthly premiums.[ix][9] 
7. Reform has caused the public sector to take-over or crowd-out private insurance.
False.  There is no evidence of a shift in enrollment from the private to the public sector. Most Massachusetts employers have continued to offer insurance to their employees, some have newly offered health benefits, and more employees have taken up their employer's offer of insurance. A survey by the state Division of Health Care Finance and Policy showed that, while nationally the number of employers offering health insurance to employees dropped from 68 to 60% between 2001 and 2007, in Massachusetts, the rate of employers offering insurance increased from 69 to 72% for the same period.[x][10] 
The state's subsidized Commonwealth Care program is structured so that co-pays and premium contributions for enrollees above 200% of the federal poverty level are in line with employer-sponsored health insurance. This alignment discourages "crowd out," or the shifting of costs from the private to the public sector. 
8. The law is unpopular.
False.  Popular support in Massachusetts has continued to grow. It was substantial immediately after passage of the law-61% of likely voters surveyed in the summer of 2006 supported the law.  With steady progress toward universal coverage, support has climbed to 67% in June 2007 and 69% in June 2008, according to the same survey.[xi][11] The most recent survey released in December of 2008 and completed by the Urban Institute for the state's Division of Health Care Finance and Policy showed public support at 75%.[xii][12]
9. Health care reform has mandated over 40 new benefits, like in vitro fertilization.
False.  Certain mandated benefits existed in Massachusetts statute prior to the advent of reform, including in vitro fertilization. The reform law (Chapter 58 of the Acts of 2006) actually placed a moratorium on legislating new mandated benefits, pending a study.
Under reform, the Connector has established Minimum Creditable Coverage ("MCC"), which does require adults who can afford insurance to have coverage for a broad range of medical services, including physicians, hospitals, diagnostic services and drugs; limits out-of-pocket spending on most services to $5,000 per person or $10,000 per family, per year; and caps annual deductibles at $2,000/$4,000 per individual/family. It also allows federally qualified, high-deductible health plans with higher patient cost-sharing, to satisfy the MCC requirement.
10. The law is fraying the safety net in Massachusetts.
One of the fundamental goals of health reform is to move individuals accessing health care through the Uncompensated Care Pool (UCP)--which is now called Health Safety Net (HSN)-from public "charity care" into insurance, without under-cutting "safety-net providers." The health benefits provided to Commonwealth Care members are more comprehensive than the episodic acute care that was generally available through UCP.
As of July 2008, nearly 70% of Commonwealth Care enrollees had previously been either UCP eligible or had used the UCP at some point in 2004 through 2007, and over 90% of Commonwealth Care enrollees joined one of three non-profit health plans sponsored and controlled by safety-net providers. Commonwealth Care has substantially increased their enrollments and medical surplus margins: medical capitations paid to them, less claims they paid out for the contract periods through the third quarter of fiscal year 2009 averaged 3%. (On the other hand, several safety-net hospitals do allege substantial harm from recent cuts in traditional Medicaid payment rates.)
As intended, utilization of the HSN declined by 36% in the first six months of HSN '08 compared to the same period in the prior year of the UCP. HSN services are still available and finance emergency, inpatient acute, and other selected medical services for residents with income at or below 400% FPL who do not qualify for or cannot afford other coverage.

Tuesday, August 25, 2009

The president and family are spending vacation time in Massachusetts – Martha's Vineyard to be precise – and it's odd to get the pool reports from the press covering him. Odd, because on one hand it's fairly bogus covering someone playing tennis, eating out, etc. On the other hand, there is always the possibility – realized when the president interrupted his vacation to speak about this support of the Fed chairman for another term – that something truly newsworthy might happen.

This schizophrenic condition can be seen in the questions and answers at the press conferecne that was conducted yesterday:


Oak Bluffs School Filing Center
Oak Bluffs, Massachusetts

10:34 A.M. EDT

MR. BURTON: Good morning. I think we're going to call this Martha's File Center. I like it. A little warm. But the President has enjoyed the hospitality of the folks here in Martha's Vineyard and has, so far, hung out last night at the house, had dinner with Valerie Jarrett and her daughter, and the Whitakers came over. This morning the President worked out. He played some tennis with the First Lady, is going to hit the links today with Congressman Clyburn, Mr. Wolf of UBS, and Marvin Nicholson of the White House.

And here's what's on the reading list, because I know that some folks have been asking -- it's long: "The Way Home," by George Pelecanos; Tom Friedman's "Hot, Flat and Crowded"; Richard Price's "Lush Life"; Kent Haruf's "Plainsong"; and "John Adams" by David McCullough.

Q What was the fourth one?

MR. BURTON: The fourth one? Kent Haruf -- "Plainsong." That one?

With that, I'll take some questions.

Q The CIA Inspector General report is expected to be released today, and it's expected to discuss detainee abuse. What reaction is the administration going to have to this report?

MR. BURTON: Well, as the President has said repeatedly, he thinks that we should be looking forward, not backward. He does agree with the Attorney General that anyone who conducted actions that had been sanctioned should not be prosecuted. But ultimately, the decisions on who is investigated and who is prosecuted are up to the Attorney General. So I would refer you to the Department of Justice for any follow-ups.

Q So now we have this report, we have looked backwards. Does the White House support going after people who may have committed crimes?

MR. BURTON: The White House supports the Attorney General making the decisions on who gets prosecuted and investigated.

Q Does the President have a preference?

MR. BURTON: The President thinks that Eric Holder, who he appointed as a very independent Attorney General, should make those decisions.

Q Bill, I know that there's no -- nothing official as far as a visit to Senator Kennedy, just across the Sound there, but is that a possibility that he might go by and visit Senator Kennedy during this week?

MR. BURTON: There's no plans for that. And I heard some reports today that the Secret Service had visited Hyannis Port. I don't think that there's any reason to believe that there's any plan to go to Hyannis Port at this point. I think that if Secret Service agents were there they probably heard, like all of you already know, that they have great lobster rolls out there and they're probably just checking on it. (Laughter.)

Hold on, I've got to get to Reuters.

Q General Motors' choice of a buyer for Opel -- there's been a lot of talk back and forth about the Secretary of State getting involved. Is there any thought that the President plans to speak with Merkel about it?

MR. BURTON: The President's view is that decisions made about the day-to-day operations at General Motors should be made by the folks at General Motors. He never wanted to get into the auto business, and he's happy for them to make their decisions and get back on their feet.

Q So no plans for him to get involved at all?

MR. BURTON: None that I know of.

Q And what about the talk that the Secretary of State may have gotten involved? Do you know anything about that?

MR. BURTON: I don't know anything about that. I would direct you over there.


Q Yes, on the new unit, the elite unit to question these terror suspects, what does the White House hope to get from this unit that it -- you know, information that couldn't have been garnered in other ways?

MR. BURTON: Well, for starters, I can confirm the Washington Post report is largely accurate, and that the President, at the consensus recommendation of his interagency task force on interrogations and detainees, did put in place a new group, the high-value interrogation group, which will be housed at the FBI. The director will report to the director of the FBI. And it'll bring together all the different elements of the intelligence community to get the best intelligence possible based on scientifically proven methods and consistent with the Army Field Manual.

The President's view is that intelligence gathering is best left to the intelligence community, and this is a way that the intelligence community can best operate, especially in these high-value instances.

Q So there's a sense, then, that what was in place before, other kinds of experts who were used to interrogate these suspects, this will be more efficient, you'll get better information?

MR. BURTON: Well, the President's view is that we can always work harder to protect the American people, and when he signed an executive order that put this task force in place to find new methods by which we can get more intelligence by scientifically proven means, he thought that they would be able to come up with a good plan in order to do just that. He has full confidence in this plan. And he's going to continue to support it going forward.

Q And one other thing on Afghanistan. Is the President at all concerned that perhaps there are not enough troops on the ground to get the job done, as he really has ramped things up there? I mean, there's the sense that we don't have enough people on the ground there to get the job done.

MR. BURTON: Well, as the -- let me start by saying that the men and women who serve the United States in Afghanistan are performing courageously and bravely under the most dangerous conditions in the world, and the President appreciates their service and is humbled by it. And the reason that we're there is because the people who plotted and executed the attacks of 9/11 operate there still and are still plotting against us. And the reason that we're there is to stop them. The President put in place a strategy by which we would disrupt, dismantle, and defeat al Qaeda and its extremist allies. And his view is that the -- when he laid out his policy earlier this year to put more troops on the ground, put a new strategy in place is a winning strategy.

As you know, General McChrystal has only been there for a short time. But he's undergoing a thorough review and assessment of the progress that we've made and what else we need to do in order to continue to make progress. So I think that we're going to hold off until we get that assessment back, not prejudge or predetermine based on reports that are coming out of the region, and make a decision accordingly.


Q On the investigation of abusive interrogations, you referred us to the Justice Department. Are you suggesting that the President will accept whatever recommendation the Attorney General comes up with?

MR. BURTON: I'm not just suggesting that. I'm saying that the President thinks that the decision of who to investigate and to prosecute is in his hands.

Q And does the -- are you saying the White House has no role? Is the White House now communicating with the Justice Department on that? Has the President himself had any communications?

MR. BURTON: When the President appointed Attorney General Holder to the job, he said specifically that he wanted him to be independent and he wanted the Department of Justice to be an independent entity. He has great faith in Attorney General Holder, but he ultimately is going to make the decisions.

Q So it's completely hands off, absolutely up to the Attorney General, no matter what the decision --

MR. BURTON: The decision is in the Attorney General's hands.

Q Does the establishment of this group within the FBI mean that the CIA is effectively out of the interrogation business?

MR. BURTON: I'm sorry, say that again.

Q Does the establishment of this group within the FBI, under the FBI's purview, mean that the CIA is out of the terror interrogation business?

MR. BURTON: Oh, no, absolutely not. The CIA is obviously -- obviously has a very important role to play as it relates to interrogations. They've done a brilliant job in doing it so far, gathering intelligence. A lot of people don't know that half of the FBI's mission is actually to gather intelligence. So what this does is it houses all these different elements under one group where they can best perform their duties. The intelligence community is going to have a deputy who will be in that group, and obviously the CIA will be very involved in this.

Q So the CIA will have a seat at that table?



Q Bill, what is the President doing to stay in front of the health care debate? He's out of the spotlight, obviously, out of Washington, behind the scenes, playing golf. Is he doing anything to maintain the message?

MR. BURTON: Well, as you know, there's no calls or meetings on his schedule right now. But I will say that he's obviously staying up to date with it. He's getting daily briefings, and he's talking to advisers as appropriate. But back at the White House, you can bet that Nancy-Ann DeParle and her team of folks is still working very hard to find some bipartisan consensus to move forward.

Q But is there a concern that they might lose steam? I mean, the President obviously is the strongest advocate on that?

MR. BURTON: I think that the President has a lot of faith in his team, and he also is due a little time to recharge his batteries with his family. So he's happy to be here in Martha's Vineyard. The health care debate I think is moving forward at a good clip. If you listen to what John McCain had to say yesterday on This Week, he said there is broad agreement on some of the key things as it relates to health care from bringing down costs to getting more folks covered to not spending too much money to do it.

So the President thinks that there is still a real possibility of getting a bipartisan plan through. He's going to continue to work towards that end. And right now -- he's probably at the golf course by now.

Q You just said he's not -- there are no calls on the schedule, but we were told by another press guy -- blond guy, glasses -- that he would be making calls to individual members of Congress on health care.

MR. BURTON: Sure. But there's nothing on the schedule. He's going to do that as appropriate. And stay tuned. If there's any readouts on anything that he's doing, I'll be sure to keep you --

Q Will you wait until the next day, or will you tell us right after that happens?

MR. BURTON: We'll go case-by-case basis.

Q Senator Kennedy, as you know, has asked the governor and the legislature to change the law to appoint someone to his seat if something should happen, if the seat is vacated for whatever reason. The big concern is about the health care vote, if it's close. Is the President concerned at all about losing Senator Kennedy's vote, and what might happen if the Senator's seat is vacated?

MR. BURTON: I don't think that there are many people in the history of our country who've worked harder towards health care reform than Senator Kennedy. So obviously any support from Senator Kennedy is critically important. The issue that you brought up isn't one that he's discussed with Senator Kennedy. I don't know that we've had any discussions, even on a staff level, with the governor of Massachusetts. But that's something for folks in Massachusetts to decide, not for the President to decide.

Q But is he concerned if it's a very close vote? I mean, if it's a real close vote and the Senator's vote isn't there, does that concern him?

MR. BURTON: Well, obviously, we'd like to get all the votes that we could for health care reform. The President would love to get 100 votes in the Senate for health care reform. We're going to work towards getting as big a majority as possible in order to achieve exactly what the President is trying to achieve. But decisions like that, that you're talking about, are up to folks in Massachusetts.

Q There are some making an issue of the President, that his arrival was not open to the public, and that the public wasn't allowed in. I mean, how is the -- the President was obviously aware of the greeting that he got on the roads and everything, but how is he going to balance that out, the security, with the fact that people want to see him?

MR. BURTON: Well, as you know, when we were originally coming in and the reason we had to delay was there were real weather concerns over whether or not we could have a big public arrival when we got here. So I don't think we were able to organize something like that knowing that the weather was going to be in such tough shape. So the President -- as I said, he really appreciates being here in Martha's Vineyard. Folks have been very warm in welcoming him. He's been coming here for some 10 years now and he plans to come back. So hopefully, going forward, there will be some opportunities for him to be out in the public, but for right now he's just spending a little time with his family.

Q Is the foursome with Congressman Clyburn, I guess, is he the only member of Congress who will be playing golf with him this week, or will there be other people visiting him throughout the week? And what's the President's relationship with Mr. Wolf?

MR. BURTON: He's friends with Mr. Wolf. And right now that's the only member of Congress he's scheduled to play golf with. You know, he's on vacation, so everything is a little bit loose. You know, you wake up, you have some breakfast, you workout, and then you decide, what do I feel like doing today? He's doing that just like anybody else.

Q Is he here specifically to play golf today?

MR. BURTON: I'm pretty sure he was already here.

Q Bill, Governor David Paterson in New York has given a couple interviews recently in which he said the criticism he's received as governor is racially based because we haven't reached a post-racial society. He suggests that Governor Deval Patrick's problems are similarly based, and he said that President Obama would be the next victim of this kind of bias in the media. Does the White House agree with that assessment that the criticism of African American politicians is often racially based?

MR. BURTON: The President's view is that -- and I'll be honest, we haven't been following that race with the sort of granularity where we might know the ins and outs of what's going on with David Paterson. But I will say that we're obviously in close touch with governors from time to time.

In terms of media coverage and the President, he thinks that there are a lot of people who agree with him in the media, there are a lot of people who disagree with him in the media, and there's a lot of folks who just report it straight. Whether or not race plays into that I don't think is the case. The President doesn't think it's the case. What he thinks is that there's a lot of people who have different opinions, and one of the great parts about the American tradition is that people are able to do that freely. And that's the sort of thing that makes our democracy so strong.

It's Major's birthday, so I'm going to go to him. (Laughter.) And I understand that on your birthday you don't have to ask too many questions --

Q No, I don't. Senator Schumer has asked for a U.N. resolution condemning the release of Megrahi. Does the administration have any position on that, number one? And number two, there are reports that if Ghadafi wants to see the President at the United Nations General Assembly in September, the White House has already decided that meeting will not happen? Can you comment on either of those two?

MR. BURTON: I don't know about Schumer's resolution. I would suggest that you contact my good friend Mark up in Ambassador Rice's office on that. As for seeing Ghadafi at the General Assembly, as you know, this year Ghadafi is the head of the General Assembly, and so I assume that at some point they'll run into each other, but there is no scheduled meeting and no plans to schedule one.

Q Is anything with Libya different now after the Megrahi welcome than it was before?

MR. BURTON: The President's view is that, as you've seen members of his administration say, from Robert Gibbs to Robert Mueller, it was disgusting to see a convicted terrorist welcomed the way that he was in Libya. So obviously the President feels like that was a particularly bad idea, that they shouldn't have done -- that we said beforehand -- that they should not have done. But in terms of our relationship, we'll just work on a case-by-case basis on whatever is appropriate going forward.

Q Senator Lieberman said over the weekend it might be worthwhile -- the White House's while to start over on health care. What's your reaction to that?

MR. BURTON: I think a lot of folks have a lot of different opinions. We're dealing with 535 members of Congress, some of which this weekend, like John McCain, said that there is great agreement. Kent Conrad said there also is great agreement. We think that the reason we've been able to make more progress on health care than any other President in the last 60 years is because the American people are foursquare behind getting something done. Costs have gotten to a point where they're completely out of control.

And the President's view is that until we get costs under control, until we get health care reform passed in this country, we're not going to be able to get everybody covered, we're not going to be able to get in place the kind of insurance reforms that the American people need, like not losing your health insurance just because you get sick, not being able to be stopped by getting health insurance because you have a preexisting condition.

And so the President feels like the process we've got moving forward is a good one. We've already gotten the support of doctors and nurses, hospitals. AARP has said that they are for health care reform. The President feels good about the progress that we've been able to make, and we're going to continue to move towards getting a bill done and getting health care reform passed this year.

Q What's your surrogate activity this week?

MR. BURTON: I don't exactly know. I will get back to you on that.

Q Bill, what kind of challenge does the administration face with half of its senior positions not being confirmed by the Senate yet?

MR. BURTON: I saw that report in The New York Times today, and I will say that what it missed was the fact that it's possible to slice presidential appointees in a whole bunch of different ways, and the way that that report did it specifically made it look like actually we're not doing very well. But if you compare where this President is to the most recent previous Presidents, we're actually far ahead of where they were when it comes to presidential appointees.

Now, are there individual frustrations along the way, like the fact that Congressman McHugh is being held up for partisan purposes and not able to serve in his job as Secretary of the Army, which people broadly think that he is able to do capably? Sure, absolutely. But if you look at the progress we've been able to make in this administration in just seven months, from what we've done on the auto industry, what we've done on the financial industry, to Iraq, to Afghanistan, to children's health care, to stem cell research, to equal pay -- we've been able to do a whole lot. And the President is confident in his team and the team that he's putting together in order to continue to make the progress that he promised on the campaign trail.

Q But just comparing it to other administrations, maybe they had problems, too. I mean, is it making the job harder when half of these positions are unfilled?

MR. BURTON: Like I said, I think that that report did not accurately reflect the fact that there actually are a lot more folks in our administration and the pace is a lot quicker than it had been in previous administrations. So the President's view is, do we have some more hiring to do? Sure. But are we able to make a lot of progress with the team that's in place right now? Absolutely.

So I think that, moving forward, the President feels good about his team and is going to continue to put together a strong team.

Q (Inaudible) in confirming these positions?

MR. BURTON: In some cases. But there's other cases like Congressman McHugh that I mentioned, for Secretary of Army, where the answer is no.


Q Why does the administration seem to be so thin-skinned with regard to Fox News?

MR. BURTON: Thin-skinned -- that's interesting. I wouldn't say that we're thin-skinned. I would say that we appreciate that there are people not just at Fox, but in all aspects of the media who are -- who come to this with sometimes very sharp opinions, sometimes very tough questions, and the President has, in the past, obviously been happy to take tough questions, and the administration certainly has. We've appeared with conservatives with Michael Smerconish as recently as this week. The President has appeared with Chris Wallace, even Bill O'Reilly.

So the President welcomes a vigorous debate. He hopes that people keep an eye on the facts, as they're having it, but I don't know what you would base that assertion on, frankly.

Q It just seems to be singled out a lot of the times, especially with regard to cable chatter. Some people consider that maybe code for the Fox News Channel?

MR. BURTON: Oh, really? Where do you think they've been singled out?

Q I don't know. It seems like it's been mentioned by Gibbs, by the President himself, and by others.


Q Over the course of the last six months.

MR. BURTON: Fox News?

Q Yes, the Fox News Channel. And it just seems like on a number of occasions --

MR. BURTON: I'm not sure I agree with the premise of your questions.

Q It seems like in a number of occasions we've been singled out for maybe being a little more critical than some of the other cable networks, some of the other media outlets. Is that a strategy or is that some -- is that more haphazard?

MR. BURTON: Yes, like I said, I don't agree with the premise of your question, and so I wouldn't really know how to answer it.


Q Could you address the sort of complaints from Republicans (inaudible) NRCC -- is this really the best time for the man leading it all to be sipping wine (inaudible).

MR. BURTON: Who's that release from, I'm sorry?


MR. BURTON: NRCC. As I recall, the previous President actually had taken quite a bit a vacation himself, and I don't think that anybody bemoaned that or bemoans this President trying to take some time with his family to recharge his batteries and get ready for the fight ahead. He's obviously worked very hard this year, as have some members of the staff. I don't know about all of them; I know Tommy is in flip-flops today. But I think the President feels good about the progress that we've been able to make, but I think that it's important for the President, just like it is for any other individual, to take a little time, spend it with their family, recharge their batteries, so they're ready for the final push for the year.

Q You mentioned surrogate activities and phone calls, that there were none set today and you didn't know of surrogate activities going forward. Is it possible that we'll go several days without any of these sorts of activities? And also, following up on Chip, are you going to let us know in advance or after these things take place?

MR. BURTON: If the President decides to pick up the phone and call a member of Congress, I'm not going to let you know in advance. But I will encourage you to stay in touch, talk to Reid Cherlin about any surrogate activity that's happening this week. But we'll keep you posted on any information about --

Q So it is possible we'll go for several days without -- with him just relaxing and not doing any of these activities?



Q Bill, over the weekend, Senator Lieberman made the argument that there may be a good moral argument for expanding coverage, health care coverage, but not a good economic one right now. Could you respond to that, and also say whether you think that might be a concern (inaudible) starting to creep through Congress?

MR. BURTON: Well, I didn't see Senator Lieberman's remarks, so I can't respond directly to that. But on the economic argument for health care reform, I think it's pretty clear -- and the President has been talking about it for quite some time -- that if we don't get costs under control, the way that they're going up is causing the health insurance industry to shed tens of thousands of Americans each month as a result of rising costs.

And those higher costs are causing Medicare and Medicaid and state-run health care programs to create budgetary problems that are just fiscally unsustainable. So the President's view is that health care reform is important for health care's sake. But if you look at the long-term fiscal health in this country, it's critically important, as well.

Q Can I ask, now that he's here, can you give us more insight as to why the President chose to come to Martha's Vineyard as opposed to any place else? And can you give us an assessment of his level of desire to in some way engage the public here? Because, as you know, there is a lot of -- a lot of desire sort of for them to be seen in some public setting.

MR. BURTON: Sure. The President has been coming to Martha's Vineyard for some 10 years. He's probably been five or six times over the course of that time period. He enjoys it. It's comfortable. The beaches are nice. The people are particularly nice. There's really good food to eat. (Laughter.) If you're lucky and you go down to the Sand Pit [sic] on a Sunday night, Charlotte is singing. There's a lot of great things about Martha's Vineyard. And the President enjoys coming here, and he probably will continue to.

In terms of engaging the public, if he decides to put anything like that on the schedule -- be it a public event or just going out for dinner or anything like that -- we'll be sure to let you know.

Q Are they interested in doing anything?

MR. BURTON: His desire in Martha's Vineyard is to get a little break. He certainly appreciates the hospitality of the folks who are here. But his desire here is to relax and spend time with the family. All right, just last one.


Q Do you know if he's got any plans to host any sort of big dinner or anything at his place with other folks on the island?

MR. BURTON: No. At this point, there's no plan for that. I wouldn't foreclose that notion. But there's no plan for that right now.

END 11:00 A.M. EDT

Friday, August 21, 2009

Rifftrax's Plan Nine show was great!

Last night I traveled up to Hadley to the Cinemark theater – one of over 4000 around the country – that was carrying a digital simulcast of the Rifftrax guys doing their thing on Ed Woods' "Plan Nine form Outer Space" live from a theater in Nashville. Aside from several technical glitches early on in the show, the two-hour performance was great – very good visuals and sound.

And it was very funny.

My friends Dogboy, his lovely wife and nephew all seemed to like it as well. Good thing as the last time we saw something together – "Watchmen" – the reaction was exactly opposite.

These guys are still at the top of their MST3K game. Check them out at rifftrax.

Thursday, August 20, 2009

Want to feel old?

Lately, I've been feeling like a 90 year-old man thanks to the rigors of the job, but now I see myself as old thanks to the Beloit College Mindset List for the Class of 2013. The college prepares this list to acclimate faculty and others to the world as the new freshman class sees it.

Remember, most students entering college for the first time this fall were born in 1991. Fricking "1991!"

Here's the list. Read it and weep, geezers.

1. For these students, Martha Graham, Pan American Airways, Michael Landon, Dr. Seuss, Miles Davis, The Dallas Times Herald, Gene Roddenberry, and Freddie Mercury have always been dead.

2. Dan Rostenkowski, Jack Kevorkian, and Mike Tyson have always been felons.

3. The Green Giant has always been Shrek, not the big guy picking vegetables.

4. They have never used a card catalog to find a book.

5. Margaret Thatcher has always been a former prime minister.

6. Salsa has always outsold ketchup.

7. Earvin "Magic" Johnson has always been HIV-positive.

8. Tattoos have always been very chic and highly visible.

9. They have been preparing for the arrival of HDTV all their lives.

10. Rap music has always been main stream.

11. Chocolate chip cookie dough ice cream has always been a flavor choice.

12. Someone has always been building something taller than the Willis (née Sears) Tower in Chicago.

13. The KGB has never officially existed.

14. Text has always been hyper.

15. They never saw the “Scud Stud” (but there have always been electromagnetic stud finders.)

16. Babies have always had a Social Security Number.

17. They have never had to “shake down” an oral thermometer.

18. Bungee jumping has always been socially acceptable.

19. They have never understood the meaning of R.S.V.P.

20. American students have always lived anxiously with high-stakes educational testing.

21. Except for the present incumbent, the President has never inhaled.

22. State abbreviations in addresses have never had periods.

23. The European Union has always existed.

24. McDonald's has always been serving Happy Meals in China.

25. Condoms have always been advertised on television.

26. Cable television systems have always offered telephone service and vice versa.

27. Christopher Columbus has always been getting a bad rap.

28. The American health care system has always been in critical condition.

29. Bobby Cox has always managed the Atlanta Braves.

30. Desperate smokers have always been able to turn to Nicoderm skin patches.

31. There has always been a Cartoon Network.

32. The nation’s key economic indicator has always been the Gross Domestic Product (GDP).

33. Their folks could always reach for a Zoloft.

34. They have always been able to read books on an electronic screen.

35. Women have always outnumbered men in college.

36. We have always watched wars, coups, and police arrests unfold on television in real time.

37. Amateur radio operators have never needed to know Morse code.

38. Belarus, Moldova, Ukraine, Uzbekistan, Armenia, Latvia, Georgia, Lithuania, and Estonia have always been independent nations.

39. It's always been official: President Zachary Taylor did not die of arsenic poisoning.

40. Madonna’s perspective on Sex has always been well documented.

41. Phil Jackson has always been coaching championship basketball.

42. Ozzy Osbourne has always been coming back.

43. Kevin Costner has always been Dancing with Wolves, especially on cable.

44. There have always been flat screen televisions.

45. They have always eaten Berry Berry Kix.

46. Disney’s Fantasia has always been available on video, and It’s a Wonderful Life has always been on Moscow television.

47. Smokers have never been promoted as an economic force that deserves respect.

48. Elite American colleges have never been able to fix the price of tuition.

49. Nobody has been able to make a deposit in the Bank of Credit and Commerce International (BCCI).

50. Everyone has always known what the evening news was before the Evening News came on.

51. Britney Spears has always been heard on classic rock stations.

52. They have never been Saved by the Bell

53. Someone has always been asking: “Was Iraq worth a war?”

54. Most communities have always had a mega-church.

55. Natalie Cole has always been singing with her father.

56. The status of gays in the military has always been a topic of political debate.

57. Elizabeth Taylor has always reeked of White Diamonds.

58. There has always been a Planet Hollywood.

59. For one reason or another, California’s future has always been in doubt.

60. Agent Starling has always feared the Silence of the Lambs.

61. “Womyn” and “waitperson” have always been in the dictionary.

62. Members of Congress have always had to keep their checkbooks balanced since the closing of the House Bank.

63. There has always been a computer in the Oval Office.

64. CDs have never been sold in cardboard packaging.

65. Avon has always been “calling” in a catalog.

66. NATO has always been looking for a role.

67. Two Koreas have always been members of the UN.

68. Official racial classifications in South Africa have always been outlawed.

69. The NBC Today Show has always been seen on weekends.

70. Vice presidents of the United States have always had real power.

71. Conflict in Northern Ireland has always been slowly winding down.

72. Migration of once independent media like radio, TV, videos and compact discs to the computer has never amazed them.

73. Nobody has ever responded to “Help, I’ve fallen and I can’t get up.”

74. Congress could never give itself a mid-term raise.

75. There has always been blue Jell-O.

Copyright © 2009 Beloit College

Saturday, August 15, 2009

I've had the pleasure and privilege of interviewing many news makers and celebs in my long and checkered career, but I'm especially proud of doing two interviews with Rachel Maddow.

I would love to do another.

She is not only a very nice person and easy to speak with, she is one of the smartest people I've met. What I love about her is that she does her homework and she is willing to engage members of the right.

The right wing pundits have done this country a disservice that I think is the moral equivalent of treason by deliberating trying to derail a discussion on health insurance. The corporate powers don't want Americans to have a better system as its working out very well for them.

is the American public so stupid, so scared, so prejudiced, so easily duped, they really believe in the pure bile that has been flowing from the special interests and the ring wing talking heads?

You know the answer.

Thursday, August 13, 2009

This weekend in the Valley

Will the glory days of Mountain Park in Holyoke return? Well don't exepct a midway and polka bands. Seen here is the park as developer and music promoter Eric Suher has made it over.

This view is from the hill on which patrons of concerts and events will sit. The stage will be at the right of concession area that is under construction. The brown area in the background will be a field of grass and is where the Mountain Park midway once stood.

Two concerts – a free one this Saturday – will be the soft opening of the venue this year. A full slate of events will start next Memorial Day weekend.

Comedy can be hard work. Just ask Dave Attell.

The veteran comedian who will be appearing at the Hu Ke Lau in Chicopee on Aug. 15 told Reminder Publications that the taping of his new comedy special, "Dave Attell: Captain Miserable," was a bit of a challenge.

"They weren't my crowd at all," Attell said.

The special was seen on Comedy Central on July 5 and it is now available on DVD.

Originally taped a year ago for HBO, Attell said Comedy Central had obtained the rights to the show and then delayed broadcasting it.

The show had some classic edgy Attell observations ranging from potential commercials for Jagermeister to performing for American troops in the Middle East.

Attell said the special was taped in a theater instead of his favored environment, a club, and had a "very politically correct" audience.

"When you do a show for a network, you're a hired hand," Attell explained. At this taping, "people weren't rolling with me. It was like going uphill."

Attell's fans know to expect the unexpected from the comic but when he launched in a joke about pedophiles, he had to change gears.

Because of the delay in broadcast, Attell said some of the material was older than he would have liked.

"[Some] made me cringe," he said.

Although he said he doesn't censor himself for Comedy Central - "you know what to say and what you can't" - Attell added, "I try not to edit myself unless I absolutely have to."

There was one political joke in the special, which Attell pointed out as his lone topical gag. He has resisted putting political material into his shows, as those jokes aren't as "evergreen" as others.

He noted, though, "everyone is talking about politics now, [it's] like sports."

He tours a lot, something he called both a "blessing and a curse," and people still recognize him from his show "Insomniac," despite it being off the air since 2004. He would like to reach a point in a couple of years where he can get off the road as much.

When he is home in New York City, he's "constantly thinking of new stuff."

"It comes together in the clubs," he explained.

Attell is working on a new CD. His first recording, "Skanks for the Memories," was a hit and he's planning to do another.

"That's the thing that's constantly there," he said.

"Skanks for the Memories" came out before the dominance of iTunes and other Web-based distribution of recordings, a technology Attell called "interesting."

"People say they love your CD and they stole it [off the Internet]. It's a compliment, but a crime," he said. "I tell them 'You owe me a $1.'"

Despite the economy, Attell said there are still a lot of comedy venues and a night at a comedy club is a "pretty good bet" as a show can provide "four hours of conversation" afterwards.

Despite the rigors of the road, Attell is looking forward to his appearance at the He Ke Lau.

"It's a hidden treasure - the last gigantic Chinese restaurant in America," he said.
© 2009 by Gordon Michael Dobbs

Wednesday, August 12, 2009

What scares me the most about too many people these days is that they too easily give in to their fears and prejudices. George Bush exploited those fears and involved us in an illegal immoral war and an assault on the Constitution.

Today corporate interest are using the fear and mis-trust of many to attack the proposed revisions to health insurance. Too many people, those who are already benefiting from some sort of government-provided health insurance are now repeating the bogus talking points of right wing pundits who are nothing more than shills for businesses that seek to retain the status quo.

Here's what the president said yesterday about the proposed revisions while at a town hall meeting in New Hampshire. You saw snippets on the news. Here is the transcript released to the press:

or Immediate Release August 11, 2009


Portsmouth High School
Portsmouth, New Hampshire

1:05 P.M. EDT

THE PRESIDENT: Hello, Portsmouth! Thank you. (Applause.) Thank you so much. Everybody have a seat. Oh, thank you so --


THE PRESIDENT: I love you back. Thank you. (Laughter.) It is great to be back in Portsmouth. (Applause.) It's great to be back in New Hampshire. I have to say, though, that most of my memories of this state are cold. (Laughter.) So it's good to be here in August.

There are a couple of people that I want to acknowledge who are here today, some special guests. First of all, I want to thank principal Jeffrey Collins, and the Portsmouth students and faculty and staff. (Applause.) Thank you -- our host for today. Your own outstanding governor, John Lynch is here. (Applause.) And his wonderful wife, Dr. Susan Lynch is here, the First Lady of New Hampshire. (Applause.) Your United States senator, doing a great job, Jeanne Shaheen is here. (Applause.) The governor of the great state of Maine, and we are glad he's here in New Hampshire today, John Baldacci is here. (Applause.)

Two of my favorite people, they are just taking Congress by storm, outstanding work -- Paul Hodes, Carol Shea-Porter -- give them a big round of applause. (Applause.) And we've got your own mayor, Tom Ferrini is here. Where's Tom? There he is. (Applause.)

Now, I want to thank more than anybody, Lori, for that introduction, and for sharing her story with the rest of us. (Applause.) Thank you, Lori. Lori's story is the same kind of story that I've read in letters, that I've heard in town hall meetings just like this one for the past five years. In fact, some of you were in that town hall -- those town hall meetings, as I was traveling all throughout New Hampshire. It's the story of hardworking Americans who are 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.

I believe it is wrong. It is bankrupting families and businesses, and that's why we are going to pass health insurance reform in 2009. (Applause.)

Now, this is obviously a tough time for families here in New Hampshire and all across America. Six months ago, we were in the middle of the worst recession of our lifetimes. I want you to remember what things were like in January and February. We were losing about 700,000 jobs per month. And economists of all stripes feared a second-coming of the Great Depression. That was only six months ago.

That's why we acted as fast as we could to pass a Recovery Act that would stop the freefall. And I want to make sure everybody understands what we did. One-third of the money in the Recovery Act went to tax cuts that have already started showing up in the paychecks of about 500,000 working families in New Hampshire -- (applause) -- 500,000 families in New Hampshire. We also cut taxes for small businesses on the investments that they make, and over 300 New Hampshire small businesses have qualified for new loans backed by the Recovery Act.

Now, that was a third -- that was a third of the Recovery Act. 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 20,000 New Hampshire residents. (Applause.) We've made health insurance 65 percent cheaper for families who rely on COBRA while they're looking for work. (Applause.) And for states that were facing historic budget shortfalls, we provided assistance that has saved the jobs of tens of thousands of workers who provided essential services -- like teachers and police officers. (Applause.) So it's prevented a lot of painful cuts in the state, but also a lot of painful state and local tax increases.

Now, the last third of the Recovery Act is for investments that are already putting people back to work. These are jobs refurbishing bridges and pavement on I-95; or jobs at the community health centers here in Portsmouth that will be able to add nurses, and extend hours, and serve up to 500 new patients. These are good jobs doing the work America needs done. And, by the way, most of the work is being done by private, local businesses, because that's how we're going to grow this economy again.

So there is no doubt that the Recovery Act has helped put the brakes on this recession. We just saw last Friday the job picture is beginning to turn. We're starting to see signs that business investment is coming back.

But, New Hampshire, that doesn't mean we're out of the woods, and you know that. It doesn't mean we can just sit back and do nothing while so many families are still struggling, because even before this recession hit we had an economy that was working pretty well for the wealthiest Americans, it was working pretty well for Wall Street bankers, it was working pretty well for big corporations, but it wasn't working so well for everybody else. It was an economy of bubbles and busts. And we can't go back to that kind of economy.

If we want this country to succeed in the 21st century -- and if we want our children to succeed in the 21st century -- then we're going to have to take the steps necessary to lay a new foundation for economic growth. We need to build an economy that works for everybody, and not just some people. (Applause.)

Now, health insurance reform is one of those pillars that we need to build up that new foundation. I don't have to explain to you that nearly 46 million Americans don't have health insurance coverage today. In the wealthiest nation on Earth, 46 million of our fellow citizens have no coverage. They are just vulnerable. If something happens, they go bankrupt, or they don't get the care they need.

But it's just as important that we accomplish health insurance reform for the Americans who do have health insurance

-- (applause) -- because right now we have a health care system that too often works better for the insurance industry than it does for the American people. And we've got to change that. (Applause.)

Now, let me just start by setting the record straight on a few things I've been hearing out here -- (laughter) -- about reform. Under the reform we're proposing, if you like your doctor, you can keep your doctor. If you like your health care plan, you can keep your health care plan.

You will not be waiting in any lines. This is not about putting the government in charge of your health insurance. I don't believe anyone should be in charge of your health insurance decisions but you and your doctor. (Applause.) I don't think government bureaucrats should be meddling, but I also don't think insurance company bureaucrats should be meddling. That's the health care system I believe in. (Applause.)

Now, we just heard from Lori about how she can't find an insurance company that will cover her because of her medical condition. She's not alone. A recent report actually shows that in the past three years, over 12 million Americans were discriminated against by insurance companies because of a preexisting condition. Either the insurance company refused to cover the person, or they dropped their coverage when they got sick and they needed it most, or they refused to cover a specific illness or condition, or they charged higher premiums and out-of-pocket costs. No one holds these companies accountable for these practices.

And I have to say, this is personal for Lori but it's also personal for me. I talked about this when I was campaigning up here in New Hampshire. I will never forget my own mother, as she fought cancer in her final months, having to worry about whether her insurance would refuse to pay for her treatment. And by the way, this was because the insurance company was arguing that somehow she should have known that she had cancer when she took her new job -- even though it hadn't been diagnosed yet. So if it could happen to her, it could happen to any one of us.

And I've heard from so many Americans who have the same worries. One woman testified that an insurance company would not cover her internal organs because of an accident she had when she was five years old. Think about that -- that covers a lot of stuff. (Laughter.) They're only going to cover your skin. (Laughter.) Dermatology, that's covered; nothing else. (Laughter.)

Another lost his coverage in the middle of chemotherapy because the insurance company discovered he had gall stones that he hadn't known about when he applied for insurance. Now, that is wrong, and that will change when we pass health care reform. That is going to be a priority. (Applause.)

Under the reform we're proposing, insurance companies will be prohibited from denying coverage because of a person's medical history. Period. (Applause.) They will not be able to drop your coverage if you get sick. (Applause.) They will not be able to water down your coverage when you need it. (Applause.) Your health insurance should be there for you when it counts -- not just when you're paying premiums, but when you actually get sick. And it will be when we pass this plan. (Applause.)

Now, when we pass health insurance reform, insurance companies will no longer be able to place some arbitrary cap on the amount of coverage you can receive in a given year or a lifetime. And we will place a limit on how much you can be charged for out-of-pocket expenses, because no one in America should go broke because they get sick. (Applause.)

And finally -- this is important -- we will require insurance companies to cover routine checkups and preventive care, like mammograms and colonoscopies -- (applause) -- because there's no reason we shouldn't be catching diseases like breast cancer and prostate cancer on the front end. That makes sense, it saves lives; it also saves money -- and we need to save money in this health care system.

So this is what reform is about. For all the chatter and the yelling and the shouting and the noise, what you need to know is this: If you don't have health insurance, you will finally have quality, affordable options once we pass reform. (Applause.) If you do have health insurance, we will make sure that no insurance company or government bureaucrat gets between you and the care that you need. And we will do this without adding to our deficit over the next decade, largely by cutting out the waste and insurance company giveaways in Medicare that aren't making any of our seniors healthier. (Applause.) Right. (Laughter.)

Now, before I start taking questions, let me just say there's been a long and vigorous debate about this, and that's how it should be. That's what America is about, is we have a vigorous debate. That's why we have a democracy. But I do hope that we will talk with each other and not over each other -- (applause) -- because one of the objectives of democracy and debate is, is that we start refining our own views because maybe other people have different perspectives, things we didn't think of.

Where we do disagree, let's disagree over things that are real, not these wild misrepresentations that bear no resemblance to anything that's actually been proposed. (Applause.) Because the way politics works sometimes is that people who want to keep things the way they are will try to scare the heck out of folks and they'll create boogeymen out there that just aren't real. (Applause.)

So this is an important and complicated issue that deserves serious debate. And we have months to go before we're done, and years after that to phase in all these reforms and get them right. And I know this: Despite all the hand-wringing pundits and the best efforts of those who are profiting from the status quo, we are closer to achieving health insurance reform than we have ever been. We have the American Nurses Association supporting us. (Applause.) We have the American Medical Association on board. (Applause.)

America's doctors and nurses know firsthand how badly we need reform. We have broad agreement in Congress on about 80 percent of what we're trying to do. We have an agreement from the drug companies to make prescription drugs more affordable for seniors. We can cut the doughnut hole in half if we pass reform. (Applause.) We have the AARP on board because they know this is a good deal for our seniors. (Applause.)

But let's face it, now is the hard part -- because the history is clear -- every time we come close to passing health insurance reform, the special interests fight back with everything they've got. They use their influence. They use their political allies to scare and mislead the American people. They start running ads. This is what they always do.

We can't let them do it again. Not this time. Not now. (Applause.) Because for all the scare tactics out there, what is truly scary -- what is truly risky -- is if we do nothing. If we let this moment pass -- if we keep the system the way it is right now -- we will continue to see 14,000 Americans lose their health insurance every day. Your premiums will continue to skyrocket. They have gone up three times faster than your wages and they will keep on going up.

Our deficit will continue to grow because Medicare and Medicaid are on an unsustainable path. Medicare is slated to go into the red in about eight to 10 years. I don't know if people are aware of that. If I was a senior citizen, the thing I'd be worried about right now is Medicare starts running out of money because we haven't done anything to make sure that we're getting a good bang for our buck when it comes to health care. And insurance companies will continue to profit by discriminating against people for the simple crime of being sick. Now, that's not a future I want for my children. It's not a future that I want for the United States of America.

New Hampshire, I was up here campaigning a long time. (Laughter.) A lot of you guys came to my town hall events. Some of you voted for me, some of you didn't. But here's one thing I've got to say: I never said this was going to be easy. I never said change would be easy. If it were easy, it would have already been done. Change is hard. And it doesn't start in Washington. It begins in places like Portsmouth, with people like Lori, who have the courage to share their stories and fight for something better. (Applause.)

That's what we need to do right now. And I need your help. If you want a health care system that works for the American people -- (applause) -- as well as it works for the insurance companies, I need your help -- knocking on doors, talking to your neighbors. Spread the facts. Let's get this done. (Applause.)

Thank you. Thank you. (Applause.)

AUDIENCE: Yes we can! Yes we can! Yes we can!

THE PRESIDENT: Thank you. I remember that.

Everybody have a seat. All right, this is the fun part. (Laughter.) Now, first of all, by the way, let's thank the band -- I didn't see the band over here. Thank you, band. (Applause.) Great job.

All right, here's how we're going to do this. We do a lot of town hall meetings in New Hampshire, so everybody knows the basic outlines of this thing. If you have a question just raise your hand. There are people with microphones in the audience. I am going to try to go girl-boy-girl-boy, to make sure it's fair. (Laughter.) If I hear only from people who agree with me I'm going to actively ask some folks who are concerned about health care, give them a chance to ask their questions, because I think we've got to make sure that we get out -- surface some of the debates and concerns that people have. Some of them are legitimate. I'm going to try to get through as many questions as I can. But if you can keep your question or comment relatively brief, then I will try to keep my answers relatively brief, okay? (Laughter.)

All right, so we're just going to go around the room and I'm going to start with this gentleman right here, this gentleman right here. Please introduce yourself, if you don't mind.

Q Thank you, Mr. President. Welcome to Portsmouth and New Hampshire. My name is Peter Schmidt. I'm a state representative from Dover. I'm a senior citizen. I have a wonderful government-run health care plan called Medicare. I like it. It's affordable, it's reasonable, nobody tells me what I need to do. I just go to my doctor at the hospital, I get care.

Now, one of the things you've been doing in your campaign to change the situation is you've been striving for bipartisanship. I think it's a wonderful idea, but my question is, if the Republicans actively refuse to participate in a reasonable way with reasonable proposals, isn't it time to just say we're going to pass what the American people need and what they want, without the Republicans? (Applause.)

THE PRESIDENT: Well, let me make a couple of points. First of all, you make a point about Medicare that's very important. I've been getting a lot of letters, pro and con, for health care reform, and one of the letters I received recently, a woman was very exercised about what she had heard about my plan. She says, "I don't want government-run health care. I don't want you meddling in the private marketplace. And keep your hands off my Medicare." (Laughter.) True story.

And so I do think it's important for particularly seniors who currently receive Medicare to understand that if we're able to get something right like Medicare, then there should be a little more confidence that maybe the government can have a role -- not the dominant role, but a role -- in making sure the people are treated fairly when it comes to insurance. (Applause.)

Under our proposal, the majority of Americans will still be getting their health care from private insurers. All we want to do is just make sure that private insurers are treating you fairly so that you are not buying something where if you failed to read the fine print, next thing you know, when you actually get sick, you have no coverage.

We also want to make sure that everybody has some options. So there's been talk about this public option. This is where a lot of the idea of government takeover of health care comes from. All we want to do is set up a set of options so that if you don't have health insurance or you're underinsured you can have the same deal that members of Congress have, which is they can look at a menu of options -- we're calling it an exchange, but it’s basically just a menu of different health care plans -- and you will be able to select the one that suits your family best.

And I do think that having a public option as part of that would keep the insurance companies honest, because if they've got a public plan out there that they've got to compete against, as long as it's not being subsidized by taxpayers, then that will give you some sense of what -- sort of a good bargain for what basic health care would be. (Applause.)

Now, I think that there are some of my Republican friends on Capitol Hill who are sincerely trying to figure out if they can find a health care bill that works -- Chuck Grassley of Iowa, Mike Enzi of Wyoming, Olympia Snowe from Maine have been -- (applause) -- yes, I got to admit I like Olympia, too. (Laughter.) They are diligently working to see if they can come up with a plan that could get both Republican and Democratic support.

But I have to tell you, when I listen to folks like Lori and families all across America who are just getting pounded by the current health care system, and when I look at the federal budget and realize that if we don't control costs on health care, there is no way for us to close the budget deficit -- it will just keep on skyrocketing -- when I look at those two things, I say we have to get it done. And my hope is we can do it in a bipartisan fashion, but the most important thing is getting it done for the American people. (Applause.)

All right. Let's -- this young lady right here. All right, this young lady right here. She's still enjoying her summer. When do you go back to school?

Q I go back to school September 3rd.

THE PRESIDENT: September 3rd, okay. What's your name?

Q Julia Hall from Malden, Massachusetts.

THE PRESIDENT: Nice to meet you, Julia. (Applause.)

Q I saw -- as I was walking in, I saw a lot of signs outside saying mean things about reforming health care. How do kids know what is true, and why do people want a new system that can -- that help more of us?

THE PRESIDENT: Well, the -- I've seen some of those signs. (Laughter.) Let me just be specific about some things that I've been hearing lately that we just need to dispose of here. The rumor that's been circulating a lot lately is this idea that somehow the House of Representatives voted for "death panels" that will basically pull the plug on grandma because we've decided that we don't -- it's too expensive to let her live anymore. (Laughter.) And there are various -- there are some variations on this theme.

It turns out that I guess this arose out of a provision in one of the House bills that allowed Medicare to reimburse people for consultations about end-of-life care, setting up living wills, the availability of hospice, et cetera. So the intention of the members of Congress was to give people more information so that they could handle issues of end-of-life care when they're ready, on their own terms. It wasn't forcing anybody to do anything. This is I guess where the rumor came from.

The irony is that actually one of the chief sponsors of this bill originally was a Republican -- then House member, now senator, named Johnny Isakson from Georgia -- who very sensibly thought this is something that would expand people's options. And somehow it's gotten spun into this idea of "death panels." I am not in favor of that. So just I want to -- (applause.) I want to clear the air here.

Now, in fairness, the underlying argument I think has to be addressed, and that is people's concern that if we are reforming the health care system to make it more efficient, which I think we have to do, the concern is that somehow that will mean rationing of care, right? -- that somehow some government bureaucrat out there will be saying, well, you can't have this test or you can't have this procedure because some bean-counter decides that this is not a good way to use our health care dollars. And this is a legitimate concern, so I just want to address this.

We do think that systems like Medicare are very inefficient right now, but it has nothing to do at the moment with issues of benefits. The inefficiencies all come from things like paying $177 billion to insurance companies in subsidies for something called Medicare Advantage that is not competitively bid, so insurance companies basically get a $177 billion of taxpayer money to provide services that Medicare already provides. And it's no better -- it doesn't result in better health care for seniors. It is a giveaway of $177 billion.

Now, think about what we could do with $177 billion over 10 years. I don't think that's a good use of money. I would rather spend that money on making sure that Lori can have coverage, making sure that people who don't have health insurance get some subsidies, than I would want to be subsidizing insurance companies. (Applause.)

Another way of putting this is right now insurance companies are rationing care. They are basically telling you what's covered and what's not. They're telling you: We'll cover this drug, but we won't cover that drug; you can have this procedure, or, you can't have that procedure. So why is it that people would prefer having insurance companies make those decisions, rather than medical experts and doctors figuring out what are good deals for care and providing that information to you as a consumer and your doctor so you can make the decisions?

So I just want to be very clear about this. I recognize there is an underlying fear here that people somehow won't get the care they need. You will have not only the care you need, but also the care that right now is being denied to you -- only if we get health care reform. That's what we're fighting for. (Applause.)

All right. Gentleman back here, with the baseball cap. Right there.

Q Good afternoon, Mr. President. Bill Anderson from New Hampshire. In reference to what you just said -- I'm presently under the New Hampshire Medicaid system and I have to take a drug called Lipitor. When I got onto this program they said, no, we're not going to cover Lipitor -- even though I'd been on that pill for probably 10 years, based on the information my doctor feels is right for me. And I had to go through two different trials of other kinds of drugs before it was finally deemed that I was able to go back on the Lipitor through the New Hampshire Medicaid system. So here it is, the Medicaid that you guys are administering and you're telling me that it's good -- but in essence, I'm dealing with the same thing, and you're telling me the insurance companies are doing. Thank you.

THE PRESIDENT: Well, I think that's a legitimate point. I don't know all the details, but it sounds to me like they were probably trying to have you take a generic as opposed to a brand name. Is that right? And it turned out that you did not have as good of a reaction under the generic as the brand name, and then they put you back on the brand name. Is that what happened?

Q Correct, to save money.

THE PRESIDENT: Well -- right. Look, there may be -- in nine out of 10 cases, the generic might work as well or better than the brand name. And we don't want to just subsidize the drug companies if you've got one that works just as well as another.

The important thing about the story that you just told me was -- is that once it was determined that, in fact, you needed the brand name, you were able to get the brand name. Now, I want to be absolutely clear here: There are going to be instances where if there is really strong scientific evidence that the generic and the brand name work just as well, and the brand name costs twice as much, that the taxpayer should try to get the best deal possible, as long as if it turns out that the generic doesn't work as well, you're able to get the brand name.

So the basic principle that we want to set up here is that -- if you're in private insurance, first of all, your private insurance can do whatever you want. If you're under a government program, then it makes sense for us to make sure that we're getting the best deal possible and not just giving drug makers or insurers more money than they should be getting. But ultimately, you've got to be able to get the best care based on what the doctor says.

And it sounds like that is eventually what happened. It may be that it wasn't as efficient -- it wasn't as smooth as it should have been, but that result is actually a good one. And you think about all the situations where a generic actually would have worked -- in fact, one of the things I want to do is to speed up generics getting introduced to the marketplace, because right now drug companies -- (applause) -- right now drug companies are fighting so that they can keep essentially their patents on their brand-name drugs a lot longer. And if we can make those patents a little bit shorter, generics get on the market sooner, ultimately you as consumers will save money. All right? But it was an excellent question, so thank you.

All right, it's a young woman's turn -- or a lady's turn. Right here. Yes, you.

Q Good afternoon, Mr. President. I'm Jackie Millet (phonetic) and I'm from Wells, Maine, and my question is, I am presently on Medicare and I do have a supplement. But if something happens to my husband, I lose the supplement. And what will happen? I take a lot of medications. I need a lot -- I've had a lot of procedures. And how will Medicare under the new proposal help people who are going to need things like this?

THE PRESIDENT: Well, first of all, another myth that we've been hearing about is this notion that somehow we're going to be cutting your Medicare benefits. We are not. AARP would not be endorsing a bill if it was undermining Medicare, okay? So I just want seniors to be clear about this, because if you look at the polling, it turns out seniors are the ones who are most worried about health care reform. And that's understandable, because they use a lot of care, they've got Medicare, and it's already hard for a lot of people even on Medicare because of the supplements and all the other costs out of pocket that they're still paying.

So I just want to assure we're not talking about cutting Medicare benefits. We are talking about making Medicare more efficient, eliminating the insurance subsidies, working with hospitals so that they are changing some of the reimbursement practices.

Right now hospitals, they are not penalized if there are constant readmission rates from patients that have gone through the hospital. If you go to a -- if you go to a car company or a auto shop, if you say, "Can I have my car repaired?", you get your car repaired -- if two weeks later it's broken down again, if you take it back, hopefully they're not going to charge you again for repairing the car. You want them to do it right the first time. And too often we're not seeing the best practices in some of these hospitals to prevent people from being readmitted. That costs a lot of money. So those are the kinds of changes we're talking about.

Now, in terms of savings for you as a Medicare recipient, the biggest one is on prescription drugs, because the prescription drug companies have already said that they would be willing to put up $80 billion in rebates for prescription drugs as part of a health care reform package.

Now, we may be able to get even more than that. But think about it. When the prescription drug plan was passed, Medicare Part D, they decided they weren't going to negotiate with the drug companies for the cheapest available price on drugs. And as a consequence, seniors are way over-paying -- there's that big doughnut hole that forces them to go out of pocket. You say you take a lot of medications; that means that doughnut hole is always something that's looming out there for you. If we can cut that doughnut hole in half, that's money directly out of your pocket. And that's one of the reasons that AARP is so supportive, because they see this as a way of potentially saving seniors a lot of money on prescription drugs. Okay?

All right. The gentleman right here in the white shirt.

Q Good afternoon, Mr. President. My name is Ben Hershinson (ph). I'm from Ogunquit, Maine, and also Florida. And I'm a Republican -- I don't know what I'm doing here, but I'm here. (Laughter.)

THE PRESIDENT: We're happy to have you. We're happy to have you. (Applause.)

Q Mr. President, you've been quoted over the years -- when you were a senator and perhaps even before then -- that you were essentially a supporter of a universal plan. I'm beginning to see that you're changing that. Do you honestly believe that? Because that is my concern. I'm on Medicare, but I still worry that if we go to a public option, period, that the private companies, the insurance companies, rather than competing -- because who can compete with the government; the answer is nobody. So my question is do you still -- as yourself, now -- support a universal plan? Or are you open to the private industry still being maintained?

THE PRESIDENT: Well, I think it's an excellent question, so I appreciate the chance to respond. First of all, I want to make a distinction between a universal plan versus a single-payer plan, because those are two different things.

A single-payer plan would be a plan like Medicare for all, or the kind of plan that they have in Canada, where basically government is the only person -- is the only entity that pays for all health care. Everybody has a government-paid-for plan, even though in, depending on which country, the doctors are still private or the hospitals might still be private. In some countries, the doctors work for the government and the hospitals are owned by the government. But the point is, is that government pays for everything, like Medicare for all. That is a single-payer plan.

I have not said that I was a single-payer supporter because, frankly, we historically have had a employer-based system in this country with private insurers, and for us to transition to a system like that I believe would be too disruptive. So what would end up happening would be, a lot of people who currently have employer-based health care would suddenly find themselves dropped, and they would have to go into an entirely new system that had not been fully set up yet. And I would be concerned about the potential destructiveness of that kind of transition.
All right? So I'm not promoting a single-payer plan.

I am promoting a plan that will assure that every single person is able to get health insurance at an affordable price, and that if they have health insurance they are getting a good deal from the insurance companies. That's what I'm fighting for. (Applause.)

Now, the way we have approached it, is that if you've got health care under a private plan, if your employer provides you health care or you buy your own health care and you're happy with it, you won't have to change.

What we're saying is, if you don't have health care, then you will be able to go to an exchange similar to the menu of options that I used to have as a member of Congress, and I can look and see what are these various private health care plans offering, what's a good deal, and I'll be able to buy insurance from that exchange. And because it's a big pool, I'll be able to drive down costs, I'll get a better deal than if I was trying to get health insurance on my own.

This is true, by the way, for small businesses, as well. A lot of small businesses, they end up paying a lot more than large businesses per person for health care, because they've got no bargaining power, they've got no leverage. So we wanted small businesses to be able to buy into this big pool, okay?

Now, the only thing that I have said is that having a public option in that menu would provide competition for insurance companies to keep them honest.

Now, I recognize, though, you make a legitimate -- you raise a legitimate concern. People say, well, how can a private company compete against the government? And my answer is that if the private insurance companies are providing a good bargain, and if the public option has to be self-sustaining -- meaning taxpayers aren't subsidizing it, but it has to run on charging premiums and providing good services and a good network of doctors, just like any other private insurer would do -- then I think private insurers should be able to compete. They do it all the time. (Applause.)

I mean, if you think about -- if you think about it, UPS and FedEx are doing just fine, right? No, they are. It's the Post Office that's always having problems. (Laughter.)

So right now you've got private insurers who are out there competing effectively, even though a lot of people get their care through Medicare or Medicaid or VA. So there's nothing inevitable about this somehow destroying the private marketplace, as long as -- and this is a legitimate point that you're raising -- that it's not set up where the government is basically being subsidized by the taxpayers, so that even if they're not providing a good deal, we keep on having to pony out more and more money. And I've already said that can't be the way the public option is set up. It has to be self-sustaining.

Does that answer your question? Okay, thank you. (Applause.)

All right, right there. Go ahead.

Q Hello, Mr. President. My name is Linda Becher (ph). I'm from Portsmouth and I have proudly taught at this high school for 37 years.

THE PRESIDENT: Well, congratulations.

Q Thank you. (Applause.)

THE PRESIDENT: What do you teach?

Q I teach English and Journalism.


Q Yes, thank you.


Q And in those 37 years, I've been lucky enough to have very good health care coverage and my concerns currently are for those who do not. And I guess my question is if every American who needed it has access to good mental health care, what do you think the impact would be on our society?

THE PRESIDENT: Well, you raise the -- (applause) -- you know, mental health has always been undervalued in the health insurance market. And what we now know is, is that somebody who has severe depression has a more debilitating and dangerous illness than somebody who's got a broken leg. But a broken leg, nobody argues that's covered. Severe depression, unfortunately, oftentimes isn't even under existing insurance policies.

So I think -- I've been a strong believer in mental health parity, recognizing that those are serious illnesses. (Applause.) And I would like to see a mental health component as part of a package that people are covered under, under our plan. Okay? (Applause.)

All right. This gentleman right here.

Q Hello, Mr. President. I'm Justin Higgins from Stratham, New Hampshire.

THE PRESIDENT: How are you, Justin?

Q Fine, thank you. There's a lot of misinformation about how we're going to pay for this health care plan. And I'm wondering how we're going to do this without raising the taxes on the middle class, because I don't want the burden to fall on my parents, and also I'm a college student so --

THE PRESIDENT: They've already got enough problems paying your college tuition. (Laughter.)

Q Exactly. Exactly.

THE PRESIDENT: I hear you.

Q Also I'm looking towards my future with career options and opportunities and I don't want inflation to skyrocket by just adding this to the national debt. So I'm wondering how we can avoid both of those scenarios. (Applause.)

THE PRESIDENT: Right, it's a great question. First of all, I said I won't sign a bill that adds to the deficit or the national debt. Okay? So this will have to be paid for. That, by the way, is in contrast to the prescription drug bill that was passed that cost hundreds of billions of dollars, by the previous administration and previous Congress, that was not paid for at all, and that was a major contributor to our current national debt.

That's why you will forgive me if sometimes I chuckle a little bit when I hear all these folks saying, "oh, big-spending Obama" -- when I'm proposing something that will be paid for and they signed into law something that wasn't, and they had no problem with it. Same people, same folks. And they say with a straight face how we've got to be fiscally responsible. (Applause.)

Now, having said that, paying for it is not simple. I don't want to pretend that it is. By definition, if we're helping people who currently don't have health insurance, that's going to cost some money. It's been estimated to cost somewhere between, let's say, $800 billion and a trillion dollars over 10 years. Now, it's important that we're talking about over 10 years because sometimes the number "trillion" gets thrown out there and everybody think it's a trillion dollars a year -- gosh, that -- how are we going to do that? So it's about a hundred billion dollars a year to cover everybody and to implement some of the insurance reforms that we're talking about.

About two-thirds of those costs we can cover by eliminating the inefficiencies that I already mentioned. So I already talked about $177 billion worth of subsidies to the insurance companies. Let's take that money, let's put it in the kitty. There's about $500 billion to $600 billion over 10 years that can be saved without cutting benefits for people who are currently receiving Medicare, actually making the system more efficient over time.

That does still leave, though, anywhere from $300 billion to $400 billion over 10 years, or $30 billion to $40 billion a year. That does have to be paid for, and we will need new sources of revenue to pay for it. And I've made a proposal that would -- I want to just be very clear -- the proposal, my preferred approach to this would have been to take people like myself who make more than $250,000 a year, and limit the itemized deductions that we can take to the same level as middle-class folks can take them. (Applause.)

Right now, the average person -- the average middle-class family, they're in the 28-percent tax bracket, and so they basically can itemize, take a deduction that is about 28 percent. I can take -- since I'm in a much higher tax bracket, I can take a much bigger deduction. And so as a consequence, if I give a charitable gift, I get a bigger break from Uncle Sam than you do.

So what I've said is let's just even it out. That would actually raise sufficient money. Now, that was my preferred way of paying for it. Members of Congress have had different ideas. And we are still exploring these ideas.

By the time that we actually have a bill that is set, that is reconciled between House and Senate and is voted on, it will be very clear what those ideas are. My belief is, is that it should not burden people who make $250,000 a year or less.

And I think that's the commitment that I made, the pledge that I made when I was up here running in New Hampshire, folks.
So I don't want anybody saying somehow that I'm pulling the bait- and-switch here. I said very specifically I thought we should roll back Bush tax cuts and use them to pay for health insurance. That's what I'm intending to do. All right? (Applause.)

Okay, I've only got time for a couple more questions. Somebody here who has a concern about health care that has not been raised, or is skeptical and suspicious and wants to make sure that -- because I don't want people thinking I just have a bunch of plants in here. All right, so I've got one right here -- and then I'll ask the guy with two hands up because he must really have a burning question. (Laughter.)

All right, go ahead.

Q Thank you, Mr. President. I've worked in the medical field for about 18 years and seen a lot of changes over those 18 years. I currently work here at the high school as a paraprofessional. I have a little, you know, couple questions about the universal insurance program, which, if I understand you correctly, President Obama, you seek to cover 50 million new people over and above the amount of people that are currently getting health care at this moment.

THE PRESIDENT: It will probably -- I just want to be honest here. There are about 46 million people who are uninsured. And under the proposals that we have, even if you have an individual mandate, probably only about 37-38 million, so somewhere in that ballpark.

Q Okay, I'm off a little bit. (Laughter.)

THE PRESIDENT: No, no, I just wanted to make sure I wasn't over-selling my plan here.

Q That's okay, Mr. President. (Laughter.)

THE PRESIDENT: She's okay --

Q He winked at me. (Laughter.) My concern is for where are we going to get the doctors and nurses to cover these? Right now I know that there's a really -- people are not going to school to become teachers to teach the nursing staffs. Doctors have huge capacities; some of them are leaving private to go to administrative positions because of the caseload that they're being made to hold. I really do feel that there will be more demand with this universal health care and no added supply. I also understand that it was to be taken from Medicare, about $500 billion -- correct me if I'm wrong on that.

THE PRESIDENT: I just said that.

Q Okay. Also, you know, I'm very, very concerned about the elderly. I don't know if this is also correct, but I understand that a federal health board will sit in judgment of medical procedures and protocols to impose guidelines on all providers -- when to withhold certain types of care -- like, what is the point you get to when we say, I'm sorry that this cannot happen. Thank you very much for letting me ask those questions, Mr. President.

THE PRESIDENT: Of course. Well, first of all, I already mentioned that we would be taking savings out of Medicare that are currently going to insurance subsidies, for example. So that is absolutely true.

I just want to be clear, again: Seniors who are listening here, this does not affect your benefits. This is not money going to you to pay for your benefits; this is money that is subsidizing folks who don't need it. So that's point number one.

Point number two: In terms of these expert health panels -- well, this goes to the point about "death panels" -- that's what folks are calling them. The idea is actually pretty straightforward, which is if we've got a panel of experts, health experts, doctors, who can provide guidelines to doctors and patients about what procedures work best in what situations, and find ways to reduce, for example, the number of tests that people take -- these aren't going to be forced on people, but they will help guide how the delivery system works so that you are getting higher-quality care. And it turns out that oftentimes higher-quality care actually costs less.

So let me just take the example of testing. Right now, a lot of Medicare patients -- you have something wrong with you, you go to your doctor, doctor checks up on you, maybe he takes -- has a test, he administers a test. You go back home, you get the results, the doctor calls you and says, okay, now you got to go to this specialist. Then you have to take another trip to the specialist. The specialist doesn't have the first test, so he does his own test. Then maybe you've got to, when you go to the hospital, you've got to take a third test.

Now, each time taxpayers, under Medicare, are paying for that test. So for a panel of experts to say, why don't we have all the specialists and the doctors communicating after the first test and let's have electronic medical records so that we can forward the results of that first test to the others -- (applause) -- that's a sensible thing to do. That is a sensible thing to do.

So we want -- if I'm a customer, if I'm a consumer and I know that I'm overpaying $6,000 for anything else, I would immediately want the best deal. But for some reason, in health care, we continue to put up with getting a bad deal. We’re paying $6,000 more than any other advanced country and we're not healthier for it -- $6,000 per person more, per year. That doesn’t make any sense. So there's got to be a lot of waste in the system. And the idea is to have doctors, nurses, medical experts look for it.

Now, the last question that you asked is very important and I don't have a simple solution to this. If you look at the makeup of the medical profession right now, we have constant nurses shortages and we have severe shortages of primary care physicians. Primary care physicians, ideally family physicians, they should be the front lines of the medical profession in encouraging prevention and wellness. (Applause.) But the problem is, is that primary care physicians, they make a lot less money than specialists --

AUDIENCE MEMBER: And nurse practitioners.

THE PRESIDENT: And nurse practitioners, too. (Applause.) And nurses, you've got a whole other issue which you already raised, which is the fact that not only are nurses not paid as well as they should, but you also have -- nursing professors are paid even worse than nurses. So as a consequence, you don't have enough professors to teach nursing, which means that's part of the reason why you've got such a shortage of nurses.

So we are going to be taking steps, as part of reform, to deal with expanding primary care physicians and our nursing corps. On the doctors' front, one of the things we can do is to reimburse doctors who are providing preventive care and not just the surgeon who provides care after somebody is sick. (Applause.) Nothing against surgeons. I want surgeons -- I don't want to be getting a bunch of letters from surgeons now. I'm not dissing surgeons here. (Laughter.)

All I'm saying is let's take the example of something like diabetes, one of --- a disease that's skyrocketing, partly because of obesity, partly because it's not treated as effectively as it could be. Right now if we paid a family -- if a family care physician works with his or her patient to help them lose weight, modify diet, monitors whether they're taking their medications in a timely fashion, they might get reimbursed a pittance. But if that same diabetic ends up getting their foot amputated, that's $30,000, $40,000, $50,000 -- immediately the surgeon is reimbursed. Well, why not make sure that we're also reimbursing the care that prevents the amputation, right? That will save us money. (Applause.)

So changing reimbursement rates will help. The other thing that will really help both nurses and doctors, helping pay for medical education for those who are willing to go into primary care. And that's something that we already started to do under the Recovery Act, and we want to do more of that under health care reform. (Applause.)

All right, last question, last question right here. This is a skeptic, right?

Q I am a skeptic.


Q Thank you, Mr. President, for coming to Portsmouth. My name is Michael Layon (ph). I'm from Derry, New Hampshire, District 1 in the congressional district. I'm one of the people that turned myself in on the White House Web page the other day for being a skeptic of this bill. I'm proud to have done so.

THE PRESIDENT: Before you ask this question, just because you referred to it, can I just say this is another example of how the media ends up just completing distorting what's taken place. What we've said is that if somebody has -- if you get an e-mail from somebody that says, for example, "Obamacare is creating a death panel," forward us the e-mail and we will answer the question that's raised in the e-mail. Suddenly, on some of these news outlets, this is being portrayed as "Obama collecting an enemies list." (Laughter.)

Now, come on, guys. You know, here I am trying to be responsive to questions that are being raised out there --

Q And appreciate it. (Applause.)

THE PRESIDENT: And I just want to be clear that all we're trying to do is answer questions.

All right, go ahead.

Q So my question is for you, and I know in the White House the stand which you're on has often been referred to as the bully pulpit. Why have you not used the bully pulpit to chastise Congress for having two systems of health care -- one for all of us, and one for them? (Applause.)

THE PRESIDENT: Well, look, first of all, if we don't have health care reform, the gap between what Congress gets and what ordinary Americans get will continue to be as wide as it is right now. And you are absolutely right -- I don't think Carol or Paul would deny they've got a pretty good deal. They've got a pretty good deal. I mean, the fact is, is that they are part -- by the way, I want you to know, though, their deal is no better than the janitor who cleans their offices; because they are part of a federal health care employee plan, it is a huge pool. So you've got millions of people who are part of the pool, which means they've got enormous leverage with the insurance companies, right? So they can negotiate the same way that a big Fortune 500 company can negotiate, and that drives down their costs -- they get a better deal.

Now, what happens is, those members of Congress -- and when I was a senator, same situation -- I could, at the beginning of the year, look at a menu of a variety of different health care options, most of them -- these are all private plans or they could be non-for-profit, Blue Cross Blue Shield, or Aetna, or what have you -- they would have these plans that were offered. And then we would then select what plan worked best for us.

But there were certain requirements -- if you wanted to sell insurance to federal employees there were certain things you had to do. You had to cover certain illnesses. You couldn't exclude for preexisting conditions. I mean, there were a lot of rules that had been negotiated by the federal government for those workers.

Now, guess what. That's exactly what we want to do with health care reform. (Applause.) We want to make sure that you are getting that same kind of option. That's what the health exchange is all about, is that you -- just like a member of Congress -- can go and choose the plan that's right for you. You don't have to. If you've got health care that you like, you don't have to use it.

So for example, for a while, Michelle, my wife, worked at the University of Chicago Hospital. She really liked her coverage that she was getting through the University of Chicago Hospital, so I did not have to use the federal employee plan. But I had that option available.

The same is true for you. Nobody is going to force you to be part of that plan. But if you look at it and you say, you know what, this is a good deal and I've got more leverage because maybe I'm a small business or maybe I'm self-employed, or maybe I'm like Lori and nobody will take me because of a preexisting condition, and now suddenly got these rules set up -- why wouldn't I want to take advantage of that?

Now, there are legitimate concerns about the cost of the program, so I understand if you just think no matter what, no matter how good the program is, you don't think that we should be paying at all for additional people to be covered, then you're probably going to be against health care reform and I can't persuade you. There are legitimate concerns about the public option -- the gentleman who raised his hand. I think it's a good idea, but I understand some people just philosophically think that if you set up a public option, that that will drive public insurance out -- or private insurers out. I think that's a legitimate concern. I disagree with it, but that's a legitimate debate to have.

But I want everybody to understand, though, the status quo is not working for you. (Applause.) The status quo is not working for you. And if we can set up a system, which I believe we can, that gives you options, just like members of Congress has options; that gives a little bit of help to people who currently are working hard every day but they don't have health care insurance on the job; and most importantly, if we can make sure that you, all of you who have insurance, which is probably 80 or 90 percent of you, that you are not going to be dropped because of a preexisting condition, or because you lose your job, or because you change your job -- that you're actually going to get what you paid for, that you're not going to find out when you're sick that you got cheated, that you're not going to hit a lifetime cap where you thought you were paying for insurance but after a certain amount suddenly you're paying out of pocket and bankrupting yourself and your family -- if we can set up a system that gives you some security, that's worth a lot.

And this is the best chance we've ever had to do that. But we're all going to have to come together, we're going to have to make it happen. I am confident we can do so, but I'm going to need your help, New Hampshire.

Thank you very much, everybody. God bless you. (Applause.)

END 2:15 P.M. EDT