President Obama, Bill Clinton Talk About Healthcare Around the World

The two Democrats discuss the important role America has in the global healthcare market.
3:00 | 09/24/13

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Transcript for President Obama, Bill Clinton Talk About Healthcare Around the World
Gentlemen please welcome Pharmasset -- -- to the United States Hillary Rodham Clinton. Well. Thank thank you thank you. You very much. I have. I have. -- -- -- To introduce our next two speakers. Who are about to have a conversation. Concerning health care. And I thought hard about how to introduce these two men -- And the -- thought about it the more I realized how much they have in common. They're both left handed. They both love golf the game that. Does not often reciprocate. The love they put into it. They both are fanatics sports fans. And go to great blanks to -- be in front of the TV you are now on the side of -- -- field. They both are master politicians. Each of them has only lost one election. They are both Democrats. They have -- fabulous daughters. They each. Married far above themselves. And they each love our country. And so please join me in welcoming. Number 42. And number forty -- are. Bill Clinton and president Barack Obama. Mr. President. -- you interview and they used. I'm gonna -- another total audience that was a good thing you did. Well thank you for coming. Well it is it is wonderful to be back and then let me start just by saying. All the people who. Have for years now supported -- incredible efforts. CG. Thank you because wherever we travel. All across the -- We see the impact that -- making every single day and we're very proud but what you all do. And let me say -- that. We still miss are former secretary of state. -- and I I should have got to. I should -- that there's nothing she says that was not true. Particular the part about us -- -- Well -- zero first the health care comment this is going to be a conversation about. Domestic and international health and America's role in it but -- -- began by telling you that. I think the First Lady he's done a great job in this fight against childhood obesity. We have been honored our foundation to be asked represented her effort. An 181000 schools. We're we've lowered the calories in drinks being served in the -- -- percent but she's been great on that. The other thing I think is that. I was a little upset and -- you know called. One of your administration members when you've got to Africa who -- when I read an article that said. That -- have a big initiative and africanized. I can't say exactly what I said but I said. That is an accurate that's the sanitized version of us. Because win. The president took office. Our programs begun under President Bush -- -- was giving anti retro viral medicine to one point seven million people. -- cause of an agreement that I made was President Bush to use generic drugs that were approved by the FDA. About half -- drugs were being purchased in that way. Under President Obama we've gone to 99%. We are treating more than five point one million people three times as many for less money. That is a stunning legacy so that more money has been put into malaria medicine bed nets and so you -- a lot of money. And save more lives while doing it and I'm very proud of that and Paula thank you for -- it's important. -- -- -- -- did his conversation we can give back to is so your current global health initiatives but. Well let's talk a little about the health care law. Because we're about to begin. -- October the first open enrollment for six months. And up. I'd like to give you a -- first of all. Two. Tell them why -- -- took office we were teetering on the brink of a depression. You had -- authority at the start to recovery again why in the midst of all this grief did you also take on this. Complex issue many people were saying. One and they just focus on the economy and leave this alone. So tell us why you did it. Well. First of all I think -- -- remember that. Health care. Is the economy. A massive part of our -- And and so did the idea that somehow we can separate out the two. Is a fallacy. Second of all. The effort for us to deal way -- A multi -- health care crisis has been going on for decades and the person -- just introduced us. As well as you -- -- leader presidency had. As much to do -- -- helping to shape the conversation. Is anybody. That the fact is that. We have been up until recently the only. Advanced industrialized nation on earth. That permits. Large numbers. Of its people. To languish without health insurance. Not only. Is there the cruelty of people who. Are unable to get health insurance -- to use the emergency room. As. Their doctor. Or their health service. But. We're also more efficient than anybody else. And so when we talk about for example our deficit. You know this better and anybody. The reason that we have not only current deficits but also. Projected long term deficits the structural deficit that we have. Is primarily based on the fact that we have the hugely inefficient wildly expensive. Health care system that does not produce better outcomes. And if we spent. The same amount of money on health care that Canada or France. Or Great Britain did. Or Japan or any other industrialized country. With the same outcomes or better outcomes. That essentially would remove. Our structural deficit which would -- free up. Dollars for us to invest in early childhood education and infrastructure. And medical research. And all the other things that can make sure that were competitive. And growing rapidly over the long term. So my view when I came in office was we've got an immediate crisis we've got to get the economy -- -- But what we also have to do is start the start tackling -- structural problems that have been building up for years. And one of the bigger structural problems was health care it's what accounts for our deficit -- what accounts for our -- it causes pain and misery. To that millions of people all across the country. It is a huge burden on our businesses. That I was out of -- plant. Missouri. And in -- the F series -- is a big stamping plant. Ford is now. The biggest seller in the United States we. Took that lead back from the Japanese auto makers. But we are still burdened by the fact that every US. Automobile that is manufactured. Requires. A couple of thousand dollars an -- helped her cross that. Our foreign competitors don't have to play. So this is -- everything to do with the economy in addition to what I consider to be. The moral imperative. That. A mom should not have to go bankrupt -- for -- her daughter gets that. -- over -- family who who's dealing with. -- lay off. And has already struggling to pay the bills shouldn't also be wondering whether -- one illness away from losing their home. And and I think most Americans agree. First of all folks did for those have you. Two were from the United States. That's about as good an overview as -- we're gonna hear. Of what this economic issue is. But -- -- the president set our structural deficit would disappear if we had a comparable. Health care system in terms of cost to the French and Germans that are consistently rated the highest it's about a trillion dollars a year in there somewhere around 44% of that money. He is -- Government funded -- So you just run the numbers that didn't think -- all over half of our deficits already disappeared because of economic growth and the revenues rise in the spending we cut. Danube -- let's get rid of the rest of it. If we just sat there comfortably expenses system to any other country. Before you took office we lost a car company that wanted to locate in Michigan that went instead to. Canada and they and else. They said look where a car company. That provides health care benefits to our employees were not health care company that sells cars to cover our bills we have to go to Canada. So I think Susan. And it was one of the few companies willing to go on the record -- -- this so. Thank you for doing so let's let's talk about this. What this is open enrollment mean how are people going to get involved. Win and you have universal enrollment you can manager costs better and cut inflation -- not. Give the presidency -- talk about all the good stuff has happened but I just want to know one thing. In the last three years just since we started doing this inflation in health care costs is dropped to 4% for three years in a row. For the first time in fifty years. Fifty years but before that. The costs are going up at three times the rate of inflation. For a decade. So. Now what what what are you gonna do on October 1 to tell me how this has got a war. Well Lou let me give folks just a little bit of background about what's already in place and then what happens on October 1. When we pass the affordable care -- There were -- armor components sort. A big part of -- -- is essentially providing a patient's bill of rights that. Americans and advocates have been fighting for for doctors. So what we want to do was make sure if you already have health insurance. That you get a fair deal. You're being treated well by -- insurers. So we eliminated. Prohibited insurance companies from imposing lifetime limits. Which oftentimes if a family member really got sick. They thought they were covered until suddenly they hit that limit and now -- out hundreds of thousand dollars -- -- -- it. We -- to insurance company is you've got to use at least 80%. Your premiums but you're receiving. On actual healthcare not on administrative -- in. CEO bonuses. And if you don't you've got a rebate. Anything that you spent. Back to the consumer. So there are. Millions of Americans who receive rebates they may not know that they got -- because before -- or quorum -- Bob Welker. -- but they're pretty happy to get those rebates back. Because it because it made sure that the insurance companies were treating. -- -- We -- that any young person who. Doesn't have health insurance. Can stay on their parents' health insurance. Until -- point -- all. And as a consequence what we've seen is steadily the creative. And in short for -- young people dropping. Over the last three years since the bill passed. And obviously providing a lot of relief to a lot of parents out there because a lot of young people -- They've been entering in the job market at a time when jobs are tough. To -- and often times benefits are -- This is providing -- an enormous security. Until they get. You know more firmly established in labor market. We provided additional discounts. For prescription drugs for seniors under the -- program and so seniors have saved billions of dollars. When it comes to their prescription drugs. So there have been over the last three years -- whole array of consumer protections. And savings for consumers. That result directly from the law we passed and for those who say they want to repeal it. Typically when you ask him about what what all these birds the for several -- group. And that -- pretty good and we keep that. And you pretty much go to west and there's not too much people object to. -- -- Paul also at the time that. Part of the way that we paid for. The health care bill was we said Medicare's -- and a lot of money without making seniors healthier. Then there was a lot of hue and cry about how. We were taken money out of Medicare. Well it turns out that we were right. That we could change. How all. Doctors and hospitals and providers were operating. Rewarding them for outcomes as opposed to simply how many procedures that they did. You started seeing practices change that. Among millions of providers across the country. Medicare. Rates have actually slowed in terms of inflation. Seniors have saved money. Folks are healthier. And some of those savings we've been able to use to make sure the people who don't have health insurance get health insurance now this. This brings -- to October 1. Don't want park. Be Affordable Care Act that. Required so -- years to set up. But -- critical for. Was how do we provide health insurance. For individuals who don't get health insurance through the job it's a historical accident that in this country. Doctors attached. Employers. And part of the problem is if you're out there are shop and for health insurance are -- are not part of a big pool. Well. There's no aggregation arrest taken place for the insurers of their -- we're gonna say. Let's -- -- fifty years old to get high blood pressure. And we just look at the actuarial tables were triggered gonna get -- so we're gonna charge you. 15100 dollars a month for health insurance which -- person has nowhere before. Because there's no pulling -- -- Source of those we need to set up a mechanism. To pool. People who currently don't have health insurance so that they have the same purchasing power the same -- the big company does when they're negotiating with the insurance company. And essentially what we've done is we've created or calling marketplaces. In every state around -- across the country. Where consumers are now able to. Be part of -- big pool insurers have to did essentially compete for the business. That pool. And what we now have. Set up our. These marketplaces that provide high quality health care at affordable prices. Giving people choices some they can get their health insurance that they need and they want and the premiums. Are significantly. Lower. Then what they were able to previously get all take the example of New York State. The insurers. Put in their bids to participate in these marketplaces. It terms that their rates are up to 50%. Lower. And what was available previously viewed as one on the open market -- tried to get health insurance. 50% lower in the state. California that's about 33% lower in my home state Illinois they just announced. About 2.5 percent -- So just by pulling and created competition. So that insurers after go after. People's business. The way they go after a group plan. We've drastically. Reduced. Premiums and cost on top of that what we're not during -- were saying. If we're the better deal that you got -- you still can't afford it. We're gonna give you tax records. Essentially subsidize your purchase. Of health insurance. And -- the net result will be. Can -- -- to roll out. What the actual prices are gonna end up being but. I can tell you right now that. In many states across the country if you're sick 47 year old young woman. Don't have health insurance. You get on that exchange. You're going to be able to purchase high quality health insurance for less -- across her cellphone bill. And because all the insurers who participated -- part to have for example provide free preventive care. Free contraceptive care. The -- young woman she may make up. What she's spending -- premiums just on her monthly use of helter. So this is going to be a -- deal for. Those who don't have health insurance. Those who already have -- -- insurance get better health insurance. And the best part of the whole thing is because of these changes we initiated. In terms of how we're paying providers. -- crosses have. That's grown and as you pointed mister president -- The slowest rate in fifty years we are bending the cost curve in getting at. The problems that are creating our deficits in Medicare and market. I should point out that so far in most states one of the good things that -- And at least I didn't know order would happen is that when we begin this is in the United States more than 80% of the American states. Had only one or two companies -- providing health insurance who had more than 80% of the market. So there was in effect no price competition. So -- what I was terrified of us you know -- -- these things and there'd only be one company's open bid and -- -- thing we'd be having an academic conversation instead. It's actually led to the establishment of more companies doing more bidding. And I think part of it is they have greater confidence that they can deliver. Health care more modest. The costs so. So far it's good but. I think it's important. For you to tell them people. Why we're doing all this outreach because. This only works for example these young people show up. And even if they buy the cheapest plan and they claim their tax credits so that won't cost them much smaller books a month or so. We got to have them in the pools. Because -- -- all these projected low cost. Cannot be held. If older people with preexisting conditions are disproportionately. Represented. In any given state you've got to have everybody lined up so. Let me explain what count all the work you've been doing on the outraged when we opted for the opening line. October. 12. -- President Clinton makes a really important point and the way police work. -- any pool. Is. Essentially of those of us who are helping. Subsidize somebody who's sick of any given time we do that because we anticipate -- at some point we'll get sick and we hope. They help the person is in our pool and so those costs in those risks gets -- that's what insurance is all about. And so what happens is if you don't. Have pools. That. Are cross section of society. -- people who are already sick or more likely to get sick all rush -- buy insurance. People who were helping. They say you know what I won't bother. And you get what's called adverse selection essentially what happens is is that the premiums are going higher and higher because. The risks aren't spread broadly enough across population so you wanna -- to a cross section in every pool. That's what big companies have an easier time. Get good rates -- -- employees of small companies because if you only have five employees. One person is stricken with breast cancer let's say. Your rates potentially shoot up but if it's a thousand employees. That it gets spread out. So on October 1. -- enrollment begins all these folks can start signing up for. The marketplace. And what we want to make sure is that everybody. In every category every age group understands. Why health insurance is important understands why. They should sign up. Understands the choices that are going to be available to them there -- -- to go to a computer. -- long. -- don't know where page and they're going to be able to shop dislike you shop for airline ticket. Or flat screen TV and see what's the best price for -- what's the plan that's best suited for your. And go ahead and sign up right there -- that and that open enrollment period will last from October 1. Until. In -- march and so there'll be six months for folks to sign up. Normally this would be. It pretty straight forward. Lot of people don't have health insurance lot of people realize they should get health insurance. But let's face it has -- -- political whistle. Obamacare back. And so what what -- -- is is an unprecedented effort. That you -- ramp up over the last month or so. In which those who have opposed the idea of universal health care. In the first place and have -- this thing to the mail through congress and through the courts and so forth. Are have been trying to scare and discourage people from getting a good deal. And -- -- you may receive some -- commercials out there that are mobile wacky. And the main message we had. And were using social media we're talking -- -- churches were talking to. You various. Civic groups. And -- what we're saying to people -- look just go to the website yourself don't you. -- -- -- -- Take a look at whether this is a good deal -- not make your own decision about whether this is good for you. Because what we are confident about is that when people look and see that they can get. High quality affordable health care for less than their cell phone bill. They're gonna sign up. There are gonna sign up and part of what I think the resistance but we've seen ramp up. Particularly over the last couple months is all about is the opponents of -- to reform -- -- -- sign up. Fact one of the major opponents when asked -- -- of the -- potentially shut down the government at this point. Just -- -- obamacare. The base we've fessed up is that well once you know consumers get hooked on -- health insurance. And subsidence. Then there won't want to -- up. About. Here you can look at the transcript that was one of the major opponents. Doctor four. It is an odd logic essentially they're saying. People like this thing too much. And that'll be really remarkable -- roll back. So. It is very important. That people just Knoll. What's out there what's available -- and let people make up -- months as to whether makes cents -- nine. Now -- one last analysts say that because. I do think sometimes people come up -- and they say well. If such a good deal. -- -- the polls show that it's not popular. One of things you and I both -- is that when you come to health care. There's no more personal and intimate decision for people because some of the people really care about. And frankly the W you know as always -- deserve better than W don't know. And then that's what Harry and Louise was all about. Back back in the -- right it was scaring people with the prospect of change. And so part of our goal. Here is just to make sure people have good information. And then there's been billions of dollars. Spent. Making people scared and worried about that stuff. And rather than trying to. Disabuse people of every single. Bit of misinformation that's been out there what we're saying is just look for yourself take a look at it. And you'll discover that this is. Take good deal for you. What was that. -- I completely agree that I think what. We've got to do is drive people who web sites. The states that are participating. The Supreme Court decision would have upheld health care law. -- that states. Didn't have to set up these marketplaces they didn't want -- but if they did in the program whatsoever about. They also says that states. Didn't have to expand Medicaid program coverage. To help people whose incomes are up 238%. Of the federal poverty level buy health insurance. There are some states believe it or not that want the marketplace but don't want to medicate. And that's gonna lead to a cruel -- then there's nothing the president can do it is not his fault that the Supreme Court -- so we can have this bizarre situation where. Let's -- out of business with sixty employees can. Are an individual going in the individual market will get the benefit it's. Tax credits for everybody within comes of -- 138% of the federal poverty level or above. But they won't get it for people who war between -- hundred -- 138%. -- lower income people who desperately need the health insurance. We would have the cruelest of all situations in those states and there's nothing the president can do about it because of the Supreme Court decision. So we -- persuade the states to come on but more and more states. With Republican governors Republican legislators are doing it. -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- Little hometown -- is nothing wrong with that the -- -- got a couple of things that are happening that I think -- very interest. First of all but I'm sympathetic to summer's Republican governors. Who are under a lot of pressure because. The whole issue of whether your vote for Bob -- -- -- has become a litmus test in the other party. So some moment politically. It's been tough sometimes. State legislatures and that refused to allow governors to go ahead and implement. But. As you indicated what we've seen is when Republican governors take a look at. The -- there getting. Where in addition to these exchanges. Were also providing. A much more significant match much more federal money to provide. -- insurance from the State's perspective they're not paying the federal government's picked up -- and this is helping them. Because people are no longer more in the emergency room they now have good helped her there not been preventive care you're -- some Republican governor step up and so I am. Don't. -- -- -- like like obamacare but. -- -- -- Make sure the Mike people. -- are benefiting from. This plan so that's one good things having the second thing that's happening is there a couple states Arkansas's good example. Kentucky's another good example. Idaho interesting example. These are states where. I just got be. I'm in you know. I do not have a big constituency. In these states. Well and I take that back you -- what -- -- percent stole our people but. I'm -- -- -- -- percent of these in these states. But the governors were still able to say we're gonna set a -- six traders. Get -- -- marketplaces. And each state is just -- -- using their own name for so. I had -- -- I had. Conference. Video conference with all the state directors -- marketplaces. And -- talking to the director in Kentucky and Idaho. In on Kentucky it's called like Kentucky connect in the -- what's called -- know -- help after exchanging. Geathers story -- and Tucker were some folks were -- people up. A county fair somewhere and some guy goes up and he stars look at the -- in just -- who's -- sign up and -- terrorists are spreading certain there's a great deal has lot better and obamacare. Which is which is fine -- Because we. Don't have pride authorship on this to -- -- to work. And the -- Arkansas just came out with with its rates. And as has been true in virtually every single state not only are premiums lower than -- war. They're a lot lower then. Even the most optimistic predictions. Were up about how -- they would be and -- -- Once. These marketplaces are up and running it turns out. That what is traditionally been a pretty conservative principle. Which is competition and -- work. Well in the insurance market competition and choice work. And to what we're seeing is that. People are going to be able to get the kind of health care -- that they've never been able to get before states are gonna. Benefit from occurs because they're gonna save money. And one thing that all of you. If there prior very few people in this room who don't have health insurance although it did don't usually does sign up -- started October 1. One of things that many people don't realize is that. Be. The subsidy that all of you provide. For the -- insure. Is about a thousand dollars per family. You pay a thousand dollars -- -- here is get health insurers -- about a thousand dollars more. For your family's insurance. Than you otherwise would have. Because. Hospitals. Are mandated they are required. To provide service anybody shows up. And so what happens where they've got. 15% of butler's run health insurance they end up showing up at the emergency -- typically at a point when their much sicker than a period. -- get regular -- -- -- preventive care. So. You pay for the most expensive -- there is because hospitals -- recoup that money somewhere. And and the way they do it is to charge higher prices. And that people who haven't helped insurance and a pick it up so. Part of what will helps reduce. The increase in health care -- is making sure that that hidden subsidy. No longer exists. Let's talk a little there about the business because -- but we're out of time but I think it's really important -- You don't but as you pointed out most people who have insurance. Work for a living or someone and their family does and they get their insurance -- their workplace. The law says that. Faults but employers -- displayed if they have fifty employees or more. Many employers with fewer than fifty employees already voluntarily provide some. Health insurance. Both the companies -- -- fifty or more and the companies with fewer than fifty. Are somewhat concerned and -- -- that have to be insured those who work thirty hours a week or more. So there were many people who speculated that when this law came into the place that they would add to the cost and there'd be a lot more part time workers at a full time workers I'll save the present time -- the energy on this so far that's not true. The overwhelming number of people who have been hired coming out of this recession. Have been they have been hard at lower wages but they have been full time employees. There -- not been an increase in the percentage of our employment in part time work. There has been an increase and moved relatively lower wage new jobs but that means -- -- health insurance even more. So explain very briefly to them. How this is gonna work out the -- private employers. Or -- to buy their insurance. No requirement well first of all. If you're a large importer -- but -- -- more -- fifty employees. Here are providing health insurance. The -- during every other than just make sure that. You can show that you're providing health insurance. And there was a lot of news recently about how we delayed. The so called -- mandate. For a year because under the law what it says there's. If you you have more than fifty employees you're not providing. Health insurance to employees then you're gonna PayPal to help subsidized to help pay for. The fact that so we the taxpayers are gonna have to provide your employer's group health insurance. Which by the way is only fair. -- a lot of the controversy around. The Affordable Care Act have to do with these so called mandates both an importer mandate and an individual -- And the employer mandate says if you don't. Meet your responsibilities by here. Your employees and they end up getting Medicaid or ending up -- emergency room you're basically dump and those costs on the society. That's not fair sort of a charger couple thousand dollars. To help pay for health care for those employees. To the individuals. What we said was. We're gonna make good health insurance so affordable. Sochi for -- so heavily subsidized if you're not -- a lot of money. That if you're not getting health insurance. That is because you just decided. You don't want to you don't need to. And in that circumstance. What happens when you get hit by a bus blue heaven forbid or somebody. -- your family get sick and you haven't had a cover. What we're gonna end up have to pay for anyway because we're not -- just what somebody. Believed in front of the emergency room. So what -- -- is you've got to take responsibility. And so there is a small penalty if you don't. Get health insurance. This is where a lot of the controversy and -- popularity came -- because people generally don't like to is he told you've got to get health insurance. Employers don't like to be told you gotta give your employees health insurance. As a society what we cannot do. Is to. Say you have no responsibilities whatsoever but you've got guaranteed coverage. And this raises -- the whole issue of preexisting conditions which we haven't talked a lot about. What is really important. 1 -- the central components of this law one of the main. Universities. The health care system before this law passed. -- -- there -- millions of people around the come true if you -- gotten sick before. He would had a heart attack. And -- have cancer if you had diabetes. Must -- when it first happened you had a job you got cure. Then you lose your job your try to change jobs or try to start a business you try to brought good health insurance good health insurance company. Not only could deny it but had every incentive to -- -- bear -- but rather have to help the people. Who are. Paying premiums and never. Ask him for a payout. They don't want somebody who. Actuary early they can anticipate -- gets. And so. Keep in mind that a huge percentage -- our society has some sort of pre existing commission. And they can't be locked out you can do everything right -- car build a strong middle class life. But if you've been sick and then you lose your job or something happens you mesa Libya blocked -- insurance market -- or the premier may be so -- that. -- The summary federalists were rich could -- So what we say it is all right you know what insurance covers you can no longer. Bar somebody from -- health insurance just because it got a preexisting condition. But the only way that works. Is if everybody. Has a requirement. To get health insurance. Does think about what happens if you don't have -- -- well all of us not all of hospital lot of us who. We're trying to figure out how to say as a -- would say well I'm not -- worried about it until like it's Sacramento right went undiagnosed. With some -- going to be expensive. -- -- insurance -- you can't prevent me from it didn't help insurance just because I've got a preexisting condition so. They could potentially game the system. And it wouldn't work. So now what we've done is you've got to. Provide health insurance to anybody all -- that's the deal. The flip side of letters numbers got some responsibility and will help you pay for to get health insurance and that's where a lot of period -- -- The misunderstandings. Frustrations about Health Care Reform came and I should add by the way -- This was the same. Proposition that was set up in Massachusetts. Under. Our government Brett Robin it's working really well not enough percent of people masters -- coverage and that same principle. Was ironically considered. You know -- -- Smart. Republican conservative principle but it was right -- the -- -- -- so just to finish up the question. When it comes to businesses. If you're providing health insurers for employees. That's great you don't have to do much other than just make sure that you show us that you've got health insurance for employees. If you have more than fifty employees and you're not providing health insurance form. You now have the opportunity. To -- -- pool small businesses to get a better price -- a better deal on health insurance. You're eligible for tax credits in providing. Health insurance your employees up to 35%. The premiums for each employee. Won't be. A tax benefit the tax credit from the federal government. But it is still are providing health insurance for employees after that they were gonna go ahead and and penalize her for. And you know I can understand why some businesses would want to pay for if they're not currently provide health insurance for the -- is what that means is that. They'd rather have. You know those additional profits than make sure that they -- their employees. Or. They're getting a fair deal in some cases they may be operating under some very small -- butt -- keep in mind -- people hurt companies are exempted. The average small business -- five employees mom and pop shop ten employees. They're not under that requirement so. I'm not that sympathetic to -- company typically that's got more than fifty employees. And generating some significant revenue. We're making it affordable for them -- private health insurance for the employers they should do the right thing. -- -- We have to close but I think there's one last issue we ought to deal with. Then most important thing obviously is just to get people enrolled in this. We'll work through it as we go along but. That you just heard the president -- that so far in virtually every state. The actual prices of the insurance are coming -- and quite low a bit lower than they were originally estimated to. With the original price estimates. There with the government obligated to provide subsidies which cost money on the budget right. It was nonetheless estimated. That in the first -- years. This would keep the national debt -- 110 billion dollars lower than it otherwise would have been. Which means if we come -- it even less. We can -- that down more are we can subsidize more small businesses and get more small businesses into this look. A lot of people. Come to me and say. You know now you sound like. The people used to criticize Tuesday we can cut taxes all -- -- increased spending and balanced budget bill period at this sounds too good to be true. So I think on -- who before you leave you should tell people. How we can spend more not so much in direct spending. But in tax credits and still -- that reducing overall federal spending by a 110 billion dollars to in this decade. Well couple things just in terms of how this whole thing got paid for first of -- I think it's -- important. To point out here. That. The total cost of -- for Booker took -- provide health insurance for every American out there. An affordable rate. Is costing about. The same amount over -- course ten years as. The costs. Of the prescription drug bill that President Bush. Pass. Except that wasn't paid for we felt obliged excellent pay for and not just -- to the deficit. So what we did. It's paid for by a combination of things we did raise taxes on some things. We. For example said that. For high end income individuals. You can pay a slightly higher. Medicare -- Medicare taxes so we bump that up a little bit. We set that. For. Employers who -- currently providing a so called Cadillac. Helped -- -- Where there's so many bells and whistles -- note. Incentive to actually. Spent wisely. When it comes to health care. Workers -- -- penalize you for that not all later -- but -- but also. To say you're encouraging the worst aspects of -- health care system where he has spent a lot of money. You don't get better outcomes. I've mentioned to you Medicare. We've basically -- there there's program and Medicare well Medicare Advantage. That. Provide some additional options for. Medicare recipients above and beyond standard -- here. And all that's very popular lot of seniors get you know eyeglasses and you know other benefits. But turned out that it was somewhat competitive. That we were providing. Tens of billions dollars -- subsidies for insurance competence. Under the Specter -- plan without. Getting better outcomes health outcomes -- -- so what we set was. We'll keep Medicare Advantage and will give them a small premium if they're providing better services to procedures but we'll make you compete for a little bit were gonna. Say tens of billions of dollars in the process and that will go into paying for the affordable care so the bottom line is through these various mechanisms. We raised. Enough money to pay for. Providing health insurance for those who don't have -- to provide these health. Are these tax credits in the marketplace. And at the same time because. We're driving down costs. We're actually end -- -- little money it is a net reduction. Up our deficit the irony of those who are talking about repealing. Obama here because it's so wildly expensive as if they actually repeal the law it would add. To the deficit it would add to the deficit. There been a couple Republicans. In the house have been Smart enough to say -- -- repeal all the benefits. So the people the other point. 4530 -- people don't have health insurance. Or acute attacks -- Obama -- we just won't talk about that. And then that way we can say we reduced the deficit. But. The obviously your your your doing some -- some funny business there with the budget. Not -- desperate. The bottom line though is do we want. -- continue to live in a society where we've got the most inefficient health care system monitor. We've -- millions of people exposed to the possibility is that they could lose everything because they get sick. -- we got little. -- children and -- -- is going to be emergency room once a week because they got asthma and other preventable diseases because. Their families are linked up with a -- her position -- -- providing -- regular care. -- but costs to society for reduce productivity. Illnesses. Etc. all Burton. Other dancers know. That and and and the notion that. We -- Resist. Or at least somewhat resistant as fiercely -- -- early as may have. Make this their number one agenda. Is perpetuating a system in which. Millions of people across the country hardworking Americans. Don't have access to health care. I think used as -- The improvement. We have to. We have to close but I know I'll closed with a story not. At all -- -- this morning that the the employee that our health access program lost in the -- most she was Dutch nurse. And us we spent a lot of time in the Netherlands play we get a lot of support there. Oxy is one of the biggest insurance companies in Europe they're one of our partners here. I went to celebrate their 200 anniversary with them they had been they started as a fire insurance company. With -- on farmers 200 years ago they -- out there in this. Big. -- feel with a in a -- In the shadow of authorities century church in a big Dutch windmill. And I asked the -- of the Communist. You -- it health insurance. Because in the Nellis there's no Medicare no Medicaid or -- and held on an individual mandate and he does subsidize people based on their incomes. He said he got right we all -- that he looked at me and he said but we don't like any money alone and he said. We shouldn't. Discuss and uses your doctor -- -- solicit an American. He said he says we shouldn't if I can't make money on this business -- traditional insurance business like it was -- some work -- to look healthcare is a public good. And you got to find a way to finance it. For everybody he. -- It's just an intermediary. Function that somebody has to handle. But in the end -- talents delivered how its -- and now healthy you can keep your people. So. The first -- trying to keep us all healthier. And you're trying to -- to delivery in the pricing and yet to cover everybody to do it. I think this is a big step forward for America this will over the next decade -- America's healthier but it will free up. In the private sector largely funds that can then be reinvested. In other areas of economic growth and give us a much more well balanced economy. But first we -- by the -- up. That -- sign up. Broader health care knock -- the much. -- -- -- -- -- -- -- -- The United States -- the -- thank you.

This transcript has been automatically generated and may not be 100% accurate.

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