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13           COX PAVILION



16     Saturday, March 24, 2007

17            9:15 a.m.







25      Reported by:    Deborah Ann Hines, CCR #473, RPR

1             VOG:    Ladies and gentlemen, please welcome

2    from the University of Nevada, Las Vegas the vice

3    president of planning and diversity and chief of

4    staff, Dr. Juanita Fain.

5             DR. JUANITA FAIN:   Good morning.   It's great

6    to see you all.   On behalf of Dr. David Ashley,

7    president of the University of Nevada, Las Vegas

8    along with the students, faculty and staff of UNLV

9    I'm pleased and excited to welcome you to our campus

10   for the New Leadership on Health Care Presidential

11   Forum.   We're glad you're here.

12            I would particularly like to welcome special

13   friends and guests of the university who are here

14   with us today.    First, I must introduce U.S.

15   Congresswoman Shelley Berkley.     Thank you so much.

16   Appreciate it.

17            Also I'd like to recognize leaders of the

18   state Democratic party who are here.    I know Clark

19   County Commissioner Tom Collins is here, who's a
20   state chair.   Also I'd like to give a special welcome

21   and thanks to the members of the state of Nevada

22   legislature who are here, members of Clark County,

23   and the City of Las Vegas governmental officials who

24   are here, and also special recognition to the Nevada

25   system of higher education board of regents who are

1    here.   I'm know for sure Regent Thalia Dondero is

2    here.   I don't know if there are others, but thank

3    you for being here.

4             And also members of our UNLV our Foundation

5    and alumni board are here with us this morning, and

6    of course all of you.   I'm so glad you're all here.

7             You know, activities that provide the public

8    with a better understanding of the major issues

9    facing us as a nation are an important aspect of the

10   university mission.   By hosting this presidential

11   forum, UNLV is providing an opportunity for the Las

12   Vegas community to hear from many of our presidential

13   candidates about their perspective on health care.

14            We are delighted to collaborate with the

15   Center for American Progress Action Fund and the

16   Service Employees International Union to host this
17   event.

18            UNLV shares with both of these organizations

19   a commitment to improvement of services and quality

20   of life for all American communities.   We thank both

21   of these organizations who are involved in the

22   University of Nevada, Las Vegas to host this

23   presidential forum on the critical topic of health

24   care which impacts all of our lives, and we commend

25   you for your efforts.

1             American university is looking for a unique

2    challenge as they move into the 21st century.    Among

3    these challenges are population growth, demographic

4    challenges, economic changes of both global and

5    regional levels.   Numerous local challenges that

6    phase today's communities.   The University of Nevada,

7    Las Vegas is no exception.   In fact, UNLV personifies

8    the new American university.   UNLV president David

9    Ashley consistently and frequently says that the

10   University of Nevada, Las Vegas is positioned to

11   build the university of the future.   And the

12   university of the future has its roots with its

13   community.
14           The university strives to demonstrate that

15   traditional higher education value can be adapted to

16   the condition and needs of individuals and

17   communities in the 21st century.   Instructional and

18   research programs, student centered and responsive to

19   the needs of local, regional and national and

20   international communities, artistic, cultural and

21   technical resources and opportunities are

22   intentionally offered to the broadest possible

23   audience.

24           In its brief 50 year history, the celebrate

25   our 50th anniversary in 2007/2008.   I have to say

1    with some concern that I'm older than the University

2    of Nevada, Las Vegas.   We're very proud of our

3    50-year history.

4            UNLV has evolved from a small regional

5    institution with 41 students, three faculty and one

6    building to the state's largest doctoral degree

7    granting institution.   Today the university has more

8    than 28,000 students, approximately 3,000 employees

9    and 99 buildings.   The main campus, where you are

10   here today, located in southwest Las Vegas,
11   classified now in the category by the Carnegie

12   Foundation for the Advancement of Teaching as a

13   research university, consists of more than 350 acres.

14           As we speak, the campus continues to expand

15   beyond the boundaries of the main campus, the

16   satellite campus is a research park, all the way from

17   southeast Asia for the hotel administration and

18   tourism program to Singapore to the future Harry Reid

19   research and technology park in southwest Las Vegas

20   to the health sciences park at Shadow Lane, located

21   in the city's meadows district.

22           This fast-paced dynamic university

23   environment at UNLV is amplified by its location in a

24   rapidly growing metropolitan area whose population

25   now exceeds 1.8 million.   UNLV is an integral part of

1    the Las Vegas community.   Stimulated economic

2    development in addressing social and environmental

3    issues are among the far-reaching influences UNLV has

4    to in great Southern Nevada area.

5            UNLV is firmly committed in our role to

6    serve the area.   Hosting this health care forum on

7    our campus represents the UNLV community partnership
8    that provides an opportunity for public discourse

9    that benefits our society.

10           On behalf of President Ashley and the entire

11   UNLV community, we enthusiastically open our campus

12   to you, and we hope you find the New Leadership on

13   Health Care a Presidential Forum informative and

14   enjoyable.

15           Welcome again and thanks for being here.

16           Thank you.     At this time I would like to

17   invite to the podium John Podesta, president and CEO

18   of the Center for American Progress Action Fund, and

19   Andy Stern, president of the Service Employees

20   International Union.

21           JOHN PODESTA:    Thank you, Dr. Fain, and

22   thank you UNLV.   What a beautiful day.   I don't have

23   time to thank and acknowledge all the people who

24   helped make this event possible and the special

25   guests who are here, but I do want to mention two:

1    Las Vegas' great congresswoman, Shelley Berkley.      And

2    Elizabeth Edwards, who won't be with us this morning,

3    whose grace and strength through her own health care

4    battle with cancer is an inspiration to us all.     I
5    pray for her success.

6             The Center for American Progress Action Fund

7    is proud to sponsor this event at UNLV with SEIU.

8    This forum is not only the first to focus completely

9    on our nation's health care crisis, but it's the

10   first presidential forum ever to take questions

11   directly from the blogosphere via think progress dot

12   org and courtesy of a wide web cast provided by Real

13   Networks.

14            We hope that what happens in Las Vegas today

15   will absolutely leave Las Vegas and set the tone for

16   the entire presidential campaign.   It's simply time

17   to make affordable, quality coverage for every

18   American a reality.   I need don't to tell Nevadans

19   that our health care system is in desperate need of a

20   fix.   More than 430,000 Nevadans, almost one in five,

21   lack health insurance.

22            In terms of health care costs, Nevada had

23   the highest percentage growth and health expenditures

24   of any state over the last 25 years.

25            The situation in Nevada highlights precisely

1    what's wrong with our health care system overall.     It
2    costs too much, it covers too few, and it delivers

3    too little in terms of health of our citizens.

4              Today 45 million Americans are uninsured,

5    including 9 million children.   Since 2000 health care

6    premiums for workers have increased four times fast

7    than wages.   Today the average family insurance

8    policy costs $11,841.   That's a thousand dollars more

9    than a full time minimum wage worker makes in a year.

10             What kind of value do we get for all that

11   money we spend on health care in the United States?

12   Not much.    The U.S. currently ranks 31st in the world

13   in terms of life expectancy, and 28 on infant

14   mortality.

15             You know, I think my grandparents came to

16   the United States from a village in Greece a hundred

17   years ago would actually be shocked to know that

18   people living in that village today have a longer

19   life expectancy than people living in the United

20   States.

21             And in our globalized economy, American

22   business isn't fairing any better.   By 2008 health

23   care costs will exceed profits in Fortune 500

24   companies.

25             Our health care system today violates

1    American's deep commit to human dignity for all and

2    fairness for all, and it hampers our nation's

3    economic competitiveness.

4            The upcoming presidential election presents

5    us with an opportunity.   We can't find leaders who

6    are willing to reject the status quo and provide

7    fundamental change.   We're pleased to have so many

8    candidates with us today and we're also grateful to

9    have an exceptionally talented and accomplished

10   moderator, Karen Tumulty of Time Magazine, to lead

11   today's discussion.

12           Now let me introduce my good friend and

13   ally, Andy Stern.   Andy is an organizer, a visionary

14   and a true champion of workers across the country.

15   Under his leadership SEIU has becomes the fastest

16   growing union in the nation, the largest health care

17   union in the U.S., and one of the most powerful

18   political voices in the country.   I'm personally

19   honored to partner with him on this and other efforts

20   so please join me in welcoming Andy Stern.

21           ANDY STERN:   Thank you, John and CAP, Vice

22   President Fain and UNLV, and of course the seven
23   candidates, but most importantly the 1.8 million

24   members of SEIU who make this first issue forum of

25   2008 election cycle possible.

1              I'd like to introduce the

2    secretary-treasurer of SEIU, the woman who is the

3    highest ranking person in the American labor movement

4    and the head of Change of Win Federation, Anna

5    Burger.   All the members of SEIU, the nurses and

6    public workers, janitors and home care workers who

7    are here with us today.

8              Quality, affordable health care for all

9    Americans is an issue on every American's mind, and

10   we are committed to make sure it's on every

11   candidates agenda.   Pat Moore is a nurse.   She works

12   at the University Medical Center which cares for half

13   of the uninsured in Southern Nevada.   She's just one

14   of the million SEIU health care workers who too often

15   treat the people that the system is failing.

16             Pat talks about a ten-year-old child with

17   diabetes whose family traveled to Nevada simply in

18   search of a good job and a better life.   Diabetes is

19   normally on easily treatable disease, unless you
20   cannot afford the regular $40 cost for Insulin

21   treatment.

22              Her family tried to get by by stretching the

23   medicine out, but sadly with their son, but that

24   didn't work and he was rushed to the ER in a coma.

25   Thank God after three days of intensive care at the

1    hospital he came out of that coma and he recovered.

2               In the richest country on earth, $40 bottle

3    of Insulin should not mean the difference between a

4    child's life and death.

5               Health care in America is no longer just a

6    moral issue, it's an economic issue as well.   America

7    cannot be the only industrialized nation on earth

8    that asks its employers to put the price of health

9    care on the cost of its products when all of its

10   competitors around the world do not.   It is not just

11   a moral crisis, it's an economic crisis.   An economic

12   plan that will not work in a 21st century global

13   economy.

14              Business knows this, which is why the

15   business round table, Fortune 500 companies, AT&T,

16   Intel, Kelly Services and Wal-Mart will be joined on
17   May 8 by many who work.    They're demanding a new

18   health care system.   The public now knows this.

19   Polling in the four early primary states shows the

20   cost of health care is the number one pocketbook

21   concern for voters of both parties.    And a vast

22   majority of Democrat and Republican voters believe

23   everyone has a right to quality, affordable health

24   care, and they want fundamental, not piecemeal change

25   anymore.

1               Governors now know this.   Governor

2    Schwarzenegger and Romney, Democrat Rendell and

3    Malloyovich have plans for all their citizens, as do

4    senators like Ron Wyden.

5               Policy leaders now know this.   Proof is wide

6    ranging as the Center for American Progress and the

7    insurance industry have proposed plans to coverage

8    for all Americans.

9               So what, what are we missing?   Leadership.

10   Leadership in Washington, D.C.   And for the next

11   president here's the final point of our pole:    Voters

12   are saying they're not hearing from you enough about

13   health care.   And in a minute we're going to start
14   solving that problem.

15              But the winds of change of health care are

16   blowing.   It's up to us voters, voters to keep the

17   pressure up, to ask questions.     But more importantly

18   let's demand detailed answers about what they're

19   going to do.

20              America's future is not a matter of chance,

21   it's a matter of choice.    And every four years our

22   choice, voters' choices really do matter.

23              Thank you very much.

24              To guide us through our discussion today is

25   Karen Tumulty, our moderator.     She's a national

1    political correspondent for Time Magazine, widely

2    considered one of the best political journalists in

3    America.

4               Karen has written over 25 cover stories for

5    Time, including this week's.      She will manage this

6    forum, take questions from our internet audience, and

7    ask her own questions.

8               We're lucky to have her here today, Karen

9    Tumulty.   Thank you.

10              KAREN TUMULTY:   Thank you very much.   It's
11   really exciting to be here.   And once again, I want

12   to thank all of you for spending your Saturday

13   morning with us.   I want to thank you on behalf of

14   UNLV, SEIU and the Center for American Progress

15   Action Fund, which is a nonprofit nonpartisan

16   organization.   The lawyers wanted to me to say that

17   part.

18           You're going to see these presidential

19   candidates in the coming months over and over and

20   over again in forums like this.   But this one is

21   very, very different, because this morning you are

22   not going to hear anything about who's got the latest

23   video on YouTube or what the latest back and forth

24   has been on the campaign trail, this morning really

25   gives us an opportunity to drill down into a

1    particular issue and one that pole after pole after

2    pole shows hits home in a way no other issue does

3    with voters.

4            Hopefully at the end of this morning you're

5    going to have a better sense of these candidate's

6    priorities as they address the health care issue.

7    You're going to have a sense of who has a plan and
8    who doesn't, and you're going to have a sense too of

9    whose plan is realistic in this political climate in

10   the environment that presumably they're going to

11   confront as they take office in January of 2009.

12           But before we get to these candidates, I

13   would like just to take care of a few housekeeping

14   issues and maybe some questions you might have as to

15   this forum is going to work.   First of all, I should

16   note that all the candidates of both parties were

17   invited to this forum.   These seven, all Democrats,

18   are the ones who accepted.

19           The order in which they will be speaking

20   this morning is the order in which they accepted the

21   invitation.

22           The format is going to go like this:     Each

23   candidate is going to have 20 minutes.   They're going

24   to have two to three minutes at the beginning to make

25   an opening statement, we'll see how well we can hold

1    politicians to that, and then of the remaining

2    minutes, the remaining 17 to 18 minutes will be

3    divided among questions from myself, questions from

4    this audience, and questions that will be coming in
5    over the internet by e-mail, because this is of

6    course being web cast, now that we're living in the

7    21st century.

8            If any of you decide that you need or want

9    to leave the room during anyone's presentation, you

10   will be allowed to leave but you will not be allowed

11   to come back until the break before the next

12   candidate.

13           And I think at this point we are ready to

14   start, so our first candidate, who I believe is now

15   in the building, is the former Senator from North

16   Carolina, John Edwards.

17           JOHN EDWARDS:     Thank you.   Thank you all

18   very much.   It's a great privilege for me to be here.

19   Let me say first a personal thank you to all of you

20   and the people who have been so kind and so generous

21   over the last few days, including, by the way, my

22   fellow candidates who will be here today.    I'm very

23   proud to have my wife Elizabeth here with me.

24           I also want to thank CAP and the SEIU for

25   sponsoring this forum and for talking about an issue

1    that's so important to us, to all Americans.    And
2    what we have is a dysfunctional health care system in

3    the United States of America.    And what we need is a

4    big, bold, dramatic change, not small change.   And we

5    do not just fix our health care system, we need to

6    fix our military and veterans' health air system.

7            Let me talk just briefly about my plan for

8    universal health care, and then I'm sure we'll get

9    into more detail as we go through this conversation.

10           Basically what we do is cover all Americans.

11   In my plan there's shared responsibilities.    The

12   employers are required to either cover their

13   employees or to pay into a fund that will help pay

14   for coverage for their employees.   The government

15   plays an important role.   The government will set up

16   health care markets all across America, and in each

17   of those markets if you're the consumer, you can go

18   in and choose what your health care plan would be.

19           Some of the choices are private insurers,

20   and then one choice is a government plan, basically a

21   Medicare Plus plan.   And the idea is to determine

22   whether Americans actually want a private insurer or

23   whether they'd rather have government run Medicare

24   Plus kind of single-payer plan.   And we'll find out

25   over time which way people go.

1             This health care plan also covers the cracks

2    that exist in our health care system.   It's complete

3    mental health care, there's coverage for chronic

4    care, coverage for preventative care, coverage for

5    long-term care.   We subsidize health insurance

6    premiums for low income and middle income families.

7    That caps out at about $80,000 of income a year.

8             There are huge cost containment pieces in

9    this health care plan, the requirement of

10   preventative care.   We require by competition lower

11   administrative costs.   We're spending 30 to 40 cents

12   on each dollar, health care dollar today for

13   administrative costs.   We've got to bring those down,

14   bring them down dramatically.

15            We require and demand the use of technology,

16   the use of electronic recordkeeping, both of which

17   are more efficient and help bring down health care

18   costs.   And then we're going to the a systematic way

19   to measure what's working, what's the most effective

20   treatment, how do we get the most effective drugs,

21   the least costly drugs.

22            So the idea is cover everybody, bring down
23   health care costs for every single American, which

24   this plan I believe will do, fill in the cracks in

25   our health care system.

1             And the last responsible party besides the

2    employers and the government are individuals.

3    Everyone in America will be required to by law to be

4    covered by this health care plan.    And the last thing

5    I'll tell you is the cost is 90 to $120 billion a

6    year.   That's the government's cost.   And I pay for

7    it by rolling back George Bush's tax cuts.   Thank you

8    all very much.

9             KAREN TUMULTY:   Thank you, Senator.   And

10   especially after the week that you and your family

11   have had, we so appreciate you being here, and of

12   course everyone's best wishes and prayers go to your

13   family in support of Mrs. Edwards.

14            Of all the candidates that we're going to be

15   hearing from today you are the only one who has a

16   detailed specific plan as to how you're going to get

17   the universal coverage.   And you have been candid

18   enough to say that it involves tax increases.

19            But one of the reasons you have said that
20   you feel so strongly about being specific on health

21   care, and you were much more cautious when you ran in

22   2004, is the personal experience that your family has

23   been through with Mrs. Edwards' illness.

24           And so you on that score, as you had a big

25   decision to make this week, you made it very quickly,

1    but as people look at the situation you are in, that

2    you and your family are in, the fact that you are

3    trying to do two all consuming things here at once,

4    and that however positive the course of this

5    treatment turns out to be, there are going to be a

6    lot personal ups and downs for you over the next year

7    and a half.

8            How are you going to be able to manage both

9    of those, and what do you say to people who are

10   thinking about supporting you, are thinking about

11   contributing to your campaign that are really worried

12   about your ability to take care of two all consuming

13   things at one time?   Will you be in this race for the

14   duration?

15           JOHN EDWARDS:    Oh, I'm definitely in the

16   race for the duration.   What is shows from our own
17   personal experience, this is not the first challenge

18   like this Elizabeth and I have been through.    As many

19   of you know we lost our son about ten, actually about

20   eleven years ago now in 1996.    And we've gone through

21   Elizabeth's first round of breast cancer treatment.

22   We went through that together.

23              So we know what it's like to function in a

24   very difficult environment.    And there is a focus and

25   a maturity that I think is requires to be able to do

1    that, but I know, because I've done it in the past

2    that we can do it.   I know because of the nature of

3    woman I'm married to that she will be there ever

4    single step of the way making sure that we do it.

5               And we take our responsibility to serving

6    this country very seriously.    And it is the reason

7    I'm running for president because I love this

8    country.   I think we can do so much better than we're

9    doing now.   And we want to serve, both of us, which

10   is why we made the decision to go forward.

11              But I want to add one thing, because there's

12   been an awful lot of attention focused on the two of

13   us, and I think we're getting far too much credit.
14   When you look at all the millions of women who had to

15   struggle with the same sort of struggles that

16   Elizabeth has had, and many of them had to struggle

17   without what we have, without great health care

18   coverage, without knowing they're going to be able to

19   get all the medicine and medications that they need.

20   One of the reasons that I want to be President of the

21   United States is to make sure that every woman and

22   every person in America gets the same kinds of things

23   that we have, because it's not right that a woman has

24   to go through, or anybody has to go through this kind

25   of struggle and have to worry about whether they can

1    afford the medicine they need, whether they can get

2    the health care that they need.   We don't have to

3    worry about that.

4             And no American should have to worry about

5    that.   And as Elizabeth said just a couple of days

6    ago, you know, for us, we can focus on what needs to

7    done for our family and for our country, but a lot of

8    women with exactly the same diagnosis had to get up

9    the next morning and go to work and the next morning

10   and go to work.   So before we start giving too much
11   credit to us, let's do what we need to do for all of

12   us.

13           KAREN TUMULTY:    Thank you, Senator.   One of

14   the criticisms of your plan has been that it

15   doesn't -- it's not aggressive enough in dealing with

16   health care costs.   You talk about saving money

17   through preventative care, through using technology

18   that is available but that really isn't being a lot

19   in the health care industry.

20           But right now I'd like to turn to one of the

21   members of our audience, a Jackie Marco, who is the

22   owner of a small business who wants to know how you

23   are going to -- how are you going to come to grips

24   with the kind of rising health care costs that he has

25   to deal with every day and that threaten his

1    business.   And, Jack, are you here?

2            JACK MARCO:   Yes, I'm a business that just

3    completed our collective bargaining agreement with

4    our employees.   And for the last 20 years we've

5    provided health insurance for them, and every year it

6    becomes more difficult.

7            And because in the process when it came down
8    to talking about wages, we had to offer less and the

9    employees had to accept less than they would like or

10   we would like to give because of the money we had to

11   pay off on health care.

12           At the same time I had to compete in an

13   industry with other people doing the same kind of

14   business I do.   So the cost that I have for my 75

15   employees compared to another firm means that I have

16   to pay -- I have to charge higher fees for the

17   services I provide; and likewise, I have to

18   provide -- I can only provide a certain level of

19   wages that perhaps a competitor could provide more

20   because they don't provide health insurance.    So my

21   question is as the President what would you do to

22   take care of this competitive problem?

23           JOHN EDWARDS:     Did you say you have 75

24   employees?

25           JACK MARCO:   Correct.

1            JOHN EDWARDS:     75.   Well, first of all, I

2    think that this plan deals directly with the concerns

3    that you have.   We have a competitiveness issue not

4    only between you and your competitors here in
5    America, we have a huge competitiveness issue, if I

6    can say the word, between our businesses in America

7    and the rest of the world.

8             We have extraordinary health care costs,

9    which you're dealing with every single year in the

10   operation of your business.   Those costs have to come

11   down.   But in addition to that, what we want is if we

12   have a truly universal health care plan that covers

13   every single American from the time they're born

14   until the time they die.   It makes American business

15   more competitive in the world.

16            We're spending 17, $1800 on health care

17   costs on every car that's manufactured in America,

18   compared to about $250 in Japan.   Creates a huge

19   disadvantage.

20            What this plan specifically does for your

21   situation is it gives you market power that you don't

22   have today.   I mean, individuals in small businesses

23   have no market power, and as a result you pay

24   extraordinary health care costs.

25            So what we do is we set up these health care

1    markets is we create the same market power for you
2    that exists for the biggest corporations in America.

3    These markets will require competitive bidding to get

4    into the markets, and also these private insurers are

5    going to have to compete with the government plan

6    with extraordinary low administrative costs, two,

7    three percent in all likelihood.   So that competition

8    will bring down costs.

9            In addition to that, these things that Karen

10   just made mention of, use of technology, electronic

11   recordkeeping, preventative care, mandatory

12   preventative care so that we are healthier, we are a

13   well people will bring down costs for everybody.

14           So I think sort of the bottom line for you

15   is we will bring down health insurance costs on the

16   whole for what you have to pay.    Second, your cost

17   directly will be lower because there will be a level

18   of competition that does not exist today, and you

19   will have the market power that does not exist today.

20           I actually believe that besides the

21   uninsured I think we have a moral obligation to,

22   besides the uninsured the people who benefit the most

23   from this health care plan are individuals and

24   smaller businesses.   I think that's the greatest

25   beneficiary of this plan.

1            KAREN TUMULTY:   Senator, the health care

2    problem has been with us for a very long time.    The

3    last time a significant effort was undertaken to

4    address it it never even got to a vote on the floor

5    of either House of Congress because of so many fronts

6    of opposition.   And of those the most important I

7    think the strongest was business.

8            So we have a question coming in over e-mail

9    from Mary in Illinois who wants to know do you have a

10   strategy for engaging American businesses in

11   achieving health care coverage for all Americans?

12           JOHN EDWARDS:    Yes, because what we want to

13   do is we want to make American business competitive.

14   We want to bring down the cost of health care, not

15   just for individuals, which we do, but also for

16   American business.

17           And so this plan does all those things.      We

18   just talked about it in the context of a small

19   business, but it actually applies to all businesses.

20   What happens is because we're bringing -- there are

21   huge cost containment elements in this plan, which I

22   won't go through again, I've gone through it.    And
23   because we are subsidizing health insurance premiums

24   for low income and middle income families this has

25   the effect of bringing down health care costs for all

1    businesses.

2            The SEIU and Andy Stern had a press

3    conference a few weeks ago with some very large

4    American businesses who were committed to achieving

5    universal health care, which is a very good thing.

6    And what I believe that actually American businesses

7    have now figured out that something has to be done

8    about our health care system that is making them

9    increasingly uncompetitive with respect to the rest

10   of the world, and that universal health care, done

11   the right way, with the right choices and the right

12   efficiencies, will actually help American businesses

13   not just help the 47 million people who don't have

14   health insurance.

15           KAREN TUMULTY:   Well, there are going to be

16   candidates who come out here today who suggest that

17   it's possible to do this, to achieve universal

18   coverage without raising taxes, without new sources

19   of revenue.   You have been very up front about the
20   fact that your plan does involve tax increases.       Do

21   you think it's possible to get their without them?

22             JOHN EDWARDS:   No, I do not.   I spent a

23   great deal of time studying this issue, working with

24   health economists around the country.     I've spent

25   many months on this.   The plan just came out a few

1    weeks ago, my plan just came out a few weeks ago.

2    I've spent a great deal of time working on this

3    issue.

4              I do not believe you can have universal

5    health care without find a source of revenue.    There

6    has to be some additional source of revenue.    We

7    don't get universal health care for free.    You have

8    to cover 47 million people who don't have coverage.

9    There's going to be a cost associated with the

10   transition from the health care system we have today

11   to a truly universal and more efficient health care

12   system.

13             So, no, I do not believe it can be achieved

14   without finding an additional source of revenue.       And

15   the joke I always make about it is that American

16   people have heard so many politicians for so long
17   say, Oh, we're going to have universal health care,

18   we're going to transform the way we use energy in

19   America, we're going to end poverty in America, and

20   in process we're going to eliminate the federal

21   deficit.   They probably got a bridge in Brooklyn they

22   want to sell you too.

23              I don't think it could be done.   I think

24   it's very important, if I could say one last thing

25   about this, I think it is really important,

1    particularly given what's happened in the last six,

2    seven years in this country, that the President of

3    the United States be honest with the American people.

4    And I also think that honesty starts right here in

5    the campaign.

6               KAREN TUMULTY:   And if you were putting

7    together your health care plan, there are people who

8    argue that the whole idea of basing your health

9    coverage on where you work is just an anachronism.

10   It's a historical accident.

11              JOHN EDWARDS:    Yes.

12              KAREN TUMULTY:   You, however, chose to build

13   on that system.   Why is it that you didn't, as some
14   people suggested, why did you reject the idea say of

15   government run Medicare for everybody or some other

16   form of health care that would again get rid of a

17   system that is essentially a historical accident.

18           JOHN EDWARDS:    Well, there's a judgment that

19   has to be made on the front end.   It is true that

20   single-payer health care systems in the world

21   dramatically reduce costs and significantly reduce

22   administrative costs, particularly compared to

23   private insurers.

24           It's also true that a lot of people who are

25   listening to this forum like the health insurance

1    they have now and would like to keep it.   And my

2    judgment is, number one, to get it done so that we

3    don't spend another decade arguing about whether we

4    keep the system we have now or actually have

5    universal health care.

6            I think this is system, my proposal, a truly

7    universal plan, a bold plan, but doesn't go directly

8    to single-payer, can be accomplished.   I think it can

9    be accomplished politically.   I think we can get

10   support from across the political spectrum and will
11   accomplish a lot of what we want to do.

12              Second, it does give people choice.   And I

13   think Americans have become accustomed to having

14   choice, and I think they want to be able to choose

15   what their health care plan is.

16              Now, it may be that that gravitates towards

17   a single-payer plan because they will have the

18   Medicare plus the choices.    And if that's the case,

19   then the whole system can go in that direction.      But

20   you'll decide that.   Consumers will decide that.

21              So I think actually this plan makes sense in

22   terms of moving us forward, getting a universal

23   health care plan in place, giving people the choice

24   of the equivalent of a single-payer plan with

25   Medicare Plus, and then we'll see where it goes from

1    there.

2               KAREN TUMULTY:   I think he have time for one

3    more question from the audience, and this is on a

4    subject that's very near and dear to a lot of SEIU

5    members.   Reggie Warner is an RN from UHS Desert

6    Springs Hospital.   Are you here?

7               REGGIE WARNER:   Hi, I'm Reggie Warner.   I'm
8    a new nurse at UHS Desert Springs Hospital.   I see

9    what happens to patients every day in the hospitals

10   because of short staffing.   And I also see what

11   happens to nurses who leave the hospital because of

12   job burnout and overall dissatisfaction.   What do you

13   plan on doing for state staffing and nurse retention?

14           JOHN EDWARDS:   Well, we have a huge nursing

15   crisis in America, which obviously you know about

16   firsthand.   I think a part of that crisis is dealt

17   with by achieving a truly universal health care

18   system where everyone gets reimbursed at a fair rate

19   for the services they're providing.   And in the

20   context of achieving this universal health care

21   system, we can regulate in a way that requires the

22   staffing be adequate.

23           What we're seeing now, as you know, nurses

24   working extraordinary -- nurses, who are the primary

25   caregivers in a hospital, certainly in a hospital

1    setting, they spend a lot more time with the patients

2    than physicians do, and in many cases they're

3    stressed, they're working long hours and they're

4    terrified, as you know, because I hear it every time
5    I talk to a nurse, they're afraid that the results of

6    all this is they're going to make a mistake, and the

7    patient is going to be the one who suffers.

8               So I think we need to, in addition to having

9    a truly universal system, in addition to regulating

10   in a way that keeps staffing at an adequate level,

11   which is much easier to accomplish in the context of

12   a universal health care system.

13              I think in addition to that we, as a nation,

14   need to make a commitment to beef up our availability

15   of nurses, which means more investment, more

16   scholarships in nursing schools.    It means providing

17   incentive to get nurses who have graduated to the

18   places where they're needed the most where the

19   nursing shortage is most severe.    In other words,

20   incentive pay, some help from the government to help

21   attract nurses to go to the places where they're

22   needed the most.   And then create a working

23   environment that allows nurses to be the

24   professionals that is they so desperately want to be.

25              KAREN TUMULTY:   That's our time, Senator

1    Edwards.   And, again, thank you very much for being
2    here, and best wishes going forward.

3            JOHN EDWARDS:    Thank you.   Thank you all

4    very much.

5            KAREN TUMULTY:    The next candidate that we

6    are about to hear from is a neighbor, Governor Bill

7    Richardson of New Mexico.

8            BILL RICHARDSON:    I want to thank SEIU and

9    the Center for America Progress for putting this

10   event together.   And my first thoughts and Barbara,

11   my wife's first thoughts today are for Elizabeth

12   Edwards and the Edwards family in this very trying

13   time.

14           And if there's one message about policy

15   message related to this situation is that as

16   Americans we should spend more, invest more in cancer

17   research and the National Institute of Health and

18   many of our entities that are underfunded and with

19   flat budgets.   We should invest more in stem cell

20   research.    We should find ways to invest in the

21   diseases in this country.

22           We, as Americans, are in crisis today.      As a

23   governor I have to deal with the health care crisis

24   every day.   We got a problem with increasing access,

25   coverage and controlling costs.   Since the year 2000,

1    health care premiums have increased for American

2    families about 80 percent.   4,000 Americans lose

3    health care coverage every day.    We spend $2 trillion

4    on health care.   31 percent of health care costs are

5    spent on bureaucracy and red tape instead of direct

6    care.

7              It is critically important that we device a

8    strategy, first of all, that doesn't create any more

9    bureaucracy we have enough bureaucracy.   As a

10   governor I've been able to control costs.   I've even

11   cut taxes for working families and at the same time

12   expended coverage.

13             So what would I do as a President?   First,

14   to deal with increasing coverage; number one, all

15   Americans and all businesses should have the same

16   coverage, should be able to purchase coverage as

17   members of Congress and the President of the United

18   States.   We need to do that and we need to do that.

19             Number two, I would start something new.

20   Americans 55 and older should be able to purchase

21   coverage through Medicare.   Today it's at 65.

22             Number three, a trade.   And this is how a
23   governor would operate.   The federal government,

24   Medicare goes to treat seniors and the disabled.    In

25   exchange for the state dealing and increasing

1    Medicare coverage for children and families.

2            And number four, veterans.    We should give

3    our military veterans the access they need anywhere

4    they want, any time they want.   And I would have a

5    heroes health card that would enable our veterans

6    when they get out to get coverage choices anywhere

7    they want.    They should not have to drive 200 miles

8    to the nearest VA hospital.

9            Now, this is how I would deal with coverage.

10   What about costs?   I would have a cooperative plan

11   between the employer, businesses, the state and the

12   federal government.   I would propose a refundable tax

13   credit for those Americans that need coverage based

14   on income.

15           Number two, I would clamp down on credit

16   card companies that are covering excessive interest

17   rate costs.   I have a health secretary who her

18   brother is paying 18 percent.    A lot of Americans pay

19   their health care through credit cards.   18 percent
20   interest rate.   I would put a cap on those costs.

21              I would also make sure that we have a

22   prevention strategy, early prevention, kids.   As a

23   governor I eliminated junk food in schools.    I just

24   signed a statewide smoking ban and I would that as

25   president.    I would have a promotion of healthy

1    lifestyles.   Gave tax credits to companies that

2    encourage their workers to be healthier, to

3    exercises.

4               I would also make sure that we have a

5    strategy to deal with a 31 percent of excessive

6    health care costs and bureaucracy by electronic

7    records.   I would also find ways to ensure that we

8    have an answer, how do we pay for this?   This is how

9    I would pay for this health care plan.

10              Number one, we reorder priorities in this

11   country.   We get out of Iraq and put the $400 billion

12   that we have in Iraq and shift it to human needs.

13              Number two, we spend 2 trillion on health

14   care.   We shift and reorder priorities in terms of

15   reducing inefficiencies in our system.

16              And number three, we would offer options for
17   all Americans to get health care coverage.     Workers

18   must get health care coverage.   But you help them.

19   But you help them if they need it.    And businesses.

20   And small businesses have to participate in health

21   care plans for all those employees.

22           That's what I would do as President.      This

23   is a plan that would not add bureaucracy.     This is a

24   plan that could be paid for without any new taxes.

25   This is a plan I believe that says to the American

1    people, if I have a health care plan and I'm

2    satisfied with it, I could keep it the way it is.

3            I believe also that as Americans we have to

4    ensure prevention.    That is so important.   Making

5    sure that we start early, making sure that we promote

6    healthy lifestyles.    That would be my plan as

7    President.

8            KAREN TUMULTY:    Governor, I'm afraid if

9    you're attacking junk food you've already lost my

10   ten-year-old's vote.

11           So how quickly under your plan do you think

12   you could get to true universal coverage?

13           BILL RICHARDSON:    I believe with a
14   Democratic President, a Democratic Congress, a

15   stronger Democratic Congress I believe this plan that

16   I outline, which is basically a plan that is taking

17   new ideas into an existing framework could be

18   achieved my first year as President.    I believe it's

19   doable.

20             I believe what you're talking about is a

21   shift in laws, for instance a trading of the federal

22   role in Medicare, the state role in Medicaid for

23   S-chip in children.   I believe what we're talking

24   about too is within the cost structure, when you're

25   spending 2 million on health care, remember they are

1    47 million uninsured in this country, and we're

2    already paying for it.     It's already being paid for.

3    They're in emergency rooms.    We're all paying for

4    this.

5              So it's a question of shifting priorities.

6    So what we're talking about is I believe a very

7    aggressive plan with new ideas that could be achieved

8    the first year that I'm President.

9              KAREN TUMULTY:   You know, as Washington has

10   failed to address this problem you and your fell
11   governors have moved forward and stepped into the

12   breach; however, one of the most controversial

13   aspects of the plan that Governor Schwarzenegger just

14   recently unveiled in California is his proposal that

15   illegal immigrants be covered under his plan.     How

16   would you see under your plan bringing in this very,

17   very large segment of the population into the system

18   or not?

19              BILL RICHARDSON:   They're children.   We

20   should cover children.   We should cover children, as

21   long as they pay their fair share with everybody

22   else.   An essential component of my plan is that we

23   all pay:   Employers, employees, the government.       But

24   we help each other pay the fair share.

25              The way you deal with immigration, one, yes

1    we have to secure our borders, no question about it.

2    Not with this stupid wall that is being proposed.

3    But you also set up a legalization plan for the 12

4    million undocumented workers that are in this

5    country.   Maybe it's not very popular, but it makes

6    sense based on setting a path to legalization that

7    involves dealing with issues like health care that
8    involves if they learn English, if they pay back

9    taxes, if they pass a background check.    They don't

10   get ahead of the line of those that are trying to get

11   her legally.   These are children.   We should insure

12   all children in this country.

13            KAREN TUMULTY:   We have a question from

14   David Slater in our audience, who's taken a look at

15   the kind of health care that Congress gets and wants

16   to know why he can't have it too.

17            DAVID SLATER:    The governor brought up, back

18   to my question, all members of Congress, Senators,

19   staff, postal workers are all in a great plan

20   sponsored by the federal government.    I was in that

21   plan.   I'm a retired postal worker.   It's a fabulous

22   plan.   Why reinvent the wheel?   We already have an

23   existing system that can function.     We don't need any

24   more bureaucracy, as you mentioned, just implement

25   that plan to everybody here in this room with

1    everybody a U.S. citizen to have the same plan.       As

2    Senator Edwards said, he's comfortable.    Every

3    federal worker is very comfortable in that plan.

4    Every postal worker has that plan.     They have an
5    option to pick from any insurance company they want.

6    Why not just give it to the United States citizens

7    right now?   And the governor says that's something I

8    can't believe can be implemented within one year.

9            BILL RICHARDSON:     Well, look, that's the

10   cornerstone of my plan that deals with coverage.      In

11   other words, you know, the members of Congress, the

12   President, they get the best plan in the world.    They

13   have all kinds of options.

14           What I'm saying is offer that to every

15   American, to every business, to every American Family

16   in that federal health care system.   I totally agree

17   with you.    It's an excellent question.   Thank you.

18           KAREN TUMULTY:    We also have a question by

19   e-mail from Ken in Olympia, Washington who wants to

20   know how do you feel your experience as governor of

21   New Mexico has prepared you to find solutions for the

22   rising cost of health care and to achieve the goal of

23   affordable health care for all.

24           And if I can just add on to that, could you

25   talk a little bit about, you know, what you've

1    learned, what parts of the problem, the health care
2    problem in dealing with it in New Mexico turned out

3    to be harder to confront than you thought they were

4    going to be?

5             BILL RICHARDSON:   As a CEO of a state

6    governors have to deal with this issue every day.

7    And the most I believe innovative programs in this

8    country are happening in the states in experiments to

9    cover our people, all our people and also control

10   costs.

11            As a governor, my approach has been, and my

12   state is one of the highest uninsured, it's about 20,

13   21 percent.    Ten percent of those are Native

14   Americans that are supposed to be covered by a

15   federal health care system, and they're not.     But the

16   federal government is abdicating.   So we try to help

17   with state programs.

18            What we need to do and is what we do in the

19   state.   I started out with a health care plan dealing

20   with this access issue.   Number one, we were able to

21   insure all children under five.   Now we're trying to

22   cover all working adults.   The next phase will be try

23   to cover the chronically unemployed.

24            But we have attacked the prevention issue

25   aggressively, as I mentioned.   We cut junk food out

1    of schools.    I signed recently last week a statewide

2    smoking ban.    We should nationally give incentives to

3    companies that give their health care workers time to

4    exercise or an opportunity to build a healthier

5    lifestyle.

6               We should find ways also that in the

7    American system we encourage the American people to

8    start earlier, early childhood, preschool.    This is

9    so important.   School based health centers at all our

10   schools.    But also recognize that it's going to take

11   research.    It's going to take efforts, aggressive

12   efforts to deal with deadly diseases, to deal with

13   malaria, to deal with issues that relate to suicide

14   prevention for children, to deal with issues that

15   relate also for children that have sickle cell anemia

16   or diabetes prevention.

17              We don't focus enough on prevention.   And

18   prevention, we spend 75 percent of health care costs

19   on chronic diseases and only five percent on

20   prevention.    That should shift.

21              KAREN TUMULTY:   We also have a question from

22   another SEIU member in the audience, Tracy Powell,
23   who works for the Department of Family and Services

24   in Clark County and is really on the front lines

25   every day of seeing another aspect of the health care

1    crisis.

2              TRACY POWELL:   Good morning.   I am a social

3    worker for Clark County Department of Family Services

4    and a member of SEIU.     On a daily basis we see how

5    mental health services and substance abuse issues

6    impact children and families.

7              Typically there's very limited resources for

8    mental health.   How would you address the mental

9    health services and the care provided and coverage

10   provided for mental health services?

11             BILL RICHARDSON:   Well, for years mental

12   health has been given lower priority in health care

13   than almost any other problem.    One out of five

14   Americans has some kind of mental health problem,

15   including schizophrenia and depression.    And for

16   years in terms of insurance and coverage we've

17   neglected mental health.

18             As President I would not do that.   What we

19   did in New Mexico is we brought all mental health
20   bureaucracy programs under one roof into what's

21   called a mental health collaborative.   And we need

22   aggressive efforts to include mental health in all

23   types of coverage.   We need to find ways also that we

24   deal with substance abuse.   You mentioned that.

25           In New Mexico and the west, and Nevada right

1    here, meth is the biggest problem, and we don't have

2    answers in terms of how we can best treat it.    If

3    you're going to deal with substance abuse, mental

4    health problems, alcoholism, what is critically

5    important not just law enforcement incarceration, but

6    treatment and education, an investment in serious

7    substance abuse programs that can make things better.

8            KAREN TUMULTY:   Governor, does that suggest

9    that you support full parody for mental health

10   coverage?   Certainty your senior Senator of your

11   state, Pete Domenici, has been very outspoken who's

12   been a national leader on that very subject, but

13   opponents say, look, this is just going to, talk

14   about rising costs, the costs would just explode if,

15   in fact, mental health services were covered the same

16   way as physical health services.
17           BILL RICHARDSON:   I would include mental

18   health services.   Yes, I would.   But, see, everybody

19   is talking about costs.   What I'm saying is if we

20   manage our health care system more efficiently,

21   eliminate a lot of the duplication.    Just think,

22   31 percent of our health care costs is bureaucracy

23   and red tape, and it's not direct care.    If we find

24   ways to make that more efficient, with perhaps

25   electronic records, with, you know, you have 50

1    states managing 50 Medicaid programs.    You've got a

2    Medicare system that has hundreds of health care

3    plans administering it.   If you're able to find an

4    elimination of that bureaucracy and red tape and make

5    it more efficient, you would have that 31 percent go

6    more to direct care.

7            So those that say you need to increase the

8    tax, you need to find other sources of revenue, I

9    believe we can do it within the existing system and

10   cover all Americans and control costs and be fair.

11   But essential component of the plan that I learned is

12   that we have to be part of it:     Employers, employees,

13   state, the federal government.     It's a cooperative,
14   collaborative relationship catalyzed by the

15   government.   Making health care universal coverage

16   something that we can do I believe, as I said, within

17   a year.   I believe it's doable.

18             KAREN TUMULTY:   Well, I think we have time

19   for one more question, and that would be so you

20   proposed basically building on the existing system

21   that we have and attacking this problem from a number

22   of different directions.     Which one do you do first?

23             BILL RICHARDSON:   Well, you have to do them

24   both at the same time.     You have to control costs,

25   and you have to expand health care coverage.    But I

1    propose, as you said, some new ideas within an

2    existing system.   And the new ideas are the trade

3    between Medicare and Medicaid, what the states would

4    do.   It has to be an exchange.    We have to make sure

5    that the states do spend money on S-chip, on

6    children, on families.

7              And new initiative would be what this

8    gentleman proposed, and that is let all Americans,

9    businesses, families be part of the federal health

10   care system that the Congress enjoys, and with our
11   veterans.    I mean, you're talking about a sizable

12   population.

13           Give them access anywhere they want to go.

14   If it's two blocks from their home, they have to

15   drive miles and miles.   This is all new within an

16   existing system.   And then finally, just find ways to

17   ensure that the states and the federal government

18   have a cooperative relationship.

19           I'm a governor.    It's very hard for us to

20   get waivers to do some of the experiments that are so

21   important to the SEIU, to the American people.    The

22   bureaucracy strangles our system so much that a major

23   component has to be a way to tame the bureaucracy so

24   that it to works for people and not against people.

25           KAREN TUMULTY:    Well, thank you very much,

1    Governor Richardson.

2            Our next candidate that we are going to hear

3    from this morning is Illinois Senator Barack Obama.

4            BARACK OBAMA:    Well, thank you so much,

5    everybody.    It is wonderful to be here.   Thank you to

6    UNLV for helping to sponsor this event, to CAP for

7    the outstanding work you do, but most of all thanks
8    to SEIU.

9               I've got a history with this union.   When I

10   was a young organizer I had just moved to Chicago.      I

11   started with working with SEIU Local 880, home health

12   care workers to make sure that they were registered

13   to vote.   I had a say in the politics in Illinois.

14   When I went to the state legislature I worked with

15   Tom Balanoff in SEIU to make sure that children who

16   didn't have health care received it.   And we made

17   sure that hospitals to report on the quality of care,

18   the staffing ratios that they had set up, and now

19   we're working together at the federal level to make

20   sure that all Americans, not just some Americans, are

21   allowed to prosper.

22              But the thing that I appreciate most about

23   SEIU and Andy Stern and Anna Burger is you guys

24   recognize this world is not standing still.      And

25   we've got to take the values that have made America

1    great but we have to adapt them to new times.

2               And we know what those challenges are.

3    Because of globalization, because of automation, what

4    we're seeing is increasingly a situation in which the
5    benefits of this new economy accrued to just some and

6    leave too many behind.   Wages, salaries have flat

7    lined and benefits are diminished.

8            And the message that we've heard over the

9    last six years is, You're on your own.   The troubles,

10   the difficulties, the burdens of globalization are

11   going to be placed on the backs of workers.   But

12   there's always been another vision that says we're in

13   it together and that the burdens and benefits of this

14   new economy have to be spread evenly across the

15   economy, and nowhere do we see that more than in the

16   issue of health care.

17           Everybody here knows the statistics.     We as

18   a nation spend $2 trillion every year, more than any

19   nation on earth, and yet we still have 47 million

20   people who are uninsured, 9 million children who are

21   uninsured.   We've got families who are being bankrupt

22   as a consequence of rising costs and we've got

23   businesses that are being rendered uncompetitive

24   because of these rising costs.

25           Now, everybody on this stage is going to

1    have a plan to move this health care debate forward.
2    I will be putting out a plan over the next couple of

3    months that details how I would approach the basic

4    principals that by the end of the next President's

5    first term, by the end of my first term, that we're

6    going to have universal health care for every single

7    American in the United States.

8             And there are going to be some basic

9    principals; that coverage has to be universal, that

10   we're going to have to save costs and get more bang

11   for our health care dollar, that employers,

12   government and individuals are all going to have to

13   put up something, and that savings that we obtain

14   from making a more efficient system can be just

15   obtained by hitting front line workers.

16            But in addition to those basic principals I

17   think, what I think is most important is we recognize

18   that every four years we hear somebody has got a

19   health care plan.   Every four years somebody trots

20   out a white paper, they post it on the web, but the

21   question we have to challenge ourselves is do we have

22   the political will and the sense of urgency to

23   actually get it done.

24            I want to be held accountable for getting it

25   done.   I will judge my first term as President based

1    on the fact on whether we have delivered the kind of

2    health care that every American deserves and that our

3    system can afford.   And I'm not going to be able to

4    do in on my own so I hope that the SEIU will partner

5    in that process.   Thanks, everybody.

6            KAREN TUMULTY:   Thank you, Senator.   You

7    gave a speech in January where you said that the time

8    for half steps and the time for half measures and

9    health care is over with.

10           BARACK OBAMA:    Right.

11           KAREN TUMULTY:   But thus far we haven't seen

12   a plan from you yet and so I'm going to turn my first

13   question over to Morgan Miller who went on your

14   website looking for specific answers and didn't find

15   them, so I'm going to give him a chance to ask you

16   those specific questions now.     Morgan?

17           MORGAN MILLER:   I like many young Americans

18   went on your website to find some information about

19   you, and all I saw when it came to addressing the

20   health care issue was things like HIV, which is very

21   important, and issues like lead poisoning.

22           And so I was wondering what really are your
23   top issues when you want to talk about health care?

24   Are you going to address the pharmaceutical

25   companies?   Are you going to address the insurance

1    companies, because it's not online.

2            BARACK OBAMA:   Right.   Well, keep in mind

3    that our campaign now is I think a little over eight

4    weeks old.   And so we will be putting a very detailed

5    plan on our website.

6            One thing I want to make sure of is that

7    you're going -- I'm not sure whether you're going to

8    the campaign website or my Senate website.    So we

9    haven't transitioned all that information from our

10   Senate website over to the campaign website.

11           But, as I indicated before, my commitment is

12   to make sure that we've got universal health care for

13   all Americans by the end of my first term as

14   President.   There are some basic principles that this

15   plan will have.

16           Number one, we're going to have to make sure

17   that everybody is in.

18           Number two, we've got to make sure that we

19   apply some principles because I think every expert
20   agrees to in terms of how we save money and get more

21   out of the dollars that we're already spending.    For

22   example, we've got to put more money in prevention.

23   It makes no sense for the children to be going to the

24   emergency room for treatable ailments like asthma.

25   And if we are giving them regular checkups with their

1    primary care physician, then we're going to save

2    money in the system.

3             Twenty percent of our patients who have

4    chronic illnesses account for eighty percent of the

5    costs.   And so it's absolutely critical that we

6    invest in managing those with chronic illnesses, like

7    diabetes.   If we, for example, hire a case manager to

8    work with them to ensure that they're taking the

9    proper treatments, then potentially we're not going

10   to spend $30,000 on a leg amputation if they're

11   diabetic.

12            Application of medical technology can not

13   only reduce administrative costs but it can also

14   improve quality and reduce medical errors.   We're

15   going to have to take those savings and apply them to

16   those persons who can't afford health insurance so
17   that they can buy into the system that we're

18   subsidizing them in some fashion.

19              Another principal is that it's going to have

20   to be some form of pooling of costs of risk.     And

21   there are going to be a number of proposals, and

22   they're out.   I heard in some of the previous

23   questions that one pool would be the federal pool

24   that already exists for myself and other federal

25   workers.   Some states, like California and

1    Massachusetts, already started to set up their pools.

2               Whatever the mechanism, we going to have to

3    have a pooling system so that individuals have the

4    benefits of being part of a larger group.

5               And the final thing that I'll just mention

6    is that we're going to have to do something serious

7    about quality and how we spend our money.     Not only

8    do we have to put more money in prevention, but we've

9    also got to make sure that, for example, if a generic

10   works just as well as a brand name drug, that we're

11   not fighting drug companies to dictate what is on the

12   formulary, what drugs are available under a plan but

13   we make sure that the money is spent on the most
14   efficient drug for that particular disease.

15           If we do all those things, I believe there's

16   no reason why we can't end up with the kind of health

17   care system that would ensure that every American has

18   high quality, basic health care.   Now, I promise you

19   that this will all be on the website.   If we have

20   another forum in a couple of months and it's still

21   not there, I'll be in trouble.

22           KAREN TUMULTY:   Senator, on the question

23   that is really the lynchpin of all these other

24   questions, which is coverage, there are only a few

25   ways of getting there.   Could you at least give us a

1    sense of where you're thinking is on this?    Have you

2    accepted or rejected any of the concepts like an

3    employer mandate or require that employers provide

4    coverage?   An individual mandate where people would

5    have to buy into the system they way they do with

6    auto insurance?   Are you wedded, for instance, to

7    this idea as the first two candidates were that we

8    basically should stick with this system in which most

9    people get their coverage from their employers or

10   have you found any positives to the idea that's being
11   offered by your colleague, Ron Wyden, to essentially

12   break that system and come up with a new one?      Could

13   you at least give us a sense of, you know, which

14   possibilities here intrigue you and which ones that

15   maybe you're dismissing at this point?

16           BARACK OBAMA:   Well, we have a plan that we

17   are in the process of unveiling.   What we want to do

18   is try to set up a series of round table discussions

19   before we actually announce it.    Not just with

20   experts, which we've already done, but rather with

21   frontline workers, with nurses, with doctors, with

22   consumers, which we're going to be scheduling over

23   the next couple of month in terms of rolling it out.

24           But let me just address a couple of points.

25   As I indicated before, I think that we're going to

1    have to some system where people can buy into a

2    larger pool.   Right now their pool typically is the

3    employer, but there are other ways of doing it.

4            I would like to -- I would hope that we

5    could set up a system that allows those who can go

6    through their employer to access a federal system or

7    a state pool of some sort.   But I don't think we're
8    going to be able to eliminate employer coverage

9    immediately.   There's going to be potentially some

10   transition process.    I can envision a decade out or

11   15 years out or 20 years out where we've got a much

12   more portable system.   Employers still have the

13   option of providing coverage, but many people may

14   find that they get better coverage, or at least

15   coverage that gives them more for health care dollars

16   than they spend outside of their employer.   And I

17   think we've got to facilitate that and let

18   individuals make that choice to transition out

19   employer coverage.

20           I do believe that employers are going to

21   have to pay or play.    I think that employers either

22   have to provide health care coverage for their

23   employees or they've got to make a decision that

24   they're going to help pay for those who don't have

25   coverage outside the employer system.   So I think

1    that's one important principle.

2            And as I said, the second important

3    principle is that we're going to have to put more

4    money into prevention, more money into chronic care
5    management, more money into medical technology,

6    because that is how we're going to accrue the savings

7    that help us provide subsidies to those who don't

8    already have it.

9               KAREN TUMULTY:   Now I think I'd like to turn

10   to a question from one of our UNLV students who's

11   here, and I'm not going to make the mistake as I did

12   with Morgan and assuming this is a male.      Michael

13   Lyle is a journalism student, and I probably ought to

14   talk to you afterwards about the wisdom of that.         Are

15   you here, Michael?

16              MICHAEL LYLE:    Yes.   Currently there are

17   major disparities in both access to insurance and

18   health care for racial and minorities.      How will your

19   plan address this issue?

20              BARACK OBAMA:    Well, one of the biggest

21   reasons that there are disparities is that African

22   Americans, Latino Americas are much more likely not

23   to have health insurance.     And so if we set up a

24   system in which everybody's got health insurance,

25   some of those disparities are immediately going to be

1    reduced.
2            And I'm sure one of the statistics that's

3    already been mentioned is that close to 80 percent of

4    those without health insurance works.   They are in

5    some cases actually folks who are working in the

6    health care system but don't have health care

7    benefits.   And they're cleaning bed pans and, you

8    know, cleaning floors in hospitals and, you know,

9    unfortunately don't have access to the same system

10   which they're a critical part of.   So those groups

11   are disproportionately minority.    That would be the

12   first step.

13           There are some particular issues within the

14   minority community that I think we can address in a

15   targeted way.   Morgan earlier mentioned the issue of

16   lead paint.   Now, that may seem like ancillary issue

17   except for the fact that in cities like Chicago the

18   incidence of lead poisoning among African-American,

19   Latino youths is sky high.   It has huge ramifications

20   in terms of their long-term health.

21           Obesity and diabetes in minority communities

22   is more severe.   And so I think targeted programs,

23   particularly to children in those communities, to

24   make sure that they've got sound nutrition that they

25   have access to fruits and vegetables and not just

1    Popeye's, that they have decent spaces to play and

2    outdoor activities instead of just being couped up in

3    the house all day.

4            Those are specific areas where I think we

5    can target the minority communities.   And we've

6    already mentioned HIV AIDS.   The incidents is

7    growing, is much higher in poorer populations, and

8    those tend to be minority populations.   And so making

9    sure that we're putting money into HIV and AIDS in

10   those communities I think would make an enormous

11   difference.

12           So there are going to be areas where we

13   target specific problems that plague minority

14   communities in particular.    But the most important

15   thing that we can do is make sure that every single

16   person has coverage, every single person has access

17   to basic primary care and preventative care.     If

18   we're doing that, we're going to see those

19   disparities close significantly.

20           KAREN TUMULTY:   Now we have another question

21   by e-mail from Wendy in Oakview, California.     And she

22   wants to know as a single mother who meets the bills
23   but not much more I fall through the cracks making

24   too much for state assistance but not enough to

25   afford health insurance.   So what will you do for

1    people like me?

2            BARACK OBAMA:   Well, I think that is the

3    group that I just referred to.   Working people aren't

4    getting benefits on the job, don't qualify for

5    Medicaid.   And we're going to have to provide them a

6    subsidy so that they can access health insurance.

7    It's pretty straightforward.   If you're working full

8    time in the economy, there's no reason why you should

9    not be able to access health care.

10           And one thing that I think is important is

11   to recognize that there are a lot of small employers

12   who would like to get health care for their workers

13   but they themselves can't afford it because they

14   don't have access to large enough pools to allow them

15   to save money.

16           That's why I think it's going to be

17   important for us in whatever system that we set up to

18   make sure that in addition to the employer based

19   system that we've got an alternative system that
20   individuals who aren't getting it through the job can

21   access.

22              Now, I just have to repeat something I said

23   earlier.   And I'm absolutely convinced of this.     The

24   most important challenge for us is to build a

25   political consensus around the need to solve this

1    problem.   There are only a handful of options.    You

2    mentioned some of them that are out there.

3               John Edwards has put out a plan which I

4    think is very credible.   Hillary Clinton has been

5    working on this for a long time.   I was listening to

6    Governor Richardson.   He's got some good ideas.

7    Everybody is going to have some good ideas, the

8    question is are we able to bring a majority of people

9    together around the need to solve the problem now.

10              And one thing that makes me feel more

11   optimistic about this than I might have been ten or

12   twelve years ago is the fact that business is feeling

13   the pinch.   You know, large corporations recognize

14   that they can't be competitive on the international

15   stage if their health care costs are rising at a

16   constant clip and their competitors don't have to pay
17   any health insurance because it's all covered through

18   a government system.

19           Small businesses know that their employees

20   are not going to as productive if they don't have

21   health insurance.   So what I think is an enormous

22   opportunity for the next President is to bring

23   business, labor, consumers, providers together and

24   stay focused on it for a year, two years, however

25   long it takes to make sure it happens.

1            KAREN TUMULTY:   Well, and one more question.

2    We have time for one more question, and so I realize

3    that your plan is still a work in progress.    We heard

4    some disagreements on this stage already today about

5    whether it is possible to do this without raising

6    more taxes.   Have you come into this with a

7    particular perspective on this or are you going to

8    put taxes on the table or take them off now?

9            BARACK OBAMA:    I think that we're going to

10   have to put some money on the front end into creating

11   a new system.   Let me just take a simple example.

12           If we're going to be serious about using

13   medical technology to cut down on the administrative
14   costs, bureaucracy, make sure that we don't have

15   every signed in triplicate every time you go into a

16   hospital, if doctors and nurses and pharmacists are

17   communicating effectively through PDAs instead of

18   writing scribbled notes that nobody can read, if we

19   do all those things, there are a lot of community

20   hospitals out there that may not afford, may not be

21   able to afford the computerization and the software

22   system to set that up, and we may need to subsidize

23   them.

24           So we're going to have to put some money in

25   on the front.   I think that we can by making the

1    system more efficient get a lot of money out of the

2    system and use that to help subsidize workers who

3    have it and to improve the efficiency of the system.

4            I haven't yet made a decision in terms of

5    how much additional money is going to be needed to

6    meet my goal of ensuring that universal health care

7    exists in this country within six years.   I can tell

8    you that I will do whatever it takes, because I think

9    over the long-term it's good for families, it's good

10   for business, it's good for the country.
11           So I have not foreclosed the possibility

12   that we might need additional revenue in order to

13   achieve my goal, but I think we shouldn't

14   underestimate the amount of money that can be saved

15   in the existing system.   And I think also it's

16   important to recognize that we may be putting in some

17   front end investments, we may have to spend several

18   extra billion dollars on the front end as we

19   transition to a more intelligent system.    We will get

20   those savings on the back end.

21           Although one last point that I would make, I

22   want to make sure that those savings go into the

23   pocket of families and not just insurance companies

24   or drug companies.   That I think is very important.

25           So one of my priorities is to create a more

1    efficient system.    Whatever the mechanism is, I want

2    to make sure that families are seeing lower premiums,

3    lower co-payments, and also that health care

4    providers are not getting squeezed in this process of

5    making more efficient.

6            I get most disturbed when I start hearing

7    the best way to save the system is basically to cut
8    reimbursements to hospitals or cut reimbursements to

9    doctors or, you know, stop giving raises to nurses or

10   have nurses work 10, 12, 15 patients or 20 patients.

11   That's not really saving the system, all that's doing

12   is just compounding some errors we've already made in

13   the system, okay.

14              KAREN TUMULTY:   Thank you very much,

15   Senator.

16              BARACK OBAMA:    Thank you very much.   I

17   appreciate it.   Thank you, guys.

18              KAREN TUMULTY:   The next candidate that

19   we're going to hear from this morning is Senator

20   Hillary Rodham Clinton.

21              HILLARY CLINTON:   Well, hello, everyone.   I

22   am so happy to be here and to be part of this today.

23   First I think we all want to make sure to send our

24   thoughts and prayers to Elizabeth and John Edwards.

25   I'm very impressed by Elizabeth's strength and

1    optimism, and I'm looking forward to seeing both

2    Elizabeth and John on the campaign trail going

3    forward.

4               And I want to thank you UNLV for hosting
5    this.   It's great to be here and to be in one of

6    early caucus states.   And I want to thank CAP, the

7    Center for American Progress, for that CAP is doing

8    to put health care in the agenda for America.

9             And I especially want to thank SEIU.   I want

10   to thank you for not just talking about health care

11   but actually representing people who provide health

12   care and take care of all of us across the country.

13   I want to thank Andy Stern for being a leader, a

14   visionary leader on this.    And I especially want to

15   thank all of my New York state 1199 SEIU members who

16   I am proud to work with every single day.

17            Now, you know, I feel a little bit like this

18   is deja vu all over again.   I mean, I worked with

19   some of you all those years ago when we tried to

20   convince the country and the Congress, we convinced

21   the country but we didn't convince the Congress, that

22   we needed for the sake of our country to move toward

23   and achieve universal health care coverage.

24            Now I am proud we tried.   We may not have

25   succeeded but we set the groundwork in place so that

1    now people are saying, boy, we wish we had done that
2    back then.    Because costs have continued to increase.

3    Pressures on the system, on our doctors, our nurses,

4    our health care workers have just been so stressful.

5            I meet nurses every day who tell me they're

6    thinking of quitting the profession they love because

7    they are having to work overtime.   They now have two

8    nurses covering where four or five used to cover.

9    They're not being given the support they need.   And

10   each one of you could tell me a story like that.

11           So what we need to do is to make a

12   commitment.   And I'm proud that everyone running on

13   the Democratic side is committed to universal health

14   care coverage.

15           Now, we were only given three minutes.     Some

16   of you know I could talk three hours or three days

17   about health care but let me just briefly say, number

18   one, I am in favor of universal health care coverage

19   that brings in the 47 million who are uninsured,

20   which is a disgrace in our country to have millions

21   of people who are left out of the system that begins

22   to guarantee coverage to people who already have

23   insurance, because let's not kid ourselves, there are

24   a lot of people who think they have insurance except

25   when they need it.

1               I met a woman in Austin, Texas last week who

2    said, I'm a teacher, Senator, I make $38,000 and I

3    have insurance through employer, but last year I

4    spent $19,000 out of my pocket, half of her income,

5    because she had a preexisting condition.

6               So we can't get universal health care

7    coverage unless we end insurance discrimination once

8    and for all.   Now, I don't want to wait until I'm

9    President to do that.   I'm going to introduce

10   legislation while I'm in the Senate to end insurance

11   discrimination.   Guaranteed coverage.   No more cherry

12   picking.   You cannot eliminate people on the basis of

13   preexisting conditions because that's what we need

14   insurance for, and, you know, we've now met the human

15   gene O.    We're going to find out we're all

16   susceptible to something.   So none of us are going to

17   be insurable if we don't change this system.     And I

18   think we need to start now in order to make sense out

19   of it and get people the coverage they deserve to

20   have.

21              We are also going to make better use of the

22   money we've got in the system.   We already spend more
23   money than anybody in the world and we don't get the

24   best results, because we have all these uninsured

25   people and all these underinsured people.   And many

1    of you and people just like you all over our country

2    who can't afford your deductibles and your co-pays so

3    you go without care and then the problem gets worse.

4            So we're going to improve quality.    We're

5    going to control costs.   And we're going to once and

6    for all have a health care system that is worthy of

7    our country.

8            Now, I know probably better than anybody how

9    hard this will be.   Yeah, I know.   I've got the scars

10   to show for it and I've been through it, but that

11   just makes me more determined but it also makes me

12   understand what we're up against, because we've got

13   to modernize and reform the way we deliver health

14   care, but we have to change the way we finance health

15   care.

16           And that's going to mean taking money away

17   from people who make out really well right now.   So

18   that is going to be a big political battle.

19           What I'm doing in my campaign is talking
20   about health care every chance I get, asking people

21   for you ideas, your suggestions.   I was listening to

22   some of the questions that were asked.   Great

23   questions, deserve answers.    We're doing to have to

24   deal with every single one of them.   But if we don't

25   have the support to get a bill through the Congress,

1    we can keep talking about universal health care

2    coverage and the number of the uninsured and the

3    underinsured will keep going up, and we'll keeping

4    spending more money and we won't have very much to

5    show for it.

6              So we don't only need candidates to talk

7    about it, and we don't just need candidates to have a

8    plan.    We're all going to have plans, that's not in

9    doubt.   We need a movement.   We need people to make

10   this the number one voting issue in the '08 election

11   to send a message to the Congress and the special

12   interests, we're serious and we're going to get it

13   done this time.

14             So as I said, Karen, I can keep talking but

15   I'm sure my time for three minutes is up, so let me

16   turn now to the questions.
17            KAREN TUMULTY:   Well, thanks a lots.   Do you

18   want to have a seat?

19            HILLARY CLINTON:    No, I'll stand.

20            KAREN TUMULTY:   Okay, terrific.

21            Well, I was intrigued by a comment you just

22   made.   You said that we're going to change the way we

23   financing the system by taking money away from people

24   who are doing well now.   Who specifically are you

25   talking about?

1             HILLARY CLINTON:    Well, let's start with the

2    insurance companies.   The insurance companies make

3    money by spending a lot of money and employing a lot

4    of people to try to avoid insuring you, and then if

5    you're insured to try to avoid paying for the health

6    care you received.

7             And I see this all the time.   You know, my

8    office spends a lot of effort helping people who have

9    insurance get health care.   Two quick examples.   A

10   father called me from northern New York, had a son

11   with a very serious ailment.   He was well insured.

12   He worked, had worked for a long time for the same

13   employer who gave him a good policy.    His son needed
14   a special operation, and the insurance company said

15   no, we're not going to pay for that.    There was only

16   one place in the country that really could perform

17   it, and the insurance company said, I'm sorry, that's

18   out of network, you've heard that, we're not going to

19   send you to have that done.

20              So my office intervened, and, you know, we

21   get a little bit of attention when I call, and we

22   said, you know, we don't think this is right.   This

23   man has paid his, you know, share of his premium.

24   His employer has bargains for this insurance

25   coverage.

1               So make a long story short, we got the

2    operation, but I just don't think that people should

3    have to go to their United States Senator to get

4    their insurance company to pay for what they deserve

5    to have.

6               Second fast story, we are having an epidemic

7    of diabetes.   You all know all that.   We have young

8    people being diagnosed with adult onset diabetes.

9    I'm talking 12, 13, 15, 16-year olds.   We are seeing

10   the cost of diabetes go up exponentially.   Well, a
11   lot of insurance companies will not pay for someone

12   who's pre-diabetic or been diagnosed with diabetes to

13   go to a nutritionist to find out how better to feed

14   themselves and their families, to go to a podiatrist

15   to have their feet checked.    But they will pay if you

16   have to have your foot amputated.    Because the

17   reasoning is, and the insurance companies will tell

18   you this, they don't want to pay for preventive

19   health care because that's like a lost amount of

20   money because they're not sure that the patient or

21   the insured person will still be with them.    But if

22   they're confronted with the doctor saying we're going

23   to have to amputate the foot, they're kind of stuck

24   with it.

25              That is upside down and backward.   So we

1    could save money if we changed the incentive to

2    require that preventative health care and wellness be

3    covered and incentivized, and we could require that

4    every insurance company had to insure everybody and

5    no exclusions for preexisting conditions, and that

6    would be one thing we could do.

7               KAREN TUMULTY:   Speaking of the way it's
8    financed, when you do come up with your plan this

9    time, is it going to once again include what was the

10   most controversial aspect of your plan last time

11   which was this employer mandate the requirement that

12   companies cover their workers, and will it also have

13   in individual mandate the way people have to buy auto

14   insurance and the model that we've seen that was put

15   forward in Massachusetts and California?

16             HILLARY CLINTON:   Well, there are only a

17   couple of ways to get universal coverage.   And I'm

18   pleased that a lot of the people on the Democratic

19   side both running for President and in the Congress

20   are saying, look, we've got to do one of a couple of

21   things.   If we're going to build on these employer

22   based system, no more free riders.   No more companies

23   that don't insure everybody and shift their costs

24   onto other companies that do and onto the taxpayer.

25             So every employer is going to have to

1    provide insurance or pay into a pool where that money

2    can be used to help people.   And we may have to say,

3    look, it is everybody's responsibility to be insured.

4    You know, sometimes young couple come up to me, and I
5    understand this, I vaguely remember being young one

6    time, and they say things like, you know, I'm

7    healthy, I don't need insurance.   I'll say, Well, do

8    you drive in cars?   Hey, have you ever drive a

9    motorcycle?   Do you walk across the street and

10   sometimes not look at the light?   You have no idea

11   what can happen to you.

12            Insurance is supposed to be available to

13   make sure that when something happens to you you'll

14   be taken care of, and frankly it is to protect the

15   rest of us who are taking cake of ourselves.    We're

16   being responsible.

17            So I've been impressed that on both ends of

18   our country, in Massachusetts and California, an idea

19   that we first floated back in '93 and '94 which was

20   to say, look, individuals have to be responsible so

21   if your employer doesn't provide it, and if you're

22   not covered by one of the government funded programs

23   then you're going to have to be in the system.

24   Because otherwise if something does happen to you

25   you're going to be the responsibility of everybody

1    else.   So the so-called individual mandate is really
2    the individual responsibility policy.   I think that

3    has to be looked as well.

4              But we also need to look at how we provide

5    an alternative for businesses that are not going to

6    provide health insurance.   And their people are not

7    going to have it and where can they go to get a good

8    policy.

9              Well, we have two really good programs

10   operating right now.   Medicare, which takes care of

11   people over 65, has the lowest administrative costs

12   of any insurance program.   You know, when you look at

13   how much private insurance charges for administration

14   and overhead and profit of course, you compare with

15   Medicare, there's no comparison.   Medicare is like

16   three percent compared to anything from 10 to 35 or

17   up.

18             And we have something called the Federal

19   Employees Health Benefit Plan, where people like

20   members of Congress and people who work for the

21   federal government, they can go into this pool, it's

22   what it's called, it's a big sharing arrangement, and

23   they can have a lot of different choices and then

24   they can pick what kind of insurance policy.

25             If they're young and they think they only

1    need catastrophic care, because that's all they're

2    worried about, they can get that.   If they have kids

3    with some kind of problem, they can get coverage for

4    that.

5            So we can look at how we provide a backup

6    government sponsored approach to compliment the

7    employer system if we stay with the employer.   And

8    the final thing I'd say about that is, you know, one

9    of the things that happened in '93 and '94 is that

10   people thought that, even though this wasn't the

11   case, but we didn't do a good enough job explaining

12   it, we're going to do a better job this time, people

13   thought, well, they're going to be required to change

14   what they had, and a lot of people like what they

15   have.

16           So we don't want to have people feeling

17   like, oh, my goodness, the government is going to

18   come in and they're going to tell me what I have to

19   do and what doctors I have to go to.   That was never

20   ever part of the plan, but some people got worried

21   about that.

22           So building on what we have and having a
23   bridge to make sure everybody is included and at the

24   end of that bridge having an alternative that is a

25   government sponsored alternative gives people choice.

1             So that's what I think we have to look at as

2    a framework, because really every plan you're going

3    to hear about has some combination of those elements.

4             KAREN TUMULTY:   Senator, right now I'd like

5    to turn things over to Courtney Erickson, who in her

6    job with the Clark County Housing Authority sees

7    every day a lot of the kind of people you're talking

8    about, people who have coverage but can't afford

9    their health care.

10            Courtney, are you here?

11            COURTNEY ERICKSON:   As you know, I'm

12   Courtney Erickson.   I'm a proud member of SEIU, and I

13   work for the Clark County Housing Authority.

14            Many of the people that I serve on a

15   day-to-day basis are low income families, seniors and

16   disabled people living on a fixed income.   Many of

17   them have health care, but still spend a lot of money

18   out of pocket which obviously they can't afford to

19   do.   So how and on what timeline are you going to
20   rein in the health care costs?

21             HILLARY CLINTON:   That's a really good

22   question, Courtney, because if we don't get costs

23   under control, you can have a universal health care

24   plan and it will still keep costing more and more

25   money for everybody in it, and then we'll be back to

1    right where we are today.

2              So I want to do several things.   Number one,

3    as I said, I want to end insurance discrimination and

4    make it clear that they're going to have to be under

5    some, you know, restrictions about what they can

6    charge people and what they can and cannot do to them

7    when it comes to their insurance.

8              Number two, I had a bill that I worked on

9    for four years in the senate to move us toward

10   electronic medical records.   We passed through the

11   senate, we didn't pass the Republican House so we're

12   coming back to make it happen.   Why do I mention

13   that?   Well, those of you in health care know the

14   answer.   You spend so much of your time, you know,

15   doing recordkeeping, trying to read records that are

16   illegible, trying to fax records to people who
17   aren't, you know, right near home and need their

18   records.   And you go through all this, misplacing

19   records.

20              We are drowning and frankly people are

21   suffering because we have a paper system in the

22   health care field.   We don't rely on paper in any

23   other big part of our economy anymore.   Because we

24   rely on paper we are wasting money.   We can save by

25   an independent assessment a hundred billion dollars a

1    year if we move toward electronic medical records.

2    And I want to start requiring that people who do

3    business with the government, namely Medicare,

4    Medicaid, VA, you name it, the Federal Employees

5    Health Benefits Plan, they're going to have to move

6    toward electronic medical records.

7               And I'm willing to put some up front money

8    into that to create a system where all these

9    different health care IT systems can talk to each

10   other, because if you're taking care of somebody here

11   in Las Vegas, they have family say in Arizona or

12   L.A., they go there, they slip and fall, they go to

13   the emergency room, you start with a history.    You
14   start with tests that maybe they took two weeks or

15   two months ago.

16           After Hurricane Katrina I went down to

17   Houston to see the people who had been evacuated,

18   most in them from the convention center.   The

19   elderly, the frail.    People who were very dependent

20   upon health care, their records were gone.   Those

21   pieces of paper were destroyed.

22           And a lot of doctors told me their biggest

23   problem was trying to figure out what prescriptions

24   to give to people because you have a lot of elderly

25   folks who knew they were taking bills but didn't know

1    what they were.   They said, Look, I take a pink pill

2    in the morning and a blue pill in the afternoon.     Had

3    no idea what it was.

4            The only people they could help were the

5    people who had shopped at chain drug stores because

6    they had electronic medical records.   If we had that

7    for all of our health care records we'd get costs

8    down and we'd have higher quality health care.   So

9    we've got to do all of this at the same time and help

10   get these costs downs and help people.
11             KAREN TUMULTY:   Senator, you said that you

12   can do this with no big new taxes.   So where does

13   this up front money come from?

14             HILLARY CLINTON:   Well, I'm talking for

15   example on the electronic medical records, maybe

16   $200 million to get the architecture of the system

17   put into place, you know, give or take money, but

18   that's what we estimated when we did it originally a

19   couple years ago.

20             And there will be some investments, but when

21   I'm talking about how much money we need to spend,

22   let's look at what we spend nationally.   It's not

23   just what the government spends, it's what all of us

24   spend.   We already spend more money than everybody

25   else.    I cannot see us putting more money as a

1    national expenditure into health care without

2    modernizing the system, without ending insurance

3    discrimination, without beginning to emphasize

4    wellness and prevention.

5              People are going to have to start taking

6    better care of themselves.   We cannot afford all the

7    illness that folks are bringing on themselves.     There
8    are some things we have no control over.   There are

9    some things we do have control over, and we need to

10   start working on that, myself included, everybody

11   else.

12            But what we really have to look at is how

13   can we save money over the long run.   So I'm willing

14   to put in some up front investments to do the right

15   thing.   And I think we can then save money as we go

16   forward, but I don't think we should start from the

17   position where we say we're going to increase all of

18   these costs by putting more money into a system that

19   is broken.   We have to fix the system so it serves

20   people better.   It takes better care of those who

21   take care of us and we take better care of ourselves

22   and that is the way that I'd like to approach this.

23            KAREN TUMULTY:   Senator Clinton, we're out

24   of time, but I did want to ask you one last quick

25   question.    Several candidates we have heard from

1    today have said that they think they can get to

2    universal coverage in their first term.    You have

3    suggested that it could take two terms.    It could

4    take eight years.   Are they being realistic?
5             HILLARY CLINTON:    Well, I think we all area

6    going to try to start as soon as possible.   You know,

7    it took three years to implement the Medicare

8    prescription drug benefit.    Well, you know what, I

9    didn't vote for it but, you know, and this

10   administrative doesn't exactly have the greatest

11   track record on competence, so I can't judge exactly

12   by that, but it took a while.

13            I think we can move forward quickly, but

14   make no mistake about it, this will be a series of

15   steps.   But let me end where I started.   We're all

16   for universal health care.    You know, we have a big

17   debate about it in '93, '94.    That debate is over.

18   The Democrats stand united.    We are all for universal

19   health care.   What we have to do is persuade the

20   country not only to vote for a Democratic President,

21   we have to help elect a Democratic Congress.

22            Because if you look at the politics of this,

23   and I know that people around are not thinking about

24   politics because that's kind of a downer, but if you

25   look at the politics, we got stopped in the Senate in

1    1994 by a filibuster.   You know what that means is
2    unless you get 60 votes, which mean usually unless

3    you've got more than 60 Democrats you've got to get

4    some Republicans.

5            We got stopped because they basically said,

6    we're not going to do it.   And we couldn't break it

7    and that was the end.   We can't get enough

8    Republicans right now to vote with us to try to begin

9    to end the war in Iraq.   We can't.   We're trying.

10   Every single week we come up with something else to

11   try to get them to vote with us.

12           But the way the Senate works you've got to

13   get the 60 votes.    So that's why I said I sure hope

14   you elect me President, but I want more Democrats in

15   the Senate, and I want a movement to support health

16   care reform, and we're going to need it so let's make

17   sure that's what we do in the next two years.    Thank

18   you all very much.

19           KAREN TUMULTY:    So our next candidate that

20   we are going to hear from is Senator Christopher Dodd

21   of Connecticut.

22           CHRISTOPHER DODD:    Well, good morning,

23   everybody.   And thank you very, very much for

24   inviting all of us to come by here this morning to be

25   a part of this program.   I thank you, Karen, for

1    acting as the host.   The Center for American

2    Progress, I want to thank them as well.   SEIU for

3    their wonderful leadership.   Andy Stern, I see Andy

4    over here as well.

5            Let me also mention, by the way, I know he's

6    already appeared here, I didn't get a change to see

7    him, but I think all of us across the country have

8    incredible respect for Elizabeth Edwards and for John

9    Edwards and what they're going through here today.

10   So I just want to begin these remarks about health

11   care and not fail to mention them as well.

12           I'm deeply proud of the invitation to be

13   with you today.   I'm Proud of my relationship with

14   the SEIU and its work over the eight decades of

15   serving the interests of not own its membership but

16   people across this country who are not members of

17   SEIU who benefitted from your leadership.

18           I've been through eight elections in the

19   state of Connecticut and I'm proud to say that those

20   eight elections I've had the support of SEIU, and I

21   thank you for that support.

22           And for those 32 years that I've been in the
23   Congress of the United States, I'm proud to say I

24   have about a 95 percent voting record with organized

25   labor in this country.   I stand with union.     I stand

1    with labor, and I thank you as well for that

2    relationship.

3               I mention that because I think it's

4    important as we talk about where we want to go from

5    here how we want to lead the country that we also

6    have a good understanding of where you've been.     And

7    so over those 32 years of work I've been engaged in

8    on behalf of working people it's something I'm proud

9    of, but it gives you some indication of what kind of

10   leadership I offer as a Democratic nominee for the

11   presidency of the United States and how I'd serve the

12   country.

13              Again I'm preaching to the choir here in a

14   sense we're talking about health care.   We all know

15   it's in a serious crisis.   The numbers are startling.

16   It is said that we rank something like 26 in the

17   world in life expectancy, something like 28 in the

18   world in infant mortality rates.   We have third and

19   fourth world countries that do far better than we do
20   in protecting our youngest children here in this

21   country.

22              We rank something like 37th in the world in

23   terms of the overall fairness of our health care

24   system, and we account for more than 50 percent of

25   all the money spent worldwide on health care in the

1    United States.

2               So anyone who tells you the health care

3    system is working, those facts alone ought to be a

4    source of collective shame in this country.   The fact

5    that we rank as poorly as we do, this is the United

6    States of America, the most affluent country in the

7    history of mankind, we need to be doing a far better

8    job in serving the American people when it comes to

9    health care.   I stand firmly in my efforts to see

10   that happen.

11              Let me say to you here as well what needs to

12   be done.   First of all, it's important we talk about

13   health care we don't limit the conversation of what

14   needs to be done within the health care system

15   itself.    It was pointed out that in the 20th century

16   we extended life expectancy in this country by 30
17   years.    Only 5 of those 30 years can be accountable

18   because of improved health care.   About 25 of those

19   years actually come from better nutrition, better

20   housing, better jobs, better incomes for people in

21   this country.    That had more to do with increasing

22   life expectancy than actually the health care system

23   itself.

24             The reason I mention that to you is because

25   it's very important as we examine this issue we also

1    look at issues like income and equality, like the

2    ability to have decent retirement, decent wages,

3    decent working conditions.   Those elements we know

4    empirically today improve the quality of people's

5    people health.

6              If you're better off financially, if you're

7    better educated, then the likelihood is you're going

8    to be in better health.   So we need to understand

9    there is a direct relationship between people and

10   people's ability to have good paying jobs with good

11   retirement and going working conditions if you're

12   truly interested in making a difference on health

13   care in this country.   It's very important those
14   concepts and ideas be included in this discussion.

15           As for the health care proposals themselves,

16   let me quickly mention the four principles which I

17   think are absolutely essentially if we're going to

18   deal with the health care system.

19           One is what you've heard already I'm sure

20   from the others as well and that is universality

21   here, that everyone participates, everyone benefits.

22   That all the stakeholders, individuals, employers,

23   the government are involved in coming up with a

24   system here that would make it possible to reduce

25   those numbers of 47 million of our fellow citizens

1    who have no health care to make sure they'll be

2    included.

3            Second is prevention alone.   Minimum we try

4    to do is see to it to reduce the cost by stopping

5    people from getting ill in the first place.   Around

6    70 percent of health care costs in this country are

7    associated with chronic illness in America.   We need

8    to be doing everything we can to see to it that

9    people get screening, get the proper management care

10   to reduce those kind of problems before they emerge.
11           The health care system today deals with

12   these when you get sick.   We ought to be doing a far

13   better job of making it possible for people not to

14   become ill because of the incentives we provide and

15   the alternatives we offer for people.

16           In fact, the Veterans Administrative, of all

17   the problems they have today have been able to

18   reduced hospitalizations by 60 percent in this

19   country because of the work they've done of

20   prescreening and dealing with people before they

21   become ill.   So prevention has to be a major part of

22   it.

23           Thirdly is building upon the good things

24   we've done already:   Forty years of Medicaid and

25   Medicare.   I would extend Medicaid to poorer

1    families, hundred percent of poverty, the ones with

2    children 300 percent of poverty.   Those programs have

3    worked very, very well for people.   Expanding them,

4    extending them makes a lot of sense too.

5            And then last is the fourth principle,

6    dealing with technology.   I'm sure you've heard of

7    this is well.   Some 80 or $90 billion could be saved,
8    not to mention the morbidity rates by doing a far

9    better job and utilizing the technology that exists

10   today to see to that people have an opportunity to

11   improve of their health conditions.

12           Let me tell you what also is important in

13   all of this.   We're looking at those of us who seek

14   your support for this nomination.   What have you been

15   able to do?    During the 26 years I've been in the

16   Senate, I've taken Democratic principles and made

17   them national policies.   I spent seven years through

18   two presidential vetoes to pass the Family and

19   Medical Leave Act.   It's my piece of legislation.    50

20   million Americans have enjoyed the benefits of that

21   legislation.

22           I started the children caucus in the Senate.

23   I authored the legislation here with improved Head

24   Start along with other programs dealing with infant

25   screening, premature births, dealing with

1    prescription drugs for children.    In every instance

2    I've done it by reaching out to people on the other

3    side of the political spectrum.

4            Whatever we talk about here today needs to
5    be a plan and a program that can build us and bring

6    us together.   We're not going to survive much longer

7    in this country, my friends, divided 51/49.   The

8    ability to just do what we want to do is going to be

9    dependent upon whether or not we can reach out off

10   this and bring them to that table and sit down and

11   work out these things together.

12           We can't wait much longer.   I've done it on

13   every one of those pieces of legislation.    That's

14   what I do as a legislature.   That's what I would do

15   as the President of the United States, to bring

16   stakeholders together, work together with a common

17   goal we all have in mind, and that is to see this

18   country have improved health care, improvement

19   economics as well for people in our nation.

20           So I ask you today as we talk about these

21   issues to look not only at what we offer you here ut

22   also the proven ability to bring people together,

23   where we've stood over the years and where we'll lead

24   in the future.

25           I'm the father of two very young children.

1    I have a two-year-old and a five-year-old.    In fact,
2    my house right now is sort of like a Petrie dish.

3    I've got a five-year-old and a three-year-old and one

4    has a strep throat and the other has an infection of

5    some kind or other, adenoids.   And so dealing with

6    children and their problems, going to school and

7    coming back.

8               In fact, I'm the only candidate that

9    actually gets mail from AARP and diapers services I

10   want you to know.   I have a broad reach here as a

11   candidate to talk about the needs of people across

12   the country.

13              But it's important to know what families go

14   through who have young children.      I'm a United States

15   Senator.   I've got a wonderful health care program.

16   I want every single American in this country to have

17   as good a health care program as every member of the

18   United States Congress.   That ought to be something

19   we're going to stand there and fight for.

20              Thank you for listening.   I ask for your

21   support on the upcoming nomination process, and I

22   promise as your President we will deal with this

23   health care issue, we'll pull the people together,

24   we'll have a good sound health care program for all

25   Americans.   Thank you very, very much.

1              KAREN TUMULTY:   Senator, at least one

2    political commenter out here has suggested that you

3    should win the caucus if only because you seem to be

4    the only person in the field who doesn't mispronounce

5    Nevada.

6              CHRISTOPHER DODD:   That's correct.   Nevada.

7    You've to pass at least that test it seems to me.

8              KAREN TUMULTY:   You were one of the original

9    co-sponsors of Hillary Clinton's health care bill in

10   1993, and it never got so far as a vote on the floor

11   of either House.    You suggested there's been a

12   failure of leadership on this issue.   But, in fact,

13   you know, all the old opponents are still out there.

14   Is there anything that has changed in the political

15   climate in the, you know, in the nature of the

16   problem that would suggest that things could be

17   accomplished on health care that simply were not

18   possible in 1994?

19             CHRISTOPHER DODD:   Yeah, I do.   I see a

20   number of things.   First of all, just the cost alone.

21   Twelve or fourteen years ago the overall cost was

22   somewhere a little less than a trillion dollars.
23   Today we're looking a cost figure of somewhere in

24   excess of $2 trillion, closer to $2.3 trillion.

25             You're watching business and industry

1    beginning to reduce those health care plans for

2    people.   They're not doing it because they're evil in

3    most cases, they're doing because of a cost factor.

4    There's a growing constituency that in the past was

5    hostile to the idea of having a universal health care

6    plan that I think didn't understand the economic

7    impact today better than they did fourteen years ago.

8              So those factors alone I think are making

9    greater and greater possibilities for people to

10   understand that this is hurting.    We're consuming now

11   15 percent of our grows domestic product in health

12   care costs.   That number could very easily jump to 20

13   or 25 percent very, very quickly.   That becomes

14   almost an un-stateable number, not to mention of

15   course the fact that we're leaving people out of the

16   system today with the numbers that are growing.

17             The irony here we've got health care costs

18   that continue to rise and the number of insureds

19   continue to rise.   So now we have a million more
20   people than we did six years ago under this

21   administration that have no health care, and that

22   cost continues to go up.

23            I think the climate, Karen, is a lot better

24   for us today, and again it comes back to bringing

25   people together.     I'm not engaging in something

1    inconceivable here.    On January 21st, the day after I

2    might be inaugurated as President of the United

3    States I could invite Lilly and Chuck Grassley, Ted

4    Kennedy, Max Baucus, Ted Stevens.    I'm talking about

5    now people in the Congress who are response before

6    the committee to deal with health care.    I've known

7    everyone of them for 30 years.    I'm not going to

8    spend a year or two getting to know them.    They know

9    me.   I know them.   We've fought against each other.

10   We've worked together on issues.    And I believe by

11   bringing people together you know you've worked with

12   to say let's sit down and get this done.    The

13   American people expect nothing less of us.    We need

14   to stop talking and achieve results I think we can

15   have.

16            KAREN TUMULTY:    Thank you.   Since 1994 when
17   efforts have -- oh, here it is, help with the issues

18   we're having.

19           CHRISTOPHER DODD:     I'm fading or something.

20           KAREN TUMULTY:   Since 1994 when health care

21   reform crashed and burned Congress has sort of

22   limited itself to incremental steps.   And you've been

23   involved in a lot of those.

24           And so right now I would like to call on Pat

25   Moore, who's an RN at UMC, to ask you about an issue

1    that you've been very active in, which is expanding

2    coverage of children.

3            Pat, are you here?

4            PAT MOORE:    Hi, I'm Pat Moore.   In the state

5    of Nevada we have an exceptionally high number of

6    uninsured children.   It's really discouraging to me

7    because I've been a pediatric IC nurse at UMC.   It's

8    the only public owned county hospital in Southern

9    Nevada, and I've worked there 25 years.

10           So I see the results of what happens when

11   parents cannot provide or seek ancillary health care

12   assistance for their children until it's too late,

13   and oftentimes the result is the death of a child.
14           So I would ask you what is your proposal,

15   what is your platform for insuring every child in the

16   United States?

17           CHRISTOPHER DODD:   Well, first of all, Pat,

18   thank you for what you do as a nurse.   And let me

19   take advantage of your question to point out as well

20   that on this Tuesday I'll be introducing something

21   called a spec cap which takes these Kentucky river

22   cases, for those who follow these questions

23   understand them, that NLRB, the National Labor

24   Relations Board last year declared that anyone who

25   was occasionally a supervisory, had a supervisory

1    function as a nurse, would be prohibited from

2    engaging in collective bargaining agreements.

3            My legislation overturned that.   I think

4    nurses ought to be organized collectively.    And then

5    I want to thank your leadership, Andy Stern, the

6    AFL-CIO and other who are already endorsing the

7    legislation.   Senator Kennedy, Senator Derby are

8    already co-sponsors of the bill, but I want you to

9    know the nurse shortage issue, how nurses get

10   treated, health care providers is something that has
11   a direct relationship again with the overall health

12   care system in the country.

13           And again I appreciate your bringing up the

14   children's issue.    I mentioned I started the

15   children's caucus in the senate with Arlen Specter

16   some 26 years ago.   12 million of that 47 million of

17   uninsured are children in our country.   The S-chip

18   program is something I was a strong backer of,

19   supporter of, early author of that legislation to

20   provide those kind of benefits.

21           I'll be quite honest with you, when that

22   first came up I had some hesitancy, in fact all of us

23   did in talking about those, Karen, because we had the

24   feeling that if we just took care of children that it

25   would make it harder to deal with the broader

1    population.

2            But frankly things were moving so slowly

3    that we decided we had to do something to directly

4    reach out to see to it that children were getting a

5    far better start in all of this.

6            So in addition to making sure that families

7    with children would get 300 percent.   300 percent of
8    poverty would be included under Medicare.   You

9    immediately pick up an awful lot of our kids that

10   you're talking about in your hospital.

11           The Family and Medical Leave Act makes a

12   difference.   I don't know if you know, C. Everett

13   Koop -- by the way, I voted against when he was

14   nominated the Attorney General because I disagreed

15   with a lot of his view, and then he turned out to be

16   my best witness when I was trying to pass the Family

17   and Medical Leave Act.   That was that radical idea

18   that you ought to able to spend time with your child

19   without having to lose your job.

20           By the way, we're going to introduce in the

21   next couple of weeks we're going to introduce the

22   Family and Medical Leave Act with paid leave for

23   people, by the way, so you don't have to -- but that

24   relationship between parents and children during

25   these period of illness make a huge difference.

1    Again I see you nodding.   You understand this better

2    than others as a pediatric nurse.

3            And by the way, I thank pediatric nurses and

4    the American Academy of Pediatrics.   They've been
5    fabulous when it comes to dealing with some of these

6    children's issues.

7               And then getting into some of this stuff

8    early on, I want to school-based clinics in our

9    country.    I want to see a Head Start program that

10   isn't just a literacy program but deals with the

11   whole child so we end up dealing with proper

12   nutrition, good beginning, food issues, all of these

13   basic things.   These are the kind of investments we

14   ought to be making.

15              I'm proud to have been chosen by the Head

16   Start Association as the Senator of the decade when

17   it comes to Head Start issues.   I wear that badge

18   very, very proudly.   I care deeply about early

19   childhood education, what happens with the Head Start

20   program.

21              Those are some of the things that we need to

22   be doing.   As I mentioned earlier, the infant

23   screening legislation that I've authored, the

24   description drugs for children, to get better testing

25   for them, the premature birth legislation dealing

1    with efforts in that regard.   We just did a major
2    bill on autism in the country for children as well.

3    I've spent an awful lot of my time working on these

4    issues.

5               When I got to the senate, I discovered there

6    was a caucus for every imaginable constituency in the

7    country except that one our of four Americans were

8    kids.   That's the reason I put so much time on it and

9    I will as President of the United States as well.      I

10   care deeply about it.

11              KAREN TUMULTY:   Senator, you've talked a lot

12   about in the past about health care involves hard

13   choices.   Sara in Minnesota has sent a question in by

14   e-mail saying what do you see as the most serious

15   problem with our health care system:    Cost, quality

16   or coverage?   And can't say all.

17              CHRISTOPHER DODD:   Well, I'll begin with

18   cost, because I think if you can deal with cost then

19   these other matters can be dealt with.    And so the

20   cost of it is what stuns me.    And out of all the

21   incentives in our health care system today, our

22   incentives driving up cost.    We need to reserve this

23   and really turn the whole system on its head.

24              If all we're talking about here is sort of

25   tinkering with the status quo all we're going to do

1    is probably raise cost, maybe marginally deal with

2    some of these questions.   But today unless you

3    fundamentally alter how the system is going to work,

4    then I'm fearful we'll be back here again four, eight

5    years from now talking about the same subject all

6    over again.

7            All these incentives today in health care

8    are cost driven.   We don't provide the incentives

9    within the system to do just the opposite way, and

10   that is to encourage the incentives to have better

11   lifestyles, to do things that are less harmful to

12   you, to encourage businesses to provide environments

13   for people to stay.

14           I come back to the point I tried to make

15   earlier as well here.   The incentive to have a

16   cleaner environment, at better energy policy in the

17   country, seeing to it that we insist on schools, for

18   instance, that you don't have to market fast food or

19   junk food.    49 percent of the schools in the United

20   States of America have contracts with soft drink

21   companies and junk food companies, 49 percent.    And

22   then we wonder why kids have obesity problems, then
23   we wonder why they have diabetes problems.

24             So the cost issue, they do that because the

25   money comes into a poor school district.   They're

1    struggling to make ends meet so that exclusive

2    contract that allows that soft drink company to have

3    a contract with them is very appealing to them to

4    save some money.   We need to deal with those

5    underlying issues in my view as well here.   The cost

6    I would think is a major issue.

7              KAREN TUMULTY:   And given this problem is

8    what it is and the urgency that people feel about it,

9    what's your sense of what is a realistic time frame

10   for getting to universal coverage?    Barack Obama says

11   it's four years.   Hillary Clinton says it's eight

12   years.

13             CHRISTOPHER DODD:   Well, you know, I'm

14   impatient.   I didn't jump into the presidential

15   politics because I woke up when I was five or ten and

16   decided this is my life's ambition.   I've been

17   relatively content and happy working in the United

18   Senate.   I've got these two kids.   A late bloomer in

19   the father business obviously.
20             KAREN TUMULTY:   What were you thinking?

21             CHRISTOPHER DODD:   My daughter Grace was

22   born 48 hours after 9/11 in Arlington, Virginia.      I'm

23   literally watching the Pentagon burning from the

24   hospital she was born.     I could watch her literally

25   being born and see the Pentagon burn.

1              And I thought ever since that moment, as all

2    of you as parents or grandparents have, what kind of

3    life is she going to have growing up watching those

4    events.   What kind of world is she going to grow up

5    in.

6              And so I feel a certain amount of impatience

7    in all of this.   I think with the right relationship

8    in the country they insist upon issuing a priority.

9    And I would tell you today I wouldn't put a time

10   frame on it, but I make this the first order of

11   business in a Dodd administration.

12             This goes to the heart of our economics.    It

13   goes to the heart of who we are as people.    It goes

14   far beyond the issue of sort of one set of issues.

15   The danger in forums like this is because we have a

16   tendency to stovepipe the issue.    We're here talking
17   about health care.   What I tried to say early on to

18   you is that what happens in the workplace in terms

19   job possibilities, income, salaries, retirement

20   benefits all contribute to the health care issues as

21   well.   Energy policy, environmental issues contribute

22   to the health care policy.

23            So when I understand the importance of

24   having this discussion, it's important to realize

25   it's far-reaching in its implications.   So to me I

1    would want to see us have a universal program begin,

2    with all due respect, four or eight years.

3             I think with leadership in the country that

4    makes this important, that makes this important.     If

5    you can have, if you get rid of these permanent tax

6    cuts to the top one percent of income earners, get

7    the war ended in Iraq that we're spending $2 million

8    a week, $8 million a month, we can provide the

9    resources to really move in this direction.   So I

10   would make it a top priority in my administration.     I

11   wouldn't want to put a time frame on it because I

12   think it's too important for us to get there as soon

13   as possible.
14           KAREN TUMULTY:   Great.   Thank you very much.

15           CHRISTOPHER DODD:   Thank you all very, very

16   much.

17           KAREN TUMULTY:   Next we're going to hear

18   from Congressman Dennis Kucinich.

19           DENNIS KUCINISH:    Good afternoon.   Good

20   afternoon.   It's wonderful to be here with you.     And

21   as I'm listening to this discussion today it reminds

22   me that you are the ones who have to insist that

23   America reconnect with its greatness and its

24   goodness.

25           Yesterday in the House of Representatives

1    Americans were told that we can't have peace.    We

2    have to keep a war going for another year or two in

3    order to have peace.   I voted against that because I

4    believe that we have to take a new direction which

5    says if you want peace, you vote for peace and you

6    have a plan for peace.

7            We're being told in this state and other

8    place that you can't have kindergarten care or

9    universal pre-kindergarten care, and yet when you

10   accept that then you don't get it.   Efforts are made
11   to just cut short a movement.

12            Today at this forum the sub-message is that

13   you can't break the hold that the insurance companies

14   have.   Not a single candidate up here has challenged

15   the underlying problem with our health care system,

16   and that is insurance companies are holding our

17   health care system hostage and forcing millions of

18   Americans into poverty with unconscionable premiums,

19   co-pays, deductibles.

20            So I ask you is it constant with America's

21   greatness that candidates step away from the one

22   solution that could change it all.   A not-for-profit

23   health care system is not only possible, but HR 676,

24   a bill that I introduced, and a number of

25   Congressmen, the Conyers Kucinich bill, actually

1    establishes Medicare for all.    A single-payer system

2    and it's a not-for-profit system.    It's time we ended

3    this thought that health care is a privilege.   It is

4    a basic right, and it's time to end this control that

5    insurance companies have not only over health care

6    but over our political system.

7             Think for a moment if Lincoln had decided,
8    well, you know, there's just too much resistance to

9    this idea of emancipation.   Think if the suffragettes

10   had decided, well, you know, we can't take on these

11   men who are determined not to include women in the

12   political process.

13            What if Martin Luther King had said, you

14   know, we can only push so far for civil rights, or

15   Cesar Chavez had said well, you know, no quoly.

16            What if we buy into this logic that says

17   can't have peace.    We're being told here today to buy

18   into a view of the world which says that, well, you

19   know, but the insurance companies run the system

20   we'll have people, you know, we'll work out

21   competition between the insurance companies and maybe

22   we'll have government subsidize the insurance

23   companies.

24            Where is our call for greatness?   What if

25   FDR said, Well, you know, we can't really do the New

1    Deal.   I'm talking about a real deal for the American

2    people, a universal single-payer not-for-profit

3    Medicare for all and it's good to be here with you to

4    talk about it.   It's already into legislative form.
5    62 members of Congress have signed onto the bill.

6    Over 14,000 physicians have signed on to the bill.

7              The people of California voted for a plan

8    just like it.   The senate of New Hampshire endorsed

9    it the other day.     The legislature in Kansas put

10   their name on it and endorsed the idea.      We can do

11   this.   Yes, we can.    Break the hold of the insurance

12   company on our health care system and lift the

13   American people out of poverty.       That's what my

14   presidency is going to be about.      Thank you.   Thank

15   you.    Thank you.   So let's talk.   Let's have a

16   conversation.

17             KAREN TUMULTY:    Congressman you are the

18   first advocate we've heard today of the single-payer

19   health care system, essential Medicare for everybody.

20             However, the last time, my understanding is,

21   that it was on the ballot was in Oregon, which is,

22   you know, except for Vermont probably, you know, the

23   most liberal state in the country on these issues and

24   it didn't pass.      Where do you find the political will

25   for a single-payer system?

1              DENNIS KUCINISH:    I traveled this country in
2    the last election, came to an understanding that

3    health care is one issue that unites everyone.    Where

4    does the support come for a not-for-profit health

5    care system?   It comes from all over the country.

6    But it's waiting for a candidate for President who

7    will lead the way, and I've already done that.

8               The Conner, Kucinish bill, HR 676, is the

9    vehicle.   Now, how can you break the hold that

10   insurance companies have?   Because, let's face it, in

11   Oregon they pumped millions of dollars into doing

12   everything they could to try to defeat the

13   initiative.

14              This is really simple.   You need a President

15   who doesn't have strings attached.    Someone who is

16   ready to confront these insurance industries.

17   Someone who isn't owned by the interests.    Look,

18   right now on Wall Street the hedge funds are coming

19   together to pour millions into campaigns of

20   candidates for President.

21              We're looking at a system that people are

22   telling you the words you want to hear, but when

23   you're looking for specifics in a plan, they're not

24   developing it.   Why can I do it and other candidates

25   can't?   Because simply I don't have strings attached.

1               I've been politics 40 years.   I've been a

2    counselman, a clerk of courts, a mayor, a state

3    Senator, a six term U.S. Congressmen.     I'm known form

4    having integrity and the willingness to take a stand

5    and for changing the outcome when others say it can't

6    be done.   This is the moment that I call upon you and

7    the SEIU and the American people to say, let's join

8    this movement that already exists, call upon the

9    power of our hearts and our intellect.

10              What are the animating forces?   How is this:

11   Half of the bankruptcies in America right now are

12   directly connected to people not being able to pay

13   their hospital bills.   And of that amount 75 percent

14   of the people are working, have jobs.     People's whole

15   lives are on the line here.

16              So the question is will the American people

17   be given a real choice in this election.    You know,

18   this isn't American Idol here, I mean, really, you

19   know.   I mean, I could come up here and, you know, do

20   a little dance about, well, you know, we're going to

21   take on those insurance companies.   Oh, really?   Are

22   you going to take away their profits?     Are you going
23   to remove the fact that, you know what, 31 percent of

24   the money that's in the system right now of $2.2

25   trillion a year goes for the activities of the for

1    profit system.

2            If we take that money away from the

3    insurance companies and use it for the American

4    people, well, guess what, we have enough money for

5    vision care, dental care, mental health, prescription

6    drugs and long-term care.   I'm going to call on the

7    American people to stand up for their rights.   Health

8    care is a right, not as a privilege.

9            KAREN TUMULTY:   Congressman, we have an

10   e-mail question from James in Patterson, California

11   who wants to know why are health care costs going up

12   so much and what can we do to stop these increases?

13           And can I just add a question to that,

14   because in the framework of a single-payer system

15   people say the consequence of trying to contain cost

16   in a single-payer system would ultimately be

17   rationing.

18           So could you take us through first how a

19   single-payer system would address costs and also what
20   you say about these sorts of concerns that people

21   raise about it?

22             DENNIS KUCINISH:   You know, think about it.

23   The insurance companies when they look at a

24   single-payer system, a not-for-profit system, they'll

25   say, my God, you're going to end up with rationing.

1    What do we have now?   46 million Americans don't even

2    have coverage.    Talk about rationing.   They're not

3    even in the line, okay.   Give me my portion.   No.

4              Another 50 million people are underinsured

5    and the rest are paying these high premiums, co-pays

6    and deductibles.   We've got to break the hold the

7    insurance companies, and their public relations

8    operations would say, well, rationing, the fact of

9    the matter is this plan I'm talking about covers

10   everyone.

11             How do you reduce costs?   Let's look at the

12   costs that are involved in the system rights now.

13   Corporate profits, stock options, executive salaries,

14   advertising, marketing, the cost of paperwork.    All

15   this takes about 31 percent out of the health care

16   dollar.
17            Now, what does all that have to do with

18   health care?   Zero.   Zip.   Nada.   I'm talking about

19   creating a system which, by the way, is similar to

20   that in every other industrialized nation in the

21   world.   We take the profit out of medicine.    Health

22   care is a right.   It is not a privilege.

23            So how do we control costs?     By having

24   everyone in the same pool, everyone.     Having everyone

25   covered and having the benefits be available to

1    everyone whatever their income, no means testing, and

2    by creating a movement.

3             I want to add something to an earlier

4    question you raised, and that is that good friend

5    Senator Edwards, who he and I campaigned together

6    four years ago, he raised this question, which is a

7    very, you know, which is the question in Washington.

8    Well, it's just not feasible to take this plan for

9    not for private health care.

10            Senator Clinton, talking about charging the

11   insurance companies but doesn't really get to the

12   ultimate challenge of who controls health care in

13   American.   Senator Obama still developing his plan.
14           This plan that I'm talking about, I

15   coauthored this plan.   I'm one of the ones that wrote

16   the plan.   I know the way the system is set up.   The

17   area that I represent, Cleveland, people are losing

18   their homes because they can't pay the doctor bills.

19           And so the question is what it ultimately

20   comes down to is who has the courage and the

21   willingness to take a stand and can reach out to the

22   breadth and depth of the American people and call for

23   that greatest to say we're going to change this.

24   We're not going to be strapped by these insurance

25   companies who give us diminishing returns who insist

1    on higher premiums, co-pays and deductibles.

2            KAREN TUMULTY:   Congressman, you're kind of

3    an urban kind of guy.   And Ashley Osborn, who is a

4    labor and delivery nurse in Elko, which is a rural

5    county in northern Nevada, has a question for you

6    about how you would address concerns in people who

7    are in her situation.

8            ASHLEY OSBORN:   Good morning.   As you know

9    my name is Ashley Osborn and I'm a labor nurse in

10   Elko, Nevada, which is a rural area up in
11   northeastern Nevada.

12            And commonly I see mom's come in to my

13   department with pregnancy induced, severe pregnancy

14   induced health care issues that could be eliminated

15   or caught early with fetal care.   Unfortunately

16   they're unable to get that.   What are your plans on

17   improving health care in the rural area in the U.S.?

18            DENNIS KUCINISH:   Well, first of all, this

19   plan covers everyone, rural as well as urban areas

20   alike.   Rural areas tend to be underserved.   I'm

21   looking also at creating a infrastructure program to

22   create millions of jobs for building America's

23   infrastructure, which would build hospitals in rural

24   areas.

25            And rural people would then have access

1    because access is a huge question in rural areas.

2    And when you talk about women being able to get the

3    care they need, this system, prenatal care, postnatal

4    care, I have a plan for child care.   This system of

5    not-for-profit health care doesn't try to stop women

6    from getting the care they need because there's not

7    an insurance agent telling a doctor, you know, OB/GYN
8    doctor that we just can't do this.   You're asking for

9    too much.

10            This system will meet the health care needs

11   of the American people.   We're being told we just

12   can't have those needs met.   We've got to start

13   thinking differently.

14            Does that answer your question?   Thank you.

15            KAREN TUMULTY:   Thanks.   And now I would

16   like to turn to a public health student here at UNLV,

17   Megan McCormick, who raises a pertinent point if

18   there's any place where you're interested in outcomes

19   is in health care.

20            Megan?

21            MEGAN MCCORMICK:   Hello, I'm Megan McCormick

22   and I'm a junior at UNLV here.   We're spending an

23   increasing percentage of our gross domestic product

24   on health care while we continue to have poor

25   outcomes in this countries who are allocating a lower

1    percentage of their GDPs towards their own health

2    care.   How does America plan to stay globally

3    competitive with increasing health care costs?

4             DENNIS KUCINISH:   You know, that's a key
5    question.   I mean, in my own congressional district

6    we have auto plants that have been threatened and

7    others throughout the country have been threatened

8    because the high cost of health care is causing Ford

9    and GM to pay billions of dollars in health care, in

10   health care costs.

11           Now, Canada, on the other hand, has a much

12   stronger industry because they have a health care

13   plan for their people.   This plan that I'm talking

14   about is going to help American business.   It's going

15   to strengthen the economy.    It's going to make it

16   possible for individuals to be able to hold on to

17   more of their money.

18           It's true that many families right now are

19   spending in excess of $10,000 a year for health care.

20   With this plan only a fraction of the money that is

21   being spent right now would have to be part of the

22   financing of the system.   I mean, do you know that 60

23   percent right now of the money that's in health care

24   is spent by the government.   The government has

25   60 percent of the spending right now.

1            If you eliminate administrative costs, if
2    you purchased bulk purchase of drugs, just the way

3    veterans does, you start to come due, you start to

4    come up with the money that you need to provide

5    coverage for everyone, and that is major help for

6    small businesses and large businesses a like.

7            This patchwork proposal that you've been

8    given here today by other candidates locks us into

9    insurance companies who then take their pound of

10   flesh and generally it keeps people from being to

11   have any control over their own budgets.

12           I want to go back to what most American

13   people are experiencing.   Economic uncertainty

14   because the way the health care system is set up.

15   People are aware no matter how much money they have

16   that if they have an illness in the family it could

17   wipe them out.

18           Who isn't going to make the choice to take

19   care of a loved one.   You do what you have to.   But

20   why I would ask you should someone have to lose their

21   home in order to ensure the health of a loved one.

22   Why should someone not be able to get the long-term

23   care they need for a loved one or have to sign on the

24   dotted line to give away everything, you know, you

25   work for for a lifetime in order to get the long-term

1    care you need.

2              See, what I'm talking about is real

3    transformation.     I think the American people are

4    ready for that, but they need someone to be not just

5    a messenger but someone who knows this issue, is

6    ready to stand up and speak out.    Yes, we can improve

7    our economy and save our businesses large and small,

8    and I'm dedicated to do that and I'm able to do it

9    too.   Thank you.

10             KAREN TUMULTY:   Congressman, earlier Senator

11   Edwards pointed out that there is a single-payer

12   Medicare like option built into his plan.    And it

13   would be, you know, one of the things that people

14   could consider in making their health care choices.

15   And he raised the possibility that if that were out

16   there as an option and people started choosing it and

17   found out that they really liked it, that the country

18   could almost, you know, evolve towards a single-payer

19   system.

20             Do you see this as a real scenario, given

21   the other interests that are out there or do you

22   think that, in fact, you know, it's going to have
23   sort of come down in one fell swoop if it's ever

24   going to happen?

25           DENNIS KUCINISH:   Well, I think you just

1    answered the question, and that is that if you have

2    competition between insurance companies, everyone

3    knows what happens.   That doesn't drive down costs,

4    it drives up profits.   That's a fact.

5            If you say, well, you're going to give

6    people a choice, either be on a private plan or be

7    with the government, what happens is that the private

8    companies start cherry picking the best, you know,

9    the people in the best health, and then you end up

10   what what's called adverse selection, those as far as

11   the most medically compromised end up on programs

12   that the government is paying for, and then the

13   government program starts to go down.    You end up in

14   an insurance death spiral, which is what it's called

15   in the industry.

16           Now, think about it.   Candidates up here

17   advocating that government provide subsidies to the

18   insurance industry.   What's that about?   I mean,

19   didn't we have enough with subsidizing the
20   pharmaceutical companies with that phoney Medicare D

21   program that President Bush had?   How are we any

22   different as Democrats?    Think about that.

23            Do you know what, universal health care, oh,

24   everybody is for it.   Almost resonant with that

25   fellow in the Music Man who said, There's trouble in

1    River City.   Universal health care.   You know what,

2    even the insurance companies are for universal health

3    care, especially the insurance companies if the

4    government is subsidizing them.    What a deal that is

5    for the insurance companies, but what a rotten deal

6    for the American people.

7             We've got to have not-for-profit health

8    care, get the insurance companies out of the picture.

9    Health care is not a privilege, it is a right and it

10   is as human right.

11            Universal health care, right.   I mean, come

12   on.   You need a President who didn't fall off the

13   Christmas tree.   You need a President who will be

14   involved in straight talk straight from the shoulder,

15   and you need a President who doesn't have a key in

16   the back being wound up by special interests to come
17   before the American people and tell them what the

18   interest want.     I'm telling you what the American

19   people want and I'm ready to take that message all

20   across this country and I'd like your help in doing

21   it.   Thank you.

22              I have four seconds left.   Buzzer shot.    You

23   want not-for-profit health care, I'm the candidate

24   who can deliver.    Thank you very much.

25              KAREN TUMULTY:   Thank you very much.   And

1    now we area going to move on to our final candidate

2    of the day, former Alaska Senator Mike Gravel.

3               MIKE GRAVEL:   Hi, all.   I just want to give

4    my condolences to all of you who realized that

5    something sad happened last night.     The Rebels lost

6    by four points.    I know what that means to you.     I

7    also want to point out that, Andy is sitting over

8    there, Andy, I have to tell you, you speak good

9    English.   I don't understand why candidates don't

10   understand you.

11              I want to thank you for getting me here.

12   It's better than what CNN is going to do to me in New

13   Hampshire by censoring my voice.     But I also want to
14   thank John Podesta.

15           But let me say that Andy pointed out one

16   thing right in the beginning is that we do have a

17   problem, and I don't want to take your time when you

18   know as well as I do.    We've heard a lot anecdotal

19   experiences and deep emotions about the problem.

20   That's not a solution.   That's not a solution.

21           What's wrong with health care in this

22   country is that we saddle the business community with

23   carrying it, and the can't do it because it's going

24   to cost you your jobs, it's going to cost -- it's

25   going to damage you internationally.   Why -- Karen

1    was alluding to it, historical accident in a second

2    World War when wages were frozen.   The only way you

3    could get people to come into your company and work

4    was to give them a lot of health care benefits.     The

5    war is over and we don't have this freeze on wages.

6    So we don't need that system to go ahead and carry.

7    And if you heard all of blame, they essentially,

8    they're for Dennis, they were all involving employers

9    and employees.   That is a non-starter and it's a

10   Band-Aid that is not going to work.
11           Now, what can we do?    Oh, well, real simple.

12   We can turn around and say let's have a health care

13   program that establishes equality.   And I'll give you

14   the name of it.   It's called the Universal

15   single-payer, by single-payer I mean all Americans

16   pay for it regardless of the system you have now but

17   the system you're going to get, single-payer Health

18   Care Voucher plan.

19           Under the plan we would issue vouchers to

20   every single American.   And the vouchers, you don't

21   pay for them, they're issued to you.   You sign up

22   every year for them.   And the vouchers will have a

23   very modest co-pay, a very modest deductible, but

24   that's it.   Everybody gets the same product

25   universally in the United States of America.

1            And then if you want more than the product

2    you got, you pay for it.   There's no magic in this

3    whole process.    Somebody is going to pay, you know

4    who pays, it's the average American, one way or the

5    other, particular under our present system.

6            And so to want to trash the business

7    community and trash our tax system, which is already
8    corrupt with greater corruption as a way to solve the

9    problem is a non-starter.

10           When they tell you about oh, you know, I've

11   done this, done that, keep in mind Harry Truman was

12   the first to raise this issue with the Democrats, and

13   they didn't do it and he haven't done it since and so

14   it's been a little Band-Aid one on top of the other.

15           Now, with these vouchers you'll be able to

16   have choice, choice of doctors, choice of hospitals,

17   free choice.   Now, you'll be able to also have a

18   choice of maybe no more than five or six plans,

19   insurance plans.

20           Now, I have my suspicions with the predator

21   activities under our present mercantile system where

22   you have your lobbyists, 30,000 in Washington, go out

23   and make sure that they take care of their clients.

24   So there's going to be some changes made in the

25   future, depends on how this is enacted into law.

1            And it's not going to be enacted by the

2    Congress.   Don't hold your breath on that please.

3    Never will happen.   For the very simple reason that

4    there's too many interests, 30,000 lobbyists.   Who do
5    you think is funneling all these millions of dollars

6    to the presidential candidates.   It isn't coming from

7    the wholly trinity.   My God, it's coming from vital

8    special interests, whether they're for Democrats or

9    Republicans, that's what you're faced with.

10             So now you're going to have a voucher.     You

11   got the freedom of choice.   You got the freedom of

12   choice in plans.   Now, you might have a public plan

13   if we don't see the insurance industry and the

14   pharmaceutical industry shaping up.   So now you got

15   public assistance.    But let's have like publica

16   assistance, let's have a central body called a health

17   care board with regional boards that they would then

18   define what the various vouchers are for.

19             And the vouchers are set up for risk on an

20   individual basis, not on a collective this fits all,

21   because if you're young you probably don't have a

22   cost of more than $3,000.    When you're my age it

23   could be 150, $180,000 in one year, which is what I

24   got hit with and I went bankrupt as a result of that.

25             So make no misunderstandings, I know the

1    system.   I get my meds from the VA and I get the rest
2    from the Medicare.    So I know the system up front and

3    personal, and I don't have to tell you about somebody

4    in Benton, Iowa crying on my shoulder.

5            Let me point out to you so what will happen,

6    when I'm talking individually designed, we're going

7    to have electronic records.   Hell, that's nothing.

8    We have to have your entire history computerized, and

9    every penny that's spent on your health care

10   computerized all the time so that when we're really

11   redesigning next year, we're going to turn around and

12   project that oh, you spent 3,000 last year, we're

13   going to give you a voucher for 3,000 the next year.

14   But suppose you've got colon cancer so it costs you

15   $150,000 next year.   That's going to be the size of

16   your voucher.   You begin to see the dynamics of this.

17           And by putting in, and with only having five

18   or six plans, and the plans would determine and there

19   will be no lemon dropping.    There will be no, well,

20   you don't qualify, you get a preexisting condition.

21   That is history under this plan.

22           So this plan can work.     All we need to do as

23   they say, oh, you've got to bring the people in.    My

24   God, bringing people in.   They're not bringing people

25   anywhere.   They're just tying to create an attitude

1    of that, my God, we're going to do something great

2    for the people.   Hell, the people are not empowered

3    to do anything.

4             In the United States more than half of the

5    American people make laws at a state, local level.

6    Why can't we do that at the federal level.    If you

7    did then of course you decide what is the health plan

8    you want to have or if you want to continue to put up

9    with the mandates that we're experiencing.

10            So how are we going to pay for my health

11   care will get done, and I want to thank my advisors,

12   Dr. Fuse and Dr. Politnocoff as both experts in the

13   field that have been advising me.   They'd be ashamed

14   the way that I presented it, but I think not.    I

15   think not.

16            And so I would just say that if we empower

17   you, then you could make the decision and not try

18   to -- it's what they're saying.    They're saying we

19   want you people to use the government for your

20   benefit, okay.    Why don't you just -- why do you have

21   to do that?   Why can't you do it directly?   You

22   can't.   There's a way to do it.   Go to Gravel OA dot
23   U.S. and you'll see the process to be able to do it.

24   Thank you very much.

25           KAREN TUMULTY:     Thank you, Senator.   It

1    sounds like the plan that you're describing about

2    your standards right have some of the elements of

3    single-payer but also some of the elements of a

4    medical savings account.   It's not a sort of

5    traditional pure single-payer plan.   And you

6    described this as something that would never come

7    from Congress.   And so can you describe again this

8    process by which -- what kind of process are you

9    talking about here?

10           MIKE GRAVEL:    I'm talking about using the

11   national initiative.   First for this to happen, and

12   I've got to tell you you're not going to have an

13   alternative because 10 years from now, 15 years from

14   now you're going to have the problem getting worse.

15   You're all right about that.   It's getting worse all

16   the time.

17           But don't worry about that.    You think that

18   that's going to cause him to solve, the Congress to

19   solve the problem?    Look at this country.   We're
20   literally bankrupt.   We're literally bankrupt and

21   nobody pays any attention to it.   We've got these

22   crazy wars.   We have a nation that's controlled by

23   the military industrial conflict that dictates what's

24   happening to your lives, and the Americans are just

25   whistling walking through the cemetery.    So I don't

1    know if I've answered your question.

2            KAREN TUMULTY:   This national initiative,

3    how does that work?

4            MIKE GRAVEL:   How does it work?

5            KAREN TUMULTY:   In terms of the petition and

6    it starts as what?

7            MIKE GRAVEL:   Well, I don't want to take the

8    time to go through this whole process, but understand

9    what I've done is I've copied the procedures that are

10   used in the Congress and every legislative body in

11   the world and I've put them into a law called the

12   National Ballot Initiative.   And that is to equip

13   every single American to become lawmakers to come

14   into the operation of government as lawmakers and

15   partners with their elected officials.

16           Now, this is revolutionary.    This is out of
17   the box.   You know what it means is we trust the

18   American people.   Isn't that revolutionary?   We trust

19   the people, rather the other politicians trust me,

20   I'll get elected, I'm going to do the job for you.

21   I've got news for you, can't be done that way.     And

22   we have historic precedence to show it.    And if that

23   doesn't convince you that we're not going in the

24   right direction electing various personalities

25   President and thinking that's going to make the

1    change, I've got to tell you, the change lies with

2    you, not the leadership.    The leadership has been

3    screwing up by the numbers for the last 50 years.

4    Have you had enough yet?    Please.

5               KAREN TUMULTY:   Senator, there was a

6    question that I had in my mind about this, and it's

7    addressed by one of our questioners in the audience,

8    and interestingly enough at this very moment a

9    question over e-mail popped up that addressed the

10   same issue.

11              You described these vouchers as addressing

12   the specific conditions you have.     You need a heart

13   bypass, you get a voucher that would cover it.     But
14   Michelle in Iowa asked how would you increase the

15   role of prevention in the American health care

16   system.   And I'd in fact like to turn to Becky, and I

17   apologize in advance, is it Estraya or Estralla,

18   who's an RN at UHS Valley Hospital.

19             Are you here, Becky?

20             BECKY ESTRAYA:   I have been a nurse for

21   37 years and I have seen patients come into the

22   hospital with medical problems that could have been

23   prevented if a doctor had seen this patient early on.

24   As President how will you ensure that more efforts

25   for preventive and wellness care is provided

1    nationwide?

2              MIKE GRAVEL:   First off, there is a role for

3    the President in his leadership capacity, or her

4    leadership capacity.     And that is to change the

5    culture, to really energize people to exercise.

6              Now, people say at my age that, you know,

7    I'm a good example.    I've had two major operations,

8    several major operations, but I'm in good shape

9    because I exercise.    I try to eat the right foods.

10   And so I have a lady on the plane that showed me that
11   she could have got this junk bar for 50 cents but

12   they were asking for a dollar 25 for the apple which

13   she was holding up about to eat.   Doesn't that tell

14   you something about the dynamics of what's going on?

15              I mean, we're all patriotic, whether it's in

16   business, whether it's in labor, we're all patriotic.

17   But we need a leadership that sets a tone, that sets

18   a tone to demand from us the best that's in us.     We

19   recognize these problems.   We know the problem of

20   obesity.    I try to diet all the time, sometimes

21   successfully, sometimes not so successfully.    But

22   when all you've got in your field of vision is junk

23   food, you got problems.

24              And that's the problem that the President

25   can bully but not giving you.   He's going to regulate

1    all this.   I got to tell you, look what happened with

2    Katrina.    You know, you heard the joke, I'm from the

3    federal government and I'm here to help you.    Well,

4    that doesn't work.

5               The government is a tool.   The people can

6    use it.    But if the people have the direct power to

7    use it, now you get to see government as a real tool,
8    not the tool you have where the special interests

9    determine how the tools of government is handled by

10   the lobbyists and the bundling to pay for the people

11   who pay for their campaign to manipulate you to vote

12   for them.   That's the process that we live under and

13   that's process that has to change.

14              KAREN TUMULTY:   Next I'd like to turn to

15   Fabiola, is it Pavol?      Pavel?   Who's a janitor in

16   Clark County.   Fabiola, are you here?

17              FABIOLA PAVA:    Pava.

18              KAREN TUMULTY:   Pava, I apologize.   I didn't

19   even come close, but I have a hard time with Tumulty

20   so I understand the issue.

21              FABIOLA PAVA:    My name is Fabiola Pava and

22   I'm an SEIU member.   I work for Clark County as a

23   janitor.    I'm also a primary caregiver for my 78 year

24   old mother.

25              My mother has Medicare and the problem lies

1    in that the providers will not use diagnostic tests

2    and treatments that will diagnose her sooner and

3    treat the problem faster.     The question is what is

4    your plan for providing preventative and diagnostic
5    services for health care for our seniors, people with

6    disabilities and all Americans?

7              MIKE GRAVEL:   One of the facets of the plan

8    would be to keep in place Medicare and Medicaid and

9    phase them out over time.   Because plans to put

10   everybody on Medicare aren't going to fly financially

11   and just can't be met.   And so they can tell you they

12   can, but they can't be met.

13             We are in deed economic difficulty and in

14   debt.    So when you talk about the seniors, this is

15   where you have these health regional boards where in

16   that region they'll be defining what goes into these

17   various vouchers.   And they're change every year

18   depending upon your personal history as you get

19   older.

20             And we know it costs less for young people

21   and it costs more for old people.   That's just the

22   nature of the situation.    So I don't have any magic

23   to take care of the seniors.   All I can say is I can

24   set up a structure that will have checks and balances

25   where they'll have a better say, they'll have a

1    better say than they have today.
2               77 million people are going to be retiring

3    in the next 25 years.   Those are the baby boomers.

4    That's twice the amount of people, the adult, the

5    senior people that exist today.    If there's a group

6    that's going to benefit from the National Ballot

7    Initiative it's going to be the seniors because

8    they'll have more clout to be able to vote for

9    programs that they feel will address their particular

10   needs.

11              That's the answer that I would offer to you,

12   not a magic wand from Mike Gravel as President, it's

13   from the people being involved directly with the

14   power to make laws on policy issues that affect your

15   lives.   That doesn't exist today, and there's nobody

16   running for President, Democrat or Republican, that's

17   even suggested that.    Oh, they talk about big

18   changes.   They're cosmetic changes and they're

19   Band-Aids to the problems we face in this country.

20              KAREN TUMULTY:   Could I ask a follow-up that

21   I think is to the premise of Fabiola's question, if

22   I'm understanding correctly, which is that, and have

23   you found that in your own experience as a patient

24   and also as a policymaker that elderly patients in

25   particular that the medical system doesn't seem to

1    have the same aggressiveness and the same sort of

2    curiosity?   Is that sort of what you were getting at

3    here in terms of diagnostic testing and the kind of

4    treatment that elderly patients receive?

5            MIKE GRAVEL:    Maybe I didn't answer her.

6    Doctors do a lot of testing today to cover their

7    backside, you know, because they want to be sued.

8    One of the futures of these regional boards is we're

9    going to do away with what we see that the attorneys

10   love, and that is to go sue doctors or raise the

11   costs where they can't even stay in business.    The

12   same thing with nurses.   That's got to go.

13           Now, you want to see how much money the

14   trial lawyers are pouring into the presidential

15   campaign?    Just as a couple of young people out there

16   doing their blogging and putting that data up, look

17   at that data, that answers the whole question.

18           So we can't have everything.    You cannot

19   have everything.   And so you can have a basic plan

20   that will cover.   And the way the plan is designed,

21   it won't raise costs, because the 30 percent that

22   they're talking about is paper cost.   If you took
23   that and put it into some real costs in health care,

24   we'd cover everybody without raising any costs.

25           But you do have to recognize that you can't

1    have everything you want.   You can't have a burp and

2    run to the doctor.    You got to be responsible as

3    citizens.   And that goes back to this whole

4    preventative medicine where we change the culture.

5    That will help to lower the cost, but also until

6    we're totally in a new culture in that regard, we

7    have to have some discipline on what the basic

8    package will be.   And that is a decision -- and you

9    want to raise the basic package and you're a

10   lawmaker, put an initial up.   Let's say we're going

11   to raise the cost, rather than seven percent for the

12   package, the basic package, we're going to raise it

13   to ten percent.    Let the people decide.   That's the

14   slogan of my campaign, let the people decide.    Why

15   should the politicians be also on the mission in this

16   area and they know it all, when they can't even

17   produce a decent plan.   I hope that addresses your

18   follow-up question.

19           KAREN TUMULTY:    We have about one minute
20   left, and so I wanted to ask you your slogan, let the

21   people decide, what's your plan from here on out?

22   You come into this race without a lot of name

23   recognition, without a lot of money, without big

24   organizations.    Where do you go from here?

25            MIKE GRAVEL:    Well, the problem with not a

1    lot of money can be solve by the people who hear my

2    voice.   It's not going to be the lobbyists bundling

3    money for me.    It's not going to be the corporations

4    that are going to be giving me money through their

5    executives giving me the money.    It's going to be if

6    my voice can be heard.

7             And I don't need the 50 million, a hundred

8    million dollars -- or a million dollars that they're

9    going to spend.   All I need is a modicum of money,

10   around $10 million and I'll win.   I'll win because

11   I'll be able to get to the American people and say

12   the solution is with you.   It's not with the leaders.

13            And if I can become President, and lightning

14   would have to strike for that to happen, but, you

15   know something, you know something, lightning has

16   struck all the time in presidential elections, all
17   the time.    Anything is possible in politics, and I

18   could be your next President.    I could be your next

19   President.    And if you're worried about my age,

20   don't.    We can get a young man who's vice president.

21   There's a few around.     I hope I've answered your

22   question.

23              KAREN TUMULTY:   Thank you very much,

24   Senator.    I think anything is possible, and politics

25   is a terrific way to end today.

1               MIKE GRAVEL:   Thank you.

2               KAREN TUMULTY:   Thank you.     Thank you very

3    much.    This is the end of our forum, and we want to

4    thank again the University of Nevada, Las Vegas for

5    hosting us.   And, Rebels, there's always next year.

6    Thanks.

7                   (Thereupon the proceedings

8                   were concluded at 12:09 p.m.)

9                    *    *      *   *      *
















1                  CERTIFICATE OF REPORTER


3                      SS:


5            I, Deborah Ann Hines, certified shorthand

6    reporter, do hereby certify that I took down in

7    shorthand (Stenotype) all of the proceedings had in

8    the before-entitled matter at the time and place

9    indicated; and that thereafter said shorthand notes

10   were transcribed into typewriting at and under my
11   direction and supervision and the foregoing

12   transcript constitutes a full, true and accurate

13   record of the proceedings had.

14           IN WITNESS WHEREOF, I have hereunto affixed

15   my hand this _____ day of _______________, 2007.



19                   Deborah Ann Hines, CCR #473, RPR