Lloyd Bentsen was a great pleasure to work for, in large part because he could make such good use of the stuff we did in his Office of Economic Policy. The White House health care staff made very little use of him in the summer of 1994. I will never understand why not: he was very effective in holding Republican moderates' feet to the fire:
American Presidency Project: Press Briefing by Secretary of the Treasury Lloyd Bentsen: July 20th, 1994:
MS. MYERS: As you know Secretary Bentsen will be briefing; the briefing is on a Treasury study. Following that briefing, Alicia Munnell, who is the Assistant Secretary of the Treasury for Economic Policy, will be generally available to answer specific questions about methodology and other questions related more specifically to the study. So, here is Secretary Bentsen.
SECRETARY BENTSEN: This is for all the crowd that's under 40.
Q: You just lost a lot of people here.
SECRETARY BENTSEN: I'm often asked, who are these people, who are these Americans without health insurance? So that's what we've done -- we've dedicated a study to accomplish that information. And we did that analysis, we did it state by state and we did it by congressional districts trying to determine who these people are without health insurance. Are they young, are they out of a job? The bottom line is they're middle-income Americans that are your neighbors. Let me illustrate that with the congressional district that I once represented, and it's now my neighborhood. They blew up this page on Texas for the report. And I hope that you take a look at your states and congressional districts like I'm doing for Texas.
In the 15th congressional district, that's on the Mexican border, that's a district now represented by Congressman Kika del la Garza; once upon a time I represented it. These are 173,000 in that congressional district that are uninsured. Almost 82 percent of them are from working families and 58,000 of them are uninsured children. In Texas there are 3.8 million people with no insurance; 84 percent of them are in working families and 972,000 of them are children. Think about it -- almost a million children in Texas have no insurance.
These are not folks that hire lobbyists. They really don't have anyone to speak for them in this debate. But they're the ones that I think are the most vulnerable. Now you know why as a Senator from Texas I spent so much time trying to get improved health care for children. Now we have a chance to complete that job.
There's a sense in this country that the uninsured are poor; that they're the elderly, they're the disabled. That's just not true. Most of these individuals already have coverage through Medicaid, through Medicare, through public assistance. By far, most of the uninsured are members of middle-income working families. The Treasury study shows there are 37 million uninsured; 84 percent are in working families; 8.3 million of them are children. And these people aren't all poor. One in three is a member of a family making over $30,000 a year. Most uninsured either have an employer who doesn't have or doesn't provide coverage, or the worker can't afford to buy it without help. And for most of the uninsured, being without insurance -- it's a long-term, not a short-term problem.
If you have insurance, it's easy to say, well, you know, this doesn't affect me; the uninsured -- that's their problem, not my problem. Don't you believe that; that's not right. It's your problem, too, because insurance costs are then higher. You've got a bed that isn't paid for in that hospital, you've got a doctor that's not paid, you've got a nurse that's not paid -- those fees go up. The hospital cost per bed goes up for those of us that have the insurance. Or if you have a public-owned hospital, like a city hospital, and the bills aren't paid, your taxes go up.
I used to be on the board of Texas Childrens Hospital in Houston. Last year they had over $40 million worth of unpaid bills. I was visiting a hospital in Dallas -- over $40 million of unpaid bills. They finally get paid -- you pay it; again, either through your taxes or through increased insurance costs. Let me conclude by saying, we have a serious shot at achieving universal coverage. And I think it makes sense to build on the employer-employee relationship, since that's where most people obtain their insurance. And we need health care to be affordable to both employers and employees. And that's important to every one of us.
Every one of us can tell a story about a family member, about a co-worker, about a neighbor who runs into trouble with the current system. That's what we're talking about; that's what we're trying to fix.
And who's first?
Q: Mr. Secretary, if 95 percent of the American public is insured as a result of new legislation, is that universal coverage?
SECRETARY BENTSEN: I think universal coverage, when you define it, what we're talking about is guaranteeing to every American the right of insurance. Now, does that mean you're going to get 100 percent? No, you're not. But I think you have to look at it to see how it's implemented over a period of time; how access is ultimately guaranteed to them. And I think that must remain the objective, not a defined percentage.
Q: You're a former senator, and you know the mix up there on the Hill. Every senator and your former colleagues are saying that employer mandates are dead in the Senate. What other way can you get to universal coverage without the employer mandate?
SECRETARY BENTSEN: Well, I frankly think that's the best way, and so does the President of the United States. And I think that's the least disruptive way. I think that's the way most people get their insurance now. I look at other systems. I look at what's happened in Hawaii in that regard. I look at the German system. So that is preferred. That does not mean that we won't look, and the President shouldn't look at other possible solutions if they achieve universal coverage. You have to stay with that basic need.
Q: Can you get there through an individual mandate, or a combination of mandates?
SECRETARY BENTSEN: I don't think we should try to pick out that one. We're seeing, at this point, there will obviously be negotiations as you look at what's offered -- if they get to the objective of universal coverage. And that just has to be.
Q: What are the other options?
SECRETARY BENTSEN: Well, Helen, there are a myriad of options.
Q: Like what?
SECRETARY BENTSEN: You know what they all are. You've got things with additional incentives and subsidies that are being offered. You're looking at situations where you've still got the single-payer approach by some. So there's a whole myriad of options. But you will look at each as it comes up. I don't think that the President ever expected that his program would come through without some changes. That's the way the congressional system works. I spent 22 years worrying about all the power at this end of Pennsylvania. And I've spent the last year and a half worrying about all the power at the other end of Pennsylvania.
Q: Mr. Secretary, do you think employer mandates can go through?
SECRETARY BENTSEN: Well, we're working at it, and we're pushing it. And I think that's the best system.
Q: If you do get a bill with universal health coverage, define who are those who do slip through the cracks. Is it the same $30,000-a-year people who don't choose to buy health care now?
SECRETARY BENTSEN: You can't -- you don't know that until you see the final structure of the legislation.
Q: Who do you miss if you have universal health coverage?
SECRETARY BENTSEN: It depends on which one you adopt. You've got all kinds of proposals out there.
Q: If you adopt the President's plan?
SECRETARY BENTSEN: If you get the President's plan, every person is going to be guaranteed the right for health insurance. The things you worry about is the fact -- as you go through some kind of an illness, they're going to take your insurance away from you. You worry about that. We see that that doesn't happen. You want to change jobs and you want portability. We see that they can't take the insurance away from you. Talk about preexisting conditions, and we take care of that. Those are the concerns of people -- how they might lose their insurance. And the President's legislation sees that doesn't happen.
Q: But he says no plan will actually hit 100 percent of the people. And since you're trying to break a myth on who doesn't have the insurance now, who wouldn't have it? Who is he worried about that wouldn't have it if a bill only sets its sights on 95 percent or 98 percent?
SECRETARY BENTSEN: Well, you set your sights on 100 percent and there will always be some slippage.
Q: Senator Breaux said he would be meeting with the President later this afternoon. And, as you know, he has proposed the idea of a trigger mechanism which would only impose employer mandate if voluntary measures don't work. Is that an idea the administration is willing to accept?
SECRETARY BENTSEN: Well, I've negotiated with the Congress a long time, and I always turn my cards over one at a time. I never turn them all over at once.
Q: Secretary Bentsen, you mention the problem with cost shifting in Texas Childrens Hospital. The President said yesterday that if you get to 95 percent, you can do something about cost shifting. Is that --
SECRETARY BENTSEN: Well, that certainly has a material effect on cost shifting. No question it has an effect.
Q: Are you able to solve the problem?
SECRETARY BENTSEN: That certainly doesn't totally eliminate it.
Q: Sir, some members on the Hill, some of the more liberal Democrats who are suggesting they're feeling let down or even betrayed by the President's remarks yesterday; that he seems to be caving in and he's backing away. You're a veteran of the Senate and the parallel is already being drawn to his withdrawal from support of the BTU tax and leaving some members out on a limb on that one. Do you see a similar kind of situation developing now?
SECRETARY BENTSEN: I don't see the President backing down. He's made these statements before. He's continued to make the statements that he's for universal coverage. He believes in universal coverage. He wants that, that's his objective. If someone can find a less expensive way to do it, a better way to do it, he's ready to listen. But as long as that principle is retained of universal coverage. If they can find a way to do it without employer mandates, fine. That is his preferred way and, frankly, it's mine. I think it's less destructive to the system.
Q: You said in your comments in defining universal coverage that it means guaranteeing the right to insurance. Since we're having such a discussion of semantics in the last 24 hours, what's the difference between guaranteeing the right to insurance and the guaranteeing insurance? Is there any? It sounds like the debate between access and --
SECRETARY BENTSEN: I don't see any difference there, no.
Q: Well, just to follow up on that -- is health care a right? Do Americans have a right to health care?
SECRETARY BENTSEN: Sure. It's got to be paid for, but I think every American ought to have a right to health insurance. And it's talking about the children and how many of them we have. One of the things I worked on in the Senate was trying to get more health coverage and health attainment for children and taking care of those problems. That's an enormous number of the constituents we're talking about that are uninsured.
Q: Does your study show why these people don't have health insurance, particularly those with incomes over $30,000?
SECRETARY BENTSEN: No, it doesn't. But this shows the reality of what's happened. This does not go to the cause. It's not that kind of a study. But you sure know that in many instances, it's because of some of these conditions we talked about -- preexisting conditions; some of them that the premium has gone so high that they can't afford it without some help. I tell you what happens in small business, I used to be a businessman. What you have, when you see that the cost for small business goes 30 and 40 percent above what it is for big business and still trying to be competitive; when you have a situation where somebody in your small business suddenly has a very serious illness and you see an experience rating by the insurance company and they jack up your premiums substantially the next year, and what do you do? You look for a competitor, maybe, to sell you the insurance. Or you increase the deductible. Then you increase the co-insurance, then you drop the dependents. And then, finally, you drop the policy altogether. And that's what we face and what we're trying to take care of after.
Q: Mr. Secretary, how are you sure that this, if it passes, will not become another runaway entitlement?
SECRETARY BENTSEN: Well, I think that cost containment has to be a part of the package and trying to figure out how that can best be done. I think that's essential, and I think that's critical.
Q: And you're satisfied that the Clinton plan achieves that goal?
SECRETARY BENTSEN: We sure looked at the numbers a long time and we crunched those numbers over in Treasury.
Q: Mr. Secretary, how would you characterize Senator Dole's speech yesterday to the governors? Do you see flexibility in his approach or do you think he's hardening his position?
SECRETARY BENTSEN: I would not try to analyze that speech.
Q: Mr. Secretary, while we have you for a second, could you comment on the Chairman of the Federal Reserve, Alan Greenspan, is suggesting today that interest rates --
SECRETARY BENTSEN: I knew I should have left once --
Q: He's suggesting interest rates --
SECRETARY BENTSEN: Wolf, I do not try to predict what the Federal Reserve is going to do. I think that the Federal Reserve and Alan Greenspan shares with us the objective of long-term growth with low inflation. And thank you very much.
END 11:30 A.M. EDT
Citation: John Woolley and Gerhard Peters, The American Presidency Project [online]. Santa Barbara, CA: University of California (hosted), Gerhard Peters (database). Available from World Wide Web: http://www.presidency.ucsb.edu/ws/?pid=59908