assistors were navigators. -- and navigators. the navigator is able to do medicaid, as well as enroll people on the qualified health care plans him explain subsidies and so on and so forth and select a specific plan. question, we were banging our heads against the wall, to. they are full-time employees. we will really boost up the education campaign. get will be a few years to people to understand what is going on. enrollmentafter open to hit the high schools, community colleges to do a very robust education effort.

toi think it is important remember there is no open enrollment for medicaid. >> we have i think had a very .ich discussion here i think it cannot be understated what's an important role commitment at the state level to making this work is in terms of being able to move forward and get people connected to insurance. we have also seen from individuals here that we are really building on the experience of the chip program where we learn to do outreach to children and use perry is mechanism to reach people in the community. i think all activities are going to be local and really does depend on mountain -- on the groundwork. important thing we have learned is also takes a

real partnership between people working at the state level tom inside of state government, outside of state government and especially with providers and community-based partners. this is a big effort going forward. starts open enrollment but does not stop the effort to get many people the kind of coverage they need either through the medicaid program or some of the available coverage in the individual market through the exchanges. will be a lot of people getting their coverage and continue to get coverage through the employer-based system. for them and medicaid population, this is not an effort to move them to something new but to help them be part of a sustainable health care system for all americans. for joining us today. thank you to samantha and oregon and the panelist and the kaiser

team that put this together. thank you very much. [applause] >> president obama was in new york city to speak at the u.n.. he stopped at the clinton global initiative for conversation about health care with bill clinton. this is a little less than an hour. >> hillary rodham clinton. [laughter] >> good afternoon, everyone. thank you.

thank you very much. i have a great pleasure to introduce our next two speakers who are about to have a conversation concerning health care. and i thought hard about how to introduce these two men. [laughter] and the more i thought about it, the more i realized how much they have in common. they are both left-handed. they both love golf, a game that does not often reciprocate the love they put into it. [laughter] they both are fanatic sports fans and go to great lengths to be in front of the tv or on the side of the court or the field.

they both are master politicians. each of them has only lost one election. they're both democrats. they have fabulous daughters. they each married far above themselves. [laughter] [applause] and they each love our country. and so, please join me in welcoming number 42 and number 44, bill clinton and president barack obama. [applause] ?him him

>> mr. president. [laughter] >> are you interviewing me? that was a good thing you did. [laughter] thank you for coming. >> it is wonderful to be back and let me start by saying to all the people who have for years now supported the incredible efforts of cgi. thank you. wherever we travel, all across the globe am a we see the impact that it's making every single day. and we are proud of the work you do. let me say that we still miss our former secretary of state. [applause] and i should add that there is

nothing that she said that was not true. [laughter] particularly about us marrying up. >> that brings me to my first health care comment. this will be a conversation about domestic and international health and america's role in it. i want to begin by telling you that i think the first lady has done a great job in this fight against childhood obesity. we have been honored in our foundation to be asked to represent her effort in 18,000 schools where we have lowered the calories in drink being served in schools by 90%. she has been great on that. the other thing i think is that i was a little upset, and as you know, karl, one of your administration members, when you got to -- i read an article that said you didn't have a dig initiative in africa. and i said -- i can't say exactly what i said.

[laughter] but it is inaccurate. that is the sanitized version of what i said. when the president took office, our programs was giving medicine to 1.7 million people because of an agreement that i made with president bush to use generic drugs that were approved by the fda. drugs are being purchased in that way. under president obama, we have gone to 99%. we are treating more than 5.1 million people, three times as many for less money. [applause] that is a stunning legacy so that more money is put into malaria and bed nets to so you save more money and save more lives while doing it. i want to thank you for that. it's important. [applause]

maybe at the end of this conversation, we can get back to some of your current global health initiatives, but let's talk a little bit about the health care law. we are about to begin on october 1 open enrollment for six months and i'd like to give you a chance first of all to tell them why, when you took office and teetering on the brink of a depression, you had to start the recovery again, why in the midst of all this grief did you take on this complex issue? many people were saying why not just focus on the economy and leave us alone? so tell us why you did it. >> first of all, i think it is important to remember that health care is the economy.

a massive part of our economy. so the idea that somehow we can separate out the two is a fallacy. second of all, the effort for us to deal with a multifaceted health care crisis has been going on for decades. and a person who just introduced us, as well as you early in your presidency, had as much to do with helping to shape the conversation as anybody. the fact is we have been, up until recently, the only advanced industrialized nation on earth that permits large numbers of its people to languish without health insurance.

not only is there the cruelty of people who are unable to get health insurance, having to use the emergency room doctor, but we are also more efficient than anybody else. so when we talk about, for example, our deficit, you know this better than anybody. the reason that we have not only current deficits but also projected long-term deficits, the structural efforts at that we had is primarily based on the fact that we have a hugely inefficient, wildly expensive health care system that does not produce better outcomes. and if we spent the same amount of money on health care that canada or france or great britain did or japan or any other industrialized country

with the same outcomes are better outcomes, that essentially would remove our structural deficit. which would then free up dollars for us to invest in early childhood education and infrastructure and medical research and all the other things that can make sure that we are competitive and growing rapidly over the long term. so my view, when i came into office, was we have a crisis. we have to get the economy going. but we have to start tackling some of the structural problems that have been building up for years. what accounts for our deficit and are dead and causes pain and misery to millions of people all across the country, it is a huge burden on our businesses. i was at a ford plant in missouri and there is a big stamping plant. ford is now the biggest seller in the united states.

we took that lead back from the japanese automakers. every u.s. automobile that is many fractured requires a couple of thousand dollars in added health care costs that our foreign competitors don't have to pay. so this has anything to do with the economy in addition to what i consider to be the moral imperative that a mom should not have to go bankrupt if her son or daughter gets sick. that a family who is dealing with a layoff and is already struggling to pay the bills shouldn't also be wondering whether they are one illness away from losing their home.

and i think most americans agree with that. [applause] >> first of all, folks, for those of you who are from the united states, that is as good an overview as you're ever going to hear of what this economic issue is. but you remember the president said that our structural deficit would disappear if we had a comparable health care system in terms of cost to the french and germans who are consistently rated the highest. it is about a trillion dollars a year. somewhere around 44% of that money is government-funded money. so you just run the numbers. over half of our deficit has already disappeared because of economic growth and the revenues you raised and the spending we cut. and you pretty much get rid of the rest of it if we just have a comprehensively competitive system.

they announce that we are a car company that provides health care benefits to employees. we are not a health care company that sells cars to cover our health. we have to go to canada. it was one of the few companies willing to go on record and say this. so thank you for doing it. what does this open enrollment mean? how will people get involved? when you have universal enrollment, you can manager costs better and cut inflation. i will give the president a chance to talk about all the

good stuff. but i will let you know one thing. in the last three years, inflation and health care costs have dropped three years in a row for the first time in 50 years. 50 years. [applause] before that, the costs were going up at three times the rate of inflation for decade. so now what? what will you do on october 1? tell them how this has to work. >> the me give folks a little bit of background on what is already in place and then what happens on october 1. when we passed the affordable care act, there were a number of components to it. a big part of it was essentially providing a patient's bill of rights that americans and advocates have been fighting for for decades. so we wanted to make sure, if you already have health insurance, you get a fair deal. that you are being treated well by your insurance. so we eliminated, prohibited insurance companies for putting lifetime limits which,

oftentimes, if a family member got sick, they thought they were covered until they hit that limit and then they have no way of paying. we said to insurance companies you've got to use at least 80% of your premium that you are receiving on actual health care, not on administrative costs and ceo bonuses. and if you don't, you have to rebate anything that you spent back to the consumer. so there are millions of americans who received rebates. they may not know that they got it because of the affordable care act or "obamacare," but they are pretty happy to get those rebates back. it made sure that the insurance companies were treating folks fairly. we said that any young person who doesn't have health

insurance can stay on their parents health insurance until they are 26 years old. as a consequence, what we have seen is steadily the rate of uninsured for young people dropping over the last three years since the bill passed. obviously providing a lot of relief to a lot of parents out there because a lot of young people have been entering the job market at a time when jobs are tough to get and oftentimes benefits are slim. this is providing an enormous security until they get more firmly established in the labor market. we provided additional discounts for prescription drugs for seniors under the medicare program. there have been, over the last three years, a whole array of consumer protections and savings

for consumers that result directly from the law that we passed. for those who say they want to repeal it, typically when you ask them about what about all these various benefits, they say, that one is good, and we would keep that, and you go down the list, and there is not too much that people object to. you will recall also at the time that part of the way we paid for the health care bill was, we said, medicare is wasting a lot of money without making seniors healthier. there was a lot of outcry about how we were taking money out of

medicare. well, it turns out that we were right. that we could change how doctors and hospitals and providers were operating, rewarding them for outcomes as opposed to simply how many procedures they did. you started seeing practices change among millions of providers across the country. medicare rates have actually slowed in terms of inflation. seniors have saved money. folks are healthier. some of those savings we have been able to use to make sure that people who do not have health insurance get health insurance. this brings me to october 1. the one part of the affordable care act that required several years to set up, but a critical part, was, how do we provide health insurance for individuals who do not get health insurance through their job? it is a historical accident that in this country health care is attached to employers. part of the problem is, if you are out there shopping for

health insurance on your own, you are not art of a big pool - part o -- part of a big pool. there is no aggregation of risk for insurers. they will say, you are 50 years old, you have high blood pressure, and we look at the actuarial tables and we figure you are going to get that, so we will charge you $1500 a month for health insurance, which the average person has no way of affording. there is no pooling of risk. we said we need to set up a mechanism to pool people who currently do not have health insurance so they have the same purchasing power, the same leverage that a big company does when they are negotiating with an insurance company. essentially, what we've done is created what we call marketplaces, and in every state across the country, consumers are now able to be part of a big pool. insurers have to bid, essentially compete, for the business of that pool. what we now have set up are these marketplaces that provide

high-quality health care at affordable prices, giving people choices so they can get the health insurance that they need and want, and the premiums are significantly lower than what they were able to previously get. i will take the example of new york state. the insurers put in their bids to participate in these marketplaces. it turns out that their rates are up to 50% lower than what was available previously if you went on the open market and you try to get health insurance. 50% lower in this state. [applause] california, about 33% lower.

in my home state of illinois, the just announced about 25% lower. just by pooling and creating competition so that insurers have to go after people's business the way they go after a group plan, we have drastically reduced premiums and cost. on top of that, what we are now doing is saying, if with the better deal that you've got, you still cannot afford it, we are going to give you tax credits to's -- to subsidize your purchase of health insurance. here is the net result -- we will be continuing to roll out what the actual prices are going to end up being, but i can tell you right now that in many states across the country, if you are a 27-year-old young woman, don't have health insurance, you get on that exchange -- you will be able to purchase high-quality health insurance for less than the cost of your cell phone bill. because all the insurers who

participate are required to provide free preventative care, free contraceptive care, that young woman, she may make up what she is spending on premiums just on her monthly use of health care. this is going to be a good deal for those who do not have health insurance. those who already have health insurance are getting better health insurance. the best part of the whole thing is, because of these changes we initiated in terms of how we are paying providers, health care costs have grown, as you pointed out, mr. president, at the slowest rate in 50 years. [applause] >> i should point out that so far in most states, one of the

good things, at least, that i do not know would happen -- when we began this, in the united states, more than 80% of american states haly two companies providing health insurance who had more than 80% of the market. there was, in effect, no price competition. what i was terrified of, we would open these things, and there would only be one company to show up to bid. we would be having an academic conversation. instead, it has led to the establishment of more companies doing more business. i think part of it is that they have more confidence that they can deliver health care at a more modest cost. so far, it is good, but i think it is important for you to tell people why we are doing all of this outreach. this only works, for example, if young people show up, and even if they buy the cheapest plan, they claim their tax credit. it will not cost them much. $100 a month or so.

we've got to have them in the pool, because otherwise all these projected low costs cannot be held if older people with pre-existing conditions are disproportionately represented in any given state. you've got to have everybody lined up. explain all the work you have been doing on the outreach for the opening on october 1. >> i think president clinton makes a really important point. the way pools work -- any pool is essentially those of us who are healthy subsidize somebody who is sick at any given time. we do that because we anticipate we will at some point get that. we hope a healthy person is in our pool, so those costs and risks get spread. that is what insurance is all about. what happens is, if you don't

have pools that are a cross- section of society, than people who are already sick were more likely to get sick, they will rush out and buy insurance. people who are healthy, they say, you know what? i won't buy it. you get what is called adverse selection. what happens is the premiums start going higher and higher because the risks are not spread broadly enough across the population. you want to get a good cross- section in every pool. that is why big companies have an easier time getting good rates for their employees than smaller companies. if you only have five employees, one person is stricken with breast cancer, let's say, and your rates potentially shoot up. but if it is 1000 employees, then it gets spread out. on october 1, open enrollment begins. all of these folks can start signing up for the marketplace.

what we want to make sure of is that everybody in every category, every age group understands why health insurance is important, understands why they should sign up, understands the choices that are going to be available to them. they will be able to go to a computer, cap on the webpage -- tap on the webpage, and they will be able to shop, just like you shop for an airline ticket or a flatscreen tv, and see what is the best price for you, the best plan suited for you, and go ahead and sign up right there and then. that open enrollment period will last from october 1 until the end of march. there will be six months for folks to sign up. normally, this would be pretty straightforward.

a lot of people do not have health insurance. a lot of people realize they should get health insurance. let's face it, it has been a little political, this whole obamacare thing. what you have had is an unprecedented effort that you have seen ramp up over the last month or so in which those who have opposed the idea of universal health care in the first place and have fought this thing tooth and nail through congress and through the courts and so forth have been trying to scare and discourage people from getting a good deal. some of you may have seen some of the commercials out there that are a little wacky. the main message we have, and we are using social media, we are talking to churches, we are talking to various civic groups, and what we are saying to people is, look, go to the website yourself. go to healthcare.gov, take a look at whether or not this is a good deal, and make your own decision. what we are confident about is that when people look and see

that they can get high quality, affordable health care for less than their cell phone bill, they are going to sign up. they are going to sign up. part of what i think the resistance we have seen ramp up, particularly over the last couple of months, is all about, his opponents of health care reform no they are going to sign up. one of the major opponents, and asked, why is it that you would potentially shut down the government at this point just to block obamacare, he basically fessed up and said, well, once consumers get hooked on having

health insurance, and subsidies, then they won't want to give it up. [laughter] you can look at the transcript. this is one of the major opponents of health care reform. it is an odd logic. essentially, they are saying -- people will like this thing too much, and then it will be really hard to roll back. so, it is very important that people just know what is out there, what is available to them, and let people make up their own minds as to whether it makes sense or not. now, one last thing i want to say. i do think sometimes people come up to me and they say, well, if this is such a good deal, how come the polls show that it is not popular? one of the things you and i both know is that when you come to health care, there is no more personal and intimate decision for people. this isn't's -- this is something that people really care about. the devil you know is always better than the w don't know. that is what the campaign was

about in the 19 -- in the 1990s. it was scaring people with the prospect of change. part of our goal here is just to make sure people have good information. there have been billions of dollars spent making people scared and worried about this stuff. rather than try to disabuse people of every single bit of misinformation out there, what we are saying is, look for yourself. take a look at it. you will discover that this is a good deal for you. >> first of all, i completely agree with that. we've got to drive people to the website and -- the website. the supreme court decision upheld the health care laughton

said that states did not have to set up these marketplaces -- the health care law and said that states did not have to set up these marketplaces. they also said states did not have to expand medicaid coverage to help people whose incomes are up to 138% of the federal poverty level. there are some states, believe it or not, that want the marketplace but do not want the medicaid. that is going to lead to a cruel result. there is nothing the president can do. it is not his fault. that is what the supreme court said. he could have this bizarre situation where, let's say, a business with 60 employees or an individual going into the individual market will get the benefit of tax credits for

everybody with incomes at 138% of the federal poverty level, but they will not get it for people between 100% and 138% of the level. low income people who desperately need health insurance, we will have the cruelest of situations in those states. there is nothing the president can do about it because of the supreme court decision. we have to persuade the states to come on. more and more states with republican governors and legislatures are doing it. arkansas, we are doing well down there. >> a little hometown bias, there is nothing wrong with that. a couple of things that are happening that i think are very interesting -- first of all, i'm sympathetic to some of these republican governors who are under a lot of pressure because the whole issue of whether you are for obamacare or not has become a litmus test your -- test.

some of them, it is lyrically tough. sometimes, state legislatures have refused to allow governors to go ahead and implement it. but as you indicated, what we have seen is that when republican governors take a look at the deal they are getting, where i'm at in addition to these exchanges, we are also providing a much more significant match, much more federal money, to provide health insurance -- the federal government is picking up the tab. this is helping them because people are no longer going to the emergency room. they now have good health care. you are seeing some republican governors step up and say, i may not like obamacare, but i'm going to go ahead and make sure that my people are benefiting from this plan. that is one good thing that is happening. the second thing that is happening, there are a couple of states, and arkansas is a good example, kentucky is another good example, idaho, an interesting example -- these are states where i just got beat. i do not have a big constituency in these states. [laughter]

well, i take that back. you know what? 40% is still a lot of people. i am losing by 20% in these states. the governors waltzed -- were still able to say, we are going to set up our state exchanges, their own marketplaces, and each state is just using their own name for it. i had a conference -- a videoconference with all the state directors of all the marketplaces, and i am talking to the director in kentucky and idaho, and in kentucky it is called kentucky connect, and in idaho, it is the idaho health care exchange. there is a story that came out of kentucky where some folks were signing people up at a county fair somewhere, and some guy goes up and starts looking

at the rates and decides he is going to sign up, and he turns to his friend and says, this is a great deal -- this is a lot better than obamacare. [laughter] which is fine. i don't have pride of authorship here. i just want this thing to work. arkansas just came out with its rates, and as has been true in virtually every single state, not only are premiums lower than they were, they are a lot lower than even the most optimistic predictions were about how low they would be. you know, once these marketplaces are up and running, it turns out that what is for additional event a pretty conservative principle, which is competition and choice, well, in the insurance market, competition and choice works. what we are seeing is that people are going to be able to

get the kind of health care that they have never been able to get before. states are going to benefit from it because they are going to save my. one thing -- save money. there are probably very few of you in this room that you not have health insurance, but if you don't, you should sign up starting on october 1. one of the things that many people do not realize is that the subsidy that all of you provide for the uninsured is about $1000 per family. you pay $1000 -- everybody here who has health insurance pays about on thousand dollars more about $1000 more for your

family's insurance than you otherwise would have because hospitals are mandated, they are required, to provide service to anybody who shows up. what happens is, when you've got 15% of the population without health insurance, i end up showing up at that emergency room -- at the emergency room. so, you pay for the most expensive care there is. hospitals have to recoup the money some way. the way they do it is to charge higher prices, and people who have health insurance and up picking it up. part of what will help reduce the increasing health-care costs is making sure that that hidden subsidy no longer exists. >> let's talk a little bit about business. we are out of time, but i think it is really important. as you pointed out, most people who have insurance work for a living or someone in their family does, and they get their insurance through their workplace. the law says that all employers have to participate if they have

50 employees or more. many employers with fewer than 50 employees already voluntarily provide some health insurance. both the companies with 50 or more and the companies with e mewhat concerned. the employees that have to be insured are those that work 30 hours a week or more. there were many people who speculated that when this law came into place that it would add to the cost and there would be a lot more part-time workers instead of full-time workers. i will say the president sometime and energy -- some time and energy on this. so far, that is not true. the overwhelming number of

people who have been hired coming out of this recession, they have been hired at lower wages, that they have been full- time employees. there has not been an increase in the percentage of our employment in part-time work. there has been an increase in relatively lower wage new jobs, but that means they need health insurance even more. explain, very briefly, to them how this is going to work, how private employers are helped to buy their insurance and the requirements. >> first of all, if you are a large employer or an employer with more than 50 employees, you are already providing health insurance, you don't have to do anything other than just make sure that you can show you are providing health insurance. there was a lot of news recently about how we delayed the so- called employer mandate. under the law, what it says is, if you have more than 50 employees, you are not providing health insurance to your employees, then you are going to pay a penalty to help subsidize,

to help pay for the fact that we, the taxpayers, are going to have to provide your employees with health insurance. which, by the way, is only fair. a lot of the controversy around the affordable care act had to do with these so-called mandates, both the employer mandate and the individual mandate. the employer mandate says, if you don't meet your responsibilities by your employees, and they end up getting medicaid or they are ending up in the emergency room, you are dumping those costs onto society. that is not fair. we will charge you a couple thousand dollars to help pay for health care for those employees. for the individuals, what we said was, we are going to make health insurance so affordable, so cheap for you, so heavily subsidized if you are not making a lot of money, that if you are not getting health insurance, it is because you decided you do not want to. you don't need to. in that circumstance, what

happens when you get hit by a bus, have inverted -- heaven forbid? or somebody in your family gets sick? we are not going to just let somebody bleed in front of the emergency room. what we have said is, you've got to take responsibility. there is a small penalty if you do not get health insurance. this is where a lot of the controversy and unpopularity came in. people generally do not like to be told, you've got to get health insurance. employers do not like to tell -- like to be told, you've got to give your employees health insurance. but as a society, what we cannot do is to say, you have no responsibilities whatsoever, but you've got guaranteed coverage. this raises the whole issue of

pre-existing conditions, which we haven't talked a lot about. it is really important. one of the central components of this law, one of the main perverts of these -- perversities of the health-care system before this law passed, there were millions of people around the country, if you had gotten sick before, you had a heart attack, if you had had cancer, if you had diabetes -- let's say, when it first happened, you had a job, you got your, and then you lose your job or you are trying to change jobs, and you try to go out and get health insurance -- the health insurance company could not only deny you, but had every incentive to deny you. they would rather have healthy people who are paying premiums and never asking for a payout.

they do not want somebody who actually early they can anticipate might get sick. keep in mind that a huge percentage of our society has some sort of pre-existing condition. they can be locked out. you can do everything right. work hard, build a strong middle class life, but if you have been sick and then you lose your job or something happens, you may suddenly be locked out of the insurance market or the premiums may be so high that only somebody fabulously rich could afford them. what we said is, you know what? insurance companies, you can no longer bar somebody from getting health insurance just because they've got a pre-existing condition. but the only way that works is if everybody has a requirement to get health insurance. think about what happens if you do not have that rule -- all of us, not all of us, but a lot of us who were trying to figure out

how to save some money would say, i'm not going to worry about it until i get sick, and when i am diagnosed with something that is going to be expensive, i will go to the insurance company and say, you cannot prevent me from getting health insurance just because i've got a pre-existing condition. so, they could potentially gain the system, and it would not work. now what we have done is said, you've got to provide health insurance to anybody. that is the deal. the flipside of it is, everybody's got some responsibility, and we will help you pay for to get health insurance. that is where a lot of the misunderstandings, the frustrations about health care reform came in. i should add, by the way, that this was the same proposition that was set up in massachusetts under a governor named mitt romney. it is working really well. 99% of people in massachusetts have coverage. the same principle was

ironically considered a very smart republican, conservative principle. just to finish up the question, when it comes to businesses, if you are already providing health insurance, that is great. you don't have to do much other than just make sure that you show us that you've got health insurance for your employees. if you have more than 50 employees and you are not providing health insurance for them, you now have the opportunity to join a pool of small businesses to get a better price and a better deal on health insurance. you are eligible for tax credits in providing health insurance to your employees, up to 35% of the premiums for each employee. that will be a tax benefit, a tax credit from the federal government. but if you still end up providing health insurance for your employees after that, then

we are going to go ahead and penalize you for it. i can understand why some businesses would not want to pay for it. if they are not currently providing health insurance for their employees, that means they would rather have those additional profits then make sure that their employees-- than make sure their employees are getting a fair deal. in some cases, they may be operating under a small margin. keep in mind, since companies are exempted, the average small business with five employees, mom-and-pop shops, 10 employees, they are not under that requirement. i'm not that sympathetic to accompany -- if you have more than 50 employees and are generating some significant revenue, we are making it affordable. they should do the right thing. [applause] >> i agree with that. we have to close, but i think there is one less issue we ought to deal with. the most important thing, obviously, is to get people

enrolled in this. we will work through it as we go along. you just heard the president say that so far in virtually every state, the actual prices of the insurance are coming in quite low, quite a bit lower than they were originally estimated. with the original price estimates and with the government obligated to provide subsidies, which cost money on the budget, it was nonetheless estimated that in the first 10 years, this would keep the national debt $110 billion lower than it otherwise would have been. which means if we come in at even less, we can bring the debt down more or we can subsidize more small businesses and get more small businesses into this loop.

a lot of people come up to me and say, you know, now you sound like the people you used to criticize who say we could cut taxes alltel on and increase spending. don't give me that. that sounds good -- too good to be true. before you leave, you should tell people how we can spend more, not so much in direct spending, but in tax credits and still wind up reducing overall federal spending by $110 billion in this decade. >> a couple things in terms of how this whole thing got paid for. it is really important, first of all, to point out that the total cost of the affordable care act, to provide health insurance for every american out there at affordable rates, is costing about the same amount over the course of 10 years as the costs of the prescription drug bill that president bush passed. except that was not paid for. we felt obliged to actually pay for it and not add to the

deficit. [applause] what we did, it is paid for by a combination of things. we did raise taxes on some things. for example, we said that for high income individuals, you can pay a slightly higher medicare rate, medicare tax. we bumped that up a little bit. we said that for employers who are currently providing a so- called cadillac health care plan, where there are so many bells and whistles there is no incentive to actually spend wisely when it comes to health care, we are going to penalize you for that not only to raise a

little bit of money, but also to say, you are encouraging the worst aspects of the health care system where you spend a lot of money and you do not get better outcomes. i mentioned to you medicare -- we basically said -- there is a program medicare called medicare advantage that provides some additional options for medicare recipients above and beyond standard medicare, and it is very popular with a lot of seniors -- you get eyeglasses and other benefits -- but it turned out that it was so uncompetitive that we were providing tens of billions of dollars in subsidies to insurance companies under this medicare advantage plan without getting better outcomes for seniors. what we said was, we will keep medicare advantage, and we will give them a small premium if they are providing better services for seniors, but we will make you compete for a

little bit. we are going to save tens of billions of dollars in the process, and that will go into paying for the affordable care act. the bottom line is, through these various mechanisms, we have raise enough money to pay for reviving health insurance for those who do not have it, to provide these tax credits in the marketplace, and, at the same time, because we are driving down costs, we actually end up saving a little money. it is a net reduction of our deficit. the irony of those who are talking about repealing obamacare because it is so wildly expensive is if they actually repealed the law, it would add to the deficit. it would add to the deficit. there have been a couple of republicans in the house who have been smart enough to say, we are going to repeal all of the benefits so 25-30,000,000 people do not get health insurance, but we are going to keep the taxes that obama

raised. we just will not talk about that. that way we can say we reduced the deficit. but, obviously, you are doing some funny business there with the budget. look, nothing is free. the bottom line is, do we want to continue to lead -- live in a society where we have the most inefficient health care system on earth, leaving millions of people exposed to the possibility that they could lose everything because they get sick, where we have little children and families going to the emergency room once a week because they have asthma and other preventable diseases because their families are not linked up with the partner position who is providing them regular care, where the cost to society for reduce productivity,

illnesses, etc. all burden our businesses -- is that the kind of society we aspire to? i think the answer is no. the notion that we would resist or at least some would resist as fiercely as they would or have, make this the number one agenda, is perpetuating a system in which millions of people across the country, hard-working americans, do not have access to health care, i think, is wrong. [applause] >> we have to -- we have to close, but i will close with a story. i told you all this morning that the employee that our health axis program lost in -- access program lost in the kenyan mall shooting lost was a dutch nurse. we spend a lot of time in the netherlands. one of our partners here, i went to celebrate the 200th anniversary with them.

they started as a fire insurance company with 39 farmers 200 years ago. we were out there in this big farm field with a tent in the shadow of a 13th century church and a big dutch will melt -- windmill. i said to the executive, you have health insurance. everybody is on an individual mandate. you just subsidize people based on their incomes. he said, yes, i have it. we all do. he said, we don't make any money on it. he said, we shouldn't. this guy is a huge insurer. can you imagine same -- somebody saying that in america? he said, i got no business in

the work. he said, health care is a public good. you've got to find a way to finance it for everybody. [applause] he said, it is just an intermediary function that somebody has to handle, but in the end, it is how it is delivered, how it is price, and how healthy you can keep your people. the first lady is trying to keep us all healthier, and you are trying to change the delivery and the pricing. you have to cover everybody to do it. i think this is a big step forward for america. this will come over the next decade, not only make us healthier, but it will free up, in the private sector, funds that can be reinvested in other areas of economic growth and give us a much more well- balanced economy. first, we've got to get everybody to sign up. >> everybody, sign up! go to healthcare.gov. thank you very much. [applause] [captioning performed by

national captioning institute] [captions copyright national cable satellite corp. 2013] >> gentlemen, please remain in your seats while the presidents of the united states depart the room. several lives in the -- live events to tell you about on c-span3. speaks keith alexander at the billington cybersecurity summits at 8:00 eastern. at 10:00, the senate environment and public works committee hold a public on infrastructure investment in roads and highways. later in the day, the senate

aging committee looks at the long-term financial outlook for retirees and ways to improve financial security. and, we will be live at 7:00 eastern for debate between the major party candidates for governor in virginia. in a few moments, a look at today's headlines, plus your calls live on washington journal. the house reconvenes at noon eastern or general business at 2:00. and about 45 minutes we will discuss the possibility of a government shutdown and efforts to defund the affordable care act with rob woodall from georgia, a member of the budget committee. we will also hear about the debate in congress over health care and spending from a member

of the financial services committee, maryland democrat john delaney. our spotlight on magazines guest will be timothy noah who wrote and article for the specific standard on job creation. >> in my mind i her and abuse it from that i heard the music from -- i heard the music from " psycho." it occurred to me develop the great philosophical conundrums more lier obama care is ke jason or freddy. that indeed -- host: 737-000