Health Care Related Excerpts from HRCs Paid Speeches

As Reported by WikiLeaks: https://wikileaks.org/podesta-emails/emailid/927

Affordable Care Act

Hillary Clinton Said She Wants Us To Have A Debate Where Our Differences Are Fully Aired On Healthcare Reform Since There Are Different Approaches. “Now, what does that have to do with health care reform?  Well, I want to see us have a debate where our differences are fully aired because, clearly, there are different approaches about what we think can work.  We don’t have one size fit all.  Our country is quite diverse.  What works in New York City is not necessarily going to work in Harrison, Arkansas or Albuquerque, so we do need to have people who are looking for common ways of approaching problems using evidence but leaving their blaming, their gaming, their shaming, point scoring at the door.  Because when we think about it, our country is such a remarkable accomplishment.  Think about how diverse we are.  We’ve had lots of disagreements.  We even had a civil war for heaven sakes, so it’s not like we just — you know, like in those drug commercials where we just hold hands and dance through the meadows while somebody is telling you everything that can go wrong like your ear’s falling off if you take the drug they’re advertising.” [02262014 HWA Remarks at HIMMS [Orlando].DOC, p. 10]

Clinton Said American People Were “Right” To Be Frustrated By Slow ACA Website But To Remember Historical Context Of Slow Starts For Medicare Part D And Massachusetts Health Care. “So President Obama and the American people are right to be frustrated by the technical problems with HealthCare.gov, the new health care website — too slow, too many people getting stuck instead of getting served, and as the President has said, there is no excuse for this.  But I think it’s important to put it into some historical context. It was the same when President Bush rolled out Medicare Part D in 2005.  I was a senator serving the people of New York.  And our seniors were even less prepared to navigate the difficulties of understanding what they wanted and then figuring out how to sign up for it. It was the same in Massachusetts when the health care plan signed into law by then Governor Romney came into effect.  It was plagued by early glitches, and only about 100 people signed up the first month.” [Remarks at Beaumont Society Dinner, 11/6/13]

Clinton Said People Should Have Been Told To Expect Problems With ACA Website Ahead Of Time. “So I knew there would always be trouble, and I think everybody who thought about it, there would be.  So I would make these — these three quick points: First, I think more people should have been told that so that we didn’t have this idea that on October 1, you just turn on your computer and it’s, like, magically going to respond to every one of your questions.  I assume that it’s going to get fixed, the sooner the better, because there is a lot of good information and comparison shopping that’s never been available in the health insurance market before.” [Remarks to New York Tri-State Of The Market, 11/14/13]

Clinton Said President Obama Spent More Time Than Democrats Wanted Him To Trying To Get Some Republicans To Support Health Care Reform. “So you can get to the point of saying, okay, we can live with this, you say you can live with that, I can sell it to the Democrats, you sell it to the Republicans, and the answer would come back, I can’t sell it to Republicans, so we have to jigger it around somehow.  Whether that was a negotiating tactic or the hard reality that it was hard to sell it to the caucus, I don’t know. But I do remember quite well the President working diligently to reach out to people and trying very hard on the health care bill, for example, spending more time than a lot of Democrats wanted him to, trying to figure out how he can get some Republicans on board.” [Goldman Sachs AIMS Alternative Investments Symposium, 10/24/13]

Clinton Said She Was “Sure That We’ll Be Struggling” With ACA Implementation “For Some Time To Come.” “MODERATOR KRUEGER:  One last easy, quick question:  Health care. SECRETARY CLINTON:  He’s known for his sense of humor. MODERATOR KRUEGER:  We now spend 18 percent, going up to 20 percent of our United States economy, the largest economy in the world, on health care.  Recent articles seem to be that ObamaCare, the Affordable Healthcare Act, is going to increase that over time. What country is doing it best out there? The next developed industrialized country spends about ten-and-a-half percent of their economy on health care.  What country is doing it best, or if we started with a blank canvas, what would we do? SECRETARY CLINTON:  Well, first I have to say that I think the jury is out, because the implementation of the Affordable Care Act is going on as we speak.  There are some very important features in that, you know, publicizing costs of medical procedures, which is giving a lot of food for thought about why does the same procedure cost three times as much three hundred miles away from where it’s done somewhere else; looking at how we try to tie prevention to outcomes more effectively.  I mean, I think there are a lot of very good parts of it. Now, implementing something this big is complicated, and I’m sure that we’ll be struggling with it for some time to come, but I think there are important measures that are included.” [Hillary Clinton remarks to ECGR Grand Rapids, 6/17/13]

Employer-Based Model

Clinton Said The US Seems “To Be Wedded To” Employer-Based Health Insurance, “It Would Be Very Difficult To Get A Consensus Politically” To Change That. “So we have made a decision built on an old Word War II program that was using health benefits as a way of keeping people in the workforce and being competitive, linked to employment.  That is very costly, and we also moved over time from what used to be non-profit insurance companies to mostly for-profit insurance companies today. People are entitled to make a profit, but that drives up costs, and we you know we have that built into this 18, 20 percent GDP. So we made decisions and we seem to be wedded to those decisions.  So it would be very difficult to get a consensus politically that would dramatically change.  I mean, if you look at the Affordable Care Act, it starts with an employer-based system.  Most people who have in the private sector insurance won’t see much change, depending upon, you know, what the pricing structure does.  But their basic policies will remain as they are.” [Hillary Clinton remarks to ECGR Grand Rapids, 6/17/13]

Improving on the Fee-for-Service Model

Clinton: “Ultimately How Might We Replace Our Fee For Service Model With Provider Led Community-Wide Care That Can Compete On Quality And Reward Value Over Volume?” [1/27/14, HWA Remarks at Premier Health] 

Clinton: “At Some Point We Have To Move Away From Fee For Service Payments For Medical Care.” “I also in my statement alluded to the idea that at some point we have to move away from fee for service payments for medical care.  It is not serving physicians well or any other health care provider, and I don’t believe it’s serving patients well.” [4/11/14, Remarks at California Medical Association]

 Clinton: “How Might We Begin To Replace The Fee For Service Model With Provider-Led, Community-Wide Care That Can Compete On Quality And Reward Value Over Volume?” “How might we begin to replace the fee for service model with provider-led, community-wide care that can compete on quality and reward value over volume? And while we try to maintain what makes the American health care system so special and extraordinarily effective, how do we work more closely with our research and scientific community, with our engineers, with our businesses so that new ideas get to market faster, can influence care and be taken to the next level?” [Remarks to Cardiovascular Research Foundation, 9/15/14]

Clinton: “…The Fee For Service Model, Which Made A Lot Of Sense For A Long Time, May Not Make Sense.” “But most of what I see that has to be done in the future in my view should be led by a partnership of purpose between physicians and other caregivers and patients and payers.  And the fact is that a lot o the cost in our system, which is not related to paying physicians, paying for research, paying for prevention, and all the things that we think would lead to better outcomes.  We have to make a very principled decision, do we want to continue paying for that or is there a better way to pay? And that’s why I said in my remarks the fee for service model, which made a lot of sense for a long time, may not make sense.  It may not make sense for physicians or hospitals or any other provider, and it may not make sense for patients and payers.  And I think we need to have as evidence-based, as mature a conversation as we can manage in our society at large.” [Remarks to Cardiovascular Research Foundation, 9/15/14]

Lowering Costs

Hillary Clinton: “Businesses Pay Taxes” On Health Care Even In Single-Payer Systems, “So Businesses Also Have A Direct Interest In Getting The Cost Of Health Care To Be Lower.” “So employers in the United States have a very direct stake in trying to assure that their employees and their employees’ families are healthier, because they end up bearing part of the cost burden when that is not the case. We just had a very widely reported incident of an executive of a major American company, you know, complaining that two babies born with serious health problems had each cost the company a million dollars. Well, there has to be a recognition that maybe some kinds of health problems cannot be avoided.  They’re genetic, they’re congenital, they’re accidental, they’re infectious, but some kinds of health problems, particularly what we’re talking about, the chronic disease load can be mitigated against. And so businesses have that direct opportunity, but even in other countries where you don’t have an employer-based system but a single-payer system, businesses pay taxes.  So businesses also have a direct interest in getting the cost of health care to be lower.” [Hillary Clinton Remarks for the Novo Nordisk Diabetes Conference, 2/14/14]

Medical Devices

Hillary Clinton Said She Worked Closely With The Medical Device Industry As Senator And Understands The “Critical Role” The Industry Plays.HILLARY CLINTON: “The Affordable Care Act also promotes innovation and incentivizes solutions that emphasize the quality of medical care, not just the quantity, and medical technology is at the heart of this effort.  Many of the innovations that will allow us both to provide care that is medically sound and cost-effective will come from companies represented in this room. When I was a Senator from New York, I worked with the medical device industry on a number of important issues, and I understand how critical the role that you play is. And yes, I know that you have important questions that you would like addressed.  But my view is that we need to keep working toward win-win solutions, improving what we have in sensible ways that will lead to lower costs, greater insurance at affordable costs for everyone, higher transparency for consumers who, after all, bear more and more of the burdens of out of pocket costs.” [Remarks for AdvaMed, 10/8/14]

Rx

Clinton Disputed A Claim That She Proposed Price Controls On Drugs In The 90s, Arguing That She Proposed Greater Competition, Which Is More Effective In Managing Costs. MR. SVOKOS:  “Secretary Clinton, this is a room filled with individuals from the pharmaceutical industry.  The policies that you proposed to contain health care costs in the ’90’s, mainly price controls, were not exactly popular with our industry at the time.  Has your opinion changed since then?  What policies would you propose today? SECRETARY CLINTON:  Well, I have to start by saying I don’t think we proposed price controls.  We proposed more competition, more transparency, state exchanges, if those sound familiar, to entice greater negotiation over price.  And I still believe in greater negotiation over price.” [Hillary Clinton Remarks at DCAT – New York City, 3/13/14]

Single-Payer Health Care

Clinton Said Single-Payer Health Care Systems “Can Get Costs Down,” And “Is As Good Or Better On Primary Care,” But “They Do Impose Things Like Waiting Times.” “If you look at countries that are comparable, like Switzerland or Germany, for example, they have mixed systems.  They don’t have just a single-payer system, but they have very clear controls over budgeting and accountability. If you look at the single-payer systems, like Scandinavia, Canada, and elsewhere, they can get costs down because, you know, although their care, according to statistics, overall is as good or better on primary care, in particular, they do impose things like waiting times, you know.  It takes longer to get like a hip replacement than it might take here.” [Hillary Clinton remarks to ECGR Grand Rapids, 6/17/13]

Universal Coverage

Clinton Said Her Goal In The 90s Was To Create A Universal Health Care System Around The Employer-Based System, Which The Affordable Care Act Achieved. “And so we were trying to build a universal system around the employer-based system. And indeed now with President Obama’s legislative success in getting the Affordable Care Act passed that is what we’ve done.  We still have primarily an employer-based system, but we now have people able to get subsidized insurance.  So we have health insurance companies playing a major role in the provision of healthcare, both to the employed whose employers provide health insurance, and to those who are working but on their own are not able to afford it and their employers either don’t provide it, or don’t provide it at an affordable price.” [Hillary Clinton Remarks for tinePublic – Saskatoon, Canada, 1/21/14] 

Clinton Cited President Johnson’s Success In Establishing Medicare And Medicaid And Said She Wanted To See The U.S. Have Universal Health Care Like In Canada. “You know, on healthcare we are the prisoner of our past.  The way we got to develop any kind of medical insurance program was during World War II when companies facing shortages of workers began to offer healthcare benefits as an inducement for employment.  So from the early 1940s healthcare was seen as a privilege connected to employment.  And after the war when soldiers came back and went back into the market there was a lot of competition, because the economy was so heated up. So that model continued.  And then of course our large labor unions bargained for healthcare with the employers that their members worked for.  So from the early 1940s until the early 1960s we did not have any Medicare, or our program for the poor called Medicaid until President Johnson was able to get both passed in 1965. So the employer model continued as the primary means by which working people got health insurance.  People over 65 were eligible for Medicare.  Medicaid, which was a partnership, a funding partnership between the federal government and state governments, provided some, but by no means all poor people with access to healthcare. So what we’ve been struggling with certainly Harry Truman, then Johnson was successful on Medicare and Medicaid, but didn’t touch the employer based system, then actually Richard Nixon made a proposal that didn’t go anywhere, but was quite far reaching.  Then with my husband’s administration we worked very hard to come up with a system, but we were very much constricted by the political realities that if you had your insurance from your employer you were reluctant to try anything else.  And so we were trying to build a universal system around the employer-based system. And indeed now with President Obama’s legislative success in getting the Affordable Care Act passed that is what we’ve done.  We still have primarily an employer-based system, but we now have people able to get subsidized insurance.  So we have health insurance companies playing a major role in the provision of healthcare, both to the employed whose employers provide health insurance, and to those who are working but on their own are not able to afford it and their employers either don’t provide it, or don’t provide it at an affordable price. We are still struggling.  We’ve made a lot of progress.  Ten million Americans now have insurance who didn’t have it before the Affordable Care Act, and that is a great step forward.  (Applause.) And what we’re going to have to continue to do is monitor what the costs are and watch closely to see whether employers drop more people from insurance so that they go into what we call the health exchange system.  So we’re really just at the beginning.  But we do have Medicare for people over 65.  And you couldn’t, I don’t think, take it away if you tried, because people are very satisfied with it, but we also have a lot of political and financial resistance to expanding that system to more people. So we’re in a learning period as we move forward with the implementation of the Affordable Care Act.  And I’m hoping that whatever the shortfalls or the glitches have been, which in a big piece of legislation you’re going to have, those will be remedied and we can really take a hard look at what’s succeeding, fix what isn’t, and keep moving forward to get to affordable universal healthcare coverage like you have here in Canada.  [Clinton Speech For tinePublic – Saskatoon, CA, 1/21/15]

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