Transcript: Sen. Hillary Clinton

The following is a transcript of Senator Hillary Clinton's speech at the Presidential Forum.

KAREN TUMULTY: The next candidate that we're going to hear from this morning is Senator Hillary Rodham Clinton.

HILLARY CLINTON: Well, hello, everyone. I am so happy to be here and to be part of this today. First I think we all want to make sure to send our thoughts and prayers to Elizabeth and John Edwards. I'm very impressed by Elizabeth's strength and optimism, and I'm looking forward to seeing both Elizabeth and John on the campaign trail going forward. And I want to thank you UNLV for hosting this.

It's great to be here and to be in one of the early caucus states. And I want to thank CAP, the Center for American Progress, for all that CAP is doing to put health care on the agenda for America. And I especially want to thank SEIU.

I want to thank you for not just talking about health care but actually representing people who provide health care and take care of all of us across the country. I want to thank Andy Stern for being a leader, a visionary leader on this. And I especially want to thank all of my New York state 1199 SEIU members who I am proud to work with every single day. Now, you know, I feel a little bit like this is deja vu all over again. I mean, I worked with some of you all those years ago when we tried to convince the country and the Congress, we convinced the country but we didn't convince the Congress, that we needed, for the sake of our country, to move toward and achieve universal health care coverage.

Now, I am proud we tried. We may not have succeeded, but we set the groundwork in place so that now people are saying, boy, we wish we had done that back then because costs have continued to increase. Pressures on the system, on our doctors, our nurses, our health care workers have just been so stressful. I meet nurses every day who tell me they're thinking of quitting the profession they love because they are having to work overtime. They now have two nurses covering where four or five used to cover. They're not being given the support they need. And each one of you could tell me a story like that. So what we need to do is to make a commitment. And I'm proud that everyone running on the Democratic side is committed to universal health care coverage. Now, we were only given three minutes.

Some of you know I could talk three hours or three days about health care, but let me just briefly say, number one, I am in favor of universal health care coverage that brings in the 47 million who are uninsured, which is a disgrace in our country to have millions of people who are left out of the system that begins to guarantee coverage to people who already have insurance, because, let's not kid ourselves, there are a lot of people who think they have insurance except when they need it.

I met a woman in Austin, Texas last week who said, I'm a teacher, Senator. I make $38,000 and I have insurance through my employer, but last year I spent $19,000 out of my pocket, half of her income, because she had a preexisting condition. So we can't get universal health care coverage unless we end insurance discrimination once and for all. Now, I don't want to wait until I'm president to do that. I'm going to introduce legislation while I'm in the Senate to end insurance discrimination. Guaranteed coverage. No more cherry picking. You cannot eliminate people on the basis of preexisting conditions, because that's what we need insurance for. And, you know, we've now met the human gene. We're going to find out we're all susceptible to something. So none of us are going to be insurable if we don't change this system. And I think we need to start now in order to make sense out of it and get people the coverage they deserve to have.

We are also going to make better use of the money we've got in the system. We already spend more money than anybody in the world and we don't get the best results, because we have all these uninsured people and all these underinsured people. And many of you, and people just like you all over our country who can't afford your deductibles and your co-pays so you go without care and then the problem gets worse. So we're going to improve quality. We're going to control costs. And we're going to once and for all have a health care system that is worthy of our country.

Now, I know probably better than anybody how hard this will be. Yeah, I know. I've got the scars to show for it and I've been through it, but that just makes me more determined. But it also makes me understand what we're up against, because we've got to modernize and reform the way we deliver health care, but we have to change the way we finance health care. And that's going to mean taking money away from people who make out really well right now. So that is going to be a big political battle.

What I'm doing in my campaign is talking about health care every chance I get, asking people for your ideas, your suggestions. I was listening to some of the questions that were asked. Great questions, deserve answers. We're doing to have to deal with every single one of them. But if we don't have the support to get a bill through the Congress, we can keep talking about universal health care coverage, and the number of the uninsured and the underinsured will keep going up, and we'll keeping spending more money and we won't have very much to show for it. So we don't only need candidates to talk about it, and we don't just need candidates to have a plan.

We're all going to have plans, that's not in doubt. We need a movement. We need people to make this the number one voting issue in the '08 election to send a message to the Congress and the special interests, we're serious and we're going to get it done this time. So as I said, Karen, I can keep talking but I'm sure my time for three minutes is up, so let me turn now to the questions.

KAREN TUMULTY: Well, thanks a lot. Do you want to have a seat?

HILLARY CLINTON: No, I'll stand.

KAREN TUMULTY: Okay, terrific. Well, I was intrigued by a comment you just made. You said that we're going to change the way we finance the system by taking money away from people who are doing well now. Who specifically are you talking about?

HILLARY CLINTON: Well, let's start with the insurance companies. The insurance companies make money by spending a lot of money and employing a lot of people to try to avoid insuring you, and then if you're insured to try to avoid paying for the health care you received.

And I see this all the time. You know, my office spends a lot of effort helping people who have insurance get health care. Two quick examples. A father called me from northern New York, had a son with a very serious ailment. He was well-insured. He worked, had worked for a long time for the same employer who gave him a good policy. His son needed a special operation, and the insurance company said no, we're not going to pay for that. There was only one place in the country that really could perform it, and the insurance company said, I'm sorry, that's out of network, you've heard that, we're not going to send you to have that done.

So my office intervened, and, you know, we get a little bit of attention when I call, and we said, you know, we don't think this is right. This man has paid his, you know, share of his premiums. His employer has bargained for this insurance coverage

So make a long story short, we got the operation, but I just don't think that people should have to go to their United States Senator to get their insurance company to pay for what they deserve to have.

Second fast story. We are having an epidemic of diabetes. You all know all that. We have young people being diagnosed with adult-onset diabetes. I'm talking 12-, 13-, 15-, 16-year-olds. We are seeing the cost of diabetes go up exponentially.

Well, a lot of insurance companies will not pay for someone who's pre-diabetic or been diagnosed with diabetes to go to a nutritionist to find out how better to feed themselves and their families, to go to a podiatrist to have their feet checked. But they will pay if you have to have your foot amputated.

Because the reasoning is, and the insurance companies will tell you this, they don't want to pay for preventative health care because that's like a lost amount of money because they're not sure that the patient or the insured person will still be with them. But if they're confronted with the doctor saying we're going to have to amputate the foot, they're kind of stuck with it.

That is upside down and backwards. So we could save money if we changed the incentive to require that preventative health care and wellness be covered and incentivized, and we could require that every insurance company had to insure everybody and no exclusions for preexisting conditions, and that would be one thing we could do.

KAREN TUMULTY: Speaking of the way it's financed, when you do come up with your plan this time, is it going to once again include what was the most controversial aspect of your plan last time, which was this employer mandate, the requirement that companies cover their workers? And will it also have an individual mandate the way people have to buy auto insurance and the model that we've seen that was put forward in Massachusetts and California?

HILLARY CLINTON: Well, there are only a couple of ways to get universal coverage. And I'm pleased that a lot of the people on the Democratic side both running for president and in the Congress are saying, look, we've got to do one of a couple of things. If we're going to build on these employer-based system[s], no more free riders. No more companies that don't insure everybody and shift their costs onto other companies that do and onto the taxpayer. So every employer is going to have to provide insurance or pay into a pool where that money can be used to help people. And we may have to say, look, it is everybody's responsibility to be insured.

You know, sometimes young people come up to me, and I understand this, I vaguely remember being young one time, and they say things like, you know, I'm healthy, I don't need insurance. I'll say, Well, do you drive in cars? Hey, have you ever driven a motorcycle? Do you walk across the street and sometimes not look at the light? You have no idea what can happen to you. Insurance is supposed to be available to make sure that when something happens to you you'll be taken care of. And frankly it is to protect the rest of us who are taking care of ourselves. We're being responsible.

So I've been impressed that on both ends of our country, in Massachusetts and California, an idea that we first floated back in '93 and '94 which was to say, look, individuals have to be responsible so if your employer doesn't provide it, and if you're not covered by one of the government-funded programs then you're going to have to be in the system. Because otherwise if something does happen to you, you're going to be the responsibility of everybody else. So the so-called individual mandate is really the individual responsibility policy. I think that has to be looked as well.

But we also need to look at how we provide an alternative for businesses that are not going to provide health insurance. And there are people that are not going to have it and where can they go to get a good policy. Well, we have two really good programs operating right now. Medicare, which takes care of people over 65, has the lowest administrative costs of any insurance program.

You know, when you look at how much private insurance charges for administration and overhead and profit of course, you compare with Medicare, there's no comparison. Medicare is like 10 three percent compared to anything from 10 to 35 or up. And we have something called the Federal Employees Health Benefit Plan, where people like members of Congress and people who work for the federal government, they can go into this pool, it's what it's called, it's a big sharing arrangement, and they can have a lot of different choices and then they can pick what kind of insurance policy. If they're young and they think they only need catastrophic care, because that's all they're worried about, they can get that. If they have kids with some kind of problem, they can get coverage for that.

So we can look at how we provide a backup government-sponsored approach to complement the employer system if we stay with the employer. And the final thing I'd say about that is, you know, one of the things that happened in '93 and '94 is that people thought that, even though this wasn't the case, but we didn't do a good enough job explaining it, we're going to do a better job this time, people thought, well, they're going to be required to change what they had, and a lot of people like what they have.

So we don't want to have people feeling like, oh, my goodness, the government is going to come in and they're going to tell me what I have to do and what doctors I have to go to. That was never ever part of the plan, but some people got worried about that. So building on what we have and having a bridge to make sure everybody is included and at the end of that bridge having an alternative that is a government-sponsored alternative gives people choice.

So that's what I think we have to look at as a framework, because really every plan you're going to hear about has some combination of those elements.

KAREN TUMULTY: Senator, right now I'd like to turn things over to Courtney Erickson, who in her job with the Clark County Housing Authority sees every day a lot of the kind of people you're talking about, people who have coverage but can't afford their health care. Courtney, are you here?

COURTNEY ERICKSON: As you know, I'm Courtney Erickson. I'm a proud member of SEIU, and I work for the Clark County Housing Authority. Many of the people that I serve on a day-to-day basis are low-income families, seniors and disabled people living on a fixed income. Many of them have health care, but still spend a lot of money out of pocket, which obviously they can't afford to do. So how and on what timeline are you going to rein in the health care costs?

HILLARY CLINTON: That's a really good question, Courtney, because if we don't get costs under control, you can have a universal health care plan and it will still keep costing more and more money for everybody in it, and then we'll be back to right where we are today.

So I want to do several things. Number one, as I said, I want to end insurance discrimination and make it clear that they're going to have to be under some, you know, restrictions about what they can charge people and what they can and cannot do to them when it comes to their insurance.

Number two, I had a bill that I worked on for four years in the senate to move us toward electronic medical records. We passed through the Senate, we didn't pass the Republican House so we're coming back to make it happen.

Why do I mention that? Well, those of you in health care know the answer. You spend so much of your time, you know, doing record-keeping, trying to read records that are illegible, trying to fax records to people who aren't, you know, right near home and need their records. And you go through all this, misplacing records.

We are drowning, and frankly people are suffering because we have a paper system in the health care field. We don't rely on paper in any other big part of our economy anymore. Because we rely on paper, we are wasting money. We can save by an independent assessment a hundred billion dollars a year if we move toward electronic medical records.

And I want to start requiring that people who do business with the government, namely Medicare, Medicaid, VA, you name it, the Federal Employees Health Benefits Plan, they're going to have to move toward electronic medical records.

And I'm willing to put some up front money into that to create a system where all these different health care IT systems can talk to each other, because if you're taking care of somebody here in Las Vegas, they have family say in Arizona or L.A., they go there, they slip and fall, they go to the emergency room, you start with a history. You start with tests that maybe they took two weeks or two months ago.

After Hurricane Katrina I went down to Houston to see the people who had been evacuated, most in them from the convention center. The elderly, the frail. People who were very dependent upon health care, their records were gone. Those 15 pieces of paper were destroyed. And a lot of doctors told me their biggest problem was trying to figure out what prescriptions to give to people, because you have a lot of elderly folks who knew they were taking pills but didn't know what they were. They said, “Look, I take a pink pill in the morning and a blue pill in the afternoon.” Had no idea what it was.

The only people they could help were the people who had shopped at chain drug stores because they had electronic medical records. If we had that for all of our health care records, we'd get costs down and we'd have higher quality health care. So we've got to do all of this at the same time and help get these costs down and help people.

KAREN TUMULTY: Senator, you said that you can do this with no big new taxes. So where does this up-front money come from?

HILLARY CLINTON: Well, I'm talking for example on the electronic medical records, maybe $200 million to get the architecture of the system put into place, you know, give or take money, but that's what we estimated when we did it originally a couple years ago. And there will be some investments, but when I'm talking about how much money we need to spend, let's look at what we spend nationally. It's not just what the government spends, it's what all of us spend. We already spend more money than everybody else.

I cannot see us putting more money as a national expenditure into health care without modernizing the system, without ending insurance discrimination, without beginning to emphasize wellness and prevention. People are going to have to start taking better care of themselves. We cannot afford all the illness that folks are bringing on themselves. There are some things we have no control over. There are some things we do have control over, and we need to start working on that, myself included, everybody else.

But what we really have to look at is how can we save money over the long run. So I'm willing to put in some up front investments to do the right thing. And I think we can then save money as we go forward, but I don't think we should start from the position where we say we're going to increase all of these costs by putting more money into a system that is broken.

We have to fix the system so it serves people better, it takes better care of those who take care of us and we take better care of ourselves and that is the way that I'd like to approach this.

KAREN TUMULTY: Senator Clinton, we're out of time, but I did want to ask you one last quick question. Several candidates we have heard from today have said that they think they can get to universal coverage in their first term. You have suggested that it could take two terms. It could take eight years. Are they being realistic?

HILLARY CLINTON: Well, I think we all are going to try to start as soon as possible. You know, it took three years to implement the Medicare prescription drug benefit. Well, you know what, I didn't vote for it, but, you know, and this administrative doesn't exactly have the greatest track record on competence, so I can't judge exactly by that, but it took a while.

I think we can move forward quickly, but make no mistake about it, this will be a series of steps. But let me end where I started. We're all for universal health care. You know, we had a big debate about it in '93, '94. That debate is over. The Democrats stand united. We are all for universal health care. What we have to do is persuade the country not only to vote for a Democratic president, we have to help elect a Democratic Congress.

Because if you look at the politics of this, and I know that people around are not thinking about politics because that's kind of a downer, but if you look at the politics, we got stopped in the Senate in 1994 by a filibuster. You know what that means is unless you get 60 votes, which mean usually unless you've got more than 60 Democrats you've got to get some Republicans.

We got stopped because they basically said, we're not going to do it. And we couldn't break it and that was the end. We can't get enough Republicans right now to vote with us to try to begin to end the war in Iraq. We can't. We're trying.

Every single week we come up with something else to try to get them to vote with us. But the way the Senate works, you've got to get the 60 votes. So that's why I said I sure hope you elect me president, but I want more Democrats in the Senate, and I want a movement to support health care reform. And we're going to need it so let's make sure that's what we do in the next two years

.Thank you all very much.