Mokhiber: There is an argument Ari, that any patients' bill of rights
bill, no matter what the approach, is bound to fail. This argument was
put forth most recently by Marcia Angell, who is the former head of the
New England Journal of Medicine, in a New York Times column a couple
days ago, "A Wrong Turn on Patients' Rights."
She argues as follow. She says: "It is becoming apparent to nearly
everyone that our experiment with private managed care has failed. The
system is imploding and a patients' bill, by increasing costs, will
accelerate its demise."
Then she says: "The answer is a single-payer bill that covers everyone
and more efficiently uses the resources we allocate to health care. This
is tantamount to extending Medicare to all Americans."
Two questions: one, do you believe that this private system has failed.
And why not Medicare for all?
Ari Fleischer: The President believes very strongly that people should
have the right to have choices in health care marketplace. And for some
people they will voluntarily want to have managed care. For other
people, they will want to have fee-for-service care. For other people they will want to have PPOs -- provider sponsored organization care. For
some people, medical savings accounts make sense.
But the point is, health care should be in the hands of consumers. They
should be empowered to be able to enter the marketplace to get the
insurance and the health care that they think is best for them and their
There are many people in this room who wrote extensively about senior
citizens who lost their HMOs because HMOs do not have sufficient
reimbursement rates, which Congress fixed, and President Clinton signed
into law late last year to increase reimbursements for HMOs.
And many seniors said thank you to President Clinton and the federal
government, because it reserved the option that they themselves chose.
And through HMOs, many seniors have access to drugs, for example, which
they cannot get through Medicare.
So, the President believes the answer is empowering consumers with
Mokhiber: But just to follow up, if in fact that is the argument, why
not just repeal Medicare and give the seniors total choice?
Ari Fleischer: Seniors are increasingly receiving choices as a result of
some of the reforms created in 1997 that President Clinton signed into
law, seniors did for the first time have more choices available to them
under Medicare. Seniors, for example, for the first time, have medical
savings accounts. Seniors, as you indicate, are in HMOs, if they want to
be in HMOs. Seniors have to pay Medigap, however. Medigap is very
Mokhiber: Why not repeal Medicare?
Ari Fleischer: The President believes very deeply that we maintain
Medicare. He believes it so deeply that he wants to make sure the system
is there for younger workers, young people, and that's why he proposes
to save Medicare, because Medicare, like Social Security, is going