Ari & I: June 27, 2001

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 families.

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 choices.

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 expensive.

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 bankrupt.