Women's Issues in the Debate
Presidential Debate 3 Excerpt: Health Care
The complete transcript of this debate is available from the Commission on Presidential Debates
Mr. Lehrer:
Now, let's go to the first question. Of over the 130 questions we
received from this panel, we will begin with one of the 19 on health
issues, and it goes to you, Mr. Vice President, and it will be asked by
James Hankin. Mr. Hankin?
MEMBER OF AUDIENCE:
How do you feel about HMOs and insurance companies making the critical
decisions that affect people's lives instead of the medical
professionals, and why are the HMOs and insurance companies not held
accountable for their decisions?
We ought to have a patient's
bill of rights to take the
medical decisions away from
the HMOs and give them back
to the doctors and nurses.
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Vice President Gore:
Mr. Hankins, I don't feel good about it, and I think we ought to have a
patient's bill of rights to take the medical decisions away from the HMOs
and give them back to the doctors and nurses. I want to come back and
tell you why, but if you will forgive me, I would like to say something
right now at the beginning of this debate following on the moment of
silence for Mel Carnahan and Randy Carnahan and Chris Sifford. Tipper
and I were good friends with Mel and Randy, and I know that all of us
here want to extend our sympathy and condolences to Jean and the family
and to the Sifford family. And I would just like to say that this debate
in a way is a living tribute to Mel Carnahan because he loved the
vigorous discussion of ideas in our democracy. He was a fantastic
governor of Missouri. This state became one of the top five in the
nation for health care coverage for children under his leadership. One
of the best in advancing all kinds of benefits for children to grow up
healthy and strong. And of course, this debate also takes place at a
time when the tragedy of the USS Cole is on our minds and hearts and
insofar as the memorial services tomorrow, I would like to also extend
sympathy to the families of those who have died and those who are still
missing, and the injured. Now, Mr. Hankins, I think that the situation
that you describe has gotten completely out of hand. Doctors are giving
prescriptions, they're recommending treatments, and then their
recommendations are being overruled by HMOs and insurance companies.
That is unacceptable. I support a strong national patient's bill of
rights. It is actually a disagreement between us, a national law that is
pending on this, the Dingle-Norwood bill, a bipartisan bill, is one that
I support and that the governor does not.
I support a national patient's
bill of rights ... I don't want
the law to supersede good law
like we've got in Texas.
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Governor Bush:
I, too, want to extend my prayers and blessings, God's blessings on the
families whose lives were overturned yes -- tod -- last night. It's a
tragic moment. Actually, Mr. Vice President, it's not true. I do
support a national patient's bill of rights. As a matter of fact, I
brought Republicans and Democrats together to do just that in the State
of Texas to get a patient's bill of rights through. It requires a
different kind of leadership style to do it, though. You see, in order
to get something done on behalf of the people, you have to put
partisanship aside, and that's what we did in my state. We have one of
the most advanced patient's bill of rights. It says, for example, that a
woman doesn't have to go through a gate keeper to go to her
gynecologist. It says that you can't gag a doctor, doctor can advise
you. The HMO, the insurance company, can't gag that doctor from giving
you full advice. And this particular bill, it allows patients to choose
a doctor, their own doctor if they want to. But we did something else
that was interesting. We're one of the first states that said you can
sue an HMO for denying you proper coverage. Now there's what's called an
Independent Review Organization that you have to go through first. It
says you have a complaint with your insurance company, you can take your
complaint to an objective body. If the objective body rules on your
behalf, the insurance company must follow those rules. However, if the
insurance company doesn't follow the findings of the IRO, then that
becomes a cause of action in a court of law. It's time for our nation to
come together and do what's right for the people, and I think this is
right for the people. You know, I support a national patient's bill of
rights, Mr. Vice President, and I want all people covered. I don't want
the law to supersede good law like we've got in Texas. I think --
Mr. Lehrer:
Just a minute, Mr. Vice President. I want to -- the way the rules go
here now, two minutes, two minutes, and then I'll decide whether we go
on. Okay. So what I want to make sure is we understand here is before
we go on to another question in the health area, would you agree that you
two agree on a national patient's bill of rights?
Vice President Gore:
Absolutely not. I referred to the Dingle-Norwood bill. It is the
bipartisan bill that is now pending in the Congress. The HMOs and the
insurance companies support the other bill that's pending, the one that
the Republican majority has put forward. They like it because it doesn't
accomplish what I think really needs to be accomplished to give the
decisions back to the doctors and nurses and give you a right of appeal
to somebody other than the HMO or insurance company, let you go to the
nearest emergency room without having to call an HMO before you call 911,
to let you see a specialist if you need to, and it has strong bipartisan
support. It is being blocked by the Republican leadership in the
Congress. And I specifically would like to know whether Governor Bush will support the Dingle-Norwood bill, which is the main one pending.
Mr. Lehrer:
Governor Bush, you may answer that if you'd like. But also I'd like to
know how you see the differences between the two of you, and we need to
move on.
Governor Bush:
Well, the difference is is that I can get it done. That I can get
something positive done on behalf of the people. That's what the
question in this campaign is about. It's not only what's your philosophy
and what's your position on issues, but can you get things done? And I
believe I can. [...] I talked about the principles and
the issues that I think are important in a patient's bill of rights.
It's kind of Washington, D.C. focus. Well, it's in this committee or
it's got this sponsor. If I'm the president, we're going to have
emergency room care, we're going have gag orders, we're going to have
direct access to OB/GYN. People will be able to take their HMO insurance
company to court. That's what I've done in Texas and that's the kind of
leadership style I'll bring to Washington.
Mr. Lehrer:
All right. Another -- the next question also on health issue is from --
it will be asked by Marie Payne Kloep, and it goes to Governor Bush.
MEMBER OF AUDIENCE:
Are either of you concerned with -- are either of you concerned with
finding some feasible way to lower the price of pharmaceutical drugs such
as education on minimizing intake, revamp of the FDA process or
streamlining the drug companies' procedures instead of just finding more
money to pay for them?
... direct money to states so
that seniors don't have to choose
between food and medicine. ...
And I'm against price controls.
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Governor Bush:
Well, that's a great question. I think one of the problems we have,
particularly for seniors, is there is no prescription drug coverage in
Medicare. And therefore, when they have to try to purchase drugs they do
so on their own, there's no kind of collective bargaining, no power of
purchasing among seniors. So I think step one to make sure prescription
drugs is more affordable for seniors, and those are the folks who really
rely upon prescription drugs a lot these days, is to reform the Medicare
system, is to have precipitation drugs as an integral part of Medicare
once and for all. The problem we have today is like the patient's bill
of rights, particularly with health care, there's a lot of bickering in
Washington, D.C. It's kind of like a political issue as opposed to a
people issue. So what I want to do is I want to call upon Republicans
and Democrats to forget all the arguing and finger pointing, and come
together and take care of our seniors' prescription drug program, that
says we'll pay for the poor seniors, we'll help all seniors with
prescription drugs. In the meantime, I think it's important to have
what's called Immediate Helping Hand, which is direct money to states so
that seniors, poor seniors, don't have to choose between food and
medicine. That's part of an overall overhaul. The purchasing powers.
And I'm against price controls. I think price controls would hurt our
ability to continue important research and development. Drug therapies
are replacing a lot of medicines as we used to know it. One of the most
important things is to continue the research and development component.
And so I'm against price controls. Expediting drugs through the FDA
makes sense, of course. Allowing the new bill that was passed in the
Congress made sense to allow for, you know, drugs that were sold overseas
to come back and other countries to come back into the United States.
That makes sense. But the best thing to do is to reform Medicare.
I want to streamline the
approval of the competing
generic drugs ...so we bring
the price down for everybody.
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Vice President Gore:
All right, here we go again. Now look, if you want someone who will
spend a lot of words describing a whole convoluted process and then end
up supporting legislation that is supported by the big drug companies,
this is your man. If you want someone who will fight for you and who
will fight for the middle-class families and working men and women, who
are sick and tired of having their parents and grandparents pay higher
prices for prescription drugs than anybody else, then I want to fight
them. And you asked a great question because it's not only seniors.
Listen, for 24 years I have never been afraid to take on the big drug
companies. They do some great things. They discover great new cures and
that's great. We want them to continue that. But they are now spending
more money on advertising and promotion. You see all these ads? Than
they are on research and development. And they are trying artificially
extend the monopoly patent protection so they can keep charging these
very high prices. I want to streamline the approval of the competing
generic drugs and the new kinds of treatments that can compete with them
so we bring the price down for everybody. Now, briefly, let me tell you
how my prescription drug plan works. The governor talked about
Medicare. I propose a real prescription drug benefit under Medicare for
all seniors, all seniors, and here's how it works. You pick your own
doctor, and nobody can take that away from you. The doctor chooses the
prescription that you need and nobody can overrule your doctor. You go
to your own pharmacy and then Medicare pays half the price. If you're
poor, they pay all of it. If you have extraordinarily high cost, then
they pay all over $4,000 out-of-pocket. And I'll bring new competition
to bring the price down. And if you pass the big drug companies' bill,
nothing will happen.
Mr. Lehrer:
All right. Another health question, it comes from Vickie French, and
it's for you, Vice President Gore. Vickie French, where are you? Oh,
there she is.
MEMBER OF AUDIENCE:
You spend billions of dollars every year on taxes, or pay billions of
dollars in taxes. Would you be open to the idea of a national health
care plan for everybody? And if not, why? If so, is this something you
would try to implement if you are elected into office and what would you
do to implement this plan?
I am not in favor of
government doing it all.
We've spent 65 years now
on the development
of a hybrid system
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Vice President Gore:
I think that we should move step-by-step toward universal health
coverage, but I am not in favor of government doing it all. We've spent
65 years now on the development of a hybrid system, partly private,
partly public, and 85% of our people have health insurance, 15% don't.
That adds up to 44 million people. That is a national outrage. We have
got to get health coverage for those who do not have it and we've got to
improve the quality for those who do with a patient's bill of rights
that's real and that works, the Dingle-Norwood bill, and we have got to
fill in the gaps in coverage by finally bringing parity for the treatment
of mental illness, because that's been left out. We have got to deal
with long-term care. Now, here are the steps that I would take, first of
all. I will make a commitment to bring health care coverage of high
quality that is affordable to every single child in America within four
years. And then we'll fill other gaps by covering the parents of those
children when the family is poor or up to two and a half times the
poverty rate. I want to give a tax credit for the purchase of individual
health insurance plans. I want to give small business employers a tax
credit, 25%, to encourage the providing of health insurance for the
employees in small businesses. I want to give seniors who are, well, the
near elderly, I don't like that term because I am just about in that
category, but those 55 to 65 ought to be able to buy into Medicare for
premiums that are reasonable and fair and significantly below what they
have to get now. Now, we have a big difference on this. And you need to
know the record here. Under Governor Bush, Texas has sunk to be 50th out
of 50 in health care -- in health insurance for their citizens. Last
week he said that they were spending 3.7 billion dollars, or 4.7 billion
dollars on this.
There needs to be more
community health clinics
where the poor can go get
health care. We need a
program for the uninsured.
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Governor Bush:
I'm absolutely opposed to a national health care plan. I don't want the
federal government making decisions for consumers or for providers. I
remember what the administration tried to do in 1993. They tried to have
a national health care plan. And fortunately, it failed. I trust
people, I don't trust the federal government. It's going to be one of
the themes you hear tonight. I don't want the federal government making
decisions on behalf of everybody. There is an issue with the uninsured,
there sure is. And we have uninsured people in my state. Ours is a big
state, a fast-growing state. We share a common border with another
nation. But we're providing health care for our people. One thing about
insurance, that's a Washington term. The question is, are people getting
health care, and we have a strong safety net, and there needs to be a
safety net in America. There needs to be more community health clinics
where the poor can go get health care. We need a program for the
uninsured. They've been talking about it in Washington, D.C. The number
of uninsured has now gone up for the past seven years. We need a $2,000
credit, rebate for people, working people that don't have insurance, they
can get in the marketplace and start purchasing insurance. We need to
have -- allow small businesses to write insurance across jurisdictional
lines so small business can afford health care, small restaurants can
afford health care. So health care needs to be affordable and
available. We have to trust people to make decisions with their lives.
In the Medicare reform I talk about it says if you are a senior, you can
stay in Medicare if you like it, and that's fine, but we're going to give
you other choices to choose if you want to do so, just like they do the
federal employees. The people that work in Washington, D.C. for the U.S.
Congress or the United States senate. Get a variety of choices to make
in their lives. And that's what we ought to do for all people in
America.
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