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- - 11 - AIDS, but because of Medicaid. We have another frriend who ... KOPPEL: Do me a favor ... Fbt;ANK : Ye s .. KO.PPEL~: ...because we .... PRESIDENT CLINTON: I know -- can I get to the -- I' know what the question FRANK: Go right ahead. PRESIDENT CZ,SNTONi: First of all, there are a lot of' doctors who don't treat Medicaid patients because it'san, incredible paperwork hassle, fooling with the federal government,, and because, often the reimbursement rates are so muchi below regular insurance reimbursement rates for Medicaid. AIDS -- people with AIDS at some point have to quit working and often-times don''t have insurance on the job so they quitt working just so they can get Medicaid. Two things will happen under this system that will really help you and people like you, all over America. There are one million Americans that are H.I.V., or AIDS today. Number one, because you will be covered with health, insurance while you're able to work, including a drug benefit that will make you able to work longer. A1ong, with everybody else, you will always have health insurance and it won't break your employer because-you'll be part of a big community pool,, so your rates will be the same as everybody else. So the first thing is, more people with H.I.V. Positive will be able to work longer without bankrupting their employers. KOPPEL: Uh, huh. PRESIDENT CLINTON: Number two, if you do have tolquit work and you go on to what we now know as the Medicaid Program, it woni't be a separate Medlicaid program. Medicaid patients will be in these big health alliances with self'-employed people, small business people, the employees of big corporations. Everybody will be in there together. Everybody will pick their plans together andithe plan will treat you just like everybody else because the reimbursement for you will be just like everybody else. And there will be one form to -fi11 out for you, just Like everybody else. So, there will no longer be an incentive.or the option to turn youdown. They won't even know, for all practical purposesl,. whether you're Medicaid or not, because you'11 be in the plan with everyone else.

- 12 - KOPPEL: Mr. President . PRESIDENT CLINTON: That's a huge thing. It's a very important thing. Thanks. KOPPEL: ...I told our audience before we went onithe air, let me take this opportunity to tell our audience at home, we have three panels of experts. One in, Boston. They're experts on, public f inance f rom Ilarvard' s Kennedy School of Government. A group in, Chicago, they're practicing physicians. They're professors' of' medicine at the University of Chicago and I'd liike to turn now to~ our panel in Los Angeles, they're three experts on public health policy at UCLA. Only one of them, if you would be kind enough, gentlemen, but I know you have some thoug,hts~on what we've: discussed thus far and I need all the help I can get. Please!' DR. ROBERT BROOK/UCLA: Mr. President, as a physician I am really quite thankful that you're proposing a health plan that insures all Americans. Since we know from research, that lack off health insurance kills people. What we: are a little concerned about is how the plan will assure quality of care for everybody, as you decrease the growth in health services by controlling the amount of money in the system!, even if you c'hoose to eliminate waste from the health care system. PRESIDENT CLINTON: Well, we will basically have, I think, two assurances~of quality of care. ~ First of all, the plans that will be provided,and'the prices that will be offered in these plans will be influenced heavily by the physicians and the other caregivers. But there will be a-lot of'incentive to lower costs because your administrative costs will be so much lower. Secondly, the national, governmen't, as happens now with the government in different ways, will prescribe certain quality standards and then each state will offer information to people in these plans! about not-only the price of'.services, but the outcomes. For example, as you probably know, Pennsylvania now has a program in which they presently publicized the price of certain services and the outcomes. And it enables people to, make judgments about both quality and price that they couldn't otherwise make. So, we're going to give consumers more information, we're going to give professionals more: capacity to figure out how to manage the system while maintaining quality, and we will have ultimately, government standards as the guarantor of quality practice. KioPPEL:~ Go ahead, doctor, if you want to, make one more, quick comment. Then, we've got to gp:to a break.

DR. BROOK: The question some patients ask are if you have a pediatrician in one plan and you're in a managed care plan and you need a service your husband needs a service of heart surgery and you want to gp to a different plan and take advantage of'some.of the information that's come out of, for instance, the State of PennsyIvania, on differencesi in quality of care.a by heart surgeon, how do you manage to do: thatT And how do you realize that the plans will operate in that regard? PPtESIDBh1T' CLINTOhi: Good question. • Let me try answer it. First of all, every person will have, at least, three choices. Most people will have more choices, but every person wi11 have~, at least three. And so, let me try say what they would be. You can choose to stay in a traditional fee, for service medicine. That is, you pick your doctor and they charge you by the service. That may be more expensive, but it may not be if big networks of doctors get together to offer these services together. In that case, you would have a cardiologist and a pediatrician working together. Secondly, you could go into what's called "'a preferred provider organization," which is normally an organization that is organized by health care managers, but that have all kinds of specialists in them.. Thirdly, you can go into an H,.M.O., which! will have a, range of specialists, but it will be a closed panel. That is~, the people that work there will be on salary, so you may not have the specialists you want. In the first two cases, youi'll probably be able to do exactly what you want, for the price that you pay up front. In the third case, if you're in an H.M.O1., you' ll still be able to say "look, my child, is really sick and I want this child to see a pediatrician who's not in this H.M.O., who's in another state, you'll still be able to gp to that other state, but that pediatrician will be reimbursed by your insurance plan only at the rate that the H.M.O. pediatrician will be reimbursed, then youu would pay the difference. KOPPEL: Okay, Mr. President. We.'re gping to take a short PRESIDENT CLINTON: But that plan will be the cheapest so ~ you'll come out about the same, no matter what. ~ ~ i t sh KO'PPBL W t k th ' t b k ~. e re go ng o a e ano er or : rea . 0 PAtESID'Bh1T' CLINTON: The least expensive. I d'on't like that N .~ word - cheap. ~ ~ ~