Okay, it's a woman's turn. It's a young lady's turn. Let me -- right there with the vest. Yes, that's you. (Laughter.)
Q Hello, Mr. President, and thanks for being here.
THE PRESIDENT: Thank you.
Q My name is Jamie and I am a nursing student at Mesa State. (Applause.)
THE PRESIDENT: Outstanding.
Q Being as I am a potential health care provider in the health care system, there are a few things in the plan that I read about that I wanted to understand more --
THE PRESIDENT: Sure.
Q -- as far as providers being required to report -- what was the words -- preventable medical errors in the health care system. Now, as far as health care systems are concerned, we are required to report every error we see. So I kind of want a clarification of how much you're expecting from providers in this system.
THE PRESIDENT: Well, different states have different rules. So we got kind of a patchwork. I don't -- I confess I don't know exactly what the rules are here in Colorado. But about 100,000 people die every year from preventable diseases and illnesses in hospitals. Some of the ways that we could solve this are so simple. There's actually a doctor who's put together a protocol -- washing your hands, a lot of just basic stuff that costs no money -- that has been shown repeatedly to cut these preventable illnesses and deaths down drastically -- by a magnitude of 50 percent, 75 percent reductions in preventable deaths just by applying these things that don't cost any money.
So the question then becomes, how do we get more hospitals, more doctors, more health systems, to adopt these systems. And the best way to do it is to make sure that not only are they reporting these preventable errors, but that they're also available to consumers -- the American people -- so that if they've got too many of them, after a while they start getting embarrassed. Right? I mean, if you found out that there are two hospitals here in this city and one hospital has half the preventable deaths of the other hospital, you'd want to know that, wouldn't you?
The problem is right now oftentimes it's very hard for consumers to get that information directly. So the idea is simply to make sure that that information is packaged in a way where you can comparison shop, and your employer -- if you're getting health insurance from your employer -- could comparison shop. So we're putting some competitive pressure to improve quality across the system. That's what we're talking about. (Applause.)
By the way, thank you for being a nurse, because we need more nurses. That's important. (Applause.)
All right, gentleman right here in the t-shirt. Hold on one second, we got a mic coming.
Q Thank you for coming to Colorado. It's a great place.
THE PRESIDENT: It's a great place. (Applause.)
Q You touched on this. I would like you to expand a little more. This problem with misinformation in our country, it seems to me that it's not only just hurting health care reform, health insurance reform, it's dividing our country. (Applause.) Is it not maybe time -- I think we all know where it's coming from. Is it not time that something can be done -- okay, I got to watch what I'm saying, but --
THE PRESIDENT: Well, look, let me -- let me just -- let me address this. You know, health care is really hard. I mean, this is not easy. I'm a reasonably dedicated student to this issue. I've got a lot of really smart people around me who have been working on this for months now. We've got really fine public servants like Senators Bennet and Udall who are working on this and thinking about it a lot.
And the truth is -- I want to be completely honest here -- there is no perfect, painless silver bullet out there that solves every problem, gives everybody perfect health care for free. There isn't. I wish there was. I wish I could just say, you know what, we're going to change the system, everybody will get as much care as they want any time they want, everybody will have it, and it won't cost anything. And doctors will be happy and nurses will be happy, hospitals will be happy, insurance companies will still make a lot of profits, drug companies will be able to charge as much as they want. I can't do it. Nobody can.
What I can do is try to sort through what are all the options available, be realistic about where we're going on health care, say to myself, if we keep on doing what we're doing, we are in a world of hurt. We can't afford what we're doing right now. More people are going to lose health insurance. More employers are going to drop coverage or push more coverage onto their employees with higher premiums and higher deductibles. Medicare and Medicaid will go broke. State budgets and federal budgets will be unsustainable.
And then we're going to have to make some really bad decisions where we had no good options -- even worse options than we have right now. And what's going to end up happening is -- mark my words -- if we do nothing, at some point Medicare in about eight to nine years goes into the red. Somebody mentioned it's going broke -- yes, it is going broke.
So here's what's going to happen if we don't change the delivery systems and change some of the incentives -- we'll have a choice. We'll either have to cut Medicare, in which case seniors then will bear the brunt of it, or we'll have to raise taxes, which nobody likes. And we still will be paying about $5,000 to $6,000 more than any other advanced country in the world and not get better health care for it. Now that doesn't make sense.
So in terms of misinformation, there is -- because there's no perfect solution, we can have legitimate debates about the public option that we just had. That was a good, serious debate, and you can make a plausible argument as to why we shouldn't have a public option. Now, I believe that we should on balance. It's not perfect. It's not going to solve every problem, but I think it actually would keep the insurance companies more honest. You can have a honest disagreement with me on that.
What you can't do -- or you can, but you shouldn't do -- is start saying things like, we want to set up death panels to pull the plug on grandma. I mean, come on. (Applause.) I mean, I just -- first of all, when you make a comment like that -- I just lost my grandmother last year. I know what it's like to watch somebody you love, who's aging, deteriorate, and have to struggle with that. So the notion that somehow I ran for public office, or members of Congress are in this so that they can go around pulling the plug on grandma? I mean, when you start making arguments like that, that's simply dishonest, especially when I hear the arguments coming from members of Congress in the other party who, turns out, sponsored similar provisions.
Here's what this was about. Here was the genesis of this little piece of information. We had a provision in the House bill that would give the option -- the option -- of somebody getting counseling on end-of-life care or hospice care, and have it reimbursed by Medicare; the option -- voluntary -- so you'd have more information about how to deal with these situations.
Turns out the biggest proponent of this was a Republican congressman who is now a senator and a colleague of Mr. Udall and Mr. Bennet. Turns out in Medicare Part D, which was passed by a Republican Congress, they had the exact same provision.
So when I have people who just a couple of years ago thought this was a good idea now getting on television suggesting that it's a plot against grandma or to sneak euthanasia into our health care system, that feels dishonest to me. And we've got enough stuff to deal with without having these kinds of arguments. (Applause.)
All right, so it's -- all right, it's a woman's turn here. Yes, I sort of neglected this area right here. Young lady right there, blond hair, black blouse -- white dress. Yes, right there. Go ahead.
Q Hi, my name is Julie, and I'm a small business owner from Colorado Springs. I am also a Republican that voted for you.
THE PRESIDENT: Thank you.
Q You're welcome. (Applause.)
THE PRESIDENT: What's your business?
Q We make software.
THE PRESIDENT: Excellent. We need that.
Q I hope so. (Laughter.) So I grew up in a blue-collar family, and my husband and I work very hard at our small business. We've always treated our employees like family, given them great benefits, any time off they need with their family. I volunteer in my professional community. I volunteer at my children's schools. And that's still not enough, because us small business owners that are on that cusp between middle class and the rich are going to bear the brunt of a lot of what this is going to cost. Why is what I do now not enough? (Applause.)
THE PRESIDENT: Let me -- I think it's a good question. Let me talk about both cost and what this would mean for small businesses, because both issues would affect you.
First of all, remember what I said, I can't come up with a perfect solution that is completely free. It is absolutely true that in order for us to provide help to those who have no insurance at all, that's going to cost some money. It's going to cost some money. We can't do it for free. They've got no health insurance right now; we're going to help them. It's 46 million people. That's going to cost some money.
Now, what I've proposed is going to cost roughly $900 billion -- $800 billion to $900 billion. That's a lot of money. Keep in mind it's over 10 years. So when you hear some of these figures thrown out there, this is not per year, this is over 10 years. So let's assume it's about $80 billion a year. It turns out that about two-thirds of that could be paid for by eliminating waste in the existing system.
So I'll give you -- let me give you one particular example. We right now provide $177 billion over 10 years -- or about $17 billion, $18 billion a year -- to insurance companies in the forms of subsidies for something called Medicare Advantage where they basically run the Medicare program that everybody else has, except they get an extra bunch of money that they make a big profit off of. And there's no proof, no evidence at all that seniors are better off using Medicare Advantage than regular Medicare. If we could save that $18 billion a year, that is money that we can use to help people who right now need some help.
So about two-thirds of what we're talking about is paid for through the existing health care system, money that's already being paid by taxpayers -- does not require additional taxes. But that still leaves one-third.
Now, in order to pay for that, there have been a lot of proposals out there. One of them that I proposed, I still think is the best idea. You may disagree, because I don't know what your income bracket is. My proposal was that for people making more than $250,000 a year -- people like myself -- that we should, instead of getting the full itemized deduction of what our highest tax bracket is, we should just cap out our itemized deduction at 28 percent, which is what the average American gets. So -- because my attitude is, I shouldn't get a bigger tax break if I write a check to my local church than if the janitor down the street writes a check to their local church. We should get the same tax break. If we were willing to do that, just that alone would pay for what we're talking about. (Applause.)
Now, some members of Congress disagree with that and they've got other proposals, and that's going to be worked out in September.
I do want to make the point, though, that I have not proposed any plan that would put the burden on middle-class families in order to deal with this. So when you hear people talking about I'm raising your taxes, the only tax policies I've implemented for middle-class families is a tax cut for 95 percent of working families.
Now, let me talk about small businesses. I don't know your particular situation, whether you're providing health insurance right now to your employees. If you are, then you stand to benefit from this plan because every proposal, both in the House and the Senate, that's been put forward, provides a huge number of subsidies to small business owners that are doing the right thing by their employees. (Applause.)
So it is very likely -- you know, obviously we'd have to look at the calculation; I'd have to figure out how many employees you have, what kind of health insurance plan you had, et cetera -- but it is very likely that you would actually make money, gain from this plan, because you're already providing health insurance to your employees and we would give you some help.
The only category of folks who might not like this plan are employers who can afford to provide health insurance to their employees but aren't doing so, because what we would then say to them, what we'd say to them is, look, we're giving you affordable options; you are going to be able now to be part of a bigger pool. You can buy your health insurance through that exchange that I was explaining to that gentleman there. So you'll be able to get premiums and prices that are comparable to what big companies, Xerox or IBM, are getting for their employees, and we'll give you some help doing it.
But if you refuse to provide any health insurance for your employees at all, then we are going to ask you to make a contribution to help make sure those employees have health insurance, because by the way, it turns out if you as an employer are not providing that health insurance, the rest of us are, because those folks are going on Medicaid, or they're going to the hospitals for uncompensated care, and that's not fair. (Applause.)
So the bottom line is this: If you are a small business person who is providing health insurance for your employees, I am very sure that you would actually benefit from this. But the problem is -- again, this is where the information has not been going out in as clear a fashion as possible, which is why I'm glad you asked the question.
All right? Okay. (Applause.)
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