# Press Briefing by Press Secretary Ari Fleischer, June 27, 2001

The James S. Brady Briefing Room
1:15 P.M. EDT
MR. FLEISCHER: Good afternoon. I have a personnel announcement and then two policy items I want to discuss. One, the President intends to nominate Donald Schregardus to be Assistant Administrator of the Environmental Protection Agency for Enforcement and Compliance Assurance. The President intends to nominate H.T. Johnson to be Assistant Secretary of the Navy for Installations and Environment. And the President intends to nominate the following individuals to be commissioners of the United States Parole Commission for a term of six years: Gilbert Gallegos, Henry Hart, Cranston J. Miller, Marie Ragghianti. Those are the individuals for the Parole Commission.
Two other items -- number one, the House Judiciary Committee tomorrow will take action on the President's faith-based initiative. The President is very pleased that action is beginning in the Congress on one of his defining policy objectives to help some 15 million children who are at risk in this country, 2 million children are prisoners, so they have more opportunities and more hope for a brighter future. The faith-based initiative is aimed squarely at bringing help to those who are often left behind in society, and an agreement has been reached with House leaders on the terms of the language. The legislation will start moving tomorrow; it will move in the Ways and Means Committee immediately following the recess. And the President is very pleased with this action. It's a sign of good things to come in the House, in his opinion.
Also, on the patients' bill of rights, earlier today the President issued a statement in support of the Fletcher-Peterson, Thomas-Hastert patients' bill of rights proposal. And if that bill is sent to the President he will sign it. Again, a sign from the President that he would like the Congress to work productively in a fashion that allows a patients' bill of rights to be signed into law this year. The President believes very strongly in putting progress before politics. This bill puts progress before politics, and the President will sign it if it sent to him.
And with that, I'm more than pleased to take any questions you have. Helen.

## Q I assume the President thinks this religious office and religious funding is constitutional.

    MR. FLEISCHER: There is no question about its constitutionality in the opinion of the lawyers who looked at and the people we have worked with on the Hill.

## Q What people have looked at it?

    MR. FLEISCHER: The Department of Justice attorneys who are responsible for this area of law. And as the President indicated in a speech he gave just the other day, there are already -- for example, under Medicaid, there are Jewish hospitals, there are Catholic hospitals that receive Medicaid funding. Yet these hospitals were originally started for the purpose -- they are Catholic hospitals, they are Jewish hospitals. They are not non-denominational.

## Q But the money goes to the patient, doesn't it?

    MR. FLEISCHER: In the case of Medicaid, it often goes directly to the service provider, the hospital or the doctor -- or the hospital. It reimburses hospitals for their costs. So it costs the government -- Habitat for Humanity receives federal funding in some cases. The Salvation Army. There are a host of groups in our society that are faith-based that do good deeds that bring help to people who otherwise would be left out --

## Q Why is he so against the government doing these things?

    MR. FLEISCHER: He believes that both are necessary. The President believes there must be a continued role for the government in these matters. But even with the government having spent trillions since the War on Poverty began in the early '60s, there have been millions of Americans who have been left behind. The government proposals, no matter how effective and how well-intentioned, have not been able to find everybody in our society who needs help. Very often the answer is --

## Q Well, isn't it Congress' fault?

    MR. FLEISCHER: I think it's a reflection of how intractable some of the social problems are. And the President does not want to give up on anyone who has been left behind after the government does everything it can do. And often the solution is found in the Salvation Armies of the world, in the faith-based organizations of the world. And the President wants to empower them to do more to bring help to those in need.

## Q Ari, in the patients' bill of rights, there are Democrats who see this House approach, especially on, yes, you can sue in state court, but the way you get there creates something of a maze before you can get there. What's -- in their view. To the President's mind, what's the road map here for some kind of compromise that allows patients to do something that Republicans have not heretofore supported, which is suing in state court and also satisfying him?

    MR. FLEISCHER: Let me begin with a basic building block. And that is why, in the President's opinion, it's important to protect people's rights and access to health insurance by keeping these cases primarily in federal courts. And the reason is relatively simple.
    President Bush believes that these suits are best handled in federal court because people typically receive their insurance through their employee. And those employees provide the same type of insurance to the residents who live in Maine as they do to the residents who live in southern California. In other words, there is a universal health care plan that is offered throughout these companies.
    And one of the reasons that plan can be uniform and universal and therefore available to so many tens of millions of Americans who get their insurance through their employer is because they know they can offer one package to all their employees and not have to design 50 packages to conform with 50 laws in 50 states.
    If all of a sudden for the first time, these employees had to revise all their health care plans to have 50 plans in 50 states subject to 50 different suits, millions of Americans could be at risk of losing their insurance. It makes it very hard and very complicated for people to get their insurance. And that's the benefit of a federal system that has brought health care to so many workers. And I dare say, many people in this room. You all work for corporations. The reason you are able to have this insurance, whether you are stationed here in Washington or whether you worked out of a bureau somewhere else, you would still have the same insurance policy. And that's because of the federal nature of insurance regulations.
    If you, for the first time in this legislation, say it's better to have suits heard in the state court than the federal court, you begin to undermine the uniformity that has allowed the package of benefits to be delivered to so many millions of workers. That's the building block. That's why the President believes these cases are best heard in federal court. If you put them in state court, as the McCain-Kennedy approach does, then you have no caps, in essence, on suits, on damages, and you'll have 50 different provisions for how people can get their insurance. And that's going to put people's ability to get insurance at risk. That's why the President believes it's best in federal court.
    He has, in the case of the Fletcher bill, indicated some flexibility on that, and that would apply to what you would call "bad actors," and that is, if an HMO, having lost a case before an independent review organization, still denies care to someone who needs the care, in that case, the President would say, you've been a bad actor, you have not listened to the independent review organization, you have bucked their will, an independent review organization should be listened to; therefore, as a punitive step to give you an incentive to comply with an independent review organization, those cases can be heard in state court. And that's a compromise the President is willing to make. The President hopes that the Congress also will be willing to compromise.

## Q Ari, who is coming to the meeting today, and what is the purpose of the meeting?

    MR. FLEISCHER: The purpose of the meeting is to discuss with many members of the House who have shown a willingness to work toward an agreement on a patients' bill of rights, have an opportunity for them to hear the President's point of view on how strongly he feels that legislation can be signed into law if the Congress is willing to compromise. So you're going to see many people who have worked very closely with Congressman Norwood, with Congressman Dingell, who are part -- Congresswoman Nancy Johnson, for example, who are part of what we view as an emerging compromise -- are the people who will be invited down. And we will have that list of people for you. I just want to again make certain that those who have been invited will actually be here.

## Q Do you have a few names? I mean, has anybody --

    MR. FLEISCHER: Again, we'll put that out as soon as we're able to confirm actual attendance.

## Q -- Norwood or Dingell --

    MR. FLEISCHER: You'll know soon enough, as soon as people are here. What I always hesitate to do on member meetings is indicate who is invited because, if somebody gets caught up on the Hill in another meeting or in another vote, out of respect for the members, we don't like to indicate they were not able to make a meeting.

## Q Hastert?

    MR. FLEISCHER: The Speaker is not coming. It is more rank and file membership.

## Q How are these people being chosen? Is it people who supported Norwood-Dingell or who seem willing to support something now?

    MR. FLEISCHER: Many of the people are people who have supported the Norwood-Dingell approach.

## Q But do you have an indication they may move and support something closer to the Fletcher bill or --

    MR. FLEISCHER: The purpose of the meeting is to continue to look for ways to put together compromises and to work with people who are willing to get a patient bill of rights signed into law.

## Q Are those who supported the Fletcher bill also who are coming?

    MR. FLEISCHER: There will be some who support the Fletcher bill coming, too.

## Q Let's move the debate question from the front of liability to these independent review boards. Democrats argue that the Senate vehicle the White House has supported, and even in this emerging Thomas Fletcher bill, HMOs are in the driver's seat as to who sits on these review boards and, in some cases, provide the financial backing for the review boards themselves. Their accusation is that they are truly not independent but much more beholden to the HMOs than would outwardly appear. What is the White House position on how these independent review boards should be created, who should finance them, and what role, if any, the HMO should play in their membership?

    MR. FLEISCHER: The independent review boards must be independent. They cannot be controlled by the HMOs, otherwise they would lose that independence. The purpose of an independent review board is to give consumers a right to an external appeal if they file a claim with their HMO and the HMO denies the appeal. It must be independent to be effective, in the President's opinion, and he will support legislation that makes them independent.
    What's interesting here is if there is a dividing line between the President and some in Congress who would prefer to have health care matters settled in court, as opposed to have health care matters settled before a panel of independent doctors, is that people don't want to go to court. They would much rather get quick adjudication and settlement through an independent review board.
    The problem the President has with the approach of some of the democrats on patient bill of rights is that they will immediately try to get people into court, where the first thing somebody has to do is pay for and hire a lawyer. And health care should not have to be administered through lawyers. Health care, in the President's opinion, should be administered through health care professionals and providers. The Democrats' solution is to right away go to court. The President's solution is to right away get people care.

## Q Are you saying that if the President is persuaded that these independent review boards, in whatever legislation finally emerges, are not truly independent and that the HMOs, in fact, do have a broad say in either financing or makeup, he will veto the legislation?

    MR. FLEISCHER: I'm saying they have to be independent. The President supports independent review boards.

## Q Does that mean that the HMOs can -- How do you pick the board members? How do you pick the board members? Who?

    MR. FLEISCHER: That's all part of the specifics of the legislation, in terms of who gets to serve on an independent review board.

## Q How does the White House see it?

    MR. FLEISCHER: It's typically done by a combination of factors that bring outsiders into the organizations that are done in concert with the health care professionals and with the consumers.

## Q Would this review board be made up of medical professionals, or would they be accountants?

    MR. FLEISCHER: Yes, medical professionals.

## Q Moving on to the Senate, can you share with us the President's views on the Snowe amendment and a little bit of their conversation, recent conversation, prospects for it over there?

    MR. FLEISCHER: The President views the Snowe amendment as one of several steps that need to be taken in the right direction. But the President supports a comprehensive fix of the liability problems that are presented in the legislation currently before the Senate. The Snowe bill is one step in that direction. More need to be taken.

## Q I have a couple global warming questions. When the President meets with the Prime Minister of Japan this weekend, will he seek to get Japan to join the United States in some alternative way of dealing with this outside the Kyoto process?

    MR. FLEISCHER: Ron, I think we will have a little bit more closer to the meeting on the agenda with Japan. I anticipate that the topic of global warming can come up and I think that you will hear the President indicate what he has indicated publicly before about his desire to find a way to reduce greenhouse gases, and he will share that with the Japanese Prime Minister.

## Q And the other question is, when the next round of global warming talks in Bonn next month -- which the President agreed the U.S. would participate -- will the representatives there flesh out in any way what the U.S. alternative approach is?

    MR. FLEISCHER: I will have a little bit more on that closer to the event. I don't want to predict this far in advance of it.

## Q Could I follow that, Ari, just a moment on global warming? The Kyoto -- it was actually the Rio agreement called for a sharing of a billion-dollar fund between many of the principal countries involved, and the United States had committed $400 million to that fund under President Clinton. Is President Bush going to live up to that commitment, or is he going to rescind it? Because if he were to pull out, that could defeat the entire Kyoto protocol right there.

    MR. FLEISCHER: Let me take that question and get back to you.

## Q Ari, back to the state court versus federal court issue. It takes a long, long time in federal court for civil cases to come to trial. There just aren't that many federal courthouses compared to state courthouses. There is a big civil case backlog. And it's more expensive, generally, because getting a lawyer who practices in federal court tends to cost more. Is the President comfortable with making people wait years before they come to adjudicate their health care claims and make them pay a lot more --

    MR. FLEISCHER: State courts are not exactly known for their swiftness. There is a whole problem with having courts resolve these problems. The President believes very strongly that individual health care consumers who are denied the health care that they are entitled to, as determined by independent review organizations, have a right to sue the HMO. The question is, is that suit best handled in a federal court or in a state court? And as I explained earlier, there are real problems and you are going to damage people's ability to get health insurance if all those cases are heard in 50 different state courts. It begins to undermine the whole pattern of people receiving their insurance through their employers. And that puts people's health care at risk.

## Q It will take longer and cost more to send them to federal court.

    MR. FLEISCHER: I'm not aware of the statistics that you're citing, Terry. I know that it's always expensive to go to court. Any time somebody sues, they make a determination to go into court, and nobody is satisfied with a court system in which the contingency fees give a lot of the rewards to the attorneys and not very much to the consumers. And the President, again, believes that when people are denied services, they want to quickly be able to get the health care they need from a medical provider, and not have to go and hire a lawyer and go to court and wait years for adjudication of a court claim. The best system --

## Q It will happen in federal court --

    MR. FLEISCHER: But it will happen immediately. Under the Democrat proposal, you will immediately go to court. There is such a loose system set up for the independent review organization under the Kennedy-McCain approach, that if you're under their approach, lawyers are going to be able to find people to just take HMOs to court in 50 different states, and we'll have a whole new system of insurance set up across the country that's going to limit people's ability to get their insurance coverage.

## Q One more on this. Chief Justice Rehnquist in the judicial conference has said repeatedly that there should not be additional enormous causes of action shifted into the federal court system. And they don't like this. Does the President believe the Chief Justice is wrong?

    MR. FLEISCHER: The President believes that a patients' bill of rights should give people health care, and that if there is an independent review organization set up properly, that health care will then be delivered as a result of the rulings of the independent review organization, so that if you are denied the care that you think you are entitled to from your HMO, the HMO won't pay your claim, you go to an independent review organization. The President believes the independent review organization should be empowered to settle the matter. And if they are empowered to settle the matter, the fact of the matter is very few people will need or want to go to court, whether it's state or federal.
    And that is the experience of the states. There are states where you are entitled to go to court -- Texas is one of the states that has a very powerful patients' bill of rights, but it also has a very effective independent review organization. As a result of the power of the independent review organization, there have not been a lot of people who have felt the need to still go to court. And after all, a patients' bill of rights is about getting people health care, not getting people lawyers.

## Q What happens now? The President suffered a setback yesterday in the House of Representatives, the very overwhelming vote against allowing Mexican trucks to come into the country. What can the President do to change the thing, having such a large difference against him?

    MR. FLEISCHER: The President believes very strongly that what the House did yesterday is wrong. And let me review the facts on this matter. In the vote in the House of Representatives yesterday, they struck the President's request to hire additional inspectors on the border so that trucks can be inspected to make sure that they are safe. The President proposed more than doubling the number of inspectors along the borders to inspect trucks to ensure they're safe. Yet the House has eliminated the President's request to hire more inspectors. The House also -- and I want to read this -- the amendment that was agreed to says, none of the funds of this act may be used to process applications by Mexico-domiciled motor carriers. They won't even allow applications to be filled out. The House action had nothing to do with safety, it has to do with banning trucks because they happen to be operated by our friends to the south. And the President thinks that's wrong.
    So the President is going to work diligently in the conference to reverse that action. Through the Department of Transportation, the federal government has already issued rules to make certain that all trucks that operate within the United States are operated safely. By doubling the number of inspectors along the border, as the President has proposed, the Congress can show its commitment to truck safety. But the House, in the President's opinion, should not ban trucks because they're operated by our Mexican friends to the south.
    Under the DOT rule, individual trucks would be subject to inspection, exactly as American trucks are subject to inspection. Same standards, same rules. But the House just said, if you're operated by Mexicans, no funds can be used to process applications. That's not safety; that's wrong. And that's why the President disagrees so strongly with it.

## Q But why are you saying -- if it's not safety, are you saying it's racism?

    MR. FLEISCHER: I'm saying -- I'm going to read again from the amendment: None of the funds from this act may be used to process applications by Mexican-domiciled motor carriers. And then it continues and it has a little bit of language about different zones, et cetera. But the House action just says it's not allowed. The House action was not tied to safety; in fact, the House action went in the opposite direction on safety by striking the President's request to more than double the number of inspectors. And this also raises real complications for NAFTA and for free trade. And therefore, the President objects to it on those grounds.

## Q Can I follow up on that? The government of Mexico has just announced that they are planning to close the border of Mexico and close the roads for American trucks. And also some Mexican legislator have said that they're planning to go to the WTO to deal with this issue. My question is, is the President planning to call the Mexican government, to plan some talks, or other members of the government to try to deal with this issue?

    MR. FLEISCHER: The place the issue needs to be dealt with is in the United States Congress. And that's going to be the focus of the President's efforts. And he's going to work hard to reverse this, and he thinks it's the right thing to do.

## Q You lost a lot of Republicans on that vote. And you lost a lot of Republicans on the off-shore drilling-monument issue. What's going on over there?

    MR. FLEISCHER: Well, again, this is not final, and the President will have this conversation in a couple of weeks before this gets final and you will judge whether the President was successful in his efforts on this. He's going to work hard on this issue.

## Q Will he bring it up at the meeting today, Ari?

    MR. FLEISCHER: No, the meeting today is about patients' bill of rights.

## Q Does the President think he's losing ground with his own party in the Congress?

    MR. FLEISCHER: No, I think you're seeing a President who has, frankly, been very successful on legislative matters. The tax cut, as you know, passed with a very large, overwhelming margin. The education bill passed with a rather large margin in the House, large margin in the Senate. And what you are talking about here are amendments on broader appropriation issues. It is not unusual for Congress to speak its mind on amendments and for that process to change several times.
    That's one of the reasons that in the House, appropriation bills are one of the few bills that are subject to amendment. Not every bill that moves through the House is subject to wide-ranging amendment. So it's not at all unusual for the House to express itself, and for the House then to take additional or corrective action when it gets to conference.

## Q Ari, does the President believe Mexican trucks are as safe as American trucks?

    MR. FLEISCHER: The President believes that all trucks operating in the United States have to be operated safely, regardless of who is at the wheel.

## Q You said that the House action was not about safety --

    MR. FLEISCHER: The one standard should apply to all, and that is, are the trucks safe. And under the rules as announced by President Bush's Department of Transportation, all trucks are subject to the same safety requirements. And that should be the factor. And by doubling the number of inspectors, it helps guarantee the safety of all trucks traveling on American roads.

## Q How do you know the House action is not about safety? If they're banning Mexican trucks and if they're assuming that Mexican trucks aren't as safe, then isn't it about safety?

    MR. FLEISCHER: Well, there was a report that I saw this morning -- this is why I addressed this -- there was a report this morning that was erroneous, saying that the House voted to make certain that trucks from Mexico are subject to the same safety requirements as trucks from the United States. That was not what the vote did. And so I'm saying that -- actually addressing that interpretation of the House vote, because there was nothing to do with that in the House vote.

## Q Ari, how long was the discussion with Tom Daschle this morning?

    MR. FLEISCHER: I didn't ask the President how long it was.

## Q Back on this question of the appropriations vote yesterday. Republicans I've talked to said the White House was caught completely flat-footed, the legislative shop had not engaged on this issue. The Teamsters had been working it for three and four weeks very hard -- the Republicans who voted against the White House position on it, many of them are strong labor Republicans, and that you were simply out-foxed and out-worked on the floor dealing with an issue that, as you already identified, violates the President's position on three key issues -- free trade, NAFTA and the safety of trucks operating --

    MR. FLEISCHER: As you know, there are very often amendments that are agreed to shortly before they're voted on, and there is not a long lead time before the votes take place. The vote was what it was and the President has said what he has said.

## Q Any message for the President from the Indian-American Association of Physicians from India? They are having a convention this afternoon in Washington, D.C., and they do support the President's patient bill of rights, number one. Number two, Sonia Ghandi will be in the White House today and tomorrow, the opposition leader in India, and President of Indian National Congress. Is the President going to drop in or is he going to meet with her?

    MR. FLEISCHER: I am so focused on answering your questions today, I have not looked at his schedule for tomorrow. I don't know. I'll have to take a look at that later today and let you know.

## Q And just to follow that, the Indian government have arrested a number of terrorists in connection with Osama bin Laden and his activities, also in Saudi Arabia now. Osama Bin Laden has called on India, that he will destroy all the U.S. installations and all the U.S. interests in India. So what is the U.S. government doing? Has the President spoken with the Prime Minister of India or anybody there?

    MR. FLEISCHER: The President is always concerned about extremism and terrorism and that is particularly the case with Osama Bin Laden. And the United States, working with our allies around the world, will remain vigilant in making certain that all steps are taken to prevent terrorist acts from taking place.

## Q Ari, about global warming issues, is there any possibility whatsoever of the President changing his well-known position on the Kyoto Protocol as a result of his meeting with Prime Minister Koizumi Saturday, or would you totally rule it out?

    MR. FLEISCHER: I think you have heard what the President has said about global warming. He is committed to reducing greenhouse gases and his position is consistent.

## Q A number of the President's presidential predecessors have been called upon in their constitutional requirement to see that the laws are enforced, to take decisive action to back up the rulings of the United States Supreme Court. And my question, the first of two

    Since the D.C. Human Rights Commission has been reported on page 1 as having defined the U.S. Supreme Court in the case of Boy Scouts of America versus Dale, by ordering two homosexual troop leaders restored to their former post. President Bush won't allow this, will he, Ari? Or will he?
    MR. FLEISCHER: I'm not familiar with that issue, Les.

## Q It was page 1 of The Washington Times, Ari. Is the President going to allow this local thing to defy the Supreme Court?

    MR. FLEISCHER: I have not talked to the President about it and he does not get involved in these local matters.

## Q The top of page one of this morning's Washington Times, which I'm sure you and the President read, reports that U.S. Commission on Civil Rights Chair Mary Frances Barry is being charged by Florida Secretary of State Harris with conducting a bogus investigation because she was a supporter of Al Gore. And since, there have been a number of similar charges against Barry. The President isn't going to remain aloof, and let her continue in this office indefinitely, and not -- he won't -- not support Secretary of State Harris, will he Ari? Or will the President leave this to what might be called an Ari-illusive? (Laughter.)

    MR. FLEISCHER: Les, for some questions, that is deserved and redundant. First, the President is always concerned about any matter dealing with any allegation of any racial problems in any elections. And he is very cognizant and careful to make certain that all the laws of our country are followed, so that everyone has the right to vote and that that right is honored.
    In the case of this specific report that you site, there have been many questions raised about whether that report was accurate, and whether the motives for that report were political. That report was not shared with all members of the panel before it was offered publicly. So there are important issues that need to be looked at.

## Q When's he going to take action on this very -- I mean, it was a Harvard Law researcher that did a huge article on a number of things. He's done this all over. And when is he going to --

    MR. FLEISCHER: I think I've addressed the question.

## Q Is he going to leave her in office forever?

    MR. FLEISCHER: I've addressed the question as fully as I can.

## Q On the Senate side, the patients' bill of rights is silent on the issue of suing in federal courts, or in fact they don't have that as an avenue. When and if the bill gets to conference, is the White House signaling today that they want Senators Breaux, Jeffords and Frist to embrace this idea of having suits --

    MR. FLEISCHER: Which Senate bill are you referring to?

## Q Breaux, Frist and Jeffords. Their view of patients' bill of rights does not allow for suits at the state level.

    MR. FLEISCHER: Well, there bill represents what the President believes in, as I explained earlier, that it's best for the health care consumers if cases are brought to federal court. That's what the President believes, and that's why the President supports that approach.

## Q They have no avenue in their state court suits, even on a limited circumstance, such as in a bill by Fletcher and Hastert. So are you saying in conference --

    MR. FLEISCHER: The President has indicated that both approaches meet his principles, because both approaches allow patients the right to sue, but mostly in federal court or entirely in federal court. And let me -- because you brought this up, let me talk a second about the other bill that is moving in the Senate, which is the Kennedy-McCain bill, in terms of what that does in terms of the venue of court cases.
    That bill creates a $5 million punitive cap for federal court only. That bill creates no caps for suits that are brought in state court, and it has no non-economic damages in state court. The McCain-Kennedy bill has one very narrow provision allowing a small number of cases to be heard in federal court. But under it, most cases would be brought in state court.
    So the problem is not only the level of the cap at $5 million for those few cases that would be brought in federal court, but under the McCain-Kennedy approach, it would funnel most cases to state courts, which will undermine people's ability to get health care insurance.

## Q There's also -- the Senate is working on a compromise plan that would have a $750,000 cap for non-economic damages. Would that be acceptable?

    MR. FLEISCHER: Again, I'm not going to negotiate for the President through the press. But the President does think a $5 million cap is too high, and the President thinks that there would be too many cases brought to state court, where the cases should be properly heard in federal court, under the approach that you just cited.

## Q 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 Angel, who's a 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. And she argues as follows

    She says it's becoming apparent to nearly everyone that our experiment with private managed care has failed. The system is imploding in the patients bill by increasing costs will accelerate its demise. And then she says, the answer is a single-payer system 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?
    MR. FLEISCHER: The President believes very strongly that people should have the right to have choices in the 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. There are other people who want to have PPOs, provider-sponsored organization care. For some people, medical savings accounts made sense.
    But the point is, health care should be in the hands of the consumers and they should be empowered to enter the marketplace and get the insurance and the health care that they think is best for them and their families. And many people in this room wrote extensively about senior citizens who lost their HMOs because HMOs did 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 to the federal government because it preserved the option that they themselves chose.
    And through HMOs, many seniors have access to drugs, for example, that they do not get under typical Medicare. So the President believes the answer is empowering consumers with choices.

## Q But just to follow up, if in fact that's the argument, why not just repeal Medicare and give seniors choice, total choice?

    MR. FLEISCHER: Seniors are increasingly receiving choices. As a result of some of the reforms that were created in 1997 that President Clinton signed into law, seniors did for the first time have choices available to them under Medicare. Seniors, for example, for the first time can 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. So there are a series of options available to seniors --

## Q But why not repeal Medicare?

    MR. FLEISCHER: The President believes very deeply that we need to have Medicare, and he believes so deeply in it that he wants to make sure that 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.

## Q Two quick questions. First, has the White House been in touch with Secretary Powell since he arrived over there?

    MR. FLEISCHER: The President has not talked with the Secretary since his arrival. The Secretary is in the middle -- actually at the very beginning of his meetings. The President will be talking with him, but has not done so yet.

## Q And then a second question is, was the administration taken by surprise yesterday by Prime Minister Sharon's insistence on a 10-day period of complete peace for Israeli citizens?

    MR. FLEISCHER: I think what the Prime Minister said privately in the Oval Office are very similar to things he had said publicly up in New York and in other places, about that he wants to reduce the violence to zero and that he had an approach that he shared with the President.

## Q Specifically on a 10-day period, that seemed to be new. And I wondered if the administration had heard that before from him or not?

    MR. FLEISCHER: I would have to check with Condi or check with the President. But I don't think there were any surprises there.
Thank you.
END
1:50 P.M. EDT