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MODERATOR:
Good
evening from the Field House at Washington University in St.
Louis.
I'm
Jim Lehrer of the News Hour on PBS.
And I welcome you to this third
and
final Campaign 2000 debate between the Democratic candidate
for
president,
Vice President Al Gore, and the Republican candidate, Governor
George
W. Bush of Texas. Let's
welcome the candidates now.
Before
proceeding
tonight we would like to observe a moment of silence in memory
of
Governor Mel Carnahan of Missouri, who along with his son and
his
former
chief of staff, died in a private plane crash last night near
St.
Louis. A reminder, as we continue now, that these debates are
sponsored
by
the Commission on Presidential Debates.
The formats and the rules
were
worked out by the commission and the two campaigns.
Tonight's
questions
will be asked by St. Louis area voters who were identified as
being
uncommitted by the Gallup organization.
Earlier today each of them
wrote
a question on a small card like this.
Those cards were collected
and
then given to me this afternoon.
My job, under the rules of the
evening,
was to decide the order the questions will be asked and to
call
on
the questioners accordingly.
I also have the option of asking
follow-ups
which -- in order to get to more of the panel's questions.
For
the record, I plan to do sparingly and mostly for
clarifications.
The
audience participants are bound by the following rule.
They shall
not
ask follow-up questions or otherwise participate in the
extended
discussion. And the questioner's microphone will be turned off after he
or
she completes asking the question.
Those are the rules.
As in
Winston-Salem
last week, no single answer or response from a candidate
can
exceed two minutes. There
is an audience here in the hall and they
have
promised to remain absolutely quiet, as did their predecessors
this
year
in Boston, Danville, and Winston-Salem.
Before we begin, a
correction
from last week's debate.
I was wrong when I said Vice
President
Gore's campaign commercials had called Governor Bush a
bumbler. That specific charge was made in a press statement by Gore
campaign
spokesman Mark Fabiani, not in a TV Guide.
GORE:
I'm
glad you clarified that.
MODERATOR:
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?
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.
MODERATOR:
Two
minutes response, Governor Bush.
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 --
MODERATOR:
Governor,
time is up, sir.
GORE:
Jim,
we have a direct disagreement on this.
MODERATOR:
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?
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.
MODERATOR:
Sir.
GORE:
And
I specifically would like to know whether Governor Bush will
support
the
Dingle-Norwood bill, which is the main one pending.
MODERATOR:
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.
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.
GORE:
What
about the Dingle-Norwood bill?
MODERATOR:
All
right. We're going to go now to another -- all right.
Yes.
BUSH:
I'm
not quite through. Let
me finish. 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.
MODERATOR:
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?
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.
MODERATOR:
Vice
President Gore, two minutes.
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.
MODERATOR:
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?
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.
MODERATOR:
Mr.
Vice president.
GORE:
Okay.
MODERATOR:
Time
is up. Governor Bush, two minutes.
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
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