Press Briefing by Press Secretary Robert Gibbs and Secretary of Health and Human Services Kathleen Sebelius

James S. Brady Press Briefing Room

10:58 A.M. EDT

MR. GIBBS: Good morning. Oh, Mr. McCormick, a special appearance. Wow.

We're doing this a little early today so you all can watch the President's events or travel, as you maybe needed to do.

Before we take our regularly scheduled questions, we'll hear from Secretary Sebelius, who will talk to you all about some demonstration projects and grants and a program that the President, as you know, during the recent joint session of Congress, asked her to look into regarding medical malpractice.

So I will turn it over to the Secretary.

SECRETARY SEBELIUS: Well, thank you. Good morning. On Tuesday of this week, we received the latest evidence that the health care system is simply unsustainable. The Kaiser Family Foundation came out with a new study showing that, for families, health insurance premiums rose from under $6,000 to over $13,000 in the last 10 years. And a second report from the Business Roundtable focused on companies which show that -- they estimate companies will pay over $28,000 in health care costs for each employee in the next 10 years.

So you heard from the President a week ago, who outlined a plan to move in a new direction, providing security and stability to Americans who have coverage, and affordable coverage to those who don't, and raise the quality for all Americans; slow the rising costs for families, businesses, and government.

But as part of that new direction, he directed me, as Secretary of Health and Human Services, to move forward on medical liability demonstration projects that put patient safety first and let doctors focus on practicing medicine.

Now, this is an area we know we can do better. As many as 98,000 Americans die every year from medical errors. And though malpractice premiums themselves count for only a small percentage of total medical costs, many doctors report that they practice costly defensive medicine because they are fearful of lawsuits.

So reflecting these concerns, the presidential memorandum that I received today directs my Department to make $25 million in grants available to states, localities, and health systems to try out new patient safety and medical liability models. Grants are going to be available for the development, implementation, and evaluation of models that do four things: put patient safety first and work to reduce preventable injuries; foster better communication between doctors and their patients; ensure that patients are compensated in a fair and timely manner for medical injuries, while reducing the incidence of frivolous lawsuits; and finally, reduce liability premiums.

Now, those goals are consistent with the principles identified by the joint commission and the Institute of Medicine, and the goals that were contained in the legislation that President Obama as a senator introduced in 2005 with then-Senator Hillary Clinton.

We're moving forward on the projects immediately, as the President requested. Within 30 days, we'll post an official funding opportunity announcement on grants.gov. After that, potential grantees will have 60 days to apply for two different kinds of grants -- one-year planning grants of up to $300,000 that will help states and localities and health systems develop and conceptualize new patient safety and medical liability models; and demonstration grants for up to three years and $3 million that will help implementation of projects that are ready to go.

We -- at the same time that the grant applications are being submitted, the Agency for Healthcare Research and Quality will be conducting a review of what is currently in place throughout the United States and what evidence there is that has been gathered about what works and doesn't work.

As required by law, every application will go through a rigorous review process at the Agency for Healthcare Research and Quality, which includes by law a peer review by independent scientific experts. At the end of the process, we'll announce the grant awards early in 2010.

So the demonstrations are about learning what works and what doesn't. Grantees will be required to report back to us with data on patient safety and medical liability costs. And as I mentioned earlier, this isn't a new area of interest for the President. He said from the start of the reform process that he's open to any idea that will help improve health care quality and patient safety and bring down overall costs.

The demonstrations made possible by the grants will help us learn what changes are needed in our health care and medical liability system to help accomplish the goals. And we're looking forward to collecting the data, sharing in and acting on part of our ongoing effort to assure that all Americans have access to the best-quality, most affordable health care possible.

Q: Secretary, if this is such a serious problem, as it says in the release, then why just a demonstration project? Why isn't this part of the comprehensive health care?

SECRETARY SEBELIUS: Well, I think the good news is that the President feels strongly enough about this that he wants us to move ahead right now. He's not using this as a lever in the health care debate, but he feels that we can move ahead. We've had this authority within the Agency for Health Research and Quality since 1999. Nobody, not the prior administration, not anybody, has ever directed that this agency move ahead, and the President thinks we should do it right now.

So we're going to move ahead the same way we moved ahead -- we announced yesterday -- we're moving ahead on a medical homes model, which is a great experiment taking place in various parts of the country, lowering costs and delivering high-quality care.

Q: But if the research is already there?

SECRETARY SEBELIUS: The research is not there.

Q: But it seems that the -- you have enough research to know this is a serious problem. Why -- why not work with Congress? It clearly could be beneficial to you guys politically. It's something Republicans want to be involved with. It just seems like -- how does somebody not interpret this as saying, well, you know what, trial lawyers are a huge interest group of the Democratic Party, so that's why they're going slowly? I mean --

MR. GIBBS: Let me step in for one second. I think you can recall from the presidential campaign, I don't recall us being the preferred candidate of the trial lawyers that you mentioned. Second, as the Secretary said --

Q: Yes you were. You got more money than any other candidate when it came to trial lawyers.

MR. GIBBS: I'd check your FEC figures on the primary.

Q: Check out opensecrets.org.

MR. GIBBS: Happy to do it. I think it came up in some interviews with your network.

The authority has existed since 1999. There are certainly provisions in some of the House bills that would codify some of the Sorry Works! ideas that the President introduced in the Senate. But the thing here, Chuck, is we could wait and wait and wait, or the President could, as he did, instruct the Secretary to act in setting these projects and programs up in order to get them going and moving to ensure patient quality and get doctors practicing medicine again, rather than waiting for a political football to get tossed around the aisles of Congress.

Q: Madam Secretary, how soon do you anticipate things actually changing in the real world, based on the grants, the work done, and the changes, as actual doctors and patients interact and the system begins to adapt to what these demonstration projects reveal?

SECRETARY SEBELIUS: Well, we're hoping that the incentives will encourage systems to come together and look at models that are already in place. We know -- you know, the kind of Sorry Works!, the system in the -- that was contemplated in the MEDiC bill is already in place -- the University of Michigan and children's hospitals throughout Kentucky that have demonstrated that they can reduce litigation costs, compensate patients in a much more timely fashion, improve communication. So there are some models in place that we hope we'll take a look at, and could be put in place very quickly.

Lots of states have bits and pieces of the puzzle. There are states with screening panels. There are states that have review processes. There's some voluntary mediation efforts. And we think this is an opportunity to not only look at what has had a proven effect lowering preventable errors; increasing patient safety, which is the number-one goal; improving communications; and lowering costs.

So we'll share that data. We're going to inform people around the country. There's never been a scientific look at what works and what doesn't. There's been a lot of anecdotal battles, really, for three decades. We think this is a big step forward.

Q: Madam Secretary, some states have passed malpractice reform, obviously. Has HHS looked at what's happened in those states and seen if any of them meet these four requirements?

SECRETARY SEBELIUS: That's what we're going to do. That's the review that's going to be underway. It's never happened before now.

Q: So when you say demonstration projects, you don't just mean -- I guess I misunderstand --

SECRETARY SEBELIUS: There are two areas where states or medical systems can apply for grants. One is a planning grant that will be up to a year, up to $300,000 to look at what may work in that jurisdiction or within that medical system and put something in place. The other is a demonstration project that could run for up to three years.

At the same time, the Agency for Health Research and Quality is going to be reviewing just exactly what is out there scientifically, what has some evidence that it's had an impact on patient safety, on lowering costs, and share that information as we go forward.

Q: Madam Secretary, $25 million is a pretty small amount at first. And I'm wondering if you've thought about how it would be expanded if these demonstration projects proved efficacious? And also, how this interacts with the legislation that's moving through Capitol Hill in the health care bill, bills, like the House one, that contains a similar program.

SECRETARY SEBELIUS: Well, I think the good news is that this can move forward within the next 60 days, and the grant applications can start coming in immediately. We'll have the framework up. So this is a faster process than legislation can be because that will take some time.

We haven't thought at this point about how to expand. We're hoping that this becomes an opportunity for -- as I say, medical systems in some jurisdictions have moved ahead. There are some states that have done work in this area. But others are strapped for cash, don't have the resources at this point, and don't really have a lot of incentive. And we hope this will jumpstart it. And we'll take a look at if this is effective and works and if the evidence shows that it helps with patient safety, lowers costs, and reduces costs and frivolous lawsuits, then I think there will be an appetite certainly on Congress and elsewhere to increase this.

Q: Related to that, I'm sorry, but on the legislation, I mean, does this counteract, does this work with --

SECRETARY SEBELIUS: Oh, I don't think it counteracts anything. I think it captures some of the legislative intent and jumpstarts it. But I think there's a lot of interest in Congress -- Republicans and Democrats -- to figure out a way to get at what, at least anecdotally, doctors say is a high cost of defensive medicine, to lower the -- we know that close to 100,000 people die from preventable errors every year.

Patient safety is something that I think Republicans and Democrats take very seriously. Certainly the President does. Improved communications, compensating victims who are injured at a more timely and more adequate fashion, I think are all part of the goals that we'll be looking at.

Q: Can I ask a question on demonstration projects? Well, you mentioned yourself that with legislation everything will take much longer. This is something administratively you can do much more quickly. But one area where the states are concerned and are trying to reach changes in the legislation is Medicaid. And if you expand Medicaid, they feel that they cannot afford themselves to share the cost. So what is the White House position, because they do oppose expanding it unless the federal government pays for all of that expansion?

SECRETARY SEBELIUS: Well, as a recently recovering governor, I certainly feel the pain of the states who are in really the worst fiscal crisis probably since the Great Depression, and are very sensitive to any unfunded mandates. I think what has happened is governors have had their voices heard. The House had a significant cost share for expanded, a 90/10 sharing. The Senate HELP Committee doesn't have jurisdiction over Medicaid, but when the Finance Committee came out with their proposal yesterday, again, it's a significant -- it's close to the 90/10 mark.

But there are additional Medicaid savings, immediate additional funding for Medicaid drug rebate and enhanced FMAP share for currently states who have picked up some of the childless adult population which would be included.

So, on balance -- we've actually put out a state-by-state analysis, and on balance, the vast majority of states, if the bills currently contemplated are passed, would actually come out as beneficiaries from the proposal.

So I think Congress has listened carefully to the states who say, we're eager to work with you on health reform, but what we can't do is absorb a huge share of new costs.

Q: Should regulators take a greater role in --

Q: Is it bad practice on the part of the doctors? Or what is the -- is malpractice the issue?

SECRETARY SEBELIUS: I think patient safety is the primary issue, to drive toward a system where we reduce -- the goal, the best goal would be to eliminate preventable medical errors. So better protocol, better safety, but certainly lowering costs of malpractice, lowering costs of defensive medicine, which causes potentially billions of dollars in redundant tests or unnecessary procedures; getting to a point where if an error occurs, there's just and rapid compensation and we move forward.

So I think there are multiple goals, as outlined by the proposals -- better communication, lowering medical errors, higher patient safety, reducing lawsuits --

Q: Will OSHA be involved in this?

SECRETARY SEBELIUS: OSHA? Not to my knowledge. There's really not a -- they don't really have a role in the malpractice system right now. It's really a framework of state and federal laws and then what occurs -- the board -- the certification of doctors often determines what the standard of practice is, so it's really not an OSHA situation.

Q: Should regulators take a greater role in investigating medical error and sanctioning doctors? Is that part of the solution? And does the pilot project look to that?

SECRETARY SEBELIUS: At this point, we are open to any demonstration projects, any planning grants that meet those four criteria. So we're not trying to prejudge what a state or health entity might come forward with. I think the regulatory role is often at the licensure end and sometimes a litigation then results in a complaint to the Board of Healing Arts or whoever has that oversight over licensure and can result in a subsequent investigation. But whether that becomes part of this opportunity at the state or local level I think remains to be seen.

Q: Is legislation still part of the mix, Robert, or Madam Secretary, as health care reform goes forward? Or do you see this move as something that takes the pressure off -- legislating on this issue in this particular bill now? At a previous briefing --

Q: (Sneezes.)

SECRETARY SEBELIUS: Bless you. (Laughter.) I mean, what is that about? (Laughter.)

MR. GIBBS: I want to point out -- I want to point out Margaret sneezed a few minutes ago, very correctly, in the sleeve. (Laughter.) I mean, it would be one thing if it was just --

Q: My Margaret at home is very good at it.

SECRETARY SEBELIUS: I don't know. Who's got some Purell? Give that to Mr. Todd right away, a little hand sanitizer.

Q: I point out my two-year-old did it the correct way this morning.

SECRETARY SEBELIUS: Good.

MR. GIBBS: I was going to say there's --

SECRETARY SEBELIUS: We'll have Elmo give Chuck a special briefing. (Laughter.) We'll get Elmo over. Elmo knows how to sneeze. (Laughter.)

MR. GIBBS: We will seek to try to bring Chuck up to the level of a four- or five- or six-year-old. (Laughter.)

SECRETARY SEBELIUS: Yes, sir.

Q: Allowing for that digression. (Laughter.) Back to the legislation. Does this -- is this something that helps it, or do you just want to keep this issue out of the legislation? Because others in the administration described tort reform, med-mal, as a potential impediment, causing more problems than it solves in the legislative debate over health care.

SECRETARY SEBELIUS: Well, I think that there's no question that the issue of tort reform has been a very contentious issue at the state level for a couple of decades, at the federal level for at least that long. I don't think this is an either/or. I see this as very complementary to some of the proposals on the table and certainly has been an interest of Republicans and Democrats to figure out the situation.

What we're able to do, because the authority has been within the Agency for Health Quality and Research, is move ahead. The legislative debate will continue. Whether or not there are various proposals in the final legislation that comes to the President's desk, I can't predict.

But what I can tell you is we can take this step now, and the President believes in this seriously enough that he directed me to do just that. He doesn't want to wait and see what may or may not happen. He introduced legislation in 2005. He coauthored a New England Journal of Medicine article in 2006. This is something that isn't new to him and isn't new in the health reform debate. He believes in it seriously, and he thinks we should go ahead and move with the authority that we've had for a decade.

Q: Just to follow up, is it a dual-track process then, doing this research, and the administration is also pushing for legislation this fall?

SECRETARY SEBELIUS: Well, as I say, I don't -- I don't have a way of telling you exactly what components of this discussion will be in the final legislation. What's in the House versions right now are very complementary to some systems that are already in place, to what the President proposed in 2005.

I think there are lots of creative ideas. I mean, states are the laboratories of innovation. There are lots of things going on at the state level within integrated health systems, within practices that I think have some real merit. What we need to do is apply some scientific rigor and see really what works.

We know what the problems are -- too many medical errors; high cost, particularly of some specialty areas of liability insurance; often lots of injured victims not being compensated at all. So the challenges are there. And I think this is a real opportunity to get some creative thinking and bring people together to figure out what works.

MR. GIBBS: Bill.

Q: So Madam Secretary, who is the real target here? Is it lawyers who are filing frivolous lawsuits, or doctors who are not practicing safe medicine?

SECRETARY SEBELIUS: All of the above. I think both.

Q: And could you kind of put it in perspective? We keep hearing about tort reform or malpractice. And the President focuses on the rapidly increasing cost of the medical system. So, like, what percentage would you say of the increase in premiums is due to malpractice? Is it 10 percent? Is it 50 percent? Is it --

SECRETARY SEBELIUS: Well, what we know, because it's a number that you can get your hands on, is about 1 percent of the overall cost of health care is attributable to malpractice premiums. That's a number that really hasn't changed very much over the years. What we don't know is how much defensive medicine could be eliminated with different kinds of systems. So doctors will tell you that they do order additional tests, look over their shoulder constantly for different procedures, fearing lawsuits. How much of that is not called for, I have no way of estimating. But we also have a fee-for-service system that rewards by contact and not quality.

So -- but I think we got too many medical errors, too many people being injured or dying every year. We have a system that often victims do not get compensated at all or it takes years to arrive at that. Any -- you know, we've got a situation where there are frivolous lawsuits being filed against practicing physicians that's discouraging some specialists from practicing in certain areas.

So there are some challenges out there that we think and the President certainly feels can be addressed by moving ahead. And to have the agency within the Department of Health and Human Services charged with quality of medical care and research moving ahead on this I think is an appropriate lens to look at what works. You know, some states have moved ahead 20 years ago, so there's a body of evidence. It really never has been examined or looked at, and that's part of what we're going to do.

Goyal, we'll take one more and then let the Secretary --

Q: Thank you, Robert. Madam Secretary, many doctors are saying that they might leave the practice, medical practice. What's wrong with them, and how can you keep them in practice? And are you worried about that?

SECRETARY SEBELIUS: Well, we certainly -- I hear that also, and particularly the providers who are paying the highest rates are often in specialized areas -- OBGYNs and neurosurgeons -- areas where they're a limited supply anyway and there are lots of folks who just say, I'm not going to do this anymore. I mean, the cost of practice is just too great.

So I think this is an effort to see if we can reduce cost, look at -- I think there are also, frankly, some insurance challenges, where liability is broken down into very small categories and charged -- you know, we talk about the big pools should be available to Americans to buy health insurance; it also should be available to medical providers. Right now, we segment -- we allow those practices to be segmented and identified and often pay four, five, six times, regardless of their individual experience.

So I think there's an opportunity to look at a whole series of reforms and let the states and local health systems figure out what works and inform Congress and the President about how we best deal with this situation.

Thank you.

Q: Thank you.

MR. GIBBS: Sir.

Q: All set?

MR. GIBBS: I am.

Q: Thanks. A few questions on missile defense, Robert. This new architecture that the President described, is there going to be any presence in the Czech Republic and Poland, or is now -- is that now just completely gone?

MR. GIBBS: No, no, no, let me -- I would point you to General Cartwright, who I think -- and the Department of Defense that -- they briefed, as you saw, right after Secretary Gates, which can give you some more technical dealings on this and a notion of the operational capabilities and where some of that's being looked at.

I think the biggest thing to step back and understand is that this is an improved ballistic missile defense system based on better technology, based on the latest intelligence assessments about threats posed, particularly by Iran, that enhances our homeland security, protects our troops based overseas, and provides for the defense of our European allies.

I think if you look at what Secretary Gates, particularly, and what General Cartwright -- General Cartwright, who has been tasked in both this administration and the previous administration at the Pentagon, in working technically with deployment of sensors and interceptors and what have you -- these are the two individuals that in '06 and at the beginning of '07 made a recommendation based on, again, the most current technology and the most current intelligence assessment. Based on changes in technology and in those assessments, that team recommended and the President accepted a decision for an improved missile defense system that we think does a better job.

Q: Still, understanding that rationale, it's still a pretty basic point to say where these land-based interceptors are going to be.

MR. GIBBS: Yes, and I would point you to the Department of Defense to answer that.

Q: What about this other issue of Russia's well-known opposition to the old plan? Can you clarify whether there was any quid pro quo? Did Russia get anything out of this deal?

MR. GIBBS: Absolutely not. No, this is not about Russia. This is about protecting our homeland. It's about protecting the troops that we have deployed overseas that protect our freedom. And it was about ensuring the defense of our allies, our European and NATO allies. That's why this decision was made. The review that the President talked about was to ensure effective -- both technologically and cost-effective. We did not want to deploy something that didn't work. I think we've gotten the best of all worlds in this, because we have a system that works better and protects us on a timeline that's quicker than we had before.

Q: So Russia's view on the old system was not a factor in any way?

MR. GIBBS: No, I think you saw the President directly address and make mention today of what he had said throughout the campaign, which was that Iran did pose -- did have a ballistic missile threat; that clearly, based on additional and more recent assessments, we believe that assessment intelligence-wise has changed from an intercontinental ballistic missile capability that's less advanced compared to a medium- and intermediate-range ballistic missile capability now. And I think you heard him say in the statement that Russian concerns about this were unfounded then, and would be today.

Q: Eastern European allies are clearly not happy about this development, the pulling back from the previous administration's missile defense plan. How do you show them the U.S. commitment to their defense? And what do you say to critics also who would think that this sends a message of weakened U.S. resolve to Iran at a time when the U.S. is trying to put the pressure on them?

MR. GIBBS: Well, let's address the second one first. I think -- in all honesty, I think they're based on some early and inaccurate and erroneous reporting on what was -- what the President had decided and ultimately announced, might have caused some to react in a way that isn't based on what the President, Secretary Gates, General Cartwright and others have come to the conclusion of.

This shows -- well, let me -- first and foremost, this does not absolve Iran from the responsibilities to the international community that it has to and must uphold, first and foremost. Secondly, again, this is based on the most up-to-date intelligence assessments about what their greatest capabilities are, where they have been making advancements in directly addressing the potential threat from that country.

So the notion that somehow we're doing anything other than improving on a plan I think is an unfounded criticism. Again, I don't doubt that part of that is because -- and I started getting e-mails, others at 1:00 in the morning, pretty early in the morning about I think a report that just simply was inaccurate.

The first part of your question, again, I think we have talked with our allies -- the Czech Republic, Poland, all of Europe and NATO. Obviously, we have extremely strong relationships that we think are strengthened and will continue. We have -- the President -- and we'll have some readouts on these calls in a little bit -- have talked to the leaders. Teams were dispatched to go meet with our allies. And I think, in all honesty, once they understand what is in this decision, they also will feel like we've come to a better decision based on improved technology that protects them too.

Q: Robert, can you talk about the threat from Iran? Vice President Biden said in an interview with our Pentagon correspondent Chris Lawrence that, "I'm much less concerned about Iranian potential. They have no potential at this point to launch a missile that can strike the United States of America." In light of the new information, the intelligence you say about long-range missiles as opposed to short- and moderate-range missiles, what is the threat from Iran? What are we conveying to the American people about the threat level that is coming from the regime?

MR. GIBBS: Well, look, I don't think anybody has sugarcoated the notion that we believe that their illicit nuclear program poses great security concerns for us and for many of our -- many in the international community. I think what Vice President Biden was talking about was exactly the renewed and updated intelligence assessment that led the very same people in 2006 to recommend one architecture and configuration to, based on that updated intelligence, recommend to the President something different in 2009, again, partly based on capability and technology.

Obviously, what worked in 2006 has been improved on for several years. And here we are in 2009. And as I said, it is our belief that the more significant threat posed right now is that of medium- and intermediate-range ballistic missiles. One important capability function of this new architecture is it lets us adapt as the intelligence changes, so that you are not having to deploy a second or a third configuration. This is an adaptable configuration that will allow us to address any changing nature of threats in the region.

Q: So what should be the takeaway when people hear about this new intelligence, and they say, okay, it's not long-range missiles, it's short-term, moderate-range missiles that Iran is capable of launching? And at the same --

MR. GIBBS: I don't want to get into operational capability. I'm simply denoting that the intelligence assessment of the likeliest threat that needed to be addressed by an architecture of ballistic missile defense is being met in this decision based on the most up-to-date intelligence assessments of the possibility.

Q: Right, but the President is going to go before the U.N. Security Council and say, you know, tougher economic sanctions if Iran doesn't comply, regarding its nuclear program. So what do the American people take away from this? Is Iran less threatening, less dangerous with this new intelligence, or more so?

MR. GIBBS: Well, I think the important thing for the American people and the international community to know is that we take any possible threat with the utmost seriousness; that the President spends a good portion of his day thinking about and ensuring the safety of our homeland, of the military that we have deployed around the world, and our allies; that this decision represents what he and the team, his national security team, believe best addresses those capabilities. We take very seriously, as the international community does, the threat posed by Iran's illicit nuclear weapons program.

This is something that will be discussed, as you mentioned, next week both at the U.N. General Assembly, when leaders convene, as well at the G20 in Pittsburgh, and ultimately in the P5-plus-1 talks that are scheduled to happen at the beginning of October.

We think Iran has some decisions to make about the pathway that they want to take and what they want to demonstrate to the international community about the responsibilities they're willing to uphold.

Q: Do you think the White House and the President consulted with Congress and allies sufficiently on this decision?

MR. GIBBS: I do. And I think additional briefings will happen on Capitol Hill today.

Q: What allies got a heads-up on this, besides Poland and the Czech Republic, ahead of time?

MR. GIBBS: To my knowledge, that's the only calls that have been made.

Q: Russia?

MR. GIBBS: Not that I know of.

Q: Robert, the Czech Prime Minister --

Q: Israel?

MR. GIBBS: I will check, and we'll read out whatever calls the President has made.

Q: The Czech Prime Minister said that he got a phone call.

MR. GIBBS: I feel like we're doing a geography thing. (Laughter.) Let me find out and we can -- I'm sorry.

Q: The Czech Prime Minister said he got a phone call from the President after midnight last night. Senator John McCain, who is the ranking Republican on Armed Services, says he doesn't know anything about this decision and he's just finding out about it through media reports. How is that adequate consultation?

MR. GIBBS: I will check with the legislative and national securities team to see the degree to which the decision was conveyed to members of Capitol Hill.

Q: Do you think that -- just could you understand why somebody would think that this was a hastily made announcement that --

MR. GIBBS: No, I can't, because it was the decision made several days ago by the President after a many months' review of our -- of missile defense architecture to address a threat we've known about for quite some time. This is -- we've talked in here about the notion that we were assessing the way forward.

Q: This seems -- to a lot of Americans, apparently including the ranking Republican on the Senate Armed Services Committee, this is the first time they've heard about this technology. You don't think that there would have been a --

MR. GIBBS: The first time they've heard of what technology?

Q: This new missile defense system, this new more mobile --

MR. GIBBS: I think it's -- I don't think that's -- I don't think that's --

Q: You think the American people --

MR. GIBBS: I don't think that's accurate because I think a lot of -- some of what we're talking about is deployed in and around -- in and around the world to address other threats.

Q: The idea -- I'm talking about the idea that there is this other option of a more mobile system that can be increasingly land- and sea-based as an alternative.

MR. GIBBS: I don't think it's new technology for the most part, but let me check, and we'll check with General Cartwright. Again, I think what's important to understand -- I keep going back to this --

Q: But a lot of us have been covering this since the election, since President Obama won, and the signals started being sent from Russia and you guys started communicating -- we went with you guys to Russia. And this idea that there's this alternative idea that would possibly be less offensive to the Russians -- though I understand you're saying that's not why you're doing it -- is new, is brand new.

MR. GIBBS: Well, I think there's -- I think there are a number of different ways that you look at addressing whatever the intelligence assesses is your most important threat. Obviously, we've talked about in here, the President wanted to ensure that whatever was deployed was both technologically effective and cost-effective. And I think one of the benefits of this is it improves on both of those things. We think there's a greater capability based on technology that has been improved upon and that we know has been tested and worked.

Q: But just to put a period on this, you believe that the administration has -- it will be yes or no --

MR. GIBBS: I did an ellipsis at the end of mine, but go ahead. (Laughter.)

Q: You believe that the administration and the President gave enough of a heads-up to Congress --

MR. GIBBS: I want to check with --

Q: -- allies, and enough preparation to the American people that this decision might be made, that this --

MR. GIBBS: Again, we've -- I assume that -- I don't know how much the American people watch our briefings, but it's been a question posed in here before about when the decision would come based on the President's review of our ballistic missile architecture.

Q: I'm not talking about the debate itself about missile defense. I'm talking about this new thing --

MR. GIBBS: No, no, no, we've talked about -- we've talked about the review in here. So I will certainly check with Legislative Affairs in terms of certain congressional notifications, but I don't think it's been a surprise to anybody, based on the fact that we've discussed it in here, that the review was ongoing.

Q: But you haven't discussed the specific plan that came out today. I mean, there weren't any --

MR. GIBBS: I know it seems weird that a group of people could go into a Situation Room, discuss a subject, make a decision, and then we'd simply announce it without three or four or five weeks of stories coming out about where we were going.

Q: I'm talking about people on Capitol Hill knowing that this is something that might be coming up -- people like John McCain.

MR. GIBBS: Again, I'll check with Legislative Affairs on that.

Q: Okay. How involved was the -- in this many-months' process, what was the White House role in that process? Was there an ongoing dialogue back and forth?

MR. GIBBS: Absolutely. Absolutely. I mean, obviously this involves the State Department, involves the Pentagon, involves the White House, and was based on a pledge that the President made during the campaign to evaluate our posture and our architecture.

Q: The way this is being described is that this was a unanimous decision coming from the Pentagon. Did the White House in any way make clear to the Pentagon that they would like to move away from Poland and Czech Republic?

MR. GIBBS: Again, this is a -- the people that made a recommendation to then-President Bush in 2006 -- Secretary Gates, General Cartwright -- are the same people involved in making a recommendation in 2009 to this President.

Q: But can you categorically deny that they were under any pressure from the White House to do so?

MR. GIBBS: Absolutely. I think the notion that somehow we would put pressure on -- and come up with something that didn't work as well -- first of all, I think that is notionally crazy, and I would of course categorically deny that what we're doing is anything but in the best interest of keeping this country, keeping the members of our armed forces, and keeping our allies safe.

Q: One more. What was the -- was the security of Israel a factor in moving to the new system?

MR. GIBBS: Let me check with NSC on that.

Q: I want to go the Iran assessment here that Vice President Biden made. Isn't this a big deal if the intelligence community is now assessing the Iranian threat as much less than what we've been told the past five or six years?

MR. GIBBS: No, no, no, no, no.

Q: I mean, that's what came out of this.

MR. GIBBS: I'm hesitant to do this here. I think the assessment that has led to the ultimate decision that we've made -- and I would point you to what Secretary Gates and what General Cartwright have said today -- what led us to this is the degree to which we think the capability is -- which is more advanced at what point? The conclusion of the intelligence assessments is that medium- and intermediate-range ballistic missiles are something that pose a greater threat at this point than intercontinental.

Q: Now, I guess going to that point, why would you only prepare to have something that meets the immediate threat that you feel like is there now? I mean, why wouldn't you want to have the maximum amount of protection?

MR. GIBBS: Well, again, that's what I talked to Suzanne about --

Q: I mean, you talked about flexibility to do this if you need to. Why not do the "if you need to" now? Couldn't it be a deterrent?

MR. GIBBS: No, no, no, no, no, no. That's what this system and capability allows you to do. It allows you to --

Q: I understand that. But why isn't that then -- why isn't that the announcement?

MR. GIBBS: No, no, no, no.

Q: We're going to -- we're going to maximize the use of this new system --

MR. GIBBS: I think the name of it -- the name of the -- the first word in the announcement is "adaptive," right?

Q: "Phased adaptive."

MR. GIBBS: Phased adaptive approach, right? I'm sorry, it's the second word. I could see how that would flummox you.

Q: Which in and of itself doesn't have a sense of --

MR. GIBBS: Adaptive, the ability to adapt to a changing circumstance based on an intelligence assessment that denoted a change in architecture in order to address that assessment.

Q: I guess what I don't understand is, why just wait for the -- I mean, isn't there an argument to be made, which some have made in pushing for this missile defense system in the past, don't just be adaptive, be fully prepared now to protect against long-range?

MR. GIBBS: Chuck, we're deploying a system that addresses the threat to our homeland, to our troops, and to our allies. That threat is being addressed by this system, okay? Again, I think part of the confusion of this is if you read early reports of this, one would believe that the entire system was being scrapped, right? Trust me, it complicated my life this morning in a way that I wish it hadn't. I can only imagine it complicated yours, as well.

Q: What story are you talking about?

MR. GIBBS: The front page of The Wall Street Journal, just to be clear.

Q: Just pick -- single out somebody. (Laughter.)

Q: Well, I asked. It's my fault.

MR. GIBBS: No, no, no, no. Jonathan didn't write the story. But the program that is announced addresses -- addresses the threat. The emphasis is on what we believe is the greatest threat right now that this -- the benefit of this is it allows us to continue that configuration and adapt to any changing intelligence assessment.

Q: So to completely eliminate this premise that somehow this doesn't prove -- this takes off a pointed issue that we -- that the United States had with the Russians, do you just dismiss the premise that it doesn't help there?

MR. GIBBS: The decision -- I'm not an international relations theorist. The decision --

Q: But if it's helpful, is that a good thing?

MR. GIBBS: Well, I think --

Q: As far as the United States is concerned?

MR. GIBBS: -- first and foremost, the decision that was made was based on what we faced and what technology we had to address what we faced. How do we protect this country, first and foremost? How do we protect those that are deployed to protect our country? And how do we protect our allies? That's the lens, the only lens through which this decision was made. That's it.

Q: Couldn't somebody make the case that improved relations with Russia helps deal with the Iranian issue, and that that --

MR. GIBBS: Well, I think the Iranians --

Q: -- that helps in your negotiations with Iran, and therefore is part of this decision?

MR. GIBBS: I think the Russians are going to get a chance to decide how constructive they want to be on Iran in the next few weeks.

Q: And this takes the issue off the table?

MR. GIBBS: The decision that was made was made purely and simply on what works, on what addresses the threat, on what protects our homeland, and what protects those that are deployed to protect our homeland.

Q: Really quickly on health care, there's a group of House Republicans, a Republican study committee, sent a letter asking for a meeting with the White House -- three or four Republicans. You guys have -- the President has said he is open to meet with other folks. Is he going to accept that meeting?

MR. GIBBS: I'll take a look at that letter. As you know, Senator Bennett from Utah was here yesterday to talk to the President about health care and I assume there will be other Republicans as this debate continues.

Jonathan.

Q: On next week, the President kind of raised the bar pretty high for September in L'Aquila. He said that on Iran the diplomatic door would be closing by this month if there weren't constructive signs out of Tehran. On trade, he said that there would be tangible signs toward reopening the Doha Round next year that we would possibly see in Pittsburgh. And on climate change, we were supposed to get a package of climate change finance. He's coming in now -- the Chinese and the Russians are saying they're not going to go along with sanctions against the energy industry in Iran.

MR. GIBBS: Who?

Q: The Chinese and the Russians.

MR. GIBBS: Well, again, to address that, I think particularly the Russians are going to get a chance to decide how constructive they want to be.

Q: Okay. And on trade, the last thing we've had was the tire tariffs. And on climate, the climate bill has been punted to next month -- I mean, next year. I'm wondering if the President -- do you feel like the President is walking into the U.N. General Assembly meeting next week and to Pittsburgh in a weakened state? How can he grab back the moral high ground on trade, on climate, and on Iran in this climate?

MR. GIBBS: Well, I think in some ways you won't find it surprising that I dispute your assessment of where we sit. I think we talked about this just yesterday, Jonathan. Climate change is not simply something that is for us to decide alone. We are going to have to take steps domestically, certainly, and the House has taken a step to pass legislation to address it, and the President will continue to work with the Senate to make sure that happens, as well.

This is something that's going to have to happen in conjunction with developed and developing nations and economies throughout the world. This is -- you know, I don't think the President thought we were going to come to Pittsburgh with everything wrapped up on the issue of climate change.

On the issue of Chinese tires, in order to have a system of free and fair trade in this country, you're going to have to have a set of rules. We simply enforced a set of rules that had been agreed to in advance. I don't think that loses the high ground on ensuring that our goods and services are bought and sold overseas as we import some goods and services, as well.

And I think this is -- there's no question this is an important several weeks for Iran. I think we -- I think -- as you know, the President will chair a U.N. Security Council meeting on proliferation. There will be assessments made at U.N. and at G20 about the Iranian willingness to live up to their international obligations, and as I mentioned earlier, a meeting on October the 1st where our full intention and that of the P5-plus-1 is to address Iran directly on that illicit nuclear program.

So I hesitate to -- it's early -- I hesitate to call the end of all this.

Q: Have you said which day the President is delivering this address to the U.N. General Assembly?

MR. GIBBS: I think it's Wednesday. It's the 23rd, I think -- I'm not sure.

Jonathan.

Q: Robert, some of us are going to --

Q: The President is speaking right now.

MR. GIBBS: Okay. If you guys want to -- I'll take a few more questions if you guys want to -- go ahead.

Q: Thank you, Robert. The President is going to honor his first Medal of Honor recipient this afternoon. He's going to meet with the family. What else does he do maybe behind the scenes to honor those who are killed in Iraq and Afghanistan? Does he make phone calls? Does he send letters? What else does he do?

MR. GIBBS: I've heard the President -- I think he's talked about this in public before -- I think the hardest thing -- the hardest job he has is signing the letters to those loved ones and family members whose sons or daughters or husbands or wives have been killed in defense of our freedom and of our country. I think it is probably the hardest part of what he does. And I think as he makes decisions about our defense, he keeps those thoughts and those family members in mind.

Q: Is there anything tangible that he does, though, on a regular basis?

MR. GIBBS: Those letters that go to family members that he signs, I think he would tell you, unfortunately all too often.

Q: I have two questions.

MR. GIBBS: Okay. Yes, ma'am.

Q: Exactly what is Iran's threat to our country? It's never threatened any country since the 16th century. What is it exactly? And also --

MR. GIBBS: Well, I think if you look at --

Q: -- is the President very happy that there's no government plan in the Baucus plan? He didn't fight for it.

MR. GIBBS: Well, let's take those two somewhat separate subjects. I think I could refer you to any number of --

Q: Threats that come up.

MR. GIBBS: Well, I can refer you to any number of threats that leaders in Iran have made against stalwart allies of ours, including Israel.

Q: Even then they haven't said they'd attack them; they don't like them, period.

MR. GIBBS: Well, Helen, we would take -- we take the threat of one international leader telling a country that they should be wiped off the map and the face of this Earth quite seriously, particularly when -- particularly when inspectors are removed from their country in order to --

Q: There are no inspectors in Israel.

MR. GIBBS: -- in order to assess --

Q: Or India or Pakistan.

MR. GIBBS: -- illicit nuclear weapons program.

Q: Why haven't you forced them to --

MR. GIBBS: Let me answer just one of your now burgeoning number of questions on this Thursday.

Q: I want to tell you that the buildup for the invasion of Iraq was in the same way -- if we're going to go after Iran.

MR. GIBBS: Going after Iran?

Q: What is the threat from Iran to us?

MR. GIBBS: Well, we've talked a little bit about that threat here today, and I think the threats that they have made capture the attention of the world. I think there's absolutely no doubt about that. Again, the Iranians are going to have decisions to make this month and the beginning of next month about the degree to which they're going to live up their international responsibilities.

Q: What about the other countries?

MR. GIBBS: Which ones?

Q: Iran -- Pakistan, India, Israel.

MR. GIBBS: I would have to check with NSC on IAEA stuff on that.

In terms of the public option, Helen, I think the President was exceedingly clear last Wednesday in speaking to -- in speaking to Congress and the American people. He prefers and believes that choice and competition through a public option is the best way to go. At the same time, if others have ideas that inject choice and competition in a private insurance and individual and small group market, he's willing to listen to those. I think there will be a debate --

Q: He wasn't just willing to listen to those who are for the public option.

MR. GIBBS: That's not true, Helen. You should --

Q: They had no place at the table.

MR. GIBBS: Helen, there's a pretty clear passage in the speech -- I'm not sure who was at the table when it got added -- but it's fairly declarative and clear.

Major.

Q: Robert, on the intelligence that has been formulated about the Iranian threat, will you be sharing that as specifically as possible with Congress?

MR. GIBBS: Let me check with -- I don't want to get way out on a limb on NSC stuff on this.

Q: And generally, you'd have no objection with sharing that --

MR. GIBBS: Well, I think some of this is based on NIE assessments, some of which I believe are --

Q: Some of them would be classified --

MR. GIBBS: -- regularly shared with --

Q: Shared. The reason I ask is because on February 2nd -- I don't want to get too deep in the weeds, but Iran launched a satellite that had long-range ballistic missile technology equivalence as a part of that launch. On May 20th, it test-fired a 1,200-mile solid fuel two-stage rocket. Some analysts have said those two tests which have been established and verified are consistent with a potential long-range nuclear missile threat -- potentially. And I'm just wondering if those things or anything -- or those facts are inconsistent with or can somehow be put in a different context by the intelligence that you have that says the real and more immediate threat is short-range and medium-range ballistic missiles?

MR. GIBBS: No, I think, in fact -- again, what I've discussed is medium- and intermediate-range, rather than intercontinental. I think some of what you just talked about -- and a 1,200-mile rocket falls in more of an immediate or intermediate-range ballistic missile capability. And look, there's no doubt that -- I don't want to get too deep in the woods, either, but obviously there is something that is solid -- a solid rocket is obviously a different capability than something that is less mobile and liquid.

So I think the system that is being deployed through this announcement allows us to address a number of those threats ongoing.

Q: And I don't want to put words in your mouth, but obviously you object to the idea of shelving the system in the headline in The Wall Street Journal. Are you trying to let us know or convey to the American public that this is in fact a tougher or more robust or more aggressive posture and system than what was on the books?

MR. GIBBS: I think it is more improved. I think we know the technology works. It's been tested. I think it covers a greater share of the area. I think it's based on the most up to date technology and our threat. I think that's been the focus of what the President's review was about. And I think the decision led from that review. I think we will do this on a timeline that allows the system to be in place and address that threat very quickly.

Q: Is Russia the threat, or Iran?

MR. GIBBS: The threat of intermediate and medium-range ballistic missiles comes from Iran.

Q: The idea of protecting against short- and mid-range missiles would seem to indicate that you'd want to move the defense systems closer physically to Iran. First of all, is that a correct assumption?

MR. GIBBS: You know, I am technologically out of my depth to talk about the geographic deployment of capabilities. General Cartwright has four stars on his shoulder and is the person tasked in the Pentagon with that technological assessment and I would point you to DOD.

Q: Okay. I think we can make this -- operate on the assumption maybe it's wrong.

MR. GIBBS: The Cartwright thing or just -- (laughter.)

Q: The assumption that you have to physically locate defense systems closer to Iran to protect against short- and mid-range. That seems to jive with Secretary Clinton's statement a month or two ago, whatever, about creating a nuclear umbrella against Iran -- which some viewed as a concession that they're going to obtain nuclear weapons. Is that in any way a plausible line of reasoning to follow?

MR. GIBBS: No. Obviously the posture that we're going to take in the next few weeks in directly engaging the Iranians through the P5-plus-1 process in addressing their illicit nuclear weapons program by no means -- and quite contrary -- does not assume on any part what Iran may or may not have.

Q: Robert, will the President meet bilaterally with the Russians and/or the Chinese?

MR. GIBBS: I don't know that the final schedule has been set yet. Those are two of the meetings that had previously been talked about, but I hesitate to get ahead of scheduling on that.

Q: So do you expect that there will be either officially, as part of U.N. proceedings or informally, some kind of progress or decision announced on sanctions on Iran?

MR. GIBBS: I believe the process of evaluating where we are, as the President talked about with other world leaders, in taking stock, I think that process -- I know he's begun -- continued to have discussions with leaders about that. And I think that process will be ongoing.

Q: Accepting that there was no quid pro quo, the action that's taken -- for whatever reason -- does involve, you know, removing a card from U.S.-Russian relations that can be played. Given that, do you expect any change in Russian behavior or attitudes on various big issues? And is there any concern that the decision will be portrayed by some Russian leaders as not necessarily a victory for dialogue and negotiation, but vindication of a strong nationalistic foreign policy?

MR. GIBBS: Again, I can't tell how other people interpret other things. I can simply tell you that the President and the team that made the original recommendation in 2006 and a different recommendation in 2009, based on assessments and based on technology, did so based on that and that alone. I can't think or surmise other things.

Q: Robert, can you update us on relocation plans on Guantanamo Bay detainees? Is Ft. Leavenworth out of the running as to -- as Kansas senators suggested yesterday? And what is the White House reaction to the defense appropriations language that would essentially prevent the President from shutting down Guantanamo Bay by not appropriating any money to do so and to build or upgrade the facility without them?

MR. GIBBS: Let me get some guidance on that and we'll get back to you in just a little bit on both those questions.

April.

Q: Robert, thanks for staying. Now on the question -- I'm going to go back to --

MR. GIBBS: You just had to get your little dig in there, didn't you? (Laughter.)

Q: No, it wasn't a dig. It wasn't a dig -- I'm thanking you for staying.

Q: It was sincere.

Q: I'm sincere.

MR. GIBBS: I'm leaving. (Laughter.) Go ahead, I'm sorry.

Q: You know, people can't be real in this place. (Laughter.)

On a whole other subject. The Jimmy Carter issue, Joe Wilson issue -- how does this White House come up with the formula to discount the fact that race was involved in this at all?

MR. GIBBS: Well, I was asked yesterday if we agreed with President Carter's assessment -- and I'm paraphrasing here -- that a majority of or a great -- I don't know what the exact quote was -- but that this was based on race. The assessment is based on discussing with people here and with the President and sharing with you that the belief is not that this is based on the color of one's skin but on honest political disagreements that have been going on for -- well, since the beginning of our country.

I think some people quoted what Secretary Powell said to some people yesterday, and I think it's something the President agrees with, is that we can have this type of disagreement, but we can do this in a way that's civil in tone and in action. I think that is what we've seen as a hallmark of even passionate political debates in this country for quite some time.

Q: But do you think that there might be an odd scenario now -- just in recent weeks you had former First Lady Laura Bush come out on television, on CNN recently, talking about the fact that people need to be respectful of this President. Do you see that there's an uptick since this President has come into office of the disrespect on certain issues -- they're not race, but on certain issues.

MR. GIBBS: Well, look, I think the way that a lot of political discourse gets covered in this country is covered at the edges. It's covered by the loudest and shrillest on either end of the political spectrum. That's what tends to get covered -- on both sides.

I think what the President believes is we can have these types of very passionate debates, but do so in a way that is civil and respectful of all of those that are participating in these debates, acknowledging a difference in opinion even if that's not the opinion with which you come to that debate with. I hope that's the way that we can deal with these problems, because the President -- and I think many people involved in seeking solutions for our country believe that we have a series of very big challenges, some of which have festered for a very long time, that have to be addressed. And that if all of our time and our energy is taken up in the exercise of yelling at each other, there's very little time left over for coming to a sensible agreement on how to move forward in addressing those problems.

Q: What do you say to people who are saying the reason why you're discounting it is because this administration does not want to amplify race because it would cause a whole host of other issues down the road?

MR. GIBBS: I rejected that yesterday, I rejected that Sunday. My opinion on that hasn't changed. You and I have talked about this; I just don't think that's true.

Q: Robert, the phone calls that the President has made in response to the missile shield -- the late-night phone calls and all of that -- what's been the role --

MR. GIBBS: Well, let me -- can I point out this? That what's late night in the Czech Republic tends not to be late night here, since I think it's about 6:00 p.m. there now and it's lunchtime here. So when we're talking about "midnight" phone calls in the Czech Republic, understand that there is, best I can last determine, a time difference.

Q: I'm aware of that, but thank you for the reminder. But the question is what has been the role --

MR. GIBBS: If you have to call your friend in the Czech Republic I'd do so, you know -- (laughter.)

Q: What has been the role of Secretary Clinton in the middle of this process? Has she been making phone calls? What has she been up to?

MR. GIBBS: I believe she has made phone calls on this. I will get -- again, I'll try to get a larger readout on exactly the scope and the nature of each one of these phone calls.

Q: As a follow-up, Senator McCain was not informed about this. He said this morning that this decision, I think he said was "seriously misguided." You laid out your case for this. What do you know that Senator McCain apparently does not, given the quote that he issued?

MR. GIBBS: I guess I would ask Senator McCain when Secretary Gates and others go to brief the Hill today to ask Secretary Gates and General Cartwright what leads them to believe the recommendation that they asked the President to make and that the President signed off on. I don't think that two people that were tasked with coming up with a recommendation for a previous President would not be giving this President their clear -- crystal clear and unvarnished opinion. I've been in meetings with both. I have not noticed a penchant for sugarcoating. I think they're very clear and very direct, and I think they will be today.

Suzanne, do you have one?

Q: Yes, on Afghanistan. Our Pentagon team has learned that General McChrystal made a decision in terms of the resources, the U.S. troops, that would be necessary in Afghanistan, but that he hasn't communicated that to the White House. Do you know if, for any reason, that he's been asked not to yet give that information to the White House at this point?

MR. GIBBS: No, I don't think that -- best to my knowledge, that's not been also communicated to the Pentagon, and this would go up through the normal chain of command. I'd reiterate exactly what I said yesterday and what, quite frankly, the President said far more eloquently than I: We are going to take a broad assessment and review of where our policy stands in Afghanistan, and that we are going to assess and get that strategy right and use that strategy to make those resource decisions.

We have all seen -- both in the somewhat short term and in the longer term -- what happens when one makes resource decisions and then looks for a strategy. I think there's some -- we've seen that movie before. The President is determined not to repeat that movie again.

Thanks, guys.

END 12:08 P.M. EDT