    [Public Papers of the Presidents of the United States: William J. Clinton (1993, Book II)]
    [October 8, 1993]
    [Pages 1716-1720]
    [From the U.S. Government Publishing Office www.gpo.gov]

    Remarks at Robert Wood Johnson Hospital in New Brunswick, New Jersey
    October 8, 1993

        Thank you very much, ladies and gentlemen, Governor and Mrs. Florio,
    Congressman Menendez, Congressman Klein, Mayor Cahill. To the
    distinguished participants in this program, Mr. Holzberg, Dr. Hammond,
    Sheriff Fontura. I hope he doesn't decide to run for President anytime
    soon. He gave a fine talk, I thought.
        Mrs. Jones, thank you for coming here and sharing your story with
    us, and I thank your son sitting over here, and two other fine young men
    who were the victims of violence, for helping to describe their
    condition to Governor and Mrs. Florio and to me today and what happened
    to them.
        I am delighted to be back here not only in New Jersey but in New
    Brunswick. I started one of my other crusades here not very long ago,
    the crusade to pass a national service bill that would give tens of
    thousands of our young people a chance to earn credit against their
    college educations by working in their communities. A few days ago, we
    signed that bill into law, and I think it will change the face of
    America.
        That is one of the many changes that I hope we can make as we move
    toward the 21st century. But I believe very strongly that in order for
    us all to have the courage to make those changes, we need a higher level
    of personal security in this country. And I wanted to come back here to
    this magnificent health facility to talk today for a moment about the
    relationship between health care and the need for health security and
    violence and the need for personal security.
        As you've already heard, these two things are very closely related.
    I'm honored to be here with my good friend and former colleague,
    Governor Jim Florio. You know, I was elated when Jim was awarded the
    John F. Kennedy Profiles in Courage Award earlier this year, because I
    think he really earned it. My guess is, he earned it by making even some
    of you in this audience mad from time to time. But I know what it's like
    to be a Governor and to have to work on a balanced budget, and I know
    what kind of trouble New Jersey was in, and you now have the best credit
    rating in the Northeast. I know, too, how hard it is to stand up and

    [[Page 1717]]

    fight for things like an end to assault weapons, and what a long
    struggle it is; just passing the law is only the beginning before the
    final impact is felt, perhaps a year, perhaps 5 years down the road.
        But we need more people in our country who will call them like they
    see them, who will try to identify the problems and try to get up every
    day and try to do something about it. And I'm just proud to be
    associated with Jim Florio, and I appreciate what the sheriff said about
    him.
        Today I saw a lot of things that I have seen before over the last
    3\1/2\ years since I started looking into the health care system and
    long before I even dreamed of running for President. I saw at this great
    American health institution, the very best of American health care, as
    well as what is wrong with America's health care. And indeed, if we want
    to finally, at long last, join the ranks of every other advanced country
    in the world and provide health care security to our people, health care
    that's always there and that can never be taken away, we have to work
    vigilantly to keep what is right with our health care system as we work
    to change what is wrong.
        What is right is obvious about this place. I saw the care that the
    nurses and the doctors were giving. I saw the concern that this hospital
    administrator had for the way each part of this hospital worked as I
    worked my way through it. And I saw the way a lot of these patients,
    many of them very young, responded to their caregivers. I saw the
    gratitude in the parents' and the family members' eyes. That is the
    core, the kernel, the heart, the spirit of our health care system. And
    we can't do anything to interfere with that. Indeed, we have to be
    committed to enhancing that.
        But I also heard three different stories about people who showed up
    here without health care coverage or with an insurance policy that
    wouldn't pay or with two different groups arguing about who owed and
    about long delays before the hospital got paid, and massive, massive
    expenditures of time and money filling out first one form and then
    another, and then hassling people to try to get them to pay the bill.
    And that is what is wrong with this health care system.
        We are the only country in the world with an advanced economy that
    can't figure out how to cover all of our people. So what happens? They
    get health care all right, and then the rest of you pay the bill or the
    hospital goes broke. And so many of our people get health care when it's
    too late and too expensive because they have no coverage; so they don't
    get the primary and preventive services that keep people well.
        And of course, as I already said, the administrative costs are
    absolute nightmares. I was in the Washington Children's Hospital the
    other day and was told that every year they spend in that one hospital
    alone $2 million filling out forms that have nothing to do with keeping
    patient records for health care purposes, that the doctor spends so much
    time, the 200 doctors on staff there, on paperwork that has nothing to
    do with patient health care and keeping records of it, that they could
    see another 10,000 children a year collectively, just 200 doctors if
    they didn't have to do it.
        So the question for us is, how do we change what's wrong, keep
    what's right, and how can we deal with the burden of our health care
    system? We now spend over 14 percent of our income in America on health
    care. Canada spends 10. No other nation in the world spends over 9. Even
    Germany and Japan, two very wealthy advanced nations, spend less than 9
    percent of their income on health care, and their health outcomes are
    roughly similar, if not better, than ours.
        Now, how did this come to be, and how can we change it? We don't
    want to do anything to undermine the quality of health care. If you
    cover everybody, if you give them primary and preventive health care
    services, if you do as our plan and you increase investment in medical
    research, you can improve quality. You certainly don't erode it. We
    don't want to destroy people's right to choose their health care system.
    Under our plan, each employee in each workplace would get at least three
    choices. Today, only one-third of workers who are insured in the
    workplace have more than one choice. Contrary to some of the complaints
    about it, our plan will increase consumer choice, not decrease it.
        We do have to simplify the system. I said that before. And we do
    have to achieve savings in some areas where they can be achieved.
    Plainly, if you reorganize the system, you won't have as much fraud and
    abuse, and you'll have dramatic savings in paperwork. Your administrator
    was telling me that this hospital has 25 percent administrative costs.
    The average hospital has hired four clerical workers for every

    [[Page 1718]]

    direct health caregiver in the last 10 years. The average doctor 10
    years ago was taking home 75 percent of all the money that came into a
    private clinic. Today, that figure is down to 52 percent, 23 cents gone
    to a system of 1,500 separate insurance companies, thousands of
    different policies, thousands of different forms, and Government
    paperwork and bureaucracy on top of that.
        And finally, we have to ask people to assume some more
    responsibility. Two-thirds of our plan will be paid for by asking
    employers and employees who don't pay anything into the system now to do
    their part, while giving discounts to very small businesses with lower
    wage workers to avoid breaking them. We have to ask people who can
    afford to pay, to pay, because the rest of you are paying for them. And
    then when they get really sick, they get their health care, and you
    still pay for them. So we need some more responsibility.
        Now, if you did all this and you look again at this American health
    care system, even if you just forget for a moment about the human
    element--and it's very hard to do with all these wonderful young people
    here--and you see us way up here at 14.5 percent a year of our income,
    everybody else at about 9. And we're losing 100,000 people a month,
    permanently, who are no longer covered with health insurance and 2
    million people a month lose their health insurance, but the rest of them
    somehow get it back. But the system is hemorrhaging.
        What can we do nothing about, and what do we want to do nothing
    about? We wouldn't want do to anything about the fact, I don't think,
    that we invest more in medical research and technological advances than
    other countries. We should be proud of that. It contributes to our
    economy. The fact that we have the strongest, in this State,
    pharmaceutical companies in the world, and they do a lot of research to
    find new drugs, we shouldn't begrudge that. Indeed, in our plan I'd like
    to make more use of pharmaceutical treatment where appropriate by giving
    people on Medicare and people with health insurance policies some
    coverage for drugs so that they can manage their health care better, I
    think many times at lower cost.
        Then you look at the things we plainly want to do something about,
    the bureaucracy, the unnecessary procedures, the fact that the system is
    rigged for defensive medicine, a lot of problems with it. Then you ask
    yourself about, what's the rest of the difference? The rest of the
    difference is, this country has more teen pregnancy, low-birthweight
    births, AIDS rates, and other kinds of serious, highly costly illnesses
    and much more violence. There is nothing I can do in a health care bill
    that will do away with that. We have simply got to be willing to change
    our behavior or admit that we are going to tolerate living in a country
    where homicide is the second leading cause of death among Americans
    between the ages of 15 and 25 and the leading cause of death among
    teenage boys today.
        We just have to say, ``Well, we've just decided we're going to
    continue to live in the only country where police routinely find
    themselves outgunned by out-of-control teenagers.'' We'll just have to
    say, ``We have decided that we're not going to make our streets, our
    parks, or even our schools safe again.'' You heard the story of this
    fine family over here that Governor Florio cited.
        I was in California this week on a town meeting. We were
    interconnected with four big cities in California. This fine, young
    Korean-American businessman stood up and talked about how his brother
    was shot dead by somebody that wasn't even mad at him in one of these
    arbitrary shootings. And then a young African-American boy, a junior
    high school student, stood up and told me how he and his brother did not
    want to be in a gang, did not want to have weapons, just wanted to be
    good students. And they were so concerned about the lack of safety in
    their school that they changed schools. So they went to the newer, safer
    school. And on the first day of school, they were lined up registering
    for school, and this young man's brother, standing right in front of
    him, was shot down because he got caught in the crossfire in a gunfight
    in the middle of the safer school.
        Now, there are a lot of people who say things like, ``Well, people
    do these things. Guns don't.'' I'll tell you what, I'll make them a bet.
    You give me the guns, and I'll see if the people can get it done.
        This is a huge economic problem, all right. You've already heard
    this. Most of the people who are victims of the $4 billion of gun
    violence every year in this country, 80 to 85 percent of them have no
    health insurance. So you pay for them. The system pays for them. It's
    part of the escalating cost of health care. It's part of why we can't
    close the gap between where we are and where other countries are. But
    the

    [[Page 1719]]

    human tragedy is the most important thing.
        Why should this young man have to worry about how well he's going to
    walk for the rest of his life? And let me just say this: I come from a
    State where over half the people have a hunting or fishing license or
    both. There are towns in my State where you have to shut the schools and
    the factories down on the opening day of deer season, because nobody's
    going to show up anyway. I was in the woods with a .22 when I was a kid.
    I love the outdoors. This has got nothing to do with people having the
    right to train, to learn how to use, to care for a sporting weapon and
    to do it under controlled circumstances. It's got nothing to do with
    this. But I also live in a State now where kids get shot in their
    schools with weapons that were designed solely for the purpose of
    killing people.
        And Dr. Hammond told me when we were making this tour something I
    didn't know. He said that just in the last few years, when people go to
    sites where people were shot with guns, they are three times more likely
    to see the gunshot end in a fatality because of the use of semiautomatic
    and automatic weapons and multiple bullets in a body, just in the last
    few years.
        And so, I tell you, my fellow Americans, we have a decision to make.
    And this is the time to make it. We can't keep saying that we deplore
    these things and it's terrible and keep extolling our American values on
    how much more law-abiding we are than other people and put up with this.
    We either need to say this is a level of chaos and human degradation and
    waste of human potential and incredible cost in society that we are
    willing to tolerate because we cannot bear to do something about it, or
    we need to get up, stand up, and be counted and do something about it.
        We have to make a decision, and it's time to make it. And it
    directly bears on the ability of your Nation to develop a health care
    system that fixes what's wrong, keeps what's right, provides security,
    and doesn't break the bank. It is directly related.
        We have a crime bill--Governor Florio mentioned it--before the
    Congress. It does a lot of things, but most importantly, here's what it
    does. It requires the Brady bill, which is a national 5-day waiting
    period, to establish background checks to check for age, criminal
    history, and mental health history. It matters. You must do it
    nationally. Why? Just near here in New York City, of the many thousands
    of weapons confiscated last year by the police, 85 percent of them came
    from other States. If you don't have a national system, you will never
    fix this. It is a huge deal.
        The second thing the crime bill does is to provide for the 50
    percent of the downpayment of the commitment I made when I was running
    for President, that I wanted to ask the Congress to give the American
    people another 100,000 police officers in the next 4 years, not just to
    catch criminals but to deter crime. And lest you think it doesn't work,
    I can cite you many examples: places in New Jersey which have more
    police officers, where the crime rate has gone down; in New York City
    where the crime rate has gone down in all the seven major FBI categories
    where community policing has been deployed; in the city of Houston which
    had a 17 percent drop in crime in 1 year, because when people are there
    in force, it prevents crimes from occurring in the first place. So
    that's an important part of this.
        Another part of the crime bill gives States funds to establish
    innovative programs for kids when they get in trouble before they do
    shoot somebody, to try to get them back into the mainstream of life.
    After all, a lot of these young people who get in terrible trouble are
    not really bad people. They have no structure, no order. They cannot
    imagine the future. There are no rules that bind them in internally to
    the things the rest of us take for granted. And we've got to try to get
    as many of them back as we can before they do something terrible which
    will require us to put them away for a long time.
        We do have to deal with these things. And we need to pass a crime
    bill this year. These Members of Congress can do it. There are still
    people who are holding them back, and you need to urge them on. And I'll
    guarantee you, I'll sign it as quick as they'll put it on my desk. We
    have to do it.
        But the second thing I want to say to you is that we need a national
    law to do what New Jersey has done here with the assault weapons. Again
    because we have a constitutional right to travel in this country. New
    Jersey can make a big dent in New Jersey's problems by abandoning these
    weapons here and then by setting up a system to try to collect them, but
    people are still crossing the State line all the time.
        We need national legislation. There are several bills in the
    Congress and arguments about which one is better than which other one,
    but

    [[Page 1720]]

    I will guarantee you they are all better than nothing. And the Congress
    should pass one of those bills and send it to me this year. It would be
    a great Christmas present to the American people to stand up for safety.
        Finally, let me just say that each of us in our own way are going to
    ask ourselves what we can do to deal with this. We have a culture of
    violence. We glorify it. I was delighted to see some of the television
    networks voluntarily say that they were going to do their best to try to
    monitor the content of violence and reduce it and degradation of people
    during prime time television.
        We have got to take a whole generation of young people who have very
    short attention spans for whom the future has no claim because they
    cannot even imagine the future, and slowly, carefully, and one-on-one,
    neighborhood by neighborhood, community by community, help them to
    rebuild the kind of inner strength and sense of values and discipline
    and control and hope that will permit us to go where we need to go. No
    law will do that, but that is not an excuse not to pass these laws.
        So I ask you today, here in this great place, let us recommit
    ourselves to keeping what's right about the health care system and to
    expand the reach of what is right when we can, with universal coverage,
    by giving pharmaceutical products to the elderly who are not poor enough
    to be on Medicaid but are on Medicare and the working people whose
    children may need it. Let us do that.
        And let us have the courage to admit that some of these problems we
    will never fix until we change our ways as a Nation, and let's start
    with violence, begin with guns, and prove that we can do in America what
    you are doing here in New Jersey. Thank you and God bless you all.

    Note: The President spoke at 3:41 p.m. in the Atrium. In his remarks, he
    referred to Mayor Jim Cahill of New Brunswick; Sheriff Armando Fontura
    of Essex County; Harvey A. Holzberg, president and chief executive
    officer, and Dr. Jeffrey Hammond, chief, trauma surgery and critical
    care, Robert Wood Johnson Hospital; and Patricia Jones, mother of a
    patient with a gunshot wound.