    [Public Papers of the Presidents of the United States: William J. Clinton (1993, Book II)]
    [September 23, 1993]
    [Pages 1565-1568]
    [From the U.S. Government Publishing Office www.gpo.gov]

    Remarks at a Rally for Health Care Reform
    September 23, 1993

        The President. Thank you very much, Tipper and Vice President Gore
    and to the First Lady and all of you. This has been an incredible 10
    days on the lawn of the White House, in the Nation's Capital, and in the
    life of your President, for me as a citizen as well as the President.
        After the Middle East peace signing, we had just a couple of days
    ago the signing of the national service bill here, with hundreds of
    young people, a bill I believe literally has the capacity to change not
    only the lives of hundreds

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    of thousands of young people but the fabric of life and the strength of
    community all across America. I signed the bill with two pens: one, the
    pen that President Roosevelt used to sign his bills with, and the other,
    the pen that President Kennedy signed the Peace Corps bill with 32 years
    ago. And I thought to myself, this is why I went to the snows of New
    Hampshire. This is why I wanted to be President, because together we can
    make this democracy work.
        And then last night, speaking to the Congress and sensing the
    incredible, historic opportunity we have to reach across party and
    regional lines, to unite people who are worried about universal coverage
    and people who are worried about cost control and people who are worried
    about the disabled and people who are worried about men and women with
    AIDS and people who are worried about mental health and people who are
    worried about elderly, to get everybody together to try to find a
    solution that will permit us at once to provide comprehensive lifetime
    health care benefits to all the people in our country and at the same
    time to stop the waste, the bureaucracy, and the unconscionable increase
    in cost that is putting a terrible burden on our economy and our
    Government's budget--to have the opportunity literally of a generation
    to see the American people come together around a common goal and
    achieve it--that's truly awesome.
        But what I want to remind you of today is this: First, we should be
    grateful that the moment has come when vast margins of our fellow
    citizens understand in their gut, even if they don't know all the
    details of this complex system, that the cost of staying with what we
    have is far greater than the cost and the risk of change; secondly, that
    for the first time in the 20th century, we sort of have everybody in the
    same place at the same time.
        Believe it or not, in the first two decades of this century there
    was one instance in which the American Medical Association wanted a
    national health program, and the AFL-CIO opposed it. It didn't take long
    until that turned around. Then there were times when Democrats wanted to
    do it but Republicans didn't. And then there was President Nixon who
    offered an employer mandate to get universal coverage, and the political
    consensus for it wasn't there. It's almost like for this whole century
    someone would decide that this was a terrible problem, that someone
    ought to do something about it, but all the other players were like
    ships passing in the night. Now you have big business and small business
    and health care providers and health care consumers, families who have
    been broken and workers who are trapped in their jobs all agreed that
    the time has come to act.
        I think my job today is to tell you that as much as I wish this to
    be a celebration to thank you for everything you've done, it's to remind
    you that our work is beginning, that the real celebration will be when
    you come back in even larger numbers to this lawn when I sign a bill to
    solve these problems.
        In the next few days the Congress will begin in earnest to take this
    issue up. It is, as all of you know as well or better than I, a matter
    of mind-boggling complexity on the one hand and simple truths on the
    other. Even all of us in this audience do not agree on every detail
    about how to reach the goal that we all share.
        So, just for one minute I would like to reiterate what I said last
    night: Let us at least commit ourselves to the principles which must
    shape the final legislation. First and most important is security. We
    have simply got to provide for every American, for a lifetime, health
    care that is comprehensive, that is always there and cannot be taken
    away.
        Second, we must make this system more simple, more simple because it
    will have more integrity and more support, because it will free up
    doctors and nurses and other medical professionals to do the work that
    they hired out to do in the first place, and thirdly, because we will
    never get real savings out of massive parts of this system until we
    simplify it.
        Next, we must insist that through simplicity and other mechanisms,
    we actually get savings. And I've said this before, I want to say it
    again, we had a couple hundred doctors in here the other day, and I
    said, you know, one of the most controversial parts of the argument
    we're making is that we can finance health care for the unemployed
    uninsured through savings in the system. Most people in Washington don't
    believe it, but everybody I've talked to outside of Washington who is in
    health care believes it because they live awash in the waste every day.
    Everybody I talked to believes that.
        I say to all of you who know something about this, we must continue
    to hammer the points of opportunity to save money so we can free up
    funds to do the things we all know we ought to do: to cover the
    unemployed uninsured

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    through public funds; to provide savings to the private sector that will
    permit them to cover the employed uninsured without going broke; to
    extend coverage to prescription drugs for all Americans, including the
    elderly; to bring in long-term care for the disabled.
        I want to point out again, if you look at this system, all of you
    know but it is still sinking in on our fellow citizens that we are
    already spending 35 percent more than any other nation on Earth as a
    percentage of our income, 40 percent more than our major competitors as
    a percentage of our income. They cover all their folks and we don't, and
    their standard benefit package is better than most of our people have.
    We can achieve savings, but it will require discipline and concentration
    and effort and belief. And you can help make that happen. Our dream of
    security can be undermined unless we have the courage and the discipline
    to keep fighting for savings.
        Fourthly, we have to guarantee choice. The American people simply
    won't put up with it if they think they have no choices in their health
    care. But again, I ask for an injection of the real world. Most of the
    decision-makers here may have choice, but fewer and fewer Americans have
    any real choice in their health care. So under this system we do propose
    to give all persons a choice between three plans, three options that
    they can buy into. We also propose to give physicians more choices about
    the plans in which they participate, because unless they have choices,
    obviously the consumer's choice is limited as well. We have to do that.
    It's an American value, and we can do it without adding to the cost of
    the system.
        Next, we have to ensure quality. And quality means value for
    service. You heard me say last night that the task force that Hillary
    headed uncovered among other things a remarkable effort in Pennsylvania
    to just publicize to health care consumers the quality and cost of
    various services and found out that for heart surgery, the same
    operation could cost between $21,000 and $84,000 in Pennsylvania with no
    discernible difference in health outcomes. If there's no difference in
    health outcomes, you might argue it's healthier to pay $21,000 than
    $84,000. This is an important issue. We have a friend in our home State
    who showed us two different bills for the same surgery he performs--a
    bill sent out from the hospitals, from two different hospitals--wildly
    different prices, exact same procedure and exact same outcomes.
        So I say to you, we must tell the American people we believe in
    quality. And we must provide quality in other ways. We must provide
    quality by understanding that by depriving ourselves of certain kinds of
    services, we inevitably undermine the quality as well as raise the cost
    of health care. And I just want to reiterate how thrilled I was last
    night to get a good response when I pointed out that our package would
    cover the whole range of preventive services because that is an
    important part of quality health care.
        And finally, let me say that we must all have responsibility, too.
    Everyone of us has pointed our finger at someone else and told them they
    should be responsible. It's that old saying, do as I say, not as I do.
    You know, we all know that there are sometimes when doctors order
    unnecessary procedures. We all know that some malpractice claims are
    frivolous. We all know that some practices of pharmaceutical companies
    can't be defended. We can all cite somebody else in the health care
    system. We all know that sometimes the insurance premiums go up or
    people get cut off in ways that are unconscionable. But it's time for us
    to admit that the vast mass of Americans have some responsibility
    problems, too.
        None of the people I just mentioned are responsible for the fact
    that we have higher AIDS rates than any other advanced nation. None of
    the people I just mentioned are responsible for the fact that we have
    much higher teen pregnancy rates than anybody I just mentioned--than any
    other country we're competing with, or higher rates of low-birth-weight
    babies. And they're certainly not directly responsible, the public
    isn't, for the fact that we have the third worst rate of immunization in
    the Western Hemisphere. And they're not responsible for the fact--that
    got such a nice line of applause last night--that we literally are
    raising tens of thousands, indeed millions, of children in war zones in
    which other children have access to weapons more sophisticated than
    police. No one can imagine, in other countries, why we would let that
    happen.
        Now, neither are those people responsible, or any of other actors in
    the health care system, when we behave in ways that are personally
    irresponsible. They don't control it if we drink too much, if we smoke.
    They don't control it if we don't take care of ourselves. They don't

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    control it if we don't even give a second thought to the way we access
    the health care system and pretend that it doesn't cost anything just
    because it's not coming out of our pocket. And it is too easy for us to
    blame the people who are providing the services, when we do things that
    are also wrong and unjustifiable. And it is very important that those of
    you who have worked so long for this effort also say that an essential
    principle of this health care plan will be responsibility from all
    Americans including us, not just them but us. I want you to stay with me
    on that.
        Now, there's still a lot of people that don't think we're going to
    get this done. You know, Roosevelt tried it; Truman tried it; Nixon
    tried it. President Johnson wanted to do it. President Carter wanted to
    do it. But we are going to get it done because things are different.
    Circumstances are more dire; it is more obvious to people that we must
    change. The system itself is hemorrhaging. Not only do one in four
    Americans find themselves without adequate coverage at least at some
    point in every 2-year period but about 100,000 Americans a month are
    losing their coverage permanently. It is hemorrhaging. We can't go on.
    But we have to do it right. And we have to do it right now. We don't
    want to rush this thing; it's too complicated. But we don't want to
    delay it using complexity as an excuse.
        So, I ask you to leave here today not simply celebrating what
    happened yesterday or lauding the work of the First Lady's task force
    for the last 8 months but leaving here determined to help the Congress
    keep the commitment that it made last night across party lines to get
    this done, to do it right, to do it for America, to make this
    opportunity of a generation a reality in the lives of every man and
    woman, every boy and girl in this country. Leave here with that
    dedication, and we'll be back here, sure enough, for a celebration in
    the future.
        Thank you, and God bless you all.

    Note: The President spoke at 2:16 p.m. on the South Lawn at the White
    House.