    [Public Papers of the Presidents of the United States: William J. Clinton (1993, Book II)]
    [August 16, 1993]
    [Pages 1381-1389]
    [From the U.S. Government Publishing Office www.gpo.gov]

    [[Page 1381]]

    Remarks to the National Governors' Association in Tulsa, Oklahoma
    August 16, 1993

        Thank you very much, Governor Romer, Governor Campbell, our host
    Governor, Governor Walters. I'm really glad to be here today. The last
    time the Governors met in Oklahoma was in 1981, right after I had just
    become the youngest former Governor in American history. I've never been
    to an NGA meeting in Oklahoma, so I would have showed up here even if
    you hadn't invited me to speak.
        I want to say that Hillary and I are both very glad to be here, to
    be with you again. We're looking forward to our meeting after this where
    we can talk about the health care issue and other issues in greater
    detail. I treasure the partnership that I have had with so many of you
    and which we are trying to develop and literally embed in Federal policy
    today. I know that you have already received an update on the progress
    that we have made together, working on more rapid processing of the
    Governors' waiver requests in many different areas and a number of other
    issues, which I hope we'll be able to talk more about later.
        I know too, that the Vice President has already been here and taken
    all my easy lines away. Even told you the ashtray story, I know,
    yesterday, which I understand Governor Richards said was one of those
    issues that her mother in Waco could understand.
        Today I come to talk to you about the issue of health care. I would
    like to put it into some context. When I became President it was obvious
    to me, based on just the announcements and evidence which had come into
    play since the November election, that the Federal deficit was an even
    bigger problem than I had previously thought and that, unless we did
    something about it, we would not have the capacity to deal with the
    whole range of other issues; that forever, at least during the term of
    my service, we would be nibbled away at the edges in trying to deal with
    health care reform or defense conversion or welfare reform or any other
    issue by the fact that we simply were not in control of our own economic
    destiny.
        And so we devoted the first several months of this administration to
    trying to pass an economic plan that would reduce the deficit by a
    record amount, that would have at least as many spending cuts as new tax
    increases--in fact, we wound up with more spending cuts--and that would
    give some incentives where they were needed, particularly in the small
    business, in the high-tech, in the new business area, to try to grow
    more jobs for the American economy. That has, I believe, laid a very
    good foundation for the future.
        This morning I was reading in the morning newspapers that long-term
    interest rates are now at a 20-year low, the lowest they've been since
    1973. And we have the basis now to proceed on a whole range of other
    issues. When the Congress comes back next month, I believe that the
    Senate will rapidly pass the national service legislation, which many of
    you are very familiar with and which many of you have supported. It will
    pass on a bipartisan basis and will enable tens of thousands of our
    young people to earn credit for their college education by serving their
    communities at home and solving problems that no Government can solve
    alone.
        We are working on defense conversion initiatives from northern
    California to South Carolina and at all points in between. I hope we can
    do more on that. We will have a major welfare reform initiative coming
    up at the first of the year, which I hope all of you will not only
    strongly support but will be active participants in. And meanwhile, keep
    doing what you're doing and asking for the waivers you think you need.
        There is now before the Congress a crime bill which can have a big
    impact in every State here, that will add 50,000 more police officers on
    the street, support innovations like boot camps for first offenders,
    help us to pass the Brady bill, and deal with a number of other issues
    facing us there.
        There will be initiatives to expand the economic range of Americans.
    As I know that you all know now--and I wish he could be here with us
    today--our Trade Ambassador, Mickey Kantor, successfully concluded the
    NAFTA negotiations just a few days ago with some historic, some historic
    provisions never before found in a trade agreement anywhere, including
    the agreement by the Government of Mexico to tie their minimum wages to
    productivity and eco-

    [[Page 1382]]

    nomic growth and then to make their compliance with that the subject of
    a trade agreement, which means that it can be reviewed, that if there
    are violations they can be subject to fine, and ultimately the trade
    sanctions can be imposed. Nothing like this has ever been found in a
    trade agreement before. It ensures that workers on both sides of our
    border can benefit. And I appreciate the support of the Governors for
    the whole issue of expanding trade. We are now in Europe trying to get
    the GATT negotiations back on track, and I hope we can do that.
        Finally, let me say there will be a whole push toward the end of the
    year on a whole range of political reform issues. One or the other House
    of Congress have already passed a campaign finance reform bill, a lobby
    limitation bill, and the modified line-item veto, which I think that 100
    percent of you think that the President ought to have.
        In addition to that, the Vice President will issue a report to me
    very shortly on the reinventing Government project, which he discussed
    with you in great detail yesterday. The only thing I can tell you is
    that everything I ever suspicioned about the way the Federal Government
    operates turned out to be true, plus some. The ashtray story is only
    illustrative. The fundamental problem is not that there are bad people
    in the Federal Government or that the payrolls have been swollen by
    people who just want to pad them. That is not true. In fact, many of the
    Federal agencies didn't grow at all in the 1980's. What has happened is
    that for the last 60 years one thing has been added on to another and
    people with the best of intentions have just piled one more requirement
    on to the Federal Government, and the fundamental systems that operate
    this Government have gone unexamined for too long, whether it's
    personnel or budgeting or procurement. And we are trying to do that in
    ways that I think would free up a lot of money and improve the
    efficiency and service that the American people are entitled to expect
    from all of us.
        Now having said all that, I want to make two comments. I don't think
    that any of it will take America where we need to go unless we also
    reform the health care system, which is the biggest outstanding culprit
    in the Federal deficit and is promoting economic dislocations in this
    economy. And secondly, I don't think we can do it unless we do it on a
    bipartisan basis.
        I never want to go through another 6 months where we have to get all
    of our votes within one party and where the other party has people that
    want to vote with us and they feel like they've got to stay--and the
    whole issue revolves around process instead of product, political
    rhetoric instead of personal concern for what's going to happen to this
    country. There's plenty of blame to go around. As far as I'm concerned
    there will be plenty of credit to go around. I don't much care who gets
    the credit for this health care reform as long as we do it.
        But I am convinced that what this Nation really needs is a vital
    center, one committed to fundamental and profound and relentless and
    continuing change in ways that are consistent with the basic values of
    most Americans and that move all of us along a path. And I don't think
    you can do it unless we can sit down together and talk and work.
        Many of the skills which are highly prized among you--both in your
    own States, where you serve and work with people who think differently
    than you do on some issues, who belong to different parties than you do,
    and the way you work around this table--those skills are not only not
    very much prized, sometimes they're absolutely demeaned in the Nation's
    Capital.
        When we come here and we try to work on something like we worked on
    the welfare reform bill in 1988, we talked about: How does this really
    work? How are people really going to be affected by this? How can we
    deal with our differences of opinion and reach real consensus that
    represents principled compromise? And how can we be judged not just on
    what we say but on what we do?
        Back east where I work, consensus is often turned into cave-in;
    people who try to work together and listen to one another, instead of
    beat each other up, are accused of being weak, not strong. And the
    process is a hundred times more important than the product. Beats
    anything I ever saw. And the people that really score are the people
    that lay one good lick on you in the newspaper every day instead of the
    people that get up and go to work, never care if they're on the evening
    news, never care if they're in the paper, and just want to make a
    difference.
        And so I say to you, anything that you can do to help me and the
    Congress to try to recreate the mechanisms by which you have to func-

    [[Page 1383]]

    tion in order to do anything at the State level and by which we have
    worked together here to move forward on a whole range of issues, I will
    be grateful for. This country has too many words and too few deeds on
    too many issues, and we can do better than that.
        Now, let's talk about the health care issue. We all know what's
    right with our health care system. For those who have access to it, it
    is the finest in the world, not only in terms of the incredible
    technological advances but in terms of having choice of our physicians,
    ready access to health care, and overall high quality that lasts
    throughout a lifetime. We can all be grateful for that.
        My Secretary of Housing and Urban Development, Henry Cisneros, and I
    were talking the other day. His son just had a profoundly important and
    difficult operation. Just a few years ago he was told that about all he
    could hope for for his boy was a comfortable life, and eventually his
    time would run out, probably sooner rather than later. And because of
    the relentless progress of medical technology, his son now has a whole
    new lease on life.
        Nobody wants to mess up what is good with American health care. We
    must preserve it and preserve it with a vengeance. But we also know what
    is not so good. We know that in a world in which we must compete for
    every job and all the incomes we can, we are spending over 14 percent of
    our income on health care. And only one other nation in the world,
    Canada, is over 9. They're at about 9.4. Our major competitors in the
    high-wage chase for the future, Japan and Germany, are down around 8
    percent. So they're at 8, and we're at 14. More troubling, if we don't
    do anything to reverse the basic trends that are now rifling through our
    system, by the end of this decade we'll be at 19 percent of GDP on
    health care. No one else will be over 10, and we'll be basically
    spotting our competitors 9 cents on the dollar in every avenue of
    economic endeavor. I don't think that is something that's right.
        We know that this places enormous pressure on businesses. I'll come
    back to some of the comments made by Mr. Motley along toward the end of
    my remarks, but the truth is that about 100,000 Americans a month are
    losing their health insurance because their employers can no longer
    afford to carry it under the present system we have, and others, holding
    on for dear life, are never giving their employees pay raises. And it is
    estimated, unless we do something about this system, that the increased
    cost of health care between now and the end of the decade will literally
    absorb all of the money that might otherwise be available in this
    economy to raise the salaries of our working people.
        We see employers unequally treated by the cruel hand of the system
    that we have. We know now we are spending far more money, about a dime
    on the dollar probably, administratively just on paperwork, pushing
    paper around, than any of our competitors are. A decade ago, the average
    doctor took home about 75 cents on the dollar that came into the clinic.
    Today that's down to 52 cents on the dollar, in only 10 years, because
    we are awash in paperwork imposed (a) by the Government and (b) for the
    fact that only the United States has 1,500 separate health insurance
    companies writing thousands and thousands of different policies.
        I have a doctor friend in Washington who recently hired somebody not
    even to do paperwork but just to stay on the phone to call insurance
    companies every day to beat them up to pay what has already been
    covered--money right out of the pockets of the nurses that work in his
    clinic. And there's a story like that in every health care establishment
    in America today.
        We know we still have almost 40 million people uninsured, and more
    every month, not fewer. We know that State governments are literally
    being bankrupt by the rising costs of Medicaid--money that used to go to
    education, money that used to go to economic development, money that
    could have gone to law enforcement going every year, just shoveling out
    the door, not for new health care, more money for the same health care.
    And even when we control the price of certain things, that extra
    utilization, or more people coming into the system because the rest of
    it is broken down, are driving the costs up. We know that there are
    still serious access problems.
        And we know, as I said, that the Federal deficit is in terrible
    shape because of health care. If you look at this budget the Congress
    just adopted, defense goes down, discretionary spending is flat. That
    means we spend more money on defense conversion, on Head Start, on
    pregnant women, on a few other things--every dollar that we spend more
    on, that something else was cut. The only thing that's going

    [[Page 1384]]

    up are the retirement programs--and Social Security taxes produced a $60
    billion surplus for us even with the cost-of-living allowances--and
    health care. Everything else is either flat or down. And under all
    scenarios proposed by all people who presented any budgets last year,
    the deficit went down for 4 years and then started going up again
    because of health care. So the only way we can keep our commitments, you
    and I, to the American people to restore real control over this budget
    is to do something about health care.
        Now, I would argue that if you know you've got a list of what's
    right and you know you've got a list of what's wrong and what's wrong is
    going to eventually consume what's right, you cannot continue to do
    nothing. And I don't think most people want to continue to do nothing.
        I want to thank the NGA and especially the Governors who have worked
    with us throughout this process. Many of you have met with the First
    Lady and Ira Magaziner and the people, literally hundreds and hundreds
    of people, who have worked with them on a bipartisan basis to try to
    craft a health care reform package that will ensure that the States are
    real partners in our efforts to preserve quality, cover everyone,
    control costs, and enable the States and the Federal Government to
    regain some control over their financial futures.
        No one embodied that spirit of bipartisanship on this issue more
    than our late friend, George Mickelson. And I just want to take a word
    here to say how very much I appreciated him as a friend, as a Governor,
    and as someone who had the sort of spirit that if it could embrace this
    country on this issue, we could solve this problem in good faith.
        The National Government has a lot to learn from the States in the
    tough decisions that some of you have made already. I can honestly say
    that along toward the end of my tenure as Governor, the most frustrating
    part of the job was simply writing bigger checks every year for the same
    Medicaid program when I didn't have the money that all of us wanted to
    spend on education and economic development and the other important
    issues before us.
        There have been phenomenally important contributions made to this
    debate already by the Governors of many States in both parties. I won't
    mention 1, 5, or 10 for fear I'll leave out someone I should have
    mentioned, but let me say that I am very grateful to all of you for the
    work that you have already done. I also want to say a special word of
    regret about the absence here of the Governor from my home State, Jim
    Guy Tucker, who himself has been getting some world-class medical care.
    And I talked to him last night. He's feeling quite well, and he promises
    to be at the next meeting.
        But all of you have a role to play in what we're about to do. Over
    the last 8 months, I've met with many of you personally in Washington.
    Many of you have lent your staffs to the efforts that we're making on
    health care reform. And we've learned clearly that what works in North
    Dakota may not work in New York. Just yesterday your executive committee
    pledged to support health care reform within a comprehensive Federal
    framework that guarantees universal coverage and controls costs. We will
    work with the States to phase in reform, and we will help you to work
    out problems as they arise. And we have to have an honest discussion
    about what that framework ought to look like.
        I want today to tell you what I think we should do. Next month I
    will outline a plan to Congress that will offer real hope for all
    Americans who want to work and take responsibility and create
    opportunities for themselves and their children. I think the elements of
    that plan ought to be as follows:
        One, we've got to provide health care security to people who don't
    have it. That means not just those who don't have health insurance
    coverage now but those who are at risk of losing it. I don't know how
    many people I met last year all over this country, all kinds of people,
    who knew they would never be able to change jobs again because someone
    in their family had been sick. I don't know how many other people I met
    who couldn't afford their health insurance package because there was
    someone in their job unit that they needed to get rid of in order to be
    able to afford it. We have got to have a system of universal coverage
    that provides security to Americans.
        Second, I think we have to have a system of managed care that
    maintains the private sector, organizes Americans in health alliances
    operated within each State, contains significant new incentives for
    prevention and for wellness and against overutilization, and that has a
    budget so that the competition forces should keep things within the
    budget. But ultimately, especially in the early years, there must be
    some limit. I will say again, if we don't change this,

    [[Page 1385]]

    we're going to go from 14 to 19 percent of our income going to health
    care by the end of the decade. It is going to be very difficult for us
    to compete and win in the global economy with that sort of differential.
        Second--third, excuse me, there must be insurance reform. There has
    to be a basic package of benefits. There needs to be community rating.
    There has to be some opportunity--I heard Governor Wilson talking about
    this before I came out--for pooling for small employers. We cannot
    permit price differentials that exist today to get worse instead of
    better simply because of the size of the work units.
        Finally, in this connection, if we do these things, there will be
    massive cuts in paperwork because you won't have to have every health
    unit in this country trying to keep up with thousands of different
    options and all the myriad complexities that flow from that. We won't
    have another decade when clerical employment in the health care area
    goes 4 times faster than health care providers. No one believes that
    that is a very sound investment in our Nation's future.
        Next, we have to have significant, significant increases, not
    decreases, in investment and research and technology.
        Next, in my judgment, we should attempt to take the health care
    costs of the workers' comp system and the auto insurance system into
    this reform. That might be the biggest thing we could do for small
    businesses. It would also perhaps be the biggest thing we could do to
    reduce some of the inequalities--some of you might not like this, and
    others would love it--but the inequalities in economic incentives that
    various States can offer because of dramatic differences in workers'
    comp costs from State to State, occasioned more than anything else by
    the health care burden of workers' comp.
        Next, I think that we should have 100 percent tax deductibility, not
    25 percent tax deductibility, for self-employed people. And that will be
    a part of the plan we will offer to Congress, something that will
    increase the capacity of people who are self-employed to maintain health
    insurance, whether they're farmers or independent business people.
        Finally, I think the States must have a strong role and essentially
    be charged with the responsibility and given the opportunity to organize
    and establish the health groups of people who will be able to purchase
    health care under the managed care system. I think we should expand
    options for people of low incomes on Medicare but not poor enough to be
    on Medicaid to get a prescription drug benefit phased in over a period
    of years. Similarly, I think we must do the same thing with long-term
    care. But as we provide more long-term care opportunities for the
    elderly and for persons with disabilities, we must also expand the
    option so that they can get the least cost, most appropriate care. We
    must remove the institutionalized biases that are in the system now,
    which keep a lot of people from having access to home care, for example.
        And finally, I think there has to be some responsibility in this
    system for everyone. There are a lot of people today that get a free
    ride out of the present system who can afford to pay something. I think
    there should be individual responsibility. I think every American should
    know that health care is not something paid for by the tooth fairy, that
    there is no free ride, that people should understand that this system
    costs a lot of money. It should cost a lot of money; it ought to be the
    world's best. But we should all be acutely aware of the costs each of us
    impose on it.
        But I also believe that in order to make individual responsibility
    meaningful and in order to control the cost of this system, there has to
    be some means of achieving universal coverage. If you don't achieve
    universal coverage, in my judgment, you will not be able to control the
    costs adequately. Why? Well, for one thing, you will continue to have
    cost shifting. If you have uncompensated care, the people who give it
    will shift the cost to the private sector or to the Government. And that
    will create significant economic dislocations.
        Now, it seems to me we have four options. If you believe--you have
    to decide--if you believe everybody should be covered, you have only
    four options. And I would argue that three of them are not, at least
    based on what I have seen and heard, very good options in practice as
    opposed to in theory.
        Option number one is to go to a single-payer system, like the
    Canadians do, because it has the least administrative cost. That would
    require us to replace over $500 billion in private insurance premiums
    with nearly that much in new taxes. I don't think that's a practical
    option. I don't think that is going to happen. That would be
    significantly dislocating in the sense that overnight, in a nation this
    size, you'd have all the people who are in the insurance business

    [[Page 1386]]

    out of it unless they were in the business of managing the health care
    plans themselves, as more and more are doing.
        Option number two would be to have an individual mandate rather than
    a mandate that applies to employers and to employees, saying that every
    individual's got to buy health insurance, and here are some insurance
    reforms to make sure you can get it. This approach has found some favor
    in the United States Congress, primarily among Republicans but not
    exclusively, because it has the appeal of not imposing a business
    mandate, which has a bad sound to it.
        Here's the problem with that, it seems to me. If you have an
    individual mandate, on whom is it imposed? And don't you have to give
    some subsidy to low-income workers, just the way you'll have to give
    some subsidy to low-income businesses if there's an employer mandate?
    Who gets it and who doesn't? And if you impose an individual mandate,
    what is to stop every other employer in America from just dumping his
    employees or her employees, to have a sweeping and extremely dislocating
    set of--a chain of events start? So it seems to me that there are a lot
    of questions that have to be asked and answered before we could embrace
    the concept of an individual mandate.
        The third thing you could do is not worry about it. You could just
    say, well, we'll have all these other reforms, and just hope that if you
    could lower the cost of insurance and simplify the premiums and have big
    pools, that sooner or later somehow everybody will be covered.
        The problem is that there is a lot of evidence that some people will
    still seek a free ride. And make no mistake about it, people that never
    see themselves as free riders still ride the system, because everybody
    in this country who needs health care eventually gets it. It may be too
    late. It may be too expensive. But if someone who works in a workplace
    where there is no insurance has a child that gets hit in a car wreck or
    just gets sick or has an acute appendix or something happens, they'll
    get health care. And that will be paid for by someone else.
        And indeed, even for the employers and employees that may go a whole
    year and never use the health care system, it's there waiting for them.
    It's an infrastructure just as much as the Interstate Highway System is.
    Every medical clinic, every hospital, every nursing home, all these
    things are the health care infrastructure of the country, all being paid
    for by someone else but still available to be used for those folks. So I
    don't think we can rationally expect to stop cost shifting or to have a
    fair system if we say we're going to organize all this and just hope
    everybody will get into it.
        That leaves the fourth alternative, which is to build on the system
    we now have. The system we now have works for most Americans. Most
    Americans are insured under a system in which employers pay for part of
    the health insurance and employees pay for part of the health insurance,
    and it's worked pretty well for them except for the laundry list of
    problems that we talked about. But most Americans are covered under it.
        What are the problems with doing this? Well, first of all, if you
    just passed an employer mandate and did nothing else, there would be a
    ton of problems in doing it, because the most vulnerable businesses
    would have the highest premiums and a bunch of them would really be in
    deep trouble. No one proposes to do that. In other words, an employer
    mandate itself would not be responsible unless you also had significant
    insurance reforms, a long period of phase-in, and a limitation on how
    much the premium could be for very small businesses or businesses with
    very low-wage workers that obviously are operating on narrow profit
    margins.
        But I would argue to you that based on my analysis of this--and I've
    been thinking about this seriously now for more than 3 years, ever since
    the Governors' Association asked me and the then-Governor of Delaware,
    now a Congressman from Delaware, to look at the health issue. And I have
    thought about it and thought about it. There may be some other issue,
    but I see only those four options for dealing with this. And it seems to
    me the shared responsibility, in a fair way, of employer and employee,
    building on the system we have now which works, taking proper account of
    the need to phase it in and to maintain limits on lower income and lower
    wage employment units, is the fairest way to go.
        Now, it seems to me that all this will be discussed and debated in
    the Congress; the Governors will be a part of it. The first decision we
    have to make is whether we can fool around with this for another 10 or
    20 years or whether the time has come to act. Just consider this one
    fact: If health care costs had been held

    [[Page 1387]]

    in check--that is, to inflation plus growth--since 1980, State and local
    governments would have, on average, 75 percent more funding for public
    school budgets. In 1993, fiscal year 1993, States spent more on Medicaid
    than on higher education for the first time. And State spending on
    Medicaid is expected to jump from $31 billion in 1990 to $81 billion in
    1995 if we don't change this system.
        I believe that health care reform will boost job creation in the
    private sector if it is done right. I believe it will offer a level
    playing field to all those small employers who are covering their
    employees right now and paying too much for it. I believe it will be a
    critical first step in rewarding work over welfare.
        When we did the Family Support Act in 1988, those of you who were
    here then will all remember what all of us concluded--and the Governor
    of South Carolina, since he had once been the ranking member of the
    appropriate subcommittee on the House Ways and Means Committee, played
    as big a role in understanding this as anybody else--that a lot of
    people stayed on welfare not because of the benefits, because the
    benefits had not kept up with inflation; they did it because they
    couldn't afford child care for their kids and because they were going to
    lose health insurance for their children.
        We have gone a long way, I think, toward reducing incentives to stay
    on welfare with this new economic plan, because the earned-income tax
    credit has increased so much that now people that work 40 hours a week
    and have children in the home will be lifted above the poverty level.
    That was the most major piece of economic social reform in the last 20
    years. But we still have to deal with the health care issue.
        I recently had a very sad conversation with a woman who became a
    friend of mine in the campaign who was a divorced mother of seven
    children, and her youngest child had a horrible, horrible and very
    expensive health care condition. The only way she could get any health
    care for this kid was to quit a job where she was making $50,000 a year,
    proudly supporting these children, to go on public assistance so she
    could get Medicaid to take care of her child. And the young child just
    recently passed away. And so I called and talked to the woman, and I was
    thinking about the incredible travail that she had gone through and
    wondering if now she would ever be able to get another job making that
    kind of money to support her remaining children and to restore her sense
    of dignity and empowerment.
        Let me say one last thing about this. I think if we do this right,
    it will restore our sense of individual and common responsibility. I
    will say again, I do not believe anybody should get a free ride in this
    deal. I think we have all--at least I've been part of it--have made a
    mistake in trying to say that people should pay absolutely nothing for
    their health care if they could afford to pay something. People ought to
    pay in proportion to what they can afford to. But I think that the
    system we have is so riddled with those who don't have any
    responsibility at all that it is chock full of loopholes.
        And let me say again, everybody who says, ``Well, this is just too
    complicated, and it's too much trouble, and it's too hard to think
    about,'' ought to consider the consequences of doing nothing. Doing
    nothing means more people lose their coverage, and those who don't will
    pay too much for their coverage. Doing nothing means that all those
    uninsured and underinsured Americans will be covered by vast outlays by
    State, local, and Federal governments. The rest of us will pay more at
    the doctor's office, the hospital, and our own businesses. Doing nothing
    means insurers will continue to be able to charge prices that are too
    high to those who don't have the good fortune of being in very large
    buying cooperatives, and that the paperwork burden of this system, I
    will say again, will continue to be a dime on the dollar more than any
    other country in the world. We cannot sustain that sort of waste and
    inefficiency. More than 60 cents of every new dollar going to the
    Federal Treasury over the next 5 years under our reduced budget will go
    to health care, after we had a $54 billion reduction in Medicare and
    Medicaid expenses over the estimated cost of the previous budget; 12 to
    15 percent added costs every year for large businesses; 20 to 30 percent
    for small businesses; no wage increases for millions, indeed tens of
    millions of workers; and continued fear and insecurity. Policing the
    system against incompetence will be left to a flawed system of
    bureaucrats, of insurance oversight and malpractice that rewards things
    that don't deserve to be rewarded and ignores legitimate problems.
        Now, let me talk about this jobs issue one more time. If you just
    imposed a mandate and did nothing else, would it cost jobs? Yes, it
    would. Any study can show that. That is not

    [[Page 1388]]

    what we propose. If you reform the insurance system and all these big
    employers that are paying way too much now and all these small employers
    that are paying way too much now, wind up with reductions or no
    increases in the years ahead, that is more money they're going to have
    to invest in creating new jobs in the private sector. If you reform the
    insurance system, you phase in the requirements, and you limit the
    amount of payroll that someone can be required to put out in an
    insurance premium, you're going to limit the job loss on the downside
    while you're increasing it dramatically on the upside. If you reduce the
    paperwork burdens, yes, you won't have this huge growth in people doing
    clerical works in doctors offices and hospitals and in insurance
    offices. But you will have more people going into old folks' homes and
    giving them good personal health care, trying to keep them alive in ways
    that are more labor intensive but less expensive. So there will be
    shifts here.
        But who can say, if you trust, if you trust the private sector to
    allocate capital in ways that will make America most competitive and to
    take advantage of lower health care costs by reinvesting it in this
    economy, who could possibly say that if we move closer to the
    international average in the percentage of our income going to health
    care, it wouldn't lead to more productive investment and more jobs in
    America? I think that is clearly what would happen.
        We have focused this debate only on the minority of people who don't
    have health insurance and don't cover their employers and assume that we
    would lay some mandate on them and make no other structural changes. I
    wouldn't be for that. You couldn't be for that, although at least that
    would stop the cost shifting. It would not be enough. That is not what
    we propose. But if you do this right and we phase it in so that as we
    deal with problems, we find them, we can correct them; if the States are
    dealing with the management side of this through these health alliances,
    we can make this work.
        It just defies common sense to say that we can't maintain the
    world's finest health care system, stop all this cost shifting, bring
    our costs back at some competitive level, cover everybody, and create
    jobs. No matter what happens we'll be spending a lot more than any other
    country on health care at the end of the decade. But we'll be protecting
    people, and we'll be working with them.
        I'm convinced that the biggest problem we've got right now is the
    fear of the unknown and the exaggeration into the unknown of what, in
    fact, is already known. To say that we're talking about some untried,
    untested thing ignores the experience of Hawaii, ignores the experience
    of every other country that we're competing with, ignores what we know
    about how our private sector could actually manage the problem better in
    some ways than Germany and Japan have managed it, and basically, is
    rooted in somehow our lack of belief that we can overcome all the
    ideological divides and the rhetorical barbs and the fears that are
    gripping us.
        So I will say again, I don't pretend to have all the answers, but I
    am absolutely sure this is the problem that America cannot let go, that
    we cannot walk away from. And I am absolutely convinced that we can
    solve it if we can meet around a table without regard to party and
    listen to the facts and work through it. I am convinced of that.
        I want to close by telling you a story. When the Pope came to Denver
    and I was given the opportunity to go out there and meet him and have a
    private audience that I will remember and cherish for the rest of my
    life, we arranged for a young girl to come there and just stand in the
    audience. And all she did was have the Pope put his hand on her head and
    say a word of blessing. This child is 13 years old. She's from
    Wisconsin. Her father we met in the course of the campaign. She was born
    with a rare bone disease which caused the bones in her body to break
    continuously so that by the time she actually came out of her mother's
    womb she had already had about more than a dozen bones break in her
    body.
        Just a few years ago, anybody like that could never have grown up
    and had anything like a normal life. They just would have been helpless,
    just continually crumbling. Now, this girl has gone to the National
    Institutes of Health every 3 months for her entire life. And even though
    she's just 13 years old, if she were here talking to you, she would
    speak with the presence, the maturity, the command of someone more than
    twice her age. And she looks a little different because the bones in her
    skull have broken, the bones in her legs have broken, the bones in her
    back have broken. But she can walk and she can function and she can go
    to school. And even though she's only 4 feet tall and weighs only 60
    pounds, she can function.

    [[Page 1389]]

        And she asked her father to take her to Iowa so she could help
    people in Iowa to fight the flood. And she went to Iowa and loaded sand
    in the sandbags, knowing that any one of those bags could have broken
    her leg above the knee, could have put her away for a year. She said,
    ``I cannot live in a closet. This is something that's there. I want to
    live. I want to do my life. I want to do what other people do.'' And I
    was so overcome by it, I brought the girl to see me, and then we just
    quietly arranged for her to be there when the Pope was there.
        I say that to make this point. I asked her why in the world she
    would have done that, why she would have risked literally breaking her
    body apart to be there with all these big, husky college kids fighting
    this flood. And she said, ``Because I want to live. And it's there, and
    I have to go on. I have to do things.'' If a child like that can do
    something like that, surely to goodness, we can stop wringing our hands
    and roll up our sleeves and solve this problem. And surely we can do it
    without the kind of rhetoric and air-filling bull that we hear so often
    in the Nation's Capital. We can do it.
        I miss you. I miss this. I miss the way we make decisions. I miss
    the sort of heart and soul and fabric of life that was a part of every
    day when I got up and went to work in a State capital. Somehow we've got
    to bring that back to Washington. Think about that little girl, and help
    us solve this health care problem.
        Thank you.

    Note: The President spoke at 10:50 a.m. at the Tulsa Convention Center.
    In his remarks, he referred to John Motley, vice president, National
    Federation of Independent Business, and Gov. George S. Mickelson of
    South Dakota, who died April 20 in an airplane crash.