    [Public Papers of the Presidents of the United States: William J. Clinton (1993, Book II)]
    [November 3, 1993]
    [Pages 1886-1890]
    [From the U.S. Government Publishing Office www.gpo.gov]

    Remarks to the Community in Ambridge, Pennsylvania
    November 3, 1993

        Thank you very much. It is wonderful to be back in Pennsylvania,
    wonderful to be here in western Pennsylvania with so many of my friends
    and so many of the people who helped to make one year ago today, the day
    that I was elected President, a wonderful day for me. I thank you for
    that.
        I thank Congressman Klink for coming here today and hosting us here
    today in his district. He's done a terrific job being your advocate. He
    has, on occasion, chewed my ear off about the interests of the people in
    this area, and I know you can be proud of him for what he has done. I
    thank Senator Specter for coming here today and for being willing to
    work across party lines to solve this problem that has affected him and
    every other American and every other American family. I thank my good
    friend, Senator Wofford--I want to say a little more about him in a
    moment--for coming here and for nourishing this issue long before it was
    popular. I want to thank you, Mayor Panek, for having us here today. And
    I thank Congressman Murphy for coming up with us. And I thank my friends
    from Allegheny County: Commissioner Tom Forrester and the outgoing Mayor
    of Pittsburgh who's serving the end of her term, Mayor Sophie Masloff.
    We're glad to see you, Sophie. [Applause] Thank you.
        I want to thank your superintendent, Dr. DePaul, and your principal,
    David Perry, for having us here. And let me say, as an old band boy, I
    congratulate the band on your achievement, and I wish you well.
        I wanted to come here to Pennsylvania today to put this book in the
    library here in your wonderful hometown, in that beautiful library, to
    symbolize the placement of the health care plan in 1,600 Federal
    depository libraries all across America today and in hundreds of others

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    who will ask for and receive copies of the book. Soon it will not only
    be in your libraries but it will be on your bookstands. I ask every one
    of you to get this book and read it.
        It deals with a system that is central to our personal health, our
    family's health, our community's health, and the economic strength and
    well-being of our Nation. For that reason alone it may contain the most
    important information of any book you could read this year. What we want
    the American people to do, as has already been said, is to read this
    book, to get familiar with the dynamics of the problem: Why is it that
    our health care system costs more than any other nation's, about 40
    percent more of our income, and still is the only major health care
    system in the world that doesn't provide health insurance to everyone?
    Why is it that it's so expensive and yet 100,000 Americans a month lose
    their health insurance permanently? Why is it that it's so costly and
    yet we still don't have the primary and preventive services that help to
    keep people well? What could we do to provide coverage to people with
    long-term diseases or people with disabilities who could be more
    independent, who could make more of a contribution to our national life
    if only they could get better health insurance themselves?
        Some of the American citizens who deal with their disabilities every
    year are in this audience today. I thank them for their courage in
    coming here. And I say to you, you and your families will be among those
    most advanced by this effort, but so will we all be helped. There are
    untold numbers of people on public assistance today who would not be
    there if only they had access to preventive, primary, and comprehensive
    health care. You should ask and answer these questions.
        Two years ago when Pennsylvania elected Harris Wofford in a stunning
    upset on the health care issue, you fired a shot heard 'round America.
    You said something to the people making public policy that had not been
    heard before. You said, ``I know this is a complicated problem. I know
    there are lot of interests on all sides. I know this gives people a
    headache. I know there's always something you can say to object to any
    reform. But I still expect you to deal with it because it is eating the
    heart out of America. There is too much insecurity. There is too much
    cost. There is too little health care. Do something to make it better.''
    And we got the message.
        One year ago when I crossed this country, I had already spent over 2
    years as a Governor trying to come to grips with a health care system
    that was threatening to bankrupt the State governments of the country
    with higher and higher costs for Medicaid programs for the poor, both
    elderly and nonelderly; with working people in my State who worked hard
    and played by the rules and wondered why they were working because their
    children didn't have health insurance; with elderly people who were not
    quite poor enough to be on Medicaid, so every month they were making a
    decision about whether to buy food or the medicine they needed to stay
    out of the hospital and save the rest of us even more money, as well as
    keeping themselves healthier; and on and on and on.
        Hillary and I have personal friends, friends from our childhood, who
    have told us the most heart-wrenching stories. A friend of ours who runs
    a small business and has only four employees because he had one employee
    with one child who had Down syndrome. And because this young man
    couldn't change his job and because that family couldn't be let go,
    their premiums went up so much in that small business that they had to
    go to a $2,500 deductible for the families, which as many of you know,
    depending on what your income is, is like not having any insurance at
    all. And many people are on even higher ones.
        I say that to make this point. This book is a specific, detailed
    reflection of years of common effort, months of effort in which
    thousands of people were involved: doctors, nurses, other health care
    providers, consumers, business people--small, medium, and large--people
    in the insurance industry, people in all aspects of health care. And it
    attempts to do something no one has yet done, except for this product,
    which is to say here is specifically how we would propose to change it.
        And when those come forward--who should come forward--who disagree
    with us, I ask only that they be held to the same standard. Where is
    their book? What are their answers? Who pays for theirs? Where are the
    costs in theirs? What is their answer? Hold them to the same standard.
        The bottom line, my fellow Americans, is this: We have to create a
    system of comprehensive benefits that are always there that can never be
    taken away. You know here in this river

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    valley as well as any group of Americans--look back over the last 20
    years--you know we are living in a churning economy that sometimes helps
    us and sometimes hurts us. You know how few guarantees there are in life
    anymore. You know how many people have been hurt by the insecurity and
    the uncertainties of the sweeping global economic changes that we have.
    We have to be able to say to the American people, if you're willing to
    work hard and play by the rules, if you're a good taxpaying citizen, if
    you're poor and you have children, no matter what happens to you, you
    will always have basic health care. And we know we can do it, because
    every other country besides us has already done it.
        We can do it. We're tired of making excuses for why we spend 10
    cents on the dollar more on paperwork, regulation, and insurance
    premiums than any country in the world and we can't figure out how to
    get health care to real people. We are tired of making excuses, and we
    are ready to solve the problem.
        When I look at all these young people here and I think about what
    their future is going to hold and I realize we are so close to the 21st
    century and you see the kids on either side of all of us adults who are
    sitting in the middle--although there are some young people in the
    middle, too; young is defined by whoever is a day younger than you are--
    [laughter]--I think about what I know in my heart are the challenges of
    this country. We basically have three huge challenges as we move toward
    the 21st century. One is economic stagnation. We're not creating enough
    jobs, and too many people are working harder without ever getting a
    raise. Right? [Applause] Two is, we are not dealing with the social
    problems we have. We are coming apart when we ought to be coming
    together. We have seen communities and families under stress. There are
    too many children who are subject to violence on our streets and in our
    schools. We have too many human problems that are not being faced. And
    the third problem is that the political system has too much talk and too
    little action on the real problems. It is too dominated by vested
    interest and fears.
        Now, in our way we have tried to address all these things in the
    last 10 months since I have been your President. The budget plan we
    adopted brought interest rates to their lowest point and mortgages to
    their lowest point in 25 years. And we now have more private sector jobs
    which have come into America in the last 10 months than in the previous
    4 years. Is it enough? Of course not, but it's a darned good beginning.
    We're moving in the right direction.
        The second thing--and we talked about this on the plane coming up
    here--to try to put the American family back together. We have passed
    the family leave law so you can get some time off without losing your
    job with a sick child or a sick parent. On April 15th this year, when
    taxes are due, over 15 million American working families will get a tax
    break because they have children and because they are working hard and
    they're still below the Federal poverty line. They will be lifted above
    it. It's the biggest incentive to get off welfare we've ever had, to
    reward the working people who make modest incomes and have children.
        To all the students, I say this Congress lowered the cost of college
    loans, made the terms of repayment easier, and will give thousands of
    young people a chance to work their way through college by serving their
    communities in national service.
        The last thing I want to say is we are also, between now and
    Thanksgiving, determined to do something that gives communities a chance
    to fight crime more, with more police officers on the street, with
    alternatives for correction, and by passing the Brady bill. To make the
    political system work better, this Congress has before it today a
    campaign finance reform bill, a bill to limit the influence of
    lobbyists, a bill to require Congress to live under the same laws that
    it requires private employers to live under, and a bill to give the
    President the power to make specific line-item vetoes in unnecessary
    spending. All of those are before the Congress today.
        But there is no issue which combines all three of these things like
    health care. Health care is important to the economy. Why? Because we're
    spending 40 percent more of our income than any other nation on health
    care; we're getting less for it. That means if you want our cars to sell
    at home and overseas, they're having to pay a nickel on the dollar more
    than the Germans and the Japanese are for health care for every dollar
    in every automobile. It's important to our economy that we do something
    to stop health care costs from going up at 3 times the rate of
    inflation.
        It's important to our social fabric. Why? Because how can you tell
    America's families that

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    they ought to get a good education and they ought to be willing to be
    retrained all through their lives and they ought to play by the rules,
    when they know if one bad thing happens to them they'll have to go home
    at night and look at their children, and they won't even be able to
    provide health care. How can we hold this country together?
        And it is important for making the political system work. Why?
    Because there will never be an issue, never, at least in my tenure,
    where so many special interests have so much to gain or lose based on
    the decisions made by Congress.
        You know, my wife had a little argument with the Health Insurance
    Association about a television ad they're running. So they're going to
    come out, they're going to run another ad and tell you they've got a
    better idea, except we're all still waiting for it.
        Let me tell you what the issue is. You need to know what's behind
    those ads. This is the only country in the world that has 1,500 separate
    companies writing thousands and thousands and thousands of different
    policies designed to divide people up into smaller and smaller and
    smaller groups, so that some of you are in insurance groups so small
    that 40 percent of your premium goes to overhead, profit, and
    administrative costs. It is because of that that hospital after hospital
    after hospital tells us that their doctors, their nurses, their
    administrators are spending millions of dollars a year in time filling
    out unnecessary forms because people have to keep up with all these
    insurance policies.
        It is because of that that a doctor I grew up with told me the other
    day that it was bad enough that he and his partner in a two-doctor
    firm--clinic--had to hire a lot of people to do administrative work. He
    now had to hire one woman to do nothing but stay on the phone all day to
    call these hundreds of different insurance companies, to pound on them
    to pay what they already owed. You pay for that when they hire somebody
    else to do that. That is what is going on here.
        Now, look, there are a lot of good people who do this work. They're
    entitled to work, too. But you've got to make up your mind. Do you want
    to spend one dime on every dollar for health care when we're already
    spending 14.5 percent of our income--no other nation over a dime, 10
    percent of their income; Germany and Japan at 9 percent of their
    income--do you want to keep paying 10 cents on every dollar to pay for
    profit and paperwork and bureaucracy that no other people anywhere in
    the world pay, money that could go to cover the uninsured, money that
    could go to give primary and preventive care, money that could go to
    give mammograms to women, to give cholesterol tests to men, to give
    dental help to children, to give drugs to the elderly who are above the
    poverty line but still don't have enough money to pay their drug bill?
        To me it is an easy answer. But you need to know what is fueling
    those television ads you see from a lot of these special interest
    groups. There's a lot of money in this health care system that doesn't
    have a rip to do with your health care. And we want to develop it in a
    way that can be devoted to your health care.
        They say, ``What are you going to do when the money runs out?'' You
    know, our plan proposes to raise public spending at twice the rate of
    inflation for the next 5 years instead of 3 times the rate of inflation.
    Nobody's cutting anything. We are going to have to have some discipline
    in this system like every other system we have. You are not going to run
    out of health care, but we are going to limit the extent to which you
    can be gouged in a system over which you now have no control. I think
    that is what you want. We have to have some discipline in this system,
    as in every other system of our life. If we need discipline for our kids
    in the schools, discipline on our streets, and enforcement of the law,
    we ought to have discipline in how our health care system operates. It
    shouldn't be able to run crazy.
        So I say to you, my fellow Americans, under this plan no insurance
    company can take away your coverage. There is a limit to how much it can
    increase. What we are trying to do over the long run is to bring
    ourselves into a position where we increase health care costs at the
    rate of inflation plus the rate of population growth, utilization of the
    system every year.
        There will have to be special provisions, as we make them, for new
    technologies, for medical research, for all those things that give us
    the best health care in the world to the people who can access it. But I
    tell you, we did not put this plan together without talking to literally
    hundreds of doctors and nurses and other health care providers. We heard
    them. They are screaming, literally screaming, for relief from the over
    complicated, burdensome, bureaucratic pa-

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    perwork decisions that are driving the costs of this system through the
    roof.
        And I ask you to remember that when you hear the million-dollar
    campaign ads of those who are going to tell you that we cannot have
    health security and comprehensive benefits for all at a price that will
    not break the American economy. I refuse to believe we can't do
    something everybody else has done. I think America can still do things
    that no one else has done. We can certainly do things that everybody
    else has done.
        Let me say a special word about senior citizens. Our plan does not
    change Medicare at all. It preserves the benefits of Medicare and the
    integrity of the system. But our plan does cover prescription medicine
    for the elderly as well as for the nonelderly.
        Now, let me tell you why that's important. If you look at the United
    States as compared with Germany, for example--two countries that have
    great pharmaceutical systems--we don't use as many prescription drugs as
    the Germans do. Why? Because they're not covered in our health care
    plans. Because they're not covered for elderly people on Medicare who
    aren't on Medicaid. What does that mean? It means people don't get the
    medicine they need. Eventually, they get sicker. They go to the
    hospital, and it costs more money. It is very important for the elderly,
    also important for a lot of these young people who might have asthma or
    some other condition that would require medication. Our plan covers it,
    and I think America should have it.
        Under this plan we also move to cover long-term care for elderly
    people who aren't in nursing homes. This is a big deal, folks. The
    fastest growing group of Americans are people over 80. And more and more
    of our elderly people are going to need some help but want to maintain
    as much independence as possible. Our plan, over a period of time, as we
    can afford it, gives our older citizens the chance to maintain that
    independence. Nobody else does it. That's another good reason to support
    it, and I hope you will.
        Finally, let me say to the students here, you will be more affected
    by this than any of the rest of us. You will live your whole life in an
    American economy hurtling toward the 21st century that will or won't
    escape economic stagnation, that will or won't bring us together as a
    family again and promote the values that made this community great, that
    will or won't have a political system that works through problems
    instead of just talks about them. The test of that, in large measure,
    will be this.
         I say, this may not be perfect, but it is the only comprehensive
    plan that gives security to all Americans. It is the only one. I
    challenge the others to come forward with their ideas, send you their
    books, stand on their ideas. And I urge all of you to read this, ask the
    questions, and push ahead. America needs it. The next generation needs
    it. And you need it right here in this wonderful town.
        Thank you, and God bless you all.

    Note: The President spoke at 2:21 p.m. in the gymnasium at Ambridge Area
    High School. In his remarks, he referred to Mayor Walter Panek of
    Ambridge and Samuel A. DePaul, superintendent of schools, Ambridge Area
    School District.