    [Public Papers of the Presidents of the United States: William J. Clinton (1993, Book II)]
    [October 21, 1993]
    [Pages 1783-1791]
    [From the U.S. Government Publishing Office www.gpo.gov]

    Remarks to the Conference of Business for Social Responsibility
    October 21, 1993

        Thank you very much, Helen and Arnold. The crowd would have clapped
    even more for you if they'd known what you were going to say before you
    said it. They were terrific, I thought. I have a great deal of
    admiration for them and for their companies and for this organization. I
    want to point out before I get into my remarks that I have two people
    here I'd like to acknowledge first: the Director of the Small Business
    Administration and one of the strongest supporters of our health care
    reform program, Mr. Erskine Bowles from North Carolina, who is here. And
    I believe a former board member of yours and the current Director of the
    Women's Bureau at Labor, Karen Nussbaum, is here.
        I believe the purpose of politics is to help the American people
    live up to the fullest of their God-given potential and to help them to
    live together in strength and harmony and to fulfill their
    responsibilities as well as their dreams. That obligation can be met in
    different ways in different times. But plainly, there are some times in
    the history of a nation in which that obligation can only be met by the
    willingness to undertake the rigors of profound change. And I believe
    this is such a time.
        The problem is that in any democracy you can only build a consensus
    for profound change when things have gotten pretty well off track. And
    by the time things have gotten pretty well off track, there are an awful
    lot of people who are unhappy and insecure and uncertain. And if you
    look around this audience at the companies here represented who have
    believed you could actually make money and be socially responsible, that
    you could actually be more productive by taking care of the people with
    whom you work and the people who are your customers, you see the intense
    dilemma we face, because people are most able to change when they are
    most secure. And yet, at large, it becomes possible for society to make
    these big changes often only when things have gotten so far off track
    that people are insecure. That, in a nutshell, is the larger dilemma
    that I face as your President today, but more importantly, that we face
    as a people.
        If you look at the conditions that so many millions of our country
    men and women face, many are insecure in their jobs. Many are insecure
    in their ability to get new jobs, in their education levels, in their
    skill levels. Many, many millions are insecure in their health care.
    Many are insecure as children in the way they are

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    growing up. And lamentably, at the end of the cold war, the wars that
    are being waged on so many streets in America have made millions of
    people insecure in their daily lives and movements.
        And yet, we have no alternative. We have to change. We have to make
    economic policy changes. We have to make all kinds of real, significant
    different directions. And yet we live at a time of such insecurity that
    people distrust their institutions, their elected leaders, and even
    their own impulses sometimes when it comes to make these changes.
        I saw that in trying to pass a budget which did some remarkable
    things: It reduced the deficit dramatically. It's given us the lowest
    long-term interest rates in 30 years. It had the most significant reform
    in the tax structure for working people in 20 years by saying to people
    with children who spend 40 hours in the work force, you won't be in
    poverty. No matter how low your job wage is, the tax system will lift
    you out of poverty, not put you into poverty. It opened the doors of
    college education to all Americans by expanding eligibility for college
    loans and lowering interest rates and making the repayment terms easier
    and tied to the incomes of young people when they get out of college--
    much of which the American people never even knew while it was going on
    because it was so easy to whip people up into a white heat about the
    word ``taxes'' and because people couldn't believe anyone would really
    do anything seriously to deal with this issue of the deficit and these
    other matters.
        I see it now as I try to pass the North American Free Trade
    Agreement through the Congress. And that agreement has become the
    repository and the symbol of all the accumulated resentments of our
    people for the 1980's, of all the people who lost their jobs and all the
    plants that moved overseas and all the times that all the workers in
    this country saw that their executives were getting pay raises 4 times
    in percentage terms what they were, 3 times what the profits were going
    up; that they could lose their health care in an instant; that they
    could have to start over in a moment; and that no one cared about them
    anymore. So they associate that with expanded global trade.
        So we know rationally that the only way a rich country ever grows
    richer is to expand its trade. And we know that wealthy countries all
    over the world, in Europe, in Japan, not just in the United States, are
    having great difficulty creating new jobs. And the only way to do that
    is to make more markets beyond the borders of the nation. And yet still,
    emotionally there is this enormous undertow rooted in the insecurities,
    the pain, the sense of loss, the disorientation, the feeling that nobody
    really looks out for me and my family.
        And so we are in so many ways, on so many fronts, my fellow
    Americans, waging a war between hope and fear: on the streets of our
    cities, in our factories and workplaces, in our homes, indeed, in the
    hearts of perhaps a majority of our fellow country men and women. And
    each of us in our own way, we have a little scale inside ourselves. When
    I don't get enough sleep, I'm more pessimistic than I am when I get more
    sleep, right? You're probably like that. And I'm more optimistic. And
    the scales are always going up and down, even in our own lives, aren't
    they, inside, about how we look at the world and how we see reality.
        This is a time when we must be bold, when we must be confident, in
    which we must have the kind of enthusiasm you exhibited when we came
    into this room, with a sense of possibility. We need more young people
    like the young man from the hotel who met me outside, who said, ``Keep
    breaking those paradigms, Mr. President.'' [Laughter] I loved it.
        But I say to you, one of the reasons that I'm so happy to see this
    organization growing and large and vibrant and vigorous is that you have
    found a way to make people feel more secure by changing by changing. You
    have found a way to live by the rhetoric of my last campaign, Putting
    People First. Putting people first.
        I believe that one of the biggest problems that this country always
    has is trying to close the gap between what we say and what we do. I am
    ecstatic and honored to be here. But I want to take a few moments today
    to talk to you about that, how to right that balance inside every
    American so that hope wins out over fear; how to pursue an agenda of
    security so that we can pursue our agenda of change; and how, in so many
    profound ways, health care is right at the core of that. Because I am
    convinced that you have proved that the future of the American private
    sector, the real triumph of free enterprise, will be in proving that we
    can actually do right by our employees, do right by our customers, and
    do right by our bottom lines if we are enlightened and we do the right
    things.

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        I believe that we have set ourselves up over the last 20 years with
    a whole series of false choices that may work in the short run, but in
    the end ultimately disappoint everyone. If we have to erode the fabric
    of family life in America by not giving our workers health care and not
    providing family leave and not providing adequate child care, ultimately
    you wind up with less productive workers. If we can't find a way to
    create new jobs even as we increase productivity, then for the first
    time in all of human history we will have given up on technology as a
    job creator and given in to the age-old fears that it is a job
    destroyer. To be sure, it's always transferred jobs. We used to have
    half the people working on the farm; now only 3 percent do. But it can
    be either, or.
        All these are questions we are dealing with. So is every other
    nation in the world now. We are going through a period of change. We
    can't see the ultimate end of it. No one knows what all these economic
    trends in the global economy will ultimately lead to, but we know what
    works. You know what works; you do it. And I came in here today as a
    friend and an ally to ask you to engage in this health care debate and
    tell the American people that this is something we have to do not
    because it is morally right--but it is morally right--but because it's
    also economically right.
        The most expensive alternative of all, looking toward the future, is
    doing nothing. It's the most expensive financially, and it's the most
    expensive in human terms, and ultimately it will be the biggest drag on
    American productivity. It also is, as Helen said in her remarks,
    guaranteed to provoke the largest amount of resentment because of the
    uneven impact of the health care system on employees and employers and
    American citizens today, depending on whether you have coverage, what
    kind of coverage you have, and how much you're paying for somebody
    else's health care because we have so much uncompensated care in this
    system.
        Now, I have watched as I have seen the Congress come to grips with
    many things and try to overcome even their own disbelief. When I took
    office, most people had been told that the country couldn't afford the
    family leave bill. But we did it, and the wheel hasn't run off. And I
    have seen the impact of that. A lot of you have heard me tell this
    story, but I had a family in the White House the other day with a dying
    child on one of these Make-A-Wish programs, that the child wanted to see
    the White House and the President. And the father told me that his
    daughter was probably not going to make it and that the time he'd spent
    with her was the most important time he'd ever spent, and if it hadn't
    been for the family leave law he would have had to choose between losing
    his job to be with his daughter and therefore doing wrong by his wife
    and his other two children, or keeping his job and letting someone else
    spend that precious time with his child. Now, I don't know about you,
    but I think that fellow is going to be a much better worker for that
    company than he would have been had that not been the law of the land.
        So we now, I think, have a chance to keep going with this engine of
    change. And we've got a lot of things we need to do on the security
    front and the change front. We've got a world of economic changes we
    need to make, but we're going to have to have--if there's no more job
    security in this America because most people when they lose their jobs
    don't get it back anymore, totally the reverse of unemployment patterns
    of the last 60 years, we have to give employment security to Americans.
    If there's no job security there has to be employment security.
    Therefore, we have to have a whole different system of lifetime
    education and training. And we have to undertake that. We'll begin to do
    that next year. A big part of welfare reform will be doing that, making
    sure people really have the capacity to move from welfare to work.
        We have to provide more security for families. That's what the
    family leave bill was all about. That's what the earned-income tax
    credit in the budget bill was all about, lifting the working poor out of
    poverty so there will never be an incentive to be on welfare and there
    will always be an incentive to be both a good parent and a good worker.
        We have to find more security for people on their streets and in
    their homes and in their schools. That's why I so desperately want to do
    something to reduce the number of automatic weapons that are in the
    hands of teenagers on the streets of the city, assault weapons.
        But we also have to do something about health security. You know,
    Hillary and I got 700,000 letters before I made my health care speech to
    Congress and she began to testify. And we're getting them in now at
    about 10,000 letters a week, more. Story after story after

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    story: the small business that had the premium go up 40 percent a year
    with no claims; the business person who has to cut his or her employees
    back to a policy with a $2,500 or $3,000 deductible even though the
    employee average salary is $22,000, $23,000 a year; the person who is
    physically disabled but who has a fine mind who can't get a job because
    the only available employers are small businesses and they don't have
    any kind of community rating, so this person will drive the premiums out
    of sight; a person with the HIV virus who may have another 10 years of
    productive life, strong, productive life and contributions to be made,
    who is either not employed now and therefore won't be employed, or can't
    ever change jobs because of the job lock provisions of the present
    system; the hospitals that are out there, struggling to do a good job on
    modest profits, or not-for-profit hospitals who can't meet their
    uncompensated care burden or those that do by raising everybody else's
    hospital costs in ways that undermine confidence of those that pay those
    bills in the integrity of the system; the doctors who talk to me about
    how, yes, their fees have gone up a lot in the 1980's, but 10 years ago
    they took 75 percent of what they earned home, and now it's down to 52
    percent, and all the rest of it has vanished in the sea of paperwork
    because they have to hassle 300 insurance companies with thousands of
    different policies to make sure they've crossed every ``t'' and dotted
    every ``i'' to get the payment they're entitled to anyway; the stories,
    over and over again, mounting up in every part of our country.
        As you know, we spend more on health care than anybody in the world,
    and yet we do less with it. Now, how would you feel if you were running
    your business, competing with people all across the country and perhaps
    all across the world for jobs and incomes, if you had to spend 14
    percent of your revenues covering only 86 percent of your market and all
    your competitors spent 8 or 9 percent of their revenues and covered 100
    percent of their market? You don't have to be as bright as a tree full
    of owls to figure out that eventually there would be some adverse
    consequence to that. But we go on blithely as if that's the way it has
    to be. And when I propose a change, some people say, ``Oh my God, we
    can't afford that. Look at this wonderful thing we've got going.''
        Now, we have in many ways the best health care system in the world.
    But we have in other ways the worst financed and organized health care
    system in the world for a country as rich as we. Otherwise, how can you
    explain the fact that we are plainly the capital of pharmaceuticals in
    the world in terms of developing new drugs and manufacturing them right
    here in America and we have the third worst immunization rate in this
    hemisphere, behind Haiti and Bolivia--I mean, ahead of them, but only
    ahead of them. You tell me why that happened. If we're so great, how
    have we permitted ourselves to go on year-in and year-out not closing
    that gap?
        Do we have the best health care in the world, the doctors and
    nurses, the hospitals, the medical research, the technology? You bet we
    do. For people who access it, it is good. And do those people resent the
    burdens that are imposed on them by this crazy-quilt system? You bet
    they do. Some of the strongest advocates for change we've had are from
    doctors who are sick and tired of having to hire one more person every
    year because of the clerical administrative burdens of this system.
        People say, ``Aw, this system the President's proposed is so
    complex.'' I get tickled; it's complex compared to what? It's complex
    compared to zero. It's simple compared to what we have now. What is the
    proper standard by which you evaluate this?
        If we do nothing to change the current course on which we have
    embarked, we'll be spending 19 percent of our income on health care by
    the year 2000. We will have a smaller percentage of our population
    covered with health insurance than we have today, because we have about
    100,000 Americans a month permanently losing health insurance, 2 million
    every month losing it but 100,000 permanently losing it. And by the year
    2000, instead of the gap being 4.5 percent to 5.5 percent between our
    major competitors, of our income, it'll be about 7 percent. Today, we
    spend 14.5 percent of our income on health care. Canada's at 10; Germany
    and Japan are just under 9. There is no measurable difference in the
    health outcomes.
        Now, to be perfectly fair, there are two elements of our cost system
    that will always, at least for the foreseeable future, keep us above
    other countries. One is, we do rely more and we invest more in
    groundbreaking technologies and pharmaceuticals, and we should continue
    to do that. And we all want them for ourselves and our family if there's
    a chance it will prolong our lives.

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        The second issue is sadder. We are quite simply, as compared with
    other wealthy countries, more willing to endure a far higher rate of
    violence. We have far higher rates of AIDS. We have far higher rates of
    teenaged mothers and out-of-wedlock births and low birth-weight babies,
    and they're far more likely to cost more. So we have system-related
    costs that are greater than our competitors. And that's about half the
    gap between us and them. But the other half is our own fault. And if we
    don't get about the business of closing it, we're going to have a
    difficult time competing. And we're going to have an increasingly
    difficult time explaining why it is we are prepared to put up with a
    system that no one else on earth tolerates and to pay the human and
    economic cost of maintaining it.
        Today I'd like to focus on two of the issues that have been raised
    by some people in the business community against our proposal. Some say
    that we propose to create a new bureaucracy by creating these health
    alliances, and we shouldn't do that. I say what we propose to do is to
    have a smaller rate of cost increases through increased competition and
    greater efficiency and reduce waste by giving small businesses the same
    bargaining power that big business and Government has today.
        If you look at the Federal employees' health insurance program, for
    example, because of the power we have to bargain and because everybody
    knows the Federal Government is up to its ears in debt and doesn't have
    a lot of money, you look at what's happened to the rates on most of the
    Federal health insurance policies: very modest increases this year. Look
    at the California public employee system: huge people in that block, a
    big block of buyers, and everybody knows California is in bad shape
    financially, so they have a rate increase this year that's right at the
    rate of inflation.
        Small business, however, has seen its rates go up at 2 and 3 times
    the rate of inflation. Why? No bargaining power. In small groups, one
    person gets real sick, explodes the rate structure for everybody. So
    what these alliances do, quite simply, is to say if you're in a firm
    with fewer than 5,000 employees, we will give you the option, the
    opportunity, to be in a big buying group. And in the course of that, we
    will give your employees the option of having more choices than you can
    probably provide for them now in health care, but none of them will cost
    you any more than you would otherwise pay as an employer.
        This will give smaller businesses and self-employed people access to
    market economics. Market economics is beginning to work in health care,
    that and all the Cain I think we've been raising the last year or so.
    It's beginning to work. The aggregate increases are beginning to slow
    some. But they're finding, again, as Helen said in the opening remarks,
    it's very uneven. You might have health care inflation at 7 percent this
    year or 6 percent, but you'll still have a lot of small businesses with
    30 percent premium increases. Why? No market power.
        So when you hear all this stuff that these alliances are big
    bureaucratic nightmares and Government creations, that's not true. The
    alliances are groups of consumers in each State in groups approved by
    the State, not by the Federal Government, that will have buying power
    presently available to governments and to big business but not to small
    business and often not even to medium-sized business. I think it will
    work.
        I also believe in order to make it work we have to have insurance
    companies that compete not on the basis of which company is most adept
    at excluding people who have problems but on the basis of cost and
    quality. Now, to be fair to the insurance companies, you can only do
    that if there is a community rating system, if you don't have all the
    risk factors calculated into every individual purchaser of insurance. If
    you do that, you have nailed small business from the get-go, the people
    that are creating most of the new jobs in this country.
        If you have a community rating system, who gets hurt, from the
    present system, who pays more? Young, single, healthy people will pay
    more, about anywhere from $6 to $8 a month more for their premiums under
    our estimate. They will, but it's fair. You know why? Because under our
    system all the young people without insurance will get insurance and
    because if they're young and healthy, they'll be middle-aged like me
    someday, and they'll get the benefit of this system. The society will be
    stronger. And it will be far better for the big job generators of the
    country, the small businesses who don't have access to health insurance
    now.
        It also will be fairer because with community rating, you will
    enable people to effectively move from job to job to job. Then you can
    say, without breaking a company, that you can't

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    deny someone the right to coverage when they change jobs. Under the
    present system that would be really tough, to say that you can't deny
    the coverage to someone who may be the best-qualified person you want to
    hire, but they have a disability which will raise the premiums of you
    and all your employees, your other employees, by 20 percent under the
    present system. That happened. We met a couple in Columbus, Ohio, that
    had one child with a birth defect. They were insured through the wife's
    community nonprofit, 20-employee group. And in order to keep that family
    on the rolls and keep that woman working for that business, they were
    going to have to raise their premiums, just the employees, every
    employee by another $200 a year, just the employees; the business by
    thousands of dollars a year. That wouldn't happen if we have community
    rating. And you could have free flow of workers from job to job to job,
    something that's quite important since we live in a time when the
    average worker will change jobs six or seven times in a lifetime.
        Finally, and again this is a matter of some controversy in this, we
    believe that if you put everybody in these competitive size groups, then
    the businesses and the employees will be able to bargain for better
    prices: and they will go up far less than they've been going up. We also
    believe there should be some backup cap on how much business could be
    required to pay in any given years until we get this system up and
    going, and we know it is, that there ought to be some ultimate budgetary
    discipline in the system.
        Now, a lot of people say, ``Well, that's Government regulation of
    health care.'' What they really are saying is this is Government
    regulation of costs that might work, because it will include the public
    sector and the private sector. We now strictly regulate the price of
    particular services under Medicare and Medicaid. Do you know how much
    the last budget increased Medicare and Medicaid? We reduced defense;
    we've got domestic discretionary spending flat at a time when we ought
    to be investing more in education and training, in converting from a
    defense to a domestic economy. But Medicare, will go up 11 percent next
    year, Medicaid 16 percent. Why? Paying more for the same health care,
    that's why, more and more and more and more procedures. You have to have
    aggregate discipline in this system if you're going to slow the rate of
    increase.
        I personally don't think the budgetary ceiling in our bill will ever
    be reached because if you give everybody the kind of competitive power
    that big business and Government have today, I think the cost increases
    will be much lower than we project them to be, and so do most of the
    business people I know who have worked on this plan and looked at the
    cost structure from the bottom up. But I don't think it's fair to say
    that this is some heavy-handed grab to control the private sector in
    health care and hurt research in the pharmaceutical industry or anyplace
    else.
        Keep in mind, we have been so conservative or liberal, depending on
    how you look at it, in our budget estimates. Well, you tell me when I
    tell you the fact: This plan that we put in estimates that we will go to
    17 percent of income spent on health care by the year 2000, as opposed
    to 19. And it actually will be more than 17, about 17.5 percent. I don't
    think that's so hot for the economy, either. And I think if we had real
    competition for quality and service, and if we continue to cover more
    primary and preventive services, we could do much better than that.
        So it's not as if we propose to drive folks into poverty. All these
    people who are complaining about the ceilings that would be on the rate
    of increase, the health insurers and others, they're going to get 17.5
    percent of our income instead of 14.5 percent by the year 2000. And they
    think it might not be enough for them to get along on.
        I just want to make that clear. You need to understand when you hear
    all this, about how the Government's regulating this, what we did was
    put a big old ceiling there in case the costs continue to shoot up even
    after we give everybody bargaining power. The essence of this is a
    competitive system for price and quality. And I think it will work.
        The second issue is whether or not we have to have universal
    coverage and whether that's bad for business, to require each business
    to shoulder some responsibility and each employee not covered now to at
    least pay some of the income of the employee to get the health care.
        Now, here are the options. And here's how we came out with basically
    taking what we've got. We've got a system in America today that's
    basically an employer-based system. And when the employers are big
    enough or they're joined with enough others to have market-based power,

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    the system works pretty well. They're beginning to moderate the rate of
    cost increases, and there are some very good health care plans out there
    which provide comprehensive benefits at affordable cost. Sometimes the
    employees don't pay anything, sometimes they pay something, but
    basically the systems work pretty well, and most employees are pretty
    satisfied with it.
        The options are the following: If you want universal coverage, you
    could go to the Canadian system--the problem is that no one I know
    thinks you could pass that in Congress--which means you basically
    replace all the health insurance sector of the country with a tax.
    That's simpler on administrative costs, but since Canada is the second
    most expensive system, if you put the politicians instead of the people
    in charge of negotiating for their health care, it may not work out so
    well. So we rejected that alternative.
        Then there are those who say, ``Well, you ought to put the mandate
    on the employee; let the employee buy it. Make it like car insurance.''
    The problem with that is, if you look at what they offer the employees,
    it's not very good. And it may encourage a total deterioration of the
    present system we have for those who presently have benefits where the
    costs are shared by employers and employees.
        Then there are those who say, ``Well, what we ought to do is give
    small businesses the right to get this market power, and the competition
    will lower the rate of cost, and say that no one can be denied coverage.
    And when you have more competition the price will go down, and everybody
    who doesn't have insurance who's got a job will be able to buy it. So
    we'll just see if it happens.'' The problem with that is that our
    experience with that is not very good. And what we know is that most
    employers and employees who have health insurance today are paying too
    much for it because they're paying for the uncompensated care that
    others get. And if you want to moderate the rate of increase on
    individual businesses' and employees' health care, you've got to make
    sure that everybody who accesses the system pays what they can afford to
    pay for the privilege of doing that. If you continue to have significant
    cost shifting here, then there will be continued irresponsibility in the
    system, which will have real uneven impacts on businesses.
        In other words, most everybody in the country today who's got a good
    health insurance plan is paying too much for it, because they're also
    paying for the uncompensated care of people who always get care but they
    get it when it's too late and too expensive. They show up at the
    emergency room with appendicitis or whatever, instead of ever going in
    for basic checkups and basic preventive mechanisms.
        So I personally don't think we'll ever get costs under control, nor
    do I ever think we'll be the society we ought to be, nor do I ever think
    we'll have the kind of personal security we need until everybody has
    health insurance. And if you don't have universal coverage, this idea
    that people are going to be able to move from job to job to job and
    always have it is just false. And I cannot tell you what it is doing to
    the families of this country who are worrying about it. It is having a
    devastating impact on the capacity of millions of people to function
    well in their jobs.
        Mr. Hiatt made a very eloquent statement before I came up. When he
    came to our economic summit in Little Rock last December, he was then
    famous at having led the way on child care for his employees, and he
    made the following statement. He said if you do right by your employees,
    you, quote, contribute to a workplace that attracts good people and
    retains them, thereby reducing turnover. Good business.
        Then there is one other issue I want to deal with on this universal
    coverage, and that is, a lot of people say it's not fair to ask
    employers to make some contribution to their part-time employees, that
    the taxpayers ought to pay for that. We think if there's a part-time
    employee that works at least 10 hours a week, a pro rata contribution
    should be made, a third of the total payment that would otherwise be
    owed, not a total contribution. And the rest will be made up from the
    monies we propose to raise.
        Now, that can be done. Starbucks Coffee's doing pretty well, and
    they take care of their part-time workers as well as their full-time
    workers. And there are others who do that. What we want to do is to make
    that more economical for everyone who will do it.
        Finally, let me say it also makes it affordable. The way we propose
    to pay for this plan, two-thirds of the money would come from premiums
    paid by employers and employees. But we know we're going to have to give
    discounts to small businesses with very low-wage employers, because we
    don't want to put people out of busi-

    [[Page 1790]]

    ness. And we know the Government has to cover the unemployed uninsured.
    How will we get the money for that? Essentially from three sources: one,
    raising the cigarette tax by 75 cents a pack and asking the large
    employers who opt out of the system, as they can, to make the
    contribution they would make if they were in the system to medical
    research and to the network of public health care clinics that we will
    have to maintain anyway. That's another thing I want to tell you, that
    this plan increases the quality of health care. We're going to increase
    medical research, increase the reach of health clinics. That's the
    second source of money. The third source of money is in the savings we
    will achieve in the Medicare and Medicaid programs, by putting Medicaid
    patients, for example, into the same kind of consumer cooperative buying
    power that those of you who are small and medium-sized businesses will
    get by going into the alliance, and by drastically simplifying the
    paperwork of the system. So that's how it will be paid for.
        I want to say again, there are these two elements. The health
    alliances will contribute to competition and to market-based forces
    getting into the health care system in a good way. It won't be a big new
    Government bureaucracy. The requirement of universal coverage will help
    to stop cost shifting and make health care security a reality and permit
    workers to know that even if they lose a given job, they'll be able to
    go on as employees. It will, in other words, give that level of personal
    security necessary for the American people to think about what our trade
    policy ought to be, what our investment policy ought to be, what our
    economic strategy ought to be for the 21st century, and to make the
    changes necessary to get that done.
        And I ask you here to think about the influence that you can have on
    your Members of Congress, without regard to party. This ought to be an
    American issue. It ought to be a matter of not only the heart but of
    hard-headed economics. If we don't, if we don't ask everybody to assume
    some responsibility--and we're not talking about breaking the bank. For
    a small firm with an average wage of $10,000, for example, the cost
    would be less than $1 a day per employee for the health care plan
    because of the discount system.
        We understand the fragility of the economy in many points. But if we
    don't face this now, we are not going to get a hold of the health care
    cost spiral. We are not going to get a hold of the fact that 100,000
    Americans are losing their health insurance a month. We are not going to
    get a hold of the fact that a lot of these costs just involve our paying
    more for the same health care every year. We get nothing for it. We're
    spending a dime on the dollar more than any other country on sheer
    paperwork, 10 cents on the dollar that nobody else in the world pays.
        So I would say to you it is time for us to say everybody ought to be
    responsible and pay something for this health care system, because we
    all have access to it. And when we really need it, we all get it. And
    it's just wrong for some people to pay for others who can pay something
    for themselves.
        And we ought to allow the small businesses of this country and the
    self-employed people of this country and the medium-sized businesses in
    this country to have the same benefit of market power that only
    Government and big business have today. It isn't fair. That's what these
    alliances do. They are not Government entities, they are private sector
    entities that we're going to put the Medicaid patients in so they can
    have the benefit of that, too.
        Now, that is the kind of thing that we need to do. That is the sort
    of security that we need to achieve, to build into the fabric of
    American life the peace of mind and the sense of fairness and justice
    that enables people to go home at night and look their children in the
    face and think they're doing a pretty good job by them, and that enables
    them to have the kind of personal security that will permit people like
    you to lead this country to make the economic changes that will enable
    this country to do what it needs to do as we move toward the 21st
    century, to keep the American dream alive, to keep this country as the
    foremost country in the world, to enable all of our children to live up
    to their God-given capacity.
        This is just one of those times when we have to decide whether we're
    going to close the gap between our rhetoric and our reality. Desperately
    I hope that 30 years from now people will look back on this time just
    the way we look back on 60 years ago when there was no Social Security.
    Now we take it for granted. We think it was an easy fight; it actually
    wasn't. It took them a couple of years and a little blood on the floor
    in the Congress to get it done. And this may take a while to get done.
    It doesn't

    [[Page 1791]]

    need to take 2 years, I'll tell you that.

        You think about it, Truman, Eisenhower, Kennedy, Johnson, and Nixon
    all followed Roosevelt, and all of them tried to get universal coverage.
    Richard Nixon proposed an employer mandate. Senator Bob Packwood from
    Oregon, still in the United States Senate, introduced it for him. And
    we've been fooling around with this now for decades. Meanwhile, we just
    keep paying more for less. We ought to be paying less for more. That's
    what you do. That's why most of you are doing very well, because you
    have provided more for less. Why should you be stuck with a health care
    system that does the reverse?

        I ask you to please, please engage yourself in this debate. Examine
    this plan. When the book comes out, go over it. If you've got a good
    idea, give it to us. But don't walk away from the plain obligation to
    have every American family with the security of health care and the
    plain need to let the small business people in this country and the
    self-employed people in this country and the middle-size business in
    this country have the same bargaining power in this system that big
    business and Government do.

        And most of all, remind the Members of the Congress that there are
    times when doing the right thing morally and ethically is also good
    business, that we can make money if we make our workers more secure and
    whole. When they go home at night and look at their families over the
    dinner table and they know they've done right by them, then America will
    be on its way to having the courage and the security to seize the next
    century and keep the American dream alive.

        Thank you, and God bless you all.

    Note: The President spoke at 11 a.m. at the Grand Hyatt Washington
    Hotel. In his remarks, he referred to Helen Mills, CEO of the Mills
    Group and Soap Box Trading Co., and Arnold Hiatt, CEO of the Stride-Rite
    Foundation.