    [Public Papers of the Presidents of the United States: William J. Clinton (1993, Book II)]
    [October 18, 1993]
    [Pages 1761-1763]
    [From the U.S. Government Publishing Office www.gpo.gov]

    [[Page 1761]]

    Remarks to the National Breast Cancer Coalition
    October 18, 1993

        Thank you very much. Secretary Shalala and Fran, Dr. Love,
    distinguished Members of Congress, Mrs. Cuomo, Mrs. Florio, and all of
    you distinguished guests. It's wonderful for me to be here today.
        I was sitting here thinking that I more or less feel like the fifth
    wheel now. Just about everything that needs to be said has been said.
    But we sort of felt one man ought to talk on this program. And I won the
    lottery. [Laughter]
        In the 3 minutes that will elapse at the beginning of this talk,
    another American woman will be diagnosed with breast cancer. If I speak
    for 12 minutes, another woman will die of it during the course of the
    remarks. And yet we know that one in every three American women does not
    receive the basic services, like mammographies, which can help to detect
    breast cancers and that the cost of not dealing with this amounts to
    about $6 billion a year to this country over and above all the human
    heartbreak involved.
        Now that means that this is another one of those terrible American
    problems that is not only tearing the heart out of so many families but
    also has left us again with no excuse for why we would spend so much
    money picking up the pieces of broken lives when we could spend a little
    bit of money trying to save them.
        We know all the stories; many of you here are the stories. I
    appreciate the reference to my brave mother, who struggles on with her
    breast cancer condition and who has resumed her remarkable life, but who
    also knows how much more we need to do. I'm glad to see Sherry
    Kohlenberg's husband and son here. When she came to see us in the Oval
    Office--Sherry was one of our 50 faces of hope, and we kind of keep up
    with all those folks that, to us, symbolize what we wanted this
    administration to be about. And when Sherry came to see us last June
    with Larry and with Sammy, she said, ``Don't ever forget what this does
    to the people who are left behind.'' And I'm glad to see them here
    today, and I'm glad they had the courage to come to remind us of that.
        Since we know that there are a lot of things we don't know, it's
    important that we focus on research as well as treatment, that we focus
    on detection early as well as care. In my first budget submission, I
    recommended the creation of the office of research on women's health and
    the largest increase in funding for breast cancer research in the
    history of the National Institutes of Health. When you add that up to
    the increased funding for detection and preventive services at the
    Center for Disease Control, the Food and Drug Administration, and the
    Department of Defense, together the combined expenditures approved by
    this Congress, thanks in no small measure to these women who are here,
    amounts to about $600 million this year alone.
        I also want to emphasize that in the health security plan that I
    have proposed to the Congress we provide for increases, not decreases in
    medical research and a means to fund those increases in medical
    research. We cannot provide basic security to all Americans and forget
    about the research that needs to be done on the things we don't know how
    to cure yet.
        To help to coordinate our research and delivery efforts, in mid-
    December Secretary Shalala will bring together a broad range of health
    professionals, Government agencies, and groups like yours to develop a
    national action plan for the prevention, the diagnosis, and the
    treatment of breast cancer. A national strategy is what these petitions
    are all about. And while I am trying to reduce the volume of paperwork
    in Washington--[laughter]--frankly, I'm glad to see these here. We will
    do better, and you will help us. And we will have this national action
    plan.
        I also want to point out that the health security plan that Hillary
    and I are fighting so hard for, along with the other members of our
    administration, will also fundamentally change the dimension of the
    fight against breast cancer. It is a plan that clearly shows the sign of
    several strong women at work, including two on this platform, based on
    the notion that when it comes to health care research and delivery,
    women can no longer be treated as second-class citizens.
        We began to manifest that commitment, frankly, in this budget which
    was just passed, in which virtually everything was cut or frozen but
    which increased services for early childhood

    [[Page 1762]]

    and for little children. We also believe that we have to further
    increase our investments in these things, in prenatal, in maternal and
    child health care and nutrition, and in detecting and preventing
    diseases.
        We believe that we need a health security plan that guarantees to
    every American a comprehensive package of benefits that not only can
    never be taken away but that includes preventive services to try to keep
    people well as well as help them when they're sick. We believe that some
    of these preventive services are so important that they should indeed
    entail no out-of-pocket costs at all to American citizens when the
    considered medical judgment is that everybody should get them on a
    regular basis. That includes routine clinician visits and not only
    appropriate breast exams but also important procedures like
    immunizations and Pap smears.
        We also know that we can reduce deaths by making mammography widely
    available and by encouraging its use. And this plan covers these
    mammograms at no additional cost to patients for all women over 50 and
    provides mammograms where important in the judgment of the physician and
    the woman in every case where there is a health care plan. So if this
    plan passes, for the first time everybody who's got a health insurance
    policy, which will be everybody in America, will have mammograms in the
    policy. That is a very important thing.
        The unique structure of this plan, with some preventive benefits
    absolutely free to Americans in the highest risk categories, was based
    upon the best available scientific evidence expressed in the findings of
    the United States Preventive Services Task Force and supported by
    forthcoming guidelines, for example on mammograms, from the National
    Cancer Institute. They were based on the best available scientific
    evidence, I will say again. And I very much appreciate the fact that
    just before we came up here today, Hillary whipped out an article that
    had Dr. Love quoted, and she said, ``Have we done it like you said we
    should?'' and Dr. Love said, ``Yes.'' I felt like I had gotten an A in
    class. [Laughter]
        I also want to emphasize that none of this can ever be fixed in
    stone. You hear a whole lot of discussion as we get into the debate on
    the health care plan about how this or that or the other problem is not
    fixed. Well, my fellow Americans, this is a very dynamic thing, health
    care. And even the countries that have the best system, if you define
    ``best'' as high quality results, universal coverage, preventive
    services at lower costs, even they have continuing problems. You have to
    work on this forever. This is the beginning of what we should have done
    a long time ago, not the end of it. And one of the things that we need
    to make a commitment to do now is to update all these preventive
    approaches as new and better studies become available, based on
    recommendations like those we'll soon receive from the President's
    Special Commission on Breast Cancer. They've worked hard for 2 years,
    and I'm looking forward to that report.
        Finally, let me say that--and this is an important thing to women
    who live in inner cities or remote rural areas--the best health care
    coverage in a policy is no good unless you can access it. We can have
    great policies and coverage, but we also have to have access. So we had
    a whole group of people who work all across America on these problems.
    And I myself spent a whole 4-hour period listening to this because I've
    worried about it for years, coming as I do from a small rural State, to
    be able to say to you that if this plan passes as we propose it, we'll
    be able to have the latest technologies given to doctors and nurses who
    can practice in the smallest rural communities and the most isolated
    parts of our large inner cities, to allow health professionals to
    contribute their best to all the people of this country who need these
    preventive services.
        As you know from your efforts to gather all these signatures, change
    requires that people work together. But when they work together and make
    their voices heard, change can come. I'll never forget the meeting I had
    with breast cancer advocates at a hospital during the election, and I
    told Hillary after it was over that if we had the energy of the women
    who were there at that meeting concentrated on about four major things
    we could turn this country around in 3\1/2\ weeks.
        And so I say to you in closing, we need that energy. And we will
    give you a vehicle, beginning with Secretary Shalala's meeting in
    December, to develop a national action plan on breast cancer. But it is
    important that that plan be fit into a larger commitment to the health
    care of Americans: to put women's health concerns, from research to the
    delivery of health care, on an equal footing with men's; to say that it
    is better to focus on keeping people well than just treating them when
    they're sick, and when

    [[Page 1763]]

    you focus on that you will find them when they're just a little sick and
    be able to get them well a whole lot quicker; and finally, to say that
    none of this will ever come to pass until we finally join the ranks of
    every other advanced country in this world and give every citizen of
    this country health care that is always there, that can never be taken
    away from them.
        Every American can bring some weapon to this struggle, and your
    weapons are unique. They are not the dollars and deal-making talents of
    lobbyists or the stethoscopes or syringes of doctors and nurses. But
    they are the power of the pen and the petition and, most important of
    all, the power of the personal story. For in the end, America ought to
    be shaped by the lives of Americans, not just by the interests of
    Americans but by the values of Americans, not just by what we want when
    everything is going well but by what we need in our direst and most
    difficult moments.
        I urge you to continue to fight in the months ahead. We can win this
    battle. As a part of the national drive for early breast cancer
    detection, tomorrow thousands of doctors and hospitals and medical
    centers across the country will offer discounted mammograms, thanks in
    no small measure to all of you.
        I'm going to sign this proclamation when I finish my remarks which
    declares tomorrow National Mammography Day. I want to thank all the
    Members of Congress who pushed this through and two who are not here,
    Senator Biden and Congresswoman Marilyn Lloyd, who were sponsors of this
    legislation. And I want to remind you that you've got to continue to
    bring this level of intensity, of energy, of passion to this battle. You
    have the most powerful thing of all, personal stories. When American
    politics works best, it's when it reflects the lives of the American
    people. You can make sure on these issues we do that. And I hope you
    will.
        Thank you, and God bless you all.

    Note: The President spoke at 11:33 a.m. in the East Room at the White
    House. In his remarks, he referred to Frances Visco, president, National
    Breast Cancer Coalition (NBCC); Dr. Susan Love, founder of the NBCC and
    director of the Breast Center at the University of California, Los
    Angeles; Matilda Cuomo, first lady of New York; and Lucinda Florio,
    first lady of New Jersey. Following his remarks, the President signed
    the National Mammography Day proclamation, which is listed in Appendix D
    at the end of this volume.