    [Public Papers of the Presidents of the United States: William J. Clinton (1993, Book II)]
    [September 22, 1993]
    [Pages 1556-1565]
    [From the U.S. Government Publishing Office www.gpo.gov]

    Address to a Joint Session of the Congress on Health Care Reform
    September 22, 1993

        Mr. Speaker, Mr. President, Members of Congress, distinguished
    guests, my fellow Americans, before I begin my words tonight I would
    like to ask that we all bow in a moment of silent prayer for the memory
    of those who were killed and those who have been injured in the tragic
    train accident in Alabama today.
        Amen.
        My fellow Americans, tonight we come together to write a new chapter
    in the American story. Our forebears enshrined the American dream: life,
    liberty, the pursuit of happiness. Every generation of Americans has
    worked to strengthen that legacy, to make our country a place of freedom
    and opportunity, a place where people who work hard can rise to their
    full potential, a place where their children can have a better future.
        From the settling of the frontier to the landing on the Moon, ours
    has been a continuous story of challenges defined, obstacles overcome,
    new horizons secured. That is what makes America what it is and
    Americans what we are. Now we are in a time of profound change and
    opportunity. The end of the cold war, the information age, the global
    economy have brought us both opportunity and hope and strife and
    uncertainty. Our purpose in this dynamic age must be to make change our
    friend and not our enemy.
        To achieve that goal, we must face all our challenges with
    confidence, with faith, and with discipline, whether we're reducing the
    deficit, creating tomorrow's jobs and training our people to fill them,
    converting from a high-tech defense to a high-tech domestic economy,
    expanding trade, reinventing Government, making our streets safer, or
    rewarding work over idleness. All these challenges require us to change.
        If Americans are to have the courage to change in a difficult time,
    we must first be secure in our most basic needs. Tonight I want to talk
    to you about the most critical thing we can do to build that security.
    This health care system of ours is badly broken, and it is time to fix
    it. Despite the dedication of literally millions of talented health care
    professionals, our health care is too uncertain and too expensive, too
    bureaucratic and too wasteful. It has too much fraud and too much greed.

    [[Page 1557]]

        At long last, after decades of false starts, we must make this our
    most urgent priority, giving every American health security, health care
    that can never be taken away, health care that is always there. That is
    what we must do tonight.
        On this journey, as on all others of true consequence, there will be
    rough spots in the road and honest disagreements about how we should
    proceed. After all, this is a complicated issue. But every successful
    journey is guided by fixed stars. And if we can agree on some basic
    values and principles, we will reach this destination, and we will reach
    it together.
        So tonight I want to talk to you about the principles that I believe
    must embody our efforts to reform America's health care system:
    security, simplicity, savings, choice, quality, and responsibility.
        When I launched our Nation on this journey to reform the health care
    system I knew we needed a talented navigator, someone with a rigorous
    mind, a steady compass, a caring heart. Luckily for me and for our
    Nation, I didn't have to look very far.

    [At this point, audience members applauded Hillary Clinton, and she
    acknowledged them.]

        Over the last 8 months, Hillary and those working with her have
    talked to literally thousands of Americans to understand the strengths
    and the frailties of this system of ours. They met with over 1,100
    health care organizations. They talked with doctors and nurses,
    pharmacists and drug company representatives, hospital administrators,
    insurance company executives, and small and large businesses. They spoke
    with self-employed people. They talked with people who had insurance and
    people who didn't. They talked with union members and older Americans
    and advocates for our children. The First Lady also consulted, as all of
    you know, extensively with governmental leaders in both parties in the
    States of our Nation and especially here on Capitol Hill. Hillary and
    the task force received and read over 700,000 letters from ordinary
    citizens. What they wrote and the bravery with which they told their
    stories is really what calls us all here tonight.
        Every one of us knows someone who's worked hard and played by the
    rules and still been hurt by this system that just doesn't work for too
    many people. But I'd like to tell you about just one. Kerry Kennedy owns
    a small furniture store that employs seven people in Titusville,
    Florida. Like most small business owners, he's poured his heart and
    soul, his sweat and blood into that business for years. But over the
    last several years, again like most small business owners, he's seen his
    health care premiums skyrocket, even in years when no claims were made.
    And last year, he painfully discovered he could no longer afford to
    provide coverage for all his workers because his insurance company told
    him that two of his workers had become high risks because of their
    advanced age. The problem was that those two people were his mother and
    father, the people who founded the business and still work in the store.
        This story speaks for millions of others. And from them we have
    learned a powerful truth. We have to preserve and strengthen what is
    right with the health care system, but we have got to fix what is wrong
    with it.
        Now, we all know what's right. We're blessed with the best health
    care professionals on Earth, the finest health care institutions, the
    best medical research, the most sophisticated technology. My mother is a
    nurse. I grew up around hospitals. Doctors and nurses were the first
    professional people I ever knew or learned to look up to. They are what
    is right with this health care system. But we also know that we can no
    longer afford to continue to ignore what is wrong.
        Millions of Americans are just a pink slip away from losing their
    health insurance and one serious illness away from losing all their
    savings. Millions more are locked into the jobs they have now just
    because they or someone in their family has once been sick and they have
    what is called the preexisting condition. And on any given day, over 37
    million Americans, most of them working people and their little
    children, have no health insurance at all.
        And in spite of all this, our medical bills are growing at over
    twice the rate of inflation, and the United States spends over a third
    more of its income on health care than any other nation on Earth. And
    the gap is growing, causing many of our companies in global competition
    severe disadvantage. There is no excuse for this kind of system. We know
    other people have done better. We know people in our own country are
    doing better. We have no excuse. My fellow Americans, we must fix this
    system, and it has to begin with congressional action.
        I believe as strongly as I can say that we can reform the costliest
    and most wasteful sys-

    [[Page 1558]]

    tem on the face of the Earth without enacting new broad-based taxes. I
    believe it because of the conversations I have had with thousands of
    health care professionals around the country, with people who are
    outside this city but are inside experts on the way this system works
    and wastes money.
        The proposal that I describe tonight borrows many of the principles
    and ideas that have been embraced in plans introduced by both
    Republicans and Democrats in this Congress. For the first time in this
    century, leaders of both political parties have joined together around
    the principle of providing universal, comprehensive health care. It is a
    magic moment, and we must seize it.
        I want to say to all of you I have been deeply moved by the spirit
    of this debate, by the openness of all people to new ideas and argument
    and information. The American people would be proud to know that earlier
    this week when a health care university was held for Members of Congress
    just to try to give everybody the same amount of information, over 320
    Republicans and Democrats signed up and showed up for 2 days just to
    learn the basic facts of the complicated problem before us.
        Both sides are willing to say, ``We have listened to the people. We
    know the cost of going forward with this system is far greater than the
    cost of change.'' Both sides, I think, understand the literal ethical
    imperative of doing something about the system we have now. Rising above
    these difficulties and our past differences to solve this problem will
    go a long way toward defining who we are and who we intend to be as a
    people in this difficult and challenging era. I believe we all
    understand that. And so tonight, let me ask all of you, every Member of
    the House, every Member of the Senate, each Republican and each
    Democrat, let us keep this spirit and let us keep this commitment until
    this job is done. We owe it to the American people. [Applause]
        Thank you. Thank you very much.
        Now, if I might, I would like to review the six principles I
    mentioned earlier and describe how we think we can best fulfill those
    principles.
        First and most important, security. This principle speaks to the
    human misery, to the costs, to the anxiety we hear about every day, all
    of us, when people talk about their problems with the present system.
    Security means that those who do not now have health care coverage will
    have it, and for those who have it, it will never be taken away. We must
    achieve that security as soon as possible.
        Under our plan, every American would receive a health care security
    card that will guarantee a comprehensive package of benefits over the
    course of an entire lifetime, roughly comparable to the benefit package
    offered by most Fortune 500 companies. This health care security card
    will offer this package of benefits in a way that can never be taken
    away. So let us agree on this: Whatever else we disagree on, before this
    Congress finishes its work next year, you will pass and I will sign
    legislation to guarantee this security to every citizen of this country.
        With this card, if you lose your job or you switch jobs, you're
    covered. If you leave your job to start a small business, you're
    covered. If you're an early retiree, you're covered. If someone in your
    family has unfortunately had an illness that qualifies as a preexisting
    condition, you're still covered. If you get sick or a member of your
    family gets sick, even if it's a life-threatening illness, you're
    covered. And if an insurance company tries to drop you for any reason,
    you will still be covered, because that will be illegal. This card will
    give comprehensive coverage. It will cover people for hospital care,
    doctor visits, emergency and lab services, diagnostic services like Pap
    smears and mammograms and cholesterol tests, substance abuse, and mental
    health treatment.
        And equally important, for both health care and economic reasons,
    this program for the first time would provide a broad range of
    preventive services including regular checkups and well-baby visits.
    Now, it's just common sense. We know, any family doctor will tell you,
    that people will stay healthier and long-term costs of the health system
    will be lower if we have comprehensive preventive services. You know how
    all of our mothers told us that an ounce of prevention was worth a pound
    of cure? Our mothers were right. And it's a lesson, like so many lessons
    from our mothers, that we have waited too long to live by. It is time to
    start doing it.
        Health care security must also apply to older Americans. This is
    something I imagine all of us in this room feel very deeply about. The
    first thing I want to say about that is that we must maintain the
    Medicare program. It works to provide that kind of security. But this
    time

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    and for the first time, I believe Medicare should provide coverage for
    the cost of prescription drugs.
        Yes, it will cost some more in the beginning. But again, any
    physician who deals with the elderly will tell you that there are
    thousands of elderly people in every State who are not poor enough to be
    on Medicaid but just above that line and on Medicare, who desperately
    need medicine, who make decisions every week between medicine and food.
    Any doctor who deals with the elderly will tell you that there are many
    elderly people who don't get medicine, who get sicker and sicker and
    eventually go to the doctor and wind up spending more money and draining
    more money from the health care system than they would if they had
    regular treatment in the way that only adequate medicine can provide.
        I also believe that over time, we should phase in long-term care for
    the disabled and the elderly on a comprehensive basis. As we proceed
    with this health care reform, we cannot forget that the most rapidly
    growing percentage of Americans are those over 80. We cannot break faith
    with them. We have to do better by them.
        The second principle is simplicity. Our health care system must be
    simpler for the patients and simpler for those who actually deliver
    health care: our doctors, our nurses, our other medical professionals.
    Today we have more than 1,500 insurers, with hundreds and hundreds of
    different forms. No other nation has a system like this. These forms are
    time consuming for health care providers. They're expensive for health
    care consumers. They're exasperating for anyone who's ever tried to sit
    down around a table and wade through them and figure them out.
        The medical care industry is literally drowning in paperwork. In
    recent years, the number of administrators in our hospitals has grown by
    4 times the rate that the number of doctors has grown. A hospital ought
    to be a house of healing, not a monument to paperwork and bureaucracy.
        Just a few days ago, the Vice President and I had the honor of
    visiting the Children's Hospital here in Washington where they do
    wonderful, often miraculous things for very sick children. A nurse named
    Debbie Freiberg told us that she was in the cancer and bone marrow unit.
    The other day a little boy asked her just to stay at his side during his
    chemotherapy. And she had to walk away from that child because she had
    been instructed to go to yet another class to learn how to fill out
    another form for something that didn't have a lick to do with the health
    care of the children she was helping. That is wrong, and we can stop it,
    and we ought to do it.
        We met a very compelling doctor named Lillian Beard, a pediatrician,
    who said that she didn't get into her profession to spend hours and
    hours--some doctors up to 25 hours a week--just filling out forms. She
    told us she became a doctor to keep children well and to help save those
    who got sick. We can relieve people like her of this burden. We learned,
    the Vice President and I did, that in the Washington Children's Hospital
    alone, the administrators told us they spend $2 million a year in one
    hospital filling out forms that have nothing whatever to do with keeping
    up with the treatment of the patients.
        And the doctors there applauded when I was told and I related to
    them that they spend so much time filling out paperwork, that if they
    only had to fill out those paperwork requirements necessary to monitor
    the health of the children, each doctor on that one hospital staff, 200
    of them, could see another 500 children a year. That is 10,000 children
    a year. I think we can save money in this system if we simplify it. And
    we can make the doctors and the nurses and the people that are giving
    their lives to help us all be healthier a whole lot happier, too, on
    their jobs.
        Under our proposal there would be one standard insurance form, not
    hundreds of them. We will simplify also--and we must--the Government's
    rules and regulations, because they are a big part of this problem. This
    is one of those cases where the physician should heal thyself. We have
    to reinvent the way we relate to the health care system, along with
    reinventing Government. A doctor should not have to check with a
    bureaucrat in an office thousands of miles away before ordering a simple
    blood test. That's not right, and we can change it. And doctors, nurses,
    and consumers shouldn't have to worry about the fine print. If we have
    this one simple form, there won't be any fine print. People will know
    what it means.
        The third principle is savings. Reform must produce savings in this
    health care system. It has to. We're spending over 14 percent of our
    income on health care. Canada's at 10. Nobody else is over 9. We're
    competing with all these people for the future. And the other major

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    countries, they cover everybody, and they cover them with services as
    generous as the best company policies here in this country.
        Rampant medical inflation is eating away at our wages, our savings,
    our investment capital, our ability to create new jobs in the private
    sector, and this public Treasury. You know the budget we just adopted
    had steep cuts in defense, a 5-year freeze on the discretionary
    spending, so critical to reeducating America and investing in jobs and
    helping us to convert from a defense to a domestic economy. But we
    passed a budget which has Medicaid increases of between 16 and 11
    percent a year over the next 5 years and Medicare increases of between
    11 and 9 percent in an environment where we assume inflation will be at
    4 percent or less. We cannot continue to do this. Our competitiveness,
    our whole economy, the integrity of the way the Government works, and
    ultimately, our living standards depend upon our ability to achieve
    savings without harming the quality of health care.
        Unless we do this, our workers will lose $655 in income each year by
    the end of the decade. Small businesses will continue to face
    skyrocketing premiums. And a full third of small businesses now covering
    their employees say they will be forced to drop their insurance. Large
    corporations will bear bigger disadvantages in global competition. And
    health care costs will devour more and more and more of our budget.
    Pretty soon all of you or the people who succeed you will be showing up
    here and writing out checks for health care and interest on the debt and
    worrying about whether we've got enough defense, and that will be it,
    unless we have the courage to achieve the savings that are plainly there
    before us. Every State and local government will continue to cut back on
    everything from education to law enforcement to pay more and more for
    the same health care.
        These rising costs are a special nightmare for our small businesses,
    the engine of our entrepreneurship and our job creation in America
    today. Health care premiums for small businesses are 35 percent higher
    than those of large corporations today. And they will keep rising at
    double-digit rates unless we act.
        So how will we achieve these savings? Rather than looking at price
    control or looking away as the price spiral continues, rather than using
    the heavy hand of Government to try to control what's happening or
    continuing to ignore what's happening, we believe there is a third way
    to achieve these savings. First, to give groups of consumers and small
    businesses the same market bargaining power that large corporations and
    large groups of public employees now have, we want to let market forces
    enable plans to compete. We want to force these plans to compete on the
    basis of price and quality, not simply to allow them to continue making
    money by turning people away who are sick or old or performing mountains
    of unnecessary procedures. But we also believe we should back this
    system up with limits on how much plans can raise their premiums year-in
    and year-out, forcing people, again, to continue to pay more for the
    same health care, without regard to inflation or the rising population
    needs.
        We want to create what has been missing in this system for too long
    and what every successful nation who has dealt with this problem has
    already had to do: to have a combination of private market forces and a
    sound public policy that will support that competition, but limit the
    rate at which prices can exceed the rate of inflation and population
    growth, if the competition doesn't work, especially in the early going.
        The second thing I want to say is that unless everybody is covered--
    and this is a very important thing--unless everybody is covered, we will
    never be able to fully put the brakes on health care inflation. Why is
    that? Because when people don't have any health insurance, they still
    get health care, but they get it when it's too late, when it's too
    expensive, often from the most expensive place of all, the emergency
    room. Usually by the time they show up, their illnesses are more severe,
    and their mortality rates are much higher in our hospitals than those
    who have insurance. So they cost us more. And what else happens? Since
    they get the care but they don't pay, who does pay? All the rest of us.
    We pay in higher hospital bills and higher insurance premiums. This cost
    shifting is a major problem.
        The third thing we can do to save money is simply by simplifying the
    system, what we've already discussed. Freeing the health care providers
    from these costly and unnecessary paperwork and administrative decisions
    will save tens of billions of dollars. We spend twice as much as any
    other major country does on paperwork. We spend at least a dime on the
    dollar more than any other major country. That is a stunning

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    statistic. It is something that every Republican and every Democrat
    ought to be able to say, we agree that we're going to squeeze this out.
    We cannot tolerate this. This has nothing to do with keeping people well
    or helping them when they're sick. We should invest the money in
    something else.
        We also have to crack down on fraud and abuse in the system. That
    drains billions of dollars a year. It is a very large figure, according
    to every health care expert I've ever spoken with. So I believe we can
    achieve large savings. And that large savings can be used to cover the
    unemployed uninsured and will be used for people who realize those
    savings in the private sector to increase their ability to invest and
    grow, to hire new workers or to give their workers pay raises, many of
    them for the first time in years.
        Now, nobody has to take my word for this. You can ask Dr. Koop. He's
    up here with us tonight, and I thank him for being here. Since he left
    his distinguished tenure as our Surgeon General, he has spent an
    enormous amount of time studying our health care system, how it
    operates, what's right and wrong with it. He says we could spend $200
    billion every year, more than 20 percent of the total budget, without
    sacrificing the high quality of American medicine.
        Ask the public employees in California, who've held their own
    premiums down by adopting the same strategy that I want every American
    to be able to adopt, bargaining within the limits of a strict budget.
    Ask Xerox, which saved an estimated $1,000 per worker on their health
    insurance premium. Ask the staff of the Mayo Clinic, who we all agree
    provides some of the finest health care in the world. They are holding
    their cost increases to less than half the national average. Ask the
    people of Hawaii, the only State that covers virtually all of their
    citizens and has still been able to keep costs below the national
    average.
        People may disagree over the best way to fix this system. We may all
    disagree about how quickly we can do the thing that we have to do. But
    we cannot disagree that we can find tens of billions of dollars in
    savings in what is clearly the most costly and the most bureaucratic
    system in the entire world. And we have to do something about that, and
    we have to do it now.
        The fourth principle is choice. Americans believe they ought to be
    able to choose their own health care plan and keep their own doctors.
    And I think all of us agree. Under any plan we pass, they ought to have
    that right. But today, under our broken health care system, in spite of
    the rhetoric of choice, the fact is that that power is slipping away for
    more and more Americans.
        Of course, it is usually the employer, not the employee, who makes
    the initial choice of what health care plan the employee will be in. And
    if your employer offers only one plan, as nearly three-quarters of small
    or medium-sized firms do today, you're stuck with that plan and the
    doctors that it covers.
        We propose to give every American a choice among high quality plans.
    You can stay with your current doctor, join a network of doctors and
    hospitals, or join a health maintenance organization. If you don't like
    your plan, every year you'll have the chance to choose a new one. The
    choice will be left to the American citizen, the worker, not the boss
    and certainly not some Government bureaucrat.
        We also believe that doctors should have a choice as to what plans
    they practice in. Otherwise, citizens may have their own choices
    limited. We want to end the discrimination that is now growing against
    doctors and to permit them to practice in several different plans.
    Choice is important for doctors, and it is absolutely critical for our
    consumers. We've got to have it in whatever plan we pass.
        The fifth principle is quality. If we reformed everything else in
    health care but failed to preserve and enhance the high quality of our
    medical care, we will have taken a step backward, not forward. Quality
    is something that we simply can't leave to chance. When you board an
    airplane, you feel better knowing that the plane had to meet standards
    designed to protect your safety. And we can't ask any less of our health
    care system.
        Our proposal will create report cards on health plans, so that
    consumers can choose the highest quality health care providers and
    reward them with their business. At the same time, our plan will track
    quality indicators, so that doctors can make better and smarter choices
    of the kind of care they provide. We have evidence that more efficient
    delivery of health care doesn't decrease quality. In fact, it may
    enhance it.
        Let me just give you one example of one

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    commonly performed procedure, the coronary bypass operation.
    Pennsylvania discovered that patients who were charged $21,000 for this
    surgery received as good or better care as patients who were charged
    $84,000 for the same procedure in the same State. High prices simply
    don't always equal good quality. Our plan will guarantee that high
    quality information is available in even the most remote areas of this
    country so that we can have high quality service, linking rural doctors,
    for example, with hospitals with high-tech urban medical centers. And
    our plan will ensure the quality of continuing progress on a whole range
    of issues by speeding research on effective prevention and treatment
    measures for cancer, for AIDS, for Alzheimer's, for heart disease, and
    for other chronic diseases. We have to safeguard the finest medical
    research establishment in the entire world. And we will do that with
    this plan. Indeed, we will even make it better.
        The sixth and final principle is responsibility. We need to restore
    a sense that we're all in this together and that we all have a
    responsibility to be a part of the solution. Responsibility has to start
    with those who profit from the current system. Responsibility means
    insurance companies should no longer be allowed to cast people aside
    when they get sick. It should apply to laboratories that submit
    fraudulent bills, to lawyers who abuse malpractice claims, to doctors
    who order unnecessary procedures. It means drug companies should no
    longer charge 3 times more per prescription drugs, made in America here
    in the United States, than they charge for the same drugs overseas.
        In short, responsibility should apply to anybody who abuses this
    system and drives up the cost for honest, hard-working citizens and
    undermines confidence in the honest, gifted health care providers we
    have. Responsibility also means changing some behaviors in this country
    that drive up our costs like crazy. And without changing it we'll never
    have the system we ought to have, we will never.
        Let me just mention a few and start with the most important: The
    outrageous costs of violence in this country stem in large measure from
    the fact that this is the only country in the world where teenagers can
    rout the streets at random with semiautomatic weapons and be better
    armed than the police.
        But let's not kid ourselves; it's not that simple. We also have
    higher rates of AIDS, of smoking and excessive drinking, of teen
    pregnancy, of low birth weight babies. And we have the third worst
    immunization rate of any nation in the Western Hemisphere. We have to
    change our ways if we ever really want to be healthy as a people and
    have an affordable health care system. And no one can deny that.
        But let me say this--and I hope every American will listen, because
    this is not an easy thing to hear--responsibility in our health care
    system isn't just about them. It's about you. It's about me. It's about
    each of us. Too many of us have not taken responsibility for our own
    health care and for our own relations to the health care system. Many of
    us who have had fully paid health care plans have used the system
    whether we needed it or not without thinking what the costs were. Many
    people who use this system don't pay a penny for their care even though
    they can afford to. I think those who don't have any health insurance
    should be responsible for paying a portion of their new coverage. There
    can't be any something for nothing, and we have to demonstrate that to
    people. This is not a free system. Even small contributions, as small as
    the $10 copayment when you visit a doctor, illustrates that this is
    something of value. There is a cost to it. It is not free.
        And I want to tell you that I believe that all of us should have
    insurance. Why should the rest of us pick up the tab when a guy who
    doesn't think he needs insurance or says he can't afford it gets in an
    accident, winds up in an emergency room, gets good care, and everybody
    else pays? Why should the small business people who are struggling to
    keep afloat and take care of their employees have to pay to maintain
    this wonderful health care infrastructure for those who refuse to do
    anything? If we're going to produce a better health care system for
    every one of us, every one of us is going to have to do our part. There
    cannot be any such thing as a free ride. We have to pay for it. We have
    to pay for it.
        Tonight I want to say plainly how I think we should do that. Most of
    the money will come, under my way of thinking, as it does today, from
    premiums paid by employers and individuals. That's the way it happens
    today. But under this health care security plan, every employer and
    every individual will be asked to contribute something to health care.
        This concept was first conveyed to the Congress about 20 years ago
    by President Nixon.

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    And today, a lot of people agree with the concept of shared
    responsibility between employers and employees and that the best thing
    to do is to ask every employer and every employee to share that. The
    Chamber of Commerce has said that, and they're not in the business of
    hurting small business. The American Medical Association has said that.
        Some call it an employer mandate, but I think it's the fairest way
    to achieve responsibility in the health care system. And it's the
    easiest for ordinary Americans to understand because it builds on what
    we already have and what already works for so many Americans. It is the
    reform that is not only easiest to understand but easiest to implement
    in a way that is fair to small business, because we can give a discount
    to help struggling small businesses meet the cost of covering their
    employees. We should require the least bureaucracy or disruption and
    create the cooperation we need to make the system cost-conscious, even
    as we expand coverage. And we should do it in a way that does not
    cripple small businesses and low-wage workers.
        Every employer should provide coverage, just as three-quarters do
    now. Those that pay are picking up the tab for those who don't today. I
    don't think that's right. To finance the rest of reform, we can achieve
    new savings, as I have outlined, in both the Federal Government and the
    private sector through better decisionmaking and increased competition.
    And we will impose new taxes on tobacco. I don't think that should be
    the only source of revenues. I believe we should also ask for a modest
    contribution from big employers who opt out of the system to make up for
    what those who are in the system pay for medical research, for health
    education centers, for all the subsidies to small business, for all the
    things that everyone else is contributing to. But between those two
    things, we believe we can pay for this package of benefits and universal
    coverage and a subsidy program that will help small business.
        These sources can cover the cost of the proposal that I have
    described tonight. We subjected the numbers in our proposal to the
    scrutiny of not only all the major agencies in Government--I know a lot
    of people don't trust them, but it would be interesting for the American
    people to know that this was the first time that the financial experts
    on health care in all of the different Government agencies have ever
    been required to sit in the room together and agree on numbers. It had
    never happened before. But obviously, that's not enough. So then we gave
    these numbers to actuaries from major accounting firms and major Fortune
    500 companies who have no stake in this other than to see that our
    efforts succeed. So I believe our numbers are good and achievable.
        Now, what does this mean to an individual American citizen? Some
    will be asked to pay more. If you're an employer and you aren't insuring
    your workers at all, you'll have to pay more. But if you're a small
    business with fewer than 50 employees, you'll get a subsidy. If you're a
    firm that provides only very limited coverage, you may have to pay more.
    But some firms will pay the same or less for more coverage.
        If you're a young, single person in your twenties and you're already
    insured, your rates may go up somewhat because you're going to go into a
    big pool with middle-aged people and older people, and we want to enable
    people to keep their insurance even when someone in their family gets
    sick. But I think that's fair because when the young get older they will
    benefit from it, first, and secondly, even those who pay a little more
    today will benefit 4, 5, 6, 7 years from now by our bringing health care
    costs closer to inflation.
        Over the long run, we can all win. But some will have to pay more in
    the short run. Nevertheless, the vast majority of the Americans watching
    this tonight will pay the same or less for health care coverage that
    will be the same or better than the coverage they have tonight. That is
    the central reality.
        If you currently get your health insurance through your job, under
    our plan you still will. And for the first time, everybody will get to
    choose from among at least three plans to belong to. If you're a small
    business owner who wants to provide health insurance to your family and
    your employees, but you can't afford it because the system is stacked
    against you, this plan will give you a discount that will finally make
    insurance affordable. If you're already providing insurance, your rates
    may well drop because we'll help you as a small business person join
    thousands of others to get the same benefits big corporations get at the
    same price they get those benefits. If you're self-employed, you'll pay
    less, and you will get to deduct from your taxes 100 percent of your
    health care premiums. If you're a large employer, your health care costs
    won't go up as fast, so that you will have more

    [[Page 1564]]

    money to put into higher wages and new jobs and to put into the work of
    being competitive in this tough global economy.

        Now, these, my fellow Americans, are the principles on which I think
    we should base our efforts: security, simplicity, savings, choice,
    quality, and responsibility. These are the guiding stars that we should
    follow on our journey toward health care reform.

        Over the coming months, you'll be bombarded with information from
    all kinds of sources. There will be some who will stoutly disagree with
    what I have proposed and with all other plans in the Congress, for that
    matter. And some of the arguments will be genuinely sincere and
    enlightening. Others may simply be scare tactics by those who are
    motivated by the self-interest they have in the waste the system now
    generates, because that waste is providing jobs, incomes, and money for
    some people. I ask you only to think of this when you hear all of these
    arguments: Ask yourself whether the cost of staying on this same course
    isn't greater than the cost of change. And ask yourself, when you hear
    the arguments, whether the arguments are in your interest or someone
    else's. This is something we have got to try to do together.

        I want also to say to the Representatives in Congress, you have a
    special duty to look beyond these arguments. I ask you instead to look
    into the eyes of the sick child who needs care, to think of the face of
    the woman who's been told not only that her condition is malignant but
    not covered by her insurance, to look at the bottom lines of the
    businesses driven to bankruptcy by health care costs, to look at the
    ``for sale'' signs in front of the homes of families who have lost
    everything because of their health care costs.

        I ask you to remember the kind of people I met over the last year
    and a half: the elderly couple in New Hampshire that broke down and
    cried because of their shame at having an empty refrigerator to pay for
    their drugs; a woman who lost a $50,000 job that she used to support her
    six children because her youngest child was so ill that she couldn't
    keep health insurance, and the only way to get care for the child was to
    get public assistance; a young couple that had a sick child and could
    only get insurance from one of the parents' employers that was a
    nonprofit corporation with 20 employees, and so they had to face the
    question of whether to let this poor person with a sick child go or
    raise the premiums of every employee in the firm by $200; and on and on
    and on.

        I know we have differences of opinion, but we are here tonight in a
    spirit that is animated by the problems of those people and by the sheer
    knowledge that if we can look into our heart, we will not be able to say
    that the greatest nation in the history of the world is powerless to
    confront this crisis.

        Our history and our heritage tell us that we can meet this
    challenge. Everything about America's past tells us we will do it. So I
    say to you, let us write that new chapter in the American story. Let us
    guarantee every American comprehensive health benefits that can never be
    taken away.

        You know, in spite of all the work we've done together and all the
    progress we've made, there's still a lot of people who say it would be
    an outright miracle if we passed health care reform. But my fellow
    Americans, in a time of change you have to have miracles. And miracles
    do happen. I mean, just a few days ago we saw a simple handshake shatter
    decades of deadlock in the Middle East. We've seen the walls crumble in
    Berlin and South Africa. We see the ongoing brave struggle of the people
    of Russia to seize freedom and democracy.

        And now it is our turn to strike a blow for freedom in this country,
    the freedom of Americans to live without fear that their own Nation's
    health care system won't be there for them when they need it. It's hard
    to believe that there was once a time in this century when that kind of
    fear gripped old age, when retirement was nearly synonymous with poverty
    and older Americans died in the street. That's unthinkable today,
    because over a half a century ago Americans had the courage to change,
    to create a Social Security System that ensures that no Americans will
    be forgotten in their later years.

        Forty years from now, our grandchildren will also find it
    unthinkable that there was a time in this country when hardworking
    families lost their homes, their savings, their businesses, lost
    everything simply because their children got sick or because they had to
    change jobs. Our grandchildren will find such things unthinkable
    tomorrow if we have the courage to change today.

    [[Page 1565]]

        This is our chance. This is our journey. And when our work is done,
    we will know that we have answered the call of history and met the
    challenge of our time.
        Thank you very much, and God bless America.

    Note: The President spoke at 9:10 p.m. in the House Chamber at the
    Capitol.