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



[[Page 1381]]


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

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


[[Page 1382]]

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


[[Page 1383]]

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

[[Page 1384]]

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

[[Page 1385]]

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

[[Page 1386]]

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

[[Page 1387]]

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

[[Page 1388]]

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

[[Page 1389]]

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

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