[Public Papers of the Presidents of the United States: William J. Clinton (1993, Book II)]
[September 23, 1993]
[Pages 1565-1568]
[From the U.S. Government Publishing Office www.gpo.gov]



Remarks at a Rally for Health Care Reform
September 23, 1993

    The President. Thank you very much, Tipper and Vice President Gore 
and to the First Lady and all of you. This has been an incredible 10 
days on the lawn of the White House, in the Nation's Capital, and in the 
life of your President, for me as a citizen as well as the President.
    After the Middle East peace signing, we had just a couple of days 
ago the signing of the national service bill here, with hundreds of 
young people, a bill I believe literally has the capacity to change not 
only the lives of hundreds

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of thousands of young people but the fabric of life and the strength of 
community all across America. I signed the bill with two pens: one, the 
pen that President Roosevelt used to sign his bills with, and the other, 
the pen that President Kennedy signed the Peace Corps bill with 32 years 
ago. And I thought to myself, this is why I went to the snows of New 
Hampshire. This is why I wanted to be President, because together we can 
make this democracy work.
    And then last night, speaking to the Congress and sensing the 
incredible, historic opportunity we have to reach across party and 
regional lines, to unite people who are worried about universal coverage 
and people who are worried about cost control and people who are worried 
about the disabled and people who are worried about men and women with 
AIDS and people who are worried about mental health and people who are 
worried about elderly, to get everybody together to try to find a 
solution that will permit us at once to provide comprehensive lifetime 
health care benefits to all the people in our country and at the same 
time to stop the waste, the bureaucracy, and the unconscionable increase 
in cost that is putting a terrible burden on our economy and our 
Government's budget--to have the opportunity literally of a generation 
to see the American people come together around a common goal and 
achieve it--that's truly awesome.
    But what I want to remind you of today is this: First, we should be 
grateful that the moment has come when vast margins of our fellow 
citizens understand in their gut, even if they don't know all the 
details of this complex system, that the cost of staying with what we 
have is far greater than the cost and the risk of change; secondly, that 
for the first time in the 20th century, we sort of have everybody in the 
same place at the same time.
    Believe it or not, in the first two decades of this century there 
was one instance in which the American Medical Association wanted a 
national health program, and the AFL-CIO opposed it. It didn't take long 
until that turned around. Then there were times when Democrats wanted to 
do it but Republicans didn't. And then there was President Nixon who 
offered an employer mandate to get universal coverage, and the political 
consensus for it wasn't there. It's almost like for this whole century 
someone would decide that this was a terrible problem, that someone 
ought to do something about it, but all the other players were like 
ships passing in the night. Now you have big business and small business 
and health care providers and health care consumers, families who have 
been broken and workers who are trapped in their jobs all agreed that 
the time has come to act.
    I think my job today is to tell you that as much as I wish this to 
be a celebration to thank you for everything you've done, it's to remind 
you that our work is beginning, that the real celebration will be when 
you come back in even larger numbers to this lawn when I sign a bill to 
solve these problems.
    In the next few days the Congress will begin in earnest to take this 
issue up. It is, as all of you know as well or better than I, a matter 
of mind-boggling complexity on the one hand and simple truths on the 
other. Even all of us in this audience do not agree on every detail 
about how to reach the goal that we all share.
    So, just for one minute I would like to reiterate what I said last 
night: Let us at least commit ourselves to the principles which must 
shape the final legislation. First and most important is security. We 
have simply got to provide for every American, for a lifetime, health 
care that is comprehensive, that is always there and cannot be taken 
away.
    Second, we must make this system more simple, more simple because it 
will have more integrity and more support, because it will free up 
doctors and nurses and other medical professionals to do the work that 
they hired out to do in the first place, and thirdly, because we will 
never get real savings out of massive parts of this system until we 
simplify it.
    Next, we must insist that through simplicity and other mechanisms, 
we actually get savings. And I've said this before, I want to say it 
again, we had a couple hundred doctors in here the other day, and I 
said, you know, one of the most controversial parts of the argument 
we're making is that we can finance health care for the unemployed 
uninsured through savings in the system. Most people in Washington don't 
believe it, but everybody I've talked to outside of Washington who is in 
health care believes it because they live awash in the waste every day. 
Everybody I talked to believes that.
    I say to all of you who know something about this, we must continue 
to hammer the points of opportunity to save money so we can free up 
funds to do the things we all know we ought to do: to cover the 
unemployed uninsured

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through public funds; to provide savings to the private sector that will 
permit them to cover the employed uninsured without going broke; to 
extend coverage to prescription drugs for all Americans, including the 
elderly; to bring in long-term care for the disabled.
    I want to point out again, if you look at this system, all of you 
know but it is still sinking in on our fellow citizens that we are 
already spending 35 percent more than any other nation on Earth as a 
percentage of our income, 40 percent more than our major competitors as 
a percentage of our income. They cover all their folks and we don't, and 
their standard benefit package is better than most of our people have. 
We can achieve savings, but it will require discipline and concentration 
and effort and belief. And you can help make that happen. Our dream of 
security can be undermined unless we have the courage and the discipline 
to keep fighting for savings.
    Fourthly, we have to guarantee choice. The American people simply 
won't put up with it if they think they have no choices in their health 
care. But again, I ask for an injection of the real world. Most of the 
decision-makers here may have choice, but fewer and fewer Americans have 
any real choice in their health care. So under this system we do propose 
to give all persons a choice between three plans, three options that 
they can buy into. We also propose to give physicians more choices about 
the plans in which they participate, because unless they have choices, 
obviously the consumer's choice is limited as well. We have to do that. 
It's an American value, and we can do it without adding to the cost of 
the system.
    Next, we have to ensure quality. And quality means value for 
service. You heard me say last night that the task force that Hillary 
headed uncovered among other things a remarkable effort in Pennsylvania 
to just publicize to health care consumers the quality and cost of 
various services and found out that for heart surgery, the same 
operation could cost between $21,000 and $84,000 in Pennsylvania with no 
discernible difference in health outcomes. If there's no difference in 
health outcomes, you might argue it's healthier to pay $21,000 than 
$84,000. This is an important issue. We have a friend in our home State 
who showed us two different bills for the same surgery he performs--a 
bill sent out from the hospitals, from two different hospitals--wildly 
different prices, exact same procedure and exact same outcomes.
    So I say to you, we must tell the American people we believe in 
quality. And we must provide quality in other ways. We must provide 
quality by understanding that by depriving ourselves of certain kinds of 
services, we inevitably undermine the quality as well as raise the cost 
of health care. And I just want to reiterate how thrilled I was last 
night to get a good response when I pointed out that our package would 
cover the whole range of preventive services because that is an 
important part of quality health care.
    And finally, let me say that we must all have responsibility, too. 
Everyone of us has pointed our finger at someone else and told them they 
should be responsible. It's that old saying, do as I say, not as I do. 
You know, we all know that there are sometimes when doctors order 
unnecessary procedures. We all know that some malpractice claims are 
frivolous. We all know that some practices of pharmaceutical companies 
can't be defended. We can all cite somebody else in the health care 
system. We all know that sometimes the insurance premiums go up or 
people get cut off in ways that are unconscionable. But it's time for us 
to admit that the vast mass of Americans have some responsibility 
problems, too.
    None of the people I just mentioned are responsible for the fact 
that we have higher AIDS rates than any other advanced nation. None of 
the people I just mentioned are responsible for the fact that we have 
much higher teen pregnancy rates than anybody I just mentioned--than any 
other country we're competing with, or higher rates of low-birth-weight 
babies. And they're certainly not directly responsible, the public 
isn't, for the fact that we have the third worst rate of immunization in 
the Western Hemisphere. And they're not responsible for the fact--that 
got such a nice line of applause last night--that we literally are 
raising tens of thousands, indeed millions, of children in war zones in 
which other children have access to weapons more sophisticated than 
police. No one can imagine, in other countries, why we would let that 
happen.
    Now, neither are those people responsible, or any of other actors in 
the health care system, when we behave in ways that are personally 
irresponsible. They don't control it if we drink too much, if we smoke. 
They don't control it if we don't take care of ourselves. They don't

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control it if we don't even give a second thought to the way we access 
the health care system and pretend that it doesn't cost anything just 
because it's not coming out of our pocket. And it is too easy for us to 
blame the people who are providing the services, when we do things that 
are also wrong and unjustifiable. And it is very important that those of 
you who have worked so long for this effort also say that an essential 
principle of this health care plan will be responsibility from all 
Americans including us, not just them but us. I want you to stay with me 
on that.
    Now, there's still a lot of people that don't think we're going to 
get this done. You know, Roosevelt tried it; Truman tried it; Nixon 
tried it. President Johnson wanted to do it. President Carter wanted to 
do it. But we are going to get it done because things are different. 
Circumstances are more dire; it is more obvious to people that we must 
change. The system itself is hemorrhaging. Not only do one in four 
Americans find themselves without adequate coverage at least at some 
point in every 2-year period but about 100,000 Americans a month are 
losing their coverage permanently. It is hemorrhaging. We can't go on. 
But we have to do it right. And we have to do it right now. We don't 
want to rush this thing; it's too complicated. But we don't want to 
delay it using complexity as an excuse.
    So, I ask you to leave here today not simply celebrating what 
happened yesterday or lauding the work of the First Lady's task force 
for the last 8 months but leaving here determined to help the Congress 
keep the commitment that it made last night across party lines to get 
this done, to do it right, to do it for America, to make this 
opportunity of a generation a reality in the lives of every man and 
woman, every boy and girl in this country. Leave here with that 
dedication, and we'll be back here, sure enough, for a celebration in 
the future.
    Thank you, and God bless you all.

Note: The President spoke at 2:16 p.m. on the South Lawn at the White 
House.