[Public Papers of the Presidents of the United States: William J. Clinton (1993, Book II)]
[October 8, 1993]
[Pages 1716-1720]
[From the U.S. Government Publishing Office www.gpo.gov]



Remarks at Robert Wood Johnson Hospital in New Brunswick, New Jersey
October 8, 1993

    Thank you very much, ladies and gentlemen, Governor and Mrs. Florio, 
Congressman Menendez, Congressman Klein, Mayor Cahill. To the 
distinguished participants in this program, Mr. Holzberg, Dr. Hammond, 
Sheriff Fontura. I hope he doesn't decide to run for President anytime 
soon. He gave a fine talk, I thought.
    Mrs. Jones, thank you for coming here and sharing your story with 
us, and I thank your son sitting over here, and two other fine young men 
who were the victims of violence, for helping to describe their 
condition to Governor and Mrs. Florio and to me today and what happened 
to them.
    I am delighted to be back here not only in New Jersey but in New 
Brunswick. I started one of my other crusades here not very long ago, 
the crusade to pass a national service bill that would give tens of 
thousands of our young people a chance to earn credit against their 
college educations by working in their communities. A few days ago, we 
signed that bill into law, and I think it will change the face of 
America.
    That is one of the many changes that I hope we can make as we move 
toward the 21st century. But I believe very strongly that in order for 
us all to have the courage to make those changes, we need a higher level 
of personal security in this country. And I wanted to come back here to 
this magnificent health facility to talk today for a moment about the 
relationship between health care and the need for health security and 
violence and the need for personal security.
    As you've already heard, these two things are very closely related. 
I'm honored to be here with my good friend and former colleague, 
Governor Jim Florio. You know, I was elated when Jim was awarded the 
John F. Kennedy Profiles in Courage Award earlier this year, because I 
think he really earned it. My guess is, he earned it by making even some 
of you in this audience mad from time to time. But I know what it's like 
to be a Governor and to have to work on a balanced budget, and I know 
what kind of trouble New Jersey was in, and you now have the best credit 
rating in the Northeast. I know, too, how hard it is to stand up and

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fight for things like an end to assault weapons, and what a long 
struggle it is; just passing the law is only the beginning before the 
final impact is felt, perhaps a year, perhaps 5 years down the road.
    But we need more people in our country who will call them like they 
see them, who will try to identify the problems and try to get up every 
day and try to do something about it. And I'm just proud to be 
associated with Jim Florio, and I appreciate what the sheriff said about 
him.
    Today I saw a lot of things that I have seen before over the last 
3\1/2\ years since I started looking into the health care system and 
long before I even dreamed of running for President. I saw at this great 
American health institution, the very best of American health care, as 
well as what is wrong with America's health care. And indeed, if we want 
to finally, at long last, join the ranks of every other advanced country 
in the world and provide health care security to our people, health care 
that's always there and that can never be taken away, we have to work 
vigilantly to keep what is right with our health care system as we work 
to change what is wrong.
    What is right is obvious about this place. I saw the care that the 
nurses and the doctors were giving. I saw the concern that this hospital 
administrator had for the way each part of this hospital worked as I 
worked my way through it. And I saw the way a lot of these patients, 
many of them very young, responded to their caregivers. I saw the 
gratitude in the parents' and the family members' eyes. That is the 
core, the kernel, the heart, the spirit of our health care system. And 
we can't do anything to interfere with that. Indeed, we have to be 
committed to enhancing that.
    But I also heard three different stories about people who showed up 
here without health care coverage or with an insurance policy that 
wouldn't pay or with two different groups arguing about who owed and 
about long delays before the hospital got paid, and massive, massive 
expenditures of time and money filling out first one form and then 
another, and then hassling people to try to get them to pay the bill. 
And that is what is wrong with this health care system.
    We are the only country in the world with an advanced economy that 
can't figure out how to cover all of our people. So what happens? They 
get health care all right, and then the rest of you pay the bill or the 
hospital goes broke. And so many of our people get health care when it's 
too late and too expensive because they have no coverage; so they don't 
get the primary and preventive services that keep people well.
    And of course, as I already said, the administrative costs are 
absolute nightmares. I was in the Washington Children's Hospital the 
other day and was told that every year they spend in that one hospital 
alone $2 million filling out forms that have nothing to do with keeping 
patient records for health care purposes, that the doctor spends so much 
time, the 200 doctors on staff there, on paperwork that has nothing to 
do with patient health care and keeping records of it, that they could 
see another 10,000 children a year collectively, just 200 doctors if 
they didn't have to do it.
    So the question for us is, how do we change what's wrong, keep 
what's right, and how can we deal with the burden of our health care 
system? We now spend over 14 percent of our income in America on health 
care. Canada spends 10. No other nation in the world spends over 9. Even 
Germany and Japan, two very wealthy advanced nations, spend less than 9 
percent of their income on health care, and their health outcomes are 
roughly similar, if not better, than ours.
    Now, how did this come to be, and how can we change it? We don't 
want to do anything to undermine the quality of health care. If you 
cover everybody, if you give them primary and preventive health care 
services, if you do as our plan and you increase investment in medical 
research, you can improve quality. You certainly don't erode it. We 
don't want to destroy people's right to choose their health care system. 
Under our plan, each employee in each workplace would get at least three 
choices. Today, only one-third of workers who are insured in the 
workplace have more than one choice. Contrary to some of the complaints 
about it, our plan will increase consumer choice, not decrease it.
    We do have to simplify the system. I said that before. And we do 
have to achieve savings in some areas where they can be achieved. 
Plainly, if you reorganize the system, you won't have as much fraud and 
abuse, and you'll have dramatic savings in paperwork. Your administrator 
was telling me that this hospital has 25 percent administrative costs. 
The average hospital has hired four clerical workers for every

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direct health caregiver in the last 10 years. The average doctor 10 
years ago was taking home 75 percent of all the money that came into a 
private clinic. Today, that figure is down to 52 percent, 23 cents gone 
to a system of 1,500 separate insurance companies, thousands of 
different policies, thousands of different forms, and Government 
paperwork and bureaucracy on top of that.
    And finally, we have to ask people to assume some more 
responsibility. Two-thirds of our plan will be paid for by asking 
employers and employees who don't pay anything into the system now to do 
their part, while giving discounts to very small businesses with lower 
wage workers to avoid breaking them. We have to ask people who can 
afford to pay, to pay, because the rest of you are paying for them. And 
then when they get really sick, they get their health care, and you 
still pay for them. So we need some more responsibility.
    Now, if you did all this and you look again at this American health 
care system, even if you just forget for a moment about the human 
element--and it's very hard to do with all these wonderful young people 
here--and you see us way up here at 14.5 percent a year of our income, 
everybody else at about 9. And we're losing 100,000 people a month, 
permanently, who are no longer covered with health insurance and 2 
million people a month lose their health insurance, but the rest of them 
somehow get it back. But the system is hemorrhaging.
    What can we do nothing about, and what do we want to do nothing 
about? We wouldn't want do to anything about the fact, I don't think, 
that we invest more in medical research and technological advances than 
other countries. We should be proud of that. It contributes to our 
economy. The fact that we have the strongest, in this State, 
pharmaceutical companies in the world, and they do a lot of research to 
find new drugs, we shouldn't begrudge that. Indeed, in our plan I'd like 
to make more use of pharmaceutical treatment where appropriate by giving 
people on Medicare and people with health insurance policies some 
coverage for drugs so that they can manage their health care better, I 
think many times at lower cost.
    Then you look at the things we plainly want to do something about, 
the bureaucracy, the unnecessary procedures, the fact that the system is 
rigged for defensive medicine, a lot of problems with it. Then you ask 
yourself about, what's the rest of the difference? The rest of the 
difference is, this country has more teen pregnancy, low-birthweight 
births, AIDS rates, and other kinds of serious, highly costly illnesses 
and much more violence. There is nothing I can do in a health care bill 
that will do away with that. We have simply got to be willing to change 
our behavior or admit that we are going to tolerate living in a country 
where homicide is the second leading cause of death among Americans 
between the ages of 15 and 25 and the leading cause of death among 
teenage boys today.
    We just have to say, ``Well, we've just decided we're going to 
continue to live in the only country where police routinely find 
themselves outgunned by out-of-control teenagers.'' We'll just have to 
say, ``We have decided that we're not going to make our streets, our 
parks, or even our schools safe again.'' You heard the story of this 
fine family over here that Governor Florio cited.
    I was in California this week on a town meeting. We were 
interconnected with four big cities in California. This fine, young 
Korean-American businessman stood up and talked about how his brother 
was shot dead by somebody that wasn't even mad at him in one of these 
arbitrary shootings. And then a young African-American boy, a junior 
high school student, stood up and told me how he and his brother did not 
want to be in a gang, did not want to have weapons, just wanted to be 
good students. And they were so concerned about the lack of safety in 
their school that they changed schools. So they went to the newer, safer 
school. And on the first day of school, they were lined up registering 
for school, and this young man's brother, standing right in front of 
him, was shot down because he got caught in the crossfire in a gunfight 
in the middle of the safer school.
    Now, there are a lot of people who say things like, ``Well, people 
do these things. Guns don't.'' I'll tell you what, I'll make them a bet. 
You give me the guns, and I'll see if the people can get it done.
    This is a huge economic problem, all right. You've already heard 
this. Most of the people who are victims of the $4 billion of gun 
violence every year in this country, 80 to 85 percent of them have no 
health insurance. So you pay for them. The system pays for them. It's 
part of the escalating cost of health care. It's part of why we can't 
close the gap between where we are and where other countries are. But 
the

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human tragedy is the most important thing.
    Why should this young man have to worry about how well he's going to 
walk for the rest of his life? And let me just say this: I come from a 
State where over half the people have a hunting or fishing license or 
both. There are towns in my State where you have to shut the schools and 
the factories down on the opening day of deer season, because nobody's 
going to show up anyway. I was in the woods with a .22 when I was a kid. 
I love the outdoors. This has got nothing to do with people having the 
right to train, to learn how to use, to care for a sporting weapon and 
to do it under controlled circumstances. It's got nothing to do with 
this. But I also live in a State now where kids get shot in their 
schools with weapons that were designed solely for the purpose of 
killing people.
    And Dr. Hammond told me when we were making this tour something I 
didn't know. He said that just in the last few years, when people go to 
sites where people were shot with guns, they are three times more likely 
to see the gunshot end in a fatality because of the use of semiautomatic 
and automatic weapons and multiple bullets in a body, just in the last 
few years.
    And so, I tell you, my fellow Americans, we have a decision to make. 
And this is the time to make it. We can't keep saying that we deplore 
these things and it's terrible and keep extolling our American values on 
how much more law-abiding we are than other people and put up with this. 
We either need to say this is a level of chaos and human degradation and 
waste of human potential and incredible cost in society that we are 
willing to tolerate because we cannot bear to do something about it, or 
we need to get up, stand up, and be counted and do something about it.
    We have to make a decision, and it's time to make it. And it 
directly bears on the ability of your Nation to develop a health care 
system that fixes what's wrong, keeps what's right, provides security, 
and doesn't break the bank. It is directly related.
    We have a crime bill--Governor Florio mentioned it--before the 
Congress. It does a lot of things, but most importantly, here's what it 
does. It requires the Brady bill, which is a national 5-day waiting 
period, to establish background checks to check for age, criminal 
history, and mental health history. It matters. You must do it 
nationally. Why? Just near here in New York City, of the many thousands 
of weapons confiscated last year by the police, 85 percent of them came 
from other States. If you don't have a national system, you will never 
fix this. It is a huge deal.
    The second thing the crime bill does is to provide for the 50 
percent of the downpayment of the commitment I made when I was running 
for President, that I wanted to ask the Congress to give the American 
people another 100,000 police officers in the next 4 years, not just to 
catch criminals but to deter crime. And lest you think it doesn't work, 
I can cite you many examples: places in New Jersey which have more 
police officers, where the crime rate has gone down; in New York City 
where the crime rate has gone down in all the seven major FBI categories 
where community policing has been deployed; in the city of Houston which 
had a 17 percent drop in crime in 1 year, because when people are there 
in force, it prevents crimes from occurring in the first place. So 
that's an important part of this.
    Another part of the crime bill gives States funds to establish 
innovative programs for kids when they get in trouble before they do 
shoot somebody, to try to get them back into the mainstream of life. 
After all, a lot of these young people who get in terrible trouble are 
not really bad people. They have no structure, no order. They cannot 
imagine the future. There are no rules that bind them in internally to 
the things the rest of us take for granted. And we've got to try to get 
as many of them back as we can before they do something terrible which 
will require us to put them away for a long time.
    We do have to deal with these things. And we need to pass a crime 
bill this year. These Members of Congress can do it. There are still 
people who are holding them back, and you need to urge them on. And I'll 
guarantee you, I'll sign it as quick as they'll put it on my desk. We 
have to do it.
    But the second thing I want to say to you is that we need a national 
law to do what New Jersey has done here with the assault weapons. Again 
because we have a constitutional right to travel in this country. New 
Jersey can make a big dent in New Jersey's problems by abandoning these 
weapons here and then by setting up a system to try to collect them, but 
people are still crossing the State line all the time.
    We need national legislation. There are several bills in the 
Congress and arguments about which one is better than which other one, 
but

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I will guarantee you they are all better than nothing. And the Congress 
should pass one of those bills and send it to me this year. It would be 
a great Christmas present to the American people to stand up for safety.
    Finally, let me just say that each of us in our own way are going to 
ask ourselves what we can do to deal with this. We have a culture of 
violence. We glorify it. I was delighted to see some of the television 
networks voluntarily say that they were going to do their best to try to 
monitor the content of violence and reduce it and degradation of people 
during prime time television.
    We have got to take a whole generation of young people who have very 
short attention spans for whom the future has no claim because they 
cannot even imagine the future, and slowly, carefully, and one-on-one, 
neighborhood by neighborhood, community by community, help them to 
rebuild the kind of inner strength and sense of values and discipline 
and control and hope that will permit us to go where we need to go. No 
law will do that, but that is not an excuse not to pass these laws.
    So I ask you today, here in this great place, let us recommit 
ourselves to keeping what's right about the health care system and to 
expand the reach of what is right when we can, with universal coverage, 
by giving pharmaceutical products to the elderly who are not poor enough 
to be on Medicaid but are on Medicare and the working people whose 
children may need it. Let us do that.
    And let us have the courage to admit that some of these problems we 
will never fix until we change our ways as a Nation, and let's start 
with violence, begin with guns, and prove that we can do in America what 
you are doing here in New Jersey. Thank you and God bless you all.

Note: The President spoke at 3:41 p.m. in the Atrium. In his remarks, he 
referred to Mayor Jim Cahill of New Brunswick; Sheriff Armando Fontura 
of Essex County; Harvey A. Holzberg, president and chief executive 
officer, and Dr. Jeffrey Hammond, chief, trauma surgery and critical 
care, Robert Wood Johnson Hospital; and Patricia Jones, mother of a 
patient with a gunshot wound.