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



[[Page 1761]]


Remarks to the National Breast Cancer Coalition
October 18, 1993

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

[[Page 1762]]

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

[[Page 1763]]

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

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