[Public Papers of the Presidents of the United States: William J. Clinton (1993, Book II)]
[October 21, 1993]
[Pages 1783-1791]
[From the U.S. Government Publishing Office www.gpo.gov]



Remarks to the Conference of Business for Social Responsibility
October 21, 1993

    Thank you very much, Helen and Arnold. The crowd would have clapped 
even more for you if they'd known what you were going to say before you 
said it. They were terrific, I thought. I have a great deal of 
admiration for them and for their companies and for this organization. I 
want to point out before I get into my remarks that I have two people 
here I'd like to acknowledge first: the Director of the Small Business 
Administration and one of the strongest supporters of our health care 
reform program, Mr. Erskine Bowles from North Carolina, who is here. And 
I believe a former board member of yours and the current Director of the 
Women's Bureau at Labor, Karen Nussbaum, is here.
    I believe the purpose of politics is to help the American people 
live up to the fullest of their God-given potential and to help them to 
live together in strength and harmony and to fulfill their 
responsibilities as well as their dreams. That obligation can be met in 
different ways in different times. But plainly, there are some times in 
the history of a nation in which that obligation can only be met by the 
willingness to undertake the rigors of profound change. And I believe 
this is such a time.
    The problem is that in any democracy you can only build a consensus 
for profound change when things have gotten pretty well off track. And 
by the time things have gotten pretty well off track, there are an awful 
lot of people who are unhappy and insecure and uncertain. And if you 
look around this audience at the companies here represented who have 
believed you could actually make money and be socially responsible, that 
you could actually be more productive by taking care of the people with 
whom you work and the people who are your customers, you see the intense 
dilemma we face, because people are most able to change when they are 
most secure. And yet, at large, it becomes possible for society to make 
these big changes often only when things have gotten so far off track 
that people are insecure. That, in a nutshell, is the larger dilemma 
that I face as your President today, but more importantly, that we face 
as a people.
    If you look at the conditions that so many millions of our country 
men and women face, many are insecure in their jobs. Many are insecure 
in their ability to get new jobs, in their education levels, in their 
skill levels. Many, many millions are insecure in their health care. 
Many are insecure as children in the way they are

[[Page 1784]]

growing up. And lamentably, at the end of the cold war, the wars that 
are being waged on so many streets in America have made millions of 
people insecure in their daily lives and movements.
    And yet, we have no alternative. We have to change. We have to make 
economic policy changes. We have to make all kinds of real, significant 
different directions. And yet we live at a time of such insecurity that 
people distrust their institutions, their elected leaders, and even 
their own impulses sometimes when it comes to make these changes.
    I saw that in trying to pass a budget which did some remarkable 
things: It reduced the deficit dramatically. It's given us the lowest 
long-term interest rates in 30 years. It had the most significant reform 
in the tax structure for working people in 20 years by saying to people 
with children who spend 40 hours in the work force, you won't be in 
poverty. No matter how low your job wage is, the tax system will lift 
you out of poverty, not put you into poverty. It opened the doors of 
college education to all Americans by expanding eligibility for college 
loans and lowering interest rates and making the repayment terms easier 
and tied to the incomes of young people when they get out of college--
much of which the American people never even knew while it was going on 
because it was so easy to whip people up into a white heat about the 
word ``taxes'' and because people couldn't believe anyone would really 
do anything seriously to deal with this issue of the deficit and these 
other matters.
    I see it now as I try to pass the North American Free Trade 
Agreement through the Congress. And that agreement has become the 
repository and the symbol of all the accumulated resentments of our 
people for the 1980's, of all the people who lost their jobs and all the 
plants that moved overseas and all the times that all the workers in 
this country saw that their executives were getting pay raises 4 times 
in percentage terms what they were, 3 times what the profits were going 
up; that they could lose their health care in an instant; that they 
could have to start over in a moment; and that no one cared about them 
anymore. So they associate that with expanded global trade.
    So we know rationally that the only way a rich country ever grows 
richer is to expand its trade. And we know that wealthy countries all 
over the world, in Europe, in Japan, not just in the United States, are 
having great difficulty creating new jobs. And the only way to do that 
is to make more markets beyond the borders of the nation. And yet still, 
emotionally there is this enormous undertow rooted in the insecurities, 
the pain, the sense of loss, the disorientation, the feeling that nobody 
really looks out for me and my family.
    And so we are in so many ways, on so many fronts, my fellow 
Americans, waging a war between hope and fear: on the streets of our 
cities, in our factories and workplaces, in our homes, indeed, in the 
hearts of perhaps a majority of our fellow country men and women. And 
each of us in our own way, we have a little scale inside ourselves. When 
I don't get enough sleep, I'm more pessimistic than I am when I get more 
sleep, right? You're probably like that. And I'm more optimistic. And 
the scales are always going up and down, even in our own lives, aren't 
they, inside, about how we look at the world and how we see reality.
    This is a time when we must be bold, when we must be confident, in 
which we must have the kind of enthusiasm you exhibited when we came 
into this room, with a sense of possibility. We need more young people 
like the young man from the hotel who met me outside, who said, ``Keep 
breaking those paradigms, Mr. President.'' [Laughter] I loved it.
    But I say to you, one of the reasons that I'm so happy to see this 
organization growing and large and vibrant and vigorous is that you have 
found a way to make people feel more secure by changing by changing. You 
have found a way to live by the rhetoric of my last campaign, Putting 
People First. Putting people first.
    I believe that one of the biggest problems that this country always 
has is trying to close the gap between what we say and what we do. I am 
ecstatic and honored to be here. But I want to take a few moments today 
to talk to you about that, how to right that balance inside every 
American so that hope wins out over fear; how to pursue an agenda of 
security so that we can pursue our agenda of change; and how, in so many 
profound ways, health care is right at the core of that. Because I am 
convinced that you have proved that the future of the American private 
sector, the real triumph of free enterprise, will be in proving that we 
can actually do right by our employees, do right by our customers, and 
do right by our bottom lines if we are enlightened and we do the right 
things.

[[Page 1785]]

    I believe that we have set ourselves up over the last 20 years with 
a whole series of false choices that may work in the short run, but in 
the end ultimately disappoint everyone. If we have to erode the fabric 
of family life in America by not giving our workers health care and not 
providing family leave and not providing adequate child care, ultimately 
you wind up with less productive workers. If we can't find a way to 
create new jobs even as we increase productivity, then for the first 
time in all of human history we will have given up on technology as a 
job creator and given in to the age-old fears that it is a job 
destroyer. To be sure, it's always transferred jobs. We used to have 
half the people working on the farm; now only 3 percent do. But it can 
be either, or.
    All these are questions we are dealing with. So is every other 
nation in the world now. We are going through a period of change. We 
can't see the ultimate end of it. No one knows what all these economic 
trends in the global economy will ultimately lead to, but we know what 
works. You know what works; you do it. And I came in here today as a 
friend and an ally to ask you to engage in this health care debate and 
tell the American people that this is something we have to do not 
because it is morally right--but it is morally right--but because it's 
also economically right.
    The most expensive alternative of all, looking toward the future, is 
doing nothing. It's the most expensive financially, and it's the most 
expensive in human terms, and ultimately it will be the biggest drag on 
American productivity. It also is, as Helen said in her remarks, 
guaranteed to provoke the largest amount of resentment because of the 
uneven impact of the health care system on employees and employers and 
American citizens today, depending on whether you have coverage, what 
kind of coverage you have, and how much you're paying for somebody 
else's health care because we have so much uncompensated care in this 
system.
    Now, I have watched as I have seen the Congress come to grips with 
many things and try to overcome even their own disbelief. When I took 
office, most people had been told that the country couldn't afford the 
family leave bill. But we did it, and the wheel hasn't run off. And I 
have seen the impact of that. A lot of you have heard me tell this 
story, but I had a family in the White House the other day with a dying 
child on one of these Make-A-Wish programs, that the child wanted to see 
the White House and the President. And the father told me that his 
daughter was probably not going to make it and that the time he'd spent 
with her was the most important time he'd ever spent, and if it hadn't 
been for the family leave law he would have had to choose between losing 
his job to be with his daughter and therefore doing wrong by his wife 
and his other two children, or keeping his job and letting someone else 
spend that precious time with his child. Now, I don't know about you, 
but I think that fellow is going to be a much better worker for that 
company than he would have been had that not been the law of the land.
    So we now, I think, have a chance to keep going with this engine of 
change. And we've got a lot of things we need to do on the security 
front and the change front. We've got a world of economic changes we 
need to make, but we're going to have to have--if there's no more job 
security in this America because most people when they lose their jobs 
don't get it back anymore, totally the reverse of unemployment patterns 
of the last 60 years, we have to give employment security to Americans. 
If there's no job security there has to be employment security. 
Therefore, we have to have a whole different system of lifetime 
education and training. And we have to undertake that. We'll begin to do 
that next year. A big part of welfare reform will be doing that, making 
sure people really have the capacity to move from welfare to work.
    We have to provide more security for families. That's what the 
family leave bill was all about. That's what the earned-income tax 
credit in the budget bill was all about, lifting the working poor out of 
poverty so there will never be an incentive to be on welfare and there 
will always be an incentive to be both a good parent and a good worker.
    We have to find more security for people on their streets and in 
their homes and in their schools. That's why I so desperately want to do 
something to reduce the number of automatic weapons that are in the 
hands of teenagers on the streets of the city, assault weapons.
    But we also have to do something about health security. You know, 
Hillary and I got 700,000 letters before I made my health care speech to 
Congress and she began to testify. And we're getting them in now at 
about 10,000 letters a week, more. Story after story after

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story: the small business that had the premium go up 40 percent a year 
with no claims; the business person who has to cut his or her employees 
back to a policy with a $2,500 or $3,000 deductible even though the 
employee average salary is $22,000, $23,000 a year; the person who is 
physically disabled but who has a fine mind who can't get a job because 
the only available employers are small businesses and they don't have 
any kind of community rating, so this person will drive the premiums out 
of sight; a person with the HIV virus who may have another 10 years of 
productive life, strong, productive life and contributions to be made, 
who is either not employed now and therefore won't be employed, or can't 
ever change jobs because of the job lock provisions of the present 
system; the hospitals that are out there, struggling to do a good job on 
modest profits, or not-for-profit hospitals who can't meet their 
uncompensated care burden or those that do by raising everybody else's 
hospital costs in ways that undermine confidence of those that pay those 
bills in the integrity of the system; the doctors who talk to me about 
how, yes, their fees have gone up a lot in the 1980's, but 10 years ago 
they took 75 percent of what they earned home, and now it's down to 52 
percent, and all the rest of it has vanished in the sea of paperwork 
because they have to hassle 300 insurance companies with thousands of 
different policies to make sure they've crossed every ``t'' and dotted 
every ``i'' to get the payment they're entitled to anyway; the stories, 
over and over again, mounting up in every part of our country.
    As you know, we spend more on health care than anybody in the world, 
and yet we do less with it. Now, how would you feel if you were running 
your business, competing with people all across the country and perhaps 
all across the world for jobs and incomes, if you had to spend 14 
percent of your revenues covering only 86 percent of your market and all 
your competitors spent 8 or 9 percent of their revenues and covered 100 
percent of their market? You don't have to be as bright as a tree full 
of owls to figure out that eventually there would be some adverse 
consequence to that. But we go on blithely as if that's the way it has 
to be. And when I propose a change, some people say, ``Oh my God, we 
can't afford that. Look at this wonderful thing we've got going.''
    Now, we have in many ways the best health care system in the world. 
But we have in other ways the worst financed and organized health care 
system in the world for a country as rich as we. Otherwise, how can you 
explain the fact that we are plainly the capital of pharmaceuticals in 
the world in terms of developing new drugs and manufacturing them right 
here in America and we have the third worst immunization rate in this 
hemisphere, behind Haiti and Bolivia--I mean, ahead of them, but only 
ahead of them. You tell me why that happened. If we're so great, how 
have we permitted ourselves to go on year-in and year-out not closing 
that gap?
    Do we have the best health care in the world, the doctors and 
nurses, the hospitals, the medical research, the technology? You bet we 
do. For people who access it, it is good. And do those people resent the 
burdens that are imposed on them by this crazy-quilt system? You bet 
they do. Some of the strongest advocates for change we've had are from 
doctors who are sick and tired of having to hire one more person every 
year because of the clerical administrative burdens of this system.
    People say, ``Aw, this system the President's proposed is so 
complex.'' I get tickled; it's complex compared to what? It's complex 
compared to zero. It's simple compared to what we have now. What is the 
proper standard by which you evaluate this?
    If we do nothing to change the current course on which we have 
embarked, we'll be spending 19 percent of our income on health care by 
the year 2000. We will have a smaller percentage of our population 
covered with health insurance than we have today, because we have about 
100,000 Americans a month permanently losing health insurance, 2 million 
every month losing it but 100,000 permanently losing it. And by the year 
2000, instead of the gap being 4.5 percent to 5.5 percent between our 
major competitors, of our income, it'll be about 7 percent. Today, we 
spend 14.5 percent of our income on health care. Canada's at 10; Germany 
and Japan are just under 9. There is no measurable difference in the 
health outcomes.
    Now, to be perfectly fair, there are two elements of our cost system 
that will always, at least for the foreseeable future, keep us above 
other countries. One is, we do rely more and we invest more in 
groundbreaking technologies and pharmaceuticals, and we should continue 
to do that. And we all want them for ourselves and our family if there's 
a chance it will prolong our lives.

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    The second issue is sadder. We are quite simply, as compared with 
other wealthy countries, more willing to endure a far higher rate of 
violence. We have far higher rates of AIDS. We have far higher rates of 
teenaged mothers and out-of-wedlock births and low birth-weight babies, 
and they're far more likely to cost more. So we have system-related 
costs that are greater than our competitors. And that's about half the 
gap between us and them. But the other half is our own fault. And if we 
don't get about the business of closing it, we're going to have a 
difficult time competing. And we're going to have an increasingly 
difficult time explaining why it is we are prepared to put up with a 
system that no one else on earth tolerates and to pay the human and 
economic cost of maintaining it.
    Today I'd like to focus on two of the issues that have been raised 
by some people in the business community against our proposal. Some say 
that we propose to create a new bureaucracy by creating these health 
alliances, and we shouldn't do that. I say what we propose to do is to 
have a smaller rate of cost increases through increased competition and 
greater efficiency and reduce waste by giving small businesses the same 
bargaining power that big business and Government has today.
    If you look at the Federal employees' health insurance program, for 
example, because of the power we have to bargain and because everybody 
knows the Federal Government is up to its ears in debt and doesn't have 
a lot of money, you look at what's happened to the rates on most of the 
Federal health insurance policies: very modest increases this year. Look 
at the California public employee system: huge people in that block, a 
big block of buyers, and everybody knows California is in bad shape 
financially, so they have a rate increase this year that's right at the 
rate of inflation.
    Small business, however, has seen its rates go up at 2 and 3 times 
the rate of inflation. Why? No bargaining power. In small groups, one 
person gets real sick, explodes the rate structure for everybody. So 
what these alliances do, quite simply, is to say if you're in a firm 
with fewer than 5,000 employees, we will give you the option, the 
opportunity, to be in a big buying group. And in the course of that, we 
will give your employees the option of having more choices than you can 
probably provide for them now in health care, but none of them will cost 
you any more than you would otherwise pay as an employer.
    This will give smaller businesses and self-employed people access to 
market economics. Market economics is beginning to work in health care, 
that and all the Cain I think we've been raising the last year or so. 
It's beginning to work. The aggregate increases are beginning to slow 
some. But they're finding, again, as Helen said in the opening remarks, 
it's very uneven. You might have health care inflation at 7 percent this 
year or 6 percent, but you'll still have a lot of small businesses with 
30 percent premium increases. Why? No market power.
    So when you hear all this stuff that these alliances are big 
bureaucratic nightmares and Government creations, that's not true. The 
alliances are groups of consumers in each State in groups approved by 
the State, not by the Federal Government, that will have buying power 
presently available to governments and to big business but not to small 
business and often not even to medium-sized business. I think it will 
work.
    I also believe in order to make it work we have to have insurance 
companies that compete not on the basis of which company is most adept 
at excluding people who have problems but on the basis of cost and 
quality. Now, to be fair to the insurance companies, you can only do 
that if there is a community rating system, if you don't have all the 
risk factors calculated into every individual purchaser of insurance. If 
you do that, you have nailed small business from the get-go, the people 
that are creating most of the new jobs in this country.
    If you have a community rating system, who gets hurt, from the 
present system, who pays more? Young, single, healthy people will pay 
more, about anywhere from $6 to $8 a month more for their premiums under 
our estimate. They will, but it's fair. You know why? Because under our 
system all the young people without insurance will get insurance and 
because if they're young and healthy, they'll be middle-aged like me 
someday, and they'll get the benefit of this system. The society will be 
stronger. And it will be far better for the big job generators of the 
country, the small businesses who don't have access to health insurance 
now.
    It also will be fairer because with community rating, you will 
enable people to effectively move from job to job to job. Then you can 
say, without breaking a company, that you can't

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deny someone the right to coverage when they change jobs. Under the 
present system that would be really tough, to say that you can't deny 
the coverage to someone who may be the best-qualified person you want to 
hire, but they have a disability which will raise the premiums of you 
and all your employees, your other employees, by 20 percent under the 
present system. That happened. We met a couple in Columbus, Ohio, that 
had one child with a birth defect. They were insured through the wife's 
community nonprofit, 20-employee group. And in order to keep that family 
on the rolls and keep that woman working for that business, they were 
going to have to raise their premiums, just the employees, every 
employee by another $200 a year, just the employees; the business by 
thousands of dollars a year. That wouldn't happen if we have community 
rating. And you could have free flow of workers from job to job to job, 
something that's quite important since we live in a time when the 
average worker will change jobs six or seven times in a lifetime.
    Finally, and again this is a matter of some controversy in this, we 
believe that if you put everybody in these competitive size groups, then 
the businesses and the employees will be able to bargain for better 
prices: and they will go up far less than they've been going up. We also 
believe there should be some backup cap on how much business could be 
required to pay in any given years until we get this system up and 
going, and we know it is, that there ought to be some ultimate budgetary 
discipline in the system.
    Now, a lot of people say, ``Well, that's Government regulation of 
health care.'' What they really are saying is this is Government 
regulation of costs that might work, because it will include the public 
sector and the private sector. We now strictly regulate the price of 
particular services under Medicare and Medicaid. Do you know how much 
the last budget increased Medicare and Medicaid? We reduced defense; 
we've got domestic discretionary spending flat at a time when we ought 
to be investing more in education and training, in converting from a 
defense to a domestic economy. But Medicare, will go up 11 percent next 
year, Medicaid 16 percent. Why? Paying more for the same health care, 
that's why, more and more and more and more procedures. You have to have 
aggregate discipline in this system if you're going to slow the rate of 
increase.
    I personally don't think the budgetary ceiling in our bill will ever 
be reached because if you give everybody the kind of competitive power 
that big business and Government have today, I think the cost increases 
will be much lower than we project them to be, and so do most of the 
business people I know who have worked on this plan and looked at the 
cost structure from the bottom up. But I don't think it's fair to say 
that this is some heavy-handed grab to control the private sector in 
health care and hurt research in the pharmaceutical industry or anyplace 
else.
    Keep in mind, we have been so conservative or liberal, depending on 
how you look at it, in our budget estimates. Well, you tell me when I 
tell you the fact: This plan that we put in estimates that we will go to 
17 percent of income spent on health care by the year 2000, as opposed 
to 19. And it actually will be more than 17, about 17.5 percent. I don't 
think that's so hot for the economy, either. And I think if we had real 
competition for quality and service, and if we continue to cover more 
primary and preventive services, we could do much better than that.
    So it's not as if we propose to drive folks into poverty. All these 
people who are complaining about the ceilings that would be on the rate 
of increase, the health insurers and others, they're going to get 17.5 
percent of our income instead of 14.5 percent by the year 2000. And they 
think it might not be enough for them to get along on.
    I just want to make that clear. You need to understand when you hear 
all this, about how the Government's regulating this, what we did was 
put a big old ceiling there in case the costs continue to shoot up even 
after we give everybody bargaining power. The essence of this is a 
competitive system for price and quality. And I think it will work.
    The second issue is whether or not we have to have universal 
coverage and whether that's bad for business, to require each business 
to shoulder some responsibility and each employee not covered now to at 
least pay some of the income of the employee to get the health care.
    Now, here are the options. And here's how we came out with basically 
taking what we've got. We've got a system in America today that's 
basically an employer-based system. And when the employers are big 
enough or they're joined with enough others to have market-based power,

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the system works pretty well. They're beginning to moderate the rate of 
cost increases, and there are some very good health care plans out there 
which provide comprehensive benefits at affordable cost. Sometimes the 
employees don't pay anything, sometimes they pay something, but 
basically the systems work pretty well, and most employees are pretty 
satisfied with it.
    The options are the following: If you want universal coverage, you 
could go to the Canadian system--the problem is that no one I know 
thinks you could pass that in Congress--which means you basically 
replace all the health insurance sector of the country with a tax. 
That's simpler on administrative costs, but since Canada is the second 
most expensive system, if you put the politicians instead of the people 
in charge of negotiating for their health care, it may not work out so 
well. So we rejected that alternative.
    Then there are those who say, ``Well, you ought to put the mandate 
on the employee; let the employee buy it. Make it like car insurance.'' 
The problem with that is, if you look at what they offer the employees, 
it's not very good. And it may encourage a total deterioration of the 
present system we have for those who presently have benefits where the 
costs are shared by employers and employees.
    Then there are those who say, ``Well, what we ought to do is give 
small businesses the right to get this market power, and the competition 
will lower the rate of cost, and say that no one can be denied coverage. 
And when you have more competition the price will go down, and everybody 
who doesn't have insurance who's got a job will be able to buy it. So 
we'll just see if it happens.'' The problem with that is that our 
experience with that is not very good. And what we know is that most 
employers and employees who have health insurance today are paying too 
much for it because they're paying for the uncompensated care that 
others get. And if you want to moderate the rate of increase on 
individual businesses' and employees' health care, you've got to make 
sure that everybody who accesses the system pays what they can afford to 
pay for the privilege of doing that. If you continue to have significant 
cost shifting here, then there will be continued irresponsibility in the 
system, which will have real uneven impacts on businesses.
    In other words, most everybody in the country today who's got a good 
health insurance plan is paying too much for it, because they're also 
paying for the uncompensated care of people who always get care but they 
get it when it's too late and too expensive. They show up at the 
emergency room with appendicitis or whatever, instead of ever going in 
for basic checkups and basic preventive mechanisms.
    So I personally don't think we'll ever get costs under control, nor 
do I ever think we'll be the society we ought to be, nor do I ever think 
we'll have the kind of personal security we need until everybody has 
health insurance. And if you don't have universal coverage, this idea 
that people are going to be able to move from job to job to job and 
always have it is just false. And I cannot tell you what it is doing to 
the families of this country who are worrying about it. It is having a 
devastating impact on the capacity of millions of people to function 
well in their jobs.
    Mr. Hiatt made a very eloquent statement before I came up. When he 
came to our economic summit in Little Rock last December, he was then 
famous at having led the way on child care for his employees, and he 
made the following statement. He said if you do right by your employees, 
you, quote, contribute to a workplace that attracts good people and 
retains them, thereby reducing turnover. Good business.
    Then there is one other issue I want to deal with on this universal 
coverage, and that is, a lot of people say it's not fair to ask 
employers to make some contribution to their part-time employees, that 
the taxpayers ought to pay for that. We think if there's a part-time 
employee that works at least 10 hours a week, a pro rata contribution 
should be made, a third of the total payment that would otherwise be 
owed, not a total contribution. And the rest will be made up from the 
monies we propose to raise.
    Now, that can be done. Starbucks Coffee's doing pretty well, and 
they take care of their part-time workers as well as their full-time 
workers. And there are others who do that. What we want to do is to make 
that more economical for everyone who will do it.
    Finally, let me say it also makes it affordable. The way we propose 
to pay for this plan, two-thirds of the money would come from premiums 
paid by employers and employees. But we know we're going to have to give 
discounts to small businesses with very low-wage employers, because we 
don't want to put people out of busi-


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ness. And we know the Government has to cover the unemployed uninsured. 
How will we get the money for that? Essentially from three sources: one, 
raising the cigarette tax by 75 cents a pack and asking the large 
employers who opt out of the system, as they can, to make the 
contribution they would make if they were in the system to medical 
research and to the network of public health care clinics that we will 
have to maintain anyway. That's another thing I want to tell you, that 
this plan increases the quality of health care. We're going to increase 
medical research, increase the reach of health clinics. That's the 
second source of money. The third source of money is in the savings we 
will achieve in the Medicare and Medicaid programs, by putting Medicaid 
patients, for example, into the same kind of consumer cooperative buying 
power that those of you who are small and medium-sized businesses will 
get by going into the alliance, and by drastically simplifying the 
paperwork of the system. So that's how it will be paid for.
    I want to say again, there are these two elements. The health 
alliances will contribute to competition and to market-based forces 
getting into the health care system in a good way. It won't be a big new 
Government bureaucracy. The requirement of universal coverage will help 
to stop cost shifting and make health care security a reality and permit 
workers to know that even if they lose a given job, they'll be able to 
go on as employees. It will, in other words, give that level of personal 
security necessary for the American people to think about what our trade 
policy ought to be, what our investment policy ought to be, what our 
economic strategy ought to be for the 21st century, and to make the 
changes necessary to get that done.
    And I ask you here to think about the influence that you can have on 
your Members of Congress, without regard to party. This ought to be an 
American issue. It ought to be a matter of not only the heart but of 
hard-headed economics. If we don't, if we don't ask everybody to assume 
some responsibility--and we're not talking about breaking the bank. For 
a small firm with an average wage of $10,000, for example, the cost 
would be less than $1 a day per employee for the health care plan 
because of the discount system.
    We understand the fragility of the economy in many points. But if we 
don't face this now, we are not going to get a hold of the health care 
cost spiral. We are not going to get a hold of the fact that 100,000 
Americans are losing their health insurance a month. We are not going to 
get a hold of the fact that a lot of these costs just involve our paying 
more for the same health care every year. We get nothing for it. We're 
spending a dime on the dollar more than any other country on sheer 
paperwork, 10 cents on the dollar that nobody else in the world pays.
    So I would say to you it is time for us to say everybody ought to be 
responsible and pay something for this health care system, because we 
all have access to it. And when we really need it, we all get it. And 
it's just wrong for some people to pay for others who can pay something 
for themselves.
    And we ought to allow the small businesses of this country and the 
self-employed people of this country and the medium-sized businesses in 
this country to have the same benefit of market power that only 
Government and big business have today. It isn't fair. That's what these 
alliances do. They are not Government entities, they are private sector 
entities that we're going to put the Medicaid patients in so they can 
have the benefit of that, too.
    Now, that is the kind of thing that we need to do. That is the sort 
of security that we need to achieve, to build into the fabric of 
American life the peace of mind and the sense of fairness and justice 
that enables people to go home at night and look their children in the 
face and think they're doing a pretty good job by them, and that enables 
them to have the kind of personal security that will permit people like 
you to lead this country to make the economic changes that will enable 
this country to do what it needs to do as we move toward the 21st 
century, to keep the American dream alive, to keep this country as the 
foremost country in the world, to enable all of our children to live up 
to their God-given capacity.
    This is just one of those times when we have to decide whether we're 
going to close the gap between our rhetoric and our reality. Desperately 
I hope that 30 years from now people will look back on this time just 
the way we look back on 60 years ago when there was no Social Security. 
Now we take it for granted. We think it was an easy fight; it actually 
wasn't. It took them a couple of years and a little blood on the floor 
in the Congress to get it done. And this may take a while to get done. 
It doesn't

[[Page 1791]]

need to take 2 years, I'll tell you that.

    You think about it, Truman, Eisenhower, Kennedy, Johnson, and Nixon 
all followed Roosevelt, and all of them tried to get universal coverage. 
Richard Nixon proposed an employer mandate. Senator Bob Packwood from 
Oregon, still in the United States Senate, introduced it for him. And 
we've been fooling around with this now for decades. Meanwhile, we just 
keep paying more for less. We ought to be paying less for more. That's 
what you do. That's why most of you are doing very well, because you 
have provided more for less. Why should you be stuck with a health care 
system that does the reverse?

    I ask you to please, please engage yourself in this debate. Examine 
this plan. When the book comes out, go over it. If you've got a good 
idea, give it to us. But don't walk away from the plain obligation to 
have every American family with the security of health care and the 
plain need to let the small business people in this country and the 
self-employed people in this country and the middle-size business in 
this country have the same bargaining power in this system that big 
business and Government do.

    And most of all, remind the Members of the Congress that there are 
times when doing the right thing morally and ethically is also good 
business, that we can make money if we make our workers more secure and 
whole. When they go home at night and look at their families over the 
dinner table and they know they've done right by them, then America will 
be on its way to having the courage and the security to seize the next 
century and keep the American dream alive.

    Thank you, and God bless you all.

Note: The President spoke at 11 a.m. at the Grand Hyatt Washington 
Hotel. In his remarks, he referred to Helen Mills, CEO of the Mills 
Group and Soap Box Trading Co., and Arnold Hiatt, CEO of the Stride-Rite 
Foundation.