[Public Papers of the Presidents of the United States: William J. Clinton (1993, Book II)]
[October 27, 1993]
[Pages 1830-1834]
[From the U.S. Government Publishing Office www.gpo.gov]



Remarks on Presenting Proposed Health Care Reform Legislation to the 
Congress
October 27, 1993

    Thank you very much. Thank you, Mr. Speaker, Senator Mitchell, 
Senator Dole, Congressman Gephardt, Congressman Michel. To all the 
distinguished Members of the Congress from both Houses and both parties 
who are here today, I thank you for your presence and your continuing 
interest. I thank you for giving Hillary and me the opportunity to come 
here to Statuary Hall.
    This has been a remarkable process. I can never remember a time in 
which so many Members of Congress from both parties and both Houses had 
so consistent and abiding commitment to finding an answer to a problem 
that has eluded the country and the Congress for a very long time. I 
want to thank the hundreds, indeed thousands, of people who have worked 
on this process which has led to the bill. I want to thank the literally 
hundreds of Members of Congress who attended the health care university 
recently, an astonishing act of outreach by a bipartisan majority of the 
United States Congress to try to just come to grips with the enormous 
complexity and challenge of this issue.
    I believe the ``Health Security Act,'' which I am here to deliver, 
holds the promise of a new era of security for every American and is an 
important building block in trying to restore the kind of self-
confidence that our country needs to face the future, to embrace the 
changes of the global economy, and to turn our Nation around. A nation 
which does not guarantee all of its people health care security at a 
time when the average 18-year-old will change jobs eight times in a 
lifetime and when the global economy is emerging in patterns yet to be 
defined can hardly have the confidence it needs to proceed forward. If 
our Nation does that, I believe we will do as we approach the 21st 
century what we have always done: We will find a way to adapt to the 
changes of this time; we will find a way to compete and win; we will 
find a way to make strength out of all of our diversity.
    This legislation, therefore, literally holds the key to a new era 
for our economy, an era in which we can get our health care costs under 
control, free our businesses to compete better in the global economy, 
and make sure that the men and women who show up for work every day are 
more productive because they're more secure and they feel that they can 
do two important jobs at once: be good members of their family, be good 
parents and good children, as

[[Page 1831]]

well as good workers.
    This is a test for all of us, a test of whether the leaders of this 
country can serve the people who sent us here and can actually take 
action on an issue that, as tough and complex as it is, is still 
absolutely central to moving us forward. And it is a test that I believe 
we can all pass. And so I have today just one simple request: I ask that 
before the Congress finishes its work next year, you pass and I sign a 
bill that will actually guarantee health security to every citizen of 
this great country of ours.
    The plan that we present today, as embodied in this book as well as 
the bill, is very specific, it is very detailed, and it is very 
responsible. And though we will debate many points, and we should debate 
many points, let me just make clear to you the central element of this 
plan that is most important to me: It guarantees every single American a 
comprehensive package of health benefits. And that, to me, is the most 
important thing, a comprehensive package of health care benefits that 
are always there and that can never be taken away. That is the bill I 
want to sign. That is my bottom line. I will not support or sign a bill 
that does not meet that criteria. That is what we owe the American 
people.
    Now, as we enter this debate, which I very much look forward to, I 
ask that we keep some things in mind. First of all, when we debate 
something that the administration recommends or something some of you 
recommend and it seems bewildering in its complexity, I ask that it be 
compared against what we have now, because none of us could devise a 
system more complex, more burdensome, more administratively costly than 
the one we have now. Let us all judge ourselves against, after all, what 
it is we are attempting to change.
    Secondly, I ask that we follow the admonition that Senator Dole laid 
for us: Let us all ask ourselves as clearly as we can, who wins, who 
loses, why is the society better off, and how much does it cost or save? 
And if we know, let us say. And if we don't know, let us frankly admit 
that we may not know the answer to every question.
    We have gotten in a lot of trouble as a nation, I think--and I see 
Senator Domenici, one of our great budget experts, nodding his head--
pretending that we could know the answer to some things that we don't 
know the answer to. We have tried to be as conservative as we could here 
in making sure that we have not overclaimed for cost savings or 
overestimated how small the cost of things will be. Therefore, I think 
we have, in our plan, put more money in than it will cost to implement 
this plan, but better to be wrong on that side than the other side. We 
have really worked hard here. And I think we must all do that.
    Thirdly, I think we should all say what are the principles that 
animate this debate. For us, the principles are simple. They're the ones 
I outlined in my address to Congress, but let me briefly state them 
again. They are: security, over and above everything; simplicity, the 
system we create must be simpler than the one we have; savings, we 
cannot continue to spend for what we have 40 percent more than any other 
country and much more than that over and above what our major 
competitors, Germany and Japan, spend to cover fewer people; quality, we 
must not ask any American to give up the quality of health care; choice, 
people have to have choice in the private system of health care. Our 
plan would provide more choices to most Americans and fewer choices to 
none. And there must be responsibility. To pretend that we can control 
the costs and take this system where it ought to go without asking more 
Americans to assume more personal responsibility is not realistic. We 
have too many costs in our system that are the direct result of personal 
decisions made by the American people that lead to rampant inflation 
based on personal irresponsibility. And we have to tell the American 
people that and be willing to honestly and forthrightly debate it.
    Now, our plan guarantees comprehensive benefits and focuses on 
keeping people healthy as well as treating them when they're sick by 
providing primary and preventive care. It reduces paperwork by 
simplifying the forms that have to be dealt with by doctors, by 
hospitals, by people with insurance. And that's important. Every one of 
us can agree on at least this: that the paperwork in this system costs 
at least a dime on the dollar more than any of our major competitors 
pay. We must deal with this. That's a dime on a dollar in a $900 billion 
health care system. We can't justify that. It has nothing to do with 
keeping people well or helping them when they are sick. We have to crack 
down on fraud. We know our system today is so complex we waste tens of 
billions of dollars in fraudulent medical expenses that we can change. 
We ought to help small and medium-


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sized businesses, self-employed people, and family farmers to have 
access to the same market power in holding their costs down that big 
business and Government have today.
    I agree with Senator Dole or whoever it was that said this term 
``alliance'' sounds foreboding, but an alliance is basically a group of 
small and medium-sized businesses and self-employed people and farmers 
designed to give them the same bargaining power in the health care 
market that only the Government and big business has today. We must do 
that. We cannot expect people to be at that kind of disadvantage, 
especially since many of them are creating most of the new jobs for the 
American economy.
    We should, and we do, protect our cherished right to choose our 
doctors. Indeed, we try to increase choices for most Americans. Most 
workers insured in the workplace have now not very many choices about 
what kind of health care they receive; only about one in three have 
choices. Under our plan, all workers would have more choices in the kind 
of health care they receive without charging their employers more for 
the workers having the option to make that choice.
    We preserve and strengthen Medicare. We give small businesses a 
discount on the cost of insurance. We invest more in medical research 
and high-quality care. We must never sacrifice that. That's something we 
want America to spend more on than any other country. We get something 
for it. It's an important part of our economy and an important part of 
our security. We should continue to do that.
    Our plan rejects broad-based taxes but does ask everyone not paying 
into the system, that is still there for them when they need it, to pay 
in accordance with their ability to pay. Two-thirds of the funds that 
finance this entire system come from asking people who can access the 
system today, who have money but don't pay a nickel for it, to pay their 
fair share. And I think we ought to do that. It's not right for people 
to avoid their responsibility and then access the system that the rest 
of the American people pay for. And they pay too much because too many 
people don't pay anything at all.
    So these are the fundamental elements of our plan, of this bill. But 
above all, it guarantees true health care security. It means if you lose 
your job, you're covered; if you move, you're covered; if you leave your 
job to start a small business, you're covered. It means if you or a 
member of your family gets sick, you're covered, even if it's a life-
threatening illness. It means if you develop a long-term illness, 
because you will be in broad-based community rating systems, you will 
still be able to work. It means that the disabled community in America, 
full of people, millions of them, who could be in the work force today, 
will now be able to work and contribute and earn money and pay taxes 
because they will be in a health care system that will not burden their 
employers or put their employers at undue risk.
    That's what security means. It means that we will, in other words, 
be able to make the most of the potential of every working American who 
wishes to work during the time they can work. It is a huge, huge 
economic benefit in that sense. Every nation with which we compete has 
achieved this. Only the United States has failed to do so. We are now 
going to be given the chance to do it. And I think we must, and I think 
we will.
    I want to reiterate what I have said so many times. I have no pride 
of authorship, nor do I wish this to be a partisan endeavor or victory. 
We have tried to draw on the best ideas put forth over the last 60 years 
by both Democrats and Republicans. This bill reflects the sense of 
responsibility that President Roosevelt tried to put forward when he 
asked that the Social Security program include health care. It reflects 
the vision of Harry Truman, the first President to put forward a plan 
for national health care reform. It reflects the pragmatic approach that 
President Nixon took in 1972 when he asked all American employers to 
take responsibility for providing health care for their employees. It 
embodies the ideas, the commitment of generations of congressional 
leaders who fought to build a health care system that honors our 
Nation's responsibilities and who have tried to learn, too, how we might 
use the mechanisms of the marketplace and the competition forces that 
have helped us in so many other areas to work in the health care arena.
    This is a uniquely American solution. It builds on the existing 
private sector system. It responds to market forces. It attempts to do 
what I think we should all be asking ourselves whether we're doing: It 
attempts to fix what's wrong and keep what's right. And that ought to be 
our guiding star, all of us, as we enter this debate.
    I think by guaranteeing comprehensive benefits and high quality and 
allowing most people

[[Page 1833]]

to get their coverage the way they do now, leaving important personal 
decisions about health care where they belong, between patients and 
doctors, we have done what we can to keep what is right. I think by 
asking people who don't pay now to be responsible, by simplifying the 
system, by cracking down on fraud, by making sure we minimize 
regulation, we are taking a long step toward doing what is necessary to 
fix what is wrong, to improve quality and hold down costs.
    All of the alternatives that will be debated, I ask only what I have 
already said: Let us measure ourselves against the present system and 
the cost of doing nothing. Let us honestly compare our ideas with one 
another and ask who wins, who loses, and how much does it cost. And let 
us see whether we are meeting the guiding principles which ought to 
drive this process.
    But when it is over, we must have achieved comprehensive health care 
security for all Americans, or the endeavor will not have been worth the 
effort. That is what we owe the American people. And let me say again, 
the most expensive thing we can do is nothing. The present system we 
have is the most complex, the most bureaucratic, the most mind-boggling 
system imposed on any people on the face of the Earth. The present 
system we have has the highest rate of inflation with the lowest rate of 
return. The present system we have is hemorrhaging, losing 100,000 
people a month permanently from the health insurance system; 2 million 
people every month newly become uninsured, the rest of them get it back. 
They are never secure. The present system we have has an indefinable 
impact on workers in the workplace, wondering what will happen if they 
lose their health insurance. What does that do to their productivity, to 
their self-confidence, to their family life? The present system we have 
is eating up the wage increases that would otherwise flow to millions of 
American workers every year because money has to go to pay more for the 
same health care. The present system we have, I would remind you, my 
fellow Democrats and Republicans, is largely responsible for the impasse 
we had over the last budget and the fights we had.
    Look what we did. We diminished defense as much as we should, and 
some of us are worried about whether we did a little more than we 
should. We froze domestic spending, discretionary spending, for 5 years, 
when all of us know we should be spending more in certain investment 
areas to help us convert from a defense to a domestic economy and put 
people back to work in our cities and our distressed urban areas. We 
froze it. We raised a good bit of taxes. And even though over 99 percent 
of the money came from people at the highest income group, nobody in 
this Congress wanted to raise as much money as we did. Why? Because we 
passed a budget after doing all of that in which Medicaid is going up at 
16 percent a year next year, declining to an increase of 11 percent a 
year in the 5th year; Medicare is going up at 11 percent a year next 
year, declining to 9 percent a year in the 5th year of our budget.
    That's why we did that. We could have had a bipartisan solution, 
lickety-split, giving the American people a plan that would have reduced 
the deficit and increased investment in putting the American people back 
to work if we were not choking on a health care system that is not 
working.
    Now, I don't know about you, but I don't ever want us to go through 
that again. That is not good for the Congress; it is not good for the 
country; it is not good for the public interest. And the most important 
thing is we can't give the American people what they need. They want to 
be rewarded for their work. They want to know if they're asked to go 
back to school, if they're asked to embrace the challenges of expanded 
trade, if they're asked to compete and win in a global marketplace, that 
if they do what they're supposed to do, they'll be rewarded. They want 
to know that they can be good parents and good workers. They want to 
know if they get sick but they're still healthy enough to work, they 
won't have to quit because of the insurance system. They want to know if 
they're disabled physically or if they have had a bout with mental 
illness or they've dealt with any other thing that can be managed, that 
they can still be productive citizens. And the bizarre thing is that we 
could do all this and still have a system that is more efficient and 
wastes less than the one we've got.

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    So I ask you, let's start with this bill and start with this plan 
and give the American people what they deserve: comprehensive, universal 
coverage. That's what we got hired to do, to solve the problems of the 
people and to take this country into the 21st century.
    Thank you very much.

Note: The President spoke at approximately 11:25 a.m. in Statuary Hall 
at the Capitol.