[Public Papers of the Presidents of the United States: William J. Clinton (1994, Book I)]
[March 23, 1994]
[Pages 537-541]
[From the U.S. Government Publishing Office www.gpo.gov]



Remarks to Health Care Providers
March 23, 1994

    Thank you very much. It's a great honor for the Vice President and 
Mrs. Gore and for Hillary and me to have all of you here today. I want 
to especially thank Dr. Haggerty for his moving account, and Marva Wade 
for having the courage not only to tell us the story of her work but the 
story of her family, and Sister Bernice Coreil for her stout-hearted 
defense of our continuing efforts. I was sitting there thinking when she 
was speaking, I wonder how many nuns have ever given a speech and quoted 
Machiavelli? Well, I suppose he was a Catholic. [Laughter] And he 
certainly was right about a lot of things.
    I want to say to all of you how important it is for us to have you 
here to validate our

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common efforts because of your work, your life, and your experience. 
We've been seeking out a lot of that lately. Hillary and I went to 
Florida the first of the week and met with thousands of senior citizens, 
some of whom had been frightened by claims that we were trying to do 
something to Medicare instead of to protect Medicare and to extend its 
benefits to prescription medicine and to long-term care options in the 
home and in the community.
    I met yesterday with a very, very moving group of a couple of 
hundred small business people, and 12 or 13 of them talked. About half 
of them, by the way, in endorsing our program, acknowledged that they 
would pay more if our plan passed, but for the first time they'd be able 
to insure all their employees instead of just a few of them and insure 
them with good benefits. And for a change their competitors would be on 
an even field with them because they would have to do the same thing, 
and they'd all make out all right.
    This morning I met by teleconference with the California Medical 
Association, the biggest affiliate of the AMA in the country, and they 
were extremely supportive of this plan and what we are trying to do. And 
of course, now I'm meeting with you. And along the way, I have had 
encounters with people that we didn't plan that have made the same 
points all of you have made.
    I was in Florida, and as I often do when I'm traveling, I agree to 
meet with children who are part of the Make-A-Wish network around the 
country, desperately ill children. And I met a family with two boys with 
a rare form of cancer which they believe must be genetically related 
because both their sons have it. And they have a daughter who is the 
youngest child and who has not yet been diagnosed, and we all hope she 
won't be. But this family was living in mortal terror because they had a 
lifetime limit on their insurance policy, and they thought, well, maybe 
one of their sons would become an adult. They're both surviving and 
maintaining it, but if they have good success with the treatment and 
both the boys are able to live and go on and do well, they'll certainly 
outrun their lifetime limits while the younger son is still at home and 
needing care.
    I was in Columbus, Ohio, the other day campaigning for our crime 
bill, and I stopped in a delicatessen where the owner of the 
delicatessen, who wound up being one of our small business people here 
yesterday by the way, came to me and said, ``I am in the worst of all 
worlds. I have 20 employees that are full-time, 20 that are part-time. I 
had cancer 5 years ago. I'm about to be declared cancer free. Because of 
my preexisting conditions, our deductibles went up, our copay went up, 
our premium went up. But I still cover my 20 employees. I'm proud of 
that because it's the right thing to do, but I'm at a competitive 
disadvantage to everybody who doesn't, and I feel guilty that I don't 
cover my part-time employees.''
    So I hear these stories always. And those of you who are on the 
frontlines of medical care must wonder from time to time when you hear 
people make these speeches or you see these television ads, what planet 
they came from--[laughter]--because it's so inconsistent with the 
personal experience you've had.
    Hillary and I have gone to extraordinary lengths to try to get 
people to look at this anew. We even made our own Harry and Louise ad 
for the national press the other day. Someone said after it was over, 
``Have you no shame left?'' And I said, ``Not very much after the last 
year.'' [Laughter]
    The purpose of all of this to me is to give the American people who 
are looking at this from their own perspective, as every person should, 
a sense of how the real world operates, how incredibly complex and 
counterproductive the present financing system is, how it encourages 
people like you to spend more time on paperwork instead of patient care, 
and how it leaves millions of our fellow citizens rife with insecurity 
that they either are going to lose their health insurance or have it 
priced out of their reach, or that the policy they have doesn't cover 
something they need.
    What we are genuinely trying to do, in good faith and with the 
consultation of thousands of people like you all across the country, is 
to fix what's wrong with this system and keep what's right. We believe 
we have to have guaranteed insurance for all Americans. Otherwise we'll 
never have security for all Americans; we'll never be able to have a 
rational system; we'll never stop all the cost-shifting; but most 
important of all, we'll never do the right thing.
    And we think that guaranteed insurance should cover comprehensive 
benefits that include primary and preventive care, that include 
prescription medicine, that builds in mental health coverage. And we 
think over the long

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run these things will give us a more cost-efficient system and a much 
healthier and happier and more secure country and a more productive 
American work force.
    We believe in order to have the kind of system we need, we have to 
find a way to capitalize on the managed competition and those 
competitive forces that we've seen taking root in health care over the 
last couple of years, but to do it in a way that preserves rather than 
undermines people's choices of providers and therefore the quality of 
our health care system.
    Fewer and fewer Americans have choice in their health care system 
today. I was glad to hear somebody mention that earlier. I hear all 
these things, saying, well, if you vote for the President's plan, you 
will lose your choices. The truth is that more than half of the 
employers who are carrying insurance for their employees today provide 
less than two or more choices. In other words, fewer than half of them 
say to their employees, here's two choices, here's three, here's more 
choices, you make a decision. Under our plan, people would be able to 
choose not just once but every year a fee-for-service approach, a 
network plan, or a network plan that has a point-of-service option so 
they could always decide that they wanted to go outside the plan and get 
other health care. And if they chose that option, the employer would 
still be obliged to pay his or her portion of the cost of care.
    In other words, we'll have more competition, we'll have more managed 
care, but we'll have more choice. And the choice will be made by the 
patients, the people who are going to get the care, based on an informed 
set of information. And they'll be able to make the choice anew every 
year. I think that is very, very important.
    The next thing we want to do is to have real insurance reform. That 
means that we're going to have to have an end to the preexisting 
condition problems that you all know very well. People cannot be denied 
coverage or have their rates raised just because someone in their family 
has been sick. We should have an end to the lifetime limits policy. And 
we should not charge older people more than younger people for their 
health insurance.
    Let me say there are sound economic reasons quite apart from health 
care to do this. The average American 18-year-old's going to change work 
eight times in a lifetime. We are now regularly seeing people in their 
sixties lose their old job and have to find a new job. We are up here 
this year, this administration is, trying to redesign the entire 
unemployment system of the country to make it a continuous reemployment 
system. What good is that if for reasons having nothing to do with your 
family's health condition or your own age, you lose your job, and then 
you can't get another one with health insurance because your child's 
been sick or because you happen to be over 60 years old? This is a very 
serious issue.
    We also have to find ways for small business people and self-
employed people to buy the kind of good insurance that people like me 
who work for the Government have or people who work for big companies 
have, at the same competitive prices. So you want a break for small 
business and the self-employed to get what the rest of us take for 
granted.
    And we have to have broadbased community rating. I will say this, 
you cannot expect the insurance industry under the present circumstance 
to provide these services, because a lot of the smaller companies will 
absolutely go broke. They cannot afford community rating. They cannot 
disregard these things because we're all insured in tiny little groups 
where a lot of those folks have to make money, a lot of money on a few 
people. The only way we can do this in a way that is fair and humane and 
practical is to have each other insured in ways that permit the 
insurance folks to make money the way grocery stores do, a little bit of 
money on a lot of people where you spread the risk. And that is what we 
are trying to do. It is what we must do.
    And we have to change the system. It is no good just railing against 
something that will not work economically. We can change it and make it 
work economically. I simply refuse to believe, by the way, that we are 
the only advanced country in the world that can't figure out how to do 
this. It's like being told--every time I see one of these ads saying, 
``We can't do this; we can't do this; we don't need to do this,'' I feel 
like someone telling me right now, not as President but as an American 
citizen, that there is some inherent defect in my country and we're all 
just consumed with the dummies and we can't figure out how to do this. 
That's not true. If we have the will to do it, we can do it. And people 
who really care about the quality of care, like you, know we can do it. 
We can

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do it, and we can still preserve Medicare. We can preserve the things 
that work, and we can do it.
    I think we ought to do it at work. I think that people ought to be 
insured at work who are working. Eighty percent of the uninsured people 
in America today have someone in their family with a job. So the 
simplest, clearest, least bureaucratically, least threatening way to do 
this is to extend the requirement that employers should pay for a 
portion of their employees' insurance; the employee should pay for a 
portion of that as well. Yes, we have a very vital small business job 
market. Interestingly enough, most of the job-creating small businesses 
in this country provide insurance for their employees right now.
    Just this week, to give you another personal story, Hillary and I 
had a family staying with us here from our home State, where the man is 
in the car business, has been for 20 years. He said, ``You know, I've 
always thought about what a competitive disadvantage I face because I've 
always covered all my employees in my automobile place and none of my 
competitors ever had. And I just moaned about it all the time. And then 
I realized, I'm in business after 20 years and doing better than I ever 
have, and three of my competitors have gone broke even though they 
didn't cover their employees and I did. And it's because I've still got 
the same people working for me that started with me 20 years ago, taking 
care of our customers, doing a good job, providing quality service and a 
good product.''
    There is a real lesson there. We cannot let people who always tell 
us about the problems beat this thing and make it worse. Yes, there are 
problems. You name me a problem that's not going to get worse if we do 
nothing. If we do nothing, next year we'll have more uninsured people 
than we had this year. If we do nothing, next year we'll have more cost-
shifting than we do this year. If we do nothing, next year we'll have 
more families with Marva stories than we do this year. If we do nothing, 
you as doctors and nurses will face more restrictions on your practice 
than you have this year. Isn't that right? If we do nothing, the 
patients that you deal with will have fewer choices than they do this 
year. If we do nothing, all the competitive forces will allow some 
bigger businesses and government to get a better deal next year, but the 
consequence of that will be, there will be more financial trouble for 
hospitals than there are this year.
    Everything we're complaining about this year will get worse if the 
people who tell us that we can't do anything because there are problems 
with anything we want to do prevail. The only certainty is the problems 
will be aggravated if we put this off another year.
    So if you believe in these principles, let me say this: We need to 
take it out to the American people and tell them what we're trying to 
do. Let me tell you--this is the most interesting thing I've read 
recently--that wouldn't be too hard. A couple of weeks ago, the Wall 
Street Journal, which is hardly the house organ of the Clinton 
administration, conducted a little forum, and they explained our health 
care program to some citizens of York, Pennsylvania, without telling 
them anything about our plan. It turned out that the great majority of 
the group thought everything about our plan was great. But they didn't 
like our plan very much because of what they had heard on the paid ads, 
and they'd heard organized groups were against it. Then when they told 
them what was in it, they thought it was peachy.
    What does that mean? Well, it means that we need people like you to 
go out and talk about the basic principles. Of course there's a 
congressional process; of course there have to be amendments made; of 
course we have to work through this the way all laws are made. But it is 
very, very important that the Congress understands that you, as people 
who have put your lives, your heart and soul into health care, are for 
this, and that the people with whom you work, the people who are the 
patients of America, want it to be done.
    Congress will go on recess soon, but democracy won't go on recess. 
It will pick up because the people will go out and talk to their 
Congressmen and Senators. So I implore you, as we look at this Easter 
recess, go tell your patients, your colleagues, your friends, your 
neighbors, and most important, your Senators and Representatives that 
the time to do this is now, that delaying it will make it just like a 
hangnail or an ingrown toenail; it's just going to get worse.
    And one of the things--it's almost like sometimes when a country has 
to face these big problems--it's like when you're trying to raise your 
kids, sooner or later you have to get across to people that when you've 
got a big problem, you

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might as well deal with it, because if you delay it, it will just get 
worse.
    We have this momentous opportunity. Machiavelli was right, there is 
nothing so difficult as to change the established order of things. But 
remember this, if it hadn't happened over and over and over again since 
he wrote that, there would be no civilized society, and America would 
not be the oldest democracy on the face of the Earth. We can do this, 
and with your help, we will.
    Thank you, and God bless you all.

Note: The President spoke at 3:14 p.m. on the South Lawn at the White 
House. In his remarks, he referred to Jesse C. Haggerty III, M.D., 
chairman and program director of a family medicine residency program, 
Topeka, KS; Marva Wade, R.N., president-elect, New York State Nurses 
Association, New York, NY; Sister Bernice Coreil, D.C., senior vice 
president, system integration, Daughters of Charity National Health 
System, St. Louis, MO.