[Public Papers of the Presidents of the United States: William J. Clinton (1994, Book I)]
[April 8, 1994]
[Pages 638-643]
[From the U.S. Government Publishing Office www.gpo.gov]



Remarks at a Rally for Health Care Reform in Minneapolis, Minnesota
April 8, 1994

    Wow! What a crowd. Thank you for coming this morning. Thank you for 
supporting health care. I want to thank Mary Ellen for that wonderful 
speech. She really left nothing for me to say. But she and the nurses of 
Minnesota have my undying gratitude for this wonderful rally and for 
their commitment to your health care and to the future of American 
health care. I want to thank Senator Wellstone and Congressman Sabo, 
who's done a wonderful job in his new leadership position, helping us to 
get a budget through that will drive down the deficit and still increase 
investment in the things that help America to grow and prosper. I thank 
you, Mayor Sayles, for being here. And I want to thank the others in the 
audience who are good friends and supporters of mine, especially 
Congressman Bruce Vento, who is also a strong supporter of health care 
reform; your secretary of state, Joan Crowe; your State treasurer, Mike 
McGrath; my good friend Skip Humphrey, your attorney general; and the 
Mayor of St. Paul, Norm Coleman. Thank you all for being here. I also 
couldn't come to Minneapolis today without saying a special word of 
gratitude for the extraordinary service being rendered to the United 
States of America under what you now know are difficult circumstances by 
our Ambassador to Japan, Vice President Fritz Mondale.
    I am honored to be here today under the sponsorship of the nurses of 
Minnesota. I thank them for doing this. I also want to say that

[[Page 639]]

I'm very grateful for the people from Heightman Properties, who made it 
possible for us to meet inside instead of outside today. At least for 
me, it's not springtime yet. The remarks that Mary Ellen made in 
introducing me speak more eloquently than I ever could to what millions 
of American nurses know are the facts of life in health care in this 
country.
    I ran for President because I thought that Washington had become a 
place where there was too much rhetoric and too little reality, where 
every statement that every person made was automatically pushed to its 
ultimate extreme: ``The Government can do nothing; you're on your own,'' 
or ``The Government can do everything; there's nothing for you to do.'' 
But real people and real life want us to come together as a people and 
figure out how to deal with our problems and seize our opportunities. 
And we have done our best there, in other words, to give the care to 
America's public life that the nurses of Minnesota give to their 
patients every day.
    If you look at what's happened in the last year, there has been a 
pretty big change in the way things work in Washington. For a dozen 
years people talked about the deficit, and the national debt tripled. 
Well, last year this Congress, working with me, adopted a budget that 
brought the deficits down, interest rates down, has helped to create 2.5 
million new jobs in this economy, more than were created in the previous 
4 years. We're on the way.
    The Congress is on a record pace to adopt a new budget which, if it 
is adopted, will eliminate 100 Government programs, cut 200 others but 
increase spending in education, in Head Start, in defense conversion, in 
the new technologies for the 21st century, in educating and training our 
people, and give us the first 3 years of declining Government deficits 
since Harry S. Truman was the President of the United States of America.
    Already this year, the Congress has passed an education bill called 
Goals 2000 which for the very first time in the history of this country 
establishes national standards for world-class education and promotes 
the kind of grassroots reforms that Minnesotans have been experimenting 
with for a decade to see that we meet those standards everywhere in the 
country for all of our children.
    And when the Congress comes back, they will take up a bill designed 
to help all the young people who don't go to college to at least get a 
year or two of further training after high school so they, too, can have 
good jobs and good skills in the global economy. And they will take up a 
bill that will completely reorder the unemployment system to make it a 
reemployment system, because people often don't get the job they lose 
back anymore; they have to find new jobs. And now, from the first day an 
American is unemployed, he or she should be eligible from day one for 
new training and new job search and new opportunities. We're going to 
change that unemployment system this year.
    The Congress will take up a crime bill designed to make us not only 
tough but smart, for a change, with crime. It puts another 100,000 
police officers on the street in community policing in models that have 
proven--proven--effective at lowering the crime rate. It takes 28 kinds 
of assault weapons off the streets and out of the hands of gangs. And if 
we do it the right way instead of the wrong way, the Congress will pass 
a bill increasing penalties for violent offenders so that we recognize 
that a relatively small number of our fellow citizens create a very high 
percentage of the seriously violent crimes. We have more people behind 
bars, as a percentage of our population, than any country in the world, 
and yet we continue to let the wrong people out from time to time. It's 
time we found alternatives to imprisonment for young people and kept the 
people behind bars who should stay there. We can do that if we do it 
intelligently.
    Now, why is this happening? It's happening partly because people 
like Paul Wellstone and Martin Sabo and Bruce Vento last year were 
willing to risk their political necks to make tough decisions, to stop 
talking about problems and start doing something about them. But it's 
happening also because the American people say, ``Look, we are tired of 
gridlock. We are tired of paralysis. We are tired of rhetoric over 
reality. We want you all in Washington to conduct your business the way 
we conduct our business at home: identify the problems, identify the 
opportunities, seize the opportunities, and beat back the problems. Show 
up for work every day.'' It's pretty simple what our strategy is: get 
people together, get things done, move the country forward, give people 
the chance to live up to their potential.
    And now we are being called upon to face one of the greatest 
challenges of this age. For

[[Page 640]]

decades and decades, the American people have been denied something that 
every other advanced country provides to its citizens, the security of 
knowing that they have good health care that is always there. Every 
other country with which we compete with an advanced economy has solved 
this problem. Only the United States, time after time after time after 
time, has found it impossible to do. For 60 years, whenever we came to 
the point when it looked like we could deal with the health care 
problems, at times when it was much simpler than it is today, when the 
money at stake was much lower than is at stake today, always, always 
fear overcame hope, entrenched interest overcame the public interest. 
Today I can tell you that we are going to make 1994 different. We can 
provide health security for all Americans this year, and I believe that 
we will.
    My fellow Americans, in Washington this may look like a partisan 
issue, but out here on Main Street it isn't. Democrats and Republicans 
and independents all get sick. They all lose their jobs. They all lose 
their health insurance. There are 39 million Americans who don't have 
any health insurance now for a whole year. In any given year there are 
58 million Americans at some time during the year, more than one in 5 of 
us, who will be without health insurance.
    There are 81 million of us, more than one in 4, who are in families 
where we've had someone with what the insurance companies call a 
preexisting condition, a child with diabetes, a mother with breast 
cancer, a father who had a premature heart attack, people who have to 
continue working but who either can't get insurance, pay more than they 
should, or can never change the job they're in because someone in their 
family has been sick.
    There are 133 million Americans who have lifetime limits on their 
insurance policies, so if, God forbid, they should give birth to a child 
with a serious illness they could run out of health care at the very 
time they need it the most.
    There are people who change jobs in an era when--look at all these 
young people in this audience today--the average 18-year-old will change 
work seven or eight times in a lifetime. And yet it is usual in America 
for people to have to wait months and months and months to get health 
insurance coverage.
    The good people of Minnesota know we can do better. You know that if 
there is a Mayo Clinic which can provide world-class health care at 
lower cost than many Americans pay for something which at least you 
could say is not better and they wish were as good, we can do better. 
You know that there is no reason in the wide world to permit Americans 
to be in this condition, to permit most Americans--those who don't work 
for secure big companies or the Government, I don't care who they are, 
are just an illness or an economic failure away from losing their health 
care.
    And we now have an economy in which we're desperately trying to 
preserve life in rural America, and more and more and more, there are no 
doctors in rural America. I was in rural North Carolina the other day, 
and I met a woman physician who told me she had worked for months on end 
over 100 hours a week. And she was now in her slow season where she was 
down to 80 hours a week because there are no doctors. We know we can do 
better than that. We know we can.
    So the question is, why haven't we done it? Well, there are a lot of 
people who don't trust the Government in America to do anything. They 
think we'd mess up a one-car parade. [Laughter] And frankly, from time 
to time, I've been in that crowd, and so have you. We do not propose--
there's not a single solitary proposal in the Congress that would have 
the Government take over the health care providers of this country. And 
don't you believe that. We've got the best doctors, the best nurses, the 
best health care providers, the best medical research, the best medical 
technology in the world. What we also have is the absolutely worst 
financing system for health care in the world. It is the way it is 
financed that is killing us.
    For all the people who tell you that if we reform health care it 
will make it more bureaucratic, let me just ask you, go talk to one 
doctor and ask a doctor how much time the people in his or her clinic 
spend on the telephone to insurance companies talking to employees who 
don't know a lick about health care, trying to get approval for a 
procedure which is obvious and clear. Ask a nurse, ask any trained nurse 
who works in a clinic or a hospital how much time he or she spends 
filling out paper instead of taking care of patients because of the 
system we have.
    It is conservatively estimated that we spend at least a dime on a 
dollar more on the administrative cost of health care than any other 
nation

[[Page 641]]

in the world. That is $90 billion we spend, because we have 1,500 
separate companies doing insurance plus the Government doing Medicare 
for the elderly and Medicaid for the poor, writing thousands and 
thousands of different policies, insuring zillions of small groups of 
people, finding out--with all these hundreds of thousands of 
paperworkers in insurance companies and hospitals and in clinics--who's 
not qualified, who's not covered, what you can and can't reimburse for. 
Nobody else does this.
    So we can't figure out how to cover all of our people, how to give 
people job security through health care security when we know they're 
going to have to change jobs. But we can figure out how to spend $90 
billion to hire people for the very frustrating work of second-guessing 
every decision the doctor and nurse makes and pushing paper around all 
day long. It is wrong, and we can do better.
    You heard Senator Wellstone say so eloquently that what we have to 
do is provide coverage for all Americans. He favors a single-payer 
system; I favor guaranteed insurance. You can argue it flat around, 
depending on the experience of the two main models we have, Canada and 
Germany. But I'll tell you one thing, both of them have lower 
administrative costs, less paperwork, more freedom to practice medicine, 
more efficiency, and people have health care.
    People should have insurance that they can never lose, not when they 
change jobs, not when they get sick, not when they're self-employed, and 
not when they get older. And they should have insurance that provides 
the right to choose their health care providers. I get tickled when 
these people attack all of us that are trying to change the health care 
system. They say, ``Oh, they're going to ration health care.'' ``Oh, 
they're going to take your choices away.'' My fellow Americans, more 
than half the people in America today who are insured in the workplace 
don't have a choice about their health care plan or their doctor. Ninety 
percent of the businesses that are providing health insurance who have 
25 employees or less have no choice. And to be fair to them and to the 
insurance companies, they can't afford it under the present system. 
They're doing the very best they can under the present system. It is not 
a bunch of evildoers out there trying to keep people sick and insecure; 
it is a badly broken system. That is what is wrong, and we can do 
better.
    Under our proposal, every American family, every year--every year--
would have access to at least three choices. You could have access to an 
HMO of your choice or a professional provider organization of your 
choice or the right to choose your own doctor and continue fee-for-
service medicine or the right to have a guaranteed health managed plan 
and still have the right to opt out when you want it for a specialist of 
your choice or your own doctor. Everybody would have those choices. And 
they would all be more affordable for most Americans than what they're 
stuck with now. We can do that if we had a system that was rational.
    Choice is important, but you can't get there unless you change the 
rules of health care finance. If you want to have a system that works, 
you can't have people denied coverage or charged more because of 
preexisting conditions. What difference does it make? I have a stake as 
an American citizen in seeing you as a successful, effective worker, 
able to change jobs, able to grow in your job even if, God forbid, your 
spouse should get cancer or your kid should have a serious illness. That 
is my interest in your future. We all share that.
    Insurance used to be that way. Everybody threw in; everybody paid; 
the risk was broadly spread. We can't have waiting periods anymore 
before there's coverage. We shouldn't have lifetime limits. We shouldn't 
deny coverage to people who need it most. And we shouldn't deny coverage 
by charging more for older people rather than younger people.
    Let me tell you, we live in a world today where people are going to 
be losing their jobs well into their fifties and sixties and still have 
to find new jobs. I met a 59-year-old man the other day who worked for 
over 30 years in the defense industry, and because of the end of the 
cold war and the reduction of defense spending--which virtually all of 
us support and thank God for the opportunity to have a more peaceful 
world--this good man lost his job. He had to find a new job; he needed 
retraining. He was, thankfully, hired by a hospital for a rewarding job. 
But there are lots of people like him who will not be hired because the 
small businesses who could hire them, who know they're reliable workers 
because they're older, they're settled, they're experienced, also know 
that they will drive up their health insurance premiums because of their 
age. We do not need that; we cannot afford that.

[[Page 642]]

    We have a bizarre system in this country when, because of certain 
training and other problems, a lot of young people are discriminated 
against in the job market. They're told, ``Well, you've got to have 
experience before we hire you.'' How do you ever get experience if you 
don't get a job? And then you have a lot of older people who don't get 
hired because even though they've got worlds of experience, their 
insurance is too high. We can overcome both of those things.
    Another big problem for insurance is that small businesses and self-
employed people pay, on average, 35 percent more than larger businesses 
and governments do because they have no bargaining power. So we have to 
reform that, too. We have to go back to what is called community rating, 
old-fashioned insurance, put people in big pools, spread the risk 
broadly, let us all share that. And then small businesses and self-
employed people have to have the right to band together in buying co-ops 
so that they can get the same deal that those of us who work for the 
Federal Government do. I want for you what I've got and what we take for 
granted in Washington.
    Now, there are a lot of people who say it's not fair to require all 
employers and employees to contribute to their own health care if they 
don't do it now. They say they can't afford it. But let me just remind 
you of this: When people in this country get real sick, they do get 
health care. It's too late; it's too expensive; they show up at the 
emergency room, then they pass the cost along to all the rest of us and 
our health care bills go up. What about the small businesses all over 
this country who are in competition with other small businesses? They 
cover their employees, and their competitors don't.
    Nine of ten Americans who have health insurance that is private get 
it at work. Eight in ten Americans who don't have any health insurance 
at all are in working families. I think everybody should do their part, 
and I know we can do it without hurting small business. Our plan has 
discounts for small businesses, recognizing that not all can afford to 
pay as much as others. We know that that happens. Our plan gives 100 
percent deductibility for self-employed people. Did you know that if 
you're self-employed in this country today, you can't deduct the entire 
cost of your health policy, but if you work for somebody else, you can? 
That's crazy. We fix that. We are not going to hurt small business; 
we're going to help small business by controlling the exploding cost of 
health care and giving people a chance to get affordable health 
insurance.
    And finally, let me say, I saw this up here on the--one of the 
wonderful signs. Our plan protects and preserves Medicare, but it also 
provides a prescription drug benefit and long-term care benefits to 
elderly people. And that is also very important. Let me tell you, folks, 
the fastest growing group of Americans are people over 80. The fastest 
growing group of Americans are people over 80. Many of them are bright, 
active, and vigorous. They don't want to be forced into a nursing home 
just because they may not be able to get along all on their own. We 
ought to reward their children who are willing to care for them at home 
and help them to get some respite care, help them to deal with these 
crises. We ought to reward the community providers who are willing to 
help elderly people stay in their communities.
    And there is ample evidence that providing help for prescription 
medicine will save money immediately in the health care system by 
reducing hospitalization, especially for elderly people but also for the 
nonelderly, and strong evidence based on population trends that over the 
long run we are going to have to do something to help people deal with 
this long-term care crisis within the family and within the community. 
We cannot afford only to have nursing homes as an option, even though we 
need them where they are appropriate. We have to think of other things 
as well.
    Now, I have been, in the last week, in North Carolina doing a health 
care forum in which I talked to people about health care and crime and 
other issues in Virginia and Tennessee and in Texas. Then yesterday I 
was down in Kansas City, and we talked to people in Kansas, Missouri, 
Oklahoma. And I'm here tonight to do one of these. Let me tell you what 
I find. I find that people really would like to know more about all 
these programs. They'd like to know honestly what the problems are. They 
know that there are tough decisions to be made. If this were an easy 
issue, somebody would have done it already and said, ``Hey, vote for me. 
I solved this problem.'' This is a hard problem. That's why it's been 
pushed to the back.
    But I think you hired me to deal with the hard problems. So we're 
trying to deal with them. And what I want to ask you today, all

[[Page 643]]

of you here, these fine nurses who have endorsed what we're trying to do 
and all the rest of you, tell the Members of your congressional 
delegation to tone down the rhetoric and open their hearts and their 
eyes and their ears and listen and talk and explain this thing and work 
through the problems. And don't use this as yet another opportunity to 
take a proposal and push it to the ideological extremes, forgetting all 
about the reality of the tens of millions of people's lives that are at 
stake here. I plead with you.
    Your wonderful State has been very good to me, from the time I came 
here in the primary when I just had a handful of friends, all the way 
through the general election. You've been wonderful to my wife when 
she's been out here on her health care crusade. You have been good to 
us, and I thank you for that.
    But I ask you, tell the Members of your congressional delegation, 
without regard to their party, that you want this dealt with and you 
want it done now. We know enough; we know as much as we're ever going to 
know. And the longer we put it off, the worse it's going to be. It's 
going to be like an ingrown toenail. [Laughter] It will not get better. 
This is a part of our growing and maturing as a nation, deal with the 
problems while we can deal with them, don't just let them get worse and 
worse and worse.
    This is an opportunity for us to come together across regional and 
racial and income and party lines to do something that is good for 
America. All of our jobs are at stake, all of our health care at stake, 
our children are at stake, our parents are at stake. This need not be an 
issue that divides us.
    But we are going to have to have a clear message from the American 
people that it will not be tolerated to do nothing, to walk away, to be 
divided, to have hot air, to turn it into a political issue. Tell the 
American people. Tell the Congress you want us to act and act now.
    Thank you, and God bless you all. Thank you.

Note: The President spoke at 12:25 p.m. in the Crystal Courtyard at the 
IDS Tower. In his remarks, he referred to Mary Ellen Imdieke, president, 
Minnesota Nurses Association, and Mayor Sharon Sayles Belton of 
Minneapolis.