    [Public Papers of the Presidents of the United States: William J. Clinton (1994, Book II)]
    [August 10, 1994]
    [Pages 1455-1458]
    [From the U.S. Government Publishing Office www.gpo.gov]

    [[Page 1455]]

    Remarks on Health Care Legislation and an Exchange With Reporters
    August 10, 1994

        The President. I'd like to make a brief statement and then ask
    Governor Waihee and Mr. Bowles to say a thing or two.
        This is a very important week for our country. You know, it's the
    first time in our history that we've ever had a debate on the floor of
    either House of the Congress on the question of health care coverage for
    all Americans. Something that in other advanced nations people take for
    granted, we've never even been able to debate on the floor of our
    Congress. And I'm very hopeful that in both Houses they'll be able to
    work out enough of a consensus to pass a bill that will enable us to go
    to conference and come out and ultimately have legislation that does
    provide universal coverage.
        We wanted to ask you here today to talk about Hawaii for a couple of
    reasons, first of all because so much of this debate--I think way too
    much--has turned on the question of the requirement that employers share
    the cost of buying private insurance with their employees. And a lot of
    very dramatic claims, dire claims have been made about that. Hawaii has
    been doing it for 20 years. It works. Businesses have thrived. Jobs have
    not been lost. And the most important thing is that you can see that in
    addition to having lower costs for small business premiums, the closer
    you get to full coverage, the closer you get to the other goals of
    health care: cost control, better health care outcomes. These are the
    things, it seems to me, that cannot be refuted by the people on the
    other side of this argument.
        What it ultimately boils down to is they're saying, ``Well, we have
    this evidence in Hawaii,'' or ``We have evidence in Germany, but we
    don't want to deal with it. We still don't want to pay.'' And it just
    seems to me that--there's another issue I want to bring up that I keep
    talking about that's very important. Health coverage for people under 65
    has dropped from 88 to 83 percent in the last 10 years. There are 5
    million Americans today who had coverage 5 years ago who don't have it
    today. Almost all of them are working people and their children. I do
    not think that Congress ought to send a message to the country that it
    is fine with us if this deplorable development continues, if we just see
    a continuing erosion of the health care system in America, more and more
    people without coverage.
        So I'm looking forward to the week and next week and the months
    ahead in the hopes that we can really get something done. And I think
    that this example of Hawaii is important because it is not refutable; it
    actually happened. And it's not like Germany; they can't say, ``Well, it
    didn't happen here.'' It actually happened in the United States.

    [At this point, the President called on Gov. John Waihee of Hawaii and
    Small Business Administrator Erskine Bowles, and each made brief
    remarks.]

    Health Care Legislation

        Q. Mr. President, the employer mandate aside, there seems to be an
    increasing frustration among some members of the business community
    about the way the health care reform bills are shaping up on Capitol
    Hill. Specifically, there are concerns that employers may lose control
    of ability to negotiate with insurance companies and, therefore, control
    their costs. This is directed specifically at the Mitchell bill,
    although they have problems with the Gephardt bill as well. Are there
    some changes that you would be willing to accept to meet some of the
    concerns being expressed now by the business community?
        The President. I hope they'll get in there and make these concerns
    known in the whole debate.
        My bottom line is what it has always been. I think we have to have a
    system that, over a period of time, will lead to universal coverage,
    because I do not believe, number one, that you can do right by the
    American people without it, and number two, that you can achieve the
    other goals we have, which are cost control--cost containment, maybe, is
    a better word--and better health care. Those are my principal goals.
        There are a lot of members of the business community that I would
    urge to get into this debate with both feet. One of the reasons that the
    bills are in the position that they're in today is that the people who
    were against this from the beginning and wanted to wreck it over the

    [[Page 1456]]

    mandate were out there focused like a laser beam on beating it. I think
    one of them was quoted in the press today talking about how great they
    were getting votes against things. Whereas all the people who were for
    it and knew it had to be done took a more wait-and-see attitude, hoping
    that this little change or that little change might make it a better
    bill. Now that it's actually on the floor, I think it's incumbent on
    everybody to get in there and participate in the debate.
        I do believe that the more you move to universal coverage, the more
    all the objectives of these employers who do cover their employees will
    be met, because it will stop cost shifting; they won't have to bear the
    burden of anybody else's cost. And it will have more employers, even the
    small business groups, in there negotiating to keep health care costs
    down, which I think will help them very much.
        Q. Mr. President, how do you feel the debate is going so far? And do
    you have any feeling on when you think it will come to a vote in the
    Senate?
        The President. I think it's going pretty well. It may take a few
    more days to start having critical votes, depending on what happens in
    the House on the crime bill. I just don't know enough about the timing
    of the bodies to be sure, but we're going to try to resolve the crime
    bill in the House this week and move it over there, and so they may take
    a little longer. I think they still want to go on their August break at
    the end of the following week. So I hope we'll have some action before
    then.
        Q. Are you disappointed that more members of the business community
    who you feel favor your ideas and proposals have not gotten involved in
    this debate and come to your defense, because as you know, the
    Washington Post reported this morning that several large business groups
    are now coming together to jointly oppose the Mitchell bill, the
    Gephardt bill? Are you disappointed that these people haven't spoken
    out?
        The President. I met yesterday with a dozen or more business leaders
    who went outside the White House and once again reaffirmed their support
    for universal coverage. And if you read between the lines in the--at
    least my reading, to go back to Donna's [Donna Smith, Reuters] question,
    my reading of the Washington Post story today is that a lot of those
    people disagree with the NFIB, think they're dead wrong, want a
    requirement that employers and employees provide for health care through
    private insurance. And they're worried that the necessary changes that
    Senator Mitchell has made to try to get the bill through the Senate may
    not meet their needs.
        Well, the answer for them is to come in and try to fix the bill and
    stay with universal coverage. That would be my counsel. The business
    leaders--I met with several yesterday--told me they were terribly
    worried that if we passed up this opportunity to have universal
    coverage, we would continue to see what has happened so dramatically in
    the last 5 years where you've lost--you know, 5 million people don't
    have coverage who had it 5 years ago. More and more businesses are
    dropping their coverage. All those costs are being shifted on to the
    employers who are taking care of their employees, which makes the small
    businesses even more vulnerable and the big businesses even less
    competitive in the global economy, which will mean further aggravation.
        That's one thing that I think that Congress has got to come to grips
    with. We just can't allow the kind of disinformation that Mr. Bowles
    talked about and the intense, almost hysterical fear that's been bred in
    some of the small business community, and has been therefore felt by the
    Congress, to ignore the fact that we have a system that is breaking up.
    We're losing ground on the coverage. We've got millions more people
    without coverage and millions more at risk of losing it than we had just
    a few years ago. So, we're going in reverse.
        That, it seems to me, is a great argument for the Hawaii system.
    You've got something you know will work, you know won't hurt business,
    and you know won't go in reverse. And we can build on it and move to
    full coverage.
        Q. Have you been disappointed with the lack of support in the
    business community to date----
        Q. But you're asking them now to come forward at this critical time.
    Where were they before, and aren't you disappointed?
        The President. First of all, we had a press conference here and
    announced 600,000 small businesses had joined our coalition. That's more
    members than NFIB has. We put this coalition together around health
    care. Therefore, unlike the NFIB, they don't have the mailing lists, the
    political action committees, the way of put-

    [[Page 1457]]

    ting pressure on people at the local level. But we've shown business
    strength.
        We've also had very large numbers of large businesses supporting our
    position. Do I wish they had come out stronger earlier? Of course I do.
    But this is nothing new. The AARP has now come out strongly in favor of
    what we're doing, but they ran ads for a long time which said, ``Don't
    support a health care plan that doesn't have prescription drugs and
    long-term care.'' Our plan did, but somebody--not we but somebody else
    did research which showed that people thought, ``Well, why didn't Bill
    Clinton's plan have prescription drugs and long-term care?''
        So this is what always happens. Some of you may have heard me quote
    this before. Machiavelli said 500 years ago that there is nothing so
    difficult in all of human affairs than to change the established order
    of things, because people who are afraid they're going to lose fight you
    like crazy and people who will win are always uncertain of the result
    until the very end. And in that vacuum the antis, even if they're less
    numerous than the pros, can acquire a strategic advantage. That's
    plainly what happened in the last 4 months, 5 months in the House and in
    the Senate where there was just this ``kill it, kill it, kill it, kill
    it, kill it'' drumbeat coming out of the ones who were negative. But
    there are more American citizens, more American businesses who know we
    ought to have universal coverage and who support it. It's not too late
    to rescue that. That's why we have a debate.
        And I would remind you, in spite of all that, this is the first time
    in history we ever even got bills to the floor of both Houses of
    Congress. Truman couldn't do it. President Nixon couldn't do it. Nobody
    who's tried to do it has ever been able to do it. So I feel good about
    where we are, and I think now the public voices of reason from the
    business community and elsewhere have a chance to be heard.
        Administrator Bowles. The Governor and I will stay for questions.
    The President is going to have one more question and then he has to
    leave.
        Q. We're getting very close to a vote on a bill that would
    restructure 15 percent of the national economy, yet Wall Street seems to
    be completely ignoring the debate right now. Why do you think that is?
        The President. You would have to ask them. I think partly because
    they know it wouldn't fully restructure 15 percent of the economy. It
    would simply build on what we have. The things the Government's doing
    wouldn't change, except we would be more efficient in the management of
    the Medicare and Medicaid programs. But that would stay there. We would
    still fund Medicare. We would still fund Medicaid. Almost all the people
    in the country today who are providing health insurance would have the
    decision, the freedom just to keep doing what they're doing now.
        Only the most limited and inadequate plans would have to be
    substantially changed, so they could go into a different plan or stay in
    the one they've got. That's why this plan shouldn't bother Wall Street
    very much because under all the scenarios we've been discussing, what
    we're basically trying to do is to close that gap of people who work but
    don't have coverage and people who don't work but are above the poverty
    line and don't have coverage. That's basically what we're trying to do.
    The whole rest of the system will stay intact. And a lot of the
    structural changes which are occurring for the better, enabling a better
    cost control for some, will now be available for all.
        I think it's important to point out--Erskine pointed out that the
    small business rates went up 14 percent last year; health care costs
    went up 4.8 percent last year. So what we're trying to do is to make
    this available for all, the cost containment as well as the coverage.
        Q. Your wife yesterday seemed to suggest that she thought the
    Gephardt bill might have a better chance of producing the results you
    want. Do you have a similar feeling of that?
        The President. I don't know. I haven't talked to her about it. And I
    read a couple of stories, and one seemed to suggest that, and one
    didn't. I can't comment on it. All I can tell you is the device for
    achieving universal coverage in both bills meets the criteria that I
    have. And I think it's quite interesting that the CBO thinks that
    Senator Mitchell could get to 95 percent by 1997, which is a very rapid
    uptake and would indicate that we could go on then and cover everybody.

    Whitewater Independent Counsel

        Q. Mr. President, what do you think of about the Starr nomination--
    --
        The President. Everybody else has talked about that. I'll cooperate
    with whoever's picked. I just want to get it done.

    [[Page 1458]]

    Health Care Legislation

        Q. Mr. President, which of the two plans, the Mitchell or the
    Gephardt plan, most closely resembles the Hawaiian model?
        The President. Ask Governor Waihee, he's an expert on that.
        Q. Thank you, Mr. President.
        The President. They both resemble it in different ways, that's my
    read. They're both different, and they both have things in common.

    Note: The President spoke at 10:45 a.m. in the Roosevelt Room at the
    White House.