    [Public Papers of the Presidents of the United States: William J. Clinton (1995, Book II)]
    [July 25, 1995]
    [Pages 1140-1143]
    [From the U.S. Government Publishing Office www.gpo.gov]

    Remarks on the 30th Anniversary of the Passage of Medicare
    July 25, 1995

        Thank you very much, Mr. Vice President, for your introduction and
    your leadership. Senator Kennedy and Congressman Dingell, thank you for
    your incredible inspiration to the country and to me. Mr. Glover, thank
    you, and thank you for your speech. To Congressman Gephardt and Senator
    Daschle, I want all of you to know that they lead well and they are
    doing well for our country. To my friend Arthur Flemming and his family
    and Mother Johnson and her family and to all of you seniors who are
    here, I am honored to be here, and I have loved listening to these
    stories and these speeches and hearing this commitment.
        I am honored to stand in the tradition of the Presidents who fought
    for Medicare. I believe that President Roosevelt and President Truman
    and President Kennedy and President Johnson were right. And I think
    those who opposed them were wrong.
        If you really think about Medicare and Medicaid, which was also
    passed at the same time, they've given all of us stories. I loved
    hearing the Vice President talk about his wonderful mother.
        All of you know that since I've been President I have lost my mother
    and my fine stepfather, but what you may not know is that my stepfather
    had a heart attack 10 years before he died, in the middle of one of my
    inaugural speeches for Governor. And when he woke up from his surgery,
    his quadruple bypass, I told him it was not that good a speech.
    [Laughter] But because he was a senior citizen covered by health care,
    he had 10 more good years. And my mother had a very difficult fight with
    cancer, which she lost. But because she was a senior citizen covered by
    good health care, she lived to see her son become President of the
    United States.
        I ran for President because I wanted to broaden that sense of
    security and opportunity for our people. I wanted middle class Americans
    to have family-wage jobs and be able to educate their children and have
    the same health security we had given to senior citizens, as Congressman
    Dingell said.
        And the same crowd that killed Harry Truman's plan for health care,
    the same crowd that fought against Medicare, were successful in
    derailing what we tried to do last year. But they did it in a brilliant
    way, because by last year Medicare had become so much of our common
    ground as Americans, so much a part of the fabric of our daily lives,
    that no one anymore thought about these Members of Congress having
    anything to do with it. It was just a part of our daily lives, just like
    getting up in the morning and seeing the Sun shine. And so these people,
    the same crowd that fought it tooth and nail 30 years ago, came up with
    this brilliant argument that because I said, when they denied it, the
    Medicare Trust Fund was in trouble and we had to reform health care,
    that I wanted to see the Government mess with their Medicare.
        And we had people all over America coming up to me or the First Lady
    or to Senator Kennedy, saying, ``Don't let the Government mess with my
    Medicare.'' People had actually forgotten where it came from, as if it
    sort of dropped out of the sky. Well, I got the message of the 1994
    election, and I'm not going to let the Government mess with your
    Medicare.
        I really thought Medicare had passed beyond the partisan and
    political divide into the generational life of our country. The people
    who passed it did it for their parents' generation and knew that they
    would have it when they came along and knew that, in so doing, they
    would relieve a burden from their children, who could then focus on
    building good lives for themselves and their children. It was sort of a
    part of the social compact of the American family.
        Now the Vice President's father, who's been mentioned several times
    and is a particular fa-

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    vorite of mine, said that the absence of health care for the elderly
    was, I quote, ``a disgrace in a country such as ours.'' We got rid of
    the disgrace, and along with Social Security, as Secretary Shalala has
    said, we at least have finished that part of our country's work.
        We still have a lot of work to do. But the answer to the problems of
    the great American middle class, the answer to the problem of curing the
    American deficit, the answer to the problem of dealing with the
    challenge of educating a new generation of Americans for a new, highly
    competitive economy--surely the answer to those problems is not break
    down the one thing we have done right completely, which is to keep faith
    with our elderly people.
        I want to talk just a little bit about what this could mean to you.
    As I said, in 1965, the legislation which created Medicare also created
    Medicaid. A lot of Americans think it's just a program for poor people.
    Well, it did provide desperately needed care for poor children and their
    mothers, but it also provided more care for older and disabled
    Americans, especially long-term care. Two-thirds of the Medicaid budget
    goes for older Americans and disabled citizens. Without Medicaid, middle
    class families struggling to pay their own bills and raise and educate
    their children could face nursing home bills for their parents averaging
    $38,000 a year. I remember what those nursing homes looked like before
    Medicaid. Some of you do, too.
        We need to celebrate and recommit ourselves to this. And we need to
    ask ourselves, what is the future? We are at an historic moment. For the
    first time in a long time there is a willingness to try to bring the
    budget into balance, a willingness to try to secure the Medicare Trust
    Fund. But I know we can do both while maintaining our generational
    commitment. I know we can do both without returning Medicare to the area
    of American partisan politics and to nightmares for the elderly people
    and their children in this country. We can do it.
        As Mr. Gephardt said, the congressional majority appears to be
    choosing for the first time ever to use the benefits we provide under
    Medicare, paid for by a dedicated payroll tax, as a piggybank to fund
    huge tax cuts for people who don't really need them. But we showed that
    you could have a balanced budget plan, with no new Medicare costs for
    older Americans, that stabilized the Medicare Trust Fund. We know that.
    They instead would cut $270 billion from Medicare and raise Medicare
    premiums and out-of-pocket costs an average of $5,600 per couple over 7
    years, even for people who don't have enough money to get by as it is.
    They want to use this to pay for a $245 billion tax cut.
        If they would just reduce the size of the tax cut, target the middle
    class families and their basic needs, string out the time which we take
    to balance the budget, we would not need one penny, not a red cent of
    the Medicare beneficiary cuts they've proposed. Don't you let anybody
    tell you that we have to do that to stabilize the trust fund or to
    balance the budget. We do have to stabilize the trust fund. We should
    balance the budget. But we don't have to raise the roof on the
    beneficiaries to do it. We do not have to break our generational
    commitment to do it. Do not let anybody tell you that. It is simply not
    true.
        This plan kind of sounds good in the rabid antigovernment atmosphere
    in which we live today--their plan does. The majority's plan in Congress
    would provide older Americans with a voucher for a set amount each year.
    They almost make it sound like you can make a profit out of it. It
    supposedly would cover enough to buy medical insurance. The problem is
    that private health care costs are projected to increase 40 percent more
    than the value of the voucher. So if you're over 65 and you're healthy
    as a horse, this might be a good deal for you. But what if you get
    sicker as you get older? If the vouchers are inadequate, the elderly
    must make up the difference out of their own pockets.
        There's no clear provision that would give a larger voucher for a
    patient like my mother, who developed cancer, as opposed to one the same
    age who was healthy, not even a clear provision to give a larger one to
    seniors who are fortunate enough to live into their eighties. That's the
    fastest growing group of elderly people in America, in percentage terms,
    people in their eighties. But to be healthy in your eighties you just
    naturally use the health care system more. There's no clear provision to
    take care of that, no clear provision to stop companies from simply
    turning seniors down because of their medical condition or cutting them
    off when they get sick.
        In the past, various experts have suggested that Medicare budget
    cuts will inflict harm and

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    financial suffering on the elderly, but as the grisly details of the
    plan become known, it becomes clearer and clearer that we could actually
    see a denial of medical care to those who need it. That was the very
    thing Medicare was designed to do away with.
        You know, my mother was a nurse-anesthetist. I can remember what it
    was like before there was any Medicare or Medicaid. I remember people
    that would actually come to our house with a bushel basket full of
    peaches, for example, trying to pay in kind for the medical service my
    mother had rendered. And I remember that the old folks weren't healthy
    enough to go pick peaches. I remember these things, and we should not
    forget. We can change without wrecking, and we need to be awfully
    careful before we buy a pig in a poke.
        It is easy to see how, in all but the direst of emergencies,
    millions of older Americans would actually just give up the medical
    attention to which they are entitled and which they need. Let me just
    give you some examples of what could happen. These are real examples of
    what could happen.
        Suppose a 75-year-old woman has exhausted her savings and is too
    sick to work, but her voucher isn't enough to permit her to afford any
    health insurance plan anymore. She'd have to reach into her own pocket,
    but she doesn't have any money there. She can't get to the hospital
    unless it's a dire emergency because she's got to pay a $750 deductible
    for that. So she can't get to the doctor's office because she can't pay
    the extra premium there. So the woman is stuck, and no care.
        Or suppose you have a 75-year-old man who gets a voucher that just
    about covers the cost of his health insurance, and in 3 years his
    voucher only goes up 5 percent a year, but the health insurance premium
    goes up 10 percent a year. So after 3 years, the gap is so wide he can't
    afford to pay. He doesn't have the money. He dropped his Medigap
    coverage because he was persuaded this voucher system would work. So
    he's stuck, no care.
        A 70-year-old man with open-heart surgery recovered enough to go
    home and be treated by a visiting nurse, but under the plan of the
    congressional majority, he must now pay $1,400 in copayments for that
    visiting nurse. He can't afford that, so he stays in the hospital at 3
    or 4 times the cost to the taxpayers. But after a while, Medicare stops
    paying for that, too. So he's stuck.
        Now, these are things that can happen. Those who want to keep what
    they have now will have to pay significantly more. Every person on
    Medicare will pay $1,650 more over 7 years. The average person who
    receives care in home--something we need more of, not less of--will pay
    $1,700 more in the year 2002 alone for the same health care. Remember,
    these are people who already pay over 20 percent of their income for
    health care.
        So I ask you, can the elderly really afford $1,650 more for premiums
    to cover their doctor bills? Can the elderly really afford $1,700 more
    for the same home health care in one year alone? Will vouchers cover
    them against sudden premium increases if they get sick? That's what
    health insurance is supposed to do, you know, cover you when you get
    sick, not when you're healthy. Will the medical costs stay sufficiently
    under control to permit these vouchers to cover the full cost of care?
    No expert thinks so.
        Is it fair to make older Americans give up their doctors and be
    forced into managed care, instead of giving the option to them to go
    into a managed care network? Is it really necessary, to balance the
    budget and to stabilize the Medicare Trust Fund, to do what the
    congressional majority proposes? The answer to every single one of these
    questions is no. No.
        Those who want to gamble with Medicare are asking Americans to bet
    their lives. And why should they bet their lives? Not to balance the
    budget, not to strengthen the Medicare Trust Fund, but simply to pay for
    a big tax cut for people who don't need it. It's a bad deal. We ought
    not to do it. It will break up America's common ground. And you can help
    to stop it.
        If the Congress and the majority really wants to balance the budget
    and reform the Medicare Trust Fund, let me ask them to join with me in a
    real commitment to health care reform that can be achievable, even by
    their standards. Senator Kennedy has already introduced a bill with
    Senator Kassebaum that goes part of the way. Let us require insurance
    plans to cover those with preexisting conditions. Let us make a
    commitment to preventive and long-term care. Let us encourage home care
    as an alternative to nursing homes and give folks a little help to have
    their parents there. Let us let workers take their insurance coverage
    with them when

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    they change jobs and crack down on fraud and abuse and give people the
    option to choose a managed care option if they want it; don't force
    people to take something they don't want.
        If we really want to work together, there ought to be four basic
    principles that everybody, without regard to party, signs off on. We
    have to make sure that good, affordable health care is available to all
    older Americans. That's what we do now; let's don't stop it. We must not
    cut Medicare to pay for a bigger tax cut than can be justified, that
    goes to people who don't really need it, a lot of whom don't even want
    it. We ought not to do that. We must be committed to reducing medical
    cost inflation and stabilizing the Medicare Trust Fund through genuine
    reforms, not by destroying Medicare and hurting the people who are on
    it. We must not balance the budget by cutting Medicare to older
    Americans. We do not have to do any of these things.
        This is a time of great and exciting change, I know that. But you
    know, the conservatives are supposed to be in charge around here, and
    conservatism means--if nothing else--if it ain't broke, don't fix it.
    And do no harm. That's the first principle.
        My fellow Americans, this is a big fight, but it's not just for the
    seniors in this audience and in this country. It's for all their
    children. Most senior citizens have children that are working harder for
    the same or lower pay they were making 5 or 10 years ago. They have
    their own insecurities and their own problems. They need their jobs and
    their incomes and their children's education and their own health care
    stabilized. We don't need to do something that makes their lives worse,
    either. And it's for all their children, the people on Medicare's
    grandchildren. They deserve a chance to have a good education, to be
    sent to college. Their parents should not wake up in the middle of the
    night torn between their own parent's health care and their children's
    education.
        This is not just a senior citizens issue. We need to increase
    opportunity and security for all Americans. And the worst thing we could
    do is to tear down Medicare. That would increase insecurity, not just
    for the elderly but for all Americans. It would cloud the future of this
    country.
        We have come a very long way by pulling together. Do not let this
    budget debate tear this country apart. Do not turn back on Medicare.
    Stand up and say, if you want to do something to balance the budget and
    stabilize the Medicare Trust Fund in a way that helps the elderly people
    of this country, we will stand with you. But if you want the Government
    to mess with my Medicare, the answer is, no.
        Thank you, and God bless you.

    Note: The President spoke at 11:06 a.m. in the Caucus Room of the Cannon
    House Office Building. In his remarks, he referred to Eugene Glover,
    national president, and Genevieve Johnson, DC chapter president,
    National Council of Senior Citizens; and Arthur Flemming, chair, Save
    Our Security. He also referred to his mother, Virginia Kelley; and his
    father-in-law, Hugh Rodham.