[Public Papers of the Presidents of the United States: William J. Clinton (1995, Book II)]
[September 20, 1995]
[Pages 1403-1407]
[From the U.S. Government Publishing Office www.gpo.gov]



Remarks to the Community at the Little Sisters of the Poor Home for the 
Aged in Denver
September 20, 1995

    Thank you very much. Thank you very much, Marie Schroeder, for that 
robust introduction. [Laughter] And quite to the point. I was almost 
lost in my notes there for a moment--[laughter]--there it was, time to 
be here.
    Mother Patricia, Mother Provincial Margaret, Archbishop Stafford, 
and my long-time friend Governor Romer, I thank you all for being here 
today, and I thank you for your wonderful welcome. I want to say a 
special word of thanks to Helen Cooper and to her daughter and son-in-
law, and to Reynalda Garcia and to her two daughters, for spending some 
time with me just a few moments ago to discuss the care that they 
receive in this wonderful home and the role that Medicare--I mean 
Medicaid plays in that. I want to thank all of you for giving me the 
chance to come here. And I'd like to begin by a special word of 
appreciation to the Little Sisters of the Poor who run this wonderful 
facility and who in their lives, with just a little bit of help from the 
Government here in the form of Medicaid, illustrate an ethic of service 
that few Americans can hope to match but all Americans should seek to 
emulate. I thank them for that.
    I have come here to talk about a Government program called Medicaid, 
what it means to families like yours all across the country and what 
role it should play in our efforts to balance the national budget.
    We are all now living through a period of remarkable change in our 
country's history. Everybody knows it. You have only to follow either 
the events in the news or perhaps even the events in the lives of your 
own families to know that we are changing the way we work and

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the way we live more dramatically than at any time in the last 100 
years.
    About 100 years ago, we began a transition from an agricultural and 
rural society to a more urban and industrial society. Now we are in the 
midst of a transition from that urban industrial society to a society 
that runs primarily on dramatic increases in technology and in 
information and one in which all the countries in the world are 
increasingly united together after the cold war in a global economy but 
one that is not free of difficulty, as you know.
    The more we seem to be integrated economically, the more we often 
seem to be splitting apart in other ways. And we see the rise, for 
example, of extremism and groups of hatred rooted in religious or ethnic 
or racial differences all across the world. We see it when a bus blows 
up in Israel or when a fanatic breaks open poison gas in a Japanese 
subway or when, unfortunately, the Federal building was blown up in 
Oklahoma City.
    So in this period of change, it is not surprising that one of the 
things that we have to do is to be open to new ideas about what we have 
to do to change the way we do business in America so that we can adapt 
to this new age. But it is also important to remember that every period 
of change is a challenge, in my mind, issued ultimately by God, to make 
the adjustments we need to make change our friend while maintaining true 
to our basic values. And that's really what this debate in Washington 
about the balanced budget is all about.
    We ought to balance the budget. We never had a permanent, built-in 
deficit in our country until 1981. We quadrupled the debt of America in 
the 12 years from 1981 until the day I became President. We built in 
this huge deficit. We wanted lower taxes and we wanted higher spending, 
and we took both and forgot about the consequences to our children, our 
grandchildren, and the future. It is so bad today that interest on the 
debt next year could exceed the defense budget. And interest payments 
today are so great that the budget would be in balance today but for the 
debt run up in the 12 years before I became President.
    On the other hand, if we're going to balance the budget, we have to 
say, why are we doing this? What's America all about? What have you 
given to us that we have to give to our children and grandchildren? A 
reverence for work and family, for personal responsibility, and 
responsibility to the community, a devotion to excellence and to 
service.
    Yesterday I was in Florida with the Governor of Florida, who is a 
friend of Governor Romer's and mine, and he said, ``America has always 
been and must always be a community, not a crowd.'' He said, ``A crowd 
is a collection of people who are all on their own, the survival of the 
fittest. Power gets more; weakness gets less. A community is a group of 
people that recognizes that they have responsibilities to each other, 
responsibilities to each other.''
    The generation that lives in this home conquered the Great 
Depression and World War II, launched the cold war to stand freedom 
against democracy, saved the world, and gave us the most prosperous 
country the world has ever known. We have obligations to the generation 
of elderly Americans who did that, our parents and our grandparents. We 
have obligations to our future, to our children and their children to 
balance the budget.
    The great question in Washington is, can we meet both obligations? 
And if so, how? I believe we can, and I am determined to do it. I 
believe that the future of this country contains our greatest day if we 
can still stand for freedom and responsibility, if we can still stand 
for work and family, if we can honor our children and our parents, and 
if we can all recognize, without regard to our income or personal 
circumstances, we're in one community and we have certain obligations to 
each other. That is really what this debate on the balanced budget is 
all about.
    I believe that we should balance the budget. When I became 
President, our annual deficit was $290 billion; now it's down to $160 
billion. Some of you may actually remember that the last time the 
deficit went down 3 years in a row was when Harry Truman was President 
of the United States. I am proud of the fact that we're emulating Mr. 
Truman's record. And I want to go all the way and bring this budget into 
balance.
    One of the biggest problems with bringing the budget into balance is 
that inflation in health care has been going up faster than economic 
growth, not only for the Government but for a lot of you who are out 
there on your own private budgets. Inflation in health care has been one 
of the fastest growing areas of a family's budget. And if we don't do 
something to lower that rate of inflation, we can never bring the budget 
into balance unless we're prepared

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to just stop investing in education or stop investing in the new 
technologies and the new sciences that may offer us the answer to a lot 
of the world's problems or walk away from some of our other obligations.
    So we have to slow the rate of medical inflation. I've worked hard 
on that. For 2\1/2\ years, we have made the Medicare Trust Fund more 
solvent, we have corrected some of the abuses that were in the Medicaid 
program, but we have really faced the fact that we still have 
fundamental responsibilities to help people who depend upon Medicare and 
Medicaid to live.
    Now, there is--the great contest in Washington today is basically 
over how much we should cut health care, how much we should cut 
education, how much we should cut the environment, how much we should 
cut taxes, to balance the budget.
    The congressional proposal, which came out yesterday, I believe, on 
Medicaid, I believe endangers the Medicaid program that makes it 
possible for places like this wonderful home to exist. And I do not 
believe it is necessary to balance the budget. So I came here today to 
tell you two things: One is, we need to slow the rate of medical 
inflation in every program, including the ones that benefit you, and we 
can. But two is, we don't have to wreck the program and throw families 
into abject insecurity to balance the budget. It is not necessary.
    I have given the Congress a balanced budget plan which will preserve 
the integrity of Medicare and Medicaid and enable us to serve the senior 
citizens of the United States. And that is important.
    Let me tell you about Medicaid. Two-thirds of the Medicaid program 
goes to benefit senior citizens and people with disabilities. Seven in 
10 Americans in nursing homes get help from Medicaid to pay their bills. 
Forty-three percent of the residents in this nursing home get that sort 
of support. Medicare can be the difference between quality care in a 
quality facility and an uncertain future. In the United States as a 
whole, the average cost of nursing home care is $38,000 a year. Three 
quarters of our senior citizens live on incomes below $24,000 a year. 
You don't have to be a mathematical genius to know that someone has to 
step into the breach. There has to be a system to honor the people in 
this country who have done their part for America and need this kind of 
help.
    The plan proposed by Congress would take away the guarantee that 
Medicare would be there to help, would instead cut future spending by 
about a third and send a check to all the States. That's what Governor 
Romer was talking about. Marie Schroeder was able to come here from 
another State to be near her son because Medicaid is a national program, 
run State-by-State, but it has certain basic guarantees in it. If it 
becomes a State-by-State program, a lot of people who live in States 
that may have good care, may literally be robbed of the chance to go 
visit and live with their children because they live in States that 
don't.
    A lot of middle class families, who have the security of knowing 
that their parents are okay, can help their children to finance their 
college education. If they lose that security, they may not be able to 
help their kids go to college. This is a huge issue. We must do this 
right.
    The plan proposed in Congress, we estimate, could mean that up to 
300,000 American senior citizens who today are eligible to go into 
nursing homes won't be eligible in just a few years. And over a million 
who get services in their own homes, who get to go to senior centers and 
other things to support in-home care, won't be able to get those 
services, not to mention the 30 percent of the program that goes to help 
the very poorest children in the United States today.
    It isn't fashionable anymore to speak up for the poor, but the truth 
is, those kids are our future. And at least in this country, as poor as 
you are, at least you can go to a doctor because of Medicaid, and these 
kids can get off to a good start in life. But there's not much of a 
political lobby for poor children. So if we become a crowd instead of a 
community, a lot of them are going to get left behind. So that's what I 
want to emphasize to you. We can slow the rate of growth in Medicaid 
without wrecking the program.
    Today, if you have to go into a nursing home and you need help from 
Medicaid, by law you can get it. And you don't have to force your 
spouse, for example, to sell your possessions. Under this new plan, 
States would be permitted to force someone, for example, whose husband 
has to go into a nursing home to actually sell her car and her house 
before they could get any help from the Government. I don't think that's 
right. I don't think that's right.

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    I also don't think it's right to totally abandon a commitment to 
national standards of quality. Now, just a few moments ago, Mother 
Patricia was telling me about some Federal rules and regulations that 
she thought ought to be changed. And we have done more to deregulate the 
Government in sensible ways than any previous administration in the last 
30 years. We've abolished 16,000 pages of Federal regulations, and we're 
working on thousands more.
    But before we had national standards for residential care in 1987--
which was, by the way, up until then, totally a bipartisan thing; it was 
signed by President Reagan--before that, up to 40 percent of people in 
nursing homes were overmedicated and overrestrained. And you don't see 
that anymore.
    You know, unfortunately, not everybody can get into a facility run 
by the Little Sisters of the Poor. I wish they could. I wish everybody 
in America could do that. So we do need some standards to protect 
people, to make sure it's not just a money deal. That would all be gone.
    The other thing I'd like to say is, a lot of our poorest elderly 
people are able to use their Medicaid money under national law to pay 
for their Part B premiums under Medicare so they can get doctor care and 
in-home services and medical equipment. This would do away with that, 
which means a lot of our poorest elderly people wouldn't be buying into 
Part B of Medicare. It's a good way to save money on Medicare. People 
say, ``Oh, my goodness, Medicare is not as expensive as it used to be,'' 
but it will be very expensive for this country not only in the 
diminished dignity of seniors who have it now but in their increasing 
health care costs when they can't be regularly treated in a preventive, 
sensible way. It's a mistake; I'm against doing away with that. It's 
unnecessary, and we shouldn't do it.
    Again, let me say to you, I have proposed reducing the rate of 
inflation in Medicare and asking the Medicare providers to take less so 
that we can keep the Trust Fund strong for another 11 years. I have 
proposed reducing the rate of inflation in Medicaid and forcing 
economies in the program but only about a third as much as the Congress 
proposes.
    The reason they have proposed this huge number is they said no 
matter what, we're going to balance the budget in 7 years, not 8, 9, or 
10, and no matter what, we're going to give a tax cut of $250 billion, a 
lot of which will go to people like me who don't need it and haven't 
asked for it.
    And the point I want to make to you is not that we don't have to 
make any changes in these programs, not that we don't have to slow the 
rate of medical inflation but that we have to do it in a way that is 
consistent with our ethical obligation to honor our parents and 
grandparents and to honor the idea that we have obligations across 
generational lines and our obligation to help middle class people free 
up their incomes so they can educate their children while their parents 
live in dignity. That this the objective here.
    So I say to you, I hope all of you will join me, without regard to 
your political party, in this national effort to balance the budget in a 
way that is consistent with our values. We're going through a time of 
big change. And the reason this country is still around after more than 
200 years is that when we have gone through periods of huge change, we 
have recognized that we needed teamwork more than conflict. We have 
recognized that no one had all the answers, that no one was the 
repository of infinite wisdom--that belongs upstairs--and that we are 
going into a future that we have to do our best to shape not for the 
moment, for what's popular in the moment, but what will work 10, 20, 30 
years from now. And we need to do it as a team. We need to do it as a 
community, not a crowd.
    We need to do it in ways that will fulfill both our objectives of 
balancing the budget and honoring our obligations to our parents and to 
our children. Now, we can do that. But we cannot do that if we are 
excessively ideological, excessively partisan and arbitrary in saying we 
care a lot about this program but not as much about the program as we do 
having a $250 billion tax cut in a 7-year time frame. We can do this, 
but we need to do it in good faith.
    So I ask all of you, in your prayers and in your pleas and in your 
letters, to reach out to the Congress in a spirit of cooperation and say 
we all want to help, but Medicaid does a lot of good for the senior 
citizens of this country. Medicaid enables this country to be what it is 
today. Medicaid supports private, charitable work. Medicaid in this 
nursing home is the embodiment of the lesson in the Catholic Bishops' 
letter that the quality of life in a society is the sum of both the 
personal choices made by individual citizens and families and the big

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choices made by the society as a whole. And they have to fit together.
    So I say to you, this should be an exciting time to be an American. 
Whatever your age, you are living through a truly historic era. But we 
have to do this right. And to do it right means we have to do it 
consistent with our basic fundamental values. If we don't stray from 
them, we can embrace all the new ideas in the world and come out on the 
other side of the divide with a stronger, better America.
    But if we forget for a moment what we owe either to our parents or 
to our children, then we will be making a grave mistake. I'm betting on 
America. I'm betting that the best is yet to come. But we have a 
difficult, invigorating, tough 60 or 90 days ahead of us in which you 
and people like you all across America can have a profound influence on 
the decisions we make and on whether we preserve this very, very 
important partnership which has brought dignity to the lives of millions 
and millions and millions of Americans.
    Thank you very much.
    While you're all standing up, I now have one more announcement to 
make. Ethel Hoag, who is sitting right over there in that pink chair, is 
94 years young today. This is her birthday. I believe we should end this 
wonderful meeting by singing ``Happy Birthday'' to Ethel Hoag.

Note: The President spoke at 10:40 a.m. In his remarks, he referred to 
Mother Provincial Margaret Halloran, Chicago Province, Little Sisters of 
the Poor; Cecile Cooper and Daniel Ely, daughter and son-in-law of home 
resident Helen Cooper; and Ramona Sena and Evangeline Landford, 
daughters of home resident Reynalda Garcia.