[Public Papers of the Presidents of the United States: William J. Clinton (1996, Book II)] [September 5, 1996] [Pages 1480-1487] [From the U.S. Government Publishing Office www.gpo.gov]Remarks in Sunrise, Florida September 5, 1996 Thank you very much. Thank you so much. I tell you, I just hope you're having as good a time as I am this afternoon. Thank you. Thank you for making me feel so welcome. Thank you, Congressman Deutsch, for your remarks today and for being a steadfast ally for the people of Florida and for our administration the last 2 years. Thank you, Governor Lawton Chiles, for your lifetime of service to the people of Florida and the people of the United States and for your brilliant service as Governor. I'm delighted to be here with your attorney general, Bob Butterworth; your State insurance commissioner, Bill Nelson; State Senator Ken Jenne; State Senator Peter Weinstein; Mayor Effman of Sunrise; Mayor Graham of West Palm Beach; Gloria Jackson, the chair of the Broward County Democratic Party; Sheriff Ron Cochran. And I'd like to say a special word of thanks to my friend Gerry McEntee, back here, the president of the American Federation of State, County, and Municipal Employees and a great [[Page 1481]] supporter of Medicare. And I'd like to thank the Boyles who own the theater here for welcoming us. But most of all I'd like to thank Sallie and her mother, her daughter, and her granddaughter. Didn't she do a good job? Let's give her another hand. I thought she was great. [Applause] Thank you. Today I want to talk to you about how all of us, regardless of our ages, grandchildren, children, parents, grandparents, great- grandparents, great-grandchildren--how we can move forward together to build that bridge to the 21st century I talked about in Chicago last Thursday night. I especially want to talk a little more about health security because I know that one of the keys to enabling our families to succeed at home and at work is finding a way for hard-working people to have that health security, to provide the best possible care for people. And I'd like to talk a little bit about those who get their care from specific health care plans that have certain requirements and standards that may lower the costs but may also raise some questions. You know, we have had a remarkable week and a half. I took that train from West Virginia to the convention in Chicago, and I stopped along the way in places that hadn't seen a passenger train in a long time, and there were thousands and tens of thousands of people all along the route. It was terribly moving. And then, of course, we had a good convention. And then Hillary and I and Al and Tipper Gore set out on our bus tour, and we made another five States. And I figure we saw in our talks about a quarter of a million people, and another 200,000 just along the road and the rails. I never saw so many crowds, people coming out, believing in America again, knowing that we're on the track, knowing that we're on the right track and the right road to the 21st century. And it was very moving. Thanks to the support I have received from others in the Congress and in the administration, we have worked very hard to move this country forward. And compared to 4 years ago, we have 10 million more jobs, almost 4\1/2\ million more homeowners, another 10 million homeowners who refinanced their mortgages at lower mortgage rates. Wages are going up for the first time in a decade. We've had record numbers of new businesses in each of the last 4 years, and businesses are growing now, coming into existence at the fastest rate since John Kennedy was President. We have record--[applause]--we're selling more of our products around the world than ever before. The combined rates of unemployment, inflation, and home mortgages are the lowest in 28 years. I am proud of these things, and you should be too, as Americans. For 4 years in a row, the crime rate has gone down. In Tampa, the crime rate fell 20 percent in 1995, just for example. I just came from there, so I asked for the numbers on Tampa, and I thought it was an amazing drop. There are 1.8 million fewer people on welfare than there were the day I took office. In Florida, there are over 135,000 fewer on welfare in the State of Florida alone. Child support collections are up 40 percent in the Nation--in Florida--thank you, Governor Chiles-- they're up 48 percent in the last 4 years. Just about 2 weeks ago, maybe 3 now--time has been flying the last few days--I signed a minimum wage bill which raised the minimum wage for 10 million hard-working Americans. It also made the employees and the owners of small businesses all across America--made it easier for them to take out retirement plans and to keep those retirement plans when they move from job to job. Most of our new jobs are being created in small businesses. More and more businesses are coming into existence, going out of existence in this new, dynamic economy. We have to make it possible for people to save for their retirement even if they're in small businesses and even if they change jobs a lot of times. And I'm proud of the fact that we've got legislation now which will make that much, much easier and safer. Another interesting provision that Governor Chiles and I were talking about with his daughter up in Tampa that was in the minimum wage bill is that we provided a $5,000 tax credit to people who will adopt children. There are tens of thousands of children out there who need a home, and I hope this will help more of them find it. In late 1994--there's one other thing I want to mention here that was done that didn't achieve a lot of notice because it was a part of a big trade bill. But we passed a provision to strengthen the protection for pensions that protected the integrity of 40 million Americans' pension, people already retired and people saving for their retirement, to make sure that these funds are not raided. [[Page 1482]] And one of the things that I vetoed in that budget that Congressman Deutsch talked about, in addition to the cuts in Medicare and Medicaid and education and the environment, was a provision which would have allowed $15 billion to be taken out of existing pension funds and put to other purposes. And I thought that was wrong. I think we ought to keep the integrity of our pensions systems in this country. And let me say to a lot of you who may have grown up in an earlier time when we thought more about balancing our books except when there was an emergency, I'm very proud of the fact that our administration is the first administration since the 1840's, before the Civil War, to have the deficit go down in each of the 4 years of its term. It's been cut by 60 percent. So compared to 4 years ago, we're in better shape. But as I said last week and I say again, there are many things we need to do to build a bridge to the 21st century that keeps the American dream alive for all of us, that enables people to succeed in their family lives and at work, that brings us together across all the lines that divide us, that keeps us the strongest country in the world for peace, freedom, and prosperity. Earlier today when I was in Tampa, I had a chance to go to a wonderful high school and speak to over 2,000 students there about our goals for education in the next 4 years. I want to mobilize an army of reading tutors so that instead of having 40 percent of our 8-year-olds who cannot read on their own, in 4 years every single 8-year-old will be able to read a book on his or her own. I want to make sure that every young child in America in school, without regard to their race, their income, where they have to live, from the poorest urban school districts to the most remote mountain school districts, will for the first time in the history of America have access to the same information in the same time, the same quality, as the children in the wealthiest districts do, by hooking all the classrooms up to the Internet, to the information superhighway, with adequate computers and trained teachers. We can do it for the first time in history. And I want to make sure that we put a college education within reach of every family. In the last 4 years, we have worked hard to increase scholarship funds for needy students. We have worked hard to reform the student loan program so that now it works faster and costs less than ever before. I remember Governor Chiles and the legislative leaders invited me to speak to the Florida Legislature up in Tallahassee. I had a very moving experience with a young couple there who had both graduated from medical school and who were doing their residency. And you know doctors don't make any money when they're residents, and they owed well over $100,000 on their education. And because we had changed the law which said that young people could pay back their loans as a percentage of their income and never be required to pay back more than that in any given year, these young people were able to avoid literally having half of their income go to their college loan repayment, and they wouldn't have had enough left to live on. We should never have anyone drop out of any level of education because of that burden. And I want to do more. A lot of you can empathize with this: It's no longer possible for people to say they're through with education when they graduate from college. And now we know when people graduate from high school, chances are better than 50-50 they will not be able to find a job with a growing income. So what I want to do in the next 4 years, within 4 years, is to make 2 more years of education, the equivalent of at least a community college degree, just as universal as a high school diploma is today by giving a tax credit for the price of the tuition to the families of this country, so we can pay for it dollar for dollar through tax cuts, and everybody can at least get a community college education. I think that's very important. I'm well aware that the largest community college in the United States is not very far from here. But nearly every American--nearly every American--is within driving distance of a community college. And more and more, the people you see at our community colleges are older students, non-traditional students. The average age at a lot of our community colleges is bumping 30 now. And they have people in their fifties there and their sixties there, people who have lost their jobs and have to go back and get new education and training. So I say to you we ought to have that tax credit for the cost of a typical tuition at a community college. And I believe we should have a tax deduction worth up to $10,000 a year [[Page 1483]] for any tuition cost at any post-high school education in the country to help people educate themselves. It will make our country stronger. So I hope you'll help me build that bridge to the future for the younger part of the families that are here. But we also have to keep this economy going strong. You know, whenever we argue about, well, how are we going to pay for Medicare or Medicaid or Social Security or whatever part of it, always assume certain things about the strength of the American economy: what will the unemployment rate be, what will the incomes be, what will the growth be. We have to keep this economy going strong, and we can grow it even faster. But if we're going to do that, we have to keep investing in the things that make us strong, like education, research, environmental technology, and we have to keep bringing this deficit down. Every time I leave Washington for the last 4 months, some expert has said, ``Now, Mr. President, don't go down there and talk about the deficit. People really cared about the deficit when the economy was bad, but nobody really understands it very well, and so they don't care about it once the economy gets better. It's boring to them. Don't talk to them about that.'' Well, I don't believe that. I think you do care about whether your country is spending itself into debt. Let me just briefly say why everyone should care about it. Because as our Republican friends said last year--they put out a paper on this, not me, but I agree with them--they said if we were not on a plan to a balanced budget, if we went back to permanent high deficit spending the way we did in the 12 years before I came here, interest rates would go up 2 percent. Why? Because the Government would be borrowing money and you would be borrowing money, and we would both be trying to borrow the same money so the price would go up. Now, what that means is 2 percent on a home mortgage, on a car payment, on a credit card payment every month. It means 2 percent more for business borrowing, which undermines the ability of businesses to borrow money and invest, to be more productive, to give their workers raises and hire more people. It's harder to borrow money to start a new business. This is a big deal, folks. We have got to keep this economy growing and going strong. And every tax cut I talked about is paid for, dime by dime, line by line. We don't want to go back to the old days where someone says, ``Hey, I'm running for office, and I'll give you a big tax cut. No, I can't pay for it, and yes, it will increase the deficit, and oh, by the way, I'll have to cut Medicare and Medicaid and education and the environment even more than last time.'' That's what their proposal is, this across-the-board thing. Don't go for that. We went down that road before. We would have a surplus in the budget today and could have a bigger tax cut or extend the life of Medicare with no sweat for another several years, a surplus today if it weren't for the interest we're paying on the debt run up in just the 12 years before I became the President. We don't want to make that mistake again. We dare not make that mistake again, and I don't think you want to make that mistake again. Every time I come to Florida, someone talks to me about personal security. I'm proud of the fact that the crime rate has come down for 4 years in a row. I want it to keep coming down. And that means we have to finish the work of putting 100,000 police on the street. It means we ought to pass a law that expands the Brady bill, which now covers anybody who has been convicted of a felon or is a fugitive or stalker-- cannot get a handgun. I think that should extend to anyone who has beaten up a child or a spouse at home. I don't believe people who are involved in domestic violence should do that. And I believe that we should ban those terrible cop-killer bullets. They have no purpose other than to shoot police officers. If the police officers are willing to protect us, we ought to be willing to protect them. It's a simple thing, and it has nothing to do with hunting or sporting. I believe that we have to build a bridge to the 21st century that works on building even stronger families. That's why I've said that the family leave law that I signed, the first bill I signed, has made it possible for 12 million American families, intergenerationally, just like these fine women up here--12 million families, where someone in the family could take some time off without losing their jobs for the birth of a baby or the illness of a parent. It's been a great thing for America, and it has not hurt the economy. And I would like to see it extended in a narrow way to say you can also take a little time off to take your child to the parent-teacher conference at school or your par- [[Page 1484]] ent to a regular doctor's appointment as well, in case there are serious problems that can't be dealt with. I want to see us stand up for the environment and prove we can grow the economy and protect the environment more in the 21st century. You know, I talked about this the other night, but I want to say it again. It's appalling to me--it's appalling to me that we still have 10 million American children living within 4 miles of toxic waste sites. Now, we've cleaned up more of those in 3 years than the previous administrations did in 12. But we're not doing enough; we have to do more. And so I propose just in the next 4 years to clean up 500 more, the two-thirds worst of those sites, so that we can say that our children are going to grow up next to parks, not poison. And I hope you'll help me with that. And here in Florida, I can say I'm very proud of the fact that in the first 4 years we saved national parks from the ill-advised scheme to sell some of them off. We negotiated an end to a proposed gold mine at Yellowstone National Park, the crown jewel of America's whole natural history. We created the largest national park south of Alaska in the Mojave Desert in California. And I hope in the next 4 years we will complete the work of saving the Florida Everglades. And I hope you will help us do that. [Applause] Thank you. Now, let's talk about health care. There are few issues that tie people together as closely as health care--all across the ages. The other night when the First Lady spoke at the Democratic Convention and said that we strongly supported a bill that says that you cannot kick a mother and her newborn child out of a hospital sooner than 48 hours, I believe that the grandmothers and the great-grandmothers and the great- grandfathers and the grandfathers were among those cheering the loudest in America. Of course these hospitals have to save money. Of course we want to cut unnecessary costs. Of course some people are healthy and fine, and there's no problem. But it ought to be a decision that the doctor can make based on what is best for the mother and the baby, and people should not be put on the street if they're not ready. When we launched a remarkable effort to dramatically increase the rate of immunizations of children up to the age of 2 so that more of them would live and live healthy lives, I think the grandparents were among those who cared the most about it. And when I was saying, look, we don't want to balance the budget in a way that not only cuts too much out of Medicare and Medicaid but fundamentally changes the system, that was as big a problem--that creates a two-tier system of Medicare where if you happen to be older or poorer or sicker at the time the changes are made, the chances of your falling into second-class health care are overwhelming; or that changes the whole system under Medicaid so that there is no longer a guarantee for people who have middle class lifestyles to get some help for their parents in nursing homes; or people who have middle class lifestyles who have children with disabilities to get some help with those children so they can keep them at home and still keep their jobs and not go broke--I don't believe that's an age-specific area. I think that we all care about that. On the other hand, I don't agree that you can't do anything to try to save money in these programs to save them. Everybody wants us to save Medicare. Everybody knows that we're all living longer and staying healthier. And that's good, isn't it? I mean, I think that's pretty good. So when somebody tells me, Mr. President, we got this terrible problem with Medicare, since the inflation per person is not going up, it's just that people are living longer and the longer you live the more health care you use--to me, that's a high-class problem. I mean, I don't understand all this hand-wringing. That's a high-class problem if we got people living longer and being healthier and hanging around and doing things. I think that's a pretty high-class problem. I don't understand why everybody is going around like Chicken Little, ``Oh, the sky is falling. We have problems in Medicare because everybody is living.'' I thought that was the object. [Laughter] I thought that was the point of the deal. Do you know, if you live in the United States--this is very interesting--in 1985, because of Social Security and SSI, for the first time in the history of our country, people over 65 had a lower poverty rate than people under 65. And because of Medicare and Medicaid, because of the things you can buy into with them, now if you live to be 65 in the United States, we have the highest life expectancy of any country in the world among people who live to be 65 going forward. [[Page 1485]] Our overall life expectancy is slightly lower, unfortunately, because we have higher rates of violence that take out too many of our children, because our maternal care programs are not as good as they should be, and because we have a disproportionate number of people, compared to a lot of other countries, with very serious illnesses. But if you live to be 65, you are in the country with the highest life expectancy for seniors in the entire world. Now, we know what did that. I don't think that's a bad thing. I think that's a good thing. This is a high-class problem, this Medicare problem. So I proposed, and I told everybody--all the advocates for the senior groups came in; we worked with them--we proposed larger savings, substantive savings over a 6-year period, in Medicare and Medicaid than any President ever had. The only problem was, I was trying to save the programs. I was trying to be fair. I wasn't trying to balance the budget on your back or make you pay for somebody else's tax cut or do something that would give us an excuse to walk away from our commitments under Medicare and Medicaid. So I say to you, the first thing we ought to do in going forward is to remember what the Hippocratic oath says: First, do no harm. Let's not do something we don't have to do. Let's do as much as we have to do to save the programs. But let's not do something we don't have to do that would make it unfair to those who depend upon them. We can--I'll say again, just like Congressman Deutsch said--we can clearly balance the budget and dramatically extend the life of the Medicare Trust Fund without the level of cuts in Medicare, Medicaid, education, and the environment in the budget that I vetoed last year. My door is still open to the Congress, even as they meet now in September to try to reach an agreement on that. But I will not do anything that will cause us to harm people who have justifiably depended on this when this program is working and the problem we have is the very problem we've been trying to create for 30 years, ever since we created it, which is we hoped people would live longer and be healthier and be stronger. We can fix it, but we don't want to destroy it. The second thing I want to say is, as we provide people more options in Medicare and more options in Medicaid and take steps that will further slow the rate of inflation and give people attractive options to be in managed care programs of various kinds, we ought to do it, again, in a way that really creates a win-win situation. And we can do that. I'm prepared to give Governor Chiles and all the other Governors in the country greater flexibility in how they administer the Medicaid program, but I don't think we should walk away from the populations, pregnant women and their poor young children, families with disabilities, and the seniors. I don't think we should do that. I think we should stay in there and serve those populations. In our balanced budget program, we actually also proposed to do some things that we think will be very good for the economy. A lot of parents--a lot of families, for example, are caring for parents with Alzheimer's. It's a painful, difficult thing. It's also a great labor of love. If a family is doing that and saving the system money by doing it, I think we ought to provide some way for them to get some respite care for those who are caring for Alzheimer's people in their own home. And that's an example of something that I think would be a good thing to do that will actually save money to the larger health care system and enable families again to make it at work and to make it at home, and to keep that close-knit bond that we all value so much. I think we are going to have to crack down even harder on those who rip the Medicare system off. We have--I will say this--I hear more about it in Florida than anyplace else, I guess, because more of you know about it, but you should know that we've saved more than $15 billion in 3 years. We have strengthened the requirements and our tools for dealing with it, and Governor Chiles has done a better job of dealing with it than any other Governor in the country, in my opinion. So we're doing our best. Two weeks ago, I had the great privilege, as has already been said in my introduction, of signing the Kennedy-Kassebaum bill, which is the most significant health care reform in a generation. The bill guarantees that working people can keep their health insurance if they change jobs, it gives self-employed business people a better tax break to buy insurance just like those who work for big firms. It means you don't lose your health insurance if you or somebody in your family gets sick. What it means is that up to 25 million Americans might [[Page 1486]] be able to get or keep health insurance now when they couldn't do it before. It is a very good bill. But we have to do more. You don't want to say to some people we have created a right for you, and it's like saying we've all got a right to go buy a Jaguar. So my next proposal is--and this, again, is paid for in my balanced budget--that we help workers and their families who are in between jobs to keep their health insurance for up to 6 months so they don't lose it while they're changing jobs. This could help to bring peace of mind to 3 million Americans a year, including 700,000 children. It is paid for in my balanced budget, and it's long overdue. I also think we have to do more to give our people the assurance that they'll get the quality they are paying for and that they deserve. That's why I'm supporting the legislation I mentioned, dealing with not forcing new mothers and their newborns out of the hospital. And that's why I believe we should extend consumer protections to the 140 million Americans who are now enrolled in managed care health plans. These plans--let me talk a little bit about--these plans, on balance, have given most people who are in them high quality care with more choices at lower costs, because they are, in various ways, managed care plans, the HMO's, the PPO's, and the others. But we have to make sure that the changes that are being made do not lead to a decline in the quality of health care. Now, I can tell you, I've spent years studying this now, as a Governor and as President, and I am convinced that the right kind of managed care can really be the best of all worlds, can give more choices to consumers, can give people more chances to make decisions that are right for them, can keep the costs of health care down, and still maintain very high quality. I am also convinced that if they're not the right kind of plans, some bad things can happen, especially by not giving managed-care customers all of the information they need. Too often, too many health care plans are literally gagging their doctors, their nurses, and other professionals by stopping them from telling patients about all their treatment options, because some of those options that may be best for the patients may be more expensive for the plan since the patient has already paid the flat rate. So I want to say to you that I think this has to stop, and this is my announcement for the day. But there is a bipartisan bill, a bipartisan bill that's been introduced in the Congress, sponsored by Representative Ed Markey, a Democrat, and Representative Greg Ganske, a Republican, that will help to protect doctors, nurses, and patients. It's called the ``Patient Right To Know Act,'' and it says that the professionals cannot be gagged from giving you the information you're entitled to and cannot be punished if they give it to you, so that we'll have the best of all worlds, managed care plus consumer protection. And I want--will you help me pass that bill? [Applause] Thank you. Again, I want to be clear: There are an awful lot of HMO's, PPO's, and other health care plans that give patients very good care at good value, even better value with more choices and less inflation in the health care premiums. But we have to make sure that we don't give up the quality of care. Doctors just must not face discrimination when they uphold their oath to give patients the best care. Patients should feel safe in the knowledge that they have been given the full story of what all their treatment options are and what are best for them. They should be told about the best treatment, whether it's the cheapest or not. There is also more to do. There are millions of Americans who are affected by the changes in our health system which ought to feel comfortable about the health care they receive. I have asked our Secretary of Health and Human Services, Donna Shalala, and our Labor Secretary, Bob Reich, to form an advisory commission about the quality of care for health care consumers with health care providers, health plans, consumers, business people--all on a bipartisan basis, everybody having their story heard, but to evaluate the ways that health plans can best serve their customers over the long run so that we can have a health care system we can afford and one we can be proud of because it keeps life expectancy going up and it keeps the health of our people improving. The Vice President I have asked to review this report because he has done such great work in other areas where we have tried to reinvent our Government and improve things. And what we're trying to do is to understand how these changes in the health care system are going to affect America's families, all generations of families, yours, mine, everyone else's. What are [[Page 1487]] the financial implications? What are the health care implications? What else should we do? But I am confident that being for a consumer's right to know is the right thing to do here. And I am confident--I will say again--I am confident that we can find a way to preserve the Medicare program in a way that gives you more options, keeps it affordable, and doesn't divide it into a two-tier system where the elderly in our country who happen to be the oldest or the poorest or the sickest wind up getting the short end of the health care stick. I don't think any one of you want that, and I'm going to do my best to avoid that. We can do what we need to do. All of this is a way of building a bridge to the future. I believe that we have to make it possible--let me say again--for families across the generations to succeed at home and at work, to honor the obligations to parents and children and still be successful in the workplace and as citizens. I believe we can do that. I believe we can do it if we build the right kind of bridge to the future, including the health care reforms I have discussed today. And I hope that every one of you will help me and yourselves and your children to build that bridge. Thank you, and God bless you all. Note: The President spoke at 3:20 p.m. at the Sunrise Musical Theater. In his remarks, he referred to Mayor Steve Effman of Sunrise; Mayor Nancy Graham of West Palm Beach; Sheriff Ron Cochran of Broward County; Jack and Janet Boyle, owners, Sunrise Musical Theater; Sallie A. Richardville, secretary-treasurer, Broward AFL-CIO, who introduced the President; and Ms. Richardville's mother, Edith B. Tuten, daughter, Mary K. Leake, and granddaughter, Nicole Washburn. The Executive order establishing the Advisory Commission on Consumer Protection and Quality in the Health Care Industry is listed in Appendix D at the end of this volume.