    [Public Papers of the Presidents of the United States: William J. Clinton (1997, Book II)]
    [September 15, 1997]
    [Pages 1162-1167]
    [From the U.S. Government Publishing Office www.gpo.gov]

    Remarks to the Service Employees International Union
    September 15, 1997

        Thank you very much. Thank you. This is a pretty good way to start
    off the week. [Laughter]
        You know, I'm getting up in years now, and--[laughter]--every day I
    start a little slower, it seems like, and I always need kind of a jolt
    of energy. I may be dancing by the time I get back to the White House.
    This may be the afternoon of my first 5-mile run since the accident.
        It's great to see you, and I thank Andy for that remarkable
    introduction and for his remarks and his passionate commitment. I thank
    your executive vice presidents who are up here on the stage with me, and
    all the rest of you for inviting me here.
        We have a large number of people from the White House who have come
    here today. I think I should mention at least two of them. One is a gift
    you gave me or a theft I accomplished--[laughter]--but Karen Tramontano
    is doing a magnificent job. I also would like to note that the Assistant
    to the President and Director of Public Liaison used to work with you at
    the Labor Department, Maria Echaveste, and she is also doing a great
    job, and she's here with me.
        Ladies and gentlemen, I am delighted to be here and delighted to see
    all of you, wishing I had one of those purple T-shirts to jog in.
    [Laughter] I'll get one before I leave. The SEIU--better not do that or
    it will be a story. [Laughter] The SEIU is leading the way for better
    wages, safer workplaces, more full-time jobs, and a brighter future for
    our working families. There's new life, new energy, new creativity in
    the labor movement in America, and a lot of it began right here with
    you, and I thank you for it. Because of your leadership in the workplace
    and your involvement in the political process, not just you but America
    is also back. I've come here today to thank you for what you've done,
    not simply for me and our administration but for the people of the
    United States,

    [[Page 1163]]

    to strengthen our families and to strengthen our economy and to
    strengthen our future.
        I also want to talk to you about what we can do now to strengthen
    America's health care system and especially to talk about what we have
    to do to reduce fraud in the Medicare program so that it can serve
    America well into the 21st century.
        We've come a long way from 6 years ago when I announced my candidacy
    for President. Then I said that I had a simple mission for America in
    the 21st century. I wanted to keep the American dream alive for every
    person responsible enough to work for it. I wanted to make sure that
    America would continue to be the world's strongest force for peace and
    freedom and prosperity. And I wanted to make sure that we could bring
    our people together across all the lines that divide us amid increasing
    diversity into one America--our oldest and most enduring values--
    opportunity for all, responsibility from all, a community of all
    Americans leading the world toward peace and freedom and prosperity.
        We began with a bold new economic course that focused on three
    things: shrinking the deficit; selling more American products and
    services around the world; and investing in our people, in the capacity
    of all of our people, and being determined to leave no one behind. We
    also put a special effort on depressed communities. We had an aggressive
    anticrime strategy to try to bring the crime rate down by putting more
    police officers on the street and keeping more kids out of trouble,
    taking assault weapons off the street, keeping handguns out of the hands
    of people with a criminal or a serious mental health history. We had an
    aggressive effort to help move people from welfare to work. Now, 6 years
    later from the time I started, almost 5 years from the time I became
    President, we see the results: nearly 13 million new jobs, unemployment
    less than 5 percent, poverty down, the biggest drop in welfare rolls in
    history, dramatic drops in the crime rate year after year.
        Maybe even more importantly, about midway through my first term,
    after decades of working harder and harder for lower wages, never
    keeping up with inflation, millions of Americans are finally beginning
    to see a rise in their paychecks. And it's about time. Incomes of
    American families have averaged an increase of $1,600 since the
    beginning of our administration, but it's getting better over time
    because of three things.
        First of all, with your help last year, we raised the minimum wage
    because no hard-working parent should have to try to raise a child on
    $4.25 an hour.
        Secondly, we more than doubled the earned-income tax credit in the
    economic program of 1993, which is worth, on average, over $1,000 a year
    in lower taxes to a family of four with an income of under $30,000 a
    year if they have a couple of children.
        And thirdly, the children's tax credit, which was just adopted--and
    adopted to cover those young public employees that start out, and may be
    eligible for, the earned-income tax credit, too--will be worth another
    $500 a child to working families throughout this country.
        These three things together are going to have a huge impact on the
    family incomes, particularly of people, let's say, in the bottom 40
    percent of the income brackets in the United States.
        From 1945 until the mid-seventies, all of us grew together. From the
    mid-seventies to the early nineties, our economy continued to grow, but
    because of inflation, because of foreign competition, because of all the
    restructuring going on in the American economy, we began to grow apart.
    Now we can grow together again. And I know that's what you want, and
    that's what I want. We've got to grow, and grow together. And that means
    we can't rest, because even though this is a time of extraordinary
    achievement and justifiable optimism for our country, we have to keep
    going until every single American can reap the rewards of a growing
    economy, and we're not there yet.
        In the last budget bill, for the first time ever, we had so much
    increased aid to help people go to college or send their children to
    college--the biggest increase in 50 years since the GI bill--we can now
    honestly say we have now opened the doors of college education to all.
    But people have to walk through them in order to get the training they
    need to get the incomes that they want for themselves and their
    children.
        We also are in the middle of a continuing struggle to secure the
    investments in the budget agreement for our schools and also to embrace
    the notion that we ought to have high national standards of academic
    excellence, which should apply to all of our children in all of our
    school districts--not Federal Government standards, national standards
    that should apply to all of our children.

    [[Page 1164]]

        We also have to pass sweeping legislation designed to continue this
    effort to keep tobacco out of the hands of our young children.
        And we have to continue to grow the economy. There are some specific
    things in this budget agreement that are very important, designed to go
    right to the heart of the poorest communities in urban and rural
    America: doubling the number of community development banks that make
    loans to people in those neighborhoods; continuing to make sure that we
    have more and more empowerment zones, the program the Vice President has
    done such a good job on, to give people incentives to invest money where
    there are people who are unemployed or underemployed. That's good for
    our economy, to keep the jobs growing.
        One other thing--and I know that we have often disagreed on this--I
    just want to say one more time. Our analysis is that between one-quarter
    and one-third of our economic growth that made 13 million jobs in the
    last 4 years came because we are selling more American products
    overseas. Why? We have 4 percent of the world's population; we have 20
    percent of the world's wealth. If you want to keep 20 percent of the
    wealth with 4 percent of the population, you have to sell something to
    the other 96 percent. Now, in the next 15 years, our estimates are that
    the developing countries of Latin America and Asia will grow 3 times as
    fast as the United States, Europe, and Japan. And therefore, we have to
    be a part of that.
        The last point I want to make is--all of you know this--our markets
    are already among the most open in the world. They're more open than all
    these countries we're making agreements with. So if we agree to have
    equally open markets, we give up far less than they do, and we open
    markets largely to our high value-added products. That's why I sought
    the fast-track trade authority, not because I want unfair trade
    agreements but because I think we have earned a presumption, at least,
    to be taken seriously when I say to you the 220 trade agreements we have
    negotiated had something to do with the 13 million jobs we have and the
    fact that we have the most successful economy we've had in a generation.
        Should there be labor and environmental standards? Should we work
    hard to raise labor standards for working people around the world so
    that it increases everyone's income? Absolutely. Should we ask people to
    adhere to global standards so that we can preserve the global
    environment? Absolutely. But that means we should, too. That means that
    we should, too. We can't tell another country they should clean up their
    sewage and clean up their water unless we're willing to clean up the
    global air that we--we have to do it, too. We have to do it, too.
        So we've got a lot still to do. But I want to focus in the last few
    minutes of my talk here on what Andy talked about. I want to talk about
    health care: Where we are and where are we going. You know, they said if
    I passed my health care plan that everybody was going to go into managed
    care, and it would be a bad thing. [Laughter] Well, we didn't pass the
    health care plan, and everybody's going into managed care. [Laughter]
    And it's not all bad.
        But also we don't have anything like the choices for health care
    consumers that we had in our plan. So the good news is, we've
    rationalized the management of the health care system. The bad news is,
    we don't have the standards in there and the choices and the consumer
    protections that we would have had.
        Now, we can't go strong into the 21st century if millions of our
    fellow citizens still go to bed every night worrying about whether their
    sons and daughters and parents can see a doctor. I said if we don't do
    something about it, the number of people without health insurance in
    America will continue to rise. And sure enough, it has. Now there are
    over 40 million of us without health insurance.
        We can't be strong in the 21st century if American patients are only
    a dollar sign on a ledger book. We cannot be a strong nation--to be
    fair, too, we can't be a strong nation unless we know that Medicare and
    Medicaid will last and will be relatively free of the fraud and abuse
    that can so easily infiltrate any big program. So we have a lot to do.
        It has become commonplace to say that we have the most excellent
    health care system in the world, but we are not very excellent in making
    sure all Americans can share in it. That is what we have to focus on.
    And it tickled me when Andy said that Bill and Hillary would outlive
    Harry and Louise. I certainly hope so. [Laughter] I have to tell you,
    though, a lot of times in my life I've gotten beat trying to do
    something I thought was right. And I prefer that than not trying in the
    first place. I'm glad

    [[Page 1165]]

    I tried to do the health care. I'm glad I tried to do that. [Applause]
    Thank you.
        As you might imagine, I've had a lot of time to sort of Monday-
    morning quarterback myself and try to figure out how I could have done a
    better job. It is ironic that, having reduced the size of the Federal
    Government by 300,000 to its smallest size since Kennedy, I was accused
    of trying to have the Government take over the health care system; that
    having given more authority to the States than even President Reagan
    did, I was accused of trying to engage in a power grab for the Federal
    Government. I wasn't trying to do that. But the fact is that we have a
    system unlike any in the advanced world. And every other advanced
    country can figure out how to get health insurance to everybody, and we
    can't. And we wind up paying more because of it, because we don't do
    enough preventive health care, we don't do enough primary health care,
    we do too much through the emergency rooms. We have too many people with
    uncompensated care that the rest of us who have insurance pay for in
    higher rates. All because we have refused to try to rationalize this
    process.
        Now, what I tried to do before won't work. Maybe we can do it in
    another way. That's what we've tried to do a step at a time until
    eventually we finish this. We can be very proud of the Family and
    Medical Leave Act. I was glad that your president mentioned that. That's
    the first major legislation I signed. Millions of people no longer have
    to make a choice between succeeding at work and home because of that.
    All the time, people still come up to me and talk about it--I travel
    around the country--just citizens come up and talk to me about their
    experiences under the Family and Medical Leave Act.
        We can be proud that after the so-called Contract With America
    revolution in 1994, we didn't allow them to take away Medicaid, and we
    were able to preserve the social safety net. There are millions of poor
    children, pregnant women, disabled and older Americans who still have
    access to health care. A lot of them don't. A lot of them can't even
    vote, and they may not have a lot of political power. But you stood up
    for them, and I appreciate it, and I hope you're proud of it.
        You can be proud that you supported and that there was enormous
    bipartisan support for the Kennedy-Kassebaum health insurance bill that
    says you can't lose your health insurance when you change jobs or just
    because someone in your family has been sick. That will preserve health
    care for enormous numbers of people, and you should be proud of that.
        And you ought to be proud of the health care provisions of this last
    budget. The biggest increase in investment in health care for children
    since the Medicaid program passed in 1965 is in the balanced budget of
    1997. It will permit us to insure up to half of the children who don't
    have health insurance. And if you'll help us, we might be able to
    actually insure more. Because of the 10 million children in America--40
    million people roughly don't have health insurance, actually a little
    more; 10 million of them are children. Of those 10 million, 3 million,
    believe it or not, are eligible for Medicaid right now. And they're not
    on it, either because maybe their parents are first generation
    immigrants, aren't fluent in English, no one has explained to them that
    they're eligible. Maybe they're people who work for low wages, but they
    think somehow they'll be on welfare if their children take Medicaid.
        It's a lot of work, but we could actually insure more than 5 million
    children with the $24 billion in this bill. If we could get the 3
    million kids who are Medicaid-eligible right now onto Medicaid, we could
    take the same money and insure far more children. And we'll be back to
    you on that. But we need your help.
        In addition to that, this budget also provided new preventive care
    benefits for mammographies, to try to head off prostate cancer, which is
    just as prominent in men as breast cancer is in women, and had what the
    American Diabetes Association said was the most significant advance in
    the care of Americans with diabetes since insulin was discovered 70
    years ago. So this is a good budget.
        But we have to work now to make sure that we devise a system that
    actually covers new children instead of a system that permits employers
    to continue to drop their employees' children from insurance because
    they're going to be picked up in public dollars. We must not do that. We
    must make sure that we cover new children.
        I need your help in this. We cannot waste this opportunity. We've
    got to work with the advocates groups, the local communities, the State
    governments, the health care providers. We cannot blow this. This is an
    enormous thing.

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    You know, when you think about the rhetoric of the health care debate
    just a couple of years ago, and now you've got 80 percent of the
    Congress in both Houses voting for the biggest increase in health care
    coverage since Medicaid passed in '65, we have come a long way. And you
    can be proud of that. And you can be glad that now there are Members of
    both parties in Congress who are willing to vote to do this.
        But it is complicated when you're doing this a piece at a time.
    We've got to do it right so we can go on to the next step and the next
    step and the next step. What about all those people that retire at 55
    and lose their employer-based health insurance and can't draw Medicare
    until they're 65? What about all those people? What about all the people
    who have a right to keep their health insurance when they're between
    jobs, but after they've been without a job for a certain amount of time,
    they still can't afford it? I've got a right to own a Jaguar, but I
    don't. [Laughter] So we've got to be careful. We've got to do this
    right. And you can help on this. You can really help us on this. But the
    children of this country have got a lot riding on us doing this right,
    and we need you.
        Finally, let me say, we've got to take some decisive steps to deal
    with some of the changes that are constantly evolving in the health
    industry. We've got to act to protect consumers first. Whether they have
    traditional health care coverage or managed care, we have to make sure
    they don't have inferior care. That's why I appointed the nonpartisan
    quality commission to write a consumer's bill of rights. And let me say,
    I want to thank your secretary-treasurer, Betty Bednarczyk, for serving
    on that. She's doing a good job, and I appreciate it.
        Congress has to pass some legislation. It should ban gag rules in
    private health care plans, just as I did in Medicare and Medicaid. It
    should ban these horrifying drive-through mastectomies, just as it
    banned drive-through baby deliveries. The First Lady and a lot of other
    people have worked hard on this since I called for it in the State of
    the Union, but Congress still has not held a hearing on this. It's time
    to move, and I ask you to help me get Congress to move on this.
        It should be made illegal for health companies to deny or drop
    coverage or raise rates based on genetic information. We're going to
    continue with this Human Genome Project, and that's a good thing. And
    some day in the not-too-distant future, young mothers and fathers will
    bring their newborn babies home from the hospital and they'll actually
    have a genetic map for their kids. And 99.9 percent of the time, I
    guess, or at least the vast majority of the time, it will just be good
    news with good information. Sometimes it will be terribly sad. But even
    when it's sad or challenging or frightening, it will give those parents
    the chance to give their children a longer life or a better life. But if
    we're going to find this information, we can't turn around and basically
    say, because of the march of science we're going to even increase
    further the number of uninsured people in America. And who's going to
    take care of them?
        So this is a very important issue. And again, I ask for your strong
    advocacy on this. Science, yes; research, yes; tell people more about
    the health condition of their children, yes; but don't strip them of
    their insurance because of this march of science.
        Congress should follow the new medical privacy guidelines we issued
    last week and pass legislation to make sure records now stored in
    computers stay just as confidential as records locked in a file cabinet.
    I think that average Americans really worry about this. You do--don't
    you worry that something gets in a computer, it will be halfway around
    the world and somebody is going to send you something in the mail to try
    to get some money out of you or do something? I think people really
    worry about this. How can we preserve privacy and still take advantage
    of the modern computer technology? We want people that deal with us to
    take advantage of computer technology if they can serve us faster or
    better or cheaper. We know they can save a lot of money. But in the end,
    privacy is worth an awful lot, and we don't want to see computer
    technology take it away.
        And the last issue I want to deal with, again, is to say that we
    will never have a health care system as strong as it can be unless we
    strengthen our efforts to root out fraud and abuse in the Medicare
    program. They amount--these kinds of practices amount to a fraud tax on
    all the taxpayers of the country. And for those of you who work in
    health care, they cost public confidence in the work that you do. I know
    home health care workers want to put a stop to fraud and abuse, and I
    look forward to working with you to do that.

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        We put more Federal resources into this. Convictions are up 240
    percent, and we've saved the taxpayers $20 billion already, but it is
    just the beginning. Home health care is one of the country's fastest
    growing industries. We want more people to be cared for at home if they
    can properly be cared for at home. Every month, nearly 100 home health
    providers--new ones--enter the Medicare program. But there is still too
    much evidence of widespread fraud and abuse that has to stop.
        First, we're going to keep scam and rip-off artists from getting
    into the Medicare system in the first place. Today I'm declaring an
    immediate moratorium on the admission of new home health agencies to
    Medicare, and during this moratorium we'll develop tough new regulations
    to ensure that no fly-by-night providers enter or remain in the Medicare
    program. Second, I'm requiring all home health agencies to re-enroll
    every 3 years so that they, too, will abide by these standards. Third,
    we will double the number of audits of home health agencies currently
    involved in the Medicare program.
        Medicare for us is a way to honor our parents and strengthen our
    families. I was glad to fight for the comprehensive reforms that we got
    in the last budget that will give more choices to Medicare customers and
    still keep the program strong for more than a decade. No matter what
    changes we make in the structure of the program, we can't maintain it
    for what it should be if we tolerate unacceptable levels of fraud and
    abuse.
        Earlier today I said that you represented the future of the American
    labor movement and the future of America. Just look around the room, and
    you'll see why--people who have come together across racial,
    professional, geographic lines to fight for a common future. That's what
    we all have to do. That's why I asked the American people to join me
    this year in a great conversation about our racial diversity and where
    we're going with it. What's our unfinished business that we've been
    lugging around for us? What about discrimination that still exists? What
    about destructive attitudes that still exist? What is the unfinished
    racial business of America? Question one.
        Question two is, what about the future? What kind of country is this
    going to be like when, 5 years from now, there's no group with a racial
    majority in our biggest State, California, and when, within 40 years,
    there will be no racial majority in the entire United States? Now, we
    can look at the census projections and tell what we're going to look
    like, but that's not the same thing as saying what we're going to be
    like.
        Everything we talked about today, every single specific issue is
    designed again to guarantee opportunity for everybody who will work for
    it, to maintain the leadership of our country in the world, and to bring
    us together in one community of America. That's what I want you to lead
    for.
        Don't ever be afraid to be an instrument of change. Don't ever be
    afraid to stick your neck out and fight for change. And don't ever be
    afraid to hold yourself up to the scrutiny of life and say we want to
    represent the future of America. You look around this room, and you know
    you can do it. And when you think about how you feel at your very best
    in your work, you think about the best days you ever have working with
    people that are so different from you, you never imagined you'd ever get
    to know them or work with them, that's the way America ought to be every
    day. And that's what we need to keep working for.
        Thank you, and God bless you.

    Note: The President spoke at 11:20 a.m. in the Phoenix Room at the Hyatt
    Grand Regency Hotel. In his remarks, he referred to Andrew Stern,
    president, Service Employees International Union; and ``Harry and
    Louise,'' characters in a series of commercials sponsored by the Health
    Insurance Association of America.