[Public Papers of the Presidents of the United States: William J. Clinton (1998, Book I)]
[June 22, 1998]
[Pages 1012-1015]
[From the U.S. Government Publishing Office www.gpo.gov]



[[Page 1012]]


Remarks to the Family Re-Union VII Conference in Nashville, Tennessee
June 22, 1998

    Thank you very much. Thank you. Thank you very much. Mr. Vice President, Tipper, to all 
the leaders of the conference, Surgeon General Satcher, Governor 
McWherter, ladies and gentlemen, first of all, let me say that I look 
forward to coming here every year so much. I always learn something, and 
I always see people who are full of energy and idealism and a sense of 
purpose, who remind me of what, at bottom, my efforts as President 
should be all about. So I always get a lot more out of being here than I 
can possibly give back, and I thank you for that.
    All these issues have been very important to our family for a long 
time. I grew up in a family where my mother was a nurse and where she 
served people before Medicare and Medicaid. I never will forget one time 
when a fruit picker that she had put to sleep for surgery brought us 
four bushels of peaches. I was really disappointed when third-party 
reimbursement came in. [Laughter] I thought the previous system was far 
superior. [Laughter]
    When Hillary and I met, she was taking an extra year in law school 
to work at the Yale University Hospital in the Child Studies Center to 
learn more about children and health and the law and how they 
interfaced. And when we went home to Arkansas, she started the Arkansas Advocates for Families and 
Children, a long time before she ever wrote her now-famous book, ``It 
Takes a Village.''
    The Vice President and Mrs. Gore have plainly been the most influential, in a 
profoundly positive sense, family ever to occupy their present position. 
Whether it was in mental health or the V-chip in television ratings or 
telecommunications policy or technology policy or environmental policy 
or reinventing Government or our relations with Russia and South Africa 
and a whole raft of other places, history will record both the Vice 
President and Mrs. Gore as an enormous force for good in America. And I 
am very grateful to them.
    This family conference is one of their most remarkable achievements. 
And as they said, it predates by a year our partnership and what 
happened since 1993. But I will always be very grateful to them for this 
as well.
    I'd like to begin with just a remark or two about the tobacco issue, 
since it's been raised and it was a big part of the movies that we saw. 
We know that it's the number one public health problem children face in 
America. We know that more people die every year from tobacco-related 
illnesses than from murders and fires and accidents and cancer--not 
cancer but AIDS--and many other conditions combined. We know that 3,000 
children start to smoke every day even though it's illegal to sell 
cigarettes to kids in every State in the country, and 1,000 die early 
because of it. We know all these things.
    We also know that in order to reduce teen smoking, you have to do 
something about price; you have to do something about access; you have 
to do something about marketing, both direct marketing, I would argue, 
by the tobacco companies and their indirect marketing by placing 
cigarettes strategically in movies, as we saw in this very compelling 
set of film clips. Now, we know all that.
    In what I had hoped was a remarkable and surprising example of 
bipartisanship in spite of enormous political pressure to the contrary, 
the United States Senate voted out of committee 19 to one, almost 
unanimously, a bill that would raise the price of cigarettes, stop 
advertising, restrict access, put penalties on companies that violated 
the requirements, and use the money for medical research--especially 
cancer research--for reimbursements to the States for the health costs 
related to smoking they had incurred, which money the States would use 
on health care, child care, and education. And for good measure, we 
accepted amendments sponsored by Republicans in the Senate to spend some 
of the money fighting drug usage among our children and to give a tax 
cut to low and moderate income working families to offset the so-called 
marriage penalty.
    Then the bill came to a vote in the Senate. The American people are 
now learning that, except for the budget, a minority in the Senate can 
require every bill to pass with 60 votes, not 51. We had 57 votes to 
pass that bill, but 43 Senators followed the bidding of the Republican 
leadership and the tobacco companies, and

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at least temporarily derailed that bill. It was a brazen act of putting 
politics over people and partisanship over progress.
    I say this to you so that you understand the importance of 
gatherings like this in grassroots networks. No one doubts that this 
came about in part because of an unanswered $40-million advertising 
campaign by the tobacco companies which could not be matched by the 
Cancer Society, the Heart Association, the Lung Association, or most of 
you in this room. What you should know is, I'll bet my bottom dollar the 
night the news of the bill dying broke on the evening news, public 
opinion switched back to our side, just like it always will as long as 
people know the facts of what's in the bill and who's behind the 
opposition to it.
    So I say to you this is the intersection of politics, public health, 
and family. And the cutting-edge issues up there right now are this bill 
and the Patients' Bill of Rights, about which the First Lady spoke. I 
don't think you should let this Congress go home, if you can stop it, 
without acting on these measures and taking care of our families and our 
future.
    Let me say, on a more positive note, this time in our history--on 
the edge of a new century, in a new millennium, with our economy strong, 
many of our social problems declining, a great deal of self-confidence 
in the country--is a real time of decision for us. Usually free 
societies at good times like this take longer summer vacations, spend 
more time in the sun. That may be good, at least the vacation part; wear 
your sunscreen if you do the other. [Laughter] Dr. Satcher will send me 
a gold star. [Laughter] Or you can say, hey, we can do things now we 
couldn't do in normal times. We have confidence. We have emotional 
space. We have the opportunity to dream dreams about the future. We can 
take on the big challenges of the country. I think that's what we ought 
to be doing, because we know that no set of circumstances stays the same 
forever, and because we know that things are really changing fast, and 
because we need to be looking to the future.
    What are these big challenges? Well, a couple related directly to 
the concerns of the conference: we need to make sure that Social 
Security and Medicare will be reformed so that they can accommodate the 
baby boom generation without bankrupting our children and our 
grandchildren, and we shouldn't be spending the surplus that finally is 
about to emerge after three decades of deficit spending. We shouldn't be 
squandering that surplus until we have saved Social Security and we know 
what we're going to do with Medicare.
    We have to figure out how to grow the economy and do more to 
preserve the environment, not just to avoid making it worse. We've got 
to actually recover many of our essential environmental things. And 
that's a health care issue.
    We're here at Vanderbilt--we've got the finest system of higher 
education in the world. We have to develop the best system of elementary 
and secondary education in the world. We've got the lowest unemployment 
rate in 28 years, but we still have double-digit unemployment in some 
urban neighborhoods, on some Native American reservations, and in some 
poor rural communities. We have to bring the spark of enterprise to 
every place in America to prove that what we're doing really works. 
These are the things that we have to do. And we have to prove that we 
can all get along together across all the racial and religious and other 
lines that divide us, because in the world today, which is supposed to 
be so modern and so wonderfully revolutionized by the Internet, old-
fashioned racial and religious and ethnic hatred seems to be dominating 
a lot of the troubles in the world. If we want to do good beyond our 
borders, we have to be good at home.
    But on that list should be health care. Why? Because we have the 
finest health care in the world, but we still can't figure out how to 
give everybody access to it in a quality, affordable way. And in some 
form or fashion, every family in America just about, sooner or later, 
runs up against that fact.
    Shirley MacLaine was in there griping about her daughter getting the 
shot on the movie, you know? Now, why do you suppose--nevermind the 
movie--why do you suppose something like that would happen in real life? 
Could it have something to do with the fact that not just HMO's but the 
Government tried to take steps to stop medical expenses from going up at 
3 times the rate of inflation, but like everything else, if you overdo 
it and the hospitals have to cut down on service personnel, that people 
will be late getting their pain shots? I mean, we have to come to grips 
with the fact that we still are alone among all the advanced societies 
in the world in not figuring out how to deal with this issue.

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    And I personally think we also--we ought to be honest--you know, 
it's easy to--we could all get laughs with HMO jokes, but the truth is 
there was a reason for managed care, and that is that it was 
unsustainable for the United States, with the smallest percentage of its 
people with health insurance of any advanced country, to keep spending a 
higher and higher percentage of its income and increasing that 
expenditure at 3 times the rate of inflation. Pretty soon it would have 
consumed everything else. That was an unsustainable situation.
    And a lot of good has come out of better management. I don't think 
anyone would deny that. The problem is, if that kind--if techniques like 
that are not anchored to fundamental bedrock principles, then in the 
end, the process overcomes the substance. And you have the kind of 
abuses and frustrations that have been talked about. That's why the 
Patients' Bill of Rights is important.
    Now, the second thing I want to say is, we have to figure out how to 
do a better job of turning laws into reality. One of the things--the 
Vice President, I hope, will get his just 
desserts--we may have to wait for 20 years of history books to be 
written--but the work that we have done in reinventing Government is not 
sexy; it doesn't rate the headlines every day; people don't scream and 
yell when you mention the phrase; it doesn't sort of ring on the tip of 
the tongue. But we've got the smallest Government we've had in 35 years, 
and it's doing more and doing it better than we were doing before in our 
core important missions. And we've gotten rid of hundreds of programs 
and thousands and thousands of pages of regulation, but the Government, 
on balance, is performing better. And it's because of our commitment to 
change the way things work.
    The biggest challenge we've got right now is to fulfill the promise 
we made to the American people when we persuaded the Congress to put in 
the Balanced Budget Act of 1997 sufficient funds--the biggest increase 
in Medicare funding since 1965--to provide health insurance to at least 
5 million more children. There are 10 million or more children in 
America without any health insurance. We had--the latest numbers 
indicate that 4\1/2\ million of those kids are actually eligible for 
Medicaid.
    Now, most of you here know that when we passed this program we 
provided for the establishment, State-by-State, of things that are 
called CHIPS, child health insurance programs, to provide health 
insurance mostly to the children of lower and moderate income working 
families that don't have health insurance at work. But if you want to 
get the maximum number of people insured for the money that's been 
allocated, obviously the first thing we need to do is to sign every 
child up for Medicaid who's eligible for it. And again, we're talking, 
most of these children live in lower income working families. They've 
been rendered eligible by action of the Federal Government or by action 
of the State legislature in Tennessee and the other 49 States in our 
Union.
    Recent studies have shown that uninsured children are more likely to 
be sick as newborns, less likely to be immunized, less likely to receive 
treatment for even recurring illnesses like ear infections or asthma, 
which without treatment can have lifelong adverse consequences and 
ultimately impose greater costs on the health care system as they 
undermine the quality of life.
    Now, we're working with the States to do more, but I want the 
Federal Government to do more as well. Four months ago I asked eight 
Federal agencies to find new ways to help provide health care for kids. 
Today, at the end of this panel, I will sign an Executive memorandum 
which directs those agencies to implement more than 150 separate 
initiatives, to involve hundreds of thousands of people getting 
information that they can use to enroll people in schools, in child care 
centers and elsewhere, involve partnerships with job centers and Head 
Start programs.
    This is what reinventing Government is all about. The American 
Academy of Pediatrics says that these initiatives are, quote, 
``representing the best of creative government and absolutely critical 
to achieving our common goal of providing health insurance for all 
eligible children.'' So that's what we're going to try to do coming out 
of this conference, to do our part.
    Let me again say that those of you who are here, if you believe that 
families are at the center of every society, if you believe they are the 
bedrock of our present and the hope of our future, if you think the most 
important job of any parent is raising a successful child, then surely--
surely--we have to deal with the health care challenges, all of which 
have been discussed: caring for our parents and grandparents, caring for 
our children. Surely we have to provide our families with tools to do 
that if we

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expect America to be what it ought to be in the new century. We'll do 
our part, and I'm proud of you for doing yours.
    Thank you, and God bless you.

Note: The President spoke at 12:45 p.m. in Langford Auditorium at 
Vanderbilt University during Family Re-Union VII: Families and Health. 
In his remarks, he referred to former Gov. Ned Ray McWherter of 
Tennessee and actress Shirley MacLaine. The transcript made available by 
the Office of the Press Secretary also included the remarks of Vice 
President Gore, Tipper Gore, and Hillary Rodham Clinton.