    [Public Papers of the Presidents of the United States: William J. Clinton (1999, Book I)]
    [June 30, 1999]
    [Pages 1040-1045]
    [From the U.S. Government Publishing Office www.gpo.gov]

    Remarks on Medicare in Chicago, Illinois
    June 30, 1999

        Thank you very much, ladies and gentlemen, and good morning. I want
    to say that it's wonderful for me to be back in Chicago. Most of you
    know how much I love it here, and I am delighted to be here. I bring you
    greetings from the First Lady, who I
    left on my way here

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    and who was jealous that I was coming and she wasn't, especially since
    I'm also going to see the Cubs play this afternoon--[laughter]--and I
    enjoy that; and from the Vice President and all the members of our
    administration who have worked so hard on this health care issue.
         I want to thank Anna Willis for her
    remarks and her leadership for the aging community here in Chicago. And
    I know that with me on the stage, and perhaps out in the audience as
    well, are members of the Mayor's Advisory Council on Aging, the Cook
    County Board of Commissioners, the Cook County Council, the Chicago City
    Council. I thank them all for being here.
        I'd like to thank Linda Esposito for
    speaking on behalf of pharmacists who have to live with the consequences
    of the absence of prescription drug coverage for our seniors every day
    and who do their best to serve them well under very adverse
    circumstances. And I thought she did a very fine job; I thank her for
    being here.
        And I want to thank Hanna Bratman for
    having the courage to get up here and tell her story and introduce me.
    You know, I do this all the time. It's second nature for me. But most
    people, it's pretty scary to get up in front of all of you and all those
    cameras and talk about your life and talk about your circumstances. And
    I thought she did a fine job, and I thank her for doing that.
        I'd also like to thank these ladies on my left, Anne Thomas and her daughters, Lee Hamilton
    and Laura Peterson, because they represent
    what I think of as the ultimate test of Medicare, which is whether it's
    fair and helpful and supportive of families and our intergenerational
    responsibilities, parents to their parents, to their children. And I'll
    say more about that, but thank you for joining us today, as well.
        Ladies and gentlemen, as is so often the case when I get up to
    speak, the people who spoke before me have said everything that needs to
    be said. One guy got up--you know the great story about the last speaker
    at a long dinner; eight people spoke, and he got to speak at 10 o'clock,
    and he said, ``Well, everything that needs to be said has been said, but
    not everyone has said it.'' [Laughter] So relax; I'm going to talk a
    little bit.
        Let me say to all of you that we have an unprecedented opportunity
    and an unprecedented responsibility to strengthen Medicare and to
    improve it, to modernize it so that no one has to make the choice that
    you have heard talked about, between affording health care and affording
    other necessities of life, between remaining independent or relying on
    your children and undermining their ability to raise your grandchildren.
        We have this opportunity because our economy is the strongest in a
    generation, perhaps ever, because our country is clearly moving in the
    right direction, a leading force for freedom and peace and human rights
    around the world, as our wonderful men and women in uniform demonstrated
    in Kosovo recently. Our social fabric here is mending. The crime rate is
    down; the welfare rolls have been cut in half; teen pregnancy is down;
    drug abuse among our young people is down; and a record 90 percent of
    our young people are immunized against serious childhood diseases for
    the first time in the history of our country. Our cities, which were
    once thought of as being economically depressed, are thriving again.
    Chicago is exhibit A--look at this beautiful building and this beautiful
    vista we have here.
        When I became President, we had a $290 billion budget deficit. The
    debt of our Nation had quadrupled in only 12 years. Today, we are going
    to be, in 1999, $99 billion in the black. We actually projected
    yesterday that for the next 15 years, the surplus will be a trillion
    dollars more than we thought it was just 6 months ago.
        Now, this is a great tribute to the ingenuity and the hard work of
    the American people and to the disciplined decisions that we have made,
    starting in 1993, to cut that deficit until we balanced the budget and
    got into surplus. If we keep going on the plan I have proposed to save
    Social Security and Medicare and pay down the debt, this country
    actually can be out of debt--out of debt--in 15 years for the first time
    since 1835.
        Now, let me just say, since all of you know it's the strength of the
    economy that has put people to work and raised their incomes and brought
    in the revenues that enabled us to save Medicare, the reason it's a good
    thing for all Americans for us to be out of debt is that if we're out of
    debt, it means that the Government won't be competing with you and the
    business people to borrow money. It means interest rates will be lower
    for business loans, for car loans, for home loans, for credit cards, for
    college loans. It means, therefore, there will be more

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    investment, more jobs, higher incomes. It means we will be less
    dependent on the world for money to come into this country, so if there
    is another financial problem as there was in Asia a couple of years ago,
    it will have less impact on us. It means people all over the world that
    we look to to buy products that are produced in Illinois and throughout
    the United States will be able to borrow money more cheaply and have
    more money to buy our products, to help our prosperity as we help
    theirs, if we get this country out of debt.
        So I want to emphasize to you, everything I am proposing to do with
    Medicare and with Social Security can be done in a way that gets the
    country out of debt for the first time since 1835. And in a global
    economy, it is very, very important to our children and our
    grandchildren that we give them the opportunities they deserve.
        Now, how are we going to do that? We have to set aside the bulk, a
    little more than three-quarters, of the surplus for saving Social
    Security and Medicare. We need to do that, quite apart from this
    prescription drug benefit. Let's talk about that. Why do we need to do
    that? Because we have a high-class problem in America: we're all living
    longer. Life expectancy is already over 76 in America. For young people
    growing up, their life expectancy will probably be over 80. Anybody who
    lives to be 65 in America today has a life expectancy of 85. People over
    80 are the fastest growing group of Americans.
        Now, when you put that life expectancy development up next to the
    fact that the baby boom generation, the biggest generation in American
    history until the present one in our schools today, is getting ready to
    retire--some of them, anyway. I'm the oldest of the baby boomers, and I
    hope I don't have to retire. But anyway, I'm going to retire from this
    job, but generally I think I should keep working. [Laughter]
        But when you look at the fact that with the baby boomers retiring,
    the oldest of the baby boomers--that's me, we turn 65 in 2011, not that
    far away--there are going to be a lot more people retired relative to
    the number of people working, which means there will be a lot more
    people drawing Social Security and a lot more people drawing Medicare
    relative to the number of people working.
        Now, we can make some changes in the program, but I would argue that
    now that we have this surplus and we project this surplus to last into
    the future, and if we know it's good for us anyway, for all Americans of
    all ages, to pay the debt down, we should save this much money now to
    stabilize Social Security and Medicare and pay the debt off.
        Now, I know there are a thousand good uses for this surplus. If I
    gave each of you a piece of paper and I said name 10 things that you
    would like to see your country do, we might have 100 different things on
    that list, and they'd all be good. But I say we should take care of
    first things first. And we don't have any more important obligation, not
    only to seniors but to their children and their grandchildren, than to
    preserve the integrity of Social Security and Medicare and preserve the
    long-term economic health of this country. So I hope that all of you
    will support that.
        We can talk more about Social Security later, but if my proposal is
    accepted, we'll have Social Security solid for way more than 50 years
    already. And with a few other changes, we could take it out to 75 years;
    we could do something to deal with the fact that elderly women on Social
    Security are far more likely to be poor, and they need some extra help;
    and we could lift the earning limitation for people on Social Security.
    I would like to see those things done.
        But let's talk about Medicare. We should secure and strengthen and
    modernize Medicare. It's been around for 34 years now. It's made health
    care more accessible and more affordable. As you heard Hanna say, it's
    given millions of American families peace of mind by paying for medical
    costs that otherwise would have bankrupted families in their later
    years. It has also freed the children of Medicare's recipients from the
    painful choice of mortgaging their children's future to provide a decent
    health care for their parents. But you've got people living longer and
    the baby boomers set to retire; therefore, more people drawing Medicare
    and fewer people paying in. What that means is that the Trust Fund will
    become insolvent by the year 2015, 15 years from now.
        Now, we've already done a lot to try to stave that off. When I
    became President in 1993, the Trust Fund was supposed to become
    insolvent in 1999--this year. We've made a lot of changes. Some of them
    were difficult and somewhat unpopular, but we have saved Medicare until
    2015.
        But that's not enough. Keep in mind, the baby boom generation won't
    begin to turn 65

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    until 2011. Then, over the next 30 years, the number of people who are
    65 or over will actually double. So we need to lengthen the life of the
    Medicare Trust Fund, and we need to do it now. The sooner you deal with
    these issues, the easier it is to deal with them. The longer we take to
    deal with them, the more painful and the more expensive it will be to
    deal with it.
        The plan I announced yesterday to secure and modernize Medicare for
    the 21st century does the following things. First of all, it extends the
    solvency of the present Medicare program to the year 2027. That is very
    important. Changes made today can keep it alive until 2027. That will
    almost completely take in the baby boom generation--not quite but
    nearly. And that gives all of our successors plenty of time to take
    advantage of all the increases in health care options that I'm convinced
    will allow people to stay healthier even longer in the years ahead.
        To do it, I propose that we use 15 percent of the budget surplus
    over the next 15 years. Again I say, there are a lot of good uses for
    the surplus. A lot of people would like to have more money right now.
    But there is nothing more important than taking care of first things
    first. Keeping the economy strong by paying the debt off and saving
    Medicare and Social Security, I think, are the most important things we
    can do, and we should do them first.
        Now, we also plan to modernize the way the program works, to
    introduce more innovations now used in private sector health plans, to
    offer seniors the chance to choose between lower cost managed care plans
    for Medicare and the traditional program without forcing the choice by
    having unreasonable increases in the premiums in the traditional
    program, to guarantee that our seniors have the information necessary to
    make informed choices and that all the available plans have certain core
    medical benefits necessary to preserve the integrity of the program, to
    make sure that as we hold costs down, we keep quality up.
        But we also, as everybody before me has said, need to modernize
    Medicare. One of the ways, but not the only way, is with prescription
    drugs. Think of it this way: Medicine has changed a lot. The whole
    health care system has changed a great deal since 1965. But Medicare
    hasn't changed with it. As a consequence, the average senior citizen
    today is paying a larger percent of his or her income, out of pocket,
    for health care than they were paying in 1965 before Medicare came in,
    primarily because of the prescription drug issue.
        But think of the other challenges. A revolution in medical science
    has brought cures to diseases once thought incurable, provided doctors
    the tools to prevent diseases from starting in the first place, and
    given millions of people the chance to live not only longer but
    healthier lives. Once, the cure for many illnesses was a surgeon's
    scalpel. Now it's just likely to be a pharmacist's prescription drug.
    Every day new drug therapies are being developed to treat chronic
    conditions such as diabetes and hypertension. We have to do more to make
    sure all seniors can take advantage of this medical revolution.
        We also have to do more to encourage seniors to take advantage of
    preventive technologies, to take advantage of screenings for cancer, for
    diabetes, for osteoporosis, and other diseases. To do that, my plan will
    eliminate the deductible and all copayments for these preventive tests.
    Just think of it this way: Under Medicare today, very often you can't
    get Medicare to pay for screening and prevention, but you can get
    Medicare to pay for the far more expensive hospitalization that would
    not have occurred in the first place if the screening and prevention had
    been done. So this will actually save us money in the long run, as well
    as making people healthier.
        We also do have to make prescription drugs more available and more
    affordable. They are essential to medical care. Just a few statistics:
    More than four out of five seniors use at least one prescription a year.
    Now, for most seniors, it's much more than that. And for many seniors,
    the proper regimen of pills, properly taken at home, can spell the
    difference between maintaining an active and independent life or being
    hospital- or nursing-home- or home-bound for life.
        If we were creating the Medicare program today, if we were starting
    from scratch and it didn't exist, no one would even consider having a
    program without a prescription drug benefit for the elderly and
    disabled.
        So what are we going to do? You heard Hanna talk about the cost of
    her drugs. This is a costly issue. A month's supply of a popular blood
    pressure medicine costs more than $70 a month. A cholesterol medication
    probably

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    taken by some of you in this room costs about $100 a month. When you
    consider that some of the newest drugs cost as much as $15 a pill, that
    two-thirds--listen to this--two-thirds of all people over 65 suffer from
    two or more chronic diseases, that one in five elderly people takes at
    least five prescription medications a day, the pharmacy bills can be
    staggering.
        Each year more than 2 million seniors spend more than $1,000 on
    medication, people such as our friend Anne Thomas, here to my left, whom I mentioned earlier with her
    daughters. She's from Oak Brook. Her osteoporosis prescriptions swallow
    up a sixth of her income, almost 17 percent. Last year she, too, was
    diagnosed with asthma, but she chose not to fill her prescription
    because the $300-a-month price tag was more than she could afford.
        Finding the funds to pay for prescription drugs is a struggle for
    seniors at many income levels, not just the poor. Indeed, of the 15
    million seniors in our country that don't have any prescription drug
    coverage, nearly half are middle class Americans. And that does not
    count the millions of seniors who have some prescription coverage, but
    the coverage is totally inadequate or far too expensive.
        The number of plans that offer coverage is declining, and those that
    charge high prices and offer modest benefits are increasing. Forty
    percent of all older Americans without prescription drugs--let me say
    that again--40 percent are middle class. Nearly half the uninsured live
    in isolated rural areas. And as I said, as drug prices rise and more
    private insurers drop drug coverage altogether, about 15 million of our
    seniors will be uninsured within the year.
        This is not the way to honor people after a lifetime of work and
    good citizenship. No American should have to choose between fighting
    infections and fighting hunger, between skipping doses and skipping
    meals, between staying healthy and paying the rent. We can do better
    than that. We are now prosperous enough to do better than that.
        And I say again, there are many good uses for the surplus. I have my
    ideas; the Congress has their ideas. But first things first: We have to
    take care of this problem and do it now.
        Now, we want to make sure that this plan is financially responsible,
    that it can be paid for, that it won't break the bank. Here's what we
    propose to do: My plan will make a prescription drug benefit available
    to all Medicare recipients but will provide extra help for those with
    lower incomes. For people up to 135 percent of the poverty rate, we will
    waive the co-pay and the monthly premium. But people with incomes a
    little higher than that, we will have other subsidies, not quite as
    generous. But for everyone, for a modest monthly premium, Medicare will
    pay for half of all the prescription drug costs, over the next few
    years, up to a ceiling of $5,000. In the first year, we have to start
    with a ceiling of $2,000, because it's a big program and we've got to
    put it in and prove we can make it work. But under my plan, I will ask
    the Congress to approve and fund going to a $5,000 ceiling drug benefit,
    half of all the costs, now, with no deductible.
        This drug benefit is one that virtually all of our seniors can
    afford, and it is constructed in a way America can afford. It will help
    millions and millions of people. Older and disabled Americans will save
    even more on prescription drugs under our plan because Medicare's
    private contractors will get big volume discounts that seniors could
    never get on their own. So when they pay for half the price, that half
    will be a much smaller amount that would otherwise be the case.
        Now, what I would like to say not only to those of you in this
    room--where I suppose I'm preaching to the saved, as we say down home--
    but to all Americans, including those who are not in this room, is that
    this is something that is important, that goes way beyond health care
    and way beyond money. How can you put a price on being able to see the
    birth of a grandchild or to enjoy them as they grow up or read to them
    or take them fishing or be active with your friends and family? How can
    you put a price, if you are a child, on being able to know and spend
    time with and enjoy your grandparents?
        There is no dollar value we can put on providing the best quality of
    life we can. And I want you all to understand, we can afford this. If
    this is not done, it is because somebody made a different decision to do
    something else with the money. This is not welfare. This is not some
    blind gift. This is something we are doing for the integrity of families
    through the generations.
        Our country is in the best shape it's been economically, maybe ever,
    certainly in a long time. And what we're going to do now will define
    what kind of country we will be well into the 21st century. Are we going
    to squander this

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    money we worked so hard for after only 6 years of effort, turned around
    an unbelievable record of fiscal irresponsibility, or are we going to
    pay off our debts in the bank and pay off our debts to our families, not
    only to our parents and grandparents but to future generations? That is
    the question.
        So I want to ask you to join me. You know, Hanna said she didn't
    know much about politics. I thought she made a pretty good political
    speech, myself. [Laughter] But she said something that's really
    important. She said, ``You know, I don't understand why this should be a
    political issue.''
        You know, sometimes when things get real tense in Washington, you
    know, and some of my friends in the other party get real excited, I say,
    ``Hey, loosen up, you know. We're all getting older; none of us are
    going to be here forever. People get a chance to vote every election.
    Loosen up. Relax, No one escapes time and age. Republicans age just like
    Democrats.'' [Laughter] People who are independents still get sick every
    now and then, even though they refuse to register in a political party.
    This is not a political issue anywhere in America, and it should not be
    a political issue in Washington, DC. This is something we can do
    together for the future of America.
        I want you to reach out to your Representatives from Illinois. You
    are represented in this State by both Republicans and Democrats in the
    United States Congress, more or less fairly apportioned. I wish it were
    different, but there it is. [Laughter] You can write to them. You can
    call them. You can say, ``Do this not only for us, but do it for our
    children and our future. Do it because we're all aging and it's a high-
    class problem, that we're living longer.''
        But we have to prepare for the day when the baby boomers retire. And
    we should not wait another day to provide the prescription drug benefit.
    And we have the money to do it. This is simply a matter of choice. I ask
    you, without regard to your party, to reach out to the members of your
    congressional delegation and say, ``This is the right choice for our
    future.''
        Thank you very much.

    Note: The President spoke at 11:15 a.m. in the Grand Army of the
    Republic Memorial Hall at the Chicago Cultural Center. In his remarks,
    he referred to Anna L. Willis, commissioner, Chicago Department on
    Aging; and pharmacist Linda Esposito, vice president, Illinois
    Pharmacists Association.