[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.