    [Public Papers of the Presidents of the United States: WILLIAM J. CLINTON (1999, Book II)]
    [July 27, 1999]
    [Pages 1329-1334]
    [From the U.S. Government Publishing Office www.gpo.gov]

    Remarks on Medicare Benefits for Women
    July 27, 1999

        Thank you. She was great, wasn't she?
    Let's give her a hand. [Applause] Well, I must say that Judith did such
    a good job, there's hardly anything left to say. [Laughter] Thank you
    very much for being here, and we welcome your daughter here.
        I want to thank Secretary Shalala and
    acknowledge the presence in the audience of Deborah Briceland-
    Betts, the executive director of the
    Older Women's League; the people here from the Henry Kaiser Family
    Foundation; and the other representatives of women's groups, senior
    women's groups, and Medicare advocates. Hillary and Secretary Shalala and
    I are delighted to welcome you to the White House today, and we thank
    you for your interest in this critical issue.
        We are here to discuss what I have repeatedly called a high-class
    problem. The American people are living longer, especially women. And it

    [[Page 1330]]

    is a high-class problem because we have this surplus today, and a
    projected surplus for several years into the future, which will enable
    us to deal with the challenge of people living longer and spending more
    money on Medicare, and then the retirement of the baby boomers, which
    will put additional pressure on Medicare and on Social Security. It is a
    high-class problem, but we don't want it to turn into a nightmare
    because we walked away from it when we could have dealt with it, and we
    had the money to deal with it--when we had the time to deal with it, and
    we know good and well we ought to deal with it.
        So, again I say I thank you for being here, and I hope today we can
    get out some information which will persuade the American people and
    Members of the Congress that the approach I have recommended for the
    future is the right one.
        For 34 years now, Medicare has protected the health of our seniors;
    it has enriched the lives of the disabled; it has eased the financial
    burdens on families as they cared for their loved ones. For millions of
    American women, in particular, Medicare has been the lifeline to a
    dignified retirement.
        As the report released today by the Older Women's League so clearly
    tell us, a strong and modern Medicare system is absolutely vital to the
    health and future of America's women. First, it is critical because the
    majority of beneficiaries, quite simply, are women. Listen to this: 20
    of the 34 million Americans currently enrolled in Medicare are women. I
    think we've got a chart that says that. But look here, 41 million--41
    percent of the people in this country on Medicare over 65 are men; 59
    percent are women. And, of course, as time goes on, the percentages get
    better or worse, depending on your perspective. [Laughter] Twenty-nine
    percent of the people over 85 are men; 71 percent are women. Seventeen
    percent of people over 100 are men; 83 percent are women. You may think
    those numbers are insubstantial, but Americans over 80 are the fastest
    growing population group in the United States, and I'm sure that most of
    us hope to be among them some day. So this is very important.
        Second, without Medicare the doors to hospitals and doctors'
    offices, to basic medical treatment and good health would actually be
    closed to millions of older women. Throughout their lives, women's
    incomes have always lagged behind those of men, a gap underscored in
    retirement through smaller pensions and Social Security checks. So even
    as they must make ends meet on smaller incomes, women must meet greater
    health care needs. Nearly three-fourths of older women have two or more
    chronic illnesses, compared to just 65 percent of older men. For these
    women, Medicare has truly meant the difference between a healthy
    retirement and one clouded by uncertainty, untreated illness, and
    poverty.
        Now, as you have just heard, the clock is ticking on Medicare's
    ability to meet the needs of our seniors in the next century--people
    living longer than ever, the retirement of the baby boom approaching,
    the Medicare Trust Fund will become insolvent by 2015. Now, you may
    think that's a good ways away, but let me tell you, when I took office,
    Medicare was supposed to become insolvent this year. And we took a lot
    of very strong steps to stop it from happening.
        But we have taken all the easy steps, and some that, arguably, have
    gone too far. Everywhere I go, people say, you know, the therapy
    services have been cut back too much, or the inner-city hospitals with
    big teaching loads or the teaching hospitals generally--not just in the
    big urban centers--everywhere I go, people talk to me about this. So it
    should be obvious to everyone there are no longer any easy ways to
    lengthen the life of the Medicare Trust Fund, just as people are living
    longer and accessing it more. So that is problem one.
        Problem two is that Medicare's benefits have not changed
    significantly since 1965, although the world of modern medicine has
    changed dramatically. There are some who really believe we can afford to
    put off this until later. I disagree. To them I say, listen to Judith
    Cato's story. Like millions of women in the
    same situation, affording prescription drugs for herself is right around
    the corner, and for her mother is today. The typical 65-year-old woman
    retiring this year can expect to live to be 84. That's 19 more years of
    retirement. But if we don't act soon, the Medicare Trust Fund will
    expire in 16 years.
        Over the past 6\1/2\ years, we have managed to transform an economy
    burdened by an unconscionable deficit of $290 billion to an economy that
    today is the picture of fiscal health, with a surplus of $99 billion and
    a large projected surplus over the next decade. We've done

    [[Page 1331]]

    this by balancing the budget, cutting unnecessary spending, expanding
    our investments in education and training, expanding our trade abroad--
    all of it bringing interest rates down and getting investment up and
    giving us a remarkable period of economic growth, the longest peacetime
    expansion in our history, nearly 19 million new jobs and the lowest
    minority unemployment and the highest homeownership ever recorded.
        The question is, what are we going to do with this? We know what one
    plan is. You have talked about it. The majority in Congress say, ``Well,
    let's approve a big tax cut now and worry about Medicare and extending
    the life of the Social Security Trust Fund scheduled to run out of money
    in a little more than 30 years, let's worry about that later.'' One of
    my bright staff members said, ``It's kind of like a family sitting
    around the kitchen table saying, `You know, we have always wanted to
    plan a really fancy vacation to Europe. Let's just do it and blow the
    works, and when we get home, we'll figure out whether we can pay the
    mortgage, the car payment, and send the kids to college.''' [Laughter]
    You're laughing, but you know, it's not just a question of the size of
    the tax cut.
        Why are we even discussing it before we decide what it takes to save
    and strengthen Medicare, what it takes to save Social Security, and what
    we have to invest in the education of our children, the defense of our
    Nation, the protection of our environment? Why don't we ask ourselves
    what it is we have to do before we ask ourselves what it is we would
    like to do?
        So what do I think we have to do? Here's what I think we should do.
    I think, first of all, my plan would secure Medicare by dedicating over
    $320 billion of our budget surplus for 10 years, to extend the life of
    the Trust Fund from 2015 to 2027; that would be the longest projected
    life we've had on a Trust Fund in many years. But we have not been this
    financially healthy in many years, nor have we faced the challenge of so
    many people retiring and living so long ever before. So we need to know
    it's going to be all right for a good while.
        Secondly, we will introduce more modern mechanisms of competition to
    improve quality but to control costs as well as we can, as private
    sector innovations have done. We will give seniors the chance to choose
    between lower cost Medicare managed care plans and the traditional
    program, but we will not support changes that would force them to move
    from one to the other.
        I also believe it's important to modernize benefits, and over the
    long run, the economical thing to do. Over the last 30 years, a medical
    revolution has transformed health care, and in many cases, prescription
    drugs now supplant what used to be routinely dealt with with surgeries.
    They have lengthened and improved the quality of life.
        As the Older Women's League study shows, women have borne the
    greatest cost of this pharmaceutical revolution. According to the next
    chart, women spend $1,200 a year on prescription drugs, on average,
    about 20 percent more than men. Now, as you have already heard, our plan
    will help seniors to afford the prescription drugs that have become
    essential to modern medicine. The plan is completely voluntary but
    available to all Medicare beneficiaries. This is a challenge, I might
    add, not just for poor women. It is also a challenge for middle class
    women as well.
        Look at the next chart. Half of all middle class women--that is, for
    seniors, those who make at least $12,700 a year or, with couples,
    $17,000 a year--have no prescription drug coverage at all. So among
    those who have no coverage, a quarter are below the poverty line, a
    quarter are between 100 and 150 percent of poverty, half are over 150
    percent of the poverty line; although, if your drug bills are big
    enough, it doesn't take long to get down below the poverty line again.
        Women who have tried to buy extra coverage through private Medigap
    policies have to cope with escalating premiums as they get older. That's
    one of the great ironies of these Medigap policies that I keep hearing
    about, you know, we don't really need this because of Medigap. They get
    more and more and more expensive as you get older and older and older
    and less and less and less able to come up with the money to pay for
    them.
        Now, I think anybody that says we don't need to do this is out of
    touch with people's real lives and out of date. I'd also like to point
    out that our plan would eliminate the last barrier between seniors and
    preventive screenings--tests for breast cancer, colon cancer, prostate
    cancer, diabetes, and osteoporosis--that can help save their lives. For
    too many seniors on fixed incomes, especially low income women, the cost
    of the modest copayment is prohibitive.

    [[Page 1332]]

    Last year for example--listen to this--just one in seven women took
    advantage of the mammograms covered by Medicare.
        So what we want to do is to eliminate the deductible and the
    copayments for the preventive screenings, and we pay for it by
    introducing a modest copay on lab tests that are frequently overused,
    ones that have been identified, and by indexing to inflation the modest
    part B premium, which will be much less burdensome because it's more
    broadly spread in a smaller amount of money. But the people who need
    these preventive screenings, this will save lives.
        Consider the irony of this. Every condition I just outlined, we pay
    for the doctor benefits, we pay for the hospital benefits, but we don't
    want to let people get the preventive screenings that will keep them
    from spending that money in the first place to keep them healthy and
    keep them alive. This is a good thing to do.
        Now, this is a good plan. It is a responsible plan. And it is
    important that we deal with the Medicare challenge now, while we have
    the funds and the prosperity to do so. I have proposed to dedicate the
    Social Security portion of the surplus to Social Security, but also to
    lengthen the life of the Trust Fund by taking the interest savings we'll
    have, because this will allow us to pay the debt down, and putting it
    into the Social Security Trust Fund, so it will last longer. So we'll
    have at least over 50 years of life on the Social Security Trust Fund.
        And as I said, I proposed to put over $320 million in Medicare.
    There's not a single expert on this program who believes that we can
    stabilize the fund and lengthen the life of it and deal with the coming
    demographic challenges without more money. No one who has looked into
    this believes it. And I think this is very, very important, because if
    the tax cut being pushed by the congressional majority, which includes
    vast benefits for people in my income group and higher--who have done
    quite well in the stock market, thank you very much--[laughter]--and are
    not clamoring for it, and are worried that it will destabilize the
    economy--even today, there are stories in the paper that if we have a
    big tax cut, with the economy growing as fast as it is, it might
    stimulate inflation, which would cause increases in interest rates,
    which would take away all the economic benefits of the tax cuts in
    higher interest rates.
        So I say to you, I do not believe that is the wise thing to do. I
    think first we should say, let's save Social Security and Medicare;
    let's add this responsible prescription drug benefit; let's decide the
    commitments that we ought to make--to give our children good education,
    to keep our streets safe, to biomedical research, to national defense,
    to the environment--and then let's decide what we can afford in a tax
    cut. Let's do first things first.
        In addition, another benefit of my plan, not present in any other
    one, is that if my proposal were to pass the Congress, in about 15 years
    we would actually be out of debt as a nation, for the first time since
    1835.
        Now, the significance of that for older Americans is quite
    important. Why? Because if we are out of debt, it means we will have
    long-term prosperity; lower interest rates, which means lower costs for
    business borrowing, more investment, more jobs, higher incomes; and for
    families, lower home mortgages, car payments, credit card payments, and
    college loan payments. That amounts to a very big tax cut over 10 or 15
    years, getting this country out of debt, making us less vulnerable to
    the vagaries of the international financial system, securing the long-
    term economic stability for the young people here in the audience and
    throughout our country.
        Believe it or not, we can do all that and still have a fairly
    sizable tax cut. I propose to let people use it for retirement savings,
    for long-term care, for child care. But the point I want to make today
    is not so much what we spend it on but how much it can be, and in what
    order we are doing this. We did not get to this moment of prosperity by
    figuring out how to eat our cake, and then looking around for the
    vegetables. [Laughter] That's not how we got here. We got here--and a
    lot of Members of Congress lost their jobs over it--because we took the
    tough decisions in 1993 to get the deficit down, to bring interest rates
    down, and to do it without having to give up on our obligations to
    education and to our other important national priorities.
        So here we are with this opportunity of a lifetime to deal with
    this, and I think we ought to do it. Now, I regret that, as all of you
    know, the congressional majority appears to have a different philosophy.
    Look what happened. Last week, in the House of Representatives, they
    passed an irresponsible tax bill that would spend our surplus; it
    wouldn't devote a dime--not a dime--not one dime to extending the
    solvency

    [[Page 1333]]

    of Medicare. And interestingly enough, these tax cuts are worded so that
    they won't go into full effect until the year 2010, just when the baby
    boomers start to retire. And in the second 10 years, they'll cost way
    over twice as much as they did in the first 10 years. So the whole
    impact of them will hit us right between the eyes as the baby boomers
    retire, Medicare nears insolvency, Social Security starts to show
    strains.
        This week the Senate is going to take up a similar bill. They also,
    I might say, as all the analysis done--I don't know if you've had--I
    don't want to take time today to do this, but if you haven't seen the
    analysis of the bills, you ought to, because they're standing up there
    saying, ``If we don't give this money back to you, `they'''--i.e., me
    and my allies in Congress--``will spend it on `their' friends.''
        Well, Judith is my friend. [Laughter] It
    sounds so great: ``We want to give it back to you; they're going to
    spend it on their friends.'' We want to spend it on saving Social
    Security and Medicare, educating our children, paying down the national
    debt, and getting us out of debt, to help our friends, the American
    people.
        They tickle me, you know, these guys. They were fighting the
    Patients' Bill of Rights several days ago, and they said, ``Oh, these
    Democrats, all they do is stand up and tell stories; we're talking about
    something besides stories.'' Well, I don't know about you, but the older
    I get, the more it seems to me like life is just a collection of
    stories. [Laughter] And people are pretty important, a lot more
    important than statistics.
        And I'm telling you, I've been at this business a long time. This
    country may never have an opportunity like this. And they're spending it
    on their friends. [Laughter] And, ironically, their friends are better
    off under our plan because the stock market has more than tripled. Their
    friends have done very well under our plan. We have had an economic
    policy that has been nondiscriminatory, benefiting Republicans and
    Democrats alike. [Laughter]
        Look, today I want you to read the papers today. They point out that
    the Congress, the majority, has begun resorting now to accounting
    gimmicks, because they've approved such a big tax cut, they can't meet
    the fundamental obligations of Government without beginning, right now,
    to spend the surplus. And they don't want to acknowledge that, so
    they've resorted to accounting gimmicks to disguise the fact that
    they're dipping into the surplus. They can't live within the budget
    limits we set in 1997. I told you, we all know we cut Medicare too much
    in '97; we're going to have to fix it. A lot of you know it. A lot of
    you deal with these programs and these health care providers. But they
    want to give the illusion they're living within the budget limits,
    nothing has to be done, and they can have this tax cut. I'm telling you
    what's going to happen. If this tax cut were to become law, it would
    mean huge cuts in education, huge cuts in the environment, huge cuts in
    medical research, huge cuts in health care, and huge cuts in national
    defense. Or if they didn't do that, we would see balloon in the deficit
    again, just like we did in the 12 years before I took office, when the
    national debt quadrupled. We tried it that way; it didn't work very
    well.
        Why are we going down the same road we tried before, when we have a
    road that we have tried for 6\1/2\ years that has brought us to this
    point? Why would we reverse course instead of building on what we've
    done and going beyond it? It is a big mistake, and it's wrong. It's not
    just wrong for the seniors; it's not just wrong for the women of this
    country; it's wrong for all Americans. It is not the right thing to do.
        Now, it also--it will take away the single best opportunity any of
    us will ever have in our lifetimes to save Social Security for the baby
    boomers, to save and strengthen Medicare, and to get us out of debt for
    the first time since 1835, to give the young people in this room a
    chance at a generation of prosperity. And I don't believe any thinking
    person, once they understand what the real numbers are--let's get out of
    the rhetoric here, who's going to give it to whose friends and all that.
    What are the numbers? This is an arithmetic problem.
        You know, I told people when I got elected President, I'd come from
    a State with fairly straightforward values and ways of doing things, and
    I thought we ought to have a radical new idea in Washington. We'd bring
    basic arithmetic back to the budget. [Laughter] And basic arithmetic has
    worked pretty well. This doesn't add up.
        And so I ask you to help me send the word to the Congress that let's
    do first things first. Let's fix Medicare. The women of America
    especially need it.
        You know, we have to work together. Every time we get in one of
    these fights, people throw their hands up. But there's normally a
    process

    [[Page 1334]]

    that goes on here. When we were doing welfare reform, I vetoed two bills
    because it took away the mandate of health care and nutrition for
    children. We finally got a welfare reform that I thought was right; it
    carried by big majorities in both parties, in both Houses; we have the
    lowest welfare rolls in 30 years. And we did it in an election year.
        Then the next year we did the Balanced Budget Act, and it has worked
    superbly. The only problem with it is that the Medicare cuts were too
    burdensome on certain groups, and we're trying to fix that. But I can
    tell you that if this tax cut passes, there will be breathtaking cuts in
    every area of our national life that you would believe is important,
    over and above what it would do to totally rob us of any chance to
    stabilize and improve Medicare and save it for the baby boom generation.
        We have big tests as a country. How are we going to deal with the
    aging of America? How are we going to give all of our kids a world-class
    education, especially since more and more of them come from families
    whose first language is not English? Those of us who expect to be alive
    in 20 years, or hope to be, better hope we do a good job of educating
    those kids. How are we going to deal with all these other challenges?
    How are we going to bring economic opportunity to people who still
    haven't felt it? How are we going to stabilize the economy so that we'll
    still be growing even better 10, 15, 20 years from now? These are big
    challenges. But they are high-class problems in the sense that nations
    rarely get these opportunities.
        Once in a lifetime you get a chance to stand up with your country in
    good shape, bring people together, look down the road, and say, yes,
    these are big challenges, and we're going to check them off--one, two,
    three, four--because we have the money and the vision to deal with them.
        So my appeal today is that we not get into a big fight; we just go
    back to basic arithmetic. These tax bills the majority is pushing could
    not get the support of their own Members if we had a chart up on the
    wall that says, here is what we have to spend just to stay where we are
    today in education, defense, the environment, medical research; here's
    what every expert says it takes to stabilize Medicare; here is the
    interest savings you ought to be putting into the Social Security Trust
    Fund; here is what we have to do to fix health care. They agree we have
    to do some more for veterans care. They agree with these things.
        The numbers don't add up. We cannot take the vacation without paying
    the home mortgage, the car payment, and the college loan bill. We can't
    do it. We can't eat the cake until the vegetables and the soup are out
    of the way. And we cannot defy the basic laws of arithmetic. And
    contrary to some of the debate, we cannot forget the stories.
        This is about how millions upon millions upon millions of Americans
    will live. Will they live in dignity and health, or will they live in
    want and insecurity, imposing unconscionable burdens on their children,
    and limiting their children's ability to raise their grandchildren? Or
    will we use this moment to build a more prosperous, more just, more
    decent society? This is about way more than drugs and trips to the
    doctor. This is about what kind of people we are and whether we can look
    beyond today to the tomorrow we all want for all of us.
        Thank you.

    Note: The President spoke at 10:24 a.m. in Presidential Hall (formerly
    Room 450) in the Old Executive Office Building. In his remarks, he
    referred to Judith G. Cato, member, Maryland Commission on Aging, who
    introduced the President, and her daughter, Harriet Pinkerton, service
    coordinator, Council House senior citizen apartments, Marlow Heights,
    MD. The transcript released by the Office of the Press Secretary also
    included the remarks of the First Lady. A portion of these remarks could
    not be verified because the tape was incomplete.