    [Public Papers of the Presidents of the United States: WILLIAM J. CLINTON (1999, Book II)]
    [October 12, 1999]
    [Pages 1749-1755]
    [From the U.S. Government Publishing Office www.gpo.gov]

    [[Page 1749]]

    Remarks to the American Academy of Pediatrics
    October 12, 1999

        Thank you very much, President Alpert--
    [laughter]--President-elect Cook. Seems like
    just yesterday I had that title for a while. [Laughter] To the executive
    board and the members of the American Academy of Pediatrics, thank you
    for welcoming me here. I am told that I'm the first President ever to
    address your convention, but I know that Hillary spoke to you in 1993, and I was thinking of, given the
    difference in our respective political prospects for the future, we
    should have reversed the order. [Laughter] But we just got back this
    morning from Camp David, where we celebrated our 24th anniversary, and
    she asked me to give you her regards, so I do so today.
        I'm delighted to be here. I think pediatricians have a special place
    in the hearts of every person who has ever been privileged to either be
    treated by one or have his or her children treated by one. Just a few
    weeks ago, the man who was my doctor in Hot Springs, Arkansas, when I
    was a little boy, Dr. Joe Rosenzweig, came to
    see me with his wife and his grandchildren. I regularly stay in touch
    with Dr. Betty Lowe, who once headed this
    distinguished group and took care of Chelsea
    when she was a little girl. And so I feel a great personal bond to the
    work that you do.
        And you should feel a great personal bond to the work that I do. I
    mean, Washington is the only place outside of a pediatrician's office
    where you can hear so much screaming and crying on a daily basis.
    [Laughter] And we all--all the politicians here have a lot in common
    with doctors. We all want to prescribe medicine, and no one wants to
    take it. [Laughter] But screaming and crying are part of the process of
    getting better, in medicine and in politics.
        Let me echo some of the things that Dr. Alpert has said. I am
    profoundly grateful for the things that we have done together and the
    leadership that you have taken to make America better. The gains that
    our administration has made for children have come with your
    organization fighting by our side: passing the family and medical leave
    law, which now over 15 million people have taken advantage of;
    immunizing more than 90 percent of our children against major childhood
    diseases for the first time in our history; passing the Brady bill and
    other measures to stem gun violence; making aggressive initiatives in
    the area of school safety, including zero tolerance for guns in schools;
    and the V-chip, the TV rating systems, and now similar systems for the
    Internet and for video games that we're working on; increasing child
    support enforcement and collection; dramatically expanding opportunities
    for adoption and for moving foster care kids into permanent adoptive
    homes--I thank you for all those things--the First Lady's prescription for reading program, and many,
    many other issues I could mention.
        One I want to talk about more later today in my remarks is your role
    in creating the $24 billion Children's Health Insurance Program, which
    is designed to address that problem of more than 10 million uninsured
    children.
        Because of all these efforts, America is a better place for
    children; they're healthier and safer than they were 7 years ago. Infant
    mortality is down. Drug abuse is down. Teen pregnancy is down. Juvenile
    crime is down. America, itself, is stronger, more prosperous, more
    confident.
        Today, we enjoy the longest peacetime expansion in our history, the
    lowest unemployment rate in 29 years, the lowest welfare rolls in 30
    years, the lowest poverty rate in 20 years, the lowest crime rate in 26
    years, the first back-to-back budget surpluses in 42 years. Thank you
    for your contribution to all of these things.
        But like your work with children, our work here is always about
    tomorrow. So the question we face is, what are we going to do with this
    phenomenal burst of good fortune that we have had by dint of effort and
    the grace of God? What are we going to do with it?
        I have been arguing very strenuously now for some time that we have
    turned the country around and we are heading in the right direction. And
    now we have, as a people, the chance--literally, the chance of a
    lifetime, that a nation gets maybe once every 30, 40, 50 years, to deal
    with its long-term challenges, to seize its long-term opportunities, to
    forge the future that our children and our grandchildren will have. And
    that is what I earnestly hope we will do. I believe that we have to use
    this moment to meet the great challenges we know,

    [[Page 1750]]

    without a doubt, 21st century America will face. What are they?
        First, the aging of America. The number of people over 65 will
    double by the year 2030. I hope I'll still be one of them. There will be
    two people working for every one person drawing Social Security.
        Second, the health and education of the largest and most diverse
    group of children in our Nation's history.
        Third, sustaining our economic prosperity over the long term and
    expanding its reach to people and places that have not been touched by
    this marvelous economic recovery.
        Fourth, making America the safest big country in the world. Yes, the
    crime rate's at a 26-year-low, but no one believes it's low enough. The
    accidental death rates by guns of children is 9 times higher than that
    of the next 25 big industrial countries combined. So, yes, we have a 26-
    year-low in crime rates, but if we're the strongest economy in the world
    and we have a free society, why don't we say we're going to not stop
    until America is the safest big country in the entire world?
        The fifth big challenge we have, which will bear directly on your
    efforts and those that succeed you in the years ahead is dealing with
    the environmental challenges we face, especially the challenge of
    climate change and global warming. I feel very, very strongly about
    that. One of the problems I have in dealing with it is that the applause
    is still scattered when I talk about it. [Laughter]
        And sixth, building one America out of all the diverse threads of
    our citizenship and doing it in a world that we help to make ever more
    interdependent, peaceful, and prosperous.
        The answers to those questions, whether we will do that, will be
    affected by the decisions we make here in Washington in the coming days
    and weeks. Ever since I gave my State of the Union Address, I have been
    working with Congress, or trying to, on a budget that will move us ahead
    in meeting all these challenges, that will leave this country in good
    shape for the new millennium, while maintaining our budget discipline
    that has been responsible for so much of the good things that have
    happened in this country in the last 6\1/2\ years.
        To meet the challenge of the aging of America, I have proposed to
    extend the life of Social Security to 2050, to get it out beyond the
    life of the baby boom generation, to lift the earnings limit, to give
    more help to older women who are disproportionately poor. I have also
    proposed to extend the life of Medicare to 2027--that's the longest
    existence of the Medicare Trust Fund in a long time--to add a voluntary
    prescription drug benefit, to allow uninsured Americans between the ages
    of 55 and 65 to buy into the Medicare program, and to provide a long-
    term care tax credit for families that are dealing with that challenge.
        To meet the challenge of our children's education, I have proposed
    to continue with our program of putting 100,000 more teachers in the
    classroom, to lower class sizes in the early grades, to build or
    modernize 6,000 schools, to complete our efforts to hook all of our
    classrooms up to the Internet by the year 2000, and to raise standards
    and accountability.
        I know Secretary Riley spoke here
    earlier, and perhaps he dealt with this at greater length, but we
    propose as we give out our Federal money and reauthorize that law every
    5 years--this is the year we do it--to say every State must have high
    standards, every State must have accountability, accountability for
    teachers, for schools, for students. We shouldn't have social promotion,
    but we shouldn't blame kids for the failure of the system. So we
    proposed to triple the number of our children served by after-school and
    summer school programs. We proposed to give funds to schools that are
    failing, to turn them around or require them to be shut down. We
    proposed to expand the number of charter schools within our public
    school system so we'll get up to 3,000 by the end of next year.
        These are very important things that I hope all Americans will
    support. Unless we can educate all our children--and increasingly they
    come from families whose first language is not English--we will not have
    the country we want in 30 years.
        To meet the challenge of expanding and continuing our economic
    prosperity and bringing it to people who haven't felt it yet, I have
    asked the Congress to adopt a new markets initiative to give Americans
    with funds to invest the same incentives to invest in poor areas in
    America we now give them to invest in poor areas in Latin America or
    Asia or Africa.
        I have proposed to increase the immensely successful community
    empowerment program that the Vice President
    has run for us over the

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    last 6\1/2\ years, to increase enterprise zones, empowerment
    communities, to increase our community development banks that make loans
    to people and places where capital is not available. And to keep this
    expansion going perhaps for another generation, through ups and downs in
    the global economy, I have asked the Congress to do this within a
    framework that would enable us to continue to pay down our national debt
    which we quadrupled in the 12 years before I took office, so that in 15
    years, America could be debt-free for the first time since 1835 when
    Andrew Jackson was the President of the United States.
        Let me say to all of you--this is a pretty progressive group, and
    you always want Government to invest in money. Why should progressives
    want America to be out of debt? I want to make this argument just very
    briefly. All of us who are over 40, at least, who went to college and
    took an economics class were told that every country needs a certain
    amount of debt, that it's healthy. And that was true when every country
    controlled its own economic destiny independent of every other. And it
    was true when people were borrowing money to invest in things like roads
    and bridges and parks and universities and long-term capital
    investments.
        But over the last 20 years, governments, the United States being the
    worst offender, got to borrowing money just to pay the bills every week.
    And in a global economy where money can move across national borders
    instantaneously, if a government is debt-free, it means the people in
    that country, whether they're businesses trying to start or expand or
    families trying to pay for homes, cars, college loans and credit card
    bills, can all borrow money more cheaply. It means that if rich
    countries like America get out of debt and other countries get in
    trouble, like our Asian partners did over the last couple of years, they
    can get money to get help more quickly, rebound more quickly, and buy
    our products more rapidly.
        So I feel very strongly that this is an important idea that I hope
    the American people will insist upon. And I hope that they will say to
    the Congress, ``Don't let tax cuts or spending increases get in the way
    of getting us out of debt. If you want to spend the money, raise it. Do
    whatever's necessary, but get America out of debt over the next 15 years
    so that we can continue to grow for the next 50 years. It's very, very
    important to our future.''
        Now, here's what's going on here. I know you see all this food fight
    in Washington and you wonder, what is really going on? Here's what's
    going on. We passed a balanced budget bill in 1997. It had very tough
    spending caps. The spending caps were too tough. If you work in a
    teaching hospital, or at other hospitals that have been handicapped by
    the Medicare cutbacks, you know they're too tough. I'll say more about
    that in a minute. But what we said was, ``We're going to balance this
    budget, and then we're going to keep it balanced by staying within these
    caps, which means we have to spend money according to a certain plan
    over the next 5 years; or, if we want to spend more money, we have to
    raise more money, either by cutting some other spending, closing some
    tax loopholes, raising some fees, or raising some tax.'' So that's why
    we're having this fight.
        Then it turns out we have a bigger surplus than we thought we would,
    thanks to the prosperity and the hard work and the productivity of the
    American people. Then the Congress said, ``We want to separate the
    Social Security fund from the other funds.'' That's something they never
    could have done before, because the only surplus we've had for the last
    17 years was in Social Security. All the others--the deficit--every
    year, you saw those deficit numbers, it was always a lot bigger than
    that. It's just we were paying more in Social Security taxes than we
    were paying out in Social Security payments. And the difference, under
    the Government's unified accounting system, lowered the deficit.
        So they said, ``Let's separate them. Now that we have a non-Social
    Security surplus, let's separate them. And we really want to do this.''
    So I said, ``Fine by me; I'll do that,'' because under my plan, we would
    keep the Social Security taxes separate, then use the interest savings
    we get on paying down the debt and put it back into Social Security and
    run Social Security out to 2050, beyond the life of almost all but the
    most fortunate baby boomers, and get us through this big population
    problem we've got.
        But when--the Congress looked at the books, and the majority party,
    the Republican Party--which normally says they're more conservative than
    we are on spending; it depends on what it is--found out that they
    couldn't spend all the money they wanted to spend with just the non-
    Social Security surplus. And they didn't want to raise the cigarette tax
    or raise fees on

    [[Page 1752]]

    people that have to help us clean up the toxic waste dumps, or close any
    of the corporate loopholes that I tried to close. And so that's why you
    see all these problems up here.
        They're having a very difficult time, even with this big surplus,
    because they promised they wouldn't touch the Social Security part of
    the surplus, crafting a budget that both protects that surplus, invests
    in important things like education and health care, does what both
    parties wanted to do in transportation, meets their defense targets, and
    stays within the spending cap. So that's why you hear about all these
    gimmicks and why they wanted to start giving poor people their tax
    returns under the earned-income tax credit every month, instead of in a
    lump sum, like the rest of us get ours, and why they wanted to put a
    13th month into the year and all that.
        All that sort of handwringing--it must strike you as crazy, since
    you know we've got a surplus. The reason is, they committed--both
    parties did, back at the first of the year--to take the Social Security
    surplus and put it over here and only spend the non-Social Security
    surplus. It never existed before, the non-Social Security surplus. And
    it's going to get bigger and bigger. And this problem won't be here next
    year or the year after next, but right now it's real small; and what
    they want to spend is real big, and they don't want to raise the money
    to raise the difference. That's what's going on.
        How many of you knew that before I explained it? [Laughter] About 10
    hands. That's what's going on. If we were under the old accounting
    system, this would be like falling off a log. It would have no, sort of,
    larger economic impact in the short run, but it could be a very bad
    habit to get into over the long run.
        So if we can stop now, we ought to stop now. But in order to stop
    now, with no gimmicks, we have to work together. If we don't, you wind
    up with the problems that the House of Representatives is confronting
    now. Just let me give you some examples.
        Already in health care, they want to cut $85 million from my request
    for childhood immunizations. That's 170,000 kids who won't get the
    vaccines they need to ward off major childhood diseases like measles and
    mumps. There's no money in this proposal, which was strongly pushed by
    the First Lady, to support graduate medical education at children's
    hospitals, where many of our pediatricians receive their training and
    over half of the specialists in many areas receive their training.
        It doesn't offer even a modest downpayment on my $1 billion effort
    to support our Nation's health care safety net of public hospitals and
    clinics, which--you remember back in '94, when we got whacked around on
    health care, and everybody accused Hillary and me of wanting to have the
    Government take over the health care system, which was not true. They
    said that if our proposal passed, it wouldn't work. We said, if
    something didn't pass, the number of uninsured would go up. And sure
    enough, we were right, and you see the numbers, now.
        Well, one of the things we can do in the short run is to
    dramatically beef up the public health care network. In my home State,
    for example, over 85 percent of all the immunizations are now done in
    the public health clinic, the county health clinic. Even upper-class
    people get their kids immunized in the health clinic. Solves all those
    liability problems and other things, and it's just something we did when
    I was there. But we need to do this. But it can't be done with this bind
    they're in.
        And let me tell you this: If something is not done, they're going to
    go back and cut everything 3 percent across the board. If they exempt
    defense, they'll have to cut everything 6 percent across the board. And
    that is a huge amount of money.
        So I'd like to respectfully suggest that Congress go back and look
    at the budget I sent them 7 months ago. It makes all the investments
    that they want to make and the investments that I believe in. It stays
    within the spending caps by providing offsets, including a 55-cents-a-
    pack excise tax on tobacco.
        Now, I believe--I think it's good fiscal policy, and you know it's
    good health policy. You know more than 400,000 Americans die every year
    from smoking-related diseases; almost 90 percent of our people start
    smoking as teenagers, and one of the most effective ways to get the
    attention of teenagers is to raise the price.
        So Congress now faces this, for them, Biblical choice: cut
    investments in areas like health care and education and the environment;
    spend from the Social Security Trust Fund at least one more year; or
    maintain our fiscal discipline and save children's lives by raising the
    price of smoking, closing some corporate loopholes, and doing a few
    other things to raise some money here.

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        I know what I believe the right choice is. I think most Americans
    would agree with me. I will work with Congress to put politics aside and
    do the right thing. Congress is clearly capable of working with me. We
    did it in 1996, with the welfare reform bill, which has cut welfare
    rolls almost in half and, after I vetoed two earlier attempts, provided
    billions of dollars in child care and kept the guarantee of Medicaid and
    food stamps for poor families and work. We did it in the 1997 Balanced
    Budget Act. And last week, the House of Representatives did it again
    when they finally passed a strong, enforceable Patients' Bill of Rights,
    thanks to you and others.
        We are one step closer to seeing all Americans, including those in
    HMO's, have the right to the nearest emergency room care, the right to a
    specialist, the right to know you can't be forced to switch doctors in
    the middle of a treatment, the right to hold a health care plan
    accountable if it causes grave harm. But let me remind you, this is not
    the law of the land yet. This is a bill which has passed the House of
    Representatives. A much, much weaker bill passed the Senate.
        So if you look at the vote in the House--thanks to the solid support
    of the Members of our party and some very, very brave people in the
    Republican Party who stuck their necks out, took a lot of heat from
    their leadership and from the health insurance companies, led by
    Congressman Norwood and others, we got a big victory in the House. It
    wasn't close. It was a big victory, won it by over 100 votes.
        Now, the Senate should listen to that and see the will of the
    American people and give us a bill that is not loaded down with special-
    interest poison pills. That was their original strategy. We'll pass this
    bill really strong, but we'll have so much other stuff on it that the
    President will not be able to sign it, or if he does, he'll be sick for
    4 days. [Laughter]
        And so I say to you, thank you for your efforts. I want to ask you
    to do two things. Number one, write every one of those Members of
    Congress that voted right on that bill and recognize that, especially
    for the Republicans, it was a tough vote, and give them a pat on the
    back. And number two, don't stop until it comes to my desk in the right
    form. We are a long way from home, but we have a good chance to win.
        Now, I want to say there are some other opportunities for victory.
    Congress can put progress ahead of partisanship by making it possible
    for the millions of Americans with disabilities who want to work but are
    afraid to because they would lose their Medicare or Medicaid, to do
    that, to go to work and keep their Government health care coverage.
        The Senate has already passed, by a 99 to zero vote, the work
    incentives improvement act, to ensure that Americans with disabilities
    can gain the dignity of a job without fear of losing their health
    insurance. A bipartisan majority in the House has co-sponsored the same
    measure. I will sign it.
        There is a modest cost associated with this bill for the Government.
    I have offered them offsets for that. And so far, they don't want to
    take that, either. But it would be a pity, when virtually everybody in
    the Congress knows this is the right thing to do, to nickel-and-dime
    this to death. We're talking about thousands and thousands and thousands
    of people's lives.
        I don't know if you know anybody like this. I've had the privilege
    of meeting a substantial number of people who are disabled, who got to
    go into the work force because somebody made provisions for health
    insurance or because they were in an income category where they could
    keep their Medicaid for a while. And I've met even more who would go in
    a New York minute if they knew they could keep their Medicaid or their
    Medicare. And I've met a lot of employers who would hire them but who
    know they cannot afford their health insurance. So I implore you, do
    what you can to help us pass this. This is a bill that everybody's for,
    and the process is still fooling around with it because of a modest cost
    that can easily be offset. That is very important.
        The third thing I ask for your help on doesn't require any more
    legislation, and it's consistent with a commitment you have already
    made, and that is to get children enrolled in the Children's Health
    Insurance Program.
        Since the CHIP program went into effect, it has provided health
    coverage to over a million children whose families can't afford health
    coverage and who make too much to be eligible for Medicaid. I am
    grateful to you for helping us to create it and for helping us put it
    into effect. But as your president said, somewhere between 10 and 11
    million children in America still lack health insurance. That's way over
    15 percent. The majority could be covered under either CHIP or Medicaid.

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        We've still got 2 or 3 million kids out there who are Medicaid-
    eligible who aren't covered. If we can get word out to their families
    and sign them up--we know that children who lack health insurance have
    higher rates of treatable conditions like asthma, ear infections, vision
    problems. We know when a child can't see a blackboard clearly or hear
    the teacher precisely or pay attention to anything other than his or her
    own pained breathing, the kids aren't going to be able to learn.
        CHIP and Medicaid can change all that for millions of people. And
    when we passed the CHIP program, we thought it would insure 5 million
    people, if we could also get the Medicaid insurance rates up, and solve
    at least half the problem. Now, 2 years later, we've only insured a
    million. But it was only this year, to be fair, that all 50 States had
    their programs in place. So we're now at the takeoff point, and we will
    be judged--you and I and all of us--on how well we do from here on out.
        This year--or last year, I established an inner-agency task force to
    come up with some innovative strategies to get the word out to parents
    about CHIP and Medicaid. Today I'm releasing their first annual report,
    which details a lot of promising outreach efforts. Just for example, the
    Department of Agriculture, which administers the school lunch program,
    has added information on CHIP and Medicaid to applications it sends to
    every school district in America. Millions of parents who fill out their
    school lunch forms now will have a chance to learn about these health
    programs.
        Other promising innovations are also in the works. Thousands of
    AmeriCorps and Vista volunteers who deal directly with low-income
    families every day will soon have information in their training manuals
    on how to enroll children in CHIP and Medicaid. Tens of millions of
    elderly Americans who may have grandchildren eligible for CHIP and
    Medicaid will soon be able to read about these programs in the annual
    letters they receive from Social Security and Medicare.
        But as the Vice President has been saying for months and months and
    months, if we're going to bring health care coverage to more children,
    we have to start with where the children are, in the schools. That's why
    today I am issuing an Executive order to the Secretaries of Education,
    Agriculture, and Health and Human Services, directing them to find the
    most innovative school-based strategies now being pursued at the State
    and local level, to report back to me in 6 months on how we can
    replicate them in every community in the country.
        I'm also sending a letter to States, clarifying that they can use
    the CHIP fund for school-based outreach efforts. And we're going to
    dedicate over $9 million in new research grants to find out what
    outreach methods in schools or elsewhere work best. I believe these
    things will go a long way toward bringing health coverage to our
    children. But we need help from the churches, from the YMCA's and the
    YWCA's, from all the community organizations. And we need help from all
    the physicians and the public health units throughout our country.
        It is simply inexcusable that we're sitting here, and have been,
    with the money for 2 years to provide health insurance to 5 million
    kids, and 80 percent of them are still uninsured. And it is conceivable
    that we could do better than 5 million children with the money
    appropriated if we had effective enough outreach.
        And to those of you who see a lot of people whose parents' first
    language is not English, I know we have trouble there. But I would
    implore you, do what you can, when you go back home, with your local
    groups and your local medical societies and your local health clinics
    and your local schools, to get them to do this. There is no stigma
    associated with this. Most people will walk through a wall to get their
    kids decent health care coverage if they know it is available.
        This is simply a question--the average person who's not covered by
    this doesn't know CHIP from block. [Laughter] Or Medicaid from Lego, or
    whatever. You know, we've got to deal with people that--you know, most
    normal people worry about their lives, not Government acronyms. And
    we're dealing with--a lot of these folks don't know anything about this.
    And you can help to make sure, in your community, that the schools and
    the community groups and the religious organizations and everybody, is
    doing their outreach on this. It is profoundly important.
        Now, let me just say this last point. If every child eligible for
    CHIP and Medicaid were enrolled, there would still be millions who
    lacked coverage. You know it, and I do, too. You know that I and Hillary
    and the Vice President, we have always believed it is wrong for any
    American, much less any child, not to have affordable,

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    quality health care. I know that the American Academy of Pediatrics
    believes that. I will keep working to change that as long as I am
    President. I will keep looking for ways to end this unconscionable and
    growing gap of uninsured care.
        Our hospitals will continue to have problems--and again, I would
    say, this has nothing to do--and you can help us with this--this has
    nothing to do with the Government taking over health care. The
    Government's not taking over health care in the CHIP program or Medicare
    or Medicaid.
        If we'd let these people--next to the kids, the fastest growing
    group of uninsured people are 55 to 65 years old, who retire and can't
    get employment-based health insurance anymore. We ought to let them buy
    into Medicare. You know, I get into all these fights with the insurance
    companies, and I hate to fight with them all the time. But the truth is
    America has a system of financing health care that dictates high levels
    of uninsured, which dictates enormous burdens on the health care system
    of the country and burdens on everybody that buys insurance.
        And they can deny otherwise as long as they want to, but all you
    have to do is look around at other examples, and you know it's simply
    not true. There is no other conceivable explanation. It is the system by
    which we finance our care which has got us in the fix we're in now.
        And so we are trying to do this, and we are trying to do the bill
    for the disabled, and there are lots of other things we can do. But if
    you look at everything we do that's going to make a difference, it's
    because we have changed the financing. And those are facts, and you can
    get them out there.
        For the last 6\1/2\ years, I have had the great honor to serve as
    President of this country. I have about a year and 4 months left, maybe
    a little more. I've worked hard to turn this country around and then to
    keep the American people always thinking about tomorrow, about the
    challenges and the opportunities of the new century and the new
    millennium.
        Well, now we have turned America around. And the great test is
    whether we are going to take this moment and shape our tomorrows. That's
    what you do every day, every time you take some preventive measure,
    every time you do something to help a child. There may be some screaming
    and crying, but you know they're all going to be better off tomorrow.
        I just would like to see all of us here in Washington take the same
    attitude toward the future of all our children's tomorrows that you take
    toward each child's tomorrow. If we do, America's best days lie in the
    new millennium.
        Thank you very much.

    Note: The President spoke at 11:37 a.m. at the Washington Convention
    Center. In his remarks, he referred to Dr. Joel J. Alpert, president,
    and Dr. Donald E. Cook, president-elect, American Academy of Pediatrics.