[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

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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

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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

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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.