[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

[[Page 1751]]

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.

[[Page 1753]]

    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.

[[Page 1754]]

    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,

[[Page 1755]]

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.