[Weekly Compilation of Presidential Documents Volume 29, Number 38 (Monday, September 27, 1993)]
[Pages 1836-1846]
[Online from the Government Publishing Office, www.gpo.gov]

<R04>
Address to a Joint Session of the Congress on Health Care Reform

 September 22, 1993

    Mr. Speaker, Mr. President, Members of Congress, distinguished 
guests, my fellow Americans, before I begin my words tonight I would 
like to ask that we all bow in a moment of silent prayer for the memory 
of those who were killed and those who have been injured in the tragic 
train accident in Alabama today.


[[Page 1837]]


[At this point, the Chamber observed a moment of silence.]

    Amen.
    My fellow Americans, tonight we come together to write a new chapter 
in the American story. Our forebears enshrined the American dream: life, 
liberty, the pursuit of happiness. Every generation of Americans has 
worked to strengthen that legacy, to make our country a place of freedom 
and opportunity, a place where people who work hard can rise to their 
full potential, a place where their children can have a better future.
    From the settling of the frontier to the landing on the Moon, ours 
has been a continuous story of challenges defined, obstacles overcome, 
new horizons secured. That is what makes America what it is and 
Americans what we are. Now we are in a time of profound change and 
opportunity. The end of the cold war, the information age, the global 
economy have brought us both opportunity and hope and strife and 
uncertainty. Our purpose in this dynamic age must be to make change our 
friend and not our enemy.
    To achieve that goal, we must face all our challenges with 
confidence, with faith, and with discipline, whether we're reducing the 
deficit, creating tomorrow's jobs and training our people to fill them, 
converting from a high-tech defense to a high-tech domestic economy, 
expanding trade, reinventing Government, making our streets safer, or 
rewarding work over idleness. All these challenges require us to change.
    If Americans are to have the courage to change in a difficult time, 
we must first be secure in our most basic needs. Tonight I want to talk 
to you about the most critical thing we can do to build that security. 
This health care system of ours is badly broken, and it is time to fix 
it. Despite the dedication of literally millions of talented health care 
professionals, our health care is too uncertain and too expensive, too 
bureaucratic and too wasteful. It has too much fraud and too much greed.
    At long last, after decades of false starts, we must make this our 
most urgent priority, giving every American health security, health care 
that can never be taken away, health care that is always there. That is 
what we must do tonight.
    On this journey, as on all others of true consequence, there will be 
rough spots in the road and honest disagreements about how we should 
proceed. After all, this is a complicated issue. But every successful 
journey is guided by fixed stars. And if we can agree on some basic 
values and principles, we will reach this destination, and we will reach 
it together.
    So tonight I want to talk to you about the principles that I believe 
must embody our efforts to reform America's health care system: 
security, simplicity, savings, choice, quality, and responsibility.
    When I launched our Nation on this journey to reform the health care 
system I knew we needed a talented navigator, someone with a rigorous 
mind, a steady compass, a caring heart. Luckily for me and for our 
Nation, I didn't have to look very far.

[At this point, the Chamber applauded Hillary Clinton, and she 
acknowledged them.]

    Over the last 8 months, Hillary and those working with her have 
talked to literally thousands of Americans to understand the strengths 
and the frailties of this system of ours. They met with over 1,100 
health care organizations. They talked with doctors and nurses, 
pharmacists and drug company representatives, hospital administrators, 
insurance company executives, and small and large businesses. They spoke 
with self-employed people. They talked with people who had insurance and 
people who didn't. They talked with union members and older Americans 
and advocates for our children. The First Lady also consulted, as all of 
you know, extensively with governmental leaders in both parties in the 
States of our Nation and especially here on Capitol Hill. Hillary and 
the task force received and read over 700,000 letters from ordinary 
citizens. What they wrote and the bravery with which they told their 
stories is really what calls us all here tonight.
    Every one of us knows someone who's worked hard and played by the 
rules and still been hurt by this system that just doesn't work for too 
many people. But I'd like to tell you about just one. Kerry Kennedy owns

[[Page 1838]]

a small furniture store that employs seven people in Titusville, 
Florida. Like most small business owners, he's poured his heart and 
soul, his sweat and blood into that business for years. But over the 
last several years, again like most small business owners, he's seen his 
health care premiums skyrocket, even in years when no claims were made. 
And last year, he painfully discovered he could no longer afford to 
provide coverage for all his workers because his insurance company told 
him that two of his workers had become high risks because of their 
advanced age. The problem was that those two people were his mother and 
father, the people who founded the business and still work in the store.
    This story speaks for millions of others. And from them we have 
learned a powerful truth. We have to preserve and strengthen what is 
right with the health care system, but we have got to fix what is wrong 
with it.
    Now, we all know what's right. We're blessed with the best health 
care professionals on Earth, the finest health care institutions, the 
best medical research, the most sophisticated technology. My mother is a 
nurse. I grew up around hospitals. Doctors and nurses were the first 
professional people I ever knew or learned to look up to. They are what 
is right with this health care system. But we also know that we can no 
longer afford to continue to ignore what is wrong.
    Millions of Americans are just a pink slip away from losing their 
health insurance and one serious illness away from losing all their 
savings. Millions more are locked into the jobs they have now just 
because they or someone in their family has once been sick and they have 
what is called the preexisting condition. And on any given day, over 37 
million Americans, most of them working people and their little 
children, have no health insurance at all.
    And in spite of all this, our medical bills are growing at over 
twice the rate of inflation, and the United States spends over a third 
more of its income on health care than any other nation on Earth. And 
the gap is growing, causing many of our companies in global competition 
severe disadvantage. There is no excuse for this kind of system. We know 
other people have done better. We know people in our own country are 
doing better. We have no excuse. My fellow Americans, we must fix this 
system, and it has to begin with congressional action.
    I believe as strongly as I can say that we can reform the costliest 
and most wasteful system on the face of the Earth without enacting new 
broad-based taxes. I believe it because of the conversations I have had 
with thousands of health care professionals around the country, with 
people who are outside this city but are inside experts on the way this 
system works and wastes money.
    The proposal that I describe tonight borrows many of the principles 
and ideas that have been embraced in plans introduced by both 
Republicans and Democrats in this Congress. For the first time in this 
century, leaders of both political parties have joined together around 
the principle of providing universal, comprehensive health care. It is a 
magic moment, and we must seize it.
    I want to say to all of you I have been deeply moved by the spirit 
of this debate, by the openness of all people to new ideas and argument 
and information. The American people would be proud to know that earlier 
this week when a health care university was held for Members of Congress 
just to try to give everybody the same amount of information, over 320 
Republicans and Democrats signed up and showed up for 2 days just to 
learn the basic facts of the complicated problem before us.
    Both sides are willing to say, ``We have listened to the people. We 
know the cost of going forward with this system is far greater than the 
cost of change.'' Both sides, I think, understand the literal ethical 
imperative of doing something about the system we have now. Rising above 
these difficulties and our past differences to solve this problem will 
go a long way toward defining who we are and who we intend to be as a 
people in this difficult and challenging era. I believe we all 
understand that. And so tonight, let me ask all of you, every Member of 
the House, every Member of the Senate, each Republican and each 
Democrat, let us keep this spirit and let us keep this commitment until 
this job is done. We owe it to the American people. [Applause]
    Thank you. Thank you very much.

[[Page 1839]]

    Now, if I might, I would like to review the six principles I 
mentioned earlier and describe how we think we can best fulfill those 
principles.
    First and most important, security. This principle speaks to the 
human misery, to the costs, to the anxiety we hear about every day, all 
of us, when people talk about their problems with the present system. 
Security means that those who do not now have health care coverage will 
have it, and for those who have it, it will never be taken away. We must 
achieve that security as soon as possible.
    Under our plan, every American would receive a health care security 
card that will guarantee a comprehensive package of benefits over the 
course of an entire lifetime, roughly comparable to the benefit package 
offered by most Fortune 500 companies. This health care security card 
will offer this package of benefits in a way that can never be taken 
away. So let us agree on this: Whatever else we disagree on, before this 
Congress finishes its work next year, you will pass and I will sign 
legislation to guarantee this security to every citizen of this country.
    With this card, if you lose your job or you switch jobs, you're 
covered. If you leave your job to start a small business, you're 
covered. If you're an early retiree, you're covered. If someone in your 
family has unfortunately had an illness that qualifies as a preexisting 
condition, you're still covered. If you get sick or a member of your 
family gets sick, even if it's a life-threatening illness, you're 
covered. And if an insurance company tries to drop you for any reason, 
you will still be covered, because that will be illegal. This card will 
give comprehensive coverage. It will cover people for hospital care, 
doctor visits, emergency and lab services, diagnostic services like Pap 
smears and mammograms and cholesterol tests, substance abuse, and mental 
health treatment.
    And equally important, for both health care and economic reasons, 
this program for the first time would provide a broad range of 
preventive services including regular checkups and well-baby visits. 
Now, it's just common sense. We know, any family doctor will tell you, 
that people will stay healthier and long-term costs of the health system 
will be lower if we have comprehensive preventive services. You know how 
all of our mothers told us that an ounce of prevention was worth a pound 
of cure? Our mothers were right. And it's a lesson, like so many lessons 
from our mothers, that we have waited too long to live by. It is time to 
start doing it.
    Health care security must also apply to older Americans. This is 
something I imagine all of us in this room feel very deeply about. The 
first thing I want to say about that is that we must maintain the 
Medicare program. It works to provide that kind of security. But this 
time and for the first time, I believe Medicare should provide coverage 
for the cost of prescription drugs.
    Yes, it will cost some more in the beginning. But again, any 
physician who deals with the elderly will tell you that there are 
thousands of elderly people in every State who are not poor enough to be 
on Medicaid but just above that line and on Medicare, who desperately 
need medicine, who make decisions every week between medicine and food. 
Any doctor who deals with the elderly will tell you that there are many 
elderly people who don't get medicine, who get sicker and sicker and 
eventually go to the doctor and wind up spending more money and draining 
more money from the health care system than they would if they had 
regular treatment in the way that only adequate medicine can provide.
    I also believe that over time, we should phase in long-term care for 
the disabled and the elderly on a comprehensive basis. As we proceed 
with this health care reform, we cannot forget that the most rapidly 
growing percentage of Americans are those over 80. We cannot break faith 
with them. We have to do better by them.
    The second principle is simplicity. Our health care system must be 
simpler for the patients and simpler for those who actually deliver 
health care: our doctors, our nurses, our other medical professionals. 
Today we have more than 1,500 insurers, with hundreds and hundreds of 
different forms. No other nation has a system like this. These forms are 
time consuming for health care providers. They're expensive for health 
care consumers. They're exasperating for anyone who's ever tried to sit 
down around a table and wade through them and figure them out.

[[Page 1840]]

    The medical care industry is literally drowning in paperwork. In 
recent years, the number of administrators in our hospitals has grown by 
4 times the rate that the number of doctors has grown. A hospital ought 
to be a house of healing, not a monument to paperwork and bureaucracy.
    Just a few days ago, the Vice President and I had the honor of 
visiting the Children's Hospital here in Washington where they do 
wonderful, often miraculous things for very sick children. A nurse named 
Debbie Freiberg told us that she was in the cancer and bone marrow unit. 
The other day a little boy asked her just to stay at his side during his 
chemotherapy. And she had to walk away from that child because she had 
been instructed to go to yet another class to learn how to fill out 
another form for something that didn't have a lick to do with the health 
care of the children she was helping. That is wrong, and we can stop it, 
and we ought to do it.
    We met a very compelling doctor named Lillian Beard, a pediatrician, 
who said that she didn't get into her profession to spend hours and 
hours--some doctors up to 25 hours a week--just filling out forms. She 
told us she became a doctor to keep children well and to help save those 
who got sick. We can relieve people like her of this burden. We learned, 
the Vice President and I did, that in the Washington Children's Hospital 
alone, the administrators told us they spend $2 million a year in one 
hospital filling out forms that have nothing whatever to do with keeping 
up with the treatment of the patients.
    And the doctors there applauded when I was told and I related to 
them that they spend so much time filling out paperwork, that if they 
only had to fill out those paperwork requirements necessary to monitor 
the health of the children, each doctor on that one hospital staff, 200 
of them, could see another 500 children a year. That is 10,000 children 
a year. I think we can save money in this system if we simplify it. And 
we can make the doctors and the nurses and the people that are giving 
their lives to help us all be healthier a whole lot happier, too, on 
their jobs.
    Under our proposal there would be one standard insurance form, not 
hundreds of them. We will simplify also--and we must--the Government's 
rules and regulations, because they are a big part of this problem. This 
is one of those cases where the physician should heal thyself. We have 
to reinvent the way we relate to the health care system, along with 
reinventing Government. A doctor should not have to check with a 
bureaucrat in an office thousands of miles away before ordering a simple 
blood test. That's not right, and we can change it. And doctors, nurses, 
and consumers shouldn't have to worry about the fine print. If we have 
this one simple form, there won't be any fine print. People will know 
what it means.
    The third principle is savings. Reform must produce savings in this 
health care system. It has to. We're spending over 14 percent of our 
income on health care. Canada's at 10. Nobody else is over 9. We're 
competing with all these people for the future. And the other major 
countries, they cover everybody, and they cover them with services as 
generous as the best company policies here in this country.
    Rampant medical inflation is eating away at our wages, our savings, 
our investment capital, our ability to create new jobs in the private 
sector, and this public Treasury. You know the budget we just adopted 
had steep cuts in defense, a 5-year freeze on the discretionary 
spending, so critical to reeducating America and investing in jobs and 
helping us to convert from a defense to a domestic economy. But we 
passed a budget which has Medicaid increases of between 16 and 11 
percent a year over the next 5 years and Medicare increases of between 
11 and 9 percent in an environment where we assume inflation will be at 
4 percent or less. We cannot continue to do this. Our competitiveness, 
our whole economy, the integrity of the way the Government works, and 
ultimately, our living standards depend upon our ability to achieve 
savings without harming the quality of health care.
    Unless we do this, our workers will lose $655 in income each year by 
the end of the decade. Small businesses will continue to face 
skyrocketing premiums. And a full third of small businesses now covering 
their employees say they will be forced to drop their insurance. Large 
corporations will bear big- 

[[Page 1841]]

ger disadvantages in global competition. And health care costs will 
devour more and more and more of our budget. Pretty soon all of you or 
the people who succeed you will be showing up here and writing out 
checks for health care and interest on the debt and worrying about 
whether we've got enough defense, and that will be it, unless we have 
the courage to achieve the savings that are plainly there before us. 
Every State and local government will continue to cut back on everything 
from education to law enforcement to pay more and more for the same 
health care.
    These rising costs are a special nightmare for our small businesses, 
the engine of our entrepreneurship and our job creation in America 
today. Health care premiums for small businesses are 35 percent higher 
than those of large corporations today. And they will keep rising at 
double-digit rates unless we act.
    So how will we achieve these savings? Rather than looking at price 
control or looking away as the price spiral continues, rather than using 
the heavy hand of Government to try to control what's happening or 
continuing to ignore what's happening, we believe there is a third way 
to achieve these savings. First, to give groups of consumers and small 
businesses the same market bargaining power that large corporations and 
large groups of public employees now have, we want to let market forces 
enable plans to compete. We want to force these plans to compete on the 
basis of price and quality, not simply to allow them to continue making 
money by turning people away who are sick or old or performing mountains 
of unnecessary procedures. But we also believe we should back this 
system up with limits on how much plans can raise their premiums year-in 
and year-out, forcing people, again, to continue to pay more for the 
same health care, without regard to inflation or the rising population 
needs.
    We want to create what has been missing in this system for too long 
and what every successful nation who has dealt with this problem has 
already had to do: to have a combination of private market forces and a 
sound public policy that will support that competition, but limit the 
rate at which prices can exceed the rate of inflation and population 
growth, if the competition doesn't work, especially in the early going.
    The second thing I want to say is that unless everybody is covered--
and this is a very important thing--unless everybody is covered, we will 
never be able to fully put the brakes on health care inflation. Why is 
that? Because when people don't have any health insurance, they still 
get health care, but they get it when it's too late, when it's too 
expensive, often from the most expensive place of all, the emergency 
room. Usually by the time they show up, their illnesses are more severe, 
and their mortality rates are much higher in our hospitals than those 
who have insurance. So they cost us more. And what else happens? Since 
they get the care but they don't pay, who does pay? All the rest of us. 
We pay in higher hospital bills and higher insurance premiums. This cost 
shifting is a major problem.
    The third thing we can do to save money is simply by simplifying the 
system, what we've already discussed. Freeing the health care providers 
from these costly and unnecessary paperwork and administrative decisions 
will save tens of billions of dollars. We spend twice as much as any 
other major country does on paperwork. We spend at least a dime on the 
dollar more than any other major country. That is a stunning statistic. 
It is something that every Republican and every Democrat ought to be 
able to say, we agree that we're going to squeeze this out. We cannot 
tolerate this. This has nothing to do with keeping people well or 
helping them when they're sick. We should invest the money in something 
else.
    We also have to crack down on fraud and abuse in the system. That 
drains billions of dollars a year. It is a very large figure, according 
to every health care expert I've ever spoken with. So I believe we can 
achieve large savings. And that large savings can be used to cover the 
unemployed uninsured and will be used for people who realize those 
savings in the private sector to increase their ability to invest and 
grow, to hire new workers or to give their workers pay raises, many of 
them for the first time in years.
    Now, nobody has to take my word for this. You can ask Dr. Koop. He's 
up here with us tonight, and I thank him for being here.

[[Page 1842]]

Since he left his distinguished tenure as our Surgeon General, he has 
spent an enormous amount of time studying our health care system, how it 
operates, what's right and wrong with it. He says we could spend $200 
billion every year, more than 20 percent of the total budget, without 
sacrificing the high quality of American medicine.
    Ask the public employees in California, who've held their own 
premiums down by adopting the same strategy that I want every American 
to be able to adopt, bargaining within the limits of a strict budget. 
Ask Xerox, which saved an estimated $1,000 per worker on their health 
insurance premium. Ask the staff of the Mayo Clinic, who we all agree 
provides some of the finest health care in the world. They are holding 
their cost increases to less than half the national average. Ask the 
people of Hawaii, the only State that covers virtually all of their 
citizens and has still been able to keep costs below the national 
average.
    People may disagree over the best way to fix this system. We may all 
disagree about how quickly we can do the thing that we have to do. But 
we cannot disagree that we can find tens of billions of dollars in 
savings in what is clearly the most costly and the most bureaucratic 
system in the entire world. And we have to do something about that, and 
we have to do it now.
    The fourth principle is choice. Americans believe they ought to be 
able to choose their own health care plan and keep their own doctors. 
And I think all of us agree. Under any plan we pass, they ought to have 
that right. But today, under our broken health care system, in spite of 
the rhetoric of choice, the fact is that that power is slipping away for 
more and more Americans.
    Of course, it is usually the employer, not the employee, who makes 
the initial choice of what health care plan the employee will be in. And 
if your employer offers only one plan, as nearly three-quarters of small 
or medium-sized firms do today, you're stuck with that plan and the 
doctors that it covers.
    We propose to give every American a choice among high quality plans. 
You can stay with your current doctor, join a network of doctors and 
hospitals, or join a health maintenance organization. If you don't like 
your plan, every year you'll have the chance to choose a new one. The 
choice will be left to the American citizen, the worker, not the boss 
and certainly not some Government bureaucrat.
    We also believe that doctors should have a choice as to what plans 
they practice in. Otherwise, citizens may have their own choices 
limited. We want to end the discrimination that is now growing against 
doctors and to permit them to practice in several different plans. 
Choice is important for doctors, and it is absolutely critical for our 
consumers. We've got to have it in whatever plan we pass.
    The fifth principle is quality. If we reformed everything else in 
health care but failed to preserve and enhance the high quality of our 
medical care, we will have taken a step backward, not forward. Quality 
is something that we simply can't leave to chance. When you board an 
airplane, you feel better knowing that the plane had to meet standards 
designed to protect your safety. And we can't ask any less of our health 
care system.
    Our proposal will create report cards on health plans, so that 
consumers can choose the highest quality health care providers and 
reward them with their business. At the same time, our plan will track 
quality indicators, so that doctors can make better and smarter choices 
of the kind of care they provide. We have evidence that more efficient 
delivery of health care doesn't decrease quality. In fact, it may 
enhance it.
    Let me just give you one example of one commonly performed 
procedure, the coronary bypass operation. Pennsylvania discovered that 
patients who were charged $21,000 for this surgery received as good or 
better care as patients who were charged $84,000 for the same procedure 
in the same State. High prices simply don't always equal good quality. 
Our plan will guarantee that high quality information is available in 
even the most remote areas of this country so that we can have high 
quality service, linking rural doctors, for example, with hospitals with 
high-tech urban medical centers. And our plan will ensure the quality of 
continuing progress on a whole range of issues by speeding research on 
effective prevention and

[[Page 1843]]

treatment measures for cancer, for AIDS, for Alzheimer's, for heart 
disease, and for other chronic diseases. We have to safeguard the finest 
medical research establishment in the entire world. And we will do that 
with this plan. Indeed, we will even make it better.
    The sixth and final principle is responsibility. We need to restore 
a sense that we're all in this together and that we all have a 
responsibility to be a part of the solution. Responsibility has to start 
with those who profit from the current system. Responsibility means 
insurance companies should no longer be allowed to cast people aside 
when they get sick. It should apply to laboratories that submit 
fraudulent bills, to lawyers who abuse malpractice claims, to doctors 
who order unnecessary procedures. It means drug companies should no 
longer charge 3 times more per prescription drugs, made in America here 
in the United States, than they charge for the same drugs overseas.
    In short, responsibility should apply to anybody who abuses this 
system and drives up the cost for honest, hard-working citizens and 
undermines confidence in the honest, gifted health care providers we 
have. Responsibility also means changing some behaviors in this country 
that drive up our costs like crazy. And without changing it we'll never 
have the system we ought to have, we will never.
    Let me just mention a few and start with the most important: The 
outrageous costs of violence in this country stem in large measure from 
the fact that this is the only country in the world where teenagers can 
rout the streets at random with semiautomatic weapons and be better 
armed than the police.
    But let's not kid ourselves; it's not that simple. We also have 
higher rates of AIDS, of smoking and excessive drinking, of teen 
pregnancy, of low birth weight babies. And we have the third worst 
immunization rate of any nation in the Western Hemisphere. We have to 
change our ways if we ever really want to be healthy as a people and 
have an affordable health care system. And no one can deny that.
    But let me say this--and I hope every American will listen, because 
this is not an easy thing to hear--responsibility in our health care 
system isn't just about them. It's about you. It's about me. It's about 
each of us. Too many of us have not taken responsibility for our own 
health care and for our own relations to the health care system. Many of 
us who have had fully paid health care plans have used the system 
whether we needed it or not without thinking what the costs were. Many 
people who use this system don't pay a penny for their care even though 
they can afford to. I think those who don't have any health insurance 
should be responsible for paying a portion of their new coverage. There 
can't be any something for nothing, and we have to demonstrate that to 
people. This is not a free system. Even small contributions, as small as 
the $10 copayment when you visit a doctor, illustrates that this is 
something of value. There is a cost to it. It is not free.
    And I want to tell you that I believe that all of us should have 
insurance. Why should the rest of us pick up the tab when a guy who 
doesn't think he needs insurance or says he can't afford it gets in an 
accident, winds up in an emergency room, gets good care, and everybody 
else pays? Why should the small business people who are struggling to 
keep afloat and take care of their employees have to pay to maintain 
this wonderful health care infrastructure for those who refuse to do 
anything? If we're going to produce a better health care system for 
every one of us, every one of us is going to have to do our part. There 
cannot be any such thing as a free ride. We have to pay for it. We have 
to pay for it.
    Tonight I want to say plainly how I think we should do that. Most of 
the money will come, under my way of thinking, as it does today, from 
premiums paid by employers and individuals. That's the way it happens 
today. But under this health care security plan, every employer and 
every individual will be asked to contribute something to health care.
    This concept was first conveyed to the Congress about 20 years ago 
by President Nixon. And today, a lot of people agree with the concept of 
shared responsibility between employers and employees and that the best 
thing to do is to ask every employer and every employee to share that. 
The Chamber of Commerce has said that, and they're not in

[[Page 1844]]

the business of hurting small business. The American Medical Association 
has said that.
    Some call it an employer mandate, but I think it's the fairest way 
to achieve responsibility in the health care system. And it's the 
easiest for ordinary Americans to understand because it builds on what 
we already have and what already works for so many Americans. It is the 
reform that is not only easiest to understand but easiest to implement 
in a way that is fair to small business, because we can give a discount 
to help struggling small businesses meet the cost of covering their 
employees. We should require the least bureaucracy or disruption and 
create the cooperation we need to make the system cost-conscious, even 
as we expand coverage. And we should do it in a way that does not 
cripple small businesses and low-wage workers.
    Every employer should provide coverage, just as three-quarters do 
now. Those that pay are picking up the tab for those who don't today. I 
don't think that's right. To finance the rest of reform, we can achieve 
new savings, as I have outlined, in both the Federal Government and the 
private sector through better decisionmaking and increased competition. 
And we will impose new taxes on tobacco. I don't think that should be 
the only source of revenues. I believe we should also ask for a modest 
contribution from big employers who opt out of the system to make up for 
what those who are in the system pay for medical research, for health 
education centers, for all the subsidies to small business, for all the 
things that everyone else is contributing to. But between those two 
things, we believe we can pay for this package of benefits and universal 
coverage and a subsidy program that will help small business.
    These sources can cover the cost of the proposal that I have 
described tonight. We subjected the numbers in our proposal to the 
scrutiny of not only all the major agencies in Government--I know a lot 
of people don't trust them, but it would be interesting for the American 
people to know that this was the first time that the financial experts 
on health care in all of the different Government agencies have ever 
been required to sit in the room together and agree on numbers. It had 
never happened before. But obviously, that's not enough. So then we gave 
these numbers to actuaries from major accounting firms and major Fortune 
500 companies who have no stake in this other than to see that our 
efforts succeed. So I believe our numbers are good and achievable.
    Now, what does this mean to an individual American citizen? Some 
will be asked to pay more. If you're an employer and you aren't insuring 
your workers at all, you'll have to pay more. But if you're a small 
business with fewer than 50 employees, you'll get a subsidy. If you're a 
firm that provides only very limited coverage, you may have to pay more. 
But some firms will pay the same or less for more coverage.
    If you're a young, single person in your twenties and you're already 
insured, your rates may go up somewhat because you're going to go into a 
big pool with middle-aged people and older people, and we want to enable 
people to keep their insurance even when someone in their family gets 
sick. But I think that's fair because when the young get older they will 
benefit from it, first, and secondly, even those who pay a little more 
today will benefit 4, 5, 6, 7 years from now by our bringing health care 
costs closer to inflation.
    Over the long run, we can all win. But some will have to pay more in 
the short run. Nevertheless, the vast majority of the Americans watching 
this tonight will pay the same or less for health care coverage that 
will be the same or better than the coverage they have tonight. That is 
the central reality.
    If you currently get your health insurance through your job, under 
our plan you still will. And for the first time, everybody will get to 
choose from among at least three plans to belong to. If you're a small 
business owner who wants to provide health insurance to your family and 
your employees, but you can't afford it because the system is stacked 
against you, this plan will give you a discount that will finally make 
insurance affordable. If you're already providing insurance, your rates 
may well drop because we'll help you as a small business person join 
thousands of others to get the same benefits big corporations get at the 
same price they get those benefits. If you're self-employed, you'll pay 
less, and you will get to deduct from your

[[Page 1845]]

taxes 100 percent of your health care premiums. If you're a large 
employer, your health care costs won't go up as fast, so that you will 
have more money to put into higher wages and new jobs and to put into 
the work of being competitive in this tough global economy.
    Now, these, my fellow Americans, are the principles on which I think 
we should base our efforts: security, simplicity, savings, choice, 
quality, and responsibility. These are the guiding stars that we should 
follow on our journey toward health care reform.
    Over the coming months, you'll be bombarded with information from 
all kinds of sources. There will be some who will stoutly disagree with 
what I have proposed and with all other plans in the Congress, for that 
matter. And some of the arguments will be genuinely sincere and 
enlightening. Others may simply be scare tactics by those who are 
motivated by the self-interest they have in the waste the system now 
generates, because that waste is providing jobs, incomes, and money for 
some people. I ask you only to think of this when you hear all of these 
arguments: Ask yourself whether the cost of staying on this same course 
isn't greater than the cost of change. And ask yourself, when you hear 
the arguments, whether the arguments are in your interest or someone 
else's. This is something we have got to try to do together.
    I want also to say to the Representatives in Congress, you have a 
special duty to look beyond these arguments. I ask you instead to look 
into the eyes of the sick child who needs care, to think of the face of 
the woman who's been told not only that her condition is malignant but 
not covered by her insurance, to look at the bottom lines of the 
businesses driven to bankruptcy by health care costs, to look at the 
``for sale'' signs in front of the homes of families who have lost 
everything because of their health care costs.
    I ask you to remember the kind of people I met over the last year 
and a half: the elderly couple in New Hampshire that broke down and 
cried because of their shame at having an empty refrigerator to pay for 
their drugs; a woman who lost a $50,000 job that she used to support her 
six children because her youngest child was so ill that she couldn't 
keep health insurance, and the only way to get care for the child was to 
get public assistance; a young couple that had a sick child and could 
only get insurance from one of the parents' employers that was a 
nonprofit corporation with 20 employees, and so they had to face the 
question of whether to let this poor person with a sick child go or 
raise the premiums of every employee in the firm by $200; and on and on 
and on.
    I know we have differences of opinion, but we are here tonight in a 
spirit that is animated by the problems of those people and by the sheer 
knowledge that if we can look into our heart, we will not be able to say 
that the greatest nation in the history of the world is powerless to 
confront this crisis.
    Our history and our heritage tell us that we can meet this 
challenge. Everything about America's past tells us we will do it. So I 
say to you, let us write that new chapter in the American story. Let us 
guarantee every American comprehensive health benefits that can never be 
taken away.
    You know, in spite of all the work we've done together and all the 
progress we've made, there's still a lot of people who say it would be 
an outright miracle if we passed health care reform. But my fellow 
Americans, in a time of change you have to have miracles. And miracles 
do happen. I mean, just a few days ago we saw a simple handshake shatter 
decades of deadlock in the Middle East. We've seen the walls crumble in 
Berlin and South Africa. We see the ongoing brave struggle of the people 
of Russia to seize freedom and democracy.
    And now it is our turn to strike a blow for freedom in this country, 
the freedom of Americans to live without fear that their own Nation's 
health care system won't be there for them when they need it. It's hard 
to believe that there was once a time in this century when that kind of 
fear gripped old age, when retirement was nearly synonymous with poverty 
and older Americans died in the street. That's unthinkable today, 
because over a half a century ago Americans had the courage to change, 
to create a Social Security System that ensures that no Americans will 
be forgotten in their later years.
    Forty years from now, our grandchildren will also find it 
unthinkable that there was

[[Page 1846]]

a time in this country when hardworking families lost their homes, their 
savings, their businesses, lost everything simply because their children 
got sick or because they had to change jobs. Our grandchildren will find 
such things unthinkable tomorrow if we have the courage to change today.
    This is our chance. This is our journey. And when our work is done, 
we will know that we have answered the call of history and met the 
challenge of our time.
    Thank you very much, and God bless America.

Note: The President spoke at 9:10 p.m. in the House Chamber at the 
Capitol.