    [Weekly Compilation of Presidential Documents Volume 30, Number 12 (Monday, March 28, 1994)]
    [Pages 621-624]
    [Online from the Government Publishing Office, www.gpo.gov]

    <R04>
    Remarks to Health Care Providers

    March 23, 1994

        Thank you very much. It's a great honor for the Vice President and
    Mrs. Gore and for Hillary and me to have all of you here today. I want
    to especially thank Dr. Haggerty for his moving account, and Marva Wade
    for having the courage not only to tell us the story of her work but the
    story of her family, and Sister Bernice Coreil for her stout-hearted
    defense of our continuing efforts.
        I was sitting there thinking when she was speaking, I wonder how
    many nuns have ever given a speech and quoted Machiavelli? Well, I
    suppose he was a Catholic. [Laughter] And he certainly was right about a
    lot of things.
        I want to say to all of you how important it is for us to have you
    here to validate our common efforts because of your work, your life, and
    your experience. We've been seeking out a lot of that lately. Hillary
    and I went to Florida the first of the week and met with thousands of
    senior citizens, some of whom have been frightened by claims that we
    were trying to do something to Medicare instead of to protect Medicare
    and to extend its benefits to prescription medicine and to long-term
    care options in the home and in the community.
        I met yesterday with a very, very moving group of a couple of
    hundred small business people, and 12 or 13 of them talked. About half
    of them, by the way, in endorsing our program, acknowledged that they
    would pay more if our plan passed, but for the first time they'd be able
    to insure all their employees instead of just a few of them and insure
    them with good benefits. And for a change their competitors would be on
    an even field with them because they would have to do the same thing,
    and they'd all make out all right.
        This morning I met by teleconference with the California Medical
    Association, the biggest affiliate of the AMA in the country, and they
    were extremely supportive of this plan and what we are trying to do.
        And of course, now I'm meeting with you. And along the way, I have
    had encounters with people that we didn't plan that have made the same
    points all of you have made. I was in Florida and as I often do when I'm
    traveling, I agree to meet with children who are part of the Make-A-Wish
    network around the country, desperately ill children. And I met a family
    with two boys with a rare form of cancer which they believe must be
    genetically related because both their sons have it, and they have a
    daughter who is the youngest child and who has not yet been diagnosed.
    And we all hope she won't be.
        But this family was living in mortal terror because they had a
    lifetime limit on their insurance policy, and they thought, well, maybe
    one of their sons would become an adult. They're both surviving and
    maintaining it, but if they have good success with the treatment and
    both the boys are able to live and go on and do well, they'll certainly
    outrun their lifetime limits while the younger son is still at home and
    needing care.
        I was in Columbus, Ohio, the other day campaigning for our crime
    bill, and I stopped in a delicatessen where the owner of the
    delicatessen, who wound up being one of our small business people here
    yesterday by the way, came to me and said, ``I am in the worst of all
    worlds. I have 20 employees that are full-time, 20 that are part-time. I
    had cancer 5 years ago. I'm about to be declared cancer free. Because of
    my preexisting conditions, our deductibles went up, our copay went up,
    our premium went up. But I still cover my 20 employees. I'm proud of
    that because it's the right thing to do, but I'm at a competitive
    disadvantage to everybody who doesn't, and I feel guilty that I don't
    cover my part-time employees.''
        So I hear these stories always. And those of you who are on the
    frontlines of medical care must wonder from time to time when you hear
    people make these speeches or you see these television ads, what planet
    they came from--[laughter]--because it's so inconsistent with the
    personal experience you've had.
        Hillary and I have gone to extraordinary lengths to try to get
    people to look at this anew. We even made our own Harry and Louise ad
    for the national press the other

    [[Page 622]]

    day. Someone said after it was over, ``Have you no shame left?'' And I
    said, ``Not very much after the last year.'' [Laughter]
        The purpose of all of this to me is to give the American people who
    are looking at this from their own perspective, as every person should,
    a sense of how the real world operates, how incredibly complex and
    counterproductive the present financing system is, how it encourages
    people like you to spend more time on paperwork instead of patient care,
    and how it leaves millions of our fellow citizens rife with insecurity
    that they either are going to lose their health insurance or have it
    priced out of their reach, or that the policy they have doesn't cover
    something they need.
        What we are genuinely trying to do in good faith and with the
    consultation of thousands of people like you all across the country is
    to fix what's wrong with this system and keep what's right. We believe
    we have to have guaranteed insurance for all Americans, otherwise we'll
    never have security for all Americans; we'll never be able to have a
    rational system; we'll never stop all the cost-shifting; but most
    important of all, we'll never do the right thing.
        And we think that guaranteed insurance should cover comprehensive
    benefits that include primary and preventive care, that include
    prescription medicine, that builds in mental health coverage. And we
    think over the long run these things will give us a more cost-efficient
    system and a much healthier and happier and more secure country, and a
    more productive American work force.
        We believe in order to have the kind of system we need, we have to
    find a way to capitalize on the managed competition and those
    competitive forces that we've seen taking root in health care over the
    last couple of years but to do it in a way that preserves rather than
    undermines people's choices of providers and therefore the quality of
    our health care system.
        Fewer and fewer Americans have choice in their health care system
    today. I was glad to hear somebody mention that earlier. I hear all
    these things, saying, well, if you vote for the President's plan, you
    will lose your choices. The truth is that more than half of the
    employers who are carrying insurance for their employees today provide
    less than two or more choices. In other words, fewer than half of them
    say to their employees, here's two choices, here's three, here's more
    choices, you make a decision. Under our plan, people would be able to
    choose not just once but every year of fee-for-service approach, a
    network plan, or a network plan that has a point-of-service option so
    they could always decide that they wanted to go outside the plan and get
    other health care. And if they chose that option, the employer would
    still be obliged to pay his or her portion of the cost of care.
        In other words, we'll have more competition. We'll have more managed
    care. But we'll have more choice, and the choice will be made by the
    patients, the people who are going to get the care based on an informed
    set of information. And they'll be able to make the choice anew every
    year. I think that is very, very important.
        The next thing we want to do is to have real insurance reform. That
    means that we're going to have to have an end to the preexisting
    condition problems that you all know very well. People cannot be denied
    coverage or have their rates raised just because someone in their family
    has been sick. We should have an end to the lifetime limits policy. And
    we should not charge older people more than younger people for their
    health insurance.
        Let me say there are sound economic reasons quite apart from health
    care to do this. The average American 18-year-old's going to change work
    eight times in a lifetime. We are now regularly seeing people in their
    sixties lose their old job and have to find a new job. We are up here
    this year, this administration is, trying to redesign the entire
    unemployment system of the country to make it a continuous reemployment
    system. What good is that if for reasons having nothing to do with your
    family's health condition or your own age, you lose your job, and then
    you can't get another one with health insurance because your child's
    been sick or because you happen to be over 60 years old? This is a very
    serious issue.
        We also have to find ways for small business people and self-
    employed people to buy the kind of good insurance that people like me
    who work for the Government have or

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    people who work for big companies have, at the same competitive prices.
    So you want a break for small business and the self-employed to get what
    the rest of us take for granted. And we have to have broadbased
    community rating. I will say this, you cannot expect the insurance
    industry under the present circumstance to provide these services
    because a lot of the smaller companies will absolutely go broke. They
    cannot afford community rating. They cannot disregard these things,
    because we're all insured in tiny little groups where a lot of those
    folks have to make money--a lot of money on a few people.
        The only way we can do this in a way that is fair and humane and
    practical is to have each other insured in ways that permit the
    insurance folks to make money the way grocery stores do, a little bit of
    money on a lot of people where you spread the risk. And that is what we
    are trying to do. It is what we must do.
        And we have to change the system. It is no good just railing against
    something that will not work economically. We can change it and make it
    work economically. I simply refuse to believe, by the way, that we are
    the only advanced country in the world that can't figure out how to do
    this. It's like being told--every time I see one of these ads saying we
    can't do this; we can't do this; we don't need to do this; I feel like
    someone telling me right now, not as President, but as an American
    citizen that there is some inherent defect in my country, and we're all
    just consumed with the dummies, and we can't figure out how to do this.
    That's not true. If we have the will to do it, we can do it.
        And people who really care about the quality of care, like you, know
    we can do it. We can do it, and we can still preserve Medicare. We can
    preserve the things that work, and we can do it. I think we ought to do
    it at work. I think that people ought to be insured at work who are
    working. Eighty percent of the uninsured people in America today have
    someone in their family with a job. So the simplest, clearest, least
    bureaucratically, least threatening way to do this is to extend the
    requirement that employers should pay for a portion of their employees'
    insurance; the employee should pay for a portion of that as well. Yes,
    we have a very vital small business job market. Interestingly enough,
    most of the job-creating small businesses in this country provide
    insurance for their employees right now.
        Just this week, to give you another personal story, Hillary and I
    had a family staying with us here from our home State, a man who is in
    the car business, has been for 20 years. He said, ``You know, I've
    always thought about what a competitive disadvantage I face because I've
    always covered all my employees in my automobile place, and none of my
    competitors ever had. And I just moaned about it all the time. And then
    I realized, I'm in business after 20 years and doing better than I ever
    have and three of my competitors have gone broke even though they didn't
    cover their employees, and I did. And it's because I've still got the
    same people working for me that started with me 20 years ago taking care
    of our customers, doing a good job, providing quality service and a good
    product.''
        There is a real lesson there. We cannot let people who always tell
    us about the problems beat this thing and make it worse. Yes, there are
    problems. You name me a problem that's not going to get worse if we do
    nothing. If we do nothing, next year we'll have more uninsured people
    than we had this year. If we do nothing, next year we'll have more cost-
    shifting than we do this year. If we do nothing, next year we'll have
    more families with Marva stories than we do this year. If we do nothing,
    you as doctors and nurses will face more restrictions on your practice
    than you have this year. Isn't that right? If we do nothing, the
    patients that you deal with will have fewer choices than they do this
    year. If we do nothing, all the competitive forces will allow some
    bigger businesses and government to get a better deal next year, but the
    consequence of that will be, there will be more financial trouble for
    hospitals than there are this year.
        Everything we're complaining about this year will get worse if the
    people who tell us that we can't do anything because there are problems
    with anything we want to do prevail. The only certainty is the problems
    will be aggravated if we put this off another year.

    [[Page 624]]

        So if you believe in these principles, let me say this: We need to
    take it out to the American people and tell them what we're trying to
    do. Let me tell you--this is the most interesting thing I've read
    recently--that wouldn't be too hard. A couple of weeks ago, the Wall
    Street Journal, which is hardly the house organ of the Clinton
    administration, conducted a little forum, and they explained our health
    care program to some citizens of York, Pennsylvania, without telling
    them anything about our plan. It turned out that the great majority of
    the group thought everything about our plan was great. But they didn't
    like our plan very much because of what they had heard on the paid ads,
    and they'd heard organized groups run against it. Then when they told
    them what was in it, they thought it was peachy.
        What does that mean? Well, it means that we need people like you to
    go out and talk about the basic principles. Of course, there's a
    congressional process. Of course, there have to be amendments made. Of
    course, we have to work through this the way all laws are made. But it
    is very, very important that the Congress understands that you, as
    people who have put your lives, your heart and soul into health care,
    are for this, and that the people with whom you work, the people who are
    the patients of America, want it to be done.
        Congress will go on recess soon, but democracy won't go on recess.
    It will pick up because the people will go out and talk to their
    Congressmen and Senators. So I implore you, as we look at this Easter
    recess, go tell your patients, your colleagues, your friends, your
    neighbors, and most important, your Senators and Representatives that
    the time to do this is now, that delaying it will make it just like a
    hangnail or an ingrown toenail; it's just going to get worse.
        And one of the things--it's almost like sometimes when a country has
    to face these big problems--it's like when you're trying to raise your
    kids, sooner or later, you have to get across to people that when you've
    got a big problem, you might as well deal with it, because if you delay
    it, it will just get worse.
        We have this momentous opportunity. Machiavelli was right. There is
    nothing too difficult as to change the established order of things. But
    remember this, if it hadn't happened over and over and over again, since
    he wrote that, there would be no civilized society, and America would
    not be the oldest democracy on the face of the Earth. We can do this,
    and with your help, we will.
        Thank you, and God bless you all.

    Note: The President spoke at 3:14 p.m. on the South Lawn at the White
    House. In his remarks, he referred to Jesse C. Haggerty III, MD,
    chairman and program director of a family medicine residency program,
    Topeka, KS; Marva Wade, RN, president-elect, New York State Nurses
    Association, New York, NY; Sister Bernice Coreil, DC, senior vice
    president, System Integration, Daughters of Charity National Health
    System, St. Louis, MO. A tape was not available for verification of the
    content of these remarks.