    [Weekly Compilation of Presidential Documents Volume 30, Number 16 (Monday, April 25, 1994)]
    [Pages 826-833]
    [Online from the Government Publishing Office, www.gpo.gov]

    <R04>
    Remarks to Ameritech Employees in Milwaukee

    April 18, 1994

        The President. Thank you very much. Thank you, Senator Kohl. And
    thank you, ladies and gentlemen, for that warm welcome. I started to
    stand on this thing so you would think I might be the Mayor of
    Milwaukee, but on reflection, I decided, like all public officials I'd
    rather be closer to the microphone. [Laughter] I want to thank Senator
    Feingold for his support and his leadership and his fine remarks.
    Congressman Barrett and Congressman Barca, we're glad to see you here.
    Thank you for being here with us. Congressman Gerry Kleczka, thank you
    so much; I'm glad to be here with you in your district and in your
    hometown. I want to say a special word of thanks to the Ameritech team
    for the welcoming here today. Dick Notebaert came out with me, along
    with Morty Bahr on the airplane, so the three of us had a chance to
    visit a little bit about what we would be doing today. And between the
    two of them, they convinced me that this may be the best company in the
    history of the world. They were talking about--[applause] I want to
    thank Gary Keating and Rick Compost in Detroit and Deborah Echols in
    Chicago and all the employees who are there. I also want to say, in
    addition to the fine work done by the CWA, I know that many of you are
    part of the International Brotherhood of Electrical Workers; I thank you
    for your support in this health care effort. There are a lot of people
    here in the audience--I won't recognize all of them, but I would like to
    say a special word of thanks to the speaker of the Wisconsin House,
    Walter Kunicki, an old friend of mine, for being here. Thank you very
    much, sir, for coming. And I'd like to thank the Wisconsin Ameritech
    team, Bronson Haase and Bob Johnson and others. Thank you so much. We're
    glad to be here.
        Ladies and gentlemen, when I came to Wisconsin first as a candidate
    for President, I did so not simply because I wanted to have the honor of
    the job, although it is a very great honor indeed, the highest any
    American citizen can receive, but because I thought the President's job
    was to bring the

    [[Page 827]]

    American people together and to move our country forward, to seize our
    opportunities, and to honestly face our problems. And we've been trying
    to do that.
        We've seen a lot of talk over the last several years about our
    deficit, for example, but finally now, in the last year, the Congress
    has passed an economic plan that has brought the deficit down, helped to
    create a stronger economic climate, and 2\1/2\ million jobs have come
    into our economy, 90 percent of them in the private sector. That's more
    in 15 months than in the previous 4 years, in fact, twice as many as in
    the previous 4 years.
        Congress now has a budget before it which it is passing in rapid
    fashion, perhaps record fashion, which does what we're supposed to do in
    Washington: make the difficult decisions. It eliminates 100 Government
    programs, cuts 200 others, reduces overall discretionary domestic
    spending for the first time since 1969, and at the same time, spends
    more money on education, on Head Start, on defense conversion, and on
    the new technologies which will create the high-wage jobs of the 21st
    century.
        If this budget passes, for the first time since Harry Truman was
    President we will have 3 years of declining deficits in the Federal
    accounts. That's a pretty good record for a Congress and an
    administration working together, breaking deadlocks, talking less, and
    doing more. I think that's what we were all hired to do.
        Congress has a lot of other interesting work to do this year. It is
    taking up sweeping education reforms, some of them modeled on a lot of
    the exciting things that have gone on here in Wisconsin and some of your
    neighboring States. I signed a bill the other day called Goals 2000
    which, for the first time ever, commits America to world-class standards
    of educational excellence in every school in the country and at the same
    time, promotes a lot of innovative grassroots reforms to achieve them
    and encourages communities to try new and different things.
        We're trying to set up a system now that takes into account the fact
    that young people don't necessarily have to have 4-year college degrees
    to get good jobs as we move toward the 21st century, but they sure need
    more training than they get in high school. So we want a school-to-work
    transition that takes account of the real needs of people who don't go
    on to 4-year colleges.
        Congress has a bill before it to completely redo the unemployment
    system. The unemployment system takes money, I would argue, under not
    entirely fair circumstances now from employers who pay the unemployment
    tax, because it used to be that when people lost their jobs, they were
    called back to their old jobs. So unemployment was a premium the
    employer paid to pay people at a lower level so they could at least get
    along until they got called back to their old jobs. Most workers do not
    get called back to their old jobs today. Most people have to find new
    jobs.
        The economy is churning and changing, and no matter how many new
    jobs we can create, there will still be a lot of change in this economy.
    So we want, instead of an unemployment system, a reemployment system, so
    the minute people lose their jobs, they're immediately eligible for
    retraining and for job help to find new jobs and different jobs, because
    the average 18-year-old will change work eight times in a lifetime, and
    we owe it to ourselves and our future to make sure that always people
    are retrained and placed as quickly as possible. We intend to do that
    this year; that's very important.
        Our administration has been committed to welfare reform, to ending
    the whole welfare system as we know it, something that Wisconsin has a
    great deal of experience in. And I want to say a special word of thanks
    to Mayor Norquist and the city of Milwaukee, who have a national model
    in Project New Hope. It says you can move people from welfare to work. I
    know we can do that; I'm going to talk more about it in a minute. But
    that is another thing we are facing this year. This is an exciting time
    in our Nation's Capital, because people are actually working on the
    problems facing America.
        The first item of business now, when we go back tomorrow in
    Congress, will be the crime bill that's in the House of Representatives.
    And then the House and the Senate will get together. If the best of both
    bills passes, we'll have 100,000 more police officers on the street;
    we'll have huge new opportunities for young people to help prevent

    [[Page 828]]

    crime, to keep our young people from getting in trouble, and give them
    some things to say yes to; we'll have drug treatment that is very
    important, that we don't now have in a lot of our programs, and alcohol
    abuse treatment; we will have a tough ``Three strikes and you're out''
    law for people who shouldn't be paroled that we know are likely to
    recreate serious violent crimes; and we'll ban 28 kinds of assault
    weapons, if the best of both bills passes. That ought to happen this
    year in the Congress.
        And I want to say a special word of thanks in that regard to Senator
    Kohl for his leadership in supporting the Brady bill, which we passed
    after 7 years of deadlock last year and his attempt to keep dangerous
    handguns out of the hands of minors who have no business carrying them
    on the streets of our cities.
        Now, last year, according to a lot of independent analyses, this
    Congress and I did more work together in more substantive ways than had
    been done in the first year of an administration in a whole generation,
    in over 30 years. But this year can be better, if we do the things that
    I just mentioned and if we have the courage, finally, to solve this
    health care problem.
        I want to talk a little bit about what specifically is in our plan
    and what some of the problems are, the real problems and the political
    problems with passing this plan, because if you're going to help us pass
    it, you have to understand the pressures that your Representatives in
    Congress are under.
        First of all, what are the problems? Well, at any given time during
    the year, 58 million Americans will be without health insurance out of a
    Nation of 255 million. About 39 million of our fellow countrymen just
    don't have it all year long. Eighty-one million of us--81 million--
    almost one in 3, live in families where someone in our family has a
    preexisting condition: a child with diabetes, a mother who has had
    breast cancer relatively early in life, a father who had an early heart
    attack. And these people either pay much higher premiums for their
    health insurance or they can't afford insurance at all or they're
    insured at their present job but they are terrified to leave their job
    for fear that they will lose their insurance. And so, at a time when job
    mobility is highly prized, we see people never leaving their jobs. This
    is a huge problem.
        And 133 million of us, more than half of our population and three-
    quarters of the Americans who are insured at work have lifetime limits
    on our policy. So that if one of our children were to be born with a
    serious long-term disease or problem--or in the case of a family I met a
    couple of weeks ago in another State, where they had three children and
    the first two sons were born with a very rare form of cancer which may
    well be treatable and which may well be able to be maintained--they're
    going to run out of their health insurance coverage before the second
    boy gets out of the house. And they'll have to figure out what to do and
    whether they can continue to work and what in the world is going to
    happen to their family.
        Not only that, 100 percent of us just about are at some risk of
    losing our health insurance. If you work for a government or if you work
    for a wonderful company like this, you won't lose it. But what if you
    decided to change your job, or what if you had to quit your job, then
    what would happen?
        And finally, as has already been said, the system we have--I was
    glad to hear Mr. Notebaert say this--is the most expensive system
    administratively in the world. We spend roughly twice as much money on
    paperwork and other administrative costs as any other country in the
    world does, with the consequence that, in America, we spend 14.5 percent
    of our income on health care. Canada spends 10 percent of its income;
    Japan and Germany spend 9 percent of their income. And half of that is
    for good things--I'll say more about that in a minute--and for things
    that we can't do anything about. We're more violent than all these other
    countries, so we have more emergency room bills. We have higher rates of
    AIDS. But half of it is the crazy way our system is organized.
        There was a recent study of two hospitals, one in Canada, one in the
    United States, with the same number of beds, the same vacancy rate, the
    same patient caseload. There were 200 people in the clerical department
    of the American hospital and 6 in the Canadian hospital. You're paying
    for that.
        You're also paying, as has been pointed out, a significant premium
    because we are

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    the only advanced country that permits some people just to say, ``I
    won't have any insurance; I don't believe I'll be covered.'' But they
    all get health care if an emergency happens or when it's too late and
    they're too sick and they show up at the emergency room. And then the
    cost is passed on to the rest of you in higher premiums.
        There are all kinds of other things we pay for, too. Because we
    don't provide prescription drugs for elderly people in a lot of family
    policies, our hospital bills are much greater, particularly for older
    people, because of maintaining themselves with adequate prescriptions, a
    lot of people on Medicare choose every month between medicine and food.
    But they wind up getting care when it's too late, too expensive, and
    they're in the hospital. And it adds costs to the whole system.
        There are millions of Americans who have disabilities that if they
    were able to have some in-home care would save us money. They would be
    able to get health insurance and millions of them would be able to work
    who cannot work today.
        So our whole system, because we don't cover everybody, because we
    are willing to spend too much on paperwork and, therefore, too little on
    things that keep people well, like primary and preventive health care,
    costs too much and does too little. You might ask, ``Well, if it's all
    that simple why haven't we fixed it?'' Well, because it's not all that
    simple. And I'll explain why.
        There are all kinds of improvements going on now all the time. I
    just got a wonderful demonstration--you all heard about it already--from
    the Wisconsin Health Information Network. And Marsha, the lady who
    showed me, was terrific; I learned a lot and I was--if I hadn't been
    late I would still be out there fiddling with the computer to prove that
    even I could do it, a total computer illiterate. [Laughter] There are
    some things we can do. But I believe with all my heart, having studied
    this now for years and years, that we cannot fix these problems unless
    we have a national response, not a national health care system run by
    the Government but a national response. The Government of the United
    States needs to reorganize the health care system to keep what's best
    and fix what's wrong. And make no mistake about it, there are a lot of
    things that are great about our system: the doctors, the nurses, the
    medical research, the technology, the advances.
        I have a friend from Wisconsin here--Brianne Schwantes. Stand up and
    wave to the crowd here. [Applause] She was born with a problem; her
    bones were prone to break easily. And she comes to the National
    Institutes of Health on a regular basis and gets world-class care. And
    so here she is. And you know where I found her? Working with the flood
    victims in the Middle West, risking her brittle bones to help other
    people who were in trouble. If it weren't for the miracles of our
    system, she would not be able to do that. And we don't have to mess that
    up. But we do have to make some hard decisions. We're going to have to
    either cover everybody or not. If we don't cover everybody, your wages
    are still going to be stressed by paying too much for health care
    because other people won't cover their own. You're still going to have
    horror story after horror story of people who can't get coverage or who
    are terrified of losing it. And we will continue to pay more than we
    should.
        If we do want to cover everybody, we only have two choices. You look
    all around the world; there are only two options. You either have to do
    it through a Government-funded program, like Medicare for everybody--
    abolish all insurance, charge everybody a tax and fund it--or you have
    to have insurance for everybody. And if you have insurance for
    everybody, then either the employers have to pay it or the employees and
    employers together have to pay it or the employees have to pay it for
    those who are working, and the Government's got to help for those who
    aren't working, who don't have insurance. Now, you can look all around
    the world. I don't think there are any other options if you believe that
    the only way to fix this is to make sure that we have health security.
        Here's my plan. First, guarantee everybody private health insurance.
    Why do it that way? Because that's a system we have now and just apply
    it to everybody. Nine out of 10 Americans who have health insurance buy
    it at work, and 8 out of 10 Americans who aren't insured have someone in
    their family

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    who works. So the simplest way is just to extend the system we have now.
        Second, make sure the benefits are adequate, not just catastrophic
    health care but primary and preventive health care, too, mammographies
    for women in the appropriate age group, cholesterol tests for people. Do
    the primary and preventive stuff that will hold down the cost of health
    care and keep us well, as well as take care of us when we're sick.
        Next, permit people to choose their own doctors and health plans.
    Less than half the American people today who are insured at work have a
    choice of the health plan they're a part of. Now, is that because
    there's somebody bad in the system? No, it's because that's all the
    employers and the insurance companies can afford under the present
    system. But if everyone were insured properly, then the employees and
    their families could choose what kind of plan they want. And under our
    plan, every employee in America and their families would get at least
    three choices every year. If you didn't like the choice you had, next
    year you could make another choice. I think that's very important.
        Third, have insurance reforms. Don't permit insurance companies who
    issue health insurance to pick and choose whom to cover. When insurance
    was started for health care by Blue Cross, that's the way it was.
    Everybody paid more or less the same thing, and we were all insured in
    huge pools. And insurance companies then made money the way grocery
    stores do: They made a little bit of money on a lot of people. Today in
    America, there are 1,500 different health insurance companies writing
    thousands of different policies and the reason is, as Mr. Notebaert
    noted, that 25 percent of our money goes to health care paperwork. You
    think about it: 1,500 companies, thousands of different policies,
    everybody with a different deal. Think about how many people you have to
    hire in insurance offices and doctors' offices and clinics just to
    figure out what's not covered, just to figure out what not to pay for.
        And when you put on top of that the cost-control pressures so that
    doctors all over America are going crazy, even as we talk, because they
    have to call some distant insurance company employee to get credit to
    perform a procedure or practice medicine in a way that to them is
    perfectly self-evident and when you add to that a separate Government
    system for the poor, Medicaid, and for the elderly, Medicare, you have a
    paperwork nightmare.
        And it's really tough. So we have got to reform insurance. We've got
    to say, you can't kick somebody off and you can't charge them more just
    because one of their children has been sick. You shouldn't charge an
    older worker more than a younger worker when the average worker is
    changing jobs six, seven times in a lifetime. You've got people losing
    jobs in defense industries that are in their late fifties and early
    sixties who must find new jobs and who cannot find them because their
    employers can't afford to provide health insurance for them. It's not
    right. So we've got to have insurance reform.
        Fourth, I think we ought to protect Medicare, as I said. Leave it
    the way it is; it's working. But extend the benefits to elderly people
    to include a benefit of prescription drugs, which will save money, and
    for help for the elderly and the disabled for long-term care in the home
    and in the community.
        I think these benefits ought to be provided at work. Why? Because
    it's the system we have. Now, you need to know that this is at the
    center of the political debate. And in Washington, a long way from
    Milwaukee, here's what they're saying. They're saying, ``Well, that's
    all very well for Ameritech. They can talk about that, they're a
    successful company, they have a strong union, they pay good wages,
    they've got a great future. But what about all these small businesses in
    America? What about the poor guys with 10 or 20 employees who have a
    very narrow profit margin? They shouldn't have to do this.'' Well--and
    the argument is that they can't afford to do this. They're going to lose
    jobs, and most new jobs are being created in the small business sector,
    and it's a terrible thing, you shouldn't do it.
        Now, what's my answer to that? First of all, there are a lot of
    small businesses in America who are providing health insurance to their
    employees today, and they are at an unfair competitive disadvantage to
    those who don't. I met a woman in Columbus, Ohio, running a restaurant
    and a deli, with 20 peo-

    [[Page 831]]

    ple--20 full-time employees, 20 part-time employees. She says to me--
    this is a typical story--she says, ``I'm in the worst of all worlds. I
    insure my full-time employees, I don't insure my part-time employees,
    and we pay too much for insurance because I had cancer 5 years ago.''
    She said, ``I got it coming and going. I pay more than I should. I feel
    guilty that I don't insure my part-time employees. And I get punished
    for insuring my full-time employees because my competitors don't even do
    that. I would gladly pay a little more if you made all my competitors do
    the same thing. That would be all right; I'd be on a fair basis with
    them.''
        I have a friend who is a car dealer at home in Arkansas, in a little
    town--said to me the other day, said, ``You know, I've been feeling
    sorry for myself for 20 years because I always covered my employees, and
    none of my competitors ever did. And I just went around feeling sorry
    for myself. And then I realized that three of my competitors had gone
    out of business, and I made more money last year than I ever have. And I
    think it's because I never lost an employee because I gave them decent
    health care.'' Interesting, right?
        Today, as I was shaking hands leaving the White House, a small
    businessman came up to me and says, ``I have got 80 employees, and I
    implore you to pass this health care. I am tired of these lobbies I pay
    my membership dues to telling you that small business doesn't want this.
    A lot of us cover our employees. I cover my 80 employees. It costs me 20
    percent of payroll. Under your plan my bills would go to 7.9 percent
    because all my competitors would have to do what I do.'' The guy just
    stopped me in the line today on the way out to the helicopter.
        Not only that, under our plan, we give discounts to small
    businesses. If you've got under 70 employees and an average payroll of
    under $24,000, you get a discount. And some of these businesses will
    only have to pay 3.5 percent of payroll for their insurance. The average
    business has about a third of their cost of doing business in labor
    costs. So if you pay 3.5 percent, and that's only a third of your cost
    of doing business, then it's only going to cost you a little more than
    one percent of the cost of doing business to insure your employees.
        I would submit to you that that much, if all your competitors are
    doing it, can either be passed along or the employees themselves will
    absorb it. It will only take one year to lower the raise they were going
    to get by one percent, and then it will all be in there. But that's what
    these Congressmen are hearing, and they're saying, ``If you do this,
    small business in America will come to an end.'' Now, the truth is, most
    small business people are paying 35 percent more than most big
    businesses for the same insurance.
        The other thing they're telling them is, this is a Government-run
    program and Government would mess up a one-car parade. [Laughter] That's
    the other thing they're saying. And we have all felt that at one time or
    another, right? Especially now, it's so close to tax day. But that's
    what they're saying. That's not true.
        Here's what the Federal Government does in our program. The Federal
    Government says everybody's got to have insurance. The Federal
    Government says there must be insurance reforms so that people can be
    insured in large pools. And the Federal Government organizes small and
    medium-sized businesses so they can get buying power to get the same
    competitive rates that people in big business and Government have. And
    we have some basic quality controls which are an extension of what we
    have now. That's what we do.
        We also leave to the States then the ability to decide exactly how
    these mechanisms will be carried out. This is not a Government-run
    program. It is private health insurance and private medical providers
    just like we have today except now the worst abuses of the present
    system will be erased. That is what we are trying to do. And I think it
    is worth doing. I think it needs to be done.
        Let me say to you that you will have to decide whether you agree.
    You'll also have to decide whether you think you can persuade your
    Members of Congress without regard to party that they can do this and be
    reelected. Every time I go into a congressional district, there are
    these furious radio campaigns run to send a message to your local
    Congressman not to bankrupt all the small businesses in the area. But we
    had several hundred small businesses in Washington

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    the other day all asking us to do this so they could get a fair deal, so
    they could buy insurance on a competitive basis.
        Now, what's behind this? Somebody's got to lose, right? There will
    be some changes. What will they be? If you endorse this program, fewer
    Americans will work in the clerical departments of hospitals, clinics,
    and insurance offices. And the small insurance companies will not be
    able to write policies for hundreds of thousands of people. So in order
    for them to keep writing health insurance, they'll either have to write
    specialty policies, like many do today for extra cancer coverage or
    something like that or somehow find a way to pool with other companies
    or they won't all make it. That's true. That is true.
        You have to decide whether you think it's worth it. Is it worth it
    for every American to have the same health care security that you have
    and to stop your wages from being depressed and your profits from being
    depressed by paying too much for health care and to provide some sort of
    security to the working people of this country. I think it is.
        We will also create more jobs in the health care industry in
    providing long-term care. There will not be a net loss of jobs, but
    there will be a shift of jobs. You need to know that. This is not a free
    thing. But is it a good swap? I think it is a laydown clear choice, the
    right thing for the country. But we have got to decide that.
        And let me close by just--I don't know if these folks are here. I
    had three letter writers, people who wrote--we had a million people who
    have written to my wife or to me on health care--and I think they're
    here. Are Sheryl Brown, Tami Stagman, and Susan Millard here? Are you
    all here anywhere? Stand up there. [Applause] Now, I want you to--now
    these are not abstract theories. These are three citizens of your State.
    Sheryl Brown from Madison wrote a letter to Hillary about her health
    insurance. And her husband came down with a serious illness; he lost his
    insurance. She had to leave her job because she couldn't insure her
    husband and go on public assistance to get the benefits she needed. Then
    when she got herself off welfare and went back to work, her family lost
    their benefits. That's the system we have today.
        If you go on welfare--this is a big State for welfare reform, right?
    I've bragged on Wisconsin until I was blue in the face, about welfare
    reform all over the country. In our country today, if you go on welfare,
    you get health care. If you get off of welfare and go to work and start
    paying taxes, if you live in a family with a preexisting condition or
    you take a minimum wage job, then all of a sudden you are paying taxes
    to pay for the people on welfare to have health care, and you don't have
    it anymore. So if you want welfare reform, you've got to pay for the
    health care of the working people because the people on welfare have got
    it.
        Susan Millard wrote me because she's had a lot of health problems,
    and she's got a job which doesn't provide health benefits. Should she
    just quit and give it up? Aren't we proud of her? Wouldn't we rather her
    work? Isn't it better for us that she works instead of going on public
    assistance?
        And Tami Stagman from Lancaster--in a way the most interesting
    letter of all. She wrote me because she had some serious health
    problems, but she had a good health insurance policy because of her
    husband's job. So she's thinking, what if my husband ever loses his job?
    What if he ever wants to change his job? And what about everybody just
    like me who doesn't have the same policy I have?
        We can fix this, folks. We can fix this if we remember that there
    are real Americans out there who are doing their very best to contribute
    to this country and to move us forward and who deserve to have this
    fixed. It is in our common interest to do it, and I think we're going to
    do it this year.
        Thank you very much. Bless you. Thank you.

    [At this point, Bronson Haase, president, Ameritech Wisconsin, presented
    the President with a jogging suit.]

        The President. I want to tell you what your fearless leader had just
    said to me, in a way that you couldn't hear over the microphone--
    [laughter]. He said, I want you to have this jogging suit because I keep
    seeing you running in running shorts, and I think

    [[Page 833]]

    it would be better if you had long pants. [Laughter] Hey, you know it's
    part of my job to make people feel better, and I've made millions of
    Americans feel better about how they look in running clothes. I thought
    it was a good idea. [Laughter]
        Thank you very much. I'll wear them. Great. Thank you.

    Note: The President spoke at 11:50 a.m. at the Italian Community Center.
    In this remarks, he referred to Richard Notebaert, chief executive
    officer, Ameritech Corp.; Morton Bahr, international president,
    Communications Workers of America; Ameritech employees Gary Keating,
    Rick Compost, and Deborah Echols; Robert D. Johnson, vice president of
    district four, Communications Workers of America; Mayor John Norquist of
    Milwaukee; and Marsha Radaj, vice president of operations, Wisconsin
    Health Information Network.