Bill Clinton photo

Remarks at a Rally for Health Care Reform

September 23, 1993

The President. Thank you very much, Tipper and Vice President Gore and to the First Lady and all of you. This has been an incredible 10 days on the lawn of the White House, in the Nation's Capital, and in the life of your President, for me as a citizen as well as the President.

After the Middle East peace signing, we had just a couple of days ago the signing of the national service bill here, with hundreds of young people, a bill I believe literally has the capacity to change not only the lives of hundreds of thousands of young people but the fabric of life and the strength of community all across America. I signed the bill with two pens: one, the pen that President Roosevelt used to sign his bills with, and the other, the pen that President Kennedy signed the Peace Corps bill with 32 years ago. And I thought to myself, this is why I went to the snows of New Hampshire. This is why I wanted to be President, because together we can make this democracy work.

And then last night, speaking to the Congress and sensing the incredible, historic opportunity we have to reach across party and regional lines, to unite people who are worried about universal coverage and people who are worried about cost control and people who are worried about the disabled and people who are worried about men and women with AIDS and people who are worried about mental health and people who are worried about elderly, to get everybody together to try to find a solution that will permit us at once to provide comprehensive lifetime health care benefits to all the people in our country and at the same time to stop the waste, the bureaucracy, and the unconscionable increase in cost that is putting a terrible burden on our economy and our Government's budget—to have the opportunity literally of a generation to see the American people come together around a common goal and achieve it—that's truly awesome.

But what I want to remind you of today is this: First, we should be grateful that the moment has come when vast margins of our fellow citizens understand in their gut, even if they don't know all the details of this complex system, that the cost of staying with what we have is far greater than the cost and the risk of change; secondly, that for the first time in the 20th century, we sort of have everybody in the same place at the same time.

Believe it or not, in the first two decades of this century there was one instance in which the American Medical Association wanted a national health program, and the AFL-CIO opposed it. It didn't take long until that turned around. Then there were times when Democrats wanted to do it but Republicans didn't. And then there was President Nixon who offered an employer mandate to get universal coverage, and the political consensus for it wasn't there. It's almost like for this whole century someone would decide that this was a terrible problem, that someone ought to do something about it, but all the other players were like ships passing in the night. Now you have big business and small business and health care providers and health care consumers, families who have been broken and workers who are trapped in their jobs all agreed that the time has come to act.

I think my job today is to tell you that as much as I wish this to be a celebration to thank you for everything you've done, it's to remind you that our work is beginning, that the real celebration will be when you come back in even larger numbers to this lawn when I sign a bill to solve these problems.

In the next few days the Congress will begin in earnest to take this issue up. It is, as all of you know as well or better than I, a matter of mind-boggling complexity on the one hand and simple truths on the other. Even all of us in this audience do not agree on every detail about how to reach the goal that we all share.

So, just for one minute I would like to reiterate what I said last night: Let us at least commit ourselves to the principles which must shape the final legislation. First and most important is security. We have simply got to provide for every American, for a lifetime, health care that is comprehensive, that is always there and cannot be taken away.

Second, we must make this system more simple, more simple because it will have more integrity and more support, because it will free up doctors and nurses and other medical professionals to do the work that they hired out to do in the first place, and thirdly, because we will never get real savings out of massive parts of this system until we simplify it.

Next, we must insist that through simplicity and other mechanisms, we actually get savings. And I've said this before, I want to say it again, we had a couple hundred doctors in here the other day, and I said, you know, one of the most controversial parts of the argument we're making is that we can finance health care for the unemployed uninsured through savings in the system. Most people in Washington don't believe it, but everybody I've talked to outside of Washington who is in health care believes it because they live awash in the waste every day. Everybody I talked to believes that.

I say to all of you who know something about this, we must continue to hammer the points of opportunity to save money so we can free up funds to do the things we all know we ought to do: to cover the unemployed uninsured through public funds; to provide savings to the private sector that will permit them to cover the employed uninsured without going broke; to extend coverage to prescription drugs for all Americans, including the elderly; to bring in long-term care for the disabled.

I want to point out again, if you look at this system, all of you know but it is still sinking in on our fellow citizens that we are already spending 35 percent more than any other nation on Earth as a percentage of our income, 40 percent more than our major competitors as a percentage of our income. They cover all their folks and we don't, and their standard benefit package is better than most of our people have. We can achieve savings, but it will require discipline and concentration and effort and belief. And you can help make that happen. Our dream of security can be undermined unless we have the courage and the discipline to keep fighting for savings.

Fourthly, we have to guarantee choice. The American people simply won't put up with it if they think they have no choices in their health care. But again, I ask for an injection of the real world. Most of the decision-makers here may have choice, but fewer and fewer Americans have any real choice in their health care. So under this system we do propose to give all persons a choice between three plans, three options that they can buy into. We also propose to give physicians more choices about the plans in which they participate, because unless they have choices, obviously the consumer's choice is limited as well. We have to do that. It's an American value, and we can do it without adding to the cost of the system.

Next, we have to ensure quality. And quality means value for service. You heard me say last night that the task force that Hillary headed uncovered among other things a remarkable effort in Pennsylvania to just publicize to health care consumers the quality and cost of various services and found out that for heart surgery, the same operation could cost between $21,000 and $84,000 in Pennsylvania with no discernible difference in health outcomes. If there's no difference in health outcomes, you might argue it's healthier to pay $21,000 than $84,000. This is an important issue. We have a friend in our home State who showed us two different bills for the same surgery he performs—a bill sent out from the hospitals, from two different hospitals—wildly different prices, exact same procedure and exact same outcomes.

So I say to you, we must tell the American people we believe in quality. And we must provide quality in other ways. We must provide quality by understanding that by depriving ourselves of certain kinds of services, we inevitably undermine the quality as well as raise the cost of health care. And I just want to reiterate how thrilled I was last night to get a good response when I pointed out that our package would cover the whole range of preventive services because that is an important part of quality health care.

And finally, let me say that we must all have responsibility, too. Everyone of us has pointed our finger at someone else and told them they should be responsible. It's that old saying, do as I say, not as I do. You know, we all know that there are sometimes when doctors order unnecessary procedures. We all know that some malpractice claims are frivolous. We all know that some practices of pharmaceutical companies can't be defended. We can all cite somebody else in the health care system. We all know that sometimes the insurance premiums go up or people get cut off in ways that are unconscionable. But it's time for us to admit that the vast mass of Americans have some responsibility problems, too.

None of the people I just mentioned are responsible for the fact that we have higher AIDS rates than any other advanced nation. None of the people I just mentioned are responsible for the fact that we have much higher teen pregnancy rates than anybody I just mentioned— than any other country we're competing with, or higher rates of low-birth-weight babies. And they're certainly not directly responsible, the public isn't, for the fact that we have the third worst rate of immunization in the Western Hemisphere. And they're not responsible for the fact—that got such a nice line of applause last night—that we literally are raising tens of thousands, indeed millions, of children in war zones in which other children have access to weapons more sophisticated than police. No one can imagine, in other countries, why we would let that happen.

Now, neither are those people responsible, or any of other actors in the health care system, when we behave in ways that are personally irresponsible. They don't control it if we drink too much, if we smoke. They don't control it if we don't take care of ourselves. They don't control it if we don't even give a second thought to the way we access the health care system and pretend that it doesn't cost anything just because it's not coming out of our pocket. And it is too easy for us to blame the people who are providing the services, when we do things that are also wrong and unjustifiable. And it is very important that those of you who have worked so long for this effort also say that an essential principle of this health care plan will be responsibility from all Americans including us, not just them but us. I want you to stay with me on that.

Now, there's still a lot of people that don't think we're going to get this done. You know, Roosevelt tried it; Truman tried it; Nixon tried it. President Johnson wanted to do it. President Carter wanted to do it. But we are going to get it done because things are different. Circumstances are more dire; it is more obvious to people that we must change. The system itself is hemorrhaging. Not only do one in four Americans find themselves without adequate coverage at least at some point in every 2-year period but about 100,000 Americans a month are losing their coverage permanently. It is hemorrhaging. We can't go on. But we have to do it right. And we have to do it right now. We don't want to rush this thing; it's too complicated. But we don't want to delay it using complexity as an excuse.

So, I ask you to leave here today not simply celebrating what happened yesterday or lauding the work of the First Lady's task force for the last 8 months but leaving here determined to help the Congress keep the commitment that it made last night across party lines to get this done, to do it right, to do it for America, to make this opportunity of a generation a reality in the lives of every man and woman, every boy and girl in this country. Leave here with that dedication, and we'll be back here, sure enough, for a celebration in the future.

Thank you, and God bless you all.

NOTE: The President spoke at 2:16 p.m. on the South Lawn at the White House.

William J. Clinton, Remarks at a Rally for Health Care Reform Online by Gerhard Peters and John T. Woolley, The American Presidency Project

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