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Remarks at the Annual Meeting of the American Hospital Association's House of Delegates.

February 05, 1974

Mr. Kauffman and all of the members and guests at this occasion of the American Hospital Association House of Delegates meeting:

I am honored to be the first President of the United States to address this organization, and of course, on such an occasion I am trying to think of a way I can relate to your organization in terms of having either been--well, I have been in a hospital, but I have never worked in a hospital.

While I have not done so, my wife has, and I am glad that you paid tribute to her as well as to our daughters, because many years ago when she was working her way through school, the University of Southern California, between junior college and finally getting her degree, she took off some time, a period of approximately 2 years, and worked as an X-ray technician in a hospital in New York City. So, she could be an honorary member of your organization.

As far as myself, I just try to stay out of the hospital.

Because this is a special occasion in terms of a President for the first time addressing this organization and because this is a significant year in terms of what may happen with regard to health care as far as your National Government is concerned, I thought, Mr. Kauffman, it would be appropriate for me to read a statement, a Presidential statement that I have prepared, in which I will be talking to you but also will be talking to the Nation about the health care proposals that the Congress will be considering during the course of this year.

I would say at the outset that I have had discussions with members of your organization and, of course, with members of the medical profession on various aspects of these proposals and will expect to have more. But just to outline them now briefly, I think this statement would be in order.

Gandhi used to say that "It is health which is real wealth . . ." And if that is the case, there is a lot of wealth in this room. By your efforts and the efforts of doctors and nurses and medical scientists in laboratories and schools throughout this country, this is a very wealthy Nation.

But, of course, we can do better, do better in this field as in every other field. I think the time has come to make it possible for every American to have access financially to the best health care this Nation is capable of providing.

Those who can afford it should pay for it, but those who cannot afford it must not have it denied on that account.

We don't want a generation of Americans on the 200th anniversary of this country--that is just 3 years away--to look back and wonder why, in the richest country in the world, some were denied the right to live because, in the starkest sense, they just couldn't afford it.

We want to leave a legacy of peace for the next generation--I will have more to say about that later--but that achievement will be flawed if we cannot also provide a legacy of life whenever we have the means to do so. We have to increase the availability of our health service, and as high as the quality of that service is--and it is high in America--we have to increase the quality as well.

There are those who say that health services in America can only be improved and extended by the Federal Government, and with that I totally disagree. That will be a major subject for debate during this session of the Congress and during the year 1974, when some health care legislation is going to be enacted, in my opinion.

But, let me give you the reasons for my opposing the total Federal involvement in this area and control of it and my reasons for the program that we have presented to the Congress.

I believe we should build on the great strengths of the health care system in this country, that we already have, and not destroy them. For 5 years we have been building on the strengths of that system, and for 5 years we have made solid progress.

I could go over the litany of what we have done. We have increased the budget. We just put out the budget yesterday, and comparing with what it was in the year 1969, 5 years ago, it has gone from $17 billion to over $35 billion for health care, including new initiatives in the field of cancer and heart disease and sickle cell anemia and drug abuse and many other areas with which all of you are familiar.

But having spoken of what we have done in the past, we today have to look to the future, and I repeat that while we do have the finest health care anywhere in the world, there are still too many Americans who lack health insurance protection.

Let me give you some of the numbers. You probably know them, but it is good for the national audience to hear them.

One out of every 10 Americans has no coverage at all, either public or private. Among those who do have it, 4 out of 10 are not covered for visits to the doctor's office.

Now, you as people who operate and work in the hospital field know that when the visits to the doctor's office are not covered, that creates an incentive for people to go into hospitals when hospital care might not be necessary.

Less than half of the present programs have major medical coverage that pays for long, expensive, what we call catastrophic illnesses, and very few over 65 have this protection at an age it is often most needed. What this all means is that a very substantial number of our people simply cannot afford the high quality medical care that is now available in America.

For some, it means that they delay seeking medical attention until no amount of medical attention can help them. And for others, catastrophic illness in America means catastrophic debt.

I would like at this point to make a personal observation from my own experience as to what catastrophic illness can do to a family.

Forty-five )'ears ago, my oldest brother contracted tuberculosis. In those days, we did not have the new methods of treatment which handled tuberculosis very effectively and very quickly, and for 5 years my oldest brother was bedridden. My mother took care of him, took him to Arizona, I remember, for 3 of those 5 years. It was, of course, a very great burden on the family from the standpoint of the separation. It was, from a financial standpoint, a disaster.

As a matter of fact, we recovered from it. We were able to go on and seek our education and the rest, but that example could be repeated today in millions of American homes. Not with regard to tuberculosis. We can be thankful, as I have indicated, that the advances in medical science would not require 5 years of bed rest as a possible, not cure, but possible way to arrest the disease.

But there are other diseases, all of which you are familiar with, which do require not only a great deal of money but also a great deal of time in a hospital.

Now, 3 years ago I proposed to the Congress a national health insurance program to insure that no American would be denied financial access to high quality medical care because of an inability to pay. I believed in that--you know, everybody in politics has some particular program that he believes in very deeply because of his own personal experience. I have related a personal experience, one from my own family, which indicates why I believe we have got to move in this area so that other families of modest means will not be driven, basically, to bankruptcy because of the inability to handle medical care problems of a catastrophic type.

And so, when I proposed that to Congress, I hoped that we would get action. No legislation has reached my desk. As a matter of fact, i imagine many in this room oppose the legislation. Many in the Congress oppose it. The end result, however, was no action.

Later this week, I am going to send a new proposal to the Congress to get this job done, and I am going to urge enactment at the earliest date. The name of the program: the comprehensive health insurance plan. It has seven main principles. Listen to them carefully, what they do say and what they do not say, what they do not say insofar as Federal involvement is concerned:

First, it will offer every American financial access to balanced comprehensive health care protection.

Second, its cost will be based on each person's ability to pay.

It will build on our existing public and private health financing systems and not destroy them.

It will use public funds only when needed.

It will maintain the freedom of both the patients and the doctors to choose.

It will encourage the most effective use of our health care resources.

And finally, it will give every American a direct stake in making the system work.

Now, building on these principles, the same balanced, dignified health care protection would be offered to every American under one of three plans.

There would be a special employment plan which would be offered where people do work and can contribute to the plan.

There would be a Government assistance plan which would cover people with low incomes and those who can't purchase health insurance at a reasonable cost, such as those already in poor health or those whose work entails risks.

And finally, the existing Medicare program would continue to serve those over 65, but it would offer improved benefits matching those in the other plans that we are recommending.

These plans would largely operate through the existing private insurance carriers. Medicare would continue to be administered as it is now. Coverage under all these plans would be identical. It would finance virtually all of the health protection people need: hospital and physician's care in and out of the hospital, drugs, laboratory tests, X-rays, medical devices, ambulance service, and so forth.

One of the most critical features of this comprehensive plan is the way it would be financed. For those who are working and who are under the employment plan, the employer would pay the bulk of the cost of the premiums while the employee would pay the rest. But note, the employee as well as the employer pays.

For those who come under the Government assistance plan, there would be a sharing of cost with the Government, based upon the individual ability to pay for premiums. Again, if the individual is able to pay even a small part, he does pay. No premiums would be charged, only for those who have very low incomes who cannot afford to pay premiums. The insurance itself would be channeled again through private insurance companies.

The overall result is, under this plan, that we would not have to have any new Federal taxes. The additional costs could be paid for out of revenue that would be already available. More importantly, our entire health care system would not be placed under the heavy hand of 'the Federal Government.

We would preserve and strengthen our present health care system, rather than destroy it. We would continue to rely on partnership, not paternalism. And, as I said in my State of 'the Union Message, most importantly the great majority of doctors in this Nation would be working for their patients rather than be working for the Government, and that is the key element of this plan.

Now, without dotting all the "i's" or crossing all the "t's," I believe that comprehensive health insurance is an idea whose time has come. I believe that some kind of program will be enacted in the year 1974. There has long been a need to assure that no American is denied high-quality health care because he can't afford it.

As costs go up, that need grows more pressing, and all of you know how the costs do go up. Now for the first time, we have not just the need but the will to get the job done, because there is widespread support in the Congress for some kind of action, even though there is disagreement as to what the action should be.

If we have the will, 1974 should also be the year that we find the way. The plan that I am proposing this week is, I believe, the best way. Improvements, undoubtedly, can be made in it. We will welcome your recommendations and suggestions, as well as those of Members of Congress, the medical professions, and others who are expert in this field.

But above all, let us not fail to act in a responsible way so that we end up acting in an irresponsible way by just turning everything over to the Federal Government and providing for a plan that would cost $80 to $100 billion in new taxes to finance.

Just let me say this: I have seen most of the nations of the world, along with Mrs. Nixon. I admire all of the people of the world, and while I disagree, as you will disagree, with many of their systems of government, we respect them as people.

But looking at health care, I have seen nation after nation that has what is called free medical care--nation after nation that has totally controlled, government subsidized medical care. Now, as far as those countries are concerned, they went that way, they have chosen that--if they had an opportunity to choose--and that is their right.

But we have a better way in the United States. What they have tried abroad, in my opinion, is not the best way for America. Let's profit from their mistakes and not make the mistake of destroying what I believe is the best medical care system in the world. That we already have in the United States.

Before I conclude, let me speak very pragmatically to you now as one who has observed the political scene for many years.

Action is going to be taken of some kind because there is a need. And when there is a need, the Congress responds to that need. And if a constructive plan to meet the need is not presented to the Congress, it will mean inevitably that a less responsible plan, even, for example, one that would appeal to the demagogs, would be the inevitable result--not that I am suggesting that all those who favor a different plan do not just as honestly and sincerely believe in their plans as I do.

But what I am simply saying is this: The people in this room know our present system; you know its strengths, and you know its weaknesses. The people in this room know what would happen if the Federal Government simply wiped out our private medical profession, our private health care system, and imposed a huge Government bureaucracy over you where the doctors would be spending more time filling out forms than they would be treating their patients--and a lot of them do that already, incidentally, I am afraid.

But with this in mind, knowing how you so deeply believe in our present system-because you have grown up in it, you have helped to make it work--I want you all to be aware of the fact that in order to save it, it is essential that we have it meet the needs that most of the people in this country feel need to be met.

Now, we have to recognize that the average person, when you poll them, says that health care costs too much, everything costs too much. That is an obvious reaction of most people, but particularly in this field there is a general rebellion against high costs. On the other hand, what we must realize is that when we are confronted with that kind of a reaction among people at large, it is essential to try to find the right answer, or otherwise, we will be plagued for the rest of our lives with the wrong answer.

I think there can be a right answer. I think that today I have outlined for you a program that moves in the right direction. And to the extent that you can sincerely bring yourselves to believe in this program as a better way to improve our health care system in the United States, I therefore ask for your support, because I think it is essential that whenever we have a Government program we should work through those that have to operate it rather than over them, have them participate voluntarily in developing it because they are the ones that are going to have to make it work.

That is why, again, I oppose the efforts of those who would simply impose a complete federally controlled program against the will of the medical profession, many in this audience who are in the health care responsibilities, because it is vitally important for any system, if it is to work, for those who have to operate it to have a part of it, to believe in it, and to feel it is a system that will be in the interest of the patients that they serve as well, of course, as in their own interests.

When I spoke at the State of the Union, I spoke of the legacy that I would like to leave after my term of service in the Presidency, 8 years. And when I referred to that, I said that many could have different priorities. One President may want to leave a legacy of parks, or another President may want to leave a legacy of better highways. As far as I am concerned, the most important legacy at this particular time in history that a President of the United States can leave is a legacy of peace.

Let me just say a word with regard to that legacy, because it relates to the legacy you will leave as well. We have peace now. We have ended the Nation's longest war. But we have ended wars before, so the real question before the American people and the question that we are now addressing is not simply ending a war and having a peace that simply is an interlude between wars but to have something that we haven't had in this country for a century, a whole generation of peace, or longer, we would trust.

And that is why the initiatives that we have made in these past 5 years, our trips to China, to Moscow, to other parts of the world, our negotiations rather than confrontation with leaders of systems of government with which we totally disagree but with whom we must negotiate or accept the consequences of a confrontation that is unacceptable to either side in a nuclear war.

And so, as we have moved in 'this direction, I would say to you today that I think the chances of building not just the temporary peace of "My, the war is over, the war in Vietnam so far away that cost so much not only abroad but at home, not only among those who died but those who suffered in prisons and, of course, in our own society. But now that that war is over, now we have peace, isn't it wonderful?"

The answer is, it will be wonderful only if we continue the kind of diplomacy that will build a lasting structure of peace that will avoid those brushfire wars that could spread into a world conflagration, that will have the great powers meeting and discussing differences, even recognizing that they are very far apart in their interests. It is this that is, in outline, the strategy of this Administration in working toward fulfilling the kind of legacy we would like to leave, a legacy of peace for the next generation.

You also have a legacy to leave. You, of course, can help in building the legacy of peace by supporting peace initiatives when you think they are right. But I go back to what Mr. Gandhi said: "It is health which is real wealth..." And you who are members of the American Hospital Association and your colleagues in the medical professions, you can help leave a legacy where America, which is, of course, the wealthiest country in the world, is also the healthiest country in the world, where America makes a great stride forward in your time in providing not only the best medical care but making it available to those who cannot afford it as well as those who can. That is a great goal, and it is one that I commend to you as being a goal that should join all of you together but would have the support of all Americans.

And so may I say to you, Mr. Kauffman, to the distinguished delegates and your guests, we are working together toward the same goal. I hope that we can leave a legacy of peace, and I hope also that we can make progress in many domestic areas. But on the domestic front there is no area in which I think people are more concerned and in which a greater contribution can be made than in the field of health. The Nation's health is in your hands, and we want to work with you in taking this great health care system that you have helped to build and make it better, make it better by making it more available to all of the people of this great land. That is a great goal, and you will leave a great legacy.

Thank you.

Note: The President spoke at 11: 10 a.m. in the International Ballroom of the Washington Hilton Hotel. He was introduced by John W. Kauffman, chairman of the Association's House of Delegates.

Richard Nixon, Remarks at the Annual Meeting of the American Hospital Association's House of Delegates. Online by Gerhard Peters and John T. Woolley, The American Presidency Project

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