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Remarks to the Community at the Little Sisters of the Poor Home for the Aged in Denver

September 20, 1995

Thank you very much. Thank you very much, Marie Schroeder, for that robust introduction. [Laughter] And quite to the point. I was almost lost in my notes there for a moment—[laughter]—there it was, time to be here.

Mother Patricia, Mother Provincial Margaret, Archbishop Stafford, and my long-time friend Governor Romer, I thank you all for being here today, and I thank you for your wonderful welcome. I want to say a special word of thanks to Helen Cooper and to her daughter and sonin-law, and to Reynalda Garcia and to her two daughters, for spending some time with me just a few moments ago to discuss the care that they receive in this wonderful home and the role that Medicare—I mean Medicaid plays in that. I want to thank all of you for giving me the chance to come here. And I'd like to begin by a special word of appreciation to the Little Sisters of the Poor who run this wonderful facility and who in their lives, with just a little bit of help from the Government here in the form of Medicaid, illustrate an ethic of service that few Americans can hope to match but all Americans should seek to emulate. I thank them for that.

I have come here to talk about a Government program called Medicaid, what it means to families like yours all across the country and what role it should play in our efforts to balance the national budget.

We are all now living through a period of remarkable change in our country's history. Everybody knows it. You have only to follow either the events in the news or perhaps even the events in the lives of your own families to know that we are changing the way we work and the way we live more dramatically than at any time in the last 100 years.

About 100 years ago, we began a transition from an agricultural and rural society to a more urban and industrial society. Now we are in the midst of a transition from that urban industrial society to a society that runs primarily on dramatic increases in technology and in information and one in which all the countries in the world are increasingly united together after the cold war in a global economy but one that is not free of difficulty, as you know.

The more we seem to be integrated economically, the more we often seem to be splitting apart in other ways. And we see the rise, for example, of extremism and groups of hatred rooted in religious or ethnic or racial differences all across the world. We see it when a bus blows up in Israel or when a fanatic breaks open poison gas in a Japanese subway or when, unfortunately, the Federal building was blown up in Oklahoma City.

So in this period of change, it is not surprising that one of the things that we have to do is to be open to new ideas about what we have to do to change the way we do business in America so that we can adapt to this new age. But it is also important to remember that every period of change is a challenge, in my mind, issued ultimately by God, to make the adjustments we need to make change our friend while maintaining true to our basic values. And that's really what this debate in Washington about the balanced budget is all about.

We ought to balance the budget. We never had a permanent, built-in deficit in our country until 1981. We quadrupled the debt of America in the 12 years from 1981 until the day I became President. We built in this huge deficit. We wanted lower taxes and we wanted higher spending, and we took both and forgot about the consequences to our children, our grandchildren, and the future. It is so bad today that interest on the debt next year could exceed the defense budget. And interest payments today are so great that the budget would be in balance today but for the debt run up in the 12 years before I became President.

On the other hand, if we're going to balance the budget, we have to say, why are we doing this? What's America all about? What have you given to us that we have to give to our children and grandchildren? A reverence for work and family, for personal responsibility, and responsibility to the community, a devotion to excellence and to service.

Yesterday I was in Florida with the Governor of Florida, who is a friend of Governor Romer's and mine, and he said, "America has always been and must always be a community, not a crowd." He said, "A crowd is a collection of people who are all on their own, the survival of the fittest. Power gets more; weakness gets less. A community is a group of people that recognizes that they have responsibilities to each other, responsibilities to each other."

The generation that lives in this home conquered the Great Depression and World War II, launched the cold war to stand freedom against democracy, saved the world, and gave us the most prosperous country the world has ever known. We have obligations to the generation of elderly Americans who did that, our parents and our grandparents. We have obligations to our future, to our children and their children to balance the budget.

The great question in Washington is, can we meet both obligations? And if so, how? I believe we can, and I am determined to do it. I believe that the future of this country contains our greatest day if we can still stand for freedom and responsibility, if we can still stand for work and family, if we can honor our children and our parents, and if we can all recognize, without regard to our income or personal circumstances, we're in one community and we have certain obligations to each other. That is really what this debate on the balanced budget is all about.

I believe that we should balance the budget. When I became President, our annual deficit was $290 billion; now it's down to $160 billion. Some of you may actually remember that the last time the deficit went down 3 years in a row was when Harry Truman was President of the United States. I am proud of the fact that we're emulating Mr. Truman's record. And I want to go all the way and bring this budget into balance.

One of the biggest problems with bringing the budget into balance is that inflation in health care has been going up faster than economic growth, not only for the Government but for a lot of you who are out there on your own private budgets. Inflation in health care has been one of the fastest growing areas of a family's budget. And if we don't do something to lower that rate of inflation, we can never bring the budget into balance unless we're prepared to just stop investing in education or stop investing in the new technologies and the new sciences that may offer us the answer to a lot of the world's problems or walk away from some of our other obligations.

So we have to slow the rate of medical inflation. I've worked hard on that. For 2 1/2 years, we have made the Medicare Trust Fund more solvent, we have corrected some of the abuses that were in the Medicaid program, but we have really faced the fact that we still have fundamental responsibilities to help people who depend upon Medicare and Medicaid to live.

Now, there is—the great contest in Washington today is basically over how much we should cut health care, how much we should cut education, how much we should cut the environment, how much we should cut taxes, to balance the budget.

The congressional proposal, which came out yesterday, I believe, on Medicaid, I believe endangers the Medicaid program that makes it possible for places like this wonderful home to exist. And I do not believe it is necessary to balance the budget. So I came here today to tell you two things: One is, we need to slow the rate of medical inflation in every program, including the ones that benefit you, and we can. But two is, we don't have to wreck the program and throw families into abject insecurity to balance the budget. It is not necessary.

I have given the Congress a balanced budget plan which will preserve the integrity of Medicare and Medicaid and enable us to serve the senior citizens of the United States. And that is important.

Let me tell you about Medicaid. Two-thirds of the Medicaid program goes to benefit senior citizens and people with disabilities. Seven in 10 Americans in nursing homes get help from Medicaid to pay their bills. Forty-three percent of the residents in this nursing home get that sort of support. Medicare can be the difference between quality care in a quality facility and an uncertain future. In the United States as a whole, the average cost of nursing home care is $38,000 a year. Three quarters of our senior citizens live on incomes below $24,000 a year. You don't have to be a mathematical genius to know that someone has to step into the breach. There has to be a system to honor the people in this country who have done their part for America and need this kind of help.

The plan proposed by Congress would take away the guarantee that Medicare would be there to help, would instead cut future spending by about a third and send a check to all the States. That's what Governor Romer was talking about. Marie Schroeder was able to come here from another State to be near her son because Medicaid is a national program, run State-by-State, but it has certain basic guarantees in it. If it becomes a State-by-State program, a lot of people who live in States that may have good care, may literally be robbed of the chance to go visit and live with their children because they live in States that don't.

A lot of middle class families, who have the security of knowing that their parents are okay, can help their children to finance their college education. If they lose that security, they may not be able to help their kids go to college. This is a huge issue. We must do this right.

The plan proposed in Congress, we estimate, could mean that up to 300,000 American senior citizens who today are eligible to go into nursing homes won't be eligible in just a few years. And over a million who get services in their own homes, who get to go to senior centers and other things to support in-home care, won't be able to get those services, not to mention the 30 percent of the program that goes to help the very poorest children in the United States today.

It isn't fashionable anymore to speak up for the poor, but the truth is, those kids are our future. And at least in this country, as poor as you are, at least you can go to a doctor because of Medicaid, and these kids can get off to a good start in life. But there's not much of a political lobby for poor children. So if we become a crowd instead of a community, a lot of them are going to get left behind. So that's what I want to emphasize to you. We can slow the rate of growth in Medicaid without wrecking the program.

Today, if you have to go into a nursing home and you need help from Medicaid, by law you can get it. And you don't have to force your spouse, for example, to sell your possessions. Under this new plan, States would be permitted to force someone, for example, whose husband has to go into a nursing home to actually sell her car and her house before they could get any help from the Government. I don't think that's right. I don't think that's right.

I also don't think it's right to totally abandon a commitment to national standards of quality. Now, just a few moments ago, Mother Patricia was telling me about some Federal rules and regulations that she thought ought to be changed. And we have done more to deregulate the Government in sensible ways than any previous administration in the last 30 years. We've abolished 16,000 pages of Federal regulations, and we're working on thousands more.

But before we had national standards for residential care in 1987—which was, by the way, up until then, totally a bipartisan thing; it was signed by President Reagan—before that, up to 40 percent of people in nursing homes were overmedicated and overrestrained. And you don't see that anymore.

You know, unfortunately, not everybody can get into a facility run by the Little Sisters of the Poor. I wish they could. I wish everybody in America could do that. So we do need some standards to protect people, to make sure it's not just a money deal. That would all be gone.

The other thing I'd like to say is, a lot of our poorest elderly people are able to use their Medicaid money under national law to pay for their Part B premiums under Medicare so they can get doctor care and in-home services and medical equipment. This would do away with that, which means a lot of our poorest elderly people wouldn't be buying into Part B of Medicare. It's a good way to save money on Medicare. People say, "Oh, my goodness, Medicare is not as expensive as it used to be," but it will be very expensive for this country not only in the diminished dignity of seniors who have it now but in their increasing health care costs when they can't be regularly treated in a preventive, sensible way. It's a mistake; I'm against doing away with that. It's unnecessary, and we shouldn't do it.

Again, let me say to you, I have proposed reducing the rate of inflation in Medicare and asking the Medicare providers to take less so that we can keep the Trust Fund strong for another 11 years. I have proposed reducing the rate of inflation in Medicaid and forcing economies in the program but only about a third as much as the Congress proposes.

The reason they have proposed this huge number is they said no matter what, we're going to balance the budget in 7 years, not 8, 9, or 10, and no matter what, we're going to give a tax cut of $250 billion, a lot of which will go to people like me who don't need it and haven't asked for it.

And the point I want to make to you is not that we don't have to make any changes in these programs, not that we don't have to slow the rate of medical inflation but that we have to do it in a way that is consistent with our ethical obligation to honor our parents and grandparents and to honor the idea that we have obligations across generational lines and our obligation to help middle class people free up their incomes so they can educate their children while their parents live in dignity. That this the objective here.

So I say to you, I hope all of you will join me, without regard to your political party, in this national effort to balance the budget in a way that is consistent with our values. We're going through a time of big change. And the reason this country is still around after more than 200 years is that when we have gone through periods of huge change, we have recognized that we needed teamwork more than conflict. We have recognized that no one had all the answers, that no one was the repository of infinite wisdom—that belongs upstairs—and that we are going into a future that we have to do our best to shape not for the moment, for what's popular in the moment, but what will work 10, 20, 30 years from now. And we need to do it as a team. We need to do it as a community, not a crowd.

We need to do it in ways that will fulfill both our objectives of balancing the budget and honoring our obligations to our parents and to our children. Now, we can do that. But we cannot do that if we are excessively ideological, excessively partisan and arbitrary in saying we care a lot about this program but not as much about the program as we do having a $250 billion tax cut in a 7-year time frame. We can do this, but we need to do it in good faith.

So I ask all of you, in your prayers and in your pleas and in your letters, to reach out to the Congress in a spirit of cooperation and say we all want to help, but Medicaid does a lot of good for the senior citizens of this country. Medicaid enables this country to be what it is today. Medicaid supports private, charitable work. Medicaid in this nursing home is the embodiment of the lesson in the Catholic Bishops' letter that the quality of life in a society is the sum of both the personal choices made by individual citizens and families and the big choices made by the society as a whole. And they have to fit together.

So I say to you, this should be an exciting time to be an American. Whatever your age, you are living through a truly historic era. But we have to do this right. And to do it right means we have to do it consistent with our basic fundamental values. If we don't stray from them, we can embrace all the new ideas in the world and come out on the other side of the divide with a stronger, better America.

But if we forget for a moment what we owe either to our parents or to our children, then we will be making a grave mistake. I'm betting on America. I'm betting that the best is yet to come. But we have a difficult, invigorating, tough 60 or 90 days ahead of us in which you and people like you all across America can have a profound influence on the decisions we make and on whether we preserve this very, very important partnership which has brought dignity to the lives of millions and millions and millions of Americans.

Thank you very much.

While you're all standing up, I now have one more announcement to make. Ethel Hoag, who is sitting right over there in that pink chair, is 94 years young today. This is her birthday. I believe we should end this wonderful meeting by singing "Happy Birthday" to Ethel Hoag.

NOTE: The President spoke at 10:40 a.m. In his remarks, he referred to Mother Provincial Margaret Halloran, Chicago Province, Little Sisters of the Poor; Cecile Cooper and Daniel Ely, daughter and son-in-law of home resident Helen Cooper; and Ramona Sena and Evangeline Landford, daughters of home resident Reynalda Garcia.

William J. Clinton, Remarks to the Community at the Little Sisters of the Poor Home for the Aged in Denver Online by Gerhard Peters and John T. Woolley, The American Presidency Project

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