Capitol Hill

September 16, 1993

2:00 A.M. EDT

MRS. CLINTON: Thank you. Thank you very much, Congressman
Stokes, other distinguished members of Congress, and the Congressional
Black Caucus. Many of you in this audience who are physicians and
nurses and pharmacists and medical technicians and medical school deans
and every other representative of the health care profession, it is a
great privilege for my to be with you because, as Congressman Stokes has
said, the Congressional Black Caucus is one of the first places I came
when I began to visit here on Capital Hill to learn from our
representatives and senators what they thought in terms of the crisis
facing our country with respect to delivering quality health care, and
what particular issues were of importance to various Americans that
could not be overlooked if we were to come with a plan that was truly an
American solution to an American problem.

And I have been very grateful for the assistance from the
members of the Congressional Black Caucus and from so many of their
staff members, both personal staff and committee staff. And I am also
grateful for the assistance of many on this podium and in this audience
who have worked very closely with the Health Care Task Force.

What I would like to do this afternoon is to talk about the
basic principles underlining the President's health care plan, his
commitment to them and the ways he has chosen to address them. As both
Congressman Conyers and Congressman Scott pointed out, there is a
significant level of support in the Congress for a single payer system
that has been developed in legislation of which there are a number of
co-sponsors. There are other bills that have been introduced in the
Congress both this session and in previous sessions as members have
searched to find ways that they thought would solve the problems that
they saw.

This issue has been with us for many years. It goes back at
least to the time when President Franklin Roosevelt was attempting to
legislate Social Security. At that time, he also intended to legislate
health security and could not achieve that political objective. But
ever since the 1930s and every congressional session, bills have been
introduced, and presidents since Franklin Roosevelt have attempted to
deal with our health care problems. President Truman came forward with
a plan. Under President Johnson we began to see Medicaid and Medicare.
President Nixon introduced a health care reform plan. Other presidents,
many members of Congress have struggled with this issue. And yet the
problem has continued to develop.

We are at a unique moment in history, when there is a
groundswell of desire on the part of Americans of all walks of life to
do something about our health care system, and when there is a critical
mass in the Congress, both Democrats and Republicans, who are finally
willing to say, yes, let us hear the people and do something. But
perhaps most importantly, we have a President who is absolutely
committed to getting that job done, and who is willing to put himself
and his administration on the line.

Many people have asked me and asked my husband since we began
this effort, why on Earth would you take this risk? Why particularly,
would you put your wife in that position? I've asked him that, myself.
(Laughter.) And he has always, without hesitation, said the same thing,
and it's what I agree with absolutely -- how can one be President today,
how can one be a member of Congress or a United States senator, how can
one be a physician or a nurse or a businessperson or a mother or a
father and not want to solve our health care problems once and for all?

There is no reason to be in public service today that is more
important to the continuing stability, the well-being, the social
fabric, the human quality of our country, and the kind of health care
system we will establish and support for all of our people.

So to that end, the President believes strongly in the following
principles, and although there will be many opportunities which will be
welcomed, to sit down and work with not only members of the
Congressional Black Caucus, but members of every caucus, of which there
are many as I have learned up here, on both sides of the aisle, to
hammer out the best possible solution.

But there are certain principles that cannot be negotiated over.
And these are the ones the President believes in. Number one, we have
to reach universal coverage as soon as it is possible to do so. Until
all Americans are secure, no American is fully secure. Even those
Americans who are currently insured -- and that includes most of the
people in this room -- we cannot with any certainty know whether we will
be insured to the same degree at the same cost next year at this time.
We cannot because we cannot predict what will happen to us, know whether
we will suffer some illness or accident, or a member of our family will
which will totally change our insurance situation.

The upcoming debate over how we will provide universal coverage
for every American is not just about insuring the uninsured, although
that is the highest moral imperative. Those who have no access now
whatsoever have to have a right to security. But the debate is also
about the many millions who are currently insured, but without any
certainty as to what their insurance will look like next year.

Every single month 2.25 million Americans lose their insurance -
- 2.25 million. Now, some may only lose it for a week, some many lose
if for three months, some may lose it for a year or more. But that
number of Americans every month is rendered insecure. Well, first and
foremost, every American must have health care coverage, and that
coverage must be secure no matter who you work for, where you work,
where you live, or whether you have ever been sick before. We will
eliminate preexisting condition problems. We will eliminate portability
problems. We will eliminate job lock. Every American because you are
an American, not because you work for a big or small company, or live in
Florida or North Dakota, you will be insured. (Applause.)

Now, the President believes that insurance should carry with it
a guaranteed benefit package so that every American will have access to
the same comprehensive benefits. And those benefits should include
primary and preventive health care. We should reverse the bias against
preventive health care and insure us against getting sicker by making it
possible to get care earlier and solve problems. (Applause.)

The benefits package will include the kind of care that the
insurance packages that most large companies offer to their employees.
And it will include mental health benefits. It will include substance
abuse benefits. But it cannot, starting where we are now, include
everything that you and I would perhaps like to see. We will try to
cover the dental care of children. We will not yet be able to reach --
to cover the dental care of adults. We will cover mental health
benefits. We won't be able to go as far as I, and particularly Tipper
Gore, would like to go, but we will establish the basic principle that a
comprehensive benefits package must include those services that not only
traditionally have been left out of insurance policies, but which we
know will save us money if they are included.

We also believe that the comprehensive benefits package that is
available has to be truly accessible. It will do very little good if we
give every American a health security card -- (Side one of tape ends;
Tape two begins) -- unless we take steps to ensure that every American
has access to the care he or she needs when that occasion arises. So we
will be looking to provide the kind of infrastructure in our public
health and private health systems that will make the delivery of care
available to every American.

It is very important that we think about how this new system
that we want to see developed will look to the point of view of the
patient or the provider, as many of you happen to be. Many of us in
this room will be accused in the next months of being policy-wonks. I
was in this committee room the other day and at least one member of the
Congressional Black Caucus who is sitting up here drilled me with five
of the most technical questions anybody has asked me ever. They were
terrifically specific, tough questions that need to be answered. They
were wonk questions, as we say.

But when we go out to talk to our friends and neighbors, when
the members of Congress go home, what people are going to want to know
is what does this do to me? How am I going to get to my doctor? How am
I going to get the care that I need? And we have tried to build on the
system that is most familiar to most Americans. Most Americans
currently get their health care at their work place if they are insured.
We intend to build on that. Most Americans sign up for a health
insurance policy. We intend to expand on that, so that instead of your
employer determining what policy you will have, the consumer will choose
the policy that you wish to have. You will be the one making the choice
among the health plans in your region.

It is similar to what we in the federal system currently have.
Those in Congress and who work for the federal government are members of
a big health alliance -- the Federal Health Benefits Group. And every
year, those who are in the system get a list of what plans they should
sign up for and then they make their choices. Some plans might cost a
little bit more or a little bit less. Your doctor may be in one instead
of the other. Your doctor may change from year to year so you can
follow him from place to place. But you make the choice. That's what
we want for every American.

As it currently stands now, most employers who provide insurance
make that choice for the employees. And increasingly because of the
pressure on costs, the choices have become more and more limited. So we
intend to preserve choice in health plans. And contrary to some of the
ads that are currently running, that is one of the major features of
this health care plan.

In addition, we believe you can control costs in the health care
system. Those of you who are in it know that better than the rest of
us. Controlling those costs will take some changes in behavior and some
different ways of doing things, but there are so many examples that I
could recite that I've heard or that you could recite back to me. There
are examples in the Medicare and Medicaid system, and there are examples
in the private insurance system. We know what they are. We see them
all the time.

If any of you saw the television program this morning where we
took some of the 700,000 letters that have been written to the White
House about health care concerns and picked out some representative ones
and people read their letters, you remember the woman who said she went
in for the knee operation and she got the bill from the hospital and
they had charged her $2,400 for a pair of crutches. And she called up
her insurance company and her insurance company said, "Oh, don't worry
about it. We already paid it." She called up the hospital and they
said, "It's too much trouble. We already paid it." And as this woman
said, "Was the decimal in the wrong place? Was $2,400 paid for a pair
of crutches, but it was just too much of a bureaucratic paperwork hassle
to get to the bottom of it because there's so much money coming into
this system all the time that we just keep paying the bills and pushing
it out the other side.

And the reverse of that is that people who make decisions about
caring for patients are having their decisions second-guessed all the
time. It's gotten so that many doctors I know feel like every time they
want to order a blood test or some other diagnostic procedure, they need
to pick up the phone and call some 800 number to some insurance office
to ask permission of whoever it is that answers the phone. And there's
been some research done recently that people who are the other end of
those phones, bless their hearts, they're are clerical employees, no
medical training -- they pull out a chart and they say, "Let's see, now.
You're in St. Louis and you want to do a blood test? Well, I don't
know. We're not sure we can do that."

I mean, that's the system that we currently have. Anytime
anybody tells you that the changes we want to put into place are going
to create bureaucracy and regulations, say, give me a break. We have
the most bureaucratic system in the entire world that is wasting
billions and billions of dollars. (Applause.)

Now, there are savings to be had, and I know that some people
are concerned about where those savings will come from. But we believe
there are savings in both the Medicare and Medicaid systems and in the
private insurance system, without undermining the quality of care or the
accessibility to care. But we will never get to those savings if we
don't start to think differently about how to better organize and
deliver care to all people.

Additionally, we have to finance this system fairly. And we
have fought long and hard about that. One of the features of HR-1200
that Congressman Conyers and Congressman Spratt referred to would be to
have some kind of broad-based tax that would fund government financed
health care. That is a way of doing it. Everybody participates,
everybody pays the same taxes.

The President believes that if we build on the existing premium
system and we control the cost of premiums, and we provide discounts to
small businesses and low-wage individuals, we will come up with a fair
financing system without transferring the entire burden from the private
sector to the government. That's a difference in approach that we have
with the single-payor approach, but we're all trying to get to the same
place: Fair financing; everybody pays; everybody is responsible; and a
health care system that is, therefore, fairly funded to take care of

In addition, we think we've got to ensure quality. All of this
is to enhance quality. There's no point in reforming our health care
system if we don't enhance quality. We want report cards on health
plans. We want health plans to start reporting information so that U.S.
consumers can make good judgments. And more than that, we want
providers to get back into making those decisions about what is or is
not appropriate care, not the bureaucrat in the insurance companies.

Pennsylvania, for example, has been collecting data on a number
of operations for a number of years. I knew nothing about this when I
started, and I've been fascinated at how some states and local
governments have tried to figure out what actually certain kinds of
medical care costs within the same general jurisdiction. In
Pennsylvania, for example, a coronary bypass might cost $20,000 in one
hospital or $80,000 in another hospital.

Pennsylvania has gone a step further. It's looked at quality
outcomes. Do the people who get the $80,000 operation get better
faster? Are they back on their feet sooner? The answer is no. But
very often, high prices don't equate with good quality. They may not
make a difference at all. Too often in our own mentality people go to
the doctor who's got the fanciest office because they think that's the
best quality doctor. Or the one who drives the biggest car.

What we need to do is to translate good quality information into
a format where average folks like you and me can understand it so we can
make better choices. And we need to keep track of quality indicators --
Is a certain kind of procedure working or not working? -- so that
doctors can make decisions based on what they know exuded in good

These kinds of principles about security and savings and
simplifying this system and ensuring quality and providing choice among
health plans and providers, and making sure that we finance it
thoroughly and everyone is responsible -- those are the bedrock
principles of what any reform health care plan has to achieve. Now, are
there various routes to get there? Yes, there are. People have
proposed different kinds of approaches. And part of what the next
couple of months of debate will be about is getting down into the hard
work of determining how any particular approach would actually work and
whether it's an approach that would be politically feasible in the
United States Congress or in the nation at large.

But if we continue to stress the principles -- and even beyond
the principles, if we keep in our minds the pictures of the hundreds and
thousands of people who need us to make these changes, I am confident we
can work out the details. Once we agree on the principles, we can work
out the details. And I think we are, as a nation and within this body
of Congress, moving toward agreement on the principles.

I want to compliment the Senate Republicans for the proposal
they put forward yesterday. They, too, talk about reaching universal
coverage. They, too, talk about a benefits package. They, too, have a
mandatory way of financing it. They choose to go through an individual
mandate with a subsidy for poor people. We don't think that's the best
way, but there's room for conversation back and forth. We are at least
all in the same ballpark.

You know, in the last week or two I've gone back and I've read
some of the editorials and some of the writings that faced us when
Franklin Roosevelt introduced Social Security. And I've gone back and
read what was said when Medicare was proposed. My goodness, the end of
the world was upon us. (Laughter.) There was no way this great country
would survive if we did something as radical as Social Security. And,
oh, heavens to Betsy, there's no way the medical system would survive if
older people had access to medical care through Medicare.

We're always going to have the naysayers. We're always going to
have the destroyers instead of the builders. We're always going to have
the people who are profiting by the current system and don't want to see
any changes in it. But those people are becoming an increasingly minor
note in this whole symphony about change. (Applause.)

What we have to do together is what I'm reminded of when I look
over and see our friend, Marie Constance Webber, one of the Faces of
Hope that we were privileged to meet along the campaign trail. What we
have to do together is to not lose hope that this will be accomplished.
To stick to the principles that we believe in and to hammer out the
details together. To raise all the hard questions among friends that we
have to raise to make sure that what we do will work. That's the most
important objective. Will it work? Is it right? Can we make it
happen? And if we do that, and if we approach this debate in that
spirit, there will be no turning back the tide of change.

It is one of the most unique moments in history -- and we had
another one just at the beginning of this week. I have to confess, as I
sat there at the ceremony at the White House watching those two men who
represent such ancient enemies commit themselves to working toward
peace, overcoming hatred and division, and even shaking hands, that I
thought to myself if that is possible, then health care reform is a cake
walk. (Applause.)

But we cannot get there without your counsel, your constructive
criticism, your outreached hands, your heart, your help. And then when
we do accomplish what we have set out to do, to ensure that no American
ever again will be left out because of their inability to afford health
care in this country, we will have such a sense of accomplishment,
because we will have taken one step more toward making this country what
it ought to be.

Thank you all very much. (Applause.)