REMARKS OF THE FIRST LADY
AT HEALTH CARE FORUM SPONSORED BY CONGRESSWOMAN SCHROEDER
March 14, 1994
|Thank you very much. Thank you, all. Thank you so
much. It is such a pleasure to be here and see all of you,
and to know that you are as concerned about health care as we
And I want to thank Orville, again, for the
institute support of forums like this all over the country.
I've had the privilege to appear on many platforms that were
sponsored by the institute, and it's been a very good
educational experience, and I'm very grateful.
I'm also really pleased to be here with your
governor, who has given real leadership to not only the State
of Colorado, but the entire country, and certainly the
governors of the United States. He's been a thoughtful,
stalwart friend of my husband's as they have worked through a
lot of the problems that this country faces, and we're just
really proud of you and grateful for your continuing support
on health care. (Applause.)
And what does anyone say about Pat? There is
nobody like her, and we are so glad to have her in
Washington, bringing a dose of fresh air all the time. I
have to confess, however, that I only wish I had her wit and
her one-liners. I'd be in a lot more trouble, but I'd have a
lot more fun if I did, you know. So this is a real
privilege, and I'm so grateful that you put this together.
Somebody asked me as I came in what this pin was,
and it looked awfully big on the screen as I look at it. I
was in Boulder, as some of you may know, at the university,
and a woman gave this me, and it is a depiction of Chelsea
and Socks, so I just had to wear it. And I hope it's not too
distracting for all of you.
I wanted to spend a few minutes talking about where
we are with health care reform and what the President's
approach really is, and maybe clear the air a little bit, try
to get back to a factual discussion about what we are trying
to do together, and then have time to answer some questions.
Because what I have found in forums all over the country is
that once we actually begin to talk, and cut through a lot of
the rhetoric and a lot of the smoke that fills the air about
health care reform, we have so much more in common.
Those of us who have worked on this issue and
worried about it, those of you in the audience who are
doctors and nurses, and hospital administrators and business
leaders, and political decision makers, and parents, all of
you have the same concern. And what we are trying to do is
to give some real structure to your concerns and put them in
the context of the principles underlying the President's
Because what we have found over the last several
months is that although people are rightly cautious about
change, are concerned about what it will mean to them and
their family, their business, their profession, there is
overwhelming public support for reform. And there is
overwhelming public support for the principles, or, as you
heard Dr. Rheinhart (phonetic) saying this morning, the
ethics of the approach that the President has presented.
So what I hope to do today is to continue the
conversation I started a year ago -- more than a year, now --
in talking about where we are, where we are heading with
respect to these activities in congress, and what this will
mean to you in your lives when reform is in place. Let me
start by saying that I think the case has been made far more
eloquently than I by your previous speakers and by much of
the publicity surrounding health care over the past year,
about what is wrong with our system and why we need to make
In fact, I have now concluded that in many people's
minds, although they fear change, they recognize that the
status quo is probably the least attractive alternative,
because it is a status quo that is not stable. It is
We have had in the past year an increase in the
uninsured. We have had in the past year an increase in
premium rates for small businesses and families. We have had
in the past year increasing pressure on our public programs,
like Medicare and Medicaid. We see some signs of hope in
some sectors of the health care industry, particularly when
it comes to very large companies and state and federal
government being able to control their costs.
But we have not seen the kind of stability that
would lead us to believe that on its own, left unaddressed,
our system can fix the problems that are undermining the
quality of services, access to services, and leading to
increased insecurity among all of us, including those of us
with insurance. So if you look at that status quo, and you
see what we see who try to follow all these pieces of
evidence that we keep accumulating, then the real issue is
not whether we reform, but how we reform. And poll after
poll supports the American public's awareness that this is
the right discussion.
Thank goodness we have gotten beyond the rather
false argument about is there or isn't there a crisis. The
folks who tried to peddle that have backed off, and they now
recognize, along with the rest of us, that there is a crisis.
It may not have entered into everyone's life, but it is a
potential crisis for all of us, because we all live with the
kind of insecurity that comes when you do not guarantee
insurance to every citizen.
The President's approach is built on five basic
ideas. The first is guaranteed private insurance for every
American. Now this is an important point to stress because
some of the critics of the President's approach have said,
well, you know, he favors government medicine. Well, in
fact, that is just not true. He favors the kind of system we
have now, but to make it work for everybody.
We now have a public and private system. Those of
us who are privately insured achieve our health coverage by
either our own funds or in cooperation with our employers.
And we have public systems like Medicare and Medicaid to take
care of those who cannot afford insurance. And then of
course we have the nearly 40 million who fall between the
What the President wants is guaranteed private
insurance with comprehensive benefits for every American.
And the benefits in the President's approach have been
Alternative approaches have said, well, let's pass
reform, and then we'll tell you what the benefits are later.
I don't know anyone who would buy an insurance policy and not
know what was going to be covered. So from the President's
perspective -- we want to know from the very beginning, what
are the benefits, in terms of hospitalization and outpatient
care, mental health coverage, and very importantly,
preventive and primary care.
One of the points that is really significant in the
President's approach to benefits is to try to move us more
toward a system of individual responsibility and wellness, so
that we no longer just take care of people when they're sick.
We actually try to insure them in a way that they can get
help trying to prevent themselves from being sick or getting
sicker. So comprehensive benefits stressing preventive
health care is a key.
The second point that the President has stressed
is, we need to eliminate the insurance practices in the
marketplace today that do drive up the cost for some people,
and discriminate against individuals and groups of
individuals. And there are several of those.
One is the whole idea of preexisting condition. If
you have some kind of an illness or other sort of medical
condition, you may find yourself ineligible for insurance, or
find insurance priced so high you cannot afford it. We want
to eliminate preexisting conditions. Everybody should be
insurable. Nobody should be eliminated from insurance
because they have been sick at one time.
And this is especially important in today's world,
because -- I recently was at the National Institutes of
Health, where they are doing fantastic research about the
human gene system. We are learning every month something
more about our human genetic makeup.
We are on the brink -- within the next 10 years --
of discovering genes that cause all kinds of diseases. We
all will be uninsurable because we will all have some genetic
condition that will make us ineligible. So if for no other
reason, we need to act now. (Applause.)
Another thing we have to eliminate from the current
way insurance is sold and marketed is something called
lifetime limits. You read the fine print of your insurance
policy. Most of you will see that you have a lifetime limit.
It may be, surprisingly, as low as $50,000, or as high as $1
million, but what it means is that if you get really sick and
need your insurance coverage the most, if you build those
expenses up you may get to the point, as many people have who
have talked with me, where their insurance company says,
we're not paying any more. We are going to eliminate, in
this approach, lifetime limits.
And the final practice that we want to eliminate is
discriminating against people on age. That is something that
I care more about every year that goes by. I am very
conscious of how, as I get older, my costs increase.
I have this old fashioned idea that we all ought to
be in this together, the old and the young, the sick and the
well, supporting each other, because every one of us will
someday be sick, and sure enough, we will all be old. So if
we eliminate that now, put everybody into the same insurance
market, the whole country, we will then all pay less to
actually guarantee more insurance for the entire population.
The third point, which is critical to the
President's approach, is guaranteeing choice of doctor and
health plan. Now there was a lot of concern about this
several months ago, and there were some ads run and some
other charges made that the President was going to make it
impossible under his approach for you to be able to pick your
Well, first of all, what is happening today, is
that more and more Americans are being deprived of choice.
How many of you in this hall today get your insurance, as
most of us do, through the work place, and have been told
sometime in the last several years that your employer has
picked a different plan?
You can only go to these certain listed doctors and
these certain listed hospitals. And you cannot, maybe, use
the children's hospital or the academic hospital associated
with the university, because they're too expensive. This
happens all over the country, every single week, because
employers and insurance companies are trying to squeeze their
costs down in a system that is letting costs run out of
control. So one of the ways they're trying to do it is by
eliminating your choice.
And we are going to reverse that, because if
everybody is in the system then there isn't any place to
shift costs to. Everybody is part of the same insurance
marketplace, and therefore we will require all health plans
to be available, in a region, to every one of you, and it
will not be your employer's choice or the insurance company's
choice, it will be your choice.
And every year you will choose the health plan with
the doctors that you prefer, and every health plan, whether
it's an HMO or a PPO, or a traditional fee-for-service health
plan, will also have to provide a -- what's called a point-
of-service option. That means that if you have some
condition, and the best person in the country is somewhere
else, you will have the right to go there.
So in fact, under the President's approach we will
reverse the decline of choice, and guarantee it to you. So
we want to make that point very explicitly. (Applause.)
The fourth point I want to make is that the
President's approach preserves Medicare. You know, there are
a lot of people in our country who are concerned about
Medicare, and those of us who have older family members who
are eligible about Medicare are also concerned. But the two
big problems with Medicare right now is that Medicare does
not cover prescription drugs, and Medicare does not give
options to older Americans when they need long-term care
other than the nursing home.
Under the President's approach, prescription drugs
will be available to the Medicare-eligible population, which
will be a huge cost saver for millions of older Americans. I
have met people in their 60s and 70s, and 80s, who pay
anywhere from 4-5,000 to $18,000 a year for their
prescription drugs, people living on fixed incomes.
And what we want to do is to make prescription
drugs affordable, because we don't want older Americans
choosing between food and prescriptions, which happens right
here in Colorado, like it does everywhere else in the
country. And because we know if older Americans get their
prescriptions filled, and they're under the supervision of a
physician who can monitor those prescriptions, they are less
likely to need hospitalization.
So prescription drugs under Medicare -- and to
begin to provide some long-term care. We want to preserve
Medicare and to use money in Medicare for the people it was
intended for, older Americans.
The fifth point I want to make -- the fifth point
has to do with how we finance health care and where we
actually will get our guaranteed private insurance. If you
believe, as the governor said, that everyone should have
health coverage in America -- and I believe that. I hope
that we're beyond that debate.
Any reform that does not include universal
guaranteed health care for every American will be vetoed by
this President, because if we don't have guaranteed health
coverage for everybody, we have not reformed our health care
system. (Applause.) Now once you believe that, there are
only three ways to do this. There's not a million different
ways, there's only three ways.
One is to take the approach that a lot of people
have looked at, which is to eliminate private insurance
coverage and instead substitute for it a tax that would be
dedicated to providing health insurance. That is sometimes
called a single-payer system. That is, as a matter of fact,
something that has a lot of support by people who know that
it would once and for all cover everybody.
And for those of you who support that, it is a goal
that the President shares. But he believes that we will be
better off if we maintain our public-private mix, so that we
can retain some competition and collaboration, and some
accountability, so that we can keep both parts of the system,
public and private, kind of moving along, doing their best,
because there are alternatives out there. So he does not
believe we ought to raise taxes and substitute tax money for
all of health insurance.
The second way to make sure everybody is covered is
by having what some argue for, called an individual mandate.
That would mean much as we do auto insurance in some states.
Every individual would be told they have to go out into the
market place and buy their own insurance. Now, the good part
of that approach is, it recognizes you have to have either a
tax or some requirement, some responsibility to get everybody
covered. The President rejected that approach because, from
his perspective, it would do two things that he does not
think are good.
First, it would send a message to employers who are
currently providing insurance they did not need to do that
anymore. I mean, if the individual is required, then why
should any of your employers continue to bear that burden?
So we would have millions and millions of Americans all of a
sudden becoming uninsured, which is absolutely the opposite
of what we want to see happen.
The second problem is that you would have to
provide some kind of subsidy for low income people. And if
you try to provide an individual subsidy where you had to
track each individual, and if you could not predict how many
more individuals would be thrown into that pool that would be
needing help because employers would be dropping them from
coverage, you would have a very big amount of money having to
come from the federal treasury that you could not count on or
really specify from year to year.
You would also probably have to use the IRS system
to keep track of individuals, and I personally am not
enthusiastic about using the IRS system to keep track of my
health care insurance. So I don't know that that's a very
good alternative. (Applause.)
The third way is to build on what works in America,
and that is employer-based, shared responsibility insurance.
What happens now is that most of us pay something out of our
own paychecks, and our employer pays something that is a
benefit to us, and the percentages vary. Some have 100
percent employer paid, some only have 50 percent, some have
high deductibles, some have low deductibles, but the system
in place is guaranteeing health insurance at the work place.
That is an American solution to an American problem
that has worked well for most of us. And the President
believes that if we build on that system, then for the vast
majority of insured Americans, we are not going to see very
much change at all. Every year we will still be contributing
at the work place, but unlike what happens now, our employer
won't decide what health plan we have. We will decide, and
we will be free to make a new decision on an annual basis.
Now what are the problems with building on the
existing system? Well, first of all, there are some people,
employers and employees, who currently pay nothing. They are
the uninsured, and that is a very large group of people and
one that unfortunately is growing, because many employers are
finding that it is not something attractive for them -- in
the existing insurance marketplace -- for them to try to
continue to provide benefits.
Small businesses in particular are the most
discriminated segment of the business community when it comes
to getting fair insurance rates, because they are usually out
there in the marketplace on their own, or in very small
groups. So we have to do a couple of things to make sure
that moving from where we are now, with the employer-employee
system, to covering everybody, will work and work fairly.
Number one, we have to provide discounts to small
business. We have to cap how much money business would be
asked to contribute. We also have to provide subsidies for
low wage workers so that they can afford their share. We
want them to be responsible. Even people on Medicaid, who
work, should contribute something.
Right now we have the rather unusual situation of
millions of Americans getting up every day, going to work,
paying taxes, not able to afford insurance, not getting
insurance from their employer, and yet they pay taxes which
go to provide health benefits to people on welfare who are
not working. (Applause.) That is wrong.
So if we provide discounts and we provide
subsidies -- we have looked very carefully at how much this
would cost. This will lower the insurance cost of the vast
majority of business that already insure. If you are a big
business, a medium sized business, or a small business, and
you already insure, we can show you how your costs will go
down, both in the short run, and then, importantly, in the
In fact, one of the conclusions of the nonpartisan
congressional budget office study was that business
particularly would be saving a great deal of money under the
President's approach. Now if you do not insure at this time,
yes, you're going to have to pay something, and your
employees, who currently do not have insurance, are going to
have to pay something.
We will do everything we can to keep the cost low.
And if we reform the insurance market, and eliminate the
experience rating and the cherry picking, and all of the
activities that have come to make your costs much higher than
they should be, it will be affordable. And again, the
nonpartisan independent studies that have been done have
demonstrated that is the case. It has also demonstrated
there would not be net job loss. So the two big arguments
about cost and job loss are ones we are very sensitive to,
but think under the President's approach we will be able to
address and provide a base of financial support to businesses
and to workers with lower income.
Those five points: guaranteed private insurance,
outlawing insurance practices that are discriminatory,
guaranteeing choice of doctor and health plan, improving and
preserving Medicare, and guaranteeing health insurance at
your place of employment, are really the underlying
principles of the President's approach. There are details
that will be debated, and should be, as the governor said,
exactly how all this will be put into practice.
But the net result when we get through with this
debate is: if we have done our job right, health insurance
will be guaranteed. You will never have to worry about
losing it. You will find it far more affordable and
accessible than you ever have before. And the country, and
our business sector in the country, will begin to save money
that they have had to spend on health care that they then can
turn around and invest in more productive uses.
So this is an approach that has been thought out.
It borrowed from a lot of different approaches to try to come
up with a solution for the problems we have in this country.
I am confident that as the debate moves forward in
congress, as people really have to focus on what the
alternatives are, what the costs are, and how much like the
President's approach your insurance situation is now, that we
will end up this year passing comprehensive reform and once
and for all make good on a promise that every one of us
should have, going all the way back to Franklin Roosevelt and
Harry Truman, as Pat said, to guarantee that no matter where
you live, how old you are, who you work for, or whether
you've ever been sick, you do not have to worry about having
your legitimate health needs met. And that's what we're
trying to make sure happens this year. And we need your help
to make that come apart.
Thank you very much. (Applause.)
A PARTICIPANT: Now we'll take questions from the
audience, and I'd like to ask Eduardo Canallis (phonetic) to
address the first question.
MR. CANALLIS: Welcome to Denver, Mrs. Clinton.
I'm a member and an organizer with the Service Employees
International Union. SEIU, as you know, is one of the
largest proponents and supporters of health care reform in
this country because we are the largest health care workers'
union in the country also. We're very concerned with
immigrant bashing in this country because we're organizing
My question to you is: Are undocumented workers
and nonresidents, legal residents -- noncitizen legal
residents -- covered by the health care security act?
MRS. CLINTON: Under the President's approach,
citizens and legal residents are, undocumented workers are
not. (Applause.) And what we will do -- what we will do is
to continue to provide the public health and emergency
medical services that any person is entitled to have, and
that we want to be able to provide.
But we do not believe we should extend this kind of
privilege and right, that carries with it comprehensive
health care benefits, to people who are not citizens or legal
residents. We need to take care of our people right now.
A PARTICIPANT: Our next question comes from
A PARTICIPANT: Instead of being melded into the
various state alliances, why can't the federal employees'
health benefit program, which serves over 9 million federal
retirees, employees and their families, have a separate
alliance of their own? Could you and President Clinton
MRS. CLINTON: Well, under the current plan, for
those of you who are not acquainted with the federal
program -- which you should be, because you pay for it -- so
let me tell you a little bit about it. Under the federal
employees' health benefit plan, the federal government acts
as the employer of people like my husband and the
congresswoman, and workers throughout the country, and it
acts as an alliance or kind of a buyers' club, if you will.
It goes out into the marketplace, and it says to
insurance companies and doctors' networks, and other health
providers, would you like to have a chance to have the
business of federal employees -- because the federal
government pays 75 percent of the health care costs and the
employee is responsible for the remainder. So every year,
everyone from my husband on down gets to choose what health
plan we will join, and then the money flows into that.
The federal government doesn't make the decision.
It does not decide what kind of health plan we want. We do
that, but they provide the 75 percent employer match. We are
in effect asking that something similar be done for every
person in America, where the employers provide an 80 percent
contribution, and the employee provides 20 percent.
That is a good model for what we are trying to do,
but we do not believe there should be a separate system for
federal employees. We believe the President and the congress
ought to live in the same system that every other American
lives under. (Applause.)
A PARTICIPANT: Our next question comes from Father
Neil Dow (phonetic).
FATHER DOW: Yes, I've been wondering if you have
specific targeting for helping people with chronic diseases,
and even more notably than that, multiple chronic diseases.
MRS. CLINTON: Yes, Father. One of the things that
will help people with chronic diseases more than anything is
guaranteeing them insurance. People with chronic diseases
are often locked out of the health insurance market today, or
have to pay an exorbitant rate, and particularly if they have
multiple problems overlapping the primary diagnosis.
So what we are attempting to do is to make sure
nobody is eliminated from coverage, and that there are
services in addition to the ones that you or I, if we did not
have chronic diseases, would be entitled to. So we do have
rehabilitation services, long-term care, not only for the
elderly but for those under 65 with chronic problems that
lead to disability.
So we are very aware of what needs the chronically
ill have and have tried to build that into the benefit
package the President has proposed, because that is a group
of people that have special needs that are expensive and need
to be addressed. And so we have tried to do that in the way
we have approached this whole issue.
A PARTICIPANT: Steve Berringer (phonetic),
MR. BERRINGER: Thank you. Mrs. Clinton, on behalf
of region 11 of the AFL-CIO, I want to thank you, for all of
us, for your leadership on the health care issue, and let you
know that we support your and the President's efforts on
behalf of the health security act.
During the health care debate, workers have
repeatedly expressed a concern; that concern is the fear that
their health care benefits would be subject to taxation, as
some others have proposed. My question is: Under the health
security act, to what extent will, or perhaps won't, health
care benefits be taxed?
MRS. CLINTON: Under the President's proposal, they
would not be taxed, because what we do not want to do is
penalize people who have insurance. What we want to do is
increase insurance availability to everybody. So we do not
propose taxing benefits in the President's approach.
A PARTICIPANT: (Inaudible.)
A PARTICIPANT: I'm with the Denver department of
social services and the coalition on long-term care, and I'd
like to know your views on long-term care and how it's
incorporated into the national health proposal.
MRS. CLINTON: You know, the whole long-term care
issue is one that we are hearing more about every day because
the fastest growing segment of our population are people over
80, and -- I was laughing. I ran into Willard Scott a few
months ago, and I asked him how he was doing. He said, well,
one of his problems was that he had so many people who were
having a 100th birthday that he was thinking of having to up
it to 105. (Laughter.)
You know, so it's a problem that we're going to
have to face, because we are aging. And I think we are all
grateful we're living longer, but we want to treat people
with dignity as they age, and we also want to treat people
with chronic disabilities who need long-term care with
What we have done -- what we have done is try to
listen to people, and what we hear all over the country is
that people want alternatives to nursing homes. They want to
be able to stay in their own homes, with their own family
members, and get some home health aids and other kinds of
help. (inaudible) -- going to do, but it will save us a lot
of money if we do it.
I just want to end with a story. I was in
Philadelphia, in a hospital, and they were running an adult
day care for people in their neighborhood. It was in a kind
of working neighborhood, a neighborhood of people who worked,
didn't make a whole lot of money, but a stable neighborhood.
And they were finding that a lot of the folks in the
neighborhood were trying to keep their parents and their
aunts and uncles at home.
But they couldn't watch them because both parents
were working, so they would take them to the hospital, to
this adult day care. But the hospital had to charge
something, so it charged $35 a day. Well, that was too much
for a lot of people. They could maybe pay $15 a day, but not
$35, so the hospital saw a lot of families being forced into
having their parents and grandparents go into nursing homes,
because they couldn't afford $35 a day, whereas the state
would pay thousands of dollars a month if you had somebody in
a nursing home.
What we want to do is to provide, on a sliding
scale, some financial support so you can keep people at home.
And you can keep them in adult day care and not put them in
nursing homes, which would save us a lot of money and be a
more effective way to take care of more people. (Applause.)
A PARTICIPANT: (Inaudible) we're running short of
time. We'll have to make this the last question, I'm
afraid -- from Brian Sullivan (phonetic).
MR. SULLIVAN: The health security act is clearly
far reaching, and in some areas controversial. While there
are a lot of differences in the federal reform movements,
there is a lot of commonalities. To avoid deadlock, would
the administration support a plan that included some of those
commonalities so we could fix much of what needs fixing now?
Or would the millions of Americans who could benefit from
some of the changes, such as insurance reform, have to wait?
MRS. CLINTON: Well, if you're asking if we would
be willing to look at different ways of reaching the
President's goal, the answer is yes. But if you're asking if
the President would be willing to sign a bill that gives you
something but did not put us on the track to guaranteed
health care coverage for everybody, the answer is no.
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