April 20, 1994

MRS. CLINTON: Do you all think you could come
back like once a week? You know, it's been a great week for
us, as Morty said. The President started his week by going
to Milwaukee and having an opportunity to spend time with
Morty and meeting many of your members. The real secret, I
have to go ahead and confess, was that Air Force One has been
having communications problems, so we thought we'd get some
really firsthand advice.

I also am pleased to be here with all of the
leadership that you are and the members you represent. I
want to particularly thank Barbara and Loretta for meeting me
and greeting me as I came in this morning. But I really am
here to say thank you to all of you.

It is true, as Morty said, that we finally look
like we're on the verge of the historic change that health
care reform will bring to our country. And we could not have
gotten there without a President whom you helped elect, who
cared about the health care of the people of this country.

But we also would not be on the verge of this
change if you at CWA had not worked year in and year out on
behalf, not only of your membership, but of millions of
Americans who may never know what CWA stands for. Because
you tried in every way you knew how to make health care a
priority for this country. They will be better off because
of it, and I am personally grateful for your support.

But you know it's not going to be easy. It is
going to be a real struggle in the next couple of months to
do what all of us in this room know needs to be done. We've
been in a situation for the last decade or so where a lot of
our problems have been denied. There's been a lot of
political rhetoric, you know, politicians, radio talk show
hosts, all kinds of people ranting and raving, but until last
year, very little action.

Now we've got a year behind us in this
administration. I think most of us, if two years ago had
been in a meeting like this, we would have thought we were
dreaming if we had said, you know, I would just like a
president who would be responsible about the budget and go
ahead and take on the problems that this country has, and go
ahead and reduce the deficit by half, and while he was at it,
give tax breaks to millions of working Americans who deserve
them because they're working every day but they can't get
themselves out of poverty. Leave everybody else alone, and
only tax the top 1.2 percent of the wealthiest of Americans.

Wasn't it interesting last week when you finally
got down to filling out those tax returns? I know. Probably
my favorite time of year.

You know, there has been this year-long blast about
how, you know, everybody's taxes were being raised, and then
a lot of the Republicans and a lot of their allies ran all
these ads last week, you know, saying, look what happened.
Lo and behold, it happened to the people it should have
happened to. I mean, that's what this is all about.

But think back, you know, two years ago, and again
let's dream a little. Suppose we had said, wouldn't it have
been wonderful to have a president who really was going to
try to do something about violence in America, not just talk
about it, not just hold press conferences about it? Wouldn't
it be wonderful to have a president who would finally have
the guts to sign the Brady Bill and start getting guns out of
the hands of teenagers?

You know, as unrealistic as it might have seemed
two years ago, wouldn't it have been wonderful to have a
president who really believed that we needed more police on
the streets? Because you know in the 1950s when I was
growing up, and maybe some of you as well, as I look around
this room, we had three police officers for every serious
felony committed. Now we've got three serious felonies for
every police officer.

So two years ago we would have been here saying,
oh, I mean, it's a pipe dream. But wouldn't it have been
great if we could get maybe another 100,000 police officers
on the street, and get us safe again in our homes and our
neighborhoods? That's what we're on the brink of doing with
the crime bill that's in the Congress right now because of
the presidential leadership.

There are so many other things like that, I mean
everything from waking up two years ago knowing that, despite
all of the confusion in the world and the Soviet Union
crumbling, there were still hundreds and thousands of
missiles pointed at our country. Now we've got, through
peaceful means and through leadership, the effort to
dismantle that.

We've got a national service program that next year
is going to start paying young people to do service in their
communities. We've got a new college loan program that's
going to start rewarding the children of people who work for
a living and can't afford college. We've done all of these
things in just one year that two years ago would have seemed
unimaginable, because we were living in a kind of drift, a
denial, and gridlock.

But leadership does make a difference, and what we
now are on the brink of facing is one of the most important
issues: health care reform. And it's an issue that's been
around for at least 60 years. You know, Franklin Roosevelt
thought that health care security would be the other half of
social security. He had to fight to get social security. He
got that, thank goodness, and yet he couldn't get health
security through.

Harry Truman made health care reform one of his
major issues. He worked as hard as he knew how -- and I've
gone back and read some of his speeches. I mean, he called
it like he saw it. He called names, he pointed fingers. He
knew exactly what he was up against, because he was trying to
change a system that is entrenched, and a lot of people make
a lot of money out of.

Dwight Eisenhower even came into his presidency
trying to do something about health care reform. Finally, in
the 1960s, Presidents Kennedy and Johnson got Medicare. And
we ought to be so grateful for that, because at least we
provided basic health care services for our older Americans.

Even President Nixon had a health care reform bill
that he fought for, that was employer-based. And Jimmy
Carter came to the Congress with ideas about health care

Oh, we've tinkered on the edges. We've gotten some
good things like Medicare. We put a safety net under the
poorest of Americans, those on Medicaid. But every year that
went by, as Morty referred to earlier, all of you have seen
wages held steady or even decline in many sectors of the
economy, when the only thing you could bargain for, the only
thing you could get, were health care benefits.

And many other workers without the kind of
leadership that you have, they've seen not only their wages
stagnate and decline, but they've seen their benefits slowly
eroded, and many of them have ended up without health care
benefits at all. You and I all know people who went to work
for corporations 20 and 30 years ago and thought they would
always be there. They aren't there anymore, and the health
care benefits have gone out with them.

So what we are facing now, as we look at health
care reform, is the possibility of making good on the
promises and the hopes of the leadership of this union of
presidents, both democrat and republican, over 60 years, and
making good on the fundamental promise that health care
should be a right, not a privilege of a select few.

Now look at what we have before us. We have the
President's approach, which will do the following things.
And we have alternatives that are being debated in the
Congress. And we have, I hope, a national consensus that the
time has come, assuming we keep the momentum going. Let me
just briefly outline the principles that the President
believes have to be part of his health care reform effort.

Number one, every American must be guaranteed
private insurance, and that must carry with it a package of
benefits that are comprehensive and emphasize primary and
preventive health care. For too long, insurance has been
penny-wise and pound-foolish. It won't pay for pre-natal
care, it won't pay for the immunization, it won't pay for the
well-child care. It often won't pay for the mammogram or the
Pap smear or the cholesterol screening, but it sure will pay
when you get real sick and go to the emergency room.

We want to start paying for and encouraging people
to use preventive health care. We want to keep people
healthy, we don't just want to take care of them when they
are real sick and need the kind of care that only is
expensive and available in hospitals. So let's begin by
committing ourselves to guaranteed insurance with a
comprehensive set of benefits.

The second thing we want to do is, we want to
outlaw insurance practices that discriminate against any
person on the basis of preexisting conditions. Nobody should
be denied health care insurance or told, yes, you can have
it, but at a price that is so out of sight that in effect
it's unaffordable, because they or a member of their family
has been sick.

You know, during the last year I have traveled all
over the country, and I have talked with so many people about
what has happened in their lives. And I've got this movie
that runs in my head. I see the faces, I see the settings, I
hear the stories. But probably nothing, nothing, summed up
the tragedy of preexisting conditions quite the way a woman
did in Cleveland, at the Children's Hospital there.

While I was talking with a group of families whose
children were seriously ill -- they had leukemia, cerebral
palsy, cystic fibrosis -- very serious illnesses which
require not only a lot of health care, but require a lot of
emotional and psychological care as well. And this woman,
whose husband was a lawyer -- they made a good income -- told
me about how their first child, their son, had been born

Then they had two little girls, both of whom had
cystic fibrosis. And she recited for me what it had meant
for this family to try to find insurance for those little
girls, because of course, once the first one was born, the
insurance company began pricing it out in such a way that
basically they were told, you can have insurance for
yourselves and your son, but not your daughter.

And then, unbelievably, a second daughter with the
same problem. This woman said to me that after going from
place to place -- they've never asked for a handout, they've
never wanted their child to be on welfare and to get
Medicaid -- she remembered talking to an insurance agent and
begging him to help her get some kind of insurance. He
finally looked at her and said, what you don't understand is,
we don't insure burning houses.

Now, you know, I could not even imagine what that
mother felt like. And I could not even imagine that if that
were to happen to Bill and me with our daughter, how I would
react. I was so stunned.

So if we do one thing in this whole year that will
mean more to me than anything, it will be to eliminate
preexisting conditions. It will also be to eliminate
lifetime limits, because what lifetime limits do is cruelly
say to a family, when you are really sick, when you need
insurance health care the most, you may run out.

Some policies, when you read the fine print, have a
lifetime limit as low as $50,000. Others go to a million.
But you know in today's high-tech medical world that often
doesn't last very long, especially if you have a really sick
member of your family. So we're going to outlaw -- make it
absolutely illegal -- for insurance companies to do anything
that will in any way restrict your coverage on the basis of
preexisting conditions or lifetime limits. That is what we
are trying to do.

The third principle is one that is very important
to me personally and I would imagine to many of you. And
that is, we want to give every American the choice of doctors
and choice of health plan. Now there has probably been more
misinformation about this than any other aspect of the
President's plan, and I think I've kind of figured out why.

In addition to the advertising campaigns run by
interests that don't want you to have choices, what's
happening right now is that many, many of us are losing our
choice. Employers are picking plans and then telling you
what doctors and hospitals you can use. I hear that
everywhere I go in the country.

I was in Baltimore on Monday, and I met a family
who had a child with a chronic condition. They were very
pleased with their doctor. The husband's employer changed
insurance policies, and all of a sudden they were told they
can't take their child to the same doctor they've been taking
him to ever since he was born. They had to go to somebody

What we want to do is to stop the trend that is
taking choice away from people, because if we do nothing, if
we do not reform the system, I can guarantee you that most of
us will not have any choice in the next 10 years. It won't
matter how hard you bargain, it won't matter how hard you
shop, there will be big conglomerates that will decide what
doctors can belong and what doctors cannot. They will offer
the lowest prices to the employers. That's what will be
taken, and the rest of us will be left with no choice.

What I want for the American people is what the
members of Congress and federal employees have today. They
have an employer-based benefit. They have the federal
government -- which pays their salary, then pays 75 percent
of their health care benefits -- going into the marketplace
and finding health plans that want to bid on my health

That's what a co-op, or an alliance, or a buyer's
club would do. It doesn't deliver health services. It does
what the federal government does for my husband and me, and
for members of Congress. Every year we get a whole bunch of
brochures and information, and can attend a meeting, so that
we're told about all the different health plans that are
available in the Washington area. This goes on all across
the country for federal employees.

What I want is for Americans to have that choice.
It's not my husband's employer, it's not the federal
government telling us what health care plan to choose, it is
our choice. If it's good enough for Congress, it's good
enough for the American people.

And the fourth principle is, we want to preserve
and improve Medicare. Medicare has worked for older
Americans, but it has two big gaps we need to fill. It does
not cover prescription drugs, and it does not provide
alternatives for long-term care to older Americans and people
with disabilities.

Why are prescription drugs important? Well, we
want them to be a part of the benefits package for all of us
under 65, and we want it to be available for the people who
use the most prescription drugs, people over 65. So we have
to change the Medicare system in order to be able to do that
and provide that benefit.

But you know, it's not only the right thing to
do -- because I have met people all over this country who
every month make a choice at the end of the month, based on
their fixed income, between prescription drugs and food. I
have met them, I have talked with them.

I have gone down rope lines on streets and in big
rallies, and people have grabbed my hands -- older men and
women -- and thrust into them their prescription drug bills.
And I had a man in New Jersey say to me, here's how much my
wife and I live on. We live on social security, a very small
pension, and here is what we make every year. I'm spending
half of my income on prescription drugs for myself and my

Now it's not only the right thing to do because we
need to help these people, but it is the economical thing to
do as well. Do you know most older Americans, when
confronted with costs like prescription drugs -- they
hesitate. You know, you've seen them. I've seen them. I've
talked to doctors and pharmacists.

They don't know whether to get the prescription
filled. They leave their doctor's office with a bunch of
prescriptions, but they may only get one of them filled, not
knowing that you need to take all three for it to work. Or
they may get the vial and it says, take four pills a day for
10 days, and they say, if I only take one a day, it will last

What happens? They end up back in the doctor's
office. About 23 percent of the admissions of older people
to hospitals are because the medication wasn't done right or
taken right, or administered right. So it's not only the
right thing to do, it will save us money. It is more
economical to help people with their prescription drugs than
to readmit them to the hospital, or to pay the doctor when
they didn't do the drugs right. So that's the first thing.

And the second is, let's begin to provide some
alternatives -- to older Americans and Americans with
disabilities -- besides nursing homes. I have met --
(Applause.) -- I have met hundreds of Americans, and I have
gotten a million letters, and many of those letters are about
the struggle families have trying to take care of their loved

Families struggling with Alzheimer's -- you know,
that's not just a disease of an individual. That affects an
entire family. Struggling with the effects of stroke or
serious diabetes, or heart conditions, all of those that not
only affect older people but also younger people, very often
lead to the person needing nearly full-time help during the

And yet for those families that want to take care
of their loved ones, we don't give them the help they need.
We don't pay for the visiting nurse. We don't help pay for
the equipment they need in the home to be able to take care
of the physical needs. We don't provide reimbursement for
adult day care so that you can keep, like, an Alzheimer's
patient at home, but drop them off on the way to work, pick
them up at night, so that the family can keep working and
stay together.

No, what we do is say, well, too bad, you're either
on your own taking care of that relative all by yourself, or
go ahead, spend yourself into poverty, and then you can go
into a nursing home that costs thousands and thousands of
dollars. That is not a very fair thing to do, and it is also
not very cost effective.

If we say to families, we want families to get
together -- you know, I'm tired of people saying they're pro-
family and not lifting a finger to help working --
(Applause.). Why don't we begin to put our policies where
our mouths are, and say, let's help families stay together?

And that's what we would do in the President's
plan. He would enable Medicare to provide options at home,
in adult community centers and congregate housing, so that
people would slowly move toward levels of needing this, that
might eventually enter the nursing home, but not necessarily.

And the fifth point is that we want to provide
health care benefits through the work place. That's where
most of us, the 100 million of us who are insured, get our
benefits. We want to be able to say to every employer and
employee, everyone must share the responsibility of paying
for health care.

Many of your employers have not only contributed to
your health care, they have subsidized their competitors,
they have subsidized other businesses in the community,
because those businesses took advantage of the health care
system you and your employer paid for without contributing
themselves. We need a level playing field where every
employer and every employee makes a fair contribution.
(Applause.) What the President has proposed will be fair to
small business, it will help give discounts to them, it will
help support low-wage workers. But the bottom line is the
principle: we have to provide that opportunity.

Now there are a couple of other things that I
wanted to say just quickly to this group. One thing that the
President's approach will not do is, it will not tax health
care benefits. (Applause.) It didn't seem right to us to
turn around and penalize the people who gave us wage
increases over the last decade or two, increase their
compensation, largely through the addition of benefits,
primarily health care, and then say, we're going to tax that.
We don't think that's right, and the President has not
proposed that. The President's plan will protect early
retirees, and it will provide a single payer option for
states that wish to pursue a single payer (inaudible).

You know, I was thinking this morning as I was
coming over here that it seems so self-evident to those of us
in this room that we need to reform our health care system,
because you've seen the effects of eroding wages, you've seen
increasing costs, as Morty said, no matter what you and your
employers try to do. You kept running up against cost
increases that were coming because the entire system was out
of control, even though you were doing your best to be

And yet you know as well as I that the same
arguments, and even some of the same people who were against
social security and against Medicare, are against health care
reform. And I don't want anyone in this room to at all feel
that this is going to be as self-evident to the congress and
the rest of the country. (Laughter.)

You know, when I first started working in public
policy -- it seems like 100 years ago, it's probably about 25
or -- 20 or 25 -- and I was primarily concerned about
children's issues. I was always amazed when I would go and
talk to somebody, and I would say, but the need is so
obvious. And you know, fill in the blanks, you know. These
children are not getting immunized. These children are not
getting, you know, good nutrition. These children are being

And I would make what I thought was certainly a
winning argument, and would be met with a blank stare, or met
with a kind of brush-off, or met with an ideological argument
about how, well, that was the way it was meant to be. So I
know that this is a challenge for all of us. But I cannot
think of anything more important for us to be engaged in
right now, because this is not just a debate about economics,
although it is.

The economy will be stronger when we stop spotting
our competitors five cents on every dollar because we spend
so much more on health care. It is not only an issue of
social justice, although it is that, because how much longer
can we live not only with the nearly 40 million uninsured but
the 25 million underinsured?

And the insecurity that any of us face is because
there is not one of us in this room, not one, who can say
with any certainty you will have the same health care benefit
at the same cost this time next year. And it's not only a
political issue to see how well our system can respond, and
whether it can actually rise to the occasion as it did 60
years ago and 30 years ago. It is also a question of what
kind of country we want to (inaudible).

We are starting to take on such problems. It's not
easy. It's controversial, but at least we're facing up to
them. We're starting to get some results. We're beginning
to see that there is some hopefulness. The economy is back.
Consumer confidence is up. We're starting to do what the
President said he wanted to see when he ran for the

But really, it's not up to him, and it's not really
even up to members of congress, is it? It's up to all of us,
the way we are every day, how we treat each other, our
responsibilities for our families, our responsibilities at
work. Those are the things that make a great nation.

We have always been great. But now we need to rise
to this occasion and make it absolutely clear that we will
not tolerate a two-class medical system, that we will not
tolerate insecurity that afflicts every one of us, and that
we can deal with and solve our problems and move toward
creating a more caring, compassionate, and yet practical

That's what my hope is, and that's why I'm going to
do everything I can to make health care reform happen this
year. Thank you all. (Applause.)

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