September 29, 1994

MRS. CLINTON: -- and say to also the Association of
American Medical Colleges they have been stalwarts, allies on
behalf of patients and physicians and other health care
professionals for the cause of expanded quality, universally
available health care.

I'm also pleased to be here again at GW. I'm delighted
to meet with the (inaudible). I feel that you're our
neighbors -- we live in the same neigborhood -- and also to
be here with the dean and some of the faculty of the
University School of Medicine and Health Sciences.

I'm also pleased that this audience is primarily medical
students and am grateful for what appears to be an increasing
interest in primary care practice. When I was asked to speak
here, I readily accepted because I think that a concerted
effort to bring attention to primary care is essential, not
only for those of you who are in the health care profession,
but also for the rest of our country to understand what is at

And on behalf of the President and certainly myself I
want to convey our appreciation to all the primary care
physicians and supporting personnel around the country who
are gathered here today to both celebrate but also emphasize
the importance of primary care.

I have been reading lately, as I'm sure you have, about
the end of health care reform. So many of these stories talk
about who won and who lost, who is up and who is down, but I
think those questions miss the point. If we have not
learned, we certainly should have learned that health care
reform is not a boxing match that goes 15 rounds and suddenly
it is over.

It is a journey, one that our country has been on for
quite a number of decades, a long journey, sometimes a rocky
one, but nevertheless a journey that we must keep making
together until every child, every mother and father, every
sister and brother and husband and wife has the right to
access to quality health care that your are training to
provide -- (applause).

Over these last months, when Congress debated reform and
opponents spent hundreds of millions of dollars to saturate
the airwaves with negative advertisements, people like you
all over our country got up every day and did the best they
could, did the best they could for their patients, did the
best they could so they could be the kind of physicians who
would invest themselves professionally and personally in
patients of the future.

And they did so every day in a system that often worked
against the best interests of physicians and patients, and
when the congressional session ends in a few weeks and
everyone in Congress goes home, primary care providers will
still be fighting the daily battles against diseases treated
too late because there was no insurance, against an insurance
system that still discriminates against the elderly and the
sick, the small businesses and the self-employed.

They will still be laboring on behalf of their patients
against a system choking on paperwork and confusion. So when
the Congress goes home and the pundits declare health care
reform dead for the time being, just remember the millions of
physicians and nurses, medical students and technicians who
don't get to go home.

They still keep working to make sure that the people of
America get the health care they deserve every single day.
As future doctors in medical professions, you know the
importance of the battle we've been waging for the last 20

You know why it is so vital that we achieve universal
coverage. You know because you have already begun to see the
reality of our health care system in the training you do
every single day. Those realities have little to do with
politics and a lot to do with people.

That's why, in the larger scheme of things, it doesn't
much matter whether the President lost or I lost or the
Republicans lost or the Democrats lost this first battle.
What matters is whether the American people win or lose.
That is what is at stake.

I'm reminded now of an Op-ed piece I read in the New
York times about a year ago. It was written by a
pediatrician whom I admire in Boston, whose books I have
read, and for those of you not yet residents and interns, you
may not want to read her book about her experience on that
until after you're finished with it, but Dr. Perryclass
(phonetic) said the following:

"I am not a policy person, but I know this much: It is
wrong that I see one child after another without any
insurance, most of them children of the working poor, the
self-employed, the part-time employees hired by large
companies anxious to avoid paying benefits.

It is wrong that when the son of a fisherman puts a
rusty boat hook through his finger his mother has to ask me
anxiously about the cost of the tetanus booster. That is
what is at stake in health care reform, and it is those
voices that need to be heard.

I spent the better part of the last 20 months traveling
around this country listening to people's stories about our
health care system. To this day I could see the faces of
mothers who worried about whether they can afford tetanus
booster. I can hear the voices of fathers who tell their
children to be careful and not go out for sports because they
couldn't afford the injury.

I hear those voices, and I see those faces over and over
in my mind, and I don't think anyone, anyone who has heard
them and seen them, listened to the kind of stories that you
will hear over and over again as you complete your training
could ever walk away from this issue now, not when tens of
thousands of American families lose their insurance coverage
each month.

Not when health care costs continue to rise faster than
our national income, not when millions of children cannot get
the vaccines or well-child care they need to protect them
against childhood diseases.

Not when a woman I met in New Orleans last year, who had
worked four years, still can't afford to get a biopsy for the
lump in her breast because she still can't afford insurance,
not when one child, who is the grandchild of people I have
talked with, with meningitis survives and another child, also
a grandchild with meningitis, dies, the difference being that
one family has insurance, and the other doesn't.

These are not political problems. These are human
problems that define who we are as a people, and that's why
when people keep asking me if I'm going to give up on health
care reform my answer is always the same.

Why would I give up on America or the American people?
I am the result of privilege. I am the result of good
health. I am the result of a great education. Why would I
not want to do what I could in any small way to make it
possible for others to have the same opportunities that I
have had over my lifetime?

As the President said earlier this week, we've had some
rough spots on the road, but this journey is far from over.
Obviously, I'm disappointed we didn't achieve our goals this
year. As you know, it's not been an easy process, but we've
learned a lot.

Boy have we learned a lot, and I'm sure we will continue
to learn more along the way, but I am personally grateful for
and proud of the enormous effort that millions of Americans
made. Thanks to the hard work of thousands of people across
the country and thanks to a public eager for progress, health
care reform is now a subject regularly discussed around the
kitchen tables of America.

Now, hopefully, that discussion will continue among
family members and friends, among colleagues at work and also
among law-makers when the new session of Congress convenes,
but today offers us a wonderful opportunity not just to talk
about what did not happen this year but to pay tribute to
what is working.

As part of this first every Primary Care Day, we have
the chance to consider the extraordinary contributions of our
primary care community, of doctors, nurses, physicians'
assistants, all those whose work embodies compassion, quality
and trust on the front lines of the American health care

And we can also reflect on the vital role of our medical
schools and teaching hospitals that serve as beacons in their
communities, providing cutting edge biomedical research,
state-of-the-art technology, clinical and tertiary care, and
perhaps most important quality treatment for those among us
who might otherwise go without.

Nearly every medical school in the country is
participating today. That's a testament to the growing
interest in primary care medicine among medical students like
yourselves, and I was heartened to see the results of this
year's Association of American Medical Colleges survey which
show that the percentage of medical school graduates
interested in careers as generalists increased for the second
time in a row.

That certainly accords with my personal experience in
talking with medical students around the country who have
expressed not only an interest personally but also a
commitment publicly to primary care.

Today more than one in five graduates say they might go
into primary care. That is a good beginning, but we need
even to do better. That number will grow higher,
particularly given the innovative programs taking root in
some of our medical schools.

There are universities now who are developing loan
programs and forgiveness programs for students entering
primary care and practice in rural areas. There are many who
are developing community-based teaching sites for medical

There are other who have set a goal as to how many of
their graduates they hope choose residencies in internal
medicine, pediatrics or family medicine, and there are others
who, because of their success over the years, are leading the
way by working with other schools to demonstrate how primary
care can be made a priority.

And here GW there now is a primary care apprenticeship
for all second-year students. These are signs that our
medical schools and our medical students are not only moving
in the right direction but leading the rest of us in the
right direction as well. That is only appropriate.

You will have to lead. You are the ones who have made a
commitment to care for children and family (inaudible). Many
who are primary care physicians have often chided their
specialist friends by pointing out that, as a generalist,
they have to know a much broader range of medical issues
because they meet and treat so many different kinds of people
with so many different presenting symptoms.

It is a compassionate and caring commitment, but it is
also an intellectually demanding one as well, and you are the
ones who have shown the courage to take that on in a time of
change and uncertainty, and that is especially important as
we chart reform in the future.

One of the great driving forces for me personally behind
health care reform has been my concern about the future of
our medical colleges and our academic health centers. The
current financial system will not permit the continuing
missions of our academic health centers and medical colleges
to be fulfilled at the level that we expect and need from

So, for me personally, the effort for health care reform
is also an effort to stabilize and always be able to say we
have the finest medical education in the entire world.
Because when we look at the state of health care today, we
know we have the finest in the world.

I was at a hospital yesterday with Mrs. Yeltsin, able to
show her advancements in technology that were beyond anything
she had ever heard of or even dreamed of. We know that we
have a system that has produced cutting-edge research and
patient treatment that is the envy of the rest of the world.

But we also know that because of the way we finance
health care all that we have accomplished is not as secure
for the future as it needs to be, and we also know that too
many of our fellow citizens currently and more to come,
because of the way we finance our system, will not receive
the care that you are being trained to offer.

In addition to the hospitals that I visited both here in
Washington and in Boston within this last week, I've also
been in clinics. I've talked with friends of mine who are
physicians. I've talked with many who worked on behalf of
health care reform, and they have asked me to continue to
remind all of us that this effort we are engaged in is an
effort that, at bottom, is really about what kind of people
we are, not just what kind of health care or medical system
we have.

Because it is very difficult when you see the rising
rates of untreated disease and you see the public health
problems that we have not to realize that the future of this
country, not just our health care system, depends upon us
continuing our journey toward universal coverage.

There are still too many babies who don't have access to
preventative health care or regular checkups. There are
still too many adults who use the emergency room as their
primary care physician, and there are still too many families
paying far too much for the care they receive at a time when
employer-based care is being cut back and benefits pared

And there are still too many physicians who are second-
guessed every day by insurance company bureaucrats who
substitute their bottom line concerns for your medical
education. We must have the courage to keep going.

If this were easy, somebody else would have done it.
It's like that great line from "A League of Their Own" where
Gena Davis says to Tom Hanks, "I can't go on. It's just too
hard." And then he does say to her, "Hard is what it's
about. If it were easy, somebody else would do it."

It is not easy for you facing the future as primary care
physicians, but it is not easy for us either as American
citizens facing the uncertain future of an unreformed health
care system that will continue to undermine what is best
about the American health care system.

At times when the path seems difficult in medical school
or internship or residency or on Capitol Hill, I hope we will
all remember what the President said a year ago when he spoke
to the nation about the need for health care reform.
Somebody we will reach a point when it will be unthinkable
that there was ever a time in this country when hard working,
tax-paying Americans couldn't get the health care they

What we have to do, those of us who care about our
future as a country, care about your futures as physicians
must resolve that we will, in our own way, continue this
journey. The journey itself is worth every single step, and
the outcome, which I am confident we will eventually reach,
will certainly be worth what any of us invests in it.

Thank you for your commitment to primary care, and thank
you for being part of the health care system in our country.

(End of tape.)