(The following is an actual transcript of President Clinton's health-care
speech AS DELIVERED to a joint session of Congress on Wed., Sept. 22, 1993,
including changes from the prepared text that was released earlier on this
health-reform mailing list.)

THE WHITE HOUSE

Office of the Press Secretary

For Immediate Release September 22, 1993

ADDRESS OF THE PRESIDENT
TO THE JOINT SESSION OF CONGRESS

U.S. Capitol
Washington, D.C.

9:10 P.M. EDT

THE PRESIDENT: Mr. Speaker, Mr. President, members of
Congress, distinguished guests, my fellow Americans. Before I begin
my words tonight I would like to ask that we all bow in a moment of
silent prayer for the memory of those who were killed and those who
have been injured in the tragic train accident in Alabama today. (A
moment of silence is observed.) Amen.

My fellow Americans, tonight we come together to write a
new chapter in the American story. Our forebears enshrined the
American Dream -- life, liberty, the pursuit of happiness. Every
generation of Americans has worked to strengthen that legacy, to make
our country a place of freedom and opportunity, a place where people
who work hard can rise to their full potential, a place where their
children can have a better future.

From the settling of the frontier to the landing on the
moon, ours has been a continuous story of challenges defined,
obstacles overcome, new horizons secured. That is what makes America
what it is and Americans what we are. Now we are in a time of
profound change and opportunity. The end of the Cold War, the
Information Age, the global economy have brought us both opportunity
and hope and strife and uncertainty. Our purpose in this dynamic age
must be to change -- to make change our friend and not our enemy.

To achieve that goal, we must face all our challenges
with confidence, with faith, and with discipline -- whether we're
reducing the deficit, creating tomorrow's jobs and training our
people to fill them, converting from a high-tech defense to a high-
tech domestic economy, expanding trade, reinventing government,
making our streets safer, or rewarding work over idleness. All these
challenges require us to change.

If Americans are to have the courage to change in a
difficult time, we must first be secure in our most basic needs.
Tonight I want to talk to you about the most critical thing we can do
to build that security. This health care system of ours is badly
broken and it is time to fix it. (Applause.)

Despite the dedication of literally millions of talented
health care professionals, our health care is too uncertain and too
expensive, too bureaucratic and too wasteful. It has too much fraud
and too much greed.

At long last, after decades of false starts, we must
make this our most urgent priority, giving every American health
security; health care that can never be taken away; health care that
is always there. That is what we must do tonight. (Applause).

On this journey, as on all others of true consequence,

there will be rough spots in the road and honest disagreements about
how we should proceed. After all, this is a complicated issue. But
every successful journey is guided by fixed stars. And if we can
agree on some basic values and principles we will reach this
destination, and we will reach it together.

So tonight I want to talk to you about the principles
that I believe must embody our efforts to reform America's health
care system -- security, simplicity, savings, choice, quality, and
responsibility.

When I launched our nation on this journey to reform the
health care system I knew we needed a talented navigator, someone
with a rigorous mind, a steady compass, a caring heart. Luckily for
me and for our nation, I didn't have to look very far. (Applause.)

Over the last eight months, Hillary and those working
with her have talked to literally thousands of Americans to
understand the strengths and the frailties of this system of ours.
They met with over 1,100 health care organizations. They talked with
doctors and nurses, pharmacists and drug company representatives,
hospital administrators, insurance company executives and small and
large businesses. They spoke with self-employed people. They talked
with people who had insurance and people who didn't. They talked
with union members and older Americans and advocates for our
children. The First Lady also consulted, as all of you know,
extensively with governmental leaders in both parties in the states
of our nation, and especially here on Capitol Hill.

Hillary and the Task Force received and read over
700,000 letters from ordinary citizens. What they wrote and the
bravery with which they told their stories is really what calls us
all here tonight.

Every one of us knows someone who's worked hard and
played by the rules and still been hurt by this system that just
doesn't work for too many people. But I'd like to tell you about
just one.

Kerry Kennedy owns a small furniture store that employs
seven people in Titusville, Florida. Like most small business
owners, he's poured his heart and soul, his sweat and blood into that
business for years. But over the last several years, again like most
small business owners, he's seen his health care premiums skyrocket,
even in years when no claims were made. And last year, he painfully
discovered he could no longer afford to provide coverage for all his
workers because his insurance company told him that two of his
workers had become high risks because of their advanced age. The
problem was that those two people were his mother and father, the
people who founded the business and still worked in the store.

This story speaks for millions of others. And from them
we have learned a powerful truth. We have to preserve and strengthen
what is right with the health care system, but we have got to fix
what is wrong with it. (Applause.)

Now, we all know what's right. We're blessed with the
best health care professionals on Earth, the finest health care
institutions, the best medical research, the most sophisticated
technology. My mother is a nurse. I grew up around hospitals.
Doctors and nurses were the first professional people I ever knew or
learned to look up to. They are what is right with this health care
system. But we also know that we can no longer afford to continue to
ignore what is wrong.

Millions of Americans are just a pink slip away from
losing their health insurance, and one serious illness away from
losing all their savings. Millions more are locked into the jobs
they have now just because they or someone in their family has once

been sick and they have what is called the preexisting condition.
And on any given day, over 37 million Americans -- most of them
working people and their little children -- have no health insurance
at all.

And in spite of all this, our medical bills are growing
at over twice the rate of inflation, and the United States spends
over a third more of its income on health care than any other nation
on Earth. And the gap is growing, causing many of our companies in
global competition severe disadvantage. There is no excuse for this
kind of system. We know other people have done better. We know
people in our own country are doing better. We have no excuse. My
fellow Americans, we must fix this system and it has to begin with
congressional action. (Applause.)

I believe as strongly as I can say that we can reform
the costliest and most wasteful system on the face of the Earth
without enacting new broad-based taxes. (Applause.) I believe it
because of the conversations I have had with thousands of health care
professionals around the country; with people who are outside this
city, but are inside experts on the way this system works and wastes
money.

The proposal that I describe tonight borrows many of the
principles and ideas that have been embraced in plans introduced by
both Republicans and Democrats in this Congress. For the first time
in this century, leaders of both political parties have joined
together around the principle of providing universal, comprehensive
health care. It is a magic moment and we must seize it. (Applause.)

I want to say to all of you I have been deeply moved by
the spirit of this debate, by the openness of all people to new ideas
and argument and information. The American people would be proud to
know that earlier this week when a health care university was held
for members of Congress just to try to give everybody the same amount
of information, over 320 Republicans and Democrats signed up and
showed up for two days just to learn the basic facts of the
complicated problem before us.

Both sides are willing to say we have listened to the
people. We know the cost of going forward with this system is far
greater than the cost of change. Both sides, I think, understand the
literal ethical imperative of doing something about the system we
have now. Rising above these difficulties and our past differences
to solve this problem will go a long way toward defining who we are
and who we intend to be as a people in this difficult and challenging
era. I believe we all understand that.

And so tonight, let me ask all of you -- every member of
the House, every member of the Senate, each Republican and each
Democrat -- let us keep this spirit and let us keep this commitment
until this job is done. We owe it to the American people.
(Applause.)

Now, if I might, I would like to review the six
principles I mentioned earlier and describe how we think we can best
fulfill those principles.

First and most important, security. This principle
speaks to the human misery, to the costs, to the anxiety we hear
about every day -- all of us -- when people talk about their problems
with the present system. Security means that those who do not now
have health care coverage will have it; and for those who have it, it
will never be taken away. We must achieve that security as soon as
possible.

Under our plan, every American would receive a health
care security card that will guarantee a comprehensive package of
benefits over the course of an entire lifetime, roughly comparable to

the benefit package offered by most Fortune 500 companies. This
health care security card will offer this package of benefits in a
way that can never be taken away.

So let us agree on this: whatever else we disagree on,
before this Congress finishes its work next year, you will pass and I
will sign legislation to guarantee this security to every citizen of
this country. (Applause.)

With this card, if you lose your job or you switch jobs,
you're covered. If you leave your job to start a small business,
you're covered. If you're an early retiree, you're covered. If
someone in your family has, unfortunately, had an illness that
qualifies as a preexisting condition, you're still covered. If you
get sick or a member of your family gets sick, even if it's a life
threatening illness, you're covered. And if an insurance company
tries to drop you for any reason, you will still be covered, because
that will be illegal. This card will give comprehensive coverage.
It will cover people for hospital care, doctor visits, emergency and
lab services, diagnostic services like Pap smears and mammograms and
cholesterol tests, substance abuse and mental health treatment.
(Applause.)

And equally important, for both health care and economic
reasons, this program for the first time would provide a broad range
of preventive services including regular checkups and well-baby
visits. (Applause.)

Now, it's just common sense. We know -- any family
doctor will tell you that people will stay healthier and long-term
costs of the health system will be lower if we have comprehensive
preventive services. You know how all of our mothers told us that an
ounce of prevention was worth a pound of cure? Our mothers were
right. (Applause.) And it's a lesson, like so many lessons from our
mothers, that we have waited too long to live by. It is time to
start doing it. (Applause.)

Health care security must also apply to older Americans.
This is something I imagine all of us in this room feel very deeply
about. The first thing I want to say about that is that we must
maintain the Medicare program. It works to provide that kind of
security. (Applause.) But this time and for the first time, I
believe Medicare should provide coverage for the cost of prescription
drugs. (Applause.)

Yes, it will cost some more in the beginning. But,
again, any physician who deals with the elderly will tell you that
there are thousands of elderly people in every state who are not poor
enough to be on Medicaid, but just above that line and on Medicare,
who desperately need medicine, who makes decisions every week between
medicine and food. Any doctor who deals with the elderly will tell
you that there are many elderly people who don't get medicine, who
get sicker and sicker and eventually go to the doctor and wind up
spending more money and draining more money from the health care
system than they would if they had regular treatment in the way that
only adequate medicine can provide.

I also believe that over time, we should phase in long-
term care for the disabled and the elderly on a comprehensive basis.
(Applause.)

As we proceed with this health care reform, we cannot
forget that the most rapidly growing percentage of Americans are
those over 80. We cannot break faith with them. We have to do
better by them.

The second principle is simplicity. Our health care
system must be simpler for the patients and simpler for those who
actually deliver health care -- our doctors, our nurses, our other

medical professionals. Today we have more than 1,500 insurers, with
hundreds and hundreds of different forms. No other nation has a
system like this. These forms are time consuming for health care
providers, they're expensive for health care consumers, they're
exasperating for anyone who's ever tried to sit down around a table
and wade through them and figure them out.

The medical care industry is literally drowning in
paperwork. In recent years, the number of administrators in our
hospitals has grown by four times the rate that the number of doctors
has grown. A hospital ought to be a house of healing, not a monument
to paperwork and bureaucracy. (Applause.)

Just a few days ago, the Vice President and I had the
honor of visiting the Children's Hospital here in Washington where
they do wonderful, often miraculous things for very sick children. A
nurse named Debbie Freiberg told us that she was in the cancer and
bone marrow unit. The other day a little boy asked her just to stay
at his side during his chemotherapy. And she had to walk away from
that child because she had been instructed to go to yet another class
to learn how to fill out another form for something that didn't have
a lick to do with the health care of the children she was helping.
That is wrong, and we can stop it, and we ought to do it.
(Applause.)

We met a very compelling doctor named Lillian Beard, a
pediatrician, who said that she didn't get into her profession to
spend hours and hours -- some doctors up to 25 hours a week just
filling out forms. She told us she became a doctor to keep children
well and to help save those who got sick. We can relieve people like
her of this burden. We learned -- the Vice President and I did --
that in the Washington Children's Hospital alone, the administrators
told us they spend $2 million a year in one hospital filling out
forms that have nothing whatever to do with keeping up with the
treatment of the patients.

And the doctors there applauded when I was told and I
related to them that they spend so much time filling out paperwork,
that if they only had to fill out those paperwork requirements
necessary to monitor the health of the children, each doctor on that
one hospital staff -- 200 of them -- could see another 500 children a
year. That is 10,000 children a year. I think we can save money in
this system if we simplify it. And we can make the doctors and the
nurses and the people that are giving their lives to help us all be
healthier a whole lot happier, too, on their jobs. (Applause.)

Under our proposal there would be one standard insurance
form -- not hundreds of them. We will simplify also -- and we must
-- the government's rules and regulations, because they are a big
part of this problem. (Applause.) This is one of those cases where
the physician should heal thyself. We have to reinvent the way we
relate to the health care system, along with reinventing government.
A doctor should not have to check with a bureaucrat in an office
thousands of miles away before ordering a simple blood test. That's
not right, and we can change it. (Applause.) And doctors, nurses
and consumers shouldn't have to worry about the fine print. If we
have this one simple form, there won't be any fine print. People
will know what it means.