THE WHITE HOUSE Office of the Press Secretary For Immediate Release September 20, 1993 REMARKS BY THE PRESIDENT, THE FIRST LADY, THE VICE PRESIDENT, MRS. GORE AND DR. C. EVERETT KOOP TO PHYSICIANS AND SUPPORTERS The East Room 8:45 A.M. EDT MRS. CLINTON: Good morning, and thank you all -- please be seated -- for joining us. We were talking so much with Dr. Koop in the back, none of us heard our names. (Laughter.) And so that's one of the reasons we were a little bit slow getting here. I want to welcome you to the White House. I want to thank you for coming and being part of this process that we believe will lead to the kind of reforms in our health care system that many of you have talked about, have spoken about, and have actually done in the practices you have, in the centers in which you practice, at the medical schools that you direct. And it is a particularly exciting moment for all of us to be on the brink of what we hope will be the kind of changes that will assure health security to every American and give opportunities, again, to physicians and nurses and those on the front lines of health care to make the decisions about what needs to be done for the patients in our country. I want to acknowledge Secretary Donna Shalala who is here. (Applause.) She's not only doing an excellent job at HHS, there are some who will argue that she may be the best golfer in the administration. (Laughter.) She played with the President last weekend. Also Dr. Joycelyn Elders, our newly confirmed Surgeon General is back there. (Applause.) I think when it comes to prevention and communicating with large groups of Americans who have not been part of the health care system but need to be for their own and their families well-being, Dr. Elders will be an extraordinary voice. Dr. Phil Lee, the longtime advocate for -- (applause) -- for better health care for Americans. We enticed him out of his position, which I think he thought was a position he would not move from in California to come back. And I personally have been very grateful for Dr. Lee's counsel and advice throughout this process. Ira Magaziner, Dr. Judy Feder, others who are here. Judy and Ira, if you would stand. (Applause.) The team that they have put together, thanks to many of your institutions, which as several of the deans of the medical schools have told me, have meant you've lost people for long periods of time to be part of this process. We are very grateful. I also want to thank the chairs of the Health Professions Review Group, Dr. Steve Gleason and Dr. Irwin Redlener, if you would stand please. (Applause.) And there are many others who are in this room who have been such great helps to us and will continue to be as we move forward. I'm particularly pleased that an old friend of mine, Dr. Terry Brazelton would be here. Dr. Brazelton, who gives the kind of -- (applause) -- gives the kind of confidence to young mothers that Dr. Spock used to give to mine and that many of you have given. And we're very grateful for that. We want to spend a few minutes this morning talking about where we go and how we get there and how we hope all of you will be involved in this process. And I would like to introduce the Vice President to say a few words about the way this relates to what we're doing across the board in the administration. Vice President Al Gore. (Applause.) THE VICE PRESIDENT: Thank you very much. Distinguished guests, ladies and gentlemen. I want to thank the First Lady for her introduction and leadership in this whole initiative. This is the week that was, as they say. And it's wonderful to see so many physicians who are here and who are so strongly supportive of the President's efforts to reform our health care system. I might say that it's a special honor to be with Dr. Koop. I look forward to his comments later. He and I had a chance to work together on a number of projects in the last several years. And it is always refreshing to hear his views. It's very interesting to take stock of how much things have changed in so short a period of time. The debate on health care is now dominating our national debate about where we go as a country. No one any longer doubts that we are going to reform our nation's health care system. Now the debate is about exactly how and what kinds of changes. It's very refreshing. I heard kind of a throwback in the last couple of days from someone who is resisting change who made a point that I haven't heard in quite a while. He said, we have the finest health care system in the world. And in many ways, of course we do. But he said, we have to resist tinkering with it because it's just -- it's great. Well, when I heard that I thought about an event last week when the President and I went over to Children's Hospital. The First Lady was out at Mayo Clinic and leading a number of events in Minnesota that day. Tipper was talking with mental health care groups. The President and I went over to Children's Hospital and talked with doctors and nurses there about the current system and what it means to them just in terms of the sheer paperwork and bureaucracy and red tape. As is often the case when a big change comes, people suddenly realize they have not allowed themselves to feel the weight of how bad things were until they can see the hope for change. Well, that's the message that we heard over there, as these doctors and nurses were saying. Since we sat down and really measured this, we didn't realize what we were doing. One patient comes in here under Medicare, and we have to fill out 26 different forms for that one patient. We went to the file room, the stack of paperwork is growing six and a half feet per day -- just in one hospital. And one doctor said that in adding up the amount of time that he spent on paperwork, he could have seen an extra 500 patients per week -- I believe it was per week -- per year, I'm sorry. (Laughter.) I don't want to get carried away with this. No, I don't think it was per year. I think it was more than one per day. MRS. CLINTON: It was one and a half per day. THE VICE PRESIDENT: In any event, it was a lot. (Laughter and applause.) The main point is, the paperwork and the red tape and the bureaucracy is so overwhelming, when people now finally let themselves look at it and realize what they've been doing -- now, I believe I've got this statistic right. A pediatrician said that she was spending 25 hours -- believe it or not -- 25 hours per week just filling out forms for her patients. Is that right? Okay. (Laughter.) The heads are nodding yes on that one. (Laughter.) Well, that's crazy. And we have been in the midst of this effort to reinvent government and we've been spotlighting the ways in which the system is very inefficient across the board. And there are so many similarities between what needs to be done government-wide and what needs to be done in the health care system. This new approach is going to be simple -- one form per patient. It is going to be effective. It is going to extend health care coverage. And it's going to eliminate the waste and inefficiency. And we are all very excited about it and very pleased that you are here to help start this important week. Thank you. (Applause.) MRS. CLINTON: I also now want to introduce someone who has been deeply involved in this. I know that there are representatives here from the American Psychiatric Association, other mental health professions, along with the APA, have worked very hard with Tipper Gore to come up with a proposal that would move our country forward on the treatment of mental health problems. And I'm very proud to introduce Tipper Gore. (Applause.) MRS. GORE: Thank you. I want to add my voice in word of welcome to all of you and my deep gratitude for the work that you have given to the health care reform. And many of you have had direct input in the proposals on mental health. I see many people that I've worked so closely with and, as Mrs. Clinton said, when I addressed the American Psychiatric Association in the spring, it was really a wonderful event in which there was a meeting of the minds about the direction in which health care reform should go and the place that mental health care should have in it. And I'm very proud to say that within this administration mental health, which has long been discriminated against, has been analyzed and debated along with all the other issues right from the very beginning. And that is a very revolutionary first step. For those of you who have worked very hard on the proposal, thank you so very much for your input and your efforts. And just know that I will continue to work with you in the years ahead to make sure that American citizens have the very best mental health care that we can give them. Thank you. (Applause.) MRS. CLINTON: One of the goals of the next weeks as we move forward is to be sure that all of the voices of those who are most involved in delivering health care will be heard. We believe that in coming forward with a plan that reflects what we have learned from listening and meeting with many of you and thousands of people around this country who are providing care that we have really sparked what will culminate in the final reform effort. But we cannot get there without all of your involvement. Many of you in the last months have shown us why we can do what we think we can do in this country. You have through your practices shown how costs can be contained without in any way impacting quality. You have shown us how we can fairly finance a system if everybody is in it and everybody is responsible. You have convinced us of the importance of simplifying the system to get to the real problems that so many of you face. We know there will be not only considerable discussion but probably even a very vigorous one in all kinds of settings around our country. And we welcome that, because we believe that this is an issue on which there are so many things to learn. And although we've tried to get it right, we are still getting it right. As the Vice President said, I was in Minnesota on Friday talking with people from the university, from Mayo who have very specific suggestions about how to make it even better, which we are bringing back and incorporating. In order to be sure that we continue to get that kind of involvement and feedback from the medical profession, we have scheduled a series of forums across the country that will bring together doctors and other local and national health care leaders to discuss various aspects of reform. It is our hope that these forums will serve as sounding boards for doctors who want to share their ideas about change, and as classrooms for ordinary citizens who want to learn more about our health care system. We are starting at two different levels at one time. There are many, not only those in this room but in other positions around our country, who know a great deal about how the health care system works and how it could be reformed to work better. There are others who are just beginning to focus their minds and attention on this. We want to be sure that the debate is as well informed as possible, because we believe that a well-informed debate will lead to the right solution for America. It is our good fortune that Dr. C. Everett Koop has agreed to lead these panel discussions. He is one of the most thoughtful, courageous and independent health care leaders in the nation. During almost a decade as or nation's Surgeon General, he moved every American with his powerful messages about the AIDS crisis, the perils of smoking, and the murderous plague of urban violence. For many years, Dr. Koop has campaigned to reform the health care system. He has been an passionate advocate of primary and preventive care, of universal coverage and cost containment. He has helped foster a new philosophy of medical education that emphasizes better communications between doctors and patients. And always he has stirred the consciences of all Americans by prodding each of us to be more responsible for our own health. Dr. Koop's unwavering dedicating to improving our individual and collective health makes him uniquely qualified to moderate a national health care discussion in the months ahead. The work that he is doing at Dartmouth -- the work that demonstrates that very often there is no difference in quality between a coronary bypass priced at $20,000 and a coronary bypass priced at $80,000; the work that he is doing with courageous and forward-thinking leaders around our country who are already keeping costs below inflation without sacrificing one bit of patient care; the kind of work that he and his colleague, Dr. Wennberg, who is here, are doing to show that better allocation of our resources will result in no diminution of quality, but in fact, better quality in many instances because more people will be brought into the system in a more cost-effective, quality-driven way. It was certainly influential to all of us, as we began to look for the kind of data that supports the sort of things and feelings and attitudes that many of you have expressed based on your own practice. If we can indeed take the physicians at Children's Hospital and relieve from them the Medicaid paperwork that is not related to patients records so that they could fulfill the promise that they made to themselves in front of the President and the Vice President, that for those 200 doctors on staff, each could then see approximately 500 more patients, that would be 10,000 more children just in Washington, DC, who could be taken care of. That's the promise of health care reform. And that is the hope we bring to this national discussion with all of you and why we're so pleased that Dr. Koop has been willing to take this leadership role. Dr. C. Everett Koop. (Applause.) DR. KOOP: Thank you very much. I know when people come to Washington, even sophisticated physicians, they like to go home having picked up some inside information. I'll let you in on a conversation that took place about two years ago when that grand old gentlemen Claude Pepper died and went directly to heaven. He had an audience with God and said, sir, just one question. Will there ever be health care reform in the United States? And the Lord answered and said, yes, Senator, there will be health care reform in the United States. That's the good news. The bad news -- not in my lifetime. (Laughter.) Since I left office as your Surgeon General four years ago, I have really dedicated most of my time and energy to speaking out whenever and wherever I could all across the United States on the need for health care reform. At first mine seemed like a lonely voice out there. But now at long last, health care reform has moved to the top of the national agenda. And I thank President Clinton and the American people for placing it there. A few weeks ago, I told the President that without passing a single law or issuing a single regulation, he had accomplished more in health care reform in the past four months than all of his living predecessors put together. (Applause.) And he did that with a special kind of leadership that is willing to take on an enormous task. This kind of leadership also takes courage because it's a daunting task to face runaway health care costs, the vexing issue of universal access, the malpractice mess, the mounting problems of Medicare and Medicaid, the application of outcomes research, a sweeping reassessment of medical ethics, to say nothing of rooting out fraud and waste and abuse and greed. Like many of our big national problems, the health care crisis in America is a very complicated one. And that means it will call for a variety of solutions. They, of course, will be national, but that means regional and local. They will have to be a public- private partnership. And there is a way in which every citizen must make a personal contribution. But the President knows that there is no panacea, there is no single magic bullet, and there are no easy answers, only a series of very difficult choices. The administration's health care reform initiative is comprehensive, it's complex, it's -- well, it's complicated. And that's because it is offered in the spirit of compromise. President Clinton has told me that he views these health care proposals not as a take it or leave it package, but as what they are -- proposals -- proposals that will lead to constructive debate and not just to constructive debate but then to constructive legislation. Some things, like universal access, are not negotiable. And that's exactly the way it should be. (Applause.) But they are proposals offered in trust that an honest congressional and public debate will bring out the best in health care reform for the American people. Now, I don't imagine that any one of us will agree with everything, every single point in the proposed reforms. I imagine the President has his own reservation about some points. When I read the first draft of the plan, I was impressed with the attention that had been given to detail: present situations that should be eliminated, needed additions that would be made. I was supportive of the plan, even if there was specific issues with which I disagreed. Later, I was also pleased that suggestions I made in a critique of the plan did not fall on deaf ears. Whether there are pieces of the administration's health plan that you don't like or not, we have to move forward with dialogue seeking consensus. But our reservations, or even outright objections, to some provisions cannot give us the excuse to oppose everything. My concerns about some issues will not stop me from fighting for the many reforms the American health care system so desperately needs. And I hope you'll approach the reform proposals in exactly that same spirit. It is in this spirit of dialogue and constructive debate that I have agreed, as the First Lady said, to moderate a dialogue between the medical profession and the administration a series of panel discussions scheduled this fall and winter in a number of cities across America. Now, these forums could, for example, combine the views and expertise of national health care figures with those of local physicians and other health care workers so they can, together, thrash out the issues of the reform proposals before the profession as they relate to a local region. Physicians have been noticeably absent from past efforts to reform the American health care system, even when it turned out that physicians proved to be among the major beneficiaries, as with Medicare. Indeed, all too often, past health care reform measures have been imposed upon physicians, often against their loudly voiced opposition. This time, doctors cannot allow themselves to be cast in the role of naysayers. In one way or another, doctors' decisions for their patients and themselves drive the entire health care system. And, therefore, I call upon the medical profession in which I have served for over half a century to assume its rightful position of leadership to drive the health care system to the reformed excellence that it can deliver. (Applause.) Our health care system may function with compassion, with competence, at times with sheer excellence. But not for enough Americans. For too many Americans, our health care system is a tyranny, and that means for them it is more a curse than it is a blessing. The next decade will force us to do some very hard thinking and deciding about the basic purpose of medicine. We haven't done much of that in days gone by. For most of human history, medicine really couldn't do very much, really couldn't cure anything. And so, at best, it offered some comfort, some relief of symptoms. And, then, beginning in the 18th century -- and remember that modern medicine and the United States are about the same age -- with the application of science and technology to medicine, we saw the age when medicine could begin to cure many problems, and it could prolong the life for millions of people. And we entered the age of what we now call "our medical miracles." But a still other age may be dawning as we come to grips with the limits of curative and reparative medicine and surgery. Today, in a strange way, hospitals and doctors -- in fact, the entire health care community -- are victims of their own success in curing disease and alleviating suffering. Increasingly, medicine decreases mortality while it increases morbidity. In other words, we have many more people living longer, but some of them are living sicker. And an increasing share of health care resources are allotted to those whom medicine cannot cure and we know about that at the start. Too much, however, of the intensifying debate about health care focuses only on questions of how we finance it on the economic and political dimensions of health care reform. I think, for many of us, this puts the cart before the horse. More important, I think, than the economic and political pressures is the ethical imperative for health care reform.