Before we can enact the sweeping reform we need in
health care, we must agree on the basic values and the ethics upon
which our health care system, and, indeed, our society is based, and
from which it draws its moral power.
 
             If we could reach an ethical consensus, I think many of
the economic and political problems of health care reform would fall
rather easily in line. Physicians and allied health workers bring a
broad field of vision to the health care reform effort. Physicians
and nurses, other health care workers, have seen firsthand their
fellow citizens' lack of health insurance go from being just an
economic inconvenience to now being a medical risk factor.
 
             Health workers know from experience that uninsured
Americans are sicker than other patients when they finally enter the
health care system, and their illnesses cost the system more to
treat. And their lack of insurance results in a higher mortality
rate than that of hospitalized Americans who do enjoy adequate health
insurance.
 
             Health care workers have also often seen patchwork
efforts at cost control result merely in cost-shifting -- squeezing
the balloon in one place, only to have it expand in another.
 
             I would suggest that you in this room can bring your
experience and expertise to the debate on health care reform so that
we can preserve what is right and correct what is wrong. In so many
ways, the American health care system, in spite of its many flaws,
offers the best health care in the world. Nevertheless, we must
remember if it ain't broke, don't fix it; but, unfortunately, an
increasingly large share of our system is breaking down. So let's be
sure that we turn our attention to ways that we can fix that.
 
             And so I do call up on the medical community to approach
the health care reform proposals now being offered in the spirit of
our high calling in the Hippocratic tradition that requires us to do
nothing but the best for our patients. Let us make sure that
physicians play their part in making sure that the health care system
we reform offers the very best for the American people. The
President has said he wants a dialogue. Let us accommodate him in
the spirit of reform and of give-and-take.
 
             Physicians are individualists to be sure, but they are
also altruists. And we have come to a time when, for once, the
medical profession and the government can work together to forge a
health care system for all Americans by achieving a new American
consensus. Let me reaffirm that I think the plan is headed and
moving in the right direction. I look forward to lending my support
as I moderate the forthcoming dialogue between the great profession
of medicine and this administration. Thank you. (Applause.)
 
             THE PRESIDENT:  Good morning. I thank you for coming
here, and I thank Dr. Koop for his stirring remarks. He always makes
a lot of sense, doesn't he. And the nation is in his debt for his
work as Surgeon General and now, for the work he is about to
undertake in behalf of the cause of health care reform.
 
             I also want to thank the many physicians from all across
America, from all walks of medical life who have made a contribution
to the debate as it has progressed thus far. I got very interested
in this subject years ago when, as the governor of my state, I
noticed I kept spending more and more for the same Medicaid and had
less and less to spend on the education of our children or on
preventive practices or other things which might make a profound
difference in the future.
 
             In 1990 I agreed to undertake a task force for the
National Governors Association, and I started by interviewing 900
people in my state who were involved in the delivery of medical care,
including several hundred doctors. Some of them are in this room
today. I thank them for their contribution, and I absolve them of
anything I do which is unpopular with the rest of you. (Laughter.)
 
             I'm glad to see my dear friend and often my daughter's
doctor, Dr. Betty Lowe, the incoming President of the American
Academy of Pediatrics. (Applause.)  My cardiologist, Dr. Drew
Kumpuris, who pulls me off a treadmill once a year and tells me I'm
trying to be 25 when I'm not. (Laughter.)  And Dr. Morris Henry from
Fayetteville, Arkansas, back here, an ophthalmologist who hosted the
wedding reception that Hillary and I had in Morris and Anne's home
almost 18 years ago next month. Dr. Jim Weber, formerly President of
the Arkansas Medical Society. A lot of our doctors here -- we
started a conversation with doctors long before I ever thought of
running for President, much less knew I would have an opportunity to
do this.
 
             This is really an historic opportunity. It is terribly
important for me. One of the central reasons that I ran for
President of the United States was to try to resolve this issue,
because I see this at the core of our absolute imperative in this
sweeping time of change to both give the American people a greater
sense of security in the health care that they have, and call forth
from our people -- all of our people, including the consumers of
health care -- a renewed sense of responsibility for doing what we
all ought to do to make this country work again.
 
             I am determined to pursue this in a completely
bipartisan fashion. And I have reached out to both Republicans and
Democrats, as well as the thoughtful Independents to help. There is
one person in the audience I want to introduce, a longtime friend of
mine who has agreed to help mobilize support for this approach among
the Democrats of the country, the distinguished former governor of
Ohio, my friend Dick Celeste, who's here. Thank you for being here.
(Applause.)
 
             When Dr. Koop talked about the ethical basis of this
endeavour, he made perhaps the most important point. If I have
learned anything in all these years of public endeavors, or anything
in the last several months of serving as your President, it is that
once people decide to do something they can figure out how to do it.
 
             When, one week ago today, on the South Lawn of the White
House, Yitzhak Rabin and Yassar Arafat signed that peace accord, they
did not even know what the ultimate map drawing of the city of
Jericho would be, or how all the elections would be held, or how the
Palestinians candidates would advertise on the radio since the radio
stations don't belong to the Palestinians -- I could give you a
hundred things they did not know the answer to. They knew one thing,
they couldn't keep going in the direction they were going and so they
decided to take a different direction.
 
             When President Kennedy's administration challenged this
country to go to the moon, they didn't have a clue about how they
were going to go. The Vice President knows more about science than
I, so he can tell it in a funnier way about they didn't understand
what kind of rocket they were going on and what their uniforms would
be like and on and on and on. But the ethical imperative is perhaps
the most important thing. We have to decide that the costs, not just
the financial costs, but the human costs, the social costs of all of
us continuing to conduct ourselves within the framework in which we
are now operating is far higher than the risk of responsible change.
 
             We have certainly tried to do this in a responsible way.
I want to thank the First Lady and all the people who work with her.
I want to thank Tipper and Ira and Judy and everybody who was
involved in this. We have really worked hard to reach out to
literally to thousands and thousands of people in this great medical
drama that unfolds in America every day.
 
             I want to thank Donna Shalala and the Department of
Human Services for the terrific work they have done. We have really
tried to do this in an embracing and a different way -- almost a
nonpolitical way. If you look around this room we have doctors from
Maine to Washington, from Minnesota to Florida, some of you see
patients in rural Virginia, some in public hospitals, others of you
devote your lives to training the next generation of physicians.
 
             But I think everyone of you is committed to seeing that
we provide the finest health care in the world. That means that as
we undertake this journey of change, we clearly must preserve what's
right with our health care system -- the close patient-doctor
relationship, the best doctors and nurses, the best academic
research, the best advance technology in the world. We can do that
and still fix what's wrong. In fact, we can enhance what's right by
fixing what's wrong.
 
             If we reduce the amount of unnecessary paperwork and
governmental regulation and bureaucracy, that will by definition
enhance the doctor-patient relationship. If we spend less money on
paying more for the same health care and the incentives to churn the
system, we will have some more money, for example, to invest more in
medical research and advanced technology and breaking down the
barriers which still limit our ability to solve the remaining
problems before us.
 
             We need a discussion, we need constructive criticism, we
need constructive disagreement on some points. This is a very
complex issue.
 
             I worked at this for over a year and realized when I was
a governor I was just beginning to come to grips with it. When we
started this great enterprise and I asked Hillary to undertake this
task and she looked at me as if I had slipped a gasket -- (laughter)
-- I knew more about it than she did. Now, she knows a lot more
about it than I do.
 
             This is a learning effort. We are going to start today,
as many of you know, this health care university we call it for
members of Congress, and about 400 members of Congress have signed up
for two intensive days of learning. That is an astonishing thing. I
have never seen anything like it. These members, without regard to
their party and completely without respect to the committees they are
on, since most of them are on committees that would not have direct
jurisdiction over this -- hungering to know what you go through
everyday. Hungering to learn, wanting to avoid making an
irresponsible decision but determined that they should make some
decisions to change this system. I think that is a terrific cause
for hope.
 
             For patients, the reform we seek will mean more choices.
Today employers are too often forced by rising health care costs to
decide which plans to offer their employees, and often they are
inadequate, or too costly. The decision is usually based on the
bottom line and is a moving bottom line as more and more Americans
every month actually lose their health insurance for good. Our plans
give consumers the power to chose between a broad range of plans
within their region, giving them more freedom to find and to stay
with a doctor they like.
 
             For doctors, reform will mean the flexibility to choose
which networks or providers you want to join. If you want to be
involved with one, that's fine. If you want to be involved with more
than one, that's fine, so that whatever you want to do to continue to
see the patients you see today, you will be able to do it -- it's
your choice.
 
             We intend to see a reform that drastically simplifies
this system, freeing you from paperwork and bureaucratic nightmares
that have already been well discussed.
 
             I cannot tell you how moved I was when we were at the
Washington Children's Hospital the other day and we heard not only
the statistics that the hospital has calculated that they spend $2
million a year on paperwork unrelated to patient care and keeping up
with the procedures. But the human stories -- I mean, we had a nurse
actually tell us about being pleaded with by a young child with
cancer to play with the child, and she couldn't do it because she had
to go to a little seminar on how to learn how to fill out a new set
of forms that they were being confronted with. And she said, that
really was a picture of what their life was like -- an eloquent
doctor who said she wanted to live in Washington, D.C., she wanted to
care for the poor children in the area. She did not go to medical
school to spend her life pouring over a piece of paper. And all of
you have had that experience.
 
             We can do better than this. We also know we're going to
have to trim back government regulations that get in your way and do
little to protect the patients or provide better care. If we
simplify the system, we will reduce the apparently insatiable
bureaucratic urge that runs through administrations of both parties
and seems to be a permanent fixture of our national life to
micromanage whatever aspect of tax dollars they have some
jurisdiction over. We are determined to undo much of that. We want
to respect your training, your judgment and your knowledge, and not
unduly interfere with what you do.
 
             We also are determined to preserve the quality of health
care that our people receive. Today, part of the reason we have the
finest doctors in the world are the academic health centers. For
years they have been the guardians, the guarantors, of quality --
training doctors and health care professionals and reaching into
surrounding communities to provide help for those in need.
 
             In the coming years, these centers, if our plan passes,
will have even greater responsibility to turn out high quality
physicians, particularly primary care physicians who will work in
underserved areas, and to create a system of lifelong learning for
health care professionals. And they must continue to expand their
partnerships with communities around them.
 
             The initiative I am offering offers the possibility of
giving real building blocks to this nation's health care system to
fill in a lot of the gaps which exist for millions of Americans --
not just universal coverage gaps, but also organizational problems
and the lack of adequate access.
 
             I want this plan to be fair, compassionate and
realistic, and I believe it is. Health security can be provided to
the American people so that you don't lose your health care when you
lose your job; you don't get frozen into a job because someone in
your family has been sick and you're in the grip of the preexisting
condition syndrome, which is literally undermining labor mobility in
a world where the average 18-year-old American must change work eight
times in a lifetime to be fully competitive. When security means the
ability to continuously learn and find new and evermore challenging
work, not to stick in the same rut you're in anymore, we don't have
that option. We are literally rendering people insecure through job
lock -- undermining their potential, keeping them from moving on, and
also keeping others from moving up into the positions they previously
held. This is a serious economic problem.
 
             This plan will guarantee that every patient who walks in
your door is covered. It will make sure you are paid to keep your
patients healthy as well as to treat them when they're sick. It will
give you the flexibility and freedom you need to do your jobs. In
return, it must demand more responsibility from all of us. We must
have a new generation of doctors which has a recommitment to primary
care. We don't have enough primary care physicians in America, and I
think we all know it. We have to care about family practice,
pediatrics and preventive medicine. And we all have to work together
to get medical costs under control.
 
             But I'm convinced with your leadership we can do that.
Without your help, we could not have covered as much ground as we
have covered so far. I thank Dr. Koop for what he said. But the
attention to detail by this project is the direct result of the
painstaking effort and the hours that have been provided by
physicians and other health care providers who have come to this town
and spent day after day after day after day almost always at their
own expense just to do something to help their country as well as to
improve the quality of their own practice. We know that this will
not be done overnight. We know that we will have to have a long-term
commitment from individuals, from government, from businesses and
from health care professionals. But we know that we have to begin
now. This is a magic moment.
 
             Let me just say two things in closing. There are a lot
of other things we haven't discussed, and I know that, but we didn't
come here for a seminar on the details of it. We are trying some
innovative approaches to the malpractice problem, which I think will
find broad favor. We are going to do some things that will increase
public health clinics' ability to access people who are otherwise
left out of the system, and try to deal with these horrible
statistics on immunization and the absence of prenatal care. There
are a lot of those things that are going to be dealt with.
 
             But I want to make two points in closing. First of all,
there are a lot of disconnects as you might imagine between
Washington, DC, and the rest of America, which everybody loves to
talk about when they get alienated from the federal government. But
one of the most amazing in this has been the following thing. I
don't talk to any doctor or any hospital administrator or any nurse
with any seniority in nursing who doesn't believe that there's a huge
amount of waste in this system that has nothing to do with caring for
people which can be gotten rid of. I don't talk to anybody in
Washington who thinks you can do it. (Laughter and applause.)
 
             Our friends in the press are laughing because you know
I'll finish this talk, then they'll go talk to somebody on the Hill
who will say, aahh, they can't save that money in Medicare and
Medicaid. It's got to be that way. We really need a room under the
garage in the Children's Hospital in Washington, DC, which is piling
up paper six and a half feet a day. We've got to have that. How
would we function?
 
             Hillary goes to the Mayo Clinic; they've already got
their annual average cost increases now down under 4 percent. And we
talk about maybe getting it down over the next three or four years to
inflation plus population plus 2 percent, and they talk about how we
are slashing Medicare and Medicaid, when what we really want to do is
take the same money and not take it out of health care, but use it to
cover the uninsured, unemployed; use it to cover some new services to
do more preventive primary health care. So this is an interesting
thing that Dr. Koop said in the past, reform has been imposed on the
doctors. You might have to come up here and impose it on the
politicians and the bureaucrats. (Applause.)  You may have to do
that.
 
             I say that not to be critical of the Congress. We are
all -- all of us see the world -- (laughter) -- no, no, no -- I don't
-- all of us see the world through the prism of our own experience,
don't we?  You do, I do -- we all do that. And they are so used to
believing that the only way they can be decent stewards of the public
trust, to take care of the poor on Medicaid and the elderly on
Medicare. They are so used to believing that the only way they can
do it is just to write out a check to pay more for the same health
care, never mind of it's two or three or four times the rate of
inflation; never mind if there's a 16-percent increase in the
Medicaid budget for the coming year, when we estimate no more than a
two-percent increase in the enrollments in Medicaid.
 
             We're just so used to believing that in this town that
we have to have your help to believe that it can be different, and
you can enhance the care people get, not undermine it. I don't want
to minimize that. Yes, we need your critical scrutiny of the
specific plan the administration will propose. Yes, we do. But we
also need for you to convince the people who live here, who believe
we are trapped in this system, that it can be different. And you are
the ones who have responsibility for caring for people. If you can
believe it can be different, you can convince the Congress that it
can be different, that they are not going to hurt, they are going to
help, by making some of these changes.
 
             The second point I want to make in closing is this:
This is really a part of a great national discussion we have to have
about what kind of people we are and what kind of country we're going
to be. And Dr. Koop said it better than I could, but we can't really
get the kind of health care system we need until there is a real
renewed sense of responsibility on the part of everyone in this
system. It is terribly important to recognize that we have certain
group behaviors in this country that, unless they are changed, we
will never get health care costs down to the level that our
competitors have.
 
             It's not just high rates of AIDS and excessive smoking;
it's high rates of teen pregnancy, of low birth weight, of poor
immunization of children. It's outrageous rates of violence that we
willfully refuse to deal with by taking away the main cause of it,
which is the unrestricted access that young people in our most
violent areas have to guns that give them better weapons --
(applause.)
 
             Yes, within the health care system, doctors shouldn't
perform unnecessary procedures, patients shouldn't bring frivolous
malpractice suits, people who use the health care system now, who
aren't in it now, are going to have to pay a little for their health
care, so they realize there is a price for everything instead of when
all of the money just comes from a third party source they don't
know. There needs to be more responsibility within this system, but
we also have got to remember that if we can plant the ethical roots
that Dr. Koop talked about, we may then be able not only to change
this system, but to use this success to try to change some of the
destructive group behavior that is tearing this country apart.
 
             But believe me, it all begins here. If we can give the
security of decent health care to every American family, it will be
the most important thing that the government has done with -- not
for, but with -- the American people in a generation. And it can
only happen if people like you lead the way.
 
             Thank you very much. (Applause.)
 
             MRS. CLINTON:  We'd like to invite all of you now to
join us for breakfast in the State Dining Room. And the President
and the Vice President will be in the Red Room, and we hope people
will come in and meet them. They'd like to meet all of you
personally to thank you for being here. So, please, join us for
breakfast.
 
             Oh, and could I also -- we just -- I just learned Dr.
Arthur Flemming is here. And talk about a reform advocate for
many decades and a strong supporter of what this President is trying
to do, Dr. Fleming(?), thank you very much. (Applause.)
 
                              * * * * *
 
             Q    Mr. President, is Senator Moynihan wrong?
 
             THE PRESIDENT:  -- you heard what he said yesterday?
What he said was absolutely right. I mean, based on the experience
of the last decade, you can't get the cost down to zero, but that's
not what we proposed. We proposed working over a five-year period to
move the government's cost to inflation plus population growth. And
in the beginning -- we have inflation plus population growth plus
another two or three percent. You do have -- where this group care
is working well, like at the Mayo Clinic, they now are down to less
than inflation plus population growth. So I believe that if you give
us five years to do it, we can get there. But it will require some
substantial changes.
 
             What I said was true. People in Washington can't
imagine that it can be different because of the experiences they've
had over the last five years. But to say we're trying to cut
Medicare and Medicaid -- it's not true. We propose never to take it
below inflation plus population growth.
 
                                 END9:35 A.M. EDT