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THE FIRST LADY'S SPEECH
BEFORE THE AMERICAN
LEGION'S ANNUAL CONFERENCE
AT THE SHERATON WASHINGTON HOTEL
February 15, 1994
MRS. CLINTON: -- officially at the Olympics, just over the
weekend. And I am so -- (Applause.) MRS. CLINTON: I'm so
proud of our young people who are there competing, and it just gave me an
enormous thrill, especially when I was able to attend the medal ceremony
for the young man from Alaska, who won the downhill skiing (inaudible)
-- (Applause.) MRS. CLINTON: -- the highlight of the
(inaudible). I am so honored to be here with your Secretary for
Veterans' Affairs and, boy, is he a good representative for all of you.
(Applause.) MRS. CLINTON: Secretary Brown brings to the
councils of the government his experience and his perspective; and those of
you who know him know that he is not shy about expressing both, and he has
been a very valued member of the President's Cabinet. I want to
thank the commander for that very kind introduction and all of the
officers, both current and former, who are here with us today. I especially
want to thank the members of the Auxiliary who are here. I had a
wonderful relationship with our Auxiliary in Arkansas during the many years
that I attended and I am very appreciative of all your hard work.
(Applause.) MRS. CLINTON: The work that the Legion and the
Auxiliary do on behalf of our young people is unparalleled; and I don't
think that we could have the quality of life that we have enjoyed in our
country all of these years had it not been, in many communities, for the
Legion and the Auxiliary, and I'm very grateful to you. I'm also
particularly grateful for the fine work you do with respect to the blood
drives every year. You know that we have a shortage of blood in many
regions of our country and, in many regions, the Legion is the number
one organizer for blood drives, and I want to thank all of you for
that, as well. (Applause.) MRS. CLINTON: It is always a
privilege, as it was for me during this past year, to meet with
representatives of our various veterans' organizations. I want to echo both
the words of the secretary and the commander in thanking the officers
and staff of the American Legion for the countless hours that you gave in
working with the VA and working with the Presidential task force on health
care. I came to this task without many preconceptions, when my
husband asked me if I would work on the whole challenge of reforming our
health care system, but I came with a personal bias in favor of the VA and
the veterans' health systems, which I think I was able to inherit. It
was passed on genetically, by my father to me. And I remember many
times, as I have shared with Roger and some others in meetings over the
past years, that one of the things my father could never understand was
why, as a veteran, he couldn't continue to use the VA system all
through his life. He had to view that as a taxpayer and a veteran, and if
he wanted to take his dollars, whether they were private dollars or
Medicare dollars, to the VA system, he should have been able to be
permitted to do so. So I admit, I came with a bias that my father
planted, indeed, very early, and I intend to do everything that I can
(inaudible) -- (Applause.) MRS. CLINTON: As many of you
probably know, my father died last year and, in his series of illnesses
over the last decade, the constant conversation we would have about his
desire to be able to use the VA system -- and I think it was as much a
sense of his belonging, as anything else. But it was one that really made a
big impression on me. But it was not only what he told me over the years.
It was reinforced many times over, as I have traveled the country.
One of the great privileges I have had in this past year is literally
to go from Maine to Hawaii, from Florida to Washington, and to visit with
thousands of Americans, both in person and through their letters. I have
now received a million letters from people. I wish you could read even
a fraction of them. They are letters from all kinds of Americans.
And I carry this movie in my head of the faces and the stories that I
have been told, and I want to start with just one that seared in my brain
what my father had told me and what many of you have shared with me over
this past year about the need for us to strengthen and enhance our VA
system and to make it a possible health care alternative for
veterans. I was in New Orleans and I was visiting with a group of
workers at a small factory there. Most of the men I was talking with did
hard, manual work every day. They were good, steady employees. Most of them
had worked for the same employer for 15 years, some as many, as I recall,
28 years. Most of them were veterans. They did not have any health care
benefits through their employer. They did not make enough money to be able
to afford insurance on their own. And the stories they told me were ones
that had become all too familiar but they were especially poignant, being
told by veterans. I will never forget a young man -- by my
standards these days, anyone in his 40s is young -- a young man, a
Vietnam veteran, a hard worker, a taxpayer, a family man, -- but without
much education so the job that he had, which was his source of livelihood
for himself and his family probably paid him, after a hard week's work,
less than $20,000 -- telling me that he just prayed that his children
wouldn't get sick, he just prayed that he wouldn't get sick, and they
always postponed going to the doctor. And, when he did finally have to go
to the doctor, it was usually at the last possible moment and he would
enter our health care system through the emergency room, which is all too
common for those working Americans without insurance who number now upwards
in the 30 millions. And he looked at me, and he wasn't asking for
any special treatment. He wasn't asking even for sympathy. He just
wanted to explain to me what his life was like. He said, "You know, the
proudest years of my life were when I served in the military, and I'm proud
to be a veteran, but I sure don't understand why I can't get health care in
the civilian world the way I could when I wore a uniform. That really
made a big impression on me, and his story could be told by countless
others. About six months later, I was out at Andrews Air Force
Base for their annual air show and I was shaking hands along a rope line.
And a man in uniform grabbed my hand and he said, "I want you to know
something. I'm in the Reserve. I don't have any health insurance. My
family doesn't have any health insurance. I'm proud to be a veteran. I'm
proud to be in the Reserve. But I'm going to have to look for another
job and move somewhere so I can get some health insurance for my family." I
had never even thought that we didn't provide some kind of support for our
Reserve military men and women. We have a situation in our country
today which, if we leave it untended, will deteriorate. That situation
is that we are spending more money than any country in the world by
far. I recently came from Norway. They spend 7-1/2 percent of their
national income on health. We spend nearly 15 percent. They cover
everybody. They also, as you may know, have universal military service.
They provide a lot of their people benefits that we probably wouldn't want
to because they cost a lot, but they sure do provide health care for
everybody, at a lower cost than we pay and don't provide it for people like
that veteran in New Orleans or that member of the Reserves out at Andrews.
We spend more money and really end up getting less for it. We are not
making a good bargain with our health care system. Over the years,
starting with Franklin Roosevelt, a lot of people and both Presidents of
the Republican and Democratic parties believed that providing health
security was a key to ensuring basic security and stability for people
in our nation. Franklin Roosevelt couldn't get it done, although he thought
it would be the second chapter to Social Security. Harry Truman
tried twice, in 1945 and 1947. He was strongly committed to it and strongly
committed to veterans, which is one of the reasons why the GI Bill, which
you helped to sponsor and bring about with presidential leadership,
became such a gateway to the future for literally millions of American
veterans. But he couldn't get health care through. And he ranted and raved
as only Harry Truman could. I've read some of those speeches. They're a lot
better than what we're hearing today and they really --
(Laughter.) MRS. CLINTON: -- they just called it for what it was
and didn't let anybody worry about it. But he couldn't get it done.
We finally took care of our elderly citizens through Medicare in the
1960s and our very poorest with Medicaid in the 1960s, but there are a lot
of misconceptions about those programs, too. We do provide basic health
care for senior citizens over 65 but we don't provide prescription drug
benefits, which is the fastest-growing cost for many of our older
Americans. And, although we do provide health care through Medicaid for the
poorest of the poor, we put working Americans like that man in New Orleans
into the unusual and, I think, unacceptable position of working and paying
taxes to pay for medical care for people on Welfare that he cannot get
himself. So we've got a funny kind of situation in our country
when it comes to health care. Some have said, "Well, we don't have a health
care crisis." Well, I would disagree with that. It is a crisis if you don't
have any doctor you can get to besides an emergency room. It is a
crisis if you want to get off Welfare but if you take a minimum wage job,
which is all you're qualified for, you don't get medical benefits, so you
have to make the decision to stay on Welfare and get your children
medical benefits or to get off Welfare and go to work, which is what we
want you to do, and not, and not get medical benefits. It is a crisis
if you're an older American with a relative, a spouse, who needs long-term
care and the only option available to you is the nursing home, when you
would rather keep that relative at home and take care of him
yourself. We have the finest doctors and hospitals in the world.
We can beat any country when it comes to the quality of health care we have
for those of us who are able to use it on a regular basis. But we do have
probably the stupidest financing system in the world for health care. We
spend -- (Applause.) MRS. CLINTON: We spend money on
paperwork, we spend money on bureaucracy, that we shouldn't have to spend.
And what the President's plan is designed to do is to simplify our
system to get it to the point where we can put doctors back in charge of
the system again, where they can be making the decisions, not insurance
company executives or government bureaucrats which is the way it is too
often today. (Applause.) MRS. CLINTON: The President's
goal is this: to guarantee private insurance to every American. Now,
you're going to hear a lot, as you already have, about how the
government is going to take over health care. That is not the President's
plan at all. That is what other countries have done. Other
countries have taken over health care and basically had it government-run.
What we want to do is to provide private insurance for everyone and have a
mix of systems the way we do now. The VA is a public system. It will
remain an independent, publicly-funded system, open, we hope, to more
veterans than it ever has been before. (Applause.) MRS.
CLINTON: Every one of your communities has public health facilities. They
have public hospitals. Some of you have counties that run hospitals in your
area. You have not-for-profits, like the Catholic Hospital Association,
which runs many hospitals around our country and you have for-profit
hospitals. We have a mix. We want to maintain and improve that mix.
In order to do that, we have to make sure every American has access to
that system. So you will hear words thrown around like "access" and
"coverage" and let me make sure that we understand the difference.
As a friend of mine said the other day, everybody in America has access to
a Cadillac, but you may not be able to afford it. We have access to health
care right now if you can afford it. What we don't have is the guarantee
that every American is covered to be able to afford health care.
So listen carefully when this debate picks up over the next months. Some
will talk about universal access. Some will talk about universal coverage.
We want coverage. I want to go back to New Orleans and that factory and be
able to look into the eyes of those men who are working and paying
taxes and tell them, "You will now have coverage because you will be able
to afford private, guaranteed insurance." Now, in addition to that, we
have to change the insurance market and the way it operates. I don't know
how many of you have ever read the fine print in your insurance
policies. I haven't. I don't think most of us do until maybe it's too late.
But 75 percent of policies have something called lifetime limits. What that
means is, if you get really sick and you spend whatever that limit is --
and some policies have limits as low as $50,000; others have $1 million
-- but once you hit that limit, you are not insurable anymore unless you
pay a huge, huge increase in your premiums. I have talked to
families. I remember so well the family that had two healthy children and a
third child born and I think to myself, "There but for the grace of God
go many of us." This little baby was born very ill. Within six months,
the $1 million lifetime limit was used up. And here's a family with a
father that makes a very good living and he cannot afford to buy insurance
to take care of that baby. So by the time I met this family, that baby had
been in the intensive care nursery for 15 months. The baby had
been put onto the Welfare Medicaid program so the hospital could get some
money. The father couldn't find anybody to insure them to be able to bring
the baby home, which is what the family wanted to do, but they needed
help to be able to pay for round-the-clock nursing and equipment. So here's
a family which, by any standards, would be a very well-off family, totally
destroyed by something called lifetime limits. Under the President's plan,
there will be no lifetime limits on insurance policies (inaudible)
-- (Applause.) MRS. CLINTON: Second, many of you know that,
under the current insurance market, if you have something called a
pre-existing condition, you pay more or, you may not be insurable at all.
There are only 81 million Americans who fall into that category. There are
a lot of us with pre- existing conditions. The scary thing to me
is that I had a scientist tell me the other day that in the future, we're
learning so much about the human gene system and what genes cause
various diseases that, by the turn of the century, every one of is
going to have a pre-existing condition. If we don't hurry up and get this
health care system reformed, none of us will be able to afford insurance at
the rate we're going. Under the President's plan, everybody gets
insurance and you do not get charged more because you have a pre-existing
condition, and that's the way insurance should operate for Americans.
(Applause.) MRS. CLINTON: And then, finally, most insurance
companies charge older people more than they charge younger people. Looking
around this room, all of us are in that category. We're going to be charged
more than 20-year-olds who think they're immortal and don't think they
need insurance, anyway. But you know what? Those 20-year-olds have a
funny way of turning out to be 40 and 60-year-olds, too, don't they?
We have this old-fashioned idea that the young and the old ought to be
in the same insurance pool together, so we do not want to permit insurance
companies to charge people in their 50s more than they charge people in
their 20s. (Applause.) MRS. CLINTON: We ought to have
insurance go back to mean what it used to mean for all Americans across
the board. Now, how will we get insurance under the
President's plan? The same way most Americans get it today -- at the
workplace. That is where we get our insurance. That, in fact, grew up
during the Second World War as the favorite means of insuring workers. What
that means is that employers and employees will make a contribution to
health care. There are only three ways to achieve universal
coverage. You can do what countries like Canada does and basically have a
big tax that eliminates all the private sector investment and has the
government run the health care system. We rejected that. You can
try to do it through an individual mandate which says, "Everybody in this
audience, you're on your own. You've go out in the insurance market and
you buy health care insurance, just like you do with auto insurance." The
only problem is, a lot of people never get around to getting their auto
insurance. Even when they have to go to get that license, somehow they
evade responsibility, don't they? It's very hard to determine which
individuals are actually paying what they should pay to be insured and
the other problem is, employers who already help insure employees would
drop a lot of their employees because, if they didn't have to contribute,
many of them would not. What we think is the better way to do is to
take what works in the American system, build on that, and provide
discounts to small businesses and discounts to low-wage workers and, if you
change the insurance market the way I've just described, the cost will go
down for everybody. The most discriminated part of the insurance
market today is the part that is small business. Any of you who are
small business owners, you know what it's like to try to buy health
insurance on your own. You don't get the same bargains as the big employers
get. You have to pay 35 to 40 percent more. We will eliminate that and the
costs for small business will be dramatically reduced. Once
everybody is in the insurance system, they will be given a health security
card and they will be entitled to certain comprehensive benefits with a
special emphasis on preventive health care. We have done this all
backwards for so long. We will pay for the surgery but we won't pay for the
test that could determine early if you had the disease so we could try to
stop it from advancing to the point of surgery. For years,
insurance companies wouldn't pay for women for a mammogram but they would
pay for breast surgery if the woman developed cancer. We don't have
insurance companies that pay for well-child care or immunizations but
they'll pay if the child gets measles or some other kind of disease that
puts him into the hospital. Now, where I come from, that is a very bad way
to run a business. We ought to be paying for prevention. We ought
to be taking care of people when they are at least able to be cured
instead of when we have to do the most extreme and expensive kind of
surgery or chemotherapy on them at the very end of the process.
(Applause.) MRS. CLINTON: Comprehensive benefits will also include
home health care and hospice care and rehabilitation which are especially
important for veterans and for older Americans. I am so tired of women
particularly -- some men but mostly women -- whose husbands are struck down
in their 60s or 70s with Alzheimer's or a stroke or some other kind of
debilitating disease and these women want to take care of their husbands
and they are given no help and no support to do so. And what they are told
is, if they spend themselves into poverty, then there will be a nursing
home waiting for their husband. They don't want their husband in a
nursing home. They want him at home. We want parents and spouses and
children to be able to take care of family members at home until it is
absolutely impossible, and the President's plan begins to provide that
opportunity. (Applause.) MRS. CLINTON: The benefits also
include mental health benefits and treatment for substance abuse. Now,
this is controversial. Many people say, "Well, you know, we should not
include that." But, you know, mental health is a huge cost to our nation.
You see the homeless people talking to themselves on the street corners,
sleeping on the grates in 20-degree weather, many of whom are veterans. You
see our prisons, filled with offenders who are there because of drugs
or alcohol or some mental illness. This is not just a health care
issue. It is an issue that runs across our entire society. And for any
member of a family in this audience who is suddenly struck by a young
person in their late teens or 20s developing schizophrenia or watched a
family member undergo the pain of clinical depression, you know that those
are as serious and disruptive illnesses as diabetes or cancer or any other.
We need to begin to provide benefits, and it will save us money if we
do it in a cost-effective way. So those kinds of comprehensive
benefits being available to all will be especially important for older
Americans because we will add coverage for long-term care and prescription
drugs to Medicare. For less than $10 a month, Medicare recipients will have
their prescription drug benefits paid for. I am so hopeful that we
can get that passed because, you know, for many older Americans, the choice
every months comes to, "Do I buy more food or do I pay for my
prescription drugs?" And I've talked to pharmacists all over this country
who tell me, whether they work in a hospital or in their retail pharmacies,
that they know that their older patients come in clutching those
prescriptions, and it says, "Take four a day for two weeks," and their
older customers say, "What if I only take one a day? Will that last
longer, will that work?" And, of course, it doesn't work. So then,
so often, that person ends up back in the hospital, which Medicare will pay
for, but they won't pay for the medication to keep you out of the hospital.
So we need to have prescription drugs. Let me say a few words
about what exactly we intend to do with the VA system, because I'm so
excited about what we have worked to create in this health bill with the
help of the Legion and other veteran organizations and with the VA.
Today you know better than most citizens that the VA system has to
overcome numerous statutory and financial obstacles. That is just to be
able to maintain its service to our veterans. The current VA system must
contend with funding resources entirely from federal appropriations
and, in today's tighter and tighter budgets. Although in this
budget that this President has presented, the appropriation for VA goes up,
that isn't true for most other departments and, with the kinds of
pressure for deficit reduction and the absence of strong support for
those federal appropriations for the VA, I'm afraid we will see cuts,
unless we have real health care reform that includes strong provisions for
the protection of the federal appropriations and other sources of income
for VA, and that means removing the prohibitions on the VA receiving
Medicare or insurance. You also are confronted with confusing and
complex eligibility rules that confuse both veterans and their caregivers
and other problem that we have looked at. The President's Health
Security Act embraces the VA system as a key component of national health
care and we expect it will provide high-quality, affordable health
care, and we're going to give you some advantages to be competitive
that we have never been able to provide before. The first is that,
under the Health Security Act, the VA will become a potential provider for
health care services for millions of Americans who are veterans without
regard to the old eligibility (inaudible). We will always --
(Applause.) MRS. CLINTON: We will always give first preference to
service-connected disabilities and to our poorest of our veterans. But
there is no reason why many of you in this audience should not be able to
choose the VA system if that is your choice and, under the President's
plan, you will make the choice. You know these television
advertisements that they spent about $20 million on saying that we're going
to take away your choice? Well, that's just flat untrue. In fact, we're
going to give you more choice because the choice is not going to be your
employer's and the choice is not going to be the government's. The choice
is going to be yours to make. The only choice we're trying to take
away is those insurance companies' that are funding that ad, so that
they can no longer choose to disqualify you from health care because
they want to do so, or charge you more than they would have otherwise. We
do want to take that choice away. (Applause.) MRS. CLINTON:
So under the Health Security Act, the VA remains an independent system. All
veterans can choose the VA plan and its special expertise on health
issues related to military service. Veterans with service-connected
disabilities and low-income veterans who choose VA as their health plan
will receive comprehensive hospital and out- patient care with no
copayments or deductibles. All veterans become eligible for the
comprehensive package of national health care benefits that includes access
to comprehensive out-patient health care. The Health Security Act
provides for a $3 billion investment fund for medical care to improve the
VA's medical delivery system and to make it more competitive. Service-
disabled and low-income veterans remain eligible for free VA benefits, such
as long-term care. The unnecessary reporting requirements and inspections
that currently burden VA institutions and providers will be reduced freeing
VA providers to concentrate on patients instead of paperwork. The VA
-- (Applause.) MRS. CLINTON: The VA will be permitted to
retain funds that are recovered from both private insurance companies
and Medicare and, we believe, with more funds coming in, the VA will be
able to offer even better care to more veterans. We want VA managers to be
allowed to control their budgets on-site so that we can delegate more
flexibility. You know, a VA hospital in Montana may have a
different need to meet in their patient community than a VA hospital in
Florida and you cannot run that from the top down. We've got to give the VA
managers in the local veterans' communities some flexibility and say in how
their local VA hospitals take care of their patients. That will help
improve health care across the board. This entire VA system, if you
look at it, has some of the highest-tech, most extraordinary medical care
going on. I've been out to the Washington center. I have seen things
that I haven't seen in the most advanced private hospitals. I have seen how
they have begun to use technology so that the VA hospital in Washington and
the VA hospital in Baltimore can communicate by satellite about a single
patient who lives in between and may go to both. We have some of
the finest-quality physicians and health care in the VA system but they
have been held down and they have not been given the support they need to
really do the job they are capable of doing, and we need to give them
that kind of help. (Applause.) MRS. CLINTON: There will no
longer be any means testing. If you choose the VA benefits package, you
will be eligible for the VA benefit package. (Applause.)
MRS. CLINTON: And so what we are trying to do is to create in the VA system
what you would want from the best- quality health care system in America.
We want the VA system to compete for every one of the veterans' dollars
that will come to it. Now, that doesn't mean you have to. You can still
choose a different health plan. But what we've talked about with the VA is
for them to begin to partner with other facilities in their regional
areas. A VA hospital in conjunction with a children's hospital, a
women's hospital, a community hospital, is going to be a very powerful
provider so that you can sign up for a health plan where your wives will be
taken care of, your children will be taken care of, and you will be able to
use your benefits at the VA hospital. That's the kind of creative use
of both our federal and our private dollars that we want to see done.
And finally, the VA will continue to provide Chapter 17 benefits
beyond the comprehensive benefits package to all veterans who are currently
eligible to receive them. This is something we believe in very strongly in
the Clinton Administration. We feel that we owe all of you a great debt
for what you have done for our country in fighting external threats.
We honestly see our health care system and the financial drain that it
is placing on families and businesses and governments as an internal threat
but one we are fully up to meeting. We do have to make some changes but we
need to make changes that make common sense and build on what we think
will work. The Legion has been a champion on behalf of veterans
for many decades. Many of these changes that we are incorporating come from
that gold book and come from the kinds of proposals that you have made for
years, that fell on deaf ears. Nobody wanted to deal with the health
care system. You know, Richard Nixon proposed a health care
reform plan very similar to what my husband is proposing, building on the
employer-based system. So both Democratic and Republican Presidents have
tried to get beyond politics on this one. But you know and I know
that we're going to have to really convince the people on the Hill that not
only do all Americans deserve secure health care, because none of has
it -- even those of us with the best insurance in the world, we don't
know that we'll have the same insurance at the same price this time next
year -- so none of us can be sure in our system. And even those eligible
for Medicaid, with the pressures on cutting the budget, you can't be sure
you'll have the same benefits at the same cost this time next year.
So we have a considerable challenge ahead of us but, just as you have
met challenges in the past, help us meet this one. Listen carefully to this
debate. Ask hard questions. Find out what will really happen to you and
your loved ones and your fellow veterans because the only plan that has
tried, in a comprehensive way, to deal with every American's needs is the
President's plan, and we have welcomed your help in creating it and we
would welcome your help in trying to bring it to reality because I want to
see every American, but particularly our veterans, get the health care
they deserve to have. Thank you very much. (Applause.)
Q Ladies and gentlemen, the First Lady of the United States. And we
appreciate your comments and information about the health care reform
package that's going through Congress today. (Applause.)
Q (Inaudible). We just need everyone to make sure you stay in place.
(End of tape.)
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