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REMARKS OF THE FIRST LADY
AT HEALTH CARE FORUM
SPONSORED BY CONGRESSWOMAN SCHROEDER
DENVER, COLORADO
March 14,
1994
Thank you very much. Thank you, all. Thank you so much. It is
such a pleasure to be here and see all of you, and to know that you are as
concerned about health care as we are. And I want to thank
Orville, again, for the institute support of forums like this all over the
country. I've had the privilege to appear on many platforms that were
sponsored by the institute, and it's been a very good educational
experience, and I'm very grateful. I'm also really pleased to be here
with your governor, who has given real leadership to not only the State
of Colorado, but the entire country, and certainly the governors of the
United States. He's been a thoughtful, stalwart friend of my husband's as
they have worked through a lot of the problems that this country faces, and
we're just really proud of you and grateful for your continuing support
on health care. (Applause.) And what does anyone say about Pat? There
is nobody like her, and we are so glad to have her in Washington,
bringing a dose of fresh air all the time. I have to confess, however, that
I only wish I had her wit and her one-liners. I'd be in a lot more trouble,
but I'd have a lot more fun if I did, you know. So this is a real
privilege, and I'm so grateful that you put this together. Somebody
asked me as I came in what this pin was, and it looked awfully big on the
screen as I look at it. I was in Boulder, as some of you may know, at the
university, and a woman gave this me, and it is a depiction of Chelsea
and Socks, so I just had to wear it. And I hope it's not too distracting
for all of you. I wanted to spend a few minutes talking about
where we are with health care reform and what the President's approach
really is, and maybe clear the air a little bit, try to get back to a
factual discussion about what we are trying to do together, and then have
time to answer some questions. Because what I have found in forums all
over the country is that once we actually begin to talk, and cut through a
lot of the rhetoric and a lot of the smoke that fills the air about
health care reform, we have so much more in common. Those of us who
have worked on this issue and worried about it, those of you in the
audience who are doctors and nurses, and hospital administrators and
business leaders, and political decision makers, and parents, all of
you have the same concern. And what we are trying to do is to give some
real structure to your concerns and put them in the context of the
principles underlying the President's approach. Because what we
have found over the last several months is that although people are rightly
cautious about change, are concerned about what it will mean to them
and their family, their business, their profession, there is
overwhelming public support for reform. And there is overwhelming public
support for the principles, or, as you heard Dr. Rheinhart (phonetic)
saying this morning, the ethics of the approach that the President has
presented. So what I hope to do today is to continue the
conversation I started a year ago -- more than a year, now -- in talking
about where we are, where we are heading with respect to these activities
in congress, and what this will mean to you in your lives when reform is in
place. Let me start by saying that I think the case has been made far
more eloquently than I by your previous speakers and by much of the
publicity surrounding health care over the past year, about what is wrong
with our system and why we need to make changes. In fact, I have
now concluded that in many people's minds, although they fear change, they
recognize that the status quo is probably the least attractive
alternative, because it is a status quo that is not stable. It is
deteriorating. We have had in the past year an increase in the
uninsured. We have had in the past year an increase in premium rates for
small businesses and families. We have had in the past year increasing
pressure on our public programs, like Medicare and Medicaid. We see some
signs of hope in some sectors of the health care industry, particularly
when it comes to very large companies and state and federal government
being able to control their costs. But we have not seen the kind of
stability that would lead us to believe that on its own, left
unaddressed, our system can fix the problems that are undermining the
quality of services, access to services, and leading to increased
insecurity among all of us, including those of us with insurance. So if you
look at that status quo, and you see what we see who try to follow all
these pieces of evidence that we keep accumulating, then the real issue
is not whether we reform, but how we reform. And poll after poll
supports the American public's awareness that this is the right
discussion. Thank goodness we have gotten beyond the rather false
argument about is there or isn't there a crisis. The folks who tried to
peddle that have backed off, and they now recognize, along with the rest of
us, that there is a crisis. It may not have entered into everyone's life,
but it is a potential crisis for all of us, because we all live with
the kind of insecurity that comes when you do not guarantee insurance
to every citizen. The President's approach is built on five basic
ideas. The first is guaranteed private insurance for every American. Now
this is an important point to stress because some of the critics of the
President's approach have said, well, you know, he favors government
medicine. Well, in fact, that is just not true. He favors the kind of
system we have now, but to make it work for everybody. We now have
a public and private system. Those of us who are privately insured achieve
our health coverage by either our own funds or in cooperation with our
employers. And we have public systems like Medicare and Medicaid to
take care of those who cannot afford insurance. And then of course we
have the nearly 40 million who fall between the cracks. What the
President wants is guaranteed private insurance with comprehensive benefits
for every American. And the benefits in the President's approach have
been spelled out. Alternative approaches have said, well, let's
pass reform, and then we'll tell you what the benefits are later. I
don't know anyone who would buy an insurance policy and not know what was
going to be covered. So from the President's perspective -- we want to know
from the very beginning, what are the benefits, in terms of hospitalization
and outpatient care, mental health coverage, and very importantly,
preventive and primary care. One of the points that is really
significant in the President's approach to benefits is to try to move us
more toward a system of individual responsibility and wellness, so that
we no longer just take care of people when they're sick. We actually try
to insure them in a way that they can get help trying to prevent themselves
from being sick or getting sicker. So comprehensive benefits stressing
preventive health care is a key. The second point that the
President has stressed is, we need to eliminate the insurance practices in
the marketplace today that do drive up the cost for some people, and
discriminate against individuals and groups of individuals. And there are
several of those. One is the whole idea of preexisting condition.
If you have some kind of an illness or other sort of medical condition,
you may find yourself ineligible for insurance, or find insurance priced so
high you cannot afford it. We want to eliminate preexisting conditions.
Everybody should be insurable. Nobody should be eliminated from
insurance because they have been sick at one time. And this is
especially important in today's world, because -- I recently was at the
National Institutes of Health, where they are doing fantastic research
about the human gene system. We are learning every month something more
about our human genetic makeup. We are on the brink -- within the next
10 years -- of discovering genes that cause all kinds of diseases. We
all will be uninsurable because we will all have some genetic condition
that will make us ineligible. So if for no other reason, we need to act
now. (Applause.) Another thing we have to eliminate from the
current way insurance is sold and marketed is something called lifetime
limits. You read the fine print of your insurance policy. Most of you will
see that you have a lifetime limit. It may be, surprisingly, as low as
$50,000, or as high as $1 million, but what it means is that if you get
really sick and need your insurance coverage the most, if you build
those expenses up you may get to the point, as many people have who
have talked with me, where their insurance company says, we're not paying
any more. We are going to eliminate, in this approach, lifetime limits.
And the final practice that we want to eliminate is discriminating
against people on age. That is something that I care more about every year
that goes by. I am very conscious of how, as I get older, my costs
increase. I have this old fashioned idea that we all ought to be
in this together, the old and the young, the sick and the well, supporting
each other, because every one of us will someday be sick, and sure enough,
we will all be old. So if we eliminate that now, put everybody into the
same insurance market, the whole country, we will then all pay less to
actually guarantee more insurance for the entire population. The third
point, which is critical to the President's approach, is guaranteeing
choice of doctor and health plan. Now there was a lot of concern about
this several months ago, and there were some ads run and some other
charges made that the President was going to make it impossible under his
approach for you to be able to pick your physician. Well, first of
all, what is happening today, is that more and more Americans are being
deprived of choice. How many of you in this hall today get your insurance,
as most of us do, through the work place, and have been told sometime
in the last several years that your employer has picked a different
plan? You can only go to these certain listed doctors and these
certain listed hospitals. And you cannot, maybe, use the children's
hospital or the academic hospital associated with the university, because
they're too expensive. This happens all over the country, every single
week, because employers and insurance companies are trying to squeeze
their costs down in a system that is letting costs run out of control.
So one of the ways they're trying to do it is by eliminating your
choice. And we are going to reverse that, because if everybody is
in the system then there isn't any place to shift costs to. Everybody is
part of the same insurance marketplace, and therefore we will require all
health plans to be available, in a region, to every one of you, and it
will not be your employer's choice or the insurance company's choice, it
will be your choice. And every year you will choose the health plan
with the doctors that you prefer, and every health plan, whether it's
an HMO or a PPO, or a traditional fee-for-service health plan, will also
have to provide a -- what's called a point- of-service option. That means
that if you have some condition, and the best person in the country is
somewhere else, you will have the right to go there. So in fact,
under the President's approach we will reverse the decline of choice, and
guarantee it to you. So we want to make that point very explicitly.
(Applause.) The fourth point I want to make is that the
President's approach preserves Medicare. You know, there are a lot of
people in our country who are concerned about Medicare, and those of us who
have older family members who are eligible about Medicare are also
concerned. But the two big problems with Medicare right now is that
Medicare does not cover prescription drugs, and Medicare does not give
options to older Americans when they need long-term care other than the
nursing home. Under the President's approach, prescription drugs
will be available to the Medicare-eligible population, which will be a huge
cost saver for millions of older Americans. I have met people in their 60s
and 70s, and 80s, who pay anywhere from 4-5,000 to $18,000 a year for
their prescription drugs, people living on fixed incomes. And what
we want to do is to make prescription drugs affordable, because we don't
want older Americans choosing between food and prescriptions, which happens
right here in Colorado, like it does everywhere else in the country.
And because we know if older Americans get their prescriptions filled, and
they're under the supervision of a physician who can monitor those
prescriptions, they are less likely to need hospitalization. So
prescription drugs under Medicare -- and to begin to provide some long-term
care. We want to preserve Medicare and to use money in Medicare for the
people it was intended for, older Americans. The fifth point I
want to make -- the fifth point has to do with how we finance health care
and where we actually will get our guaranteed private insurance. If you
believe, as the governor said, that everyone should have health coverage in
America -- and I believe that. I hope that we're beyond that debate.
Any reform that does not include universal guaranteed health care for
every American will be vetoed by this President, because if we don't have
guaranteed health coverage for everybody, we have not reformed our health
care system. (Applause.) Now once you believe that, there are only
three ways to do this. There's not a million different ways, there's only
three ways. One is to take the approach that a lot of people have
looked at, which is to eliminate private insurance coverage and instead
substitute for it a tax that would be dedicated to providing health
insurance. That is sometimes called a single-payer system. That is, as a
matter of fact, something that has a lot of support by people who know
that it would once and for all cover everybody. And for those of
you who support that, it is a goal that the President shares. But he
believes that we will be better off if we maintain our public-private mix,
so that we can retain some competition and collaboration, and some
accountability, so that we can keep both parts of the system, public and
private, kind of moving along, doing their best, because there are
alternatives out there. So he does not believe we ought to raise taxes and
substitute tax money for all of health insurance. The second way
to make sure everybody is covered is by having what some argue for, called
an individual mandate. That would mean much as we do auto insurance in
some states. Every individual would be told they have to go out into
the market place and buy their own insurance. Now, the good part of
that approach is, it recognizes you have to have either a tax or some
requirement, some responsibility to get everybody covered. The President
rejected that approach because, from his perspective, it would do two
things that he does not think are good. First, it would send a
message to employers who are currently providing insurance they did not
need to do that anymore. I mean, if the individual is required, then
why should any of your employers continue to bear that burden? So we
would have millions and millions of Americans all of a sudden becoming
uninsured, which is absolutely the opposite of what we want to see
happen. The second problem is that you would have to provide some
kind of subsidy for low income people. And if you try to provide an
individual subsidy where you had to track each individual, and if you could
not predict how many more individuals would be thrown into that pool that
would be needing help because employers would be dropping them from
coverage, you would have a very big amount of money having to come from the
federal treasury that you could not count on or really specify from year to
year. You would also probably have to use the IRS system to keep
track of individuals, and I personally am not enthusiastic about using the
IRS system to keep track of my health care insurance. So I don't know that
that's a very good alternative. (Applause.) The third way is to
build on what works in America, and that is employer-based, shared
responsibility insurance. What happens now is that most of us pay
something out of our own paychecks, and our employer pays something that is
a benefit to us, and the percentages vary. Some have 100 percent
employer paid, some only have 50 percent, some have high deductibles, some
have low deductibles, but the system in place is guaranteeing health
insurance at the work place. That is an American solution to an
American problem that has worked well for most of us. And the President
believes that if we build on that system, then for the vast majority of
insured Americans, we are not going to see very much change at all. Every
year we will still be contributing at the work place, but unlike what
happens now, our employer won't decide what health plan we have. We will
decide, and we will be free to make a new decision on an annual basis.
Now what are the problems with building on the existing system? Well,
first of all, there are some people, employers and employees, who currently
pay nothing. They are the uninsured, and that is a very large group of
people and one that unfortunately is growing, because many employers
are finding that it is not something attractive for them -- in the
existing insurance marketplace -- for them to try to continue to provide
benefits. Small businesses in particular are the most
discriminated segment of the business community when it comes to getting
fair insurance rates, because they are usually out there in the marketplace
on their own, or in very small groups. So we have to do a couple of things
to make sure that moving from where we are now, with the
employer-employee system, to covering everybody, will work and work
fairly. Number one, we have to provide discounts to small
business. We have to cap how much money business would be asked to
contribute. We also have to provide subsidies for low wage workers so that
they can afford their share. We want them to be responsible. Even people on
Medicaid, who work, should contribute something. Right now we have
the rather unusual situation of millions of Americans getting up every day,
going to work, paying taxes, not able to afford insurance, not getting
insurance from their employer, and yet they pay taxes which go to provide
health benefits to people on welfare who are not working. (Applause.) That
is wrong. So if we provide discounts and we provide subsidies --
we have looked very carefully at how much this would cost. This will lower
the insurance cost of the vast majority of business that already insure. If
you are a big business, a medium sized business, or a small business,
and you already insure, we can show you how your costs will go down,
both in the short run, and then, importantly, in the long run. In
fact, one of the conclusions of the nonpartisan congressional budget office
study was that business particularly would be saving a great deal of money
under the President's approach. Now if you do not insure at this time,
yes, you're going to have to pay something, and your employees, who
currently do not have insurance, are going to have to pay something.
We will do everything we can to keep the cost low. And if we reform
the insurance market, and eliminate the experience rating and the cherry
picking, and all of the activities that have come to make your costs much
higher than they should be, it will be affordable. And again, the
nonpartisan independent studies that have been done have demonstrated that
is the case. It has also demonstrated there would not be net job loss. So
the two big arguments about cost and job loss are ones we are very
sensitive to, but think under the President's approach we will be able
to address and provide a base of financial support to businesses and to
workers with lower income. Those five points: guaranteed private
insurance, outlawing insurance practices that are discriminatory,
guaranteeing choice of doctor and health plan, improving and preserving
Medicare, and guaranteeing health insurance at your place of employment,
are really the underlying principles of the President's approach. There are
details that will be debated, and should be, as the governor said,
exactly how all this will be put into practice. But the net result
when we get through with this debate is: if we have done our job right,
health insurance will be guaranteed. You will never have to worry about
losing it. You will find it far more affordable and accessible than you
ever have before. And the country, and our business sector in the country,
will begin to save money that they have had to spend on health care that
they then can turn around and invest in more productive uses. So
this is an approach that has been thought out. It borrowed from a lot of
different approaches to try to come up with a solution for the problems we
have in this country. I am confident that as the debate moves forward
in congress, as people really have to focus on what the alternatives
are, what the costs are, and how much like the President's approach your
insurance situation is now, that we will end up this year passing
comprehensive reform and once and for all make good on a promise that every
one of us should have, going all the way back to Franklin Roosevelt and
Harry Truman, as Pat said, to guarantee that no matter where you live, how
old you are, who you work for, or whether you've ever been sick, you do not
have to worry about having your legitimate health needs met. And that's
what we're trying to make sure happens this year. And we need your help
to make that come apart. Thank you very much. (Applause.) A
PARTICIPANT: Now we'll take questions from the audience, and I'd like to
ask Eduardo Canallis (phonetic) to address the first question. MR.
CANALLIS: Welcome to Denver, Mrs. Clinton. I'm a member and an organizer
with the Service Employees International Union. SEIU, as you know, is one
of the largest proponents and supporters of health care reform in this
country because we are the largest health care workers' union in the
country also. We're very concerned with immigrant bashing in this country
because we're organizing service workers. My question to you is:
Are undocumented workers and nonresidents, legal residents -- noncitizen
legal residents -- covered by the health care security act? MRS.
CLINTON: Under the President's approach, citizens and legal residents are,
undocumented workers are not. (Applause.) And what we will do -- what we
will do is to continue to provide the public health and emergency
medical services that any person is entitled to have, and that we want to
be able to provide. But we do not believe we should extend this kind
of privilege and right, that carries with it comprehensive health care
benefits, to people who are not citizens or legal residents. We need to
take care of our people right now. (Applause.) A PARTICIPANT: Our
next question comes from Barbara (inaudible). A PARTICIPANT:
Instead of being melded into the various state alliances, why can't the
federal employees' health benefit program, which serves over 9 million
federal retirees, employees and their families, have a separate
alliance of their own? Could you and President Clinton support that?
MRS. CLINTON: Well, under the current plan, for those of you who are
not acquainted with the federal program -- which you should be, because you
pay for it -- so let me tell you a little bit about it. Under the
federal employees' health benefit plan, the federal government acts as
the employer of people like my husband and the congresswoman, and workers
throughout the country, and it acts as an alliance or kind of a buyers'
club, if you will. It goes out into the marketplace, and it says
to insurance companies and doctors' networks, and other health
providers, would you like to have a chance to have the business of federal
employees -- because the federal government pays 75 percent of the health
care costs and the employee is responsible for the remainder. So every
year, everyone from my husband on down gets to choose what health plan
we will join, and then the money flows into that. The federal
government doesn't make the decision. It does not decide what kind of
health plan we want. We do that, but they provide the 75 percent employer
match. We are in effect asking that something similar be done for every
person in America, where the employers provide an 80 percent contribution,
and the employee provides 20 percent. That is a good model for what we
are trying to do, but we do not believe there should be a separate system
for federal employees. We believe the President and the congress ought
to live in the same system that every other American lives under.
(Applause.) A PARTICIPANT: Our next question comes from Father
Neil Dow (phonetic). FATHER DOW: Yes, I've been wondering if you
have specific targeting for helping people with chronic diseases, and
even more notably than that, multiple chronic diseases. MRS. CLINTON:
Yes, Father. One of the things that will help people with chronic diseases
more than anything is guaranteeing them insurance. People with chronic
diseases are often locked out of the health insurance market today, or
have to pay an exorbitant rate, and particularly if they have multiple
problems overlapping the primary diagnosis. So what we are attempting
to do is to make sure nobody is eliminated from coverage, and that there
are services in addition to the ones that you or I, if we did not have
chronic diseases, would be entitled to. So we do have rehabilitation
services, long-term care, not only for the elderly but for those under 65
with chronic problems that lead to disability. So we are very
aware of what needs the chronically ill have and have tried to build that
into the benefit package the President has proposed, because that is a
group of people that have special needs that are expensive and need to
be addressed. And so we have tried to do that in the way we have approached
this whole issue. A PARTICIPANT: Steve Berringer (phonetic),
question? MR. BERRINGER: Thank you. Mrs. Clinton, on behalf of
region 11 of the AFL-CIO, I want to thank you, for all of us, for your
leadership on the health care issue, and let you know that we support your
and the President's efforts on behalf of the health security act.
During the health care debate, workers have repeatedly expressed a concern;
that concern is the fear that their health care benefits would be subject
to taxation, as some others have proposed. My question is: Under the
health security act, to what extent will, or perhaps won't, health care
benefits be taxed? MRS. CLINTON: Under the President's proposal,
they would not be taxed, because what we do not want to do is penalize
people who have insurance. What we want to do is increase insurance
availability to everybody. So we do not propose taxing benefits in the
President's approach. A PARTICIPANT: (Inaudible.) A
PARTICIPANT: I'm with the Denver department of social services and the
coalition on long-term care, and I'd like to know your views on long-term
care and how it's incorporated into the national health proposal.
MRS. CLINTON: You know, the whole long-term care issue is one that we are
hearing more about every day because the fastest growing segment of our
population are people over 80, and -- I was laughing. I ran into Willard
Scott a few months ago, and I asked him how he was doing. He said,
well, one of his problems was that he had so many people who were
having a 100th birthday that he was thinking of having to up it to 105.
(Laughter.) You know, so it's a problem that we're going to have
to face, because we are aging. And I think we are all grateful we're living
longer, but we want to treat people with dignity as they age, and we also
want to treat people with chronic disabilities who need long-term care
with dignity. (Applause.) What we have done -- what we have done
is try to listen to people, and what we hear all over the country is
that people want alternatives to nursing homes. They want to be able to
stay in their own homes, with their own family members, and get some home
health aids and other kinds of help. (inaudible) -- going to do, but it
will save us a lot of money if we do it. I just want to end with a
story. I was in Philadelphia, in a hospital, and they were running an
adult day care for people in their neighborhood. It was in a kind of
working neighborhood, a neighborhood of people who worked, didn't make a
whole lot of money, but a stable neighborhood. And they were finding that
a lot of the folks in the neighborhood were trying to keep their parents
and their aunts and uncles at home. But they couldn't watch them
because both parents were working, so they would take them to the hospital,
to this adult day care. But the hospital had to charge something, so it
charged $35 a day. Well, that was too much for a lot of people. They could
maybe pay $15 a day, but not $35, so the hospital saw a lot of families
being forced into having their parents and grandparents go into nursing
homes, because they couldn't afford $35 a day, whereas the state would
pay thousands of dollars a month if you had somebody in a nursing home.
What we want to do is to provide, on a sliding scale, some financial
support so you can keep people at home. And you can keep them in adult day
care and not put them in nursing homes, which would save us a lot of money
and be a more effective way to take care of more people. (Applause.)
A PARTICIPANT: (Inaudible) we're running short of time. We'll have to
make this the last question, I'm afraid -- from Brian Sullivan
(phonetic). MR. SULLIVAN: The health security act is clearly far
reaching, and in some areas controversial. While there are a lot of
differences in the federal reform movements, there is a lot of
commonalities. To avoid deadlock, would the administration support a plan
that included some of those commonalities so we could fix much of what
needs fixing now? Or would the millions of Americans who could benefit
from some of the changes, such as insurance reform, have to wait?
MRS. CLINTON: Well, if you're asking if we would be willing to look at
different ways of reaching the President's goal, the answer is yes. But if
you're asking if the President would be willing to sign a bill that gives
you something but did not put us on the track to guaranteed health care
coverage for everybody, the answer is no. (Applause.) *
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