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HRC REMARKS ON NATIONAL PRIMARY DAY CARE
September 29, 1994
MRS. CLINTON: -- and say to also the Association of American
Medical Colleges they have been stalwarts, allies on behalf of patients and
physicians and other health care professionals for the cause of expanded
quality, universally available health care. I'm also pleased to
be here again at GW. I'm delighted to meet with the (inaudible). I feel
that you're our neighbors -- we live in the same neigborhood -- and also
to be here with the dean and some of the faculty of the University
School of Medicine and Health Sciences. I'm also pleased that this
audience is primarily medical students and am grateful for what appears to
be an increasing interest in primary care practice. When I was asked to
speak here, I readily accepted because I think that a concerted effort
to bring attention to primary care is essential, not only for those of you
who are in the health care profession, but also for the rest of our country
to understand what is at stake. And on behalf of the President
and certainly myself I want to convey our appreciation to all the primary
care physicians and supporting personnel around the country who are
gathered here today to both celebrate but also emphasize the importance of
primary care. I have been reading lately, as I'm sure you have,
about the end of health care reform. So many of these stories talk
about who won and who lost, who is up and who is down, but I think those
questions miss the point. If we have not learned, we certainly should have
learned that health care reform is not a boxing match that goes 15 rounds
and suddenly it is over. It is a journey, one that our country
has been on for quite a number of decades, a long journey, sometimes a
rocky one, but nevertheless a journey that we must keep making together
until every child, every mother and father, every sister and brother and
husband and wife has the right to access to quality health care that your
are training to provide -- (applause). Over these last months,
when Congress debated reform and opponents spent hundreds of millions of
dollars to saturate the airwaves with negative advertisements, people like
you all over our country got up every day and did the best they could,
did the best they could for their patients, did the best they could so they
could be the kind of physicians who would invest themselves professionally
and personally in patients of the future. And they did so every
day in a system that often worked against the best interests of physicians
and patients, and when the congressional session ends in a few weeks
and everyone in Congress goes home, primary care providers will still
be fighting the daily battles against diseases treated too late because
there was no insurance, against an insurance system that still
discriminates against the elderly and the sick, the small businesses and
the self-employed. They will still be laboring on behalf of their
patients against a system choking on paperwork and confusion. So when
the Congress goes home and the pundits declare health care reform dead for
the time being, just remember the millions of physicians and nurses,
medical students and technicians who don't get to go home. They
still keep working to make sure that the people of America get the health
care they deserve every single day. As future doctors in medical
professions, you know the importance of the battle we've been waging for
the last 20 months. You know why it is so vital that we achieve
universal coverage. You know because you have already begun to see the
reality of our health care system in the training you do every single day.
Those realities have little to do with politics and a lot to do with
people. That's why, in the larger scheme of things, it doesn't
much matter whether the President lost or I lost or the Republicans lost or
the Democrats lost this first battle. What matters is whether the American
people win or lose. That is what is at stake. I'm reminded now
of an Op-ed piece I read in the New York times about a year ago. It was
written by a pediatrician whom I admire in Boston, whose books I have
read, and for those of you not yet residents and interns, you may not want
to read her book about her experience on that until after you're finished
with it, but Dr. Perryclass (phonetic) said the following: "I am
not a policy person, but I know this much: It is wrong that I see one child
after another without any insurance, most of them children of the working
poor, the self-employed, the part-time employees hired by large
companies anxious to avoid paying benefits. It is wrong that when the
son of a fisherman puts a rusty boat hook through his finger his mother has
to ask me anxiously about the cost of the tetanus booster. That is what
is at stake in health care reform, and it is those voices that need to be
heard. I spent the better part of the last 20 months traveling
around this country listening to people's stories about our health care
system. To this day I could see the faces of mothers who worried about
whether they can afford tetanus booster. I can hear the voices of fathers
who tell their children to be careful and not go out for sports because
they couldn't afford the injury. I hear those voices, and I see
those faces over and over in my mind, and I don't think anyone, anyone who
has heard them and seen them, listened to the kind of stories that you
will hear over and over again as you complete your training could ever walk
away from this issue now, not when tens of thousands of American families
lose their insurance coverage each month. Not when health care
costs continue to rise faster than our national income, not when millions
of children cannot get the vaccines or well-child care they need to protect
them against childhood diseases. Not when a woman I met in New
Orleans last year, who had worked four years, still can't afford to get a
biopsy for the lump in her breast because she still can't afford
insurance, not when one child, who is the grandchild of people I have
talked with, with meningitis survives and another child, also a grandchild
with meningitis, dies, the difference being that one family has insurance,
and the other doesn't. These are not political problems. These are
human problems that define who we are as a people, and that's why when
people keep asking me if I'm going to give up on health care reform my
answer is always the same. Why would I give up on America or the
American people? I am the result of privilege. I am the result of good
health. I am the result of a great education. Why would I not want to do
what I could in any small way to make it possible for others to have the
same opportunities that I have had over my lifetime? As the
President said earlier this week, we've had some rough spots on the road,
but this journey is far from over. Obviously, I'm disappointed we didn't
achieve our goals this year. As you know, it's not been an easy process,
but we've learned a lot. Boy have we learned a lot, and I'm sure
we will continue to learn more along the way, but I am personally grateful
for and proud of the enormous effort that millions of Americans made.
Thanks to the hard work of thousands of people across the country and
thanks to a public eager for progress, health care reform is now a subject
regularly discussed around the kitchen tables of America. Now,
hopefully, that discussion will continue among family members and friends,
among colleagues at work and also among law-makers when the new session of
Congress convenes, but today offers us a wonderful opportunity not just to
talk about what did not happen this year but to pay tribute to what is
working. As part of this first every Primary Care Day, we have
the chance to consider the extraordinary contributions of our primary care
community, of doctors, nurses, physicians' assistants, all those whose
work embodies compassion, quality and trust on the front lines of the
American health care system. And we can also reflect on the vital
role of our medical schools and teaching hospitals that serve as beacons in
their communities, providing cutting edge biomedical research,
state-of-the-art technology, clinical and tertiary care, and perhaps most
important quality treatment for those among us who might otherwise go
without. Nearly every medical school in the country is
participating today. That's a testament to the growing interest in primary
care medicine among medical students like yourselves, and I was heartened
to see the results of this year's Association of American Medical Colleges
survey which show that the percentage of medical school graduates
interested in careers as generalists increased for the second time in a
row. That certainly accords with my personal experience in
talking with medical students around the country who have expressed not
only an interest personally but also a commitment publicly to primary care.
Today more than one in five graduates say they might go into
primary care. That is a good beginning, but we need even to do better. That
number will grow higher, particularly given the innovative programs taking
root in some of our medical schools. There are universities now
who are developing loan programs and forgiveness programs for students
entering primary care and practice in rural areas. There are many who
are developing community-based teaching sites for medical students.
There are other who have set a goal as to how many of their graduates
they hope choose residencies in internal medicine, pediatrics or family
medicine, and there are others who, because of their success over the
years, are leading the way by working with other schools to demonstrate how
primary care can be made a priority. And here GW there now is a
primary care apprenticeship for all second-year students. These are signs
that our medical schools and our medical students are not only moving
in the right direction but leading the rest of us in the right direction as
well. That is only appropriate. You will have to lead. You are the
ones who have made a commitment to care for children and family
(inaudible). Many who are primary care physicians have often chided
their specialist friends by pointing out that, as a generalist, they
have to know a much broader range of medical issues because they meet and
treat so many different kinds of people with so many different presenting
symptoms. It is a compassionate and caring commitment, but it is
also an intellectually demanding one as well, and you are the ones who have
shown the courage to take that on in a time of change and uncertainty, and
that is especially important as we chart reform in the future.
One of the great driving forces for me personally behind health care reform
has been my concern about the future of our medical colleges and our
academic health centers. The current financial system will not permit the
continuing missions of our academic health centers and medical colleges
to be fulfilled at the level that we expect and need from them.
So, for me personally, the effort for health care reform is also an effort
to stabilize and always be able to say we have the finest medical education
in the entire world. Because when we look at the state of health care
today, we know we have the finest in the world. I was at a
hospital yesterday with Mrs. Yeltsin, able to show her advancements in
technology that were beyond anything she had ever heard of or even dreamed
of. We know that we have a system that has produced cutting-edge research
and patient treatment that is the envy of the rest of the world.
But we also know that because of the way we finance health care all that we
have accomplished is not as secure for the future as it needs to be, and we
also know that too many of our fellow citizens currently and more to
come, because of the way we finance our system, will not receive the
care that you are being trained to offer. In addition to the
hospitals that I visited both here in Washington and in Boston within this
last week, I've also been in clinics. I've talked with friends of mine who
are physicians. I've talked with many who worked on behalf of health
care reform, and they have asked me to continue to remind all of us that
this effort we are engaged in is an effort that, at bottom, is really about
what kind of people we are, not just what kind of health care or medical
system we have. Because it is very difficult when you see the
rising rates of untreated disease and you see the public health
problems that we have not to realize that the future of this country, not
just our health care system, depends upon us continuing our journey toward
universal coverage. There are still too many babies who don't have
access to preventative health care or regular checkups. There are still
too many adults who use the emergency room as their primary care physician,
and there are still too many families paying far too much for the care they
receive at a time when employer-based care is being cut back and benefits
pared down. And there are still too many physicians who are
second- guessed every day by insurance company bureaucrats who
substitute their bottom line concerns for your medical education. We must
have the courage to keep going. If this were easy, somebody else
would have done it. It's like that great line from "A League of Their Own"
where Gena Davis says to Tom Hanks, "I can't go on. It's just too
hard." And then he does say to her, "Hard is what it's about. If it were
easy, somebody else would do it." It is not easy for you facing the
future as primary care physicians, but it is not easy for us either as
American citizens facing the uncertain future of an unreformed health
care system that will continue to undermine what is best about the American
health care system. At times when the path seems difficult in medical
school or internship or residency or on Capitol Hill, I hope we will
all remember what the President said a year ago when he spoke to the nation
about the need for health care reform. Somebody we will reach a point when
it will be unthinkable that there was ever a time in this country when hard
working, tax-paying Americans couldn't get the health care they needed.
What we have to do, those of us who care about our future as a
country, care about your futures as physicians must resolve that we will,
in our own way, continue this journey. The journey itself is worth every
single step, and the outcome, which I am confident we will eventually
reach, will certainly be worth what any of us invests in it.
Thank you for your commitment to primary care, and thank you for being part
of the health care system in our country. (applause). (End of
tape.) | 
