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.)

September-October 1994

National Primary Day Care

C. Everett Koop National Health Awards

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