Gopher Example 1

President Clinton Speech at ANA Conference 5/10/1994

                           THE WHITE HOUSE

                    Office of the Press Secretary

_____________________________________________________________________
For Immediate Release                                    May 10, 1994

                        REMARKS BY THE PRESIDENT
                TO AMERICAN NURSES ASSOCIATION CONFERENCE

                              Hyatt Regency
                             Washington, DC



9:56 A.M. EDT


             THE PRESIDENT:  Thank you so much.  Thank you for your
warm welcome.  And thank you, Ginna, for that award.

             I arrived a few moments ago, and I remember the first
time I ever heard your president speak.  I knew that she had worked
for Vice President Gore, and I thought it was so interesting to hear
the head of a national association who was speaking without an
accent.  (Laughter and applause.)

             I want to say a special word of appreciation to your
first vice president, Ellen Sanders, who's participated in White
House and congressional meetings on health reform; and to Diane
Weaver, the president of the Association of Nurse Executives, who
cosponsored this breakfast.

             I am very proud to share the stage today with all the
fine nurses in the Executive and the Legislative Branches whom you
have honored.  And I thank you for doing that.  And I thank them for
their service.

             I also want to say a special word of thanks to all of
you and to the ANA for the courage and the vision you have
demonstrated by fighting for health care reform -- and the right kind
of health care reform -- long before it was a hot issue.  As you
know, the position paper you put out on national health reform
probably more closely parallels the recommendations that our
administration has made than that of any other professional health
care group in the country.  And I thank you for that very much.
(Applause.)

             I want to thank you, too, for recognizing my mother, who
worked for 30 years and then some as a nurse and was deeply proud of
what she did.  I remember when I was little boy watching her get up
in the middle of the night always starting work by 7:00 a.m. or 7:30
a.m. in the morning, always telling me stories that indicated that
there was literally nothing in the world more important to her than
dealing with a person frightened, in pain, with a caring and
effective manner.

             This award will help to expand the frontiers of nursing
in the areas of women's health, something that she would have been
very proud to be a part of.

             My mother, as all of you now know, completed her
memoirs, which became her autobiography shortly before she died.  She
went over about half of it and was able to do the final editing, and
it was my privilege after she passed away to work with the author and
just try to make sure all the facts were right.  I got very stern
instructions from her.  She said, now if you have to do this --
(laughter) -- do not change one word I said about you -- (laughter)
-- especially the part about your manners not always being great.
(Laughter.)  And make sure you get the facts straight, otherwise
leave it alone.

             But I was very pleased with the two book reviews that
her book got yesterday.  One by the great American author, Joyce
Carol Oaks in The New York Times, and then another one here in The
Washington Post.  But it tickled me -- the one in The Washington Post
said that if you read this book, you would understand why I perplexed
people in Washington.  I was actually brought up by real people and
occasionally I still acted like one.  (Laughter.)  I didn't know what
that -- (laughter and applause).  I'm trying to get over it, but it's
hard even here.  (Laughter.)

             Anyway, here's something my mother said about her work,
which would apply to all of you and those whom you represent.  But it
meant a lot to me.  It was just her words.  "Nurse anesthetist work
is all-consuming.  You don't do it halfway.  You don't daydream.  You
don't let your emotions wander.  You're the person responsible for
putting another human being into a state of unconsciousness,
somewhere between life and death.  For 30 years, from the minute that
I would walk into the operating room and start talking to the patient
and begin putting him to sleep, until I got him safely back to the
recovery room, nothing in the world could have crossed my mind.  I
don't care what problems were on the outside.  I don't care what
problems I might have been having at home.  I never thought of my
life beyond the moment."

             I remember when I was also a child, things were somewhat
more informal.  My mother used to take me to the hospital and let me
meet the other nurses and the doctors and watch the emergency room,
and watch people go into the operating room.  It was utterly
fascinating.  And the work you do has always sort of captured my
imagination.

             My own wife had never been in a hospital before in her
entire life until our daughter was born.  Never been in a hospital
for any kind of sickness.  And learned only a few moments before the
happy event that she was going to have to have a c-section.  And we
had gone through Lamaze, and we had done all this stuff, and I was
supposed to be in the operating room.  And our hospital at that time
had never before let a father into the delivery room if it wasn't a
natural birth.  It was a big deal.  So I said, look, I've been
watching people get cut on and bleed since I was a little boy.  I'll
do fine.  (Laughter.)  But she had never been here before, and she
may not -- you better let me come in.  (Laughter.)  So they did and
actually change the policy so that if fathers had been through the
Lamaze course and then the mothers eventually had to have a c-
section, they got to go.  So I felt -- that's my one contribution to
medical advances.  (Laughter and applause.)

             But I owe all that to my mother, who was a remarkably
determined woman in the face of often excruciating adversity.  I
think one of the reasons that the Nurses Association has been so
forthright about this health care reform issue is that you see it
from the grass roots up in human terms, and you don't get so hung up
as some people do on all the political rhetoric and the positioning
and the characterizations that have, frankly, put a lot of members of
Congress at a severe disadvantage because they haven't had the chance
to spend the time and make the effort to deal with this issue that
you have.  It is, after all, a mind-bendingly complex problem.  It's
14.5 percent of our income, and for people who don't live in it every
day it can be a very difficult thing.

             But I just wanted to thank you because I believe that
the personal experiences you have shared, so many of you common to
the ones that my own mother shared, really animated the Nurses
Association to take the position that you have taken.

             I want to emphasize today that what I seek, contrary to
the attacks, and what you have sought, is not a government-run health
system, it's a private insurance health system that covers everybody
where the health care professionals run it and not the insurance
companies.  That's what we seek.  (Applause.)

             We seek private insurance that can never be taken away.
It's wrong to treat seriously ill children in an emergency room who
could have been treated more easily and more inexpensively if their
parents had just had the coverage.  With our reforms, every family
will have that kind of quality insurance.  We ought to reform the
insurance system that today often only covers the healthiest people,
and even then will deny them coverage for anything they've been sick
with before.

             When you go to a patient's bedside, you ask why does it
hurt, where does it hurt, how can I help?  You don't ask whether this
is a pre-existing condition you're looking at.  (Laughter.)  It's a
very important issue.

             If you think about all this preexisting condition
business, there are 81 million Americans who live in families where
there's been a child with diabetes or a mother that had cancer
prematurely or a father that had an early heart attack or some other
problem.  I see these people everywhere.  This is no small number.
Now, we get action lickety-split up here all the time when a million
people or 2 million people are adversely affected by something -- if
they are well organized.  But these 81 million people, they're
professionals and blue-collar workers; they're old folks and young
folks; they're all different kinds of people; and they are by
definition disorganized.  There is no national association of people
with preexisting conditions.  (Laughter.)  You think about it -- if
there were, and 10 million of them showed up here, we'd have health
care reform so fast you couldn't blink.  (Applause.)

             You must be their voice in an organized way.  And you
can be.  So we ought to cover everybody with private insurance, and
we ought to have insurance reforms that deal with preexisting
conditions, and don't discriminate people based on age.  This is
somewhat controversial -- I know that.  But I believe if we went back
to health insurance the way it originally was when Blue Cross first
started writing it, where everybody was put in a large group, risk
was broadly spread, and people paid a fee against the day when they
would be sick, it would be fairer for all Americans.  And our economy
would work better, our society would have a stronger sense of
community, our families would function better.  People would be free
of a lot of the anxiety that comes --.

             Hillary and I have receive about a million letters.  And
whenever I go somewhere now, they arrange for some of the letter-
writers to come see me.  And it's just -- it's just gripping to see
people just over and over and over, and stunning to see how they do
come from all walks of life, and how they have been broken by the
things which have happened.

             The third thing I think we should do is to preserve the
Medicare program.  It's interesting, the people who criticize our
program say this is government-run health care, which, of course, it
isn't.  And if you tried to take away Medicare, which is a
government-funded health care, well, they would be up in a tree
somewhere screaming about it.

             But we don't want to do anything to the Medicare
program, except to make it better.  I do believe we should add a
prescription drug benefit and phase in long-term care that is
community-based or home-based for two simple reasons.  One is, there
are an awful lot of elderly people who aren't poor enough to be on
Medicaid but aren't well off, who have significant medical bills.  We
know the elderly use four times the prescription drugs that the
nonelderly do.  And we know from study after study after study that a
proper medication regime can keep people out of the hospital and can
save money.  And that we now have -- any number of elderly people
every month -- I was in a grocery store in New York yesterday called
Pathmark, which also operates, as many do now, a drugstore.  And it
was gripping -- the CEO was saying, my workers tell me that every day
they watch older come in this store and go from the drugstore, down
the food isle, and try to make up their mind what food they're going
to give up to get their medicine, or whether they're going to give up
their medicine to buy their food -- gripping.

             So I do believe we should do that.  But the Medicare
program works.  It has low administrative overhead.  We think it
should be secured.

             The fourth thing we want to do is to bring greater
choice to our people.  I guess the thing that has made me the maddest
in the relentless campaign against this plan are all those bogus ads
where they say, you're going to have to call some government office
to figure out where you go to the doctor.

             There are two realities of modern life that you have to
drive home to every member of Congress, without regard to party or
philosophy.  Number one, Americans are rapidly losing their choices
today.  Already, of people who are insured at work, fewer than half
have more than one choice of a health plan.  That's a fact today.
And they're rapidly losing their choices.

             Number two, medical professionals are increasingly
losing their right to decide unilaterally, may have to have somebody
get on the phone to an insurance company executive a long way away to
ask for permission to do what anybody knows ought to be done under
the circumstances.

             Now, most Americans, believe it or not, don't know
either one of those things, even though they may be caught up in it.
And I think it's very important -- our plan is designed, number one,
to increase the choices that consumers have.  We're moving to more
managed care.  There can be a lot of good things in it, but under our
plan, every year, every person would have a choice between at least
three plans, or among at least three plans -- but in all probability
many more.

             And number two, under our plan, medical professionals
would also be given more choices and would have to do less checking
in with the insurance company in advance.   Now, being treated by
doctors and nurses, you know, is an American tradition.  Every time I
do one of these town meetings, like I did in Rhode Island last night,
I talk to somebody that's just been forced to give up their doctor,
and just move away from the choices they made.

             We believe when all Americans can choose among several
health plans, many Americans, many more Americans, will choose to
stay with their own providers.  And many more of these plans will be
organized in such a way that all providers can participate if they'll
do it for the agreed-upon fee.  That's what we believe will happen.
And if we don't do this, if we don't have some legal action to
reorganize this, you're going to have less choice by consumers, less
choice by providers.

             Time and again, we've also seen that the quality of care
is directly related to the quality and the quantity of the nursing
staff.  One of the things that amazes me is how many nurses have been
laid off in recent months and been told, well, this is because health
care reform is coming.  I'll tell you what, one of Clinton's
unbending laws of politics is, whenever somebody who's got a tough
decision to make can shift the heat from the themselves to you,
they'll do it every time.  (Applause.)  They will do it every time.
(Applause.)  That law never varies.  (Applause.)

             Now, what is really going on?  What's really going on
is, a lot of these health care providers are under the gun.  Right?
More managed care; people bargaining tougher for prices; more and
more people who are uncovered where there's uncompensated care that
has to be provided; less and less ability to pass on the cost of
uncompensated care to other people because they're in these managed
care networks they're in.  All this stuff is going to happen if we
don't do anything.  All of us could go on vacation for a year, and
this same thing would go on.  You know that.  And don't let your
members fall for it.

             What's going to happen is we'll continue to see these
trends occur unless we find a way to give health care providers
reimbursement for all the people for whom they care at an appropriate
level in an appropriate way.  More than a decade of research now
shows that more and better trained nurses result in shorter hospital
stays, better survival rates, fewer complications, whether you're
dealing with low birth rate babies or older people.  (Laughter.)

             You do not have to work for the Congressional Budget
Office to understand that healthier patients and shorter stays means
lower health care costs.  Sometimes I think if you do work for the
Congressional Budget Office you will never get that, but --
(laughter).  We're working pretty well on the whole.  This is a big
deal.  This choice issue and maintaining an array of qualified people
doing the things for which they are best qualified is terribly
important.

             Finally, let me say -- and this, I guess, is -- except
for this whole issue of whether this is a government program, which
is isn't -- is the most controversial part of it -- our reform is
based on providing guaranteed benefits at work.  Now the reason for
that is simple -- for the people in this country that have health
insurance, nine out of ten of them have it at work where there is
some shared responsibility between the employer and the employee.
For the people who don't have insurance, eight out of 10 of them have
someone in their family who is working.

             It seems to me that the fairest and simplest, and if you
will, the most conservative way to achieve universal coverage, to
have health care security for everybody, is to ask employers and
employees who aren't doing anything or barely doing anything, to do
more so that they can fulfill their own responsibilities, and then
use tax funds to cover the unemployed, uninsured -- people for whom
you could say, well, there's a general responsibility just like
Medicare and Medicaid.  And then organize the market so that smaller
businesses and self-employed people, a, get discounts if they need it
and, b, are able to buy good insurance on the same terms that those
of us who are insured by government or larger businesses can.

             Now it seems to me that is a fair and simple and obvious
way to do this.  I think that any other way will sooner or later
involve either a radical change -- that is, getting rid of the whole
health insurance market and substituting taxes for it, or involve
people who are already paying too much for their own health care,
having to pay something for people who won't do anything for
themselves because they say they should be exempt.

             Now I think that this is a very important issue.  You
know, again, we lose sight of the fact that most small businesses are
making an effort to cover their employees.  We have brought hundreds
and hundreds of small businesses to Washington to talk to the
Congress, but they are not organized.  There is no association called
small businesses who cover their employees and are mad they're
competitors don't and mad they can't get better insurance rates --
(laughter) -- and wish somebody would help them.

             So an association that may have a lot of folks in the
insurance industry, along with other small businesses, says don't do
this, the whole small business economy will break, says this, and
there's no association on the other side.  You have to be their
voice.

             Had a car dealer from a town of 7,000 people in Arkansas
up staying with me the other night -- he and his wife, long-time
friends of mine.  She's a college teacher.  He's a car dealer.  He
said to me the other night -- it was funny -- he said, you know, for
20 years I have been feeling sorry for myself because I've provided a
good health plan for my employees, and none of my competitors did.
So he said, I was so happy when you proposed this just because I
thought I was going to get even.  (Laughter.)  And then he said, but
you know, then I remembered that in the last 20 years I put three of
my competitors out of business.  And I'm making more money than I
ever have.  And the reason is I still got the same folks working for
me I had 20 years ago because I gave them health benefits.
(Applause.)

             And yesterday I went to New York and I visited this
Pathmark store.  They have 175 stores, 28,000 employees, the 10th
biggest supermarket chain in the country.  We're all told, oh, if you
do this, the retailing business will go to pieces.  These people have
put new stores in inner city areas that other chains would not touch,
fine new stores.  They are making money and they have always provided
comprehensive health benefits to their employees.  And they are now
sacking their groceries in a bag that says they favor health care
benefits to all Americans guaranteed through the workplace.
(Applause.)

             I say this to you because, as you know, there are a lot
of nurses that don't have any health care coverage.  And a lot of
nurses who are single parents who don't have health care coverage.
And this is the other point I want to make that I did to all those
young people working in that grocery store yesterday:  Everybody now
in Washington is for welfare reform, and I guess it means different
things to different people.

             But I have basically a three-point strategy to achieve
what I think would end the welfare system as we know it.  One was
embodied in last year's economic plan -- lower income taxes for
working people who are hovering just above the poverty line with
children.  This year one in six American working families will be
eligible for lower income taxes so they can succeed at work and can
succeed as parents.

             Strategy number two -- give people education and
training and then give them a certain amount of time to find a job.
And if they don't, require them to take it.  And if they can't,
provide some public subsidy in the private sector or some publicly
funded job so that work is preferable to welfare.

             Strategy number three has got to be cover the people
with health insurance.  Consider this:  All these people on welfare
in this country who are dying to get off -- and by the way, that's
most of them -- who are dying to get off, most of them have limited
education.  Suppose they go through a little training program and
they get a job that pays a modest wage but is still more than the
welfare benefits.  But they go to work for an employer who does not
provide for health care.

             Think about this -- you are a mother with two children.
You give up being on welfare to take a job that pays more than the
welfare check, but you lose health care coverage for your kids.  What
are you going to do if your kid has to go to the dentist?  What are
you going to do if your child is desperately ill?  How are you going
to feel every week, every two weeks or every month when you get your
paycheck and you see what's taken out of it in taxes and you realize
those taxes are going to pay for the health care benefits of people
who decided to stay on welfare instead of going to work?  You don't
have to be as bright as a treeful of owls to figure out that this
doesn't make a lot of sense.  (Laughter.)

             Now a lot of American nurses are in this situation
today.  Getting up every day, slaving away, trying to take care of
people, have children without insurance, caring for people who come
into their office who are on public assistance who have children with
insurance because of the Medicaid program.  It is not fair.  It is
not right.  It is not smart.

             And you could say, well, if this were -- all this
inability to cover everybody -- if this were fueling some enormous
American economic expansion, because we were saving so much money on
health care, maybe you could deal with that.  But the truth is we're
spending over 40 percent more of our income on health care than any
other country in the world.  Oh yes, some of it because we're more
violent and that's something we pay for; some of it because we have
better medical research and technology, and that's worth paying for.
But a whole lot of it, as you well know, because of the way we have
financed health care, which has employed hundreds of thousands of
people in doctor's offices, in clinics, in hospitals, and in
insurance companies to read the fine print on thousands and thousands
of policies to see who and what is not covered.

             And it has rifled inefficiencies through this system
that we are all paying for.  We can fix this.  We can fix it by
having a law which fixes what's wrong, keeps what's right, provides
health care security to everybody through a private system, increases
the choices consumers have, and increases the decisions that doctors
and nurses and other qualified providers make without oversight by
others.  We can do it.

             In order to do it, we have to recognize we have to go
through a fog of misinformation, a torrent of labels which aren't
right, and recognize, too, that you have to lobby and stand up for in
an organized and very personal way that great association that
doesn't exist -- the association of 81 million Americans and families
with preexisting conditions; the association of hundreds of thousands
of small businesses who are doing the right thing and being punished
for it; the association of all the poor women in this country who are
out there working their hearts out and their fingers to the bone to
do right by their kids without health insurance and paying taxes for
people on public assistance who have it for their children.  All of
those associations are disorganized.

             You have devoted your lives to providing health care to
all Americans.  You have honored my favorite nurse today.  You have
given me a chance to hope that my mother and my grandmother are
looking down on me thinking I'm -- I was the first generation in
three that didn't produce anybody that was caring for other people in
health care.  So they think at least I walked off with the award
today.  (Laughter.)  It means more to me than I can say.

             But the determination that my mother showed in getting
up off the pavement many times in her life is the same sort of
determination you have to show for us to get health care reform this
year.  And remember, most of these members of Congress want to do the
right thing.  But they don't know what you know; they haven't spent
the time that you've spent; they haven't had the experiences you have
had.  You have to help them.  And the people in their districts that
really need their help are not in those great national associations.

             You keep them in your mind and keep that example in your
mind.  Don't let this year go by.  We can do this this year with your
help and your leadership.

             Thank you and God bless you all.  (Applause.)


                                 END10:26 A.M. EDT

..

.