For Immediate Release September 20, 1993
MRS. CLINTON: Good morning, and thank you all -- please be seated -- for joining us. We were talking so much with Dr. Koop in the back, none of us heard our names. (Laughter.) And so that's one of the reasons we were a little bit slow getting here.
I want to welcome you to the White House. I want to thank you for coming and being part of this process that we believe will lead to the kind of reforms in our health care system that many of you have talked about, have spoken about, and have actually done in the practices you have, in the centers in which you practice, at the medical schools that you direct. And it is a particularly exciting moment for all of us to be on the brink of what we hope will be the kind of changes that will assure health security to every American and give opportunities, again, to physicians and nurses and those on the front lines of health care to make the decisions about what needs to be done for the patients in our country.
I want to acknowledge Secretary Donna Shalala who is here. (Applause.) She's not only doing an excellent job at HHS, there are some who will argue that she may be the best golfer in the administration. (Laughter.) She played with the President last weekend.
Also Dr. Joycelyn Elders, our newly confirmed Surgeon General is back there. (Applause.) I think when it comes to prevention and communicating with large groups of Americans who have not been part of the health care system but need to be for their own and their families well-being, Dr. Elders will be an extraordinary voice.
Dr. Phil Lee, the longtime advocate for -- (applause) -- for better health care for Americans. We enticed him out of his position, which I think he thought was a position he would not move from in California to come back. And I personally have been very grateful for Dr. Lee's counsel and advice throughout this process.
Ira Magaziner, Dr. Judy Feder, others who are here. Judy and Ira, if you would stand. (Applause.) The team that they have put together, thanks to many of your institutions, which as several of the deans of the medical schools have told me, have meant you've lost people for long periods of time to be part of this process. We are very grateful.
I also want to thank the chairs of the Health Professions Review Group, Dr. Steve Gleason and Dr. Irwin Redlener, if you would stand please. (Applause.)
And there are many others who are in this room who have been such great helps to us and will continue to be as we move forward. I'm particularly pleased that an old friend of mine, Dr. Terry Brazelton would be here. Dr. Brazelton, who gives the kind of -- (applause) -- gives the kind of confidence to young mothers that Dr. Spock used to give to mine and that many of you have given. And we're very grateful for that.
We want to spend a few minutes this morning talking about where we go and how we get there and how we hope all of you will be involved in this process. And I would like to introduce the Vice President to say a few words about the way this relates to what we're doing across the board in the administration.
Vice President Al Gore. (Applause.)
THE VICE PRESIDENT: Thank you very much. Distinguished guests, ladies and gentlemen. I want to thank the First Lady for her introduction and leadership in this whole initiative. This is the week that was, as they say. And it's wonderful to see so many physicians who are here and who are so strongly supportive of the President's efforts to reform our health care system.
I might say that it's a special honor to be with Dr. Koop. I look forward to his comments later. He and I had a chance to work together on a number of projects in the last several years. And it is always refreshing to hear his views.
It's very interesting to take stock of how much things have changed in so short a period of time. The debate on health care is now dominating our national debate about where we go as a country. No one any longer doubts that we are going to reform our nation's health care system. Now the debate is about exactly how and what kinds of changes. It's very refreshing.
I heard kind of a throwback in the last couple of days from someone who is resisting change who made a point that I haven't heard in quite a while. He said, we have the finest health care system in the world. And in many ways, of course we do. But he said, we have to resist tinkering with it because it's just -- it's great. Well, when I heard that I thought about an event last week when the President and I went over to Children's Hospital. The First Lady was out at Mayo Clinic and leading a number of events in Minnesota that day. Tipper was talking with mental health care groups. The President and I went over to Children's Hospital and talked with doctors and nurses there about the current system and what it means to them just in terms of the sheer paperwork and bureaucracy and red tape.
As is often the case when a big change comes, people suddenly realize they have not allowed themselves to feel the weight of how bad things were until they can see the hope for change. Well, that's the message that we heard over there, as these doctors and nurses were saying. Since we sat down and really measured this, we didn't realize what we were doing. One patient comes in here under Medicare, and we have to fill out 26 different forms for that one patient.
We went to the file room, the stack of paperwork is growing six and a half feet per day -- just in one hospital. And one doctor said that in adding up the amount of time that he spent on paperwork, he could have seen an extra 500 patients per week -- I believe it was per week -- per year, I'm sorry. (Laughter.) I don't want to get carried away with this. No, I don't think it was per year. I think it was more than one per day.
MRS. CLINTON: It was one and a half per day.
THE VICE PRESIDENT: In any event, it was a lot. (Laughter and applause.) The main point is, the paperwork and the red tape and the bureaucracy is so overwhelming, when people now finally let themselves look at it and realize what they've been doing -- now, I believe I've got this statistic right. A pediatrician said that she was spending 25 hours -- believe it or not -- 25 hours per week just filling out forms for her patients. Is that right? Okay. (Laughter.) The heads are nodding yes on that one. (Laughter.) Well, that's crazy.
And we have been in the midst of this effort to reinvent government and we've been spotlighting the ways in which the system is very inefficient across the board. And there are so many similarities between what needs to be done government-wide and what needs to be done in the health care system.
This new approach is going to be simple -- one form per patient. It is going to be effective. It is going to extend health care coverage. And it's going to eliminate the waste and inefficiency. And we are all very excited about it and very pleased that you are here to help start this important week. Thank you. (Applause.)
MRS. CLINTON: I also now want to introduce someone who has been deeply involved in this. I know that there are representatives here from the American Psychiatric Association, other mental health professions, along with the APA, have worked very hard with Tipper Gore to come up with a proposal that would move our country forward on the treatment of mental health problems. And I'm very proud to introduce Tipper Gore. (Applause.)
MRS. GORE: Thank you. I want to add my voice in word of welcome to all of you and my deep gratitude for the work that you have given to the health care reform. And many of you have had direct input in the proposals on mental health. I see many people that I've worked so closely with and, as Mrs. Clinton said, when I addressed the American Psychiatric Association in the spring, it was really a wonderful event in which there was a meeting of the minds about the direction in which health care reform should go and the place that mental health care should have in it.
And I'm very proud to say that within this administration mental health, which has long been discriminated against, has been analyzed and debated along with all the other issues right from the very beginning. And that is a very revolutionary first step.
For those of you who have worked very hard on the proposal, thank you so very much for your input and your efforts. And just know that I will continue to work with you in the years ahead to make sure that American citizens have the very best mental health care that we can give them. Thank you. (Applause.)
MRS. CLINTON: One of the goals of the next weeks as we move forward is to be sure that all of the voices of those who are most involved in delivering health care will be heard. We believe that in coming forward with a plan that reflects what we have learned from listening and meeting with many of you and thousands of people around this country who are providing care that we have really sparked what will culminate in the final reform effort. But we cannot get there without all of your involvement.
Many of you in the last months have shown us why we can do what we think we can do in this country. You have through your practices shown how costs can be contained without in any way impacting quality. You have shown us how we can fairly finance a system if everybody is in it and everybody is responsible. You have convinced us of the importance of simplifying the system to get to the real problems that so many of you face.
We know there will be not only considerable discussion but probably even a very vigorous one in all kinds of settings around our country. And we welcome that, because we believe that this is an issue on which there are so many things to learn. And although we've tried to get it right, we are still getting it right.
As the Vice President said, I was in Minnesota on Friday talking with people from the university, from Mayo who have very specific suggestions about how to make it even better, which we are bringing back and incorporating.
In order to be sure that we continue to get that kind of involvement and feedback from the medical profession, we have scheduled a series of forums across the country that will bring together doctors and other local and national health care leaders to discuss various aspects of reform. It is our hope that these forums will serve as sounding boards for doctors who want to share their ideas about change, and as classrooms for ordinary citizens who want to learn more about our health care system.
We are starting at two different levels at one time. There are many, not only those in this room but in other positions around our country, who know a great deal about how the health care system works and how it could be reformed to work better.
There are others who are just beginning to focus their minds and attention on this. We want to be sure that the debate is as well informed as possible, because we believe that a well-informed debate will lead to the right solution for America.
It is our good fortune that Dr. C. Everett Koop has agreed to lead these panel discussions. He is one of the most thoughtful, courageous and independent health care leaders in the nation. During almost a decade as or nation's Surgeon General, he moved every American with his powerful messages about the AIDS crisis, the perils of smoking, and the murderous plague of urban violence.
For many years, Dr. Koop has campaigned to reform the health care system. He has been an passionate advocate of primary and preventive care, of universal coverage and cost containment. He has helped foster a new philosophy of medical education that emphasizes better communications between doctors and patients. And always he has stirred the consciences of all Americans by prodding each of us to be more responsible for our own health.
Dr. Koop's unwavering dedicating to improving our individual and collective health makes him uniquely qualified to moderate a national health care discussion in the months ahead. The work that he is doing at Dartmouth -- the work that demonstrates that very often there is no difference in quality between a coronary bypass priced at $20,000 and a coronary bypass priced at $80,000; the work that he is doing with courageous and forward-thinking leaders around our country who are already keeping costs below inflation without sacrificing one bit of patient care; the kind of work that he and his colleague, Dr. Wennberg, who is here, are doing to show that better allocation of our resources will result in no diminution of quality, but in fact, better quality in many instances because more people will be brought into the system in a more cost-effective, quality-driven way.
It was certainly influential to all of us, as we began to look for the kind of data that supports the sort of things and feelings and attitudes that many of you have expressed based on your own practice. If we can indeed take the physicians at Children's Hospital and relieve from them the Medicaid paperwork that is not related to patients records so that they could fulfill the promise that they made to themselves in front of the President and the Vice President, that for those 200 doctors on staff, each could then see approximately 500 more patients, that would be 10,000 more children just in Washington, DC, who could be taken care of. That's the promise of health care reform. And that is the hope we bring to this national discussion with all of you and why we're so pleased that Dr. Koop has been willing to take this leadership role.
Dr. C. Everett Koop. (Applause.)
DR. KOOP: Thank you very much. I know when people come to Washington, even sophisticated physicians, they like to go home having picked up some inside information. I'll let you in on a conversation that took place about two years ago when that grand old gentlemen Claude Pepper died and went directly to heaven. He had an audience with God and said, sir, just one question. Will there ever be health care reform in the United States? And the Lord answered and said, yes, Senator, there will be health care reform in the United States. That's the good news. The bad news -- not in my lifetime. (Laughter.)
Since I left office as your Surgeon General four years ago, I have really dedicated most of my time and energy to speaking out whenever and wherever I could all across the United States on the need for health care reform. At first mine seemed like a lonely voice out there. But now at long last, health care reform has moved to the top of the national agenda. And I thank President Clinton and the American people for placing it there.
A few weeks ago, I told the President that without passing a single law or issuing a single regulation, he had accomplished more in health care reform in the past four months than all of his living predecessors put together. (Applause.) And he did that with a special kind of leadership that is willing to take on an enormous task. This kind of leadership also takes courage because it's a daunting task to face runaway health care costs, the vexing issue of universal access, the malpractice mess, the mounting problems of Medicare and Medicaid, the application of outcomes research, a sweeping reassessment of medical ethics, to say nothing of rooting out fraud and waste and abuse and greed.
Like many of our big national problems, the health care crisis in America is a very complicated one. And that means it will call for a variety of solutions. They, of course, will be national, but that means regional and local. They will have to be a public- private partnership. And there is a way in which every citizen must make a personal contribution.
But the President knows that there is no panacea, there is no single magic bullet, and there are no easy answers, only a series of very difficult choices. The administration's health care reform initiative is comprehensive, it's complex, it's -- well, it's complicated. And that's because it is offered in the spirit of compromise.
President Clinton has told me that he views these health
care proposals not as a take it or leave it package, but as what they
are -- proposals -- proposals that will lead to constructive debate
and not just to constructive debate but then to constructive
legislation. Some things, like universal access, are not negotiable.
And that's exactly the way it should be. (Applause.) But they are
proposals offered in trust that an honest congressional and public
debate will bring out the best in health care reform for the American
people.
Now, I don't imagine that any one of us will agree with
everything, every single point in the proposed reforms. I imagine
the President has his own reservation about some points.
When I read the first draft of the plan, I was impressed
with the attention that had been given to detail: present situations
that should be eliminated, needed additions that would be made. I
was supportive of the plan, even if there was specific issues with
which I disagreed.
Later, I was also pleased that suggestions I made in a
critique of the plan did not fall on deaf ears. Whether there are
pieces of the administration's health plan that you don't like or
not, we have to move forward with dialogue seeking consensus. But
our reservations, or even outright objections, to some provisions
cannot give us the excuse to oppose everything.
My concerns about some issues will not stop me from
fighting for the many reforms the American health care system so
desperately needs. And I hope you'll approach the reform proposals
in exactly that same spirit. It is in this spirit of dialogue and
constructive debate that I have agreed, as the First Lady said, to
moderate a dialogue between the medical profession and the
administration a series of panel discussions scheduled this fall and
winter in a number of cities across America.
Now, these forums could, for example, combine the views
and expertise of national health care figures with those of local
physicians and other health care workers so they can, together,
thrash out the issues of the reform proposals before the profession
as they relate to a local region.
Physicians have been noticeably absent from past efforts
to reform the American health care system, even when it turned out
that physicians proved to be among the major beneficiaries, as with
Medicare. Indeed, all too often, past health care reform measures
have been imposed upon physicians, often against their loudly voiced
opposition. This time, doctors cannot allow themselves to be cast in
the role of naysayers.
In one way or another, doctors' decisions for their
patients and themselves drive the entire health care system. And,
therefore, I call upon the medical profession in which I have served
for over half a century to assume its rightful position of leadership
to drive the health care system to the reformed excellence that it
can deliver. (Applause.)
Our health care system may function with compassion,
with competence, at times with sheer excellence. But not for enough
Americans. For too many Americans, our health care system is a
tyranny, and that means for them it is more a curse than it is a
blessing. The next decade will force us to do some very hard
thinking and deciding about the basic purpose of medicine. We
haven't done much of that in days gone by. For most of human
history, medicine really couldn't do very much, really couldn't cure
anything. And so, at best, it offered some comfort, some relief of
symptoms.
And, then, beginning in the 18th century -- and remember
that modern medicine and the United States are about the same age --
with the application of science and technology to medicine, we saw
the age when medicine could begin to cure many problems, and it could
prolong the life for millions of people. And we entered the age of
what we now call "our medical miracles." But a still other age may
be dawning as we come to grips with the limits of curative and
reparative medicine and surgery.
Today, in a strange way, hospitals and doctors -- in
fact, the entire health care community -- are victims of their own
success in curing disease and alleviating suffering. Increasingly,
medicine decreases mortality while it increases morbidity. In other
words, we have many more people living longer, but some of them are
living sicker. And an increasing share of health care resources are
allotted to those whom medicine cannot cure and we know about that at
the start.
Too much, however, of the intensifying debate about
health care focuses only on questions of how we finance it on the
economic and political dimensions of health care reform. I think,
for many of us, this puts the cart before the horse. More important,
I think, than the economic and political pressures is the ethical
imperative for health care reform.
Before we can enact the sweeping reform we need in
health care, we must agree on the basic values and the ethics upon
which our health care system, and, indeed, our society is based, and
from which it draws its moral power.
If we could reach an ethical consensus, I think many of
the economic and political problems of health care reform would fall
rather easily in line. Physicians and allied health workers bring a
broad field of vision to the health care reform effort. Physicians
and nurses, other health care workers, have seen firsthand their
fellow citizens' lack of health insurance go from being just an
economic inconvenience to now being a medical risk factor.
Health workers know from experience that uninsured
Americans are sicker than other patients when they finally enter the
health care system, and their illnesses cost the system more to
treat. And their lack of insurance results in a higher mortality
rate than that of hospitalized Americans who do enjoy adequate health
insurance.
Health care workers have also often seen patchwork
efforts at cost control result merely in cost-shifting -- squeezing
the balloon in one place, only to have it expand in another.
I would suggest that you in this room can bring your
experience and expertise to the debate on health care reform so that
we can preserve what is right and correct what is wrong. In so many
ways, the American health care system, in spite of its many flaws,
offers the best health care in the world. Nevertheless, we must
remember if it ain't broke, don't fix it; but, unfortunately, an
increasingly large share of our system is breaking down. So let's be
sure that we turn our attention to ways that we can fix that.
And so I do call up on the medical community to approach
the health care reform proposals now being offered in the spirit of
our high calling in the Hippocratic tradition that requires us to do
nothing but the best for our patients. Let us make sure that
physicians play their part in making sure that the health care system
we reform offers the very best for the American people. The
President has said he wants a dialogue. Let us accommodate him in
the spirit of reform and of give-and-take.
Physicians are individualists to be sure, but they are
also altruists. And we have come to a time when, for once, the
medical profession and the government can work together to forge a
health care system for all Americans by achieving a new American
consensus. Let me reaffirm that I think the plan is headed and
moving in the right direction. I look forward to lending my support
as I moderate the forthcoming dialogue between the great profession
of medicine and this administration. Thank you. (Applause.)
THE PRESIDENT: Good morning. I thank you for coming
here, and I thank Dr. Koop for his stirring remarks. He always makes
a lot of sense, doesn't he. And the nation is in his debt for his
work as Surgeon General and now, for the work he is about to
undertake in behalf of the cause of health care reform.
I also want to thank the many physicians from all across
America, from all walks of medical life who have made a contribution
to the debate as it has progressed thus far. I got very interested
in this subject years ago when, as the governor of my state, I
noticed I kept spending more and more for the same Medicaid and had
less and less to spend on the education of our children or on
preventive practices or other things which might make a profound
difference in the future.
In 1990 I agreed to undertake a task force for the
National Governors Association, and I started by interviewing 900
people in my state who were involved in the delivery of medical care,
including several hundred doctors. Some of them are in this room
today. I thank them for their contribution, and I absolve them of
anything I do which is unpopular with the rest of you. (Laughter.)
I'm glad to see my dear friend and often my daughter's
doctor, Dr. Betty Lowe, the incoming President of the American
Academy of Pediatrics. (Applause.) My cardiologist, Dr. Drew
Kumpuris, who pulls me off a treadmill once a year and tells me I'm
trying to be 25 when I'm not. (Laughter.) And Dr. Morris Henry from
Fayetteville, Arkansas, back here, an ophthalmologist who hosted the
wedding reception that Hillary and I had in Morris and Anne's home
almost 18 years ago next month. Dr. Jim Weber, formerly President of
the Arkansas Medical Society. A lot of our doctors here -- we
started a conversation with doctors long before I ever thought of
running for President, much less knew I would have an opportunity to
do this.
This is really an historic opportunity. It is terribly
important for me. One of the central reasons that I ran for
President of the United States was to try to resolve this issue,
because I see this at the core of our absolute imperative in this
sweeping time of change to both give the American people a greater
sense of security in the health care that they have, and call forth
from our people -- all of our people, including the consumers of
health care -- a renewed sense of responsibility for doing what we
all ought to do to make this country work again.
I am determined to pursue this in a completely
bipartisan fashion. And I have reached out to both Republicans and
Democrats, as well as the thoughtful Independents to help. There is
one person in the audience I want to introduce, a longtime friend of
mine who has agreed to help mobilize support for this approach among
the Democrats of the country, the distinguished former governor of
Ohio, my friend Dick Celeste, who's here. Thank you for being here.
(Applause.)
When Dr. Koop talked about the ethical basis of this
endeavour, he made perhaps the most important point. If I have
learned anything in all these years of public endeavors, or anything
in the last several months of serving as your President, it is that
once people decide to do something they can figure out how to do it.
When, one week ago today, on the South Lawn of the White
House, Yitzhak Rabin and Yassar Arafat signed that peace accord, they
did not even know what the ultimate map drawing of the city of
Jericho would be, or how all the elections would be held, or how the
Palestinians candidates would advertise on the radio since the radio
stations don't belong to the Palestinians -- I could give you a
hundred things they did not know the answer to. They knew one thing,
they couldn't keep going in the direction they were going and so they
decided to take a different direction.