THE WHITE HOUSE Office of the Press Secretary ______________________________________________________________ For Immediate Release June 21, 1994 REMARKS BY THE PRESIDENT TO BUSINESS ROUNDTABLE J.W. Marriott Washington, D.C. 12:55 P.M. EDT THE PRESIDENT: Thank you very much, John. I'm trying to fix this lectern, if you're wondering what I'm doing up here. I'm proving that I don't have sufficient mechanical skills. (Laughter.) [...] Now, despite all these efforts, I have to tell you that I do not believe that the American people, as individuals, will be able to embrace the changes of the global economy, and successful workers, unless and until we address the health care crisis. This goes to the heart of our debate on all of the other things in the strategy I outlined. It goes to the heart of whether we can get our own economic house in order, it goes to the heart of whether we can make government work from ordinary people, it goes to the heart of whether we can empower people to view change as a friend instead of an enemy. Unless we can provide coverage for every American in a reform system which focuses on both quality and control of costs, the deficit will grow, your costs will continue to grow and undermine productivity, and more and more Americans will lose their coverage or be at risk. Let me briefly discuss this whole thing from my point of view, from your point of view, and from the American citizen's point of view -- from a worker's point of view. From my point of view, as the President in charge of the budget, I've worked hard to get this deficit down for three years in a row for the first time since Truman was President. I have done things that people who say they're more conservative than me talk about but don't do. We're eliminating over 100 government programs. We're cutting 200 others. We're reducing discretionary spending for the first time in 25 years, and still with the discipline to increase investment in education and new technologies and training. We have reduced defense all we can reduce it. And I think we are right at the margin, and we should not reduce it any more, given the challenges we face in this economy. A lot of you will probably be called to testify or to support the work of Senator Kerrey, Senator Danforth and others in this entitlements commission, because you know that the only thing that is increasing our deficit now is entitlements. Keep in mind, when you strip all that away, some of the entitlements are going down; Social Security is going up only with the rate of inflation, and is roughly the same percentage of our GDP it was 20 years ago. The only part of the entitlements going up much more rapidly than inflation are Medicare and Medicaid -- the government's programs for the elderly and the poor. And I can tell you that unless we can bring them in line with inflation, we will be forced to either let the deficit go up again, raise taxes more than we should, or cut our investment in public investment -- in things you support -- to a dangerously low level in a global economy. So that's what it looks like from my point of view just from a budget perspective. From your point of view, you know already that the government does not reimburse Medicare and Medicaid providers at 100 percent of cost, so the costs are being shifted to you. The other people who are shifting costs to you are businesses and employers who do not have health insurance but who get health care. They are shifting the cost to you. Now, if our deficit goes up, and we have to bring the deficit down, and we cut Medicare and Medicaid without fundamental reform, we're going to shift more cost to you. And you will be put in the position of paying more or covering less. Keep in mind -- in the last three years, three million American workers have lost their health insurance. There are three million more Americans without health coverage today than there were three years ago. You are also paying for them in cost shifting. So unless we have comprehensive reform, you will be put in the position of some day coming to the end of how much you can do managing your health care costs on your own, which you've done a very good job of, almost all of you. And you will be facing the cost shift coming at you from the federal government and from the increasing numbers of employers who don't provide any coverage. Now, the third and most important thing of all -- what does this look like if you're out there working in this country and you hadn't had much of a pay increase in the last 10 years; but you know that your country's becoming more competitive; and you're excited about the 21st century; and you know that you're raising children who will have to change jobs eight times in a lifetime? What are you going to do? If you're a man and you have a premature heart attack, or your wife gets breast cancer, your kid develops some strange disease, and you have a preexisting condition? And you're being told it's a brave new world out there -- don't worry if you have to change jobs, just get some new retraining; you'll do fine. And then it turns out nobody wants to hire you because you've got a preexisting condition. Oh, I know there are those who say we can just legislate these things. We'll just legislate the insurance reforms, say you can't discriminate against anybody, and it will be fixed. Look at the study that many of my adversaries in the Congress on this issue keep citing -- the Lewin VHI study. They say that all you can get out of insurance reforms is coverage in the short run for 2.2 million more people. They say that if you -- you look at the experience of New York that tried to mandate insurance reforms alone. What happens, a lot of people's insurance goes up, and a lot more people opt out of the system. I say, if you look at the rest of the world and you look at us, we have 81 million Americans out of a population of only 255 million, 81 million of us live in families with people who have preexisting conditions. But they all still need to be able to change work seven times in a lifetime. Thirty-nine million of us do not have health insurance. There is no compelling evidence that we can both have quality and cost control and stop cost-shifting in the absence of covering everyone. There is no compelling evidence. The Lewin VHI study, so often cited by those who say, well, we could get 91 percent coverage in America, up from 83 percent, covering 97 percent of the cost of health care if only we did this stuff, which doesn't require employer mandates or of some other universal coverage. That's being talked about. But if you notice, there's not been a bill really pushing that. Why? Because when you strip it away, you see that it costs literally hundreds of billions of dollars over the next five or six years to finance that in massive subsidies which basically benefit poor people, most of whom are not working, some of whom are working, and does nothing for middle-class workers. Which means to do that, instead of an employer mandate, we would have to go back and raise the heck out of everybody's taxes, which we are not about to do. At that level it would not be fair. Now, how is it that every other advanced country in the world and all of our competitors -- we're only too happy to learn from our competitors in every other way, and we're very proud when we beat our competitors. And I don't know how many of you have told me personally, we're better now than anybody else in the world at what we do. We went through all kinds of agonies in the '80s and we faced all these challenges, and now we're better than our competitors. Well, our competitors, not a single, solitary one of them, spends more than 10 percent of GDP on health care; we spend 14 percent, and we're the only people that can't figure out how to cover everybody. Now, I refuse to declare defeat. Why should we jump in the tank? I heard the messages about what people didn't like about our original proposal. Don't put restrictions on experimental drugs; don't make businesses go into alliances if they don't want to; let it be voluntary. People know their own interests. Let multistate businesses have an approach which makes sense for all their employers. We're making the changes that we heard people complain about. Those changes are being made. We know we needed to make some changes. But if you remember, when I offered my health care plan, I said, this is not the end all and be all; it's the beginning of a debate. But what we need to decide is whether we're going to walk away from this session of Congress without the debate. Harry Truman said 50 years ago, Americans will never be secure unless we did something about health care. Everybody thinks of Harry Truman now as the fount of all wisdom. I come from a family that liked him when he was unpopular. (Laughter.) But most Americans didn't like him too much at the time. He kept telling them uncomfortable truths. He was right 50 years ago, and it's still true.So, yes, we need to make some changes in the original proposal I made. We put them out there. But what we need is a quick, honest, forthright debate. We need to deal with this issue this year because, until we do, we will continue to spend a higher percentage on health care than our competitors; you will continue to have costs shifted to you; your government will continue to face the agonizing choice of continuing to spend more and more of your tax money on entitlements, less on investment, and still increasing the deficit and still shifting costs to you. So, I ask you, enter the debate and just tell people what you have to do every day in your own businesses. You get a real hard decision. If you don't want the thing to collapse, you can't walk away. And almost always, you make a decision that is less than perfect but is better than making no decision. So I ask you, help me pass the reemployment bill. Help us pass GATT. Help us pass welfare reform. But don't walk away from health care. The numbers are big; they're enormous. And we can't tell an average American, can't tell a mother on welfare, get off of welfare and take a job so you can lose your children's health insurance and start paying taxes for people to pay for their kids' health care who stayed on welfare. We can't tell a worker, give up your job security and find a new security in your mind, in you ability to learn and change, if your illness or the illness of someone in your family will put you out of the job market. We must not ask people to choose between being good parents and good workers. We cannot ask people to risk their children's health to participate in the global economy. And most importantly, we can't just keep working with a system that is fundamentally flawed that we can fix. We can look around the world; we know there are all kinds of fixes here. We may have to do more for small business; I'm willing to do that. We may have to do more, and we should, to make the thing less regulatory; I've already made a lot of those changes. But let us not walk away. When I spoke at Normandy a couple of weeks ago, in the greatest honor of Presidency, to represent our country in commemorating the 50th anniversary of D-Day, the thing that overwhelmed me about that was that people did what they had to do because there was no option; and they measured up and literally saved the world. And that, in that moment, there was no option to be cynical. There was no luxury available for people to avoid the decisions before them, and they did not have the option to be cynical. Today, I tell you, we have fundamental decisions to make about what kind of people are going to be into the future. Walking away is an option that's not really there. Being cynical or negative is always an option that's there, but it's something we pay a terrible price for. This country can do what we have to do. We have to be what the people that led the D-Day invasion were; they were called pathfinders -- the people that went first. That's what we're being asked to do. You live in an age which glorifies commerce and success and international trade more than any other in the lifetime of anybody in this room. Therefore, you have enormous responsibilities. And you have to light the path to the future in the way that the GI Bill did 50 years ago. We can do it. We can do it -- if we make the right choices. Thank you very much. (Applause.) END 1:28 P.M. EDT