View Header


Office of the Press Secretary

For Immediate Release September 22, 1993

Address of President William Jefferson Clinton

Before a Joint Session of Congress

"Health Security For All Americans"

Mr. Speaker, Mr. President, Members of Congress, distinguished guests, my fellow Americans --

Tonight, we come together to write a new chapter in the American story.

Our Forebears enshrined the American dream -- life, liberty and the pursuit of happiness. Every generation of Americans has worked to strengthen that legacy to make America a place of freedom and opportunity, where people who work hard could rise to their full potential, and where their children could live a better life than they did.

From the settling of the frontier to the landing on the Moon, ours has been a story of challenges defined, obstacles overcome, new horizons secured. This is what makes America what it is and Americans who we are.

Now we are in a time of profound change and opportunity: the end of the Cold War, the information age, the global economy that have brought us both opportunity and hope, and dislocation and uncertainty. Our goal in this dynamic age is to make change our friend and not our enemy. To achieve that goal, we must face our challenges with confidence, faith and discipline -- whether it's reducing the deficit, increasing investment, creating jobs and expanding trade, converting from a high-tech defense to a high-tech peacetime economy, making our streets safe or rewarding work over idleness. All these challenges require change.

If Americans are to have the courage to change we must be secure in our most basic needs. Tonight I want to talk with you about one of the most essential things we can do to build that security: it is time for America to fix a health care system that is badly broken.

Despite the dedication of millions of talented health care professionals, our health care is too uncertain and too expensive; too bureaucratic and too wasteful. It has too much fraud and too much greed.

At long last, after decades of false starts, we must make this our most urgent priority: Giving every American health security -- health care that's always there -- health care that can never be taken away.

On this journey, as on all others of consequence, there will be rough stretches and honest disagreements about how to reach our destination. After all, this is a complicated issue.

But every successful journey is guided by fixed stars. And if we can agree on some basic values and principles, we will reach that destination together. So tonight, I want to talk with you about the principles that must guide our reform of America's health care system: Security, simplicity, and savings; choice, quality and responsibility.

When I launched our nation on the journey to reform the health care system, I knew we needed a talented navigator -- someone with a rigorous mind, a steady compass, and a caring heart. Luckily for me and for our nation, I didn't have to search very far. Because I could turn to the First Lady.

I think she has done a brilliant job.

Over the past eight months, Hillary and those working with her talked to literally thousands of Americans to understand the strengths and frailties of our health care system.

They met with over 1,100 health care organizations. They talked with doctors, nurses, pharmacists, hospital administrators, insurance and drug company executives and small and large business owners. They talked with the uninsured and the self-insured, with union members, older Americans and advocates for children.

The First Lady consulted extensively with government leaders of both political parties, across the states of our country, and especially here on Capitol Hill.

The Stories and the Letters

Hillary and the Task Force received and read 700,000 letters from ordinary citizens. And what they wrote -- and how bravely they spoke about their struggle -- is what calls us all to action.

Every one of us knows someone who has worked hard and played by the rules but has been hurt by this system that just doesn't work. Let me tell you about just one.

Kerry Kennedy owns a small furniture franchise that employs seven people in Titusville, Florida. Like most small business owners, Kerry has poured his sweat and blood into that company. But over the last few years, the cost of insuring his seven workers has skyrocketed, as did the cost of the coverage for himself, his wife, and his daughter. Last year, however, Kerry could no longer afford to provide coverage for all his workers because the insurance companies had labeled two of them high risk simply because of their age. But, you know what? Those two people are Kerry's Mother and Father who built the family business and now work in the store.

That story speaks for millions of others. And from them, we have learned a powerful truth: we have to preserve and strengthen what is right with our health care system and fix what is wrong with it.

This is what is right: We are blessed with the best health care professionals, the finest health care institutions, the most advanced research, and the most sophisticated medical technology on the face of the earth. My mother is a Nurse, and I grew up around hospitals. The first professional people I ever knew and looked up to were doctors and nurses. They represent what is right with our health care system.

But we cannot ignore what is wrong. Millions of Americans are just a pink slip away from losing their health coverage, and one serious illness away from losing their life savings. Millions more are locked into the wrong jobs, because they'd lose their coverage if they left their companies. And on any given day over 37 million of our fellow citizens, the vast majority of them children or hard working adults, have no health insurance at all. And despite all of this, our medical bills are growing at more than twice the rate of inflation.

Our health care system takes 35% more of our income than any other country, insures fewer people, requires more Americans to pay more and more for less and less, and gives them fewer choices. There is no excuse for that kind of system, and it's time to fix it.

The proposal I will describe tonight will reform the costliest and most wasteful health care system on Earth without any new broad-based taxes.

Many of the principles in my plan have already been embraced by Republicans as well as Democrats. For the first time in this century, leaders of both political parties have committed themselves irrevocably to providing universal, comprehensive health care for every American.

I have been deeply moved by the spirit of this debate. We now have both Republicans and Democrats willing to say, yes, let us listen to the people, and let us act. Both sides understand the ethical imperative of solving this problem; both sides know it will define who we are as a people. Let me ask all of you -- every Member of the House, every Member of the Senate, every Democrat and every Republican -- let us keep this spirit and keep this commitment until our work is done.


The first principle of health care reform -- the most important -- must be security. This principle speaks to the human misery and costs that we hear about every day when Americans lack or lose health care coverage.

Security means that those who do not have health care coverage will have it and, for those who have coverage, it will never be taken away. We must achieve that security as soon as possible.

Under our plan, every American will receive a health security card that will guarantee you a comprehensive package of benefits over the course of your lifetime that will equal benefits provided by most Fortune 500 corporations.

This card will guarantee you a comprehensive package of benefits that can never be taken away. And let us pledge tonight: Before this Congress adjourns next year, you will pass, and I will sign a new law to create health security for every American.

With this card, if you lose your job or switch jobs, you're covered.

If you leave your job to start a small business, you're covered.

If you are an early retiree, you're covered.

        If you or someone in your family has a preexisting medical
        condition, you're covered.

        If you get sick or a member of your family gets sick, even if
        it's a life-threatening illness, you're covered.

        And if an insurance company tries to drop you for any reason,

you'll still be covered -- because that will be illegal.

This card will give you comprehensive coverage. You will be covered for hospital care, doctors visits, emergency and laboratory services, diagnostic services like Pap smears and mammograms, substance abuse and mental health treatment.

And our proposal will pay for regular check-ups, well-baby visits and other preventive care. It's just common sense. People will stay healthier and at affordable costs. You know how your mother told you that an ounce of prevention is worth a pound of cure? Well, your mother was right. And we've ignored that lesson for too long.

Security must also apply to older Americans. This is something I feel very strongly about: We will maintain the Medicare program. And for the first time, Medicare will cover the cost of prescription drugs. And over time our proposal will provide assistance in the home for the elderly and disabled who need long term care. As we proceed with health care, we must not break faith with our older Americans.


The second principle is simplicity. Our health care system must be simpler for the patients and simpler for those who actually deliver health care: our physicians, our nurses, and our other medical professionals.

Today, we have more than fifteen hundred insurers with hundreds and hundreds of different forms. They are time consuming for health care providers, expensive for health care consumers, and exasperating for anyone who has ever tried to sit down at the kitchen table and wade through the paperwork.

The medical care industry is drowning in paperwork. In recent years, the number of administrators has grown four times as fast as the number of doctors. A hospital should be a house of healing, not a monument to bureaucracy.

A few days ago, the Vice President and I visited Children's Hospital in Washington, where they do wonderful, often miraculous things for very sick children.

Nurse Debbie Freiberg in the cancer and bone marrow unit told us that, the other day, a little boy asked her to stay at his side during his chemotherapy. But she had to tell him no. She had to go to yet another meeting to learn how to fill out yet another form. That's wrong.

Dr. Lillian Beard, a pediatrician, in that same hospital, said she did not get into her profession to spend hours every week filling out forms. She became a doctor to help save lives. If we can relieve them of that burden, they believe that each doctor in her hospital could see 500 additional children each year.

Under our proposal, there will be one standard insurance form, not hundreds. We will simplify government rules and regulations so that a doctor doesn't have to check with a bureaucrat in an office thousands of miles away before ordering a simple blood test. And you won't have to worry about the fine print, because there won't be any fine print.


The third principle is that reform must produce savings in our health care system.

Today, rampant medical inflation is eating away at our wages, our savings, our investment capital, and our public treasury. It undermines America's economy, competitiveness, confidence, and living standards.

Unless we curb health care inflation, American workers will lose $655 in income each year by the end of the decade. Small businesses will continue to face skyrocketing premiums, and a full third say they will be forced to drop insurance. Large employers will have to pay as much as $20,000 a year for each employee. And health care costs will devour more and more of the federal budget.

Every state government and every local government will continue to cut back on everything else they must do -- from police protection to education -- to pay more for the same health care.

These rising costs are a special nightmare for America's small businesses -- the engine of entrepreneurship and job creation. Health care premiums for small businesses are 35% higher than those of large corporations, and they will keep rising at double-digit rates unless we act.

How will we achieve savings? Rather than looking away as the price spiral continues, and rather than using government to set health care prices, our proposal relies on a third way. We want to give groups of consumers and small businesses the same bargaining clout that the biggest corporations now have. We will force plans to compete on the basis of price and quality, rather than making money by turning away people who are sick, or performing unnecessary procedures. And we will back the system up with limits on how much plans can raise their premiums. We will create what has been missing for too long: a combination of private market forces and sound policy to support that competition.

Unless every one is covered, we can never put the brakes on health care inflation. Because when people don't have insurance, they wait to see a doctor until their illness is more severe and more costly, and they often seek treatment in the most expensive settings -- like emergency rooms. And when they can't pay their bills, because they aren't insured -- who do you think picks up the tab? -- the rest of us do: through higher hospital bills and higher insurance premiums.

We will also save money by simplifying the system and freeing health care providers from costly and unnecessary paperwork and administrative overload that now costs $100 billion a year. We will crack down on the fraud and abuse that drains billions per year.

This system will work. You don't have to take my word for it. Ask Dr. C. Everett Koop. He says we could spend $200 billion less every year without sacrificing the high quality of American medicine. Ask the public employees in California, who have held their own premiums down by adopting this very same approach. Ask Xerox, which saved an estimated $1,000 per worker. Ask the staff of the Mayo Clinic, who provide some of the finest care in the world, while holding their cost increases to less than half the national average. Ask the people of Hawaii, the only state that covers virtually all of their citizens, and whose costs are well below the national average.

People may disagree over the best way to fix the system. But no one can disagree that we can find billions of dollars of savings in the most costly and bureaucratic system in the world, and we ought to be doing something about it now.


The fourth principle is choice. Americans believe they should be able to choose their own health care plans and their own doctor. And under our plan they will have that right.

But, today, under our broken health care system, that power to choose is slipping away. Now it is usually the employer -- and not the employee -- who makes the choice of what health care plan will be provided. If your employer only offers one plan, as do nearly three-quarters of small and medium-sized businesses, you're stuck with that plan and the doctors it covers.

We propose to give every American a choice among high quality plans. You can stay with your current doctor, join a network of doctors and hospitals, or join a Health Maintenance Organization. If you don't like your plan, every year you'll have the chance to choose a new one.

The choice will be left to you -- not your boss -- and not some bureaucrat.

And we also believe that doctors should have a choice as to what plans they practice in. We want to end the discrimination that is now growing against doctors and permit them to practice in several different plans. Choice is important for doctors, and critical for consumers.


The fifth principle is quality. If we reformed everything else in health care but failed to preserve and enhance the high quality of our medical care, we would have taken a step backward, not forward.

Quality is something that cannot be left to chance. When you board an airplane, you feel better knowing that plane had to meet standards designed to protect your safety. We must ask no less of our health care system.

We don't propose a government-run health care system. We propose that government sets standards to ensure health care quality. Our proposal will create report cards on health plans, so that consumers can choose the highest quality providers, and reward them with their business. At the same time, our plan will track quality indicators, so that doctors can make better and smarter choices about the kind of care they provide.

We have evidence that more efficient delivery of health care does not decrease quality, and may even enhance it. Let me give you an example of one commonly performed procedure, the coronary bypass operation.

Pennsylvania discovered that patients who were charged $21,000 for this surgery received as good or better quality care as patients who were charged up to $84,000. High prices don't always equal good quality.

Our plan will guarantee that quality health care is available in even the most remote areas of our nation, linking rural doctors and hospitals with high-tech urban medical centers. And our plan will ensure quality by speeding research on effective prevention and treatment measures for cancer, for AIDS, for Alzheimers, for heart disease and for other chronic diseases. Our plan safeguards the finest medical research establishment in the world, and makes it even better.


The sixth and final principle is responsibility. We need to restore a sense that we are all in this together, and we all have a responsibility to be a part of the solution.

Responsibility must start with those who have profited from the current health care system. Responsibility means insurance companies will no longer be allowed to cast people aside when they get sick. It must also apply to laboratories that submit fraudulent bills; to lawyers who abuse the malpractice system; to doctors who order unnecessary procedures. It means drug companies will no longer be allowed to charge three times more for prescription drugs here in the United States than they charge overseas. Responsibility must apply to anyone who abuses our system and drives up costs for honest, hard-working citizens and health care providers.

Responsibility also means changing the behavior in this country that drive up our health care costs and cause untold suffering. It's the outrageous costs of violence from far too many handguns, especially among the young. It's high rates of AIDS, smoking and excessive drinking; it's teenage pregnancy, low-birth weight babies, and not enough vaccinations for the most vulnerable.

But let me also say this. And I hope you will listen, because it is a hard thing to hear. Responsibility in our health care system isn't about "them". It's about you. It's about me. It's about each of us.

Too many Americans have not taken responsibility for their health. Too many Americans use this health care system but don't pay a penny for their health care. I believe those who do not have health insurance should be responsible for paying something. There can be no more something for nothing.

Your contribution may be as small as a ten dollar co-payment when you visit the doctor. But all of us must have insurance. Why should the rest of us pick up the tab when a guy who doesn't think he needs insurance gets in an accident and winds up in the emergency room?

Reform is going to produce a better health care system for every one of us. But no one should think it's going to be a free ride. We have to pay for it. Tonight I want to tell you very plainly how we plan to do that.

Most of the money will come, as it does today, from premiums paid by employers and individuals. But under our Health Security Plan, every employer and every individual will be asked to contribute to health care. This concept was first conveyed to the Congress by President Nixon. And today a lot of people agree that the concept of shared responsibility between employers and employees is the best way to go, from the US Chamber of Commerce to the American Medical Association.

Some people call it an employer mandate, but I think it is the fairest way to achieve responsibility in the health care system. It builds on what we already have, and what already works. It is the reform that is easiest for consumers to understand. It includes a discount to help struggling small businesses meet the cost of covering their employees. It requires the least bureaucracy or disruption and creates the cooperation we need to make the system cost-conscious even as we expand health coverage.

Every employer should provide coverage. Three-quarters do it now. Those that pay are picking up the tab for those that do not. And it's just not right.

To finance the rest of reform, we'll achieve new savings in both the Federal government and the private sector through better decision making and increased competition, and we will impose new taxes on tobacco.

These sources will cover the costs of the proposal I have described to you tonight. We have subjected our numbers to the scrutiny of the major agencies in our government as well as some of the most respected actuaries from private accounting firms and Fortune 500 companies.

What does all this mean for you as individuals?

Some will be asked to pay more. If you are an employer, and you are not insuring your workers, you will have to pay more.

If you are a firm that provides only limited coverage, you may have to pay more.

If you are a young single person in your twenties and you are already insured, your rates may go up somewhat. But some day you will get older. And then under this proposal, you will be guaranteed affordable coverage.

But for the vast majority of you watching tonight will pay the same or less for your health care coverage and, at the same time, get the same or better coverage than you have today.

If you currently get your health insurance through your job, under our plan you still will. And, for the first time, all of you will get to choose what plan you belong to.

If you're a small business owner who wants to provide health insurance to your family and your employees but can't afford to because the system is stacked against you, this plan will give you a discount that will finally make insurance affordable. And if you are already providing insurance, your rates will drop because we'll help you join with thousands of other small firms to get the same benefits big corporations get.

If you are self employed, you will pay less, and you will get to deduct from your taxes 100% of your health care premiums.

If you are a large employer, your health care costs will stop increasing at double digit rates, so that you will have more money to put into higher wages and new jobs.

These are the principles on which we must base our efforts -- Security, simplicity, and savings; choice, quality and responsibility. These are the guiding stars that we must follow on our journey toward health care reform.


Over the coming months, you are going to be bombarded with scare tactics by those who profit enormously from the current health care system. Some of the arguments you hear will be sincere. Others will be motivated by self-interest. And when they tell you that we cannot afford to change the current system, I want you to stop and think: Who are they trying to protect. You or themselves? And can we afford to stay with the current system.

As Representatives in Congress, you have a special duty to look beyond such arguments. I ask you to look into the eyes of a sick child who needs care. Look at the face of a woman who has been told not only that it is malignant, but also that it's not covered by her insurance. Look at the bottom lines of the businesses driven to bankruptcy by health care costs. And at the forest of For Sale signs in front of homes of families who have lost their health insurance. Then look in your heart and tell me that the greatest nation in the history of the world is powerless to confront this crisis. Our history and our heritage tell us we can meet this challenge and we shall meet this challenge.

Let us write that new chapter in America's story, and guarantee every American comprehensive health benefits that can never be taken away.

Some people have said that it would be a miracle if we passed health care reform. But, my fellow Americans, I believe we live in a time of great change when miracles do happen.

Just a few days ago, we saw a simple handshake shatter decades of deadlock in the Middle East. We have seen walls crumble from Berlin to South Africa. Now it is our turn to strike a blow for freedom -- the freedom for Americans to live without fear of their own nation's health care system.

It's hard to believe that once there was a time -- even in this century -- when retirement was nearly synonymous with poverty, and older Americans died in our streets. That is unthinkable today because over a half century ago Americans had the courage to change -- to create a Social Security System that ensures that no Americans will be forgotten in their later years.

I believe that forty years from now, our grandchildren will also find it unthinkable that there was a time in our country when hardworking families lost their homes and savings simply because their child fell ill, or lost their health coverage when they changed jobs. Yet, our grandchildren will only find such things unthinkable tomorrow, if we have the courage to change today.

This is our chance. This is our journey. And, when our work is done, we will know that we have answered the call of history and met the challenge of our times.

Thank you. And God bless America.