



			 THE WHITE HOUSE

		  Office of the Press Secretary
		     (Minneapolis, Minnesota)
______________________________________________________________
For Immediate Release                          April 8, 1994     

	     
		     REMARKS BY THE PRESIDENT
		 TO RALLY FOR HEALTH CARE REFORM
	     
			Crystal Courtyard
			    IDS Tower
		      Minneapolis, Minnesota
	     


12:25 P.M. CDT
	     
	     
	     THE PRESIDENT:  Wow!  (Laughter.)  What a crowd.  
Thank you for coming this morning.  (Applause.)  Thank you for 
supporting health care.  I want to thank Mary Ellen for that 
wonderful speech.  She really left nothing for me to say.  
(Laughter.)  But she and the nurses of Minnesota have my undying 
gratitude for this wonderful rally and for their commitment to 
your health care and to the future of American health care.
	     
	     I want to thank Senator Wellstone, and Congressman 
Sabo who's done a wonderful job in his new leadership position, 
helping us to get a budget through that will drive down the 
deficit and still increase investment in the things that help 
America to grow and prosper.  (Applause.)
	     
	     I thank you, Mayor Sayles, for being here.  And I 
want to thank the others in the audience who are good friends and 
supporters of mine, especially Congressman Bruce Vento, who is 
also a strong supporter of health care reform; your Secretary of 
State Joan Crowe; your State Treasurer Mike McGrath; my good 
friend, Skip Humphrey, your Attorney General; and the Mayor of 
St. Paul Norm Coleman.  Thank you all for being here.  
(Applause.)
	     
	     I also couldn't come to Minneapolis today without 
saying a special word of gratitude for the extraordinary service 
being rendered to the United States of America under what you now 
know are difficult circumstances by our Ambassador to Japan, Vice 
President Fritz Mondale.  (Applause.)
	     
	     I am honored to be here today under the sponsorship 
of the nurses of Minnesota.  I thank them for doing this.  I also 
want to say that I'm very grateful for the people from Heightman 
Properties, who made it possible for us to meet inside instead of 
outside today.  At least for me it's not springtime yet.  
(Applause.)
	     
	     The remarks that Mary Ellen made in introducing me 
speak more eloquently than I ever could to what millions of 
American nurses know are the facts of life in health care in this 
country.
	     
	      I ran for President because I thought that 
Washington had become a place where there was too much rhetoric 
and too little reality; where every statement that every person 
made was automatically pushed to its ultimate extreme.  The 
government can do nothing -- you're on your own; or the 
government can do everything -- there's nothing for you to do.  
But real people and real life want us to come together as a 
people and figure out how to deal with our problems and seize our 
opportunities.  And we have done our best there, in other words, 
to give the care to America's public life that the nurses of 
Minnesota give to their patients every day.
	     
	     If you look at what's happened in the last year, 
there has been a pretty big change in the way things work in 
Washington.  For a dozen years people talked about the deficit, 
and the national debt tripled.  Well, last year, this Congress, 
working with me, adopted a budget that brought the deficits down, 
interest rates down, has helped to create 2.5 million new jobs in 
this economy -- more than were created in the previous four 
years.  (Applause.)  We're on the way.  
	     
	     The Congress is on a record pace to adopt a new 
budget which, if it is adopted, will eliminate 100 government 
programs, cut 200 others, but increase spending in education, in 
Head Start, in defense conversion, in the new technologies for 
the 21st century, in educating and training our people, and give 
us the first three years of declining government deficits since 
Harry S. Truman was the President of the United States of 
America.  (Applause.)
	     
	     Already this year, the Congress has passed an 
education bill called Goals 2000 which, for the very first time 
in the history of this country, establishes national standards 
for world-class education and promotes the kind of grass roots 
reforms that Minnesotans have been experimenting with for a 
decade to see that we meet those standards everywhere in the 
country for all of our children.  (Applause.)  
	     
	     And when the Congress comes back, they will take up 
a bill designed to help all the young people who don't go to 
college to at least get a year or two of further training after 
high school so they, too, can have good jobs and good skills in 
the global economy.  (Applause.)  And they will take up a bill 
that will completely reorder the unemployment system to make it a 
reemployment system, because people often don't get the job they 
lose back anymore; they have to find new jobs.  And now, from the 
first day an American is unemployed, he or she should be eligible 
from day one for new training and new job search and new 
opportunities.  We're going to change that unemployment system 
this year.  (Applause.)
	     
	     The Congress will take up a crime bill  designed to 
make us not only tough, but smart for a change, with crime.  It 
puts another 100,000 police officers on the street in community 
policing in models that have proven -- proven -- effective at 
lowering the crime rate.  It takes 28 kinds of assault weapons 
off the streets and out of the hands of gangs.  (Applause.)  
	     
	     And if we do it the right way instead of the wrong 
way, the Congress will pass a bill increasing penalties for 
violent offenders so that we recognize that a relatively small 
number of our fellow citizens create a very high percentage of 
the seriously violent crimes.  We have more people behind bars, 
as a percentage of our population, than any country in the world; 
and yet we continue to let the wrong people out from time to 
time.  It's time we found alternatives to imprisonment for young 
people and kept the people behind bars who should stay there.  We 
can do that if we do it intelligently.  (Applause.)
	     
	     Now, why is this happening?  It's happening partly 
because people like Paul Wellstone and Martin Sabo and Bruce 
Vento last year were willing to risk their political necks to 
make tough decisions to stop talking about problems and start 
doing something about them.  (Applause.)  But it's happening also 
because the American people say, look, we are tired of gridlock, 
we are tired of paralysis, we are tired of rhetoric over reality, 
we want you all in Washington to conduct your business the way we 
conduct our business at home -- identify the problems, identify 
the opportunities, seize the opportunities and beat back the 
problems; show up for work every day.  It's pretty simple what 
our strategy is -- get people together, get things done, move the 
country forward, give people the chance to live up to their 
potential.  (Applause.)
	     
	     And now we are being called upon to face one of the 
greatest challenges of this age.  For decades and decades, the 
American people have been denied something that every other 
advanced country provides to its citizens -- the security of 
knowing that they have good health care that is always there.  
	     
	     Every other country with which we compete with an 
advanced economy has solved this problem.  Only the United 
States, time after time after time after time, has found it 
impossible to do.  For 60 years, whenever we came to the point 
where it looked like we could deal with the health care problems, 
at times when it was much simpler than it is today, when the 
money at stake was much lower than is at stake today, always, 
always fear overcame hope, entrenched interest overcame the 
public interest.  
	     
	     Today I can tell you that we are going to make 1994 
different.  We can provide health security for all Americans this 
year, and I believe that we will.  (Applause.)  
	     
	     My fellow Americans, in Washington this may look 
like a partisan issue, but out here on Maine Street, it isn't.  
Democrats and Republicans and independents all get sick.  They 
all lose their jobs.  They all lose their health insurance.  
There are 39 million Americans who don't have any health 
insurance now for a whole year.  In any given year there are 58 
million Americans at sometime during the year, more than one in 
five of us, who will be without   health insurance.  
	     
	     There are 81 million of us, more than one in four, 
who are in families where we've had someone with what the 
insurance companies call a preexisting condition -- a child with 
diabetes, a mother with breast cancer, a father who had a 
premature heart attack.  People who have to continue working, but 
who either can't get insurance, pay more than they should, or can 
never change the job they're in because someone in their family 
has been sick.
	     
	     There are 133 million Americans who have lifetime 
limits on their insurance policies, so if, God forbid, they 
should give birth to a child with a serious illness they could 
run out of health care at the very time they need it the most.
	     
	     There are people who change jobs in an era when --
look at all these young people in this audience today -- the 
average 18-year-old will change work seven or eight times in a 
lifetime.  And yet it is usual in America for people to have to 
wait months and months and months to get health insurance 
coverage.
	     
	     The good people of Minnesota know we can do better.  
You know that if there is a Mayo Clinic which can provide world-
class health care at lower cost than many Americans pay for 
something which at least you could say is not better, and they 
wish were as good, we can do better.  You know that there is no 
reason in the wide world to permit Americans to be in this 
condition; to permit most Americans -- those who don't work for 
secure big companies or the government, I don't care who they 
are, are just an illness or an economic failure away from losing 
their health care. 
	     
	     And we now have an economy in which we're 
desperately trying to preserve life in rural America -- and more 
and more and more, there are no doctors in rural America.  I was 
in rural North Carolina the other day, and I met a woman 
physician who told me she had worked for months on end over 100 
hours a week, and she was now in her slow season where she was 
down to 80 hours a week because there are no doctors.  We know we 
can do better than that.  We know we can.
	     
	     So the question is, why haven't we done it?  Well, 
there are a lot of people who don't trust the government in 
America to do anything.  They think we'd mess up a one-car 
parade.  (Laughter.)  And, frankly, from time to time, I've been 
in that crowd -- and so have you.  We do not propose -- there's 
not a single, solitary proposal in the Congress that would have 
the government take over the health care providers of this 
country.  And don't you believe that.
	     
	     We've got the best doctors, the best nurses, the 
best health care providers, the best medical research, the best 
medical technology in the world.  What we also have is the 
absolutely worst financing system for health care in the world.  
It is the way it is financed that is killing us.  (Applause.)
	     
	     For all the people who tell you that if we reform 
health care it will make it more bureaucratic, let me just ask 
you, go talk to one doctor and ask a doctor how much time the 
people in his or her clinic spend on the telephone to insurance 
companies talking to employees who don't know a lick about health 
care, trying to get approval for a procedure which is obvious and 
clear.  (Applause.)  Ask a nurse -- ask any trained nurse who 
works in a clinic or a hospital how much time he or she spends 
filling out paper instead of taking care of patients because of 
the system we have.  (Applause.)
	     
	     It is conservatively estimated that we spend at 
least a dime on a dollar more on the administrative cost of 
health care than any other nation in the world.  That is $90 
billion we spend -- because we have 1,500 separate companies 
doing insurance, plus the government doing Medicare for the 
elderly and Medicaid for the poor; writing thousands and 
thousands of different policies, insuring zillions of small 
groups of people, finding out -- with all these hundreds of 
thousands of paperworkers in insurance companies and hospitals 
and in clinics -- who's not qualified, who's not covered, what 
you can and can't reimburse for.  Nobody else does this.
	     
	     So we can't figure out how to cover all of our 
people, how to give people job security through health care 
security when we know they're going to have to change jobs.  But 
we can figure out how to spend $90 billion to hire people for the 
very frustrating work of second-guessing every decision the 
doctor and nurse makes, and pushing paper around all day long.  
It is wrong, and we can do better.  (Applause.)
	     
	     You heard Senator Wellstone say so eloquently that 
what we have to do is provide coverage for all Americans.  He 
favors a single-payer system; I favor guaranteed insurance.  You 
can argue it flat around, depending on the experience of the two 
main models we have -- Canada and Germany.  But I'll tell you one 
thing, both of them have lower administrative costs, less 
paperwork, more freedom to practice medicine, more efficiency and 
people have health care.  (Applause.)
	     
	     People should have insurance that they can never 
lose -- not when they change jobs, not when they get sick, not 
when they're self-employed and not when they get older.  And they 
should have insurance that provides the right to choose their 
health care providers.  I get tickled when these people attack 
all of us that are trying to change the health care system.  They 
say, oh, they're going to ration health care; oh, they're going 
to take your choices away.  My fellow Americans, more than half 
the people in American today who are insured in the workplace 
don't have a choice about their health care plan or their doctor.  
Ninety percent of the businesses that are providing health 
insurance who have 25 employees or less have no choice.  And be 
fair to them and to the insurance companies -- they can't afford 
it under the present system.  They're doing the very best they 
can under the present system.  It is not a bunch of evil-doers 
out there trying to keep people sick and insecure, it is a badly 
broken system.   That is what is wrong; and we can do better.  
(Applause.)
	     
	     Under our proposal, every American family every year 
-- every year -- would have access to at least three choices.  
You could have access to an HMO of your choice; or a professional 
provider organization of your choice; or the right to choose your 
own doctor and continue fee-for-service medicine; or the right to 
have a guaranteed health managed plan and still have the right to 
opt out when you want it for a specialist of your choice or your 
own doctor.  Everybody would have those choices.  And they would 
all be more affordable for most Americans than what they're stuck 
with now.  We can do that if we had a system that was rational. 
	     
	     Choice is important, but you can't get there unless 
you change the rules of health care finance.  If you want to have 
a system that works, you can't have people denied coverage or 
charged more because of preexisting conditions.  What difference 
does it make?  I have a stake, as an American citizen, in seeing 
you, as a successful, effective worker able to change jobs, able 
to grow in your job even if, God forbid, your spouse should get 
cancer or your kid should have a serious illness.  That is my 
interest in your future.  We all share that.
	     
	     Insurance used to be that way.  Everybody threw in, 
everybody paid, the risk was broadly spread.  We can't have 
waiting periods anymore before there's coverage.  We shouldn't 
have lifetime limits.  We shouldn't deny coverage to people who 
need it most.  And we shouldn't deny coverage by charging more 
for older people rather than younger people.  
	     
	     Let me tell you, we live in a world today where 
people are going to be losing their jobs well into their 50s and 
60s and still have to find new jobs.  I met a 59-year old man the 
other day who worked for over 30 years in the defense industry, 
and because of the end of the Cold War and the reduction of 
defense spending -- which virtually all of us support and thank 
God for the opportunity to have a more peaceful world -- this 
good man lost his job.  He had to find a new job; he needed 
retraining.  He was, thankfully, hired by a hospital for a 
rewarding job.  
	     
	     But there are lots of people like him who will not 
be hired because the small businesses who could hire them, who 
know they're reliable workers because they're older, they're 
settled, they're experienced also know that they will drive up 
their health insurance premiums because of their age.  We do not 
need that, we cannot afford that.
	     
	     We have a bizarre system in this country when, 
because of certain training and other problems, a lot of young 
people are discriminated against in the job market.  They're 
told, well, you've got to have experience before we hire you.  
How do you ever get experience if you don't get a job?  And then 
you have a lot of older people who don't get hired because even 
though they've got worlds of experience, their insurance is too 
high.  We can overcome both of those things.  (Applause.)
	     
	     Another big problem for insurance is that small 
businesses and self-employed people pay, on average, 35 percent 
more than larger businesses and governments do because they have 
no bargaining power.  So we have to reform that, too.  We have to 
go back to what is called community rating -- old fashioned 
insurance; put people in big pools, spread the risk broadly, let 
us all share that.  And then small businesses and self-employed 
people have to have the right to ban together in buying co-ops so 
that they can get the same deal that those of us who work for the 
federal government do.  I want for you what I've got and what we 
take for granted in Washington.  (Applause.)
	     
	     Now, there are a lot of people who say it's not fair 
to require all employers and employees to contribute to their own 
health care if they don't do it now.  They say they can't afford 
it.  But let me just remind you of this -- when people in this 
country get real sick, they do get health care.  It's too late, 
it's too expensive; they show up at the emergency room, then they 
pass the cost along to all the rest of us and our health care 
bills go up.  What about the small businesses all over this 
country who are in competition with other small businesses?  They 
cover their employees and their competitors don't.
	     
	     Nine of ten Americans who have health insurance that 
is private get it at work.  Eight in ten Americans who don't have 
any health insurance at all are in working families.  I think 
everybody should do their part, and I know we can do it without 
hurting small business.  Our plan has discounts for small 
businesses, recognizing that not all can afford to pay as much as 
others.  We know that that happens.  Our plan gives 100 percent 
deductibility for self-employed people.  
	     
	     Did you know that if you're self-employed in this 
country today, you can't deduct the entire cost of your health 
policy, but if you work for somebody else you can?  That's crazy.  
We fix that.  We are not going to hurt small business --
(applause) -- we're going to help small business by controlling 
the exploding cost of health care and giving people a chance to 
get affordable health insurance.  (Applause.)
	     
	     And, finally, let me say, I saw this up here on the 
-- one of the wonderful signs.  Our plan protects and preserves 
Medicare.  But it also provides a prescription drug benefit and 
long-term drug benefits to elderly people.  And that is also very 
important.  (Applause.)
	     
	     Let me tell you, folks, the fastest growing group of 
Americans are people over 80.  The fastest growing group of 
Americans are people over 80.  Many of them are bright, active, 
and vigorous; they don't want to be forced into a nursing home 
just because they may not be able to get along all on their own.  
We ought to reward their children who are willing to care for 
them at home, and help them to get some respite care, help them 
to deal with these crises.  (Applause.)  We ought to reward the 
community providers who are willing to help elderly people stay 
in their communities.  (Applause.)  
	     
	     And there is ample evidence that providing help for 
prescription medicine will save money immediately in the health 
care system by reducing hospitalization, especially for elderly 
people, but also for the nonelderly.  And strong evidence based 
on population trends that over the long run we are going to have 
to do something to help people deal with this long-term care 
crisis within the family and within the community.  We cannot 
afford only to have nursing homes as an option, even though we 
need them where they are appropriate.  We have to think of other 
things as well.  (Applause.)
	     
	     Now, I have been, in the last week, in North 
Carolina doing a health care forum in which I talked to people 
about health care and crime and other issues in Virginia and 
Tennessee and in Texas.  Then yesterday, I was down in Kansas 
City, and we talked to people in Kansas, Missouri, Oklahoma.  And 
I'm here tonight to do one of these.  Let me tell you what I 
find.
	     
	     I find that people really would like to know more 
about all these programs.  They'd like to know honestly what the 
problems are.  They know that there are tough decisions to be 
made.  If this were an easy issue, somebody would have done it 
already, and said, hey, vote for me; I solved this problem.  This 
is a hard problem.  That's why it's been pushed to the back.  
	     
	     But I think you hired me to deal with the hard 
problems.  So we're trying to deal with them.  (Applause.)  And 
what I want to ask you today, all of you here -- these fine 
nurses who have endorsed what we're trying to do, and all the 
rest of you -- tell the members of your congressional delegation 
to tone down the rhetoric and open their hearts and their eyes 
and their ears, and listen and talk and explain this thing and 
work through the problems.  And don't use this as yet another 
opportunity to take a proposal and push it to the ideological 
extremes, forgetting all about the reality of the tens of 
millions of people's lives that are at stake here.  (Applause.)  
I plead with you.  (Applause.)
	     
	     Your wonderful state has been very good to me, from 
the time I came here in the primary when I just had a handful of 
friends, all the way through the general election.  You've been 
wonderful to my wife when she's been out here on her health care 
crusade.  You have been good to us, and I thank you for that.  
(Applause.)
	     
	     But I ask you, tell the members of your 
congressional delegation, without regard to their party, that you 
want this dealt with and you want it done now.  We know enough; 
we know as much as we're ever going to know; and the longer we 
put it off the worse it's going to be.  It's going to be like an 
ingrown toenail.  (Laughter.)  It will not get better.  This is a 
part of our growing and maturing as a nation -- deal with the 
problems while we can deal with them.  Don't just let them get 
worse and worse and worse. 
	     
	     This is an opportunity for us to come together 
across regional and racial and income and party lines to do 
something that is good for America.  All of our jobs are at 
stake, all of our health care at stake, our children are at 
stake, our parents are at stake.  This need not be an issue that 
divides us.  
	     
	     But we are going to have to have a clear message 
from the American people that it will not be tolerated to do 
nothing, to walk away, to be divided, to have hot air, to turn it 
into a political issue.  (Applause.)  Tell the American people.  
Tell the Congress you want us to act and act now.  (Applause.)  
	     
	     Thank you, and God bless you all.  (Applause.)  
Thank you.  (Applause.)

			       END12:51 P.M. CDT

