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Tuesday, September 7, 1999

I'm so pleased to be here at the Children's Hospital of Los Angeles – one of the finest hospitals in this nation, and a world resource for pediatric care. You've come a long way since you were founded, nearly a century ago, with four beds in a converted private home.

I'm here today to discuss one of America's most urgent and continuing challenges.

For more than 50 years, we have been engaged in a battle to provide the kind of health care a great nation owes its people. Now, after that long century of effort, conflict, and concern, it is time to move past theoretical and philosophical divisions – beyond a sterile debate about labels and abstractions – to ask how we can now take concrete, specific, realistic steps to improve health coverage for all the American people.

Today I am proposing – and as President, I will fight for – a series of steps that do just that.

We must and we can ensure a set of rights so that all Americans who have health coverage actually get the care they are entitled to.

We must and we can secure access to affordable, quality health care for every child in America by 2005.

We must and we can move toward access to affordable, quality health care for every American family.

This is a fundamentally different approach. We have all learned that we cannot overhaul the system in one fell swoop. Experience has taught us that there is a way to keep what is right, while fixing what is wrong with American health care.

The focus of my proposal is health care for working families.

It will put doctors and patients in charge, not HMO's and insurance companies.

The steps that I am proposing today will guarantee access to affordable health coverage for every child in America – and will provide more affordable health care options for millions more adults. But let me be clear: we cannot rest until every single American has affordable health coverage.

The steps I am proposing represent the kind of change we need – the kind of change we can achieve; the kind of change that works for working families.

It's the kind of change that I've fought for all my public life.

In the House and the Senate, I fought for investments in medical research, to unlock the deadly secrets of cancer, Alzheimer's, and AIDS. I led the fight to make infant formula safer, and require warning labels about the dangers of alcohol for pregnant women. I co-authored the National Organ Transplant Act, and worked to strengthen America's rural hospitals – because I wanted to make sure that a great health care system left no one behind.

From tougher cigarette warning labels and tough measures to combat teen smoking; to a crack-down on health care fraud against seniors – for me, improving health care for working families is central to the work of change.

As Vice President, I am proud of the advances we have been able to make – even in the face of a Congress that so often seems determined to hold back change. Never forget: when the Gingrich Republicans took over Congress in 1994, some believed that we should just fold our tent; just cut and run. I believed that we should stay and fight. And we did.

Together, we beat back the most damaging Republican cuts and changes ever proposed in Medicare and Medicaid. Together, we made sure that Americans do not have to go without a doctor just because they lose or change jobs. Together, we passed the single largest investment in children's health in a generation -- to help states provide health coverage to millions of uninsured children. Together, we brought immunization rates to an all-time high – and worked to give our children the cleanest, healthiest air and water in a generation.

These successes have taught us that step-by-step change is the path to progress.

But we as a country cannot be satisfied with the progress we have made.

I'm not satisfied when I meet someone like eighty-eight-year-old Florence Seitz, of Manchester, New Hampshire, who is so hard-pressed to pay for her prescription drugs, she told me she sits up and night, and worries, and then decides again and again to cut her dosages in half – gambling with her health to save precious pills and dollars.

I'm not satisfied when a child's ear infection goes untreated because the family can't afford a doctor – leading to hearing loss so grave that the child can barely hear her teacher's voice.

I am not satisfied when life-or-death medical decisions are made by HMO bureaucrats at the other end of a telephone line – people with no license to practice medicine, and no right to play God.

One health plan even told its patients they had to call the HMO before calling 911. What's next? Prior approval for a heart attack?

When you have a medical emergency, you need an ambulance – not an accountant.

All of us are too familiar with such false and dangerous answers on health care. It's wrong to let the insurance industry determine your health and well-being on a spreadsheet. It's wrong to raise the eligibility age for Medicare to save money. That is change, all right – the wrong kind of change.

Real step-by-step progress is the right kind of change – the only true course to achieve the ideal expressed by President Kennedy early in the fight for what later became Medicare: "Whenever the miracles of modern medicine are beyond the reach of any group of Americans, for whatever reason -- economic, geographic, occupational or other -- we must find a way to meet their needs and fulfill their hopes. For one true measure of a nation is its success in fulfilling the promise of a better life for each of its members."

Today, I want to propose ways to help all our working families reach that better life.

First and fundamentally, we will write this principle into law: Americans have the right to have their medical decisions made by them and their doctors, not by bureaucrats sitting behind a computer screen hundreds of miles away.

I will lead the fight for HMO reform in this country – by passing a real, enforceable Patients' Bill of Rights.

It will guarantee the right to see a specialist – without pleading phone calls and endless appeals.

It will guarantee access to an emergency room – when you need it, and where you need it.

It will make sure doctors can tell patients all their options – not just the cheapest ones.

It will ensure that pregnant women and cancer patients don't have to change doctors in the middle of treatment.

It will hold health plans accountable for unfairly depriving patients of coverage.

Our opponents claim that they have a Patients' Bill of Rights, too. But it's another one of those wonderfully Republican ideas: it just happens to leave out 100 million Americans. It doesn't even guarantee access to a specialist.

We need a real Patients' Bill of Rights – and I will not stop fighting for it until Congress stops giving in to special interests and passes it into law.

There is more we have to do to reform health coverage for those who have it today:

Tipper and I have worked toward the day when mental illness is treated like any other illness, by every health plan in America. I want to make sure that a patient with depression is given access to care on terms no different from a patient who has diabetes. And I will begin by improving mental health services for those who receive Medicaid.

As we raise up health care quality, we have to make sure that every patient in America has clear and accurate measures of a health plan's quality – building on a public-private partnership we launched last year. Too often, we have seen cases where serious surgery is performed unnecessarily, or when the right medical procedures aren't followed. Right now, we have consumer reports for everything from bread-makers to automobiles; we should work to provide measures of health care quality to every family and business in America.

We must also ensure that our newest medical breakthroughs do not compromise our oldest values – especially the right to privacy. Just over the horizon lies a future where we will know the location and makeup of every human gene -- unlocking the deepest secrets of human disease. But many Americans are rightfully concerned that this could bring threats as well as progress.

Already, too many women are afraid to get tests that would show their vulnerability to breast cancer -- because they fear that an insurance company or potential employer would use the results to discriminate against them. Genetic discrimination is wrong -- and it should be illegal in the United States. As President, I will lead the fight to outlaw it once and for all.

At the same time, no one should decide not to see a doctor because they're afraid of who will see their medical records. And every time you fill a prescription, your mailbox shouldn't fill up with junk mail about your medical condition. We must guarantee by law the right of every patient to keep his or her personal records private.

At a time when our senior population is expected to double in the next 30 years, we need a new commitment to the quality of health care for our seniors. As President, I will fight to use the surplus to keep Medicare solvent -- and to make affordable prescription drugs available under Medicare.

As we strengthen Medicare, I want to make sure that America's hospitals, academic health centers, nursing homes, and home health care centers have the resources they need for the vital care they provide.

And I will fight for new help and new, affordable, targeted tax cuts to ease the burden of providing long-term care to a loved one.

As we secure these patients' rights, we must also empower every patient, and every patient's family, to be partners in assuring good health and high quality care. We will establish new public-private partnerships, to expand access to prevention and wellness programs -- which will save money and save lives. And we will work to promote prevention and wellness initiatives in the workplace – for example, employer-sponsored health fairs and cancer screenings.

Of course, we can work to ensure the highest quality health care in the world – but it still won't help working families if they can't afford it.

The uninsured see doctors less often, fill prescriptions less often, and are far less likely to have life-saving mammograms and screening tests. This is not only wrong; we also pay a price for it. When people are forced to neglect their health, and a sudden illness strikes, the care they finally get costs far more – and often does far less to save their health, or even their lives.

We know a lot about the more than 43 million Americans who lack health coverage today:

They are children who are eligible for Medicaid or for coverage under our children's health initiative, but who are not enrolled.

They are children who don't qualify for these programs, but who also can't get access to private insurance.

They are the disabled, or those with cancer – those who have what the insurance companies call "pre-existing conditions" – who switch jobs and find that premiums are way too high.

They are legal immigrants who aren't informed about their eligibility for coverage.

They work for employers who either cannot afford to provide coverage or choose not to provide coverage – and when the employees have to find coverage on their own, they find they are priced out of the market.

They are men and women who have retired or lost their jobs before they are old enough to be eligible for Medicare.

We know something else about the uninsured. Their numbers continue to grow -- about a million people a year over this decade.

We must redouble our commitment, as an American community, to bring the uninsured into our community of care.

That is why, as President, I will lead the fight to move this nation toward quality, affordable health coverage for every family.

We will begin with the earliest years, by extending access to affordable health coverage to every American child. Let me be crystal clear on this point: if you elect me President, I will ensure that by the year 2005, every single child in our country has full access to fully affordable health coverage. If you want a President who will take the oath of office on January 20, 2001 at high noon committed, heart and soul, to achieving that goal, then I ask for your support – because I'll make it happen.

We can build on the progress we've made by making sure that we reach every child who is already eligible under the historic expansion we have already passed. There are still four million uninsured children eligible for Medicaid who are not yet enrolled. And there are millions more eligible under the children's health initiative we passed in 1997 who have not yet been signed up.

In some states -- Texas springs to mind – one quarter of all children are still out in the cold.

That is unacceptable. We know that uninsured children are more likely to be sick as newborns, and less likely to be immunized as pre-schoolers. They're less likely to get treated for illnesses like asthma or tooth decay. More than twice as many uninsured children go a full year or more without ever seeing a doctor. That is why I will fight for new incentives for states to identify and enroll uninsured children – and new rewards for states that do a good job.

Fighting for working families means taking on those who are standing in the way of their best interests. States who are not doing the job need to be held accountable. As President, I will hold them accountable, and make sure that working families get the health care to which they are entitled.

Then I will propose that every school and every school district be the focus of an unprecedented outreach and enrollment campaign.

I will propose to expand the current our children's health initiative so that families earning up to $41,000 per year --250% of poverty -- will be eligible for the benefits it provides.

For children in families who still don't qualify for the children's health initiative and whose parents work for companies that do not provide health coverage, I propose to let their families buy into this initiative and provide coverage for their children, whatever their income.

And as we reach out to every uninsured child, we cannot forget that there are seven million uninsured parents whose children are eligible for coverage.

So as President, I will offer another new proposal, to empower states to expand coverage to all parents whose children are eligible either for Medicaid or our children's health initiative.

Next, we will focus on the disabled, who too often can't return to the workplace because they can't get affordable health care -- and on the fastest-growing group of uninsured Americans, the near-elderly.

We should let people with disabilities keep Medicare or Medicaid when they return to the workplace. This change will help people with disabilities participate to their full potential.

And we should enable all those between the ages of 55 and 65 to buy into Medicare early.

If we want to knock down the barriers to affordable health care, we must also address this fundamental fact: one of the fastest-growing sectors of our economy – small business, which has accounted for the vast majority of new jobs these past seven years – has become one of the hardest places for a working family to find health care.

On average, small companies spend about three times as much of their total insurance costs on administrative overhead as large companies do. No wonder workers in small firms make up about 30 percent of the workforce, but almost half the uninsured.

My plan will help small businesses band together to negotiate for lower rates for their employees' coverage. And for businesses that join in this effort, my plan will provide special tax benefits and grants for the health insurance policies they offer.

In this way, we can expand access to affordable health coverage without burdening small business.

But we can't afford to focus only on providing coverage through employers. We also have to help individuals who don't get coverage in the workplace.

So as President, I will propose a major reform to help them -- a 25 percent refundable tax credit to cover their costs for health insurance. Today, companies that provide coverage get a tax break. But not individuals who have to get coverage on their own. That's just not fair, and we have to change it.

We made one important change a few years ago when we passed the Kennedy-Kassebaum law. It helps Americans keep coverage when they change jobs, and it limits restrictions based on "pre-existing conditions."

But too often, people are still priced out of the market when they try to exercise these new rights. As President, I will work to reform the individual insurance market, so that it becomes truly affordable for those who need to buy into it.

Taken together, these steps will make health care affordable for millions of Americans who can't afford it today. They will move toward the day when every American has access to affordable, quality coverage.

And for those we have not yet reached, we need a strong safety net, so nobody will be left without care when they need it.

My plan will strengthen America's community health centers, and empower them to do this job. And as we expand other efforts to cover children, we will free up community health centers to focus on challenges such as prevention, immunization, and outreach. My plan will also invest in public hospitals, academic medical centers, and other providers in our most vulnerable communities.

Let me be clear what I am proposing today:

As President, I will commit our nation to the goals of universal rights for those who have health coverage; universal access for all American children; and real progress toward access to quality, affordable health care for every American family.

My plan will extend that access to millions of Americans who don't have it today, provide a strong safety net for others, and move us toward full access. And it will do so by building on the strengths of our existing health care system, and maintaining the strength of the American economy. I believe that every step we take as Americans must be fiscally responsible, and economically sound.

Every step we take must be consistent with our commitment to save Social Security and Medicare. And as we expand access to the uninsured, we must not reduce coverage for those who have it today.

We must rely on the strength of markets to increase competition, restrain costs, and expand choice for consumers. And we must squeeze out every last dime of fraud and abuse, so that all that money goes into quality care for working families.

Some will argue that greater access to health care is a luxury we can't afford – even as they covet our record surplus for the special interests, and propose to blow it on a risky tax scheme that would drive us back into spiraling federal deficits.

For more than two decades, I have seen the struggle between working families and special interests – the tobacco lobby, the gun lobby, those who stood against the Family Leave bill I co-sponsored in the Senate. We've had to fight them all. And we're not about to stop now.

Others will argue against reforming our health care system carefully, realistically, and step-by-step. Some of them will tell you that the only acceptable answer is a one-size-fits-all solution. But I believe Americans know better.

They know – you and I know -- we need visionary but practical change. Change that can be enacted into law. Change that works for working families. Change that meets their cares and concerns, but respects the rich diversity of their health needs.

Our cause is working families. And in this campaign, and in the years ahead, let's put their interests first -- ahead of the special interests, ahead of anything.

We've come a long way these past seven years. This is a unique moment for our nation. Our economy is strong – indeed we are in the midst of the longest period of prosperity in our peacetime history.

But we know that prosperity alone will not meet the challenges that we face in American health care. And as Harry Truman reminded us when he began this fight fifty years ago, in a time of prosperity "we can afford many things. But ill-health which can be prevented or cured is one thing we cannot afford."

We must use our prosperity now – to bring new change to our health care system – to make our families healthier and more hopeful for the new century ahead. That's the kind of change that works for working families – and that is why I am running for President of these United States.



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