THE FIRST LADY'S SPEECH
BEFORE THE AMERICAN LEGION'S ANNUAL CONFERENCE
AT THE SHERATON WASHINGTON HOTEL
 February 15, 1994

MRS. CLINTON: -- officially at the Olympics, just
over the weekend. And I am so --

(Applause.)

MRS. CLINTON: I'm so proud of our young people who
are there competing, and it just gave me an enormous thrill,
especially when I was able to attend the medal ceremony for
the young man from Alaska, who won the downhill skiing
(inaudible) --

(Applause.)

MRS. CLINTON: -- the highlight of the (inaudible).
I am so honored to be here with your Secretary for Veterans'
Affairs and, boy, is he a good representative for all of you.

(Applause.)

MRS. CLINTON: Secretary Brown brings to the
councils of the government his experience and his
perspective; and those of you who know him know that he is
not shy about expressing both, and he has been a very valued
member of the President's Cabinet.

I want to thank the commander for that very kind
introduction and all of the officers, both current and
former, who are here with us today. I especially want to
thank the members of the Auxiliary who are here. I had a
wonderful relationship with our Auxiliary in Arkansas during
the many years that I attended and I am very appreciative of
all your hard work.

(Applause.)

MRS. CLINTON: The work that the Legion and the
Auxiliary do on behalf of our young people is unparalleled;
and I don't think that we could have the quality of life that
we have enjoyed in our country all of these years had it not
been, in many communities, for the Legion and the Auxiliary,
and I'm very grateful to you.

I'm also particularly grateful for the fine work
you do with respect to the blood drives every year. You know
that we have a shortage of blood in many regions of our
country and, in many regions, the Legion is the number one
organizer for blood drives, and I want to thank all of you
for that, as well.

(Applause.)

MRS. CLINTON: It is always a privilege, as it was
for me during this past year, to meet with representatives of
our various veterans' organizations. I want to echo both the
words of the secretary and the commander in thanking the
officers and staff of the American Legion for the countless
hours that you gave in working with the VA and working with
the Presidential task force on health care.

I came to this task without many preconceptions,
when my husband asked me if I would work on the whole
challenge of reforming our health care system, but I came
with a personal bias in favor of the VA and the veterans'
health systems, which I think I was able to inherit. It was
passed on genetically, by my father to me.

And I remember many times, as I have shared with
Roger and some others in meetings over the past years, that
one of the things my father could never understand was why,
as a veteran, he couldn't continue to use the VA system all
through his life. He had to view that as a taxpayer and a
veteran, and if he wanted to take his dollars, whether they
were private dollars or Medicare dollars, to the VA system,
he should have been able to be permitted to do so.

So I admit, I came with a bias that my father
planted, indeed, very early, and I intend to do everything
that I can (inaudible) --

(Applause.)

MRS. CLINTON: As many of you probably know, my
father died last year and, in his series of illnesses over
the last decade, the constant conversation we would have
about his desire to be able to use the VA system -- and I
think it was as much a sense of his belonging, as anything
else. But it was one that really made a big impression on
me. But it was not only what he told me over the years. It
was reinforced many times over, as I have traveled the
country.

One of the great privileges I have had in this past
year is literally to go from Maine to Hawaii, from Florida to
Washington, and to visit with thousands of Americans, both in
person and through their letters. I have now received a
million letters from people. I wish you could read even a
fraction of them. They are letters from all kinds of
Americans.

And I carry this movie in my head of the faces and
the stories that I have been told, and I want to start with
just one that seared in my brain what my father had told me
and what many of you have shared with me over this past year
about the need for us to strengthen and enhance our VA system
and to make it a possible health care alternative for
veterans.

I was in New Orleans and I was visiting with a
group of workers at a small factory there. Most of the men I
was talking with did hard, manual work every day. They were
good, steady employees. Most of them had worked for the same
employer for 15 years, some as many, as I recall, 28 years.
Most of them were veterans. They did not have any health
care benefits through their employer. They did not make
enough money to be able to afford insurance on their own.
And the stories they told me were ones that had become all
too familiar but they were especially poignant, being told by
veterans.

I will never forget a young man -- by my standards
these days, anyone in his 40s is young -- a young man, a
Vietnam veteran, a hard worker, a taxpayer, a family man, --
but without much education so the job that he had, which was
his source of livelihood for himself and his family probably
paid him, after a hard week's work, less than $20,000 --
telling me that he just prayed that his children wouldn't get
sick, he just prayed that he wouldn't get sick, and they
always postponed going to the doctor. And, when he did
finally have to go to the doctor, it was usually at the last
possible moment and he would enter our health care system
through the emergency room, which is all too common for those
working Americans without insurance who number now upwards in
the 30 millions.

And he looked at me, and he wasn't asking for any
special treatment. He wasn't asking even for sympathy. He
just wanted to explain to me what his life was like. He
said, "You know, the proudest years of my life were when I
served in the military, and I'm proud to be a veteran, but I
sure don't understand why I can't get health care in the
civilian world the way I could when I wore a uniform. That
really made a big impression on me, and his story could be
told by countless others.

About six months later, I was out at Andrews Air
Force Base for their annual air show and I was shaking hands
along a rope line. And a man in uniform grabbed my hand and
he said, "I want you to know something. I'm in the Reserve.
I don't have any health insurance. My family doesn't have
any health insurance. I'm proud to be a veteran. I'm proud
to be in the Reserve. But I'm going to have to look for
another job and move somewhere so I can get some health
insurance for my family." I had never even thought that we
didn't provide some kind of support for our Reserve military
men and women.

We have a situation in our country today which, if
we leave it untended, will deteriorate. That situation is
that we are spending more money than any country in the world
by far. I recently came from Norway. They spend 7-1/2
percent of their national income on health. We spend nearly
15 percent.

They cover everybody. They also, as you may know,
have universal military service. They provide a lot of their
people benefits that we probably wouldn't want to because
they cost a lot, but they sure do provide health care for
everybody, at a lower cost than we pay and don't provide it
for people like that veteran in New Orleans or that member of
the Reserves out at Andrews. We spend more money and really
end up getting less for it. We are not making a good bargain
with our health care system.

Over the years, starting with Franklin Roosevelt, a
lot of people and both Presidents of the Republican and
Democratic parties believed that providing health security
was a key to ensuring basic security and stability for people
in our nation. Franklin Roosevelt couldn't get it done,
although he thought it would be the second chapter to Social
Security.

Harry Truman tried twice, in 1945 and 1947. He was
strongly committed to it and strongly committed to veterans,
which is one of the reasons why the GI Bill, which you helped
to sponsor and bring about with presidential leadership,
became such a gateway to the future for literally millions of
American veterans. But he couldn't get health care through.
And he ranted and raved as only Harry Truman could. I've
read some of those speeches. They're a lot better than what
we're hearing today and they really --

(Laughter.)

MRS. CLINTON: -- they just called it for what it
was and didn't let anybody worry about it. But he couldn't
get it done.

We finally took care of our elderly citizens
through Medicare in the 1960s and our very poorest with
Medicaid in the 1960s, but there are a lot of misconceptions
about those programs, too. We do provide basic health care
for senior citizens over 65 but we don't provide prescription
drug benefits, which is the fastest-growing cost for many of
our older Americans. And, although we do provide health care
through Medicaid for the poorest of the poor, we put working
Americans like that man in New Orleans into the unusual and,
I think, unacceptable position of working and paying taxes to
pay for medical care for people on Welfare that he cannot get
himself.

So we've got a funny kind of situation in our
country when it comes to health care. Some have said, "Well,
we don't have a health care crisis." Well, I would disagree
with that. It is a crisis if you don't have any doctor you
can get to besides an emergency room.

It is a crisis if you want to get off Welfare but
if you take a minimum wage job, which is all you're qualified
for, you don't get medical benefits, so you have to make the
decision to stay on Welfare and get your children medical
benefits or to get off Welfare and go to work, which is what
we want you to do, and not, and not get medical benefits.

It is a crisis if you're an older American with a
relative, a spouse, who needs long-term care and the only
option available to you is the nursing home, when you would
rather keep that relative at home and take care of him
yourself.

We have the finest doctors and hospitals in the
world. We can beat any country when it comes to the quality
of health care we have for those of us who are able to use it
on a regular basis. But we do have probably the stupidest
financing system in the world for health care. We spend --

(Applause.)

MRS. CLINTON: We spend money on paperwork, we
spend money on bureaucracy, that we shouldn't have to spend.
And what the President's plan is designed to do is to
simplify our system to get it to the point where we can put
doctors back in charge of the system again, where they can be
making the decisions, not insurance company executives or
government bureaucrats which is the way it is too often
today.

(Applause.)

MRS. CLINTON: The President's goal is this: to
guarantee private insurance to every American. Now, you're
going to hear a lot, as you already have, about how the
government is going to take over health care. That is not
the President's plan at all. That is what other countries
have done.

Other countries have taken over health care and
basically had it government-run. What we want to do is to
provide private insurance for everyone and have a mix of
systems the way we do now. The VA is a public system. It
will remain an independent, publicly-funded system, open, we
hope, to more veterans than it ever has been before.

(Applause.)

MRS. CLINTON: Every one of your communities has
public health facilities. They have public hospitals. Some
of you have counties that run hospitals in your area. You
have not-for-profits, like the Catholic Hospital Association,
which runs many hospitals around our country and you have
for-profit hospitals. We have a mix. We want to maintain
and improve that mix.

In order to do that, we have to make sure every
American has access to that system. So you will hear words
thrown around like "access" and "coverage" and let me make
sure that we understand the difference.

As a friend of mine said the other day, everybody
in America has access to a Cadillac, but you may not be able
to afford it. We have access to health care right now if
you can afford it. What we don't have is the guarantee that
every American is covered to be able to afford health care.

So listen carefully when this debate picks up over
the next months. Some will talk about universal access.
Some will talk about universal coverage. We want coverage.
I want to go back to New Orleans and that factory and be able
to look into the eyes of those men who are working and paying
taxes and tell them, "You will now have coverage because you
will be able to afford private, guaranteed insurance."

Now, in addition to that, we have to change the
insurance market and the way it operates. I don't know how
many of you have ever read the fine print in your insurance
policies. I haven't. I don't think most of us do until
maybe it's too late. But 75 percent of policies have
something called lifetime limits. What that means is, if you
get really sick and you spend whatever that limit is -- and
some policies have limits as low as $50,000; others have $1
million -- but once you hit that limit, you are not insurable
anymore unless you pay a huge, huge increase in your
premiums.

I have talked to families. I remember so well the
family that had two healthy children and a third child born
and I think to myself, "There but for the grace of God go
many of us." This little baby was born very ill. Within six
months, the $1 million lifetime limit was used up. And
here's a family with a father that makes a very good living
and he cannot afford to buy insurance to take care of that
baby. So by the time I met this family, that baby had been
in the intensive care nursery for 15 months.

The baby had been put onto the Welfare Medicaid
program so the hospital could get some money. The father
couldn't find anybody to insure them to be able to bring the
baby home, which is what the family wanted to do, but they
needed help to be able to pay for round-the-clock nursing and
equipment. So here's a family which, by any standards, would
be a very well-off family, totally destroyed by something
called lifetime limits. Under the President's plan, there
will be no lifetime limits on insurance policies (inaudible)
--

(Applause.)

MRS. CLINTON: Second, many of you know that, under
the current insurance market, if you have something called a
pre-existing condition, you pay more or, you may not be
insurable at all. There are only 81 million Americans who
fall into that category. There are a lot of us with pre-
existing conditions.

The scary thing to me is that I had a scientist
tell me the other day that in the future, we're learning so
much about the human gene system and what genes cause various
diseases that, by the turn of the century, every one of is
going to have a pre-existing condition. If we don't hurry up
and get this health care system reformed, none of us will be
able to afford insurance at the rate we're going.

Under the President's plan, everybody gets
insurance and you do not get charged more because you have a
pre-existing condition, and that's the way insurance should
operate for Americans.

(Applause.)

MRS. CLINTON: And then, finally, most insurance
companies charge older people more than they charge younger
people. Looking around this room, all of us are in that
category. We're going to be charged more than 20-year-olds
who think they're immortal and don't think they need
insurance, anyway. But you know what? Those 20-year-olds
have a funny way of turning out to be 40 and 60-year-olds,
too, don't they?

We have this old-fashioned idea that the young and
the old ought to be in the same insurance pool together, so
we do not want to permit insurance companies to charge people
in their 50s more than they charge people in their 20s.

(Applause.)

MRS. CLINTON: We ought to have insurance go back
to mean what it used to mean for all Americans across the
board.

Now, how will we get insurance under the
President's plan? The same way most Americans get it
today -- at the workplace. That is where we get our
insurance. That, in fact, grew up during the Second World
War as the favorite means of insuring workers. What that
means is that employers and employees will make a
contribution to health care.

There are only three ways to achieve universal
coverage. You can do what countries like Canada does and
basically have a big tax that eliminates all the private
sector investment and has the government run the health care
system. We rejected that.

You can try to do it through an individual mandate
which says, "Everybody in this audience, you're on your own.
You've go out in the insurance market and you buy health care
insurance, just like you do with auto insurance." The only
problem is, a lot of people never get around to getting their
auto insurance. Even when they have to go to get that
license, somehow they evade responsibility, don't they?

It's very hard to determine which individuals are
actually paying what they should pay to be insured and the
other problem is, employers who already help insure employees
would drop a lot of their employees because, if they didn't
have to contribute, many of them would not.

What we think is the better way to do is to take
what works in the American system, build on that, and provide
discounts to small businesses and discounts to low-wage
workers and, if you change the insurance market the way I've
just described, the cost will go down for everybody.

The most discriminated part of the insurance market
today is the part that is small business. Any of you who are
small business owners, you know what it's like to try to buy
health insurance on your own. You don't get the same
bargains as the big employers get. You have to pay 35 to 40
percent more. We will eliminate that and the costs for small
business will be dramatically reduced.

Once everybody is in the insurance system, they
will be given a health security card and they will be
entitled to certain comprehensive benefits with a special
emphasis on preventive health care. We have done this all
backwards for so long. We will pay for the surgery but we
won't pay for the test that could determine early if you had
the disease so we could try to stop it from advancing to the
point of surgery.

For years, insurance companies wouldn't pay for
women for a mammogram but they would pay for breast surgery
if the woman developed cancer. We don't have insurance
companies that pay for well-child care or immunizations but
they'll pay if the child gets measles or some other kind of
disease that puts him into the hospital. Now, where I come
from, that is a very bad way to run a business.

We ought to be paying for prevention. We ought to
be taking care of people when they are at least able to be
cured instead of when we have to do the most extreme and
expensive kind of surgery or chemotherapy on them at the very
end of the process.

(Applause.)

MRS. CLINTON: Comprehensive benefits will also
include home health care and hospice care and rehabilitation
which are especially important for veterans and for older
Americans. I am so tired of women particularly -- some men
but mostly women -- whose husbands are struck down in their
60s or 70s with Alzheimer's or a stroke or some other kind of
debilitating disease and these women want to take care of
their husbands and they are given no help and no support to
do so. And what they are told is, if they spend themselves
into poverty, then there will be a nursing home waiting for
their husband.

They don't want their husband in a nursing home.
They want him at home. We want parents and spouses and
children to be able to take care of family members at home
until it is absolutely impossible, and the President's plan
begins to provide that opportunity.

(Applause.)

MRS. CLINTON: The benefits also include mental
health benefits and treatment for substance abuse. Now, this
is controversial. Many people say, "Well, you know, we
should not include that." But, you know, mental health is a
huge cost to our nation. You see the homeless people talking
to themselves on the street corners, sleeping on the grates
in 20-degree weather, many of whom are veterans. You see our
prisons, filled with offenders who are there because of drugs
or alcohol or some mental illness.

This is not just a health care issue. It is an
issue that runs across our entire society. And for any
member of a family in this audience who is suddenly struck by
a young person in their late teens or 20s developing
schizophrenia or watched a family member undergo the pain of
clinical depression, you know that those are as serious and
disruptive illnesses as diabetes or cancer or any other. We
need to begin to provide benefits, and it will save us money
if we do it in a cost-effective way.

So those kinds of comprehensive benefits being
available to all will be especially important for older
Americans because we will add coverage for long-term care and
prescription drugs to Medicare. For less than $10 a month,
Medicare recipients will have their prescription drug
benefits paid for.

I am so hopeful that we can get that passed
because, you know, for many older Americans, the choice every
months comes to, "Do I buy more food or do I pay for my
prescription drugs?" And I've talked to pharmacists all over
this country who tell me, whether they work in a hospital or
in their retail pharmacies, that they know that their older
patients come in clutching those prescriptions, and it says,
"Take four a day for two weeks," and their older customers
say, "What if I only take one a day? Will that last longer,
will that work?" And, of course, it doesn't work.

So then, so often, that person ends up back in the
hospital, which Medicare will pay for, but they won't pay for
the medication to keep you out of the hospital. So we need
to have prescription drugs.

Let me say a few words about what exactly we intend
to do with the VA system, because I'm so excited about what
we have worked to create in this health bill with the help of
the Legion and other veteran organizations and with the VA.

Today you know better than most citizens that the
VA system has to overcome numerous statutory and financial
obstacles. That is just to be able to maintain its service
to our veterans. The current VA system must contend with
funding resources entirely from federal appropriations and,
in today's tighter and tighter budgets.

Although in this budget that this President has
presented, the appropriation for VA goes up, that isn't true
for most other departments and, with the kinds of pressure
for deficit reduction and the absence of strong support for
those federal appropriations for the VA, I'm afraid we will
see cuts, unless we have real health care reform that
includes strong provisions for the protection of the federal
appropriations and other sources of income for VA, and that
means removing the prohibitions on the VA receiving Medicare
or insurance. You also are confronted with confusing and
complex eligibility rules that confuse both veterans and
their caregivers and other problem that we have looked at.

The President's Health Security Act embraces the VA
system as a key component of national health care and we
expect it will provide high-quality, affordable health care,
and we're going to give you some advantages to be competitive
that we have never been able to provide before.

The first is that, under the Health Security Act,
the VA will become a potential provider for health care
services for millions of Americans who are veterans without
regard to the old eligibility (inaudible). We will always --

(Applause.)

MRS. CLINTON: We will always give first preference
to service-connected disabilities and to our poorest of our
veterans. But there is no reason why many of you in this
audience should not be able to choose the VA system if that
is your choice and, under the President's plan, you will make
the choice.

You know these television advertisements that they
spent about $20 million on saying that we're going to take
away your choice? Well, that's just flat untrue. In fact,
we're going to give you more choice because the choice is not
going to be your employer's and the choice is not going to be
the government's. The choice is going to be yours to make.

The only choice we're trying to take away is those
insurance companies' that are funding that ad, so that they
can no longer choose to disqualify you from health care
because they want to do so, or charge you more than they
would have otherwise. We do want to take that choice away.

(Applause.)

MRS. CLINTON: So under the Health Security Act,
the VA remains an independent system. All veterans can
choose the VA plan and its special expertise on health issues
related to military service. Veterans with service-connected
disabilities and low-income veterans who choose VA as their
health plan will receive comprehensive hospital and out-
patient care with no copayments or deductibles. All veterans
become eligible for the comprehensive package of national
health care benefits that includes access to comprehensive
out-patient health care.

The Health Security Act provides for a $3 billion
investment fund for medical care to improve the VA's medical
delivery system and to make it more competitive. Service-
disabled and low-income veterans remain eligible for free VA
benefits, such as long-term care. The unnecessary reporting
requirements and inspections that currently burden VA
institutions and providers will be reduced freeing VA
providers to concentrate on patients instead of paperwork.
The VA --

(Applause.)

MRS. CLINTON: The VA will be permitted to retain
funds that are recovered from both private insurance
companies and Medicare and, we believe, with more funds
coming in, the VA will be able to offer even better care to
more veterans. We want VA managers to be allowed to control
their budgets on-site so that we can delegate more
flexibility.

You know, a VA hospital in Montana may have a
different need to meet in their patient community than a VA
hospital in Florida and you cannot run that from the top
down. We've got to give the VA managers in the local
veterans' communities some flexibility and say in how their
local VA hospitals take care of their patients. That will
help improve health care across the board.

This entire VA system, if you look at it, has some
of the highest-tech, most extraordinary medical care going
on. I've been out to the Washington center. I have seen
things that I haven't seen in the most advanced private
hospitals. I have seen how they have begun to use technology
so that the VA hospital in Washington and the VA hospital in
Baltimore can communicate by satellite about a single patient
who lives in between and may go to both.

We have some of the finest-quality physicians and
health care in the VA system but they have been held down and
they have not been given the support they need to really do
the job they are capable of doing, and we need to give them
that kind of help.

(Applause.)

MRS. CLINTON: There will no longer be any means
testing. If you choose the VA benefits package, you will be
eligible for the VA benefit package.

(Applause.)

MRS. CLINTON: And so what we are trying to do is
to create in the VA system what you would want from the best-
quality health care system in America. We want the VA system
to compete for every one of the veterans' dollars that will
come to it. Now, that doesn't mean you have to. You can
still choose a different health plan. But what we've talked
about with the VA is for them to begin to partner with other
facilities in their regional areas.

A VA hospital in conjunction with a children's
hospital, a women's hospital, a community hospital, is going
to be a very powerful provider so that you can sign up for a
health plan where your wives will be taken care of, your
children will be taken care of, and you will be able to use
your benefits at the VA hospital. That's the kind of
creative use of both our federal and our private dollars that
we want to see done.

And finally, the VA will continue to provide
Chapter 17 benefits beyond the comprehensive benefits package
to all veterans who are currently eligible to receive them.
This is something we believe in very strongly in the Clinton
Administration. We feel that we owe all of you a great debt
for what you have done for our country in fighting external
threats.

We honestly see our health care system and the
financial drain that it is placing on families and businesses
and governments as an internal threat but one we are fully up
to meeting. We do have to make some changes but we need to
make changes that make common sense and build on what we
think will work.

The Legion has been a champion on behalf of
veterans for many decades. Many of these changes that we are
incorporating come from that gold book and come from the
kinds of proposals that you have made for years, that fell on
deaf ears. Nobody wanted to deal with the health care
system.

You know, Richard Nixon proposed a health care
reform plan very similar to what my husband is proposing,
building on the employer-based system. So both Democratic
and Republican Presidents have tried to get beyond politics
on this one.

But you know and I know that we're going to have to
really convince the people on the Hill that not only do all
Americans deserve secure health care, because none of has it
-- even those of us with the best insurance in the world, we
don't know that we'll have the same insurance at the same
price this time next year -- so none of us can be sure in our
system. And even those eligible for Medicaid, with the
pressures on cutting the budget, you can't be sure you'll
have the same benefits at the same cost this time next year.

So we have a considerable challenge ahead of us
but, just as you have met challenges in the past, help us
meet this one. Listen carefully to this debate. Ask hard
questions. Find out what will really happen to you and your
loved ones and your fellow veterans because the only plan
that has tried, in a comprehensive way, to deal with every
American's needs is the President's plan, and we have
welcomed your help in creating it and we would welcome your
help in trying to bring it to reality because I want to see
every American, but particularly our veterans, get the health
care they deserve to have.

Thank you very much.

(Applause.)

Q Ladies and gentlemen, the First Lady of the
United States. And we appreciate your comments and
information about the health care reform package that's going
through Congress today.

(Applause.)

Q (Inaudible). We just need everyone to make sure
you stay in place.

(End of tape.)