President Clinton Addresses the Conference

Office of the Press Secretary
(Nashville, Tennessee)

For Immediate Release June 22, 1998


Vanderbilt University
Nashville, Tennessee

12:45 P.M. CDT

THE VICE PRESIDENT: Thank you very much, ladies andgentlemen, and thank you, Bill, and thank you for thecosponsorship of the Child and Family Policy Center and for thevery hard work of the past year that's made today possible.

Thank you, Chancellor Wyatt, for the wonderfulhospitality of Vanderbilt in hosting this important event. Andwe, Tipper and I, earlier thanked Dr. and Mrs. Hefner forTennessee State's role in hosting the Experts Forum again.

Many thanks also to Marty Erickson and theConsortium for Children, Youth and Families of the University ofMinnesota. Your energy and wisdom are crucial to thisconference, and I know there are many distinguished delegatesfrom Minnesota who are with us here today.

Thanks also to our wonderful conference chair, JillIscol. Your tireless energy and vision for the future of FamilyReunion is contagious and has won us many new friends for thisinitiative. And I will thank all of the others who have been apart of this year's conference and necessary to making it happenat the conclusion of our session tomorrow, but I want to thankNancy Hoyt, our conference director, and all of those who haveworked with her.

And among the many distinguished guests here, Ihesitate to even start mentioning people and I will miss a lot ofpeople, but I do want to acknowledge our wonderful SurgeonGeneral, David Satcher, a kind of a homecoming to Nashville.(Applause.) We're proud of you, Dr. Satcher, thank you so much.(Applause.)

Tennessee's Chief Justice Riley Anderson is here andour former Governor, Ned McWhorter, and our Speaker Pro Tem,Louise DeBarry is here. All three of them are wonderfullywelcome. (Applause.) There are many other state officials,members of the state legislature, both from Tennessee and fromother states, and local elected officials, Democrats andRepublicans. Welcome all.

Now, Tipper and I would like to briefly welcomeeveryone here to our Family Reunion. This is a tradition thatwe're proud to continue, and initiative that is helping shapepolicy for children and families. And we also welcome thethousands who are linked to our site here today by satellite.There are lots and lots of downlinks around the country -- we'llbe interacting with some of them this afternoon. We appreciateyour presence here.

We're looking forward to two days filled with ideasand strategies that will move us toward improving family-centeredhealth care for all generations. We'll hear stories that willremind us how family-centered health care changes the lives ofboth patients and health care professionals. We'll hear howhospitals and communities are changing to be more responsive tothe needs of families, how these changes are affecting medicaltraining and education, and how information drives the healthcare system.

This afternoon, you'll meet some of the best mindsin this field who will be leading workshops around the campus.And then tomorrow, we will hear a summary of those discussionsand then move forward in our concluding sessions tomorrow.

Before I begin the session today, I just want totell you what a special honor and privilege it is for Tipper andme to be able to be joined by two very good and close friends whohave in recent years made it a practice to come and attend thesesessions. And, of course, as many of you know, our ability --everybody in these Family Reunion conferences to get the rightkinds of policy outcomes based on the learning experience thattakes place here would be very much less -- except for the factthat we have a President and a First Lady who are so committed tothese issues and to the progress that we all want to see in ourcountry.

And Tipper and I are so touched that once again thisyear they have come to be a part of this Family Reunionconference. Ladies and gentlemen, it is an honor to be able towelcome to our conference the President of the United States andthe First Lady, Bill Clinton and Hillary Rodham Clinton.(Applause.) Welcome, Mr. President, Mrs. Clinton. We're sohonored that you're here.

Traditionally, we open up these Family Reunionconferences with just a brief film presentation. Because just aseach of us lives our lives primarily in the venue of ourfamilies, whenever we have an effort to try to advanceunderstanding of a particular issue -- like families and healthcare -- it's always useful to remind ourselves how we talk to oneanother about this issue in our culture, in movies and intelevision.

Jeffrey Cole, Director of the Center forCommunication Policy at UCLA, along with his staff, have onceagain this year enabled us to begin with a brief collage, thistime a collage of media scenes designed to show the images offamilies and health that we have absorbed from television andfilm. This video will show us many truths. We'll see dramaticfamily moments seen in the midst of health and sickness, life anddeath and birth. We will also see the impact of our culture onfamilies and health care, including the glamorizing of tobaccoand we'll see how the media educate us about health care,including educating us about the ugly truth concerning tobaccoand the other aspects of families and health care.

This is the first time I've had to issue a ratingfor our media clips. If one of the scenes in this collage isfrom a movie that's rated "R" for language, and if you are goingto be offended by it, now is a good time to leave. (Laughter.)You'll recognize it when it comes. (Laughter.)

But as almost everyone will see, in at least onescene or two, an emotional episode from our own past will remindus of something about what it means to be caring for a familymember, or to be cared for by a family member at a time ofweakness, uncertainty or need.

And so at that point, let's just watch this video.

(A video is shown.)

THE VICE PRESIDENT: We're very grateful to JeffCole and his team. I know that you worked right up until thelast minute, Jeff, to include some scenes that were hard tolocate. And you've succeeded, once again, in producing a verypower piece. I'd like to ask Jeff Cole, who produced that filmto please stand up and accept our thanks. (Applause.) Thank youvery much. (Applause.)

The power of that video we just saw comes from thefact that, in this case, art does indeed imitate life. Itprovides a window into our own lives. A health problem facing aloved one may be contained in the body of that one person, but itaffects the entire family's soul. Yet far too often, modernmedical practices sees a patient's family as another problem tobe managed and not as a critical part of any solution. Theyoften see the family as a roadblock to proper treatment ratherthan a building block for a health future.

For seven years now, Tipper and I have convenedthese Family Reunion conferences for the express purpose ofshining the spotlight of public attention on the often overlookedrole of the family in the life of this nation and its people.The initiatives coming out of these conferences have beennumerous, whether they've been from government, the privatesector, community groups, or partnerships among all of the above.And in recent years, the regular attendance of the President andthe First Lady has guaranteed that the meaningful solutionsdeveloped at each conference become a part of our nation'sagenda.

Just to cite a couple of examples from previousFamily Reunion conferences, our Conference on Family and Medialed to the V-chip that will soon allow parents to blocktelevision programming that they feel is inappropriate for theirown children to watch. Our conference on the role of fathers inchildren's lives has led to Father To Father, a national networkfor fathers assisting fathers; a web site known as Fathernet; anda presidential memorandum issued by the President directingagencies to promote fatherhood through their programs, policies,and personnel decisions. And that is working extremely well.

Our Conference on Family and Work contributed to anational dialogue on balancing these two roles, and led to, amongother things, proposals for comp time and the expansion of Familyand Medical Leave.

And last year's Conference on Families and Learninglaunched efforts to expand quality after-school programs, developnew techniques to encourage parent-teacher communication, andinvolve parents and communities in designing new public schools.

This year, we're exploring family-centered healthcare, because our system of medical care, while scientificallyingenious, has not made proper use of the crucial healing powerof the family. It has too often left family members confused andabandoned in the waiting room.

We will hear about fresh, new approaches, likeredesigning spaces in children's hospitals to encourage familyinvolvement, allowing family perspectives to shape the medicaleducation of the next generation of doctors and nurses; creatingpartnerships among organizations in a community to offer familiesin one place a full range of medical treatment and health advice.We will hear from people who know that health care information isoften the world's most effective medicine, and who find ways ofpassing that information to families.

Family-centered care is an approach that relies onpartnerships between providers, patients and families to helppromote health and healing. You know, even though the phrase"primary health care provider" is used in a specialized way bythe medical community, usually the true primary health careprovider in America today is the family. How many of us havebeen, as family members, the person who said or heard the phrase,"did you take your medicine," "put this thermometer under yourtongue," "open wide."

This conference is designed to help us all find waysto more effectively unleash the healing power of the family.Family-centered health care recognizes the family's expertise,encourages collaboration and shares information.

After working to get parents better informationabout prenatal care and nutrition, one hospital in Ohio saw amore than 30-percent reduction in the length of hospitalizationfor babies. Family-centered support for children infected withHIV and for children with asthma has decreased hospital stays.Family involvement during a mother's hospital stay has reduceddepression. Today, 21 million Americans provide health care tomembers of their own family. That is a threefold increase injust the last 10 years.

Of course, one of the reasons that families are nowmore involved in health care is that our population is growingolder and living longer. Those of us in the baby boom generationare the first generation to have more parents than children, andmany of us care for both parents and children. More than 90percent of chronically-disabled elderly people receive informalcare from family members and loved ones. In fact, according to astudy from the National Nursing Home survey, so many people areinvolved in informal care-giving for the elderly that if the costof that care had to be provided by professionals it would add asmuch as $94 billion to our health care bills.

For five years, with the courageous and tirelessleadership of President and Mrs. Clinton, our administration hasbeen fighting to improve health care for families. We passedlegislation to let all families keep their health care coveragewhen they changed jobs. We passed a new law so that new motherscan stay in the hospital for at least 48 hours after the deliveryof a child. We passed a Mental Health Parity Act, with theleadership of Tipper, to fight discrimination against familymembers with mental illnesses. The President signed into law thenew children's health insurance program, which helps providecoverage for children who would otherwise not get it.

Last year, we passed a bipartisan balanced budgetagreement with reforms that gave older Americans new choices andexpanded benefits in Medicare. That's a step in the rightdirection, but language and choice can often be confusing. So weneed to make sure that Americans can understand their choices andthat their families understand their choices and learn how tomake use of the new preventive care options available to them.We can use our newest technology to help ensure that olderAmericans and their families have access to the most up-to-dateavailable information about their medical benefits.

Today, I'm pleased to announce a new nationwideInternet site,, that will help familiesunderstand the new options and services that Medicare provides.It's up and running as of now. And from now on people will beable to type in their ZIP codes and see the specific health planoptions available in their own communities for their older familymembers.

At the same time, to ensure that no family fallsthrough the cracks, I'm pleased to announce today the creation ofa nationwide public/private Medicare alliance including over 80national organizations. Members of the alliance, including theAFL-CIO, the American Association of Retired Persons, theNational Rural Health Association and Health Care FinancingAdministration and others, will reach out to communities largeand small, urban and rural, all over this nation, so thatfamilies understand the new options available to them, know aboutthe new preventive benefits and are aware of the consumerprotections available under Medicare.

Today, I'm pleased to announce that starting July1st for the very first time, Medicare will cover tests andeducation for Americans with diabetes. With this announcementtoday, the 20 percent of older Americans with diabetes will beable to take preventive steps to help them and their familiesavoid the pain and loss that can come when this disease isundetected and untreated. One of the scenes in the video collagethat dealt with this problem. That could have been prevented.

Also starting on July 1st, for the very first timeMedicare will cover the bone mass measurement test that canidentify osteoporosis, the silent killer. For the one out of twoAmerican women over the age of 50 who have anosteoporosis-related fracture, this new benefit does more thanoffer hope for stronger bones, it offers hope for a strongerfuture for them and their families.

These new steps will make Medicare more responsiveto the needs of families, helping them find information,encourage prevention, and get the care they need for their eldestand often most vulnerable members. But there is still so much todo to improve the health and health care of Americans. I want toissue a challenge to all of us gathered at this conference tounderstand and expand the practice of family-centered care. Andhere are five steps to help us meet that challenge -- you couldcall it a SMART plan for family centered health care: support,measure, ask, respect and train.

Number one, support. Around the nation, communitieshave developed support systems that can offer family care-giversthe emotional and psychological respite they need. We know thatmany families are more than willing to be giving care to a familymember, but they are often exhausted by it. They need respite.

President Clinton has taken the lead by givingstates new flexibility to support home- and community-basedoptions, adult day care and respite care, so that families havethe options they need to supplement -- not supplant -- familycare-giving.

Number two, measure. We have to measure theperformance of our health care programs and clinics andhospitals, and do it in language that families can understand.Not only will this help patients choose better health careoptions, it will reward the better health care plans andproviders and increase competition that could improve health carequality overall.

Just last week, I had the opportunity to announcethat private businesses, health consumer groups, professionalorganizations, labor unions, and employers, are coming togetherto plan America's very first health care quality forum, designinga comprehensive plan to ensure the widespread availability ofcomparative information to improve the quality of health care.

Number three, ask. Ask families for their knowledgeand for their participation. We must encourage our health caresystem to ask families to play a role, to make them a vital partof our care-giving system. And we must ask the medical communityto help design new ways to involve the family, and after theyask, they have to listen. We all must listen to the answers thatfamilies provide. We're taking an important step in Washingtonright now to listen to families. The President is asking theCongress to pass a Patient's Bill of Rights that providesfamilies with new protections in the changing health care system.

Number four, respect. We must make sure each healthcare professional respects the power of families as health careproviders and offers families the information, guidance,assistance, and encouragement that they need to keep theirmembers healthy.

Number five, train. Doctors and other health careprofessionals must be trained to be more sensitive to the needsand roles of families. We will hear a new announcement from

medical schools and nursing schools about historic changes in howwe train the next generation of health care providers to be moreresponsive to the needs of families. And we will hear ideas onhow we can train families in how to use new technologiesavailable for home care-giving. We saw a scene in the collagewhere a nurse was teaching the family member how to handle theparticular technology that was important for the patient.

So these five steps -- support, measure, ask,respect, and train -- spell more than "SMART", they spell our avision for maximizing the healing power of families in our healthcare system.

We have an extraordinary opportunity at this FamilyReunion conference, because there are people gathered here fromall over the country, representing every aspect of our healthcare system -- patients, families, doctors, heads of medicalschools, nurses, insurers, professors, hospital administrators,and others. Let's learn everything that we can from each other,today and tomorrow so we can change the nature and the culture ofour health care system and unleash the healing and loving powerof families.

Thank you and thank you for coming to thisconference. (Applause.)

Now, it is my great pleasure to introduce my partnerwho co-hosts these conferences with me every single year, and hassince the time when I was back in the Senate, the love of mylife, Tipper Gore. (Applause.)

MRS. GORE: Thank you. Thank you very much.(Applause.) Well, thank you, this is -- it's wonderful, we'revery excited that all of you are here.

And Al, let me add my voice to yours by welcomingeveryone, all our distinguished guests, the people that are goingto share their expertise, everyone here that's listening, themedia that's reporting. We really appreciate all of you inhelping us help others to keep their families healthy and toshare ideas about how we can best do that.

I know that a lot of you here today know Al verywell, and if you do, you probably know that he undertakeseverything with great enthusiasm. When he takes on an issue, hedevotes a lot of time and energy to researching that and todiscussing it and to trying to get all the very best opinionsthat he can on the issue.

When he was still in the Senate many years ago, helooked at policies that impeded families helping themselves tobecome strong and to stay strong, and he wanted to take a look athow you could change those policies so that families can reallysupport one another and can become stronger the in process. So,together, we've taken a look at a way to create policy, to buildpolicy, to encourage policy, that will help to strengthenfamilies, which in turn, strengthens communities. And that's thepoint that we are here to discuss today.

He has looked at issues that impact families, fromeducation to fatherhood and to health care. All of us havelooked at the issue of health care, and everyone in this room, Iknow, has a huge, huge stake in how we can best deliver healthcare in our own families and in our communities.

We've reached the same conclusion, and that is thatfamilies truly are at the heart of each and every solution tohealth problems, and that policies and programs that support andstrengthen families will ultimately strengthen our nation.That's just common sense.

I'm really proud and honored to be a part of thisevent. I'm happy that we're taking a look at the family centerapproach to health care. As many of you know, we're veryinterested in how mental health care fits into health care as awhole. Of course, it does, but we need to continue to talk aboutthat and to destigmatize mental or behavioral health care. And Ithink that this conference is going to go a long way toward thatend.

One of the topics that I'll be discussing tomorrowand later today we'll be addressing mental health care forchildren, and also children that are facing chronic healthproblems of their parents and how we can best support them.

But now it is a great privilege and honor for me tobe able to introduce to you a very special woman who has been alifelong advocate on issues ranging from health care to women'srights to strengthening families, back in her home state ofArkansas as well as our nation's First Lady. And she's also atremendous voice in addressing the needs of women and children.

She has a very compassionate spirit. She has thecourage to speak out and always has, and she has a greatdetermination to fight on behalf of women -- not just for womenhere in this country, but for women across the world. And sherepresents our nation, and I know all of us appreciate andrespect her voice as it is our voice around the world.

She has demonstrated a lifelong commitment toimproving health care for all of our families. And as theadministration's leading voice on health care, she foughttirelessly for the passage of the landmark Children's HealthInitiative, giving hundreds of thousands of previously uninsuredchildren the opportunity to have health insurance and come underhealth care coverage.

Her efforts have helped to shed light, to educatepeople about the national need for more comprehensive health careservices and benefits for all American families. And she hastalked long and hard about a family centered approach to healthcare, the very issue that we are here to talk about in furtherdetail today.

So I know all of you will join me in giving a verywarm welcome to a very special woman, a very special leader, andour nation's First Lady, Hillary Rodham Clinton. (Applause.)

MRS. CLINTON: Thank you all. Thank you somuch, and it is great to be back here to join Tipper and Al forthis seventh Family Reunion conference. I know that many of youin the audience have followed with great interest the FamilyReunion conferences of the past years, have been part of thedeliberations and the follow-up. Others of you are new to thisexperience, but I can guarantee you that this is one of the mostmeaningful public policy discussions that you will be part ofbecause it is aimed at really changing the way we look at aproblem and coming up with practical solutions.

The Vice President made reference to some of whathas already flowed from previous Reunion conferences, and Iexpect the same from this one, because certainly the issue is animportant one in the lives of our families and is a timely one,as we know, as we look at the impact of a changing health caresystem on all of us.

The people who have planned this conference havebeen very thoughtful in bringing all of us together and settingan agenda that will lead to the kind of thoughtful reflection andresults that are the hallmark of what Al and Tipper have beendoing for the last years. Their vision to launch this series ofFamily Reunions seven years ago was really in line with theirlifetime of work and commitment to seeking to bring peopletogether, not drive them apart; looking for ways to buildconsensus, not flame conflict; and making it possible for peopleof different points of view and experiences to find commonground. We need that more than ever in our nation because we areat a point in our history where we should be, with all theblessings that we're enjoying, be able to address some of theproblems that underlie the stresses and strains that tear at thefabric of family life.

So I am personally very grateful to my friends, Aland Tipper, but I am even more grateful as a citizen to the VicePresident and Tipper for making it possible for all of us to takesome time out and think about these difficult problems that theyhave addressed through the Family Reunion conferences.

I want to thank everyone who has worked on this,particularly the two cohosts of the conference, Dr. MarthaErickson and Bill Purcell. I want to thank the chair of theconference, Jill Iscol; and Nancy Hoyt, who doesn't seem to beslowed down at all by her crutches and is a walking example offamily-centered health care, since both her daughter and herhusband are here as part of her support system. But that's whatthese Family Reunion conferences are all about -- bringing ustogether.

And today we are surely talking about a subject thataffects all of us -- how do we get the health care system to bemore responsive to the needs of families. Every one of us has apersonal experience like the ones we just saw on the screen. Weknow the pain and anguish of having a family member who is sickor injured or in need of long-term care. I think every one of ushas sat in a hospital waiting room worrying about achronically-ill relative or close friend. We have faced thefrustration of trying to understand the mind-numbing rules andregulations of medical insurance forms.

And we know how difficult it is to deal with theemotional stress that comes upon us at such a time. Now, wecertainly have made a lot of progress in the last 30 years, 40years, in moving toward being much more sensitive.

I well recall the anguish of my family when one ofmy brother came down with rheumatic fever, and in those days, inthe 1960s, there were no special considerations given to parentsor family members, and there was a very strict set of rules aboutwhat governed visiting, even for a young boy of the age of 8,alone in the hospital. So my mother and father were permittedonly see him an hour a day, and certainly my brother and I werenot permitted to see him at all.

What a difference that was from time that whenChelsea had her tonsils out and had to spend the night in thehospital both Bill and I her able to be there with her. So we'vemake a lot of progress in the hospital system, the entire healthcare system appreciating the role that families play in thehealing of a member of a family and how we now have to look athow we move that further in the face of new challenges.

Now, the administration, under the leadership of thePresident and the Vice President, have been looking for ways todeal with the changing nature of the health care system. We'llbe hearing in a few minutes from the forum panelists up here onthe stage before you. And what you will hear from them is goodnews about how hospitals and health care providers are workingwith families and communities to make sure that families areparticipants in important medical decisions, that they get theinformation they need and the support they need and the respectthey deserve.

But we know that there are still a lot of obstaclesand difficulties. And one of the reasons this conference is sotimely is that we have to be sure that as the way we organize andpay for health care changes we don't lose the advances we've madesince my brother was in a hospital, and lose the extraordinarywork that is being done by the panelists and many of you to makethe health care system more family responsive.

You all know that we face an entirely differentsituation than we had just a few years ago: 160 million peopleare enrolled in managed care plans today. Now, that's anincrease of 75 percent just since 1990. And as with any sweepingchange, it has the potential for both harm and benefit. We arelearning, as we work our way through this new system, that morepeople are feeling like numbers instead of patients.

I remember before my father died in 1993, he went tosee a doctor that had taken over the practice of his longtimephysician. And he got into the waiting room and there was noperson there. And he had to punch a button and an automaticvoice came on and asked him who he was. And my father said,"None of your business, I'm leaving," and walked out the door.(Laughter.) Well, I think that a lot of people had that feelingand have that feeling, that we don't want to be treated likenumbers and we especially don't want our children and our parentsand our loved ones treated like numbers. So how do we take thebenefits of a changing health care system and put them to work onbehalf of all of us?

Now, this administration has worked very hard toimprove the health and well-being of our families and children,and to make sure, particularly, that children and elderlyrelatives and citizens with special needs are given the supportand protections that they deserve.

One of the battles that the President and the VicePresident have taken on is against the tobacco lobby and they'vetaken up the challenge of helping parents protect their kids fromthe deadly habit of smoking. Now, while that initiative took abeating last week in Congress, I know you can count on thePresident and Vice President never to walk away from fight whenthe fight is on behalf of the children of America. (Applause.)And as the President has said, if the members of the Senate hadvoted more like parents, instead of partisans, the outcome wouldhave been different. And it still can be. (Applause.)

One of the important steps that the President andVice President are also working to achieve is to pass thePatient's Bill of Rights, which would give Americans much neededprotection.

Now, what does that mean to all of us? Well, Iimagine, like me, you've heard of or you've seen with your owneyes some of the stories that are coming back from what'shappening in the health care system -- people denied emergencycare because somebody, hundreds or even thousands of miles away,decides they don't need it; someone denied access to a specialistbecause someone looking at paper, not looking at the patient,decides they don't need a specialist.

So the Patient's Bill of Rights would once againenshrine what we should never lose sight of: that the mostimportant goal of any health care system is the well-being of thepatient. And we should once again protect the physician-patientrelationship and put it above any other consideration.(Applause.) The bottom line of profits cannot ever be permittedto interfere with the bottom line of patient care.

So this Patient's Bill of Rights would do thingssuch as guarantee access to health care specialists and emergencyservices. It would create a strong grievance and appeals processso that consumers can resolve their differences with health plansand health care providers. We must work to make sure that theCongress passes protections such as that this year.

Yet, all of us who have followed what goes on --whether it's in a state capital or our Nation's Capital -- knowsthat passing legislation doesn't guarantee change. There is alot of hard work to implement a law, and that is certainly thecase with the historic children's health insurance program thatextended health insurance for up to 5 million of our uninsuredchildren. The administration has been working with states andcommunities to get the word out about the expanded coverage.

And I wanted to just show you a report that is beingissued today, a report to the President of an interagency taskforce of government officials in Washington that have reallylooked hard about how we will implement this. And all of you whoare from all over our country, in so many different settings, Ihope will really help us make sure that the word gets out toparents and others that their children are now eligible forhealth care coverage. And the President will talk further aboutthe steps that are going to be taken to reach as many children aspossible.

The Vice President also referenced thisadministration's commitment to improving the quality andeffectiveness of health care for our elderly citizens. AndTipper and I will be working together to get the word out aboutone of the new benefits that Medicare is covering tests to detectosteoporosis. And many of you are equally concerned about thenew benefit on diabetes education. So we will do our best to getthe word out in every way possible about osteoporosis, aboutdiabetes, so that we can reach Americans so that they can helptake care of themselves and family members can help take care ofeach other by spreading the word.

This conference today and tomorrow has suchtremendous potential. But just like a piece of legislation thatis passed standing alone it won't do anything other than perhapseducate those who are here and provide more opportunities forcontinuing to learn from each other. In and of themselves, thoseare very worthy outcomes. But we want to be sure that all of ustake what we learn from this conference back to the hospitals,the community centers, the neighborhood health clinics, theadvocacy groups -- everyone who is represented here -- and makesure that all of us know that fighting for health care, makingsure it is family-centered, is not a luxury, it's not somethingthat we can wait to do, but it is critical to how we definehealth care going into the 21st century.

Because of all the changes that we're coping with,we have a chance to really make some important decisions thatwill determine whether people are treated like numbers or whetherpeople continue to be given the respect they deserve at a momentin their lives when all of us feel vulnerable and alone. And oneof the ways of doing that is for each of us to be sure to get theword out that taking care of health care means taking care offamilies and giving families more of a voice and an opportunityto be part of everything that happens to one of their loved oneswhen the worst occurs.

So all of you are making it possible to fight forgreater protections and services for Americans. And for that, Iam very grateful and very pleased to be part of this importanteffort.

Thank you. (Applause.)

THE VICE PRESIDENT: Thank you so much. That was awonderful presentation. And now ladies and gentlemen, I'mhonored to introduce to you an individual who has been leadingour country's efforts one health care. And let me say right atthe outset, no President has ever worked harder to improve healthcare for all Americans.

President Bill Clinton has increased access tohealth insurance for people who are self-employed, for people whohave preexisting conditions, for people who are changing jobs,for children of low-income families. He's now working to expandhealth insurance for Americans aged 55 to 65. No one in historyhas cared more or done more to bring health care to a poor child,a working parent, or an ailing grandparent.

But President Clinton also understands that we mustwork to maintain the quality of American health care, to ensurethat the dramatic changes in today's health care system work for,and not against, American families. That's why he's pushing sohard for passage of the Patient's Bill of Rights, so that everyAmerican gets quality health care.

I'm honored to introduce to you a President who hasthe strength, the stamina, and the commitment to help us build,step-by-step, a new nationwide commitment to health care accessand excellence.

Ladies and gentlemen, the President of the UnitedStates, Bill Clinton. (Applause.)

THE PRESIDENT: Thank you very much. Thank you.(Applause.) Thank you very much. Mr. Vice President, Tipper, toall the leader of the conference, Surgeon General Satcher,Governor McWhorter, ladies and gentlemen, first of all, let mesay that I look forward to coming here every year so much. Ialways learn something and I always see people who are full ofenergy and idealism and a sense of purpose who remind me of what,at bottom, my efforts as President should be all about. So Ialways get a lot more out of being here than I can possibly giveback, and I thank you for that.

All these issues have been very important to ourfamily for a long time. I grew up in a family where my motherwas a nurse and where she served people before Medicare andMedicaid. I never will forget one time when a fruit picker thatshe had put to sleep for surgery brought us four bushels ofpeaches. I was really disappointed when third-partyreimbursement came in. (Laughter.) I thought the previoussystem was far superior. (Laughter.)

When Hillary and I met, she was taking an extra yearin law school to work at the Yale University Hospital in theChild Studies Center to learn more about children and health andthe law and how they interfaced. And when we went home toArkansas she started the Arkansas Advocates for Families andChildren -- a long time before she ever wrote her now famousbook, "It Takes a Village."

The Vice President and Mrs. Gore have plainly beenthe most influential, in a profoundly positive sense, family everto occupy their present position -- whether it was in mentalhealth or the V-chip in television ratings or telecommunicationspolicy or technology policy or environmental policy orreinventing government or our relations with Russia and SouthAfrica and a whole raft of other places -- history will recordboth the Vice President and Mrs. Gore as an enormous force forgood in America. And I am very grateful to them.

This Family Conference is one of their mostremarkable achievements. And as they said, it predates by a yearour partnership and what happened since 1993. But I will alwaysbe very grateful to them for this as well.

I'd like to begin with just a remark or two aboutthe tobacco issue, since it's been raised and it was a big partof the movies that we saw. We know that it's the number onepublic health problem children face in America. We know thatmore people die every year from tobacco-related illnesses thanfrom murders and fires and accidents and cancer -- not cancer,but AIDS and many other conditions combined. We know that 3,000children start to smoke every day -- even though it's illegal tosell cigarettes to kids in every state in the country -- and1,000 die early because of it. We know all these things.

We also know that in order to reduce teen smokingyou have to do something about price, you have to do somethingabout access, you have to do something about marketing -- bothdirect marketing, I would argue, by the tobacco companies, andtheir indirect marketing by placing cigarettes strategically inmovies, as we saw in this very compelling set of film clips.Now, we know all that.

And what I had hoped was a remarkable and surprisingexample of bipartisanship in spite of enormous political pressureto the contrary, the United States Senate voted out of committee19-1, almost unanimously, a bill that would raise the price ofcigarettes; stop advertising, restrict access, put penalties oncompanies that violated the requirements and use the money formedical research -- especially cancer research -- forreimbursements to the states for the health costs related tosmoking they had incurred, which money the states would use onhealth care, child care and education. And, for good measure, weaccepted amendments sponsored by Republicans in the Senate tospend some of the money fighting drug usage among our childrenand to give a tax cut to low and moderate income working familiesto offset the so-called marriage penalty.

Then the bill came to a vote in the Senate. TheAmerican people are now learning that, except for the budget, aminority in the Senate can require every bill to pass with 60votes, not 51. We had 57 votes to pass that bill. But 43senators followed the bidding of the Republican leadership andthe tobacco companies and at least temporarily derailed thatbill. It was a brazen act of putting politics over people andpartisanship over progress.

I say this to you so that you understand theimportance of gatherings like this in grass-roots networks. Noone doubts that this came about in part because of an unanswered$40 million advertising campaign by the tobacco companies whichcould not be matched by the Cancer Society, the HeartAssociation, the Lung Association or most of you in this room.What you should know is, I'll bet my bottom dollar the night thenews of the bill dying broke on the evening news, public opinionswitched back to our side, just like it always will as long aspeople know the facts of what's in the bill and who's behind theopposition to it.

So I say to you this is the intersection ofpolitics, public health and family. And the cutting-edge issuesup there right now are this bill and the Patient's Bill ofRights, about which the First Lady spoke. I don't think youshould let this Congress go home, if you can stop it, withoutacting on these measures and taking care of our families and ourfuture. (Applause.)

Let me say, on a more positive note, this time inour history -- on the edge of a new century, in a new millennium,with our economy strong, many of our social problems declining, agreat deal of self-confidence in the country -- is a real time ofdecision for us. Usually free societies in good times like thistake longer summer vacations, spend more time in the sun -- thatmay be good, at least the vacation part -- wear your sunscreen ifyou do the other. (Laughter.) Dr. Satcher will send me a goldstar. (Laughter.) Or you can say, hey, we can do things now wecouldn't do in normal times. We have confidence. We haveemotional space. We have the opportunity to dream dreams aboutthe future. We can take on the big challenges of the country. Ithink that's what we ought to be doing. Because we know that noset of circumstances stays the same forever, and because we knowthat things are really changing fast and because we need to belooking to the future.

What are these big challenges? Well, a couplerelated directly to the concerns of the conference -- we need tomake sure that Social Security and Medicare will be reformed sothat they can accommodate the baby boom generation withoutbankrupting our children and our grandchildren. And we shouldn'tbe spending the surplus that finally is about to emerge afterand we shouldn't be spending the surplus that finally is about toemerge after three decades of deficit spending, we shouldn't besquandering that surplus until we have saved Social Security andwe know what we're going to do with Medicare. (Applause.)

We have to figure out how to grow the economy and domore to preserve the environment -- not just to avoid making itworse, we've got to actually recover many of our essentialenvironmental things. (Applause.) And that's a health careissue.

We're here at Vanderbilt -- we've got the finestsystem of higher education in the world. We have to develop thebest system of elementary and secondary education in the world.(Applause.)

We've got the lowest unemployment rate in 28 years,but we still have double-digit unemployment in some urbanneighborhoods, on some Native American reservations, and in somepoor rural communities. We have to bring the spark of enterpriseto every place in America to prove that what we're doing reallyworks. (Applause.) These are the things that we have to do.And we have to prove that we can all get along together acrossall the racial and religious and other lines that divide us,because in the world today, which is supposed to be so modern andso wonderfully revolutionized by the Internet, old-fashionedracial and religious and ethnic hatred seems to be dominating alot of the troubles in the world. If we want to do good beyondour borders, we have to be good at home. (Applause.)

But on that list should be health care. Why?Because we have the finest health care in the world, but we stillcan't figure out how to give everybody access to it in a quality,affordable way. And in some form or fashion, every family inAmerica just about, sooner or later, runs up against that fact.

Shirley McLaine was in there griping about herdaughter getting the shot on the movie, you know? Now, why doyou suppose -- never mind the movie -- why do you supposesomething like that would happen in real life? Could it havesomething to do with the fact that not just HMOs, but thegovernment, tried to take steps to stop medical expenses fromgoing up at three times the rate of inflation, but, likeeverything else, if you overdo it, and the hospitals have to cutdown on service personnel, that people will be late getting theirpain shots? I mean, we have to come to grips with the fact thatwe still are alone among all the advanced societies in the worldin not figuring out how to deal with this issue.

And I personally think we also -- we ought to behonest -- you know, it's easy to -- we could all get laughs withHMO jokes, but the truth is there was a reason for managed care,and that is that it was unsustainable for the United States, withthe smallest percentage of its people with health insurance ofany advanced country, to keep spending a higher and higherpercentage of its income and increasing that expenditure at threetimes the rate of inflation. Pretty soon it would have consumedeverything else. That was an unsustainable situation.

And a lot of good has come out of better management.I don't think anyone would deny that. The problem is, if thatkind -- if techniques like that are not anchored to fundamentalbedrock principles, then in the end, the process overcomes thesubstance. And you have the kind of abuses and frustrations thathave been talked about. That's why the Patient's Bill of Rightsis important.

Now, the second thing I want to say is, we have tofigure out how to do a better job of turning laws into reality.One of the things the Vice President I hope will get his justdesserts -- we may have to wait for 20 years of history books tobe written -- but the work that we have done in reinventinggovernment is not sexy, it doesn't rate the headlines every day,

people don't scream and yell when you mention the phrase, itdoesn't sort of ring on the tip of the tongue. But we've got thesmallest government we've had in 35 years, and it's doing moreand doing it better than we were doing before in our coreimportant missions.

And we've gotten rid of hundreds of programs andthousands and thousands of pages of regulation -- but thegovernment, on balance, is performing better. And it's becauseof our commitment to change the way things work. The biggestchallenge we've got right now is to fulfill the promise we madeto the American people when we persuaded the Congress to put inthe Balanced Budget Act of 1997 sufficient funds -- the biggestincrease in Medicare funding since 1965, to provide healthinsurance to at least 5 million more children. There are 10million or more children in America without any health insurance.

We had -- the latest numbers indicate that 4.5million of those kids are actually eligible for Medicaid. Now,most of you here know that when we passed this program weprovided for the establishment state-by-state of things that arecalled CHIPS, child health insurance programs, to provide healthinsurance mostly to the children of lower and moderate incomeworking families that don't have health insurance at work.

But if you want to get the maximum number of peopleinsured for the money that's bean allocated, obviously the firstthing we need to do is to sign every child up for Medicaid who'seligible for it. And, again, most of these children live inlower income working families. They've been rendered eligible byaction of the federal government or by action of the statelegislature in Tennessee and the other 49 states in our union.

Recent studies have shown that uninsured childrenare more likely to be sick as newborns, less likely to beimmunized, less likely to receive treatment for even recurringillnesses like ear infections or asthma -- which withouttreatment can have lifelong adverse consequences and ultimatelyimpose greater cost on the health care system as they underminethe quality of life.

Now, we're working with the states to do more, but Iwant the federal government to do more as well. Four months agoI asked eight federal agencies to find new ways to help providehealth care for kids. Today, at the end of this panel, I willsign an executive memorandum which directs those agencies toimplement more than 150 separate initiatives, to involve hundredsof thousands of people getting information that they can use toenroll people in schools, in child care centers and elsewhere--involve partnerships with job centers and Head Start programs.

This is what reinventing government is all about.The America Academy of Pediatrics says that these initiatives are"representing the best of creative government and absolutelycritical to achieving our common goal of providing healthinsurance for all eligible children." So that's what we're goingto try to do coming out of this conference to do our part.

Let me again say that those of you who are here, ifyou believe that families are at the center of every society, ifyou believe they are the bedrock of our present and the hope ofour future, if you think the most important job of any parent israising a successful child, then surely -- surely -- we have todeal with the health care challenges, all of which have beendiscussed -- caring for our parents and grandparents, caring forour children. Surely we have to provide our families the toolsto do that if we expect America to be what it ought to be in thenew century. We'll do our part and I'm proud of you for doingyours.

Thank you and God bless you. (Applause.)

What's New - June 1998

National Ocean Conference

Equal Pay Act

Family Re-Union Conference

Portland State University Commencement

Ocean Conference

South Asia

Thurston High School Remarks

National Ocean Conference

Presidential Scholars

Bulletproof Vest Partnership Grant Act

ISTEA Legislation

SAVER Summit

Speaks to DLC

National Ocean Conference, Plenary Session

New Efforts to Protect Our Oceans

The Opening of the Thoreau Institute

Oceans Announcements

Fight Against Drugs

Welcoming Ceremony in Xian, China

Korean President Kim Dae Jung

Roundtable Discussion in Xiahe, China

President Kim of South Korea

Deadbeat Parents Punishment Act

21st Century Community Learning Grants

Pritzker Awards Dinner

Nominations of Bill Richardson and Richard Holbrooke

Remarks to Religious Leaders

Family Re-Union Media Advisory

Meeting With Economic Advisors

Conference Address

A Fair, Accurate Census

New Data On Teen Smoking

Roundtable Discussion Remarks

Landmark Agricultural Bill

Conference Remarks

Denver Broncos, Super Bowl Champions

Family Re-Union Press Release

U.S.-China Relations in the 21st Century

Roundtable Discussion in Shanghai, China.

MIT Commencement Address

Commencement Address to MIT Graduates

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