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children for people who leave welfare is an enormous disincentive to get 
off of it.
    That's why I think that a year ago in the winter meeting, the 
Governors hit the nail on the head when they said the kinds of 
structural changes that must occur in the health care system can't be 
effective until every legal resident of America has health insurance. I 
believe that the health care solution and the welfare solution are 
inextricably linked.
    Let me say just a few words about health care. I'm encouraged by 
what I understand was said by the speakers before I got here today. And 
again, I wish I could keep you in constant session here. You seem to 
have a leveling effect on the political rhetoric of the Nation's 
Capital. Guaranteed private insurance for every American is the only way 
we'll ever be able to control the cost of this system, simplify it, and 
provide the American people with security of health benefits that can 
never be taken away. Unless we do that, too many will continue to get 
their care in emergency rooms, which will add billions of dollars to the 
health care bill. Too many will continue to not have certain things 
covered. Too many, for example, will be part of the Americans who add an 
estimated $21 billion to our health care bills every year because they 
can't afford medicine that would keep them out of hospitals, so they 
wind up going to the hospitals and costing the American people much 
more. We certainly won't be able to simplify the system and reduce the 
unnecessary bureaucracy.
    One of the things that I challenge all the folks to do who believe 
that the beginning of health care reform is to tax the benefits of 
middle class workers who have generous health care packages, is to say: 
How can we do that? How can we start with that when we know we have a 
system where we spend 10 percent more on paperwork, bureaucracy, and 
insurance premiums than any other nation in the world? And these things 
have nothing to do with health care. We just have a system that is 
organized so that we spend a dime on the dollar more on paperwork than 
any other country in the world, paperwork in the insurance office, 
paperwork in the hospitals, paperwork in the doctor's office.
    I just left the American Hospital Association, and they have said, 
clearly, the only way you'll ever fix this is to have a system that 
provides basic coverage to everybody, so that you can have a single 
claims form which will be imposed on the patients, single claims form 
for the hospitals, single claims form for the doctors. It is imperative 
that we do that.
    There was a study in the New England Journal of Medicine a year or 
so ago: two hospitals, one in the United States, one in Canada, same 
number of beds, same rate of occupancy, same general mix of treatment, 
one of them had 200 people in their clerical department, the other had 
6. Now, I don't advocate going to the single-payer system for other 
reasons; there are other problems in the Canadian system. And it is the 
second most expensive in the world. I think managed competition will 
work better. But it is clear that we cannot justify, in my view, taking 
something away from the working people of this country before we clean 
up the administrative costs of the present system.
    I also will say without full coverage, I don't see any way to avoid 
the conclusion that States will continue to bear a disproportionate 
burden of skyrocketing health care costs. The Lewin study showed that 
States would pay less under our approach than if we just left things the 
way they are and that health care would improve.
    I still believe in the requirement for employers to cover their 
employees. First of all, that's the way most people get their health

[[Page 184]]

insurance today. Under our approach people would have a choice in their 
health care program. There's been a lot of discussion about this. Let's 
go beyond the rhetoric to the reality today.
    Today, fifty-five percent of all employers and 40 percent of all 
employees who are covered with health insurance through the workplace 
have no choice in the health care plan or the doctors they get, they are 
selected by the employer, today. Under our plan, every employee would 
have to get at least three choices once a year, one of which would be 
just picking your doctor and having fee-for-service medicine.
    So I'm all for choice, but we need to recognize that if we want the 
benefits of competition and the benefits of choice, we have to move away 
from the trend that we are setting now. We are moving in the direction 
of getting the benefits of competition and market power for big business 
and Government. And some of you have asked for reforms, Governor 
McWherter, among others, to put Medicaid into a managed competition 
environment to get the benefits of that. But the problem is some people 
will get the benefits of that, other people on the other end will lose 
choice. So if you want to pursue both values at once, we plainly have to 
change the direction in which we are going. And we have to have a 
different framework if you wish to have both.
    Now, in spite of some of the interesting art work that you've seen 
in the last couple of weeks, the Washington Post said that our approach 
would create, and I quote, ``a surprisingly simple world for 
consumers.'' You make a decision once a year, among at least three 
plans, based on what you want. I wish we could even have more choice. We 
haven't figured out how to do that yet. But Federal employees have a 
great deal, for example, and many of you in States have given your State 
employees more and more choices. And because you have market power, you 
can do that, which is why you have to give some framework for the small 
businesses to have the same market power that big business and 
Government does.
    Now, a lot of this approach builds on what I have seen a lot of you 
do in the States. Hawaii proved a long time ago that if you did it 
right, you can have an employer requirement to cover employees without 
bankrupting small business but providing better coverage, stronger work 
force, and lowering health care costs because of the way the market can 
be organized. The Governor of Hawaii has spoken eloquently about this. 
You can say, ``Well, Hawaii is geographically isolated and, besides 
that, we all like to go there and surf and play golf or whatever.'' 
Well, that's why we want to do it for the whole country instead of just 
impose it on one State or another.
    We learned from Minnesota that health care cost targets can be set 
and met through strong leadership, market-forces competition, and high 
quality. And I might say, Governor Carlson, that the Mayo Clinic 
stands--if there were no other example in this country, and there are--
but if you just take that one example, it is a sterling and a stunning 
rebuke to those who say you cannot provide the world's highest class 
health care and control costs.
    We learned from the example of Washington State and of Florida and 
most recently of Maryland that you can pool businesses and families 
together to change the David-and-Goliath equation, and then small 
businesses and families can get affordable health insurance that covers 
the things which need to be covered. We learn from Pennsylvania--we 
learn two things from Pennsylvania. The first thing is that the Governor 
of Pennsylvania proves that you can do anything in the health care 
system. We also learn that better tracking of costs and outcomes 
improves the quality and lowers the cost. This is an amazing thing they 
did, and our approach encompasses this. Whatever the Congress does, this 
should be a part of it. Pennsylvania actually took the time to study and 
report on the cost of different procedures in different hospitals in 
different parts of the State and then measured the cost against the 
results, proving that there was not a necessary connection in many areas 
between cost and quality and changing the whole environment in terms of 
what consumers then could ask for and get. This sounds like a simple 
thing, but in a system this complicated this information, available in a 
way that people can act on it, is a rarity, not the rule, in American 
health care.

[[Page 185]]

    So I believe that if we at the Federal level can learn from these 
things and finally solve this problem in a comprehensive way, we will go 
a long way toward dealing with the welfare reform issue, and we will lay 
to rest one of the biggest problems for American families and for the 
long-term stability of our society.
    Now, what normally happens around here is that everybody gives their 
speeches, and then we have Washington-style reform where we tinker at 
the edges, expand the Medicaid program a little more. That's what we've 
been doing for years, you know, just kind of backing toward universal 
coverage by expanding Medicaid mandates. And then at the same time, we 
try to ratchet down the Federal spending a little more and pass some 
other incremental reforms. You know what's going to happen? We do that, 
more mandates on you and less money for you to pay. That's what's going 
to happen. More State money put into a system that is fundamentally 
broken, without enough security, where someone else is making the 
fundamental policy decisions.
    I talked to you a few moments ago about Jo Anne Osteen from Sumter, 
South Carolina. She wrote us last June, struggling to hang on to both 
her small business and her insurance. She had to make a choice, and she 
chose her business and lost her coverage. After decades and decades, 
it's time to solve that woman's problem, because her problem is our 
problem. And her problem is now the State government's problem.
    We really can do things around here when we put our minds to it. 
We've got the deficit going down instead of up. We all got together, 
some of you mentioned it yesterday, in a bipartisan and Federal, State 
way and passed NAFTA when it was given up for dead. That enabled us to 
get a GATT agreement which was stalled for 7 years. Congress passed the 
Brady bill after a 7-year stall. We actually can do things around here 
when people work at it and they keep pushing us to make a decision and 
they keep us all in the right frame of mind and they keep us thinking 
about real things. You cannot escape the real world and the rhetoric. 
You can't do it because you're too close to your folks.
    Here, we communicate most often with the American people through an 
array of intermediaries. And most times, too many times people can't get 
to us with their real problems. So there is always a danger here that 
the policy apparatus will just slip the tracks and that we'll forget 
what this is about.
    Yesterday, Families USA issued this report, which I urge you all to 
get and read. It just takes 10 typical health care situations that 
actually happen to real Americans and identifies how those things would 
be dealt with under the major bills pending before Congress. In other 
words, it's not about politics and rhetoric and theory, it's about real 
lives.
    So I ask you to help us do this. You all differ among yourselves; we 
have some differences with you. That's fine, that's good, that's what 
this is all about. But I remember in 1987 and 1988, we were struggling 
to deal with welfare reform. And every Governor in the country wanted to 
do something about it. And the political rhetoric--the Governors were 
converging around an issue, but the political rhetoric in Washington was 
diverging right and left. And we sat around here and talked; we tried to 
get agreement on a policy position. And Governor Campbell had just left 
the Congress where he had been the minority leader of the subcommittee 
that dealt with welfare. And he said to the Democrats and Republicans 
alike, ``Look, I had to go talk to a bunch of people on welfare, and 
here is the way this works. Here is the intersection of welfare, health 
care, food stamps, the whole thing.''
    It was an incredible moment where all of us had to say, this is not 
about rhetoric, this is about real people. And we went on and passed the 
Family Support Act, which Senator Moynihan said was the most significant 
piece of social reform in the welfare area in three decades.
    Now, we can do this on health care. I don't believe we can do it 
unless everybody gets coverage. But we can do it, and you can help us do 
it if you push the thing together around real problems, real facts, and 
real issues, and don't let Washington rhetoric pull the country apart. 
The country needs you, and I hope you'll stay with us until the job is 
done.
    Thank you very much.

[[Page 186]]

Note: The President spoke at 11:46 a.m. at the J.W. Marriott. In his 
remarks, he referred to Gov. Carroll Campbell of South Carolina, Gov. 
Ned Ray McWherter of Tennessee, and Gov. Arne Carlson of Minnesota.


<DOC>
[Weekly Compilation of Presidential Documents]
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[Page 186-188]
 
Monday, February 7, 1994
 
Volume 30--Number 5
Pages 167-215
 
Week Ending Friday, February 4, 1994
 
Remarks Announcing the Nomination of Deval L. Patrick To Be Assistant 
Attorney General for Civil Rights and an Exchange With Reporters

February 1, 1994

    The President. Good afternoon. For tens of millions of Americans the 
Civil Rights Division of the Department of Justice has historically 
embodied what is best about our country. It's helped us to keep the 
promise of our Constitution, to provide to every American equal 
opportunity and equal protection under the law, regardless of race or 
gender or disability. Because of our pursuit of equal treatment under 
the law, we've made a lot of progress in this country in the workplace, 
in the schools, in the voting booths, and in the courts. But there is 
still much more to be done. We need a strong and aggressive Civil Rights 
Division and a strong and compassionate advocate for freedom and 
fairness at the helm of that Division.
    Today I am proud to nominate Deval Patrick to be Assistant Attorney 
General for Civil Rights. I believe he is uniquely qualified to lead 
this Division in this decade. He's been chosen because he has 
distinguished himself as a lawyer whose wise counsel, keen negotiating 
skills, and mastery at litigation are held in the highest esteem.
    He's fought successfully against discrimination and for civil rights 
for his entire life, both professionally and personally. He understands 
that the law is a tool to help real people with real problems. He's here 
with his family today, having come a long way from his childhood on the 
south side of Chicago through a distinguished academic and professional 
career of which any American could be proud.
    The quest for civil rights gives life to our highest ideals and our 
deepest hopes. For his entire career Deval Patrick has played a role in 
that struggle, and he has made a real difference. Therefore, I know he 
will perform in a very outstanding manner in his new role as Assistant 
Attorney General for Civil Rights.
    Mr. Patrick?
    Attorney General? [Laughter] I don't know what order he's in.
    Mr. Patrick. Stick with me.
    The President. That's the idea.

[At this point, Attorney General Janet Reno and Deval Patrick made brief 
remarks.]

Conservative Groups

    Q. Mr. President, conservative groups are already attacking Mr. 
Patrick, the same groups that attacked Lani Guinier, saying that he is 
the ``Stealth Guinier.'' How are you going to sell this nomination and 
make sure that your view of his record gets out accurately?
    The President. Well, I think that this nomination may be about those 
groups and whether they're proceeding in good faith. That is, you know, 
before those groups said, ``Well, we don't object to Lani Guinier's 
career as a lawyer. We just don't agree with her writings about future 
remedies.'' So now when they say ``Stealth Guinier,'' what they mean is 
that both these people have distinguished legal careers in trying to 
enforce the civil rights laws of the country. I hope that Mr. Patrick 
would plead guilty to that.
    And the truth is, a lot of those people are going to be exposed 
because they never believed in the civil rights laws; they never 
believed in equal opportunity; they never lifted a finger to give 
anybody of a minority race a chance in this country. And this time, if 
they try that, it's going to be about them, because they won't be able 
to say it's about somebody's writings, about future remedies. If they 
attack his record it means just exactly what we've all suspected all 
along, they don't give a riff about civil rights.
    Well, those of us who care about civil rights were elected by the 
American people to take care of them. That's what we intended to do.

Death Penalty

    Q. Mr. President, do you agree with his argument that the death 
penalty is racially discriminatory against blacks?

[[Page 187]]

    The President. Do I agree? He's made that argument in court. I don't 
agree with that, no.
    Q. A 1987 Supreme Court case.
    The President. No.
    Q. Have you talked with him about----
    The President. But I think the most compelling evidence that was 
introduced to support it, as I've said many times as a supporter of 
capital punishment, is that the race of the victim seems to determine 
the outcome of the verdict. There's a lot of evidence--the Supreme Court 

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