Remarks to the Family Re-Union VII Conference in Nashville, Tennessee

Thank you very much. Thank you. Thank you very much. Mr. Vice President, Tipper, to all the leaders of the conference, Surgeon General Satcher, Governor McWherter, ladies and gentlemen, first of all, let me say that I look forward to coming here every year so much. I always learn something, and I always see people who are full of energy and idealism and a sense of purpose, who remind me of what, at bottom, my efforts as President should be all about. So I always get a lot more out of being here than I can possibly give back, and I thank you for that.

All these issues have been very important to our family for a long time. I grew up in a family where my mother was a nurse and where she served people before Medicare and Medicaid. I never will forget one time when a fruit picker that she had put to sleep for surgery brought us four bushels of peaches. I was really disappointed when third-party reimbursement came in. [Laughter] I thought the previous system was far superior. [Laughter]

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

The Vice President and Mrs. Gore have plainly been the most influential, in a profoundly positive sense, family ever to occupy their present position. Whether it was in mental health or the V-chip in television ratings or telecommunications policy or technology policy or environmental policy or reinventing Government or our relations with Russia and South Africa and a whole raft of other places, history will record both the Vice President and Mrs. Gore as an enormous force for good in America. And I am very grateful to them.

This family conference is one of their most remarkable achievements. And as they said, it predates by a year our partnership and what happened since 1993. But I will always be very grateful to them for this as well.

I'd like to begin with just a remark or two about the tobacco issue, since it's been raised and it was a big part of the movies that we saw. We know that it's the number one public health problem children face in America. We know that more people die every year from tobacco-related illnesses than from murders and fires and accidents and cancer—not cancer but AIDS—and many other conditions combined. We know that 3,000 children start to smoke every day even though it's illegal to sell cigarettes to kids in every State in the country, and 1,000 die early because of it. We know all these things.

We also know that in order to reduce teen smoking, you have to do something about price; you have to do something about access; you have to do something about marketing, both direct marketing, I would argue, by the tobacco companies and their indirect marketing by placing cigarettes strategically in movies, as we saw in this very compelling set of film clips. Now, we know all that.

In what I had hoped was a remarkable and surprising example of bipartisanship in spite of enormous political pressure to the contrary, the United States Senate voted out of committee 19 to one, almost unanimously, a bill that would raise the price of cigarettes, stop advertising, restrict access, put penalties on companies that violated the requirements, and use the money for medical research—especially cancer research—for reimbursements to the States for the health costs related to smoking they had incurred, which money the States would use on health care, child care, and education. And for good measure, we accepted amendments sponsored by Republicans in the Senate to spend some of the money fighting drug usage among our children and to give a tax cut to low and moderate income working families to offset the so-called marriage penalty.

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

I say this to you so that you understand the importance of gatherings like this in grassroots networks. No one doubts that this came about in part because of an unanswered $40-million advertising campaign by the tobacco companies which could not be matched by the Cancer Society, the Heart Association, the Lung Association, or most of you in this room. What you should know is, I'll bet my bottom dollar the night the news of the bill dying broke on the evening news, public opinion switched back to our side, just like it always will as long as people know the facts of what's in the bill and who's behind the opposition to it.

So I say to you this is the intersection of politics, public health, and family. And the cutting-edge issues up there right now are this bill and the Patients' Bill of Rights, about which the First Lady spoke. I don't think you should let this Congress go home, if you can stop it, without acting on these measures and taking care of our families and our future.

Let me say, on a more positive note, this time in our history—on the edge of a new century, in a new millennium, with our economy strong, many of our social problems declining, a great deal of self-confidence in the country— is a real time of decision for us. Usually free societies at good times like this take longer summer vacations, spend more time in the sun. That may be good, at least the vacation part; wear your sunscreen if you do the other. [Laughter] Dr. Satcher will send me a gold star. [Laughter] Or you can say, hey, we can do things now we couldn't do in normal times. We have confidence. We have emotional space. We have the opportunity to dream dreams about the future. We can take on the big challenges of the country. I think that's what we ought to be doing, because we know that no set of circumstances stays the same forever, and because we know that things are really changing fast, and because we need to be looking to the future.

What are these big challenges? Well, a couple related directly to the concerns of the conference: we need to make sure that Social Security and Medicare will be reformed so that they can accommodate the baby boom generation without bankrupting our children and our grandchildren, and we shouldn't be spending the surplus that finally is about to emerge after three decades of deficit spending. We shouldn't be squandering that surplus until we have saved Social Security and we know what we're going to do with Medicare.

We have to figure out how to grow the economy and do more to preserve the environment, not just to avoid making it worse. We've got to actually recover many of our essential environmental things. And that's a health care issue.

We're here at Vanderbilt—we've got the finest system of higher education in the world. We have to develop the best system of elementary and secondary education in the world. We've got the lowest unemployment rate in 28 years, but we still have double-digit unemployment in some urban neighborhoods, on some Native American reservations, and in some poor rural communities. We have to bring the spark of enterprise to every place in America to prove that what we're doing really works. These are the things that we have to do. And we have to prove that we can all get along together across all the racial and religious and other lines that divide us, because in the world today, which is supposed to be so modern and so wonderfully revolutionized by the Internet, old-fashioned racial and religious and ethnic hatred seems to be dominating a lot of the troubles in the world. If we want to do good beyond our borders, we have to be good at home.

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

Shirley MacLaine was in there griping about her daughter getting the shot on the movie, you know? Now, why do you suppose— nevermind the movie—why do you suppose something like that would happen in real life? Could it have something to do with the fact that not just HMO's but the Government tried to take steps to stop medical expenses from going up at 3 times the rate of inflation, but like everything else, if you overdo it and the hospitals have to cut down on service personnel, that people will be late getting their pain shots? I mean, we have to come to grips with the fact that we still are alone among all the advanced societies in the world in not figuring out how to deal with this issue.

And I personally think we also—we ought to be honest—you know, it's easy to—we could all get laughs with HMO jokes, but the truth is there was a reason for managed care, and that is that it was unsustainable for the United States, with the smallest percentage of its people with health insurance of any advanced country, to keep spending a higher and higher percentage of its income and increasing that expenditure at 3 times the rate of inflation. Pretty soon it would have consumed everything 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 that kind—if techniques like that are not anchored to fundamental bedrock principles, then in the end, the process overcomes the substance. And you have the kind of abuses and frustrations that have been talked about. That's why the Patients' Bill of Rights is important.

Now, the second thing I want to say is, we have to figure out how to do a better job of turning laws into reality. One of the things— the Vice President, I hope, will get his just desserts—we may have to wait for 20 years of history books to be written—but the work that we have done in reinventing Government is not sexy; it doesn't rate the headlines every day; people don't scream and yell when you mention the phrase; it doesn't sort of ring on the tip of the tongue. But we've got the smallest Government we've had in 35 years, and it's doing more and doing it better than we were doing before in our core important missions. And we've gotten rid of hundreds of programs and thousands and thousands of pages of regulation, but the Government, on balance, is performing better. And it's because of our commitment to change the way things work.

The biggest challenge we've got right now is to fulfill the promise we made to the American people when we persuaded the Congress to put in the Balanced Budget Act of 1997 sufficient funds—the biggest increase in Medicare funding since 1965—to provide health insurance to at least 5 million more children. There are 10 million or more children in America without any health insurance. We had—the latest numbers indicate that 4 1/2 million of those kids are actually eligible for Medicaid.

Now, most of you here know that when we passed this program we provided for the establishment, State-by-State, of things that are called CHIPS, child health insurance programs, to provide health insurance mostly to the children of lower and moderate income working families that don't have health insurance at work. But if you want to get the maximum number of people insured for the money that's been allocated, obviously the first thing we need to do is to sign every child up for Medicaid who's eligible for it. And again, we're talking, most of these children live in lower income working families. They've been rendered eligible by action of the Federal Government or by action of the State legislature in Tennessee and the other 49 States in our Union.

Recent studies have shown that uninsured children are more likely to be sick as newborns, less likely to be immunized, less likely to receive treatment for even recurring illnesses like ear infections or asthma, which without treatment can have lifelong adverse consequences and ultimately impose greater costs on the health care system as they undermine the quality of life.

Now, we're working with the States to do more, but I want the Federal Government to do more as well. Four months ago I asked eight Federal agencies to find new ways to help provide health care for kids. Today, at the end of this panel, I will sign an Executive memorandum which directs those agencies to implement more than 150 separate initiatives, to involve hundreds of thousands of people getting information that they can use to enroll 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 American Academy of Pediatrics says that these initiatives are, quote, "representing the best of creative government and absolutely critical to achieving our common goal of providing health insurance for all eligible children." So that's what we're going to try to do coming out of this conference, to do our part.

Let me again say that those of you who are here, if you believe that families are at the center of every society, if you believe they are the bedrock of our present and the hope of our future, if you think the most important job of any parent is raising a successful child, then surely—surely—we have to deal with the health care challenges, all of which have been discussed: caring for our parents and grandparents, caring for our children. Surely we have to provide our families with tools to do that if we expect America to be what it ought to be in the new century. We'll do our part, and I'm proud of you for doing yours.

Thank you, and God bless you.