Remarks to the National Breast Cancer Coalition

Thank you very much. Secretary Shalala and Fran, Dr. Love, distinguished Members of Congress, Mrs. Cuomo, Mrs. Florio, and all of you distinguished guests. It's wonderful for me to be here today.

I was sitting here thinking that I more or less feel like the fifth wheel now. Just about everything that needs to be said has been said. But we sort of felt one man ought to talk on this program. And I won the lottery. [Laughter]

In the 3 minutes that will elapse at the beginning of this talk, another American woman will be diagnosed with breast cancer. If I speak for 12 minutes, another woman will die of it during the course of the remarks. And yet we know that one in every three American women does not receive the basic services, like mammographies, which can help to detect breast cancers and that the cost of not dealing with this amounts to about $6 billion a year to this country over and above all the human heartbreak involved.

Now that means that this is another one of those terrible American problems that is not only tearing the heart out of so many families but also has left us again with no excuse for why we would spend so much money picking up the pieces of broken lives when we could spend a little bit of money trying to save them.

We know all the stories; many of you here are the stories. I appreciate the reference to my brave mother, who struggles on with her breast cancer condition and who has resumed her remarkable life, but who also knows how much more we need to do. I'm glad to see Sherry Kohlenberg's husband and son here. When she came to see us in the Oval Office— Sherry was one of our 50 faces of hope, and we kind of keep up with all those folks that, to us, symbolize what we wanted this administration to be about. And when Sherry came to see us last June with Larry and with Sammy, she said, "Don't ever forget what this does to the people who are left behind." And I'm glad to see them here today, and I'm glad they had the courage to come to remind us of that.

Since we know that there are a lot of things we don't know, it's important that we focus on research as well as treatment, that we focus on detection early as well as care. In my first budget submission, I recommended the creation of the office of research on women's health and the largest increase in funding for breast cancer research in the history of the National Institutes of Health. When you add that up to the increased funding for detection and preventive services at the Center for Disease Control, the Food and Drug Administration, and the Department of Defense, together the combined expenditures approved by this Congress, thanks in no small measure to these women who are here, amounts to about $600 million this year alone.

I also want to emphasize that in the health security plan that I have proposed to the Congress we provide for increases, not decreases in medical research and a means to fund those increases in medical research. We cannot provide basic security to all Americans and forget about the research that needs to be done on the things we don't know how to cure yet.

To help to coordinate our research and delivery efforts, in mid-December Secretary Shalala will bring together a broad range of health professionals, Government agencies, and groups like yours to develop a national action plan for the prevention, the diagnosis, and the treatment of breast cancer. A national strategy is what these petitions are all about. And while I am trying to reduce the volume of paperwork in Washington—[laughter]—frankly, I'm glad to see these here. We will do better, and you will help us. And we will have this national action plan.

I also want to point out that the health security plan that Hillary and I are fighting so hard for, along with the other members of our administration, will also fundamentally change the dimension of the fight against breast cancer. It is a plan that clearly shows the sign of several strong women at work, including two on this platform, based on the notion that when it comes to health care research and delivery, women can no longer be treated as secondclass citizens.

We began to manifest that commitment, frankly, in this budget which was just passed, in which virtually everything was cut or frozen but which increased services for early childhood and for little children. We also believe that we have to further increase our investments in these things, in prenatal, in maternal and child health care and nutrition, and in detecting and preventing diseases.

We believe that we need a health security plan that guarantees to every American a comprehensive package of benefits that not only can never be taken away but that includes preventive services to try to keep people well as well as help them when they're sick. We believe that some of these preventive services are so important that they should indeed entail no out-ofpocket costs at all to American citizens when the considered medical judgment is that everybody should get them on a regular basis. That includes routine clinician visits and not only appropriate breast exams but also important procedures like immunizations and Pap smears.

We also know that we can reduce deaths by making mammography widely available and by encouraging its use. And this plan covers these mammograms at no additional cost to patients for all women over 50 and provides mammograms where important in the judgment of the physician and the woman in every case where there is a health care plan. So if this plan passes, for the first time everybody who's got a health insurance policy, which will be everybody in America, will have mammograms in the policy. That is a very important thing.

The unique structure of this plan, with some preventive benefits absolutely free to Americans in the highest risk categories, was based upon the best available scientific evidence expressed in the findings of the United States Preventive Services Task Force and supported by forthcoming guidelines, for example on mammograms, from the National Cancer Institute. They were based on the best available scientific evidence, I will say again. And I very much appreciate the fact that just before we came up here today, Hillary whipped out an article that had Dr. Love quoted, and she said, "Have we done it like you said we should?" and Dr. Love said, "Yes." I felt like I had gotten an A in class. [Laughter]

I also want to emphasize that none of this can ever be fixed in stone. You hear a whole lot of discussion as we get into the debate on the health care plan about how this or that or the other problem is not fixed. Well, my fellow Americans, this is a very dynamic thing, health care. And even the countries that have the best system, if you define "best" as high quality results, universal coverage, preventive services at lower costs, even they have continuing problems. You have to work on this forever. This is the beginning of what we should have done a long time ago, not the end of it. And one of the things that we need to make a commitment to do now is to update all these preventive approaches as new and better studies become available, based on recommendations like those we'll soon receive from the President's Special Commission on Breast Cancer. They've worked hard for 2 years, and I'm looking forward to that report.

Finally, let me say that—and this is an important thing to women who live in inner cities or remote rural areas—the best health care coverage in a policy is no good unless you can access it. We can have great policies and coverage, but we also have to have access. So we had a whole group of people who work all across America on these problems. And I myself spent a whole 4-hour period listening to this because I've worried about it for years, coming as I do from a small rural State, to be able to say to you that if this plan passes as we propose it, we'll be able to have the latest technologies given to doctors and nurses who can practice in the smallest rural communities and the most isolated parts of our large inner cities, to allow health professionals to contribute their best to all the people of this country who need these preventive services.

As you know from your efforts to gather all these signatures, change requires that people work together. But when they work together and make their voices heard, change can come. I'll never forget the meeting I had with breast cancer advocates at a hospital during the election, and I told Hillary after it was over that if we had the energy of the women who were there at that meeting concentrated on about four major things we could turn this country around in 3 1/2 weeks.

And so I say to you in closing, we need that energy. And we will give you a vehicle, beginning with Secretary Shalala's meeting in December, to develop a national action plan on breast cancer. But it is important that that plan be fit into a larger commitment to the health care of Americans: to put women's health concerns, from research to the delivery of health care, on an equal footing with men's; to say that it is better to focus on keeping people well than just treating them when they're sick, and when you focus on that you will find them when they're just a little sick and be able to get them well a whole lot quicker; and finally, to say that none of this will ever come to pass until we finally join the ranks of every other advanced country in this world and give every citizen of this country health care that is always there, that can never be taken away from them.

Every American can bring some weapon to this struggle, and your weapons are unique. They are not the dollars and deal-making talents of lobbyists or the stethoscopes or syringes of doctors and nurses. But they are the power of the pen and the petition and, most important of all, the power of the personal story. For in the end, America ought to be shaped by the lives of Americans, not just by the interests of Americans but by the values of Americans, not just by what we want when everything is going well but by what we need in our direst and most difficult moments.

I urge you to continue to fight in the months ahead. We can win this battle. As a part of the national drive for early breast cancer detection, tomorrow thousands of doctors and hospitals and medical centers across the country will offer discounted mammograms, thanks in no small measure to all of you.

I'm going to sign this proclamation when I finish my remarks which declares tomorrow National Mammography Day. I want to thank all the Members of Congress who pushed this through and two who are not here, Senator Biden and Congresswoman Marilyn Lloyd, who were sponsors of this legislation. And I want to remind you that you've got to continue to bring this level of intensity, of energy, of passion to this battle. You have the most powerful thing of all, personal stories. When American politics works best, it's when it reflects the lives of the American people. You can make sure on these issues we do that. And I hope you will.

Thank you, and God bless you all.