Remarks to the Service Employees International Union

Thank you very much. Thank you. This is a pretty good way to start off the week. [Laughter]

You know, I'm getting up in years now, and— [laughter]—every day I start a little slower, it seems like, and I always need kind of a jolt of energy. I may be dancing by the time I get back to the White House. This may be the afternoon of my first 5-mile run since the accident.

It's great to see you, and I thank Andy for that remarkable introduction and for his remarks and his passionate commitment. I thank your executive vice presidents who are up here on the stage with me, and all the rest of you for inviting me here.

We have a large number of people from the White House who have come here today. I think I should mention at least two of them. One is a gift you gave me or a theft I accomplished— [laughter]—but Karen Tramontano is doing a magnificent job. I also would like to note that the Assistant to the President and Director of Public Liaison used to work with you at the Labor Department, Maria Echaveste, and she is also doing a great job, and she's here with me.

Ladies and gentlemen, I am delighted to be here and delighted to see all of you, wishing I had one of those purple T-shirts to jog in. [Laughter] I'll get one before I leave. The SEIU—better not do that or it will be a story. [Laughter] The SEIU is leading the way for better wages, safer workplaces, more full-time jobs, and a brighter future for our working families. There's new life, new energy, new creativity in the labor movement in America, and a lot of it began right here with you, and I thank you for it. Because of your leadership in the workplace and your involvement in the political process, not just you but America is also back. I've come here today to thank you for what you've done, not simply for me and our administration but for the people of the United States, to strengthen our families and to strengthen our economy and to strengthen our future.

I also want to talk to you about what we can do now to strengthen America's health care system and especially to talk about what we have to do to reduce fraud in the Medicare program so that it can serve America well into the 21st century.

We've come a long way from 6 years ago when I announced my candidacy for President. Then I said that I had a simple mission for America in the 21st century. I wanted to keep the American dream alive for every person responsible enough to work for it. I wanted to make sure that America would continue to be the world's strongest force for peace and freedom and prosperity. And I wanted to make sure that we could bring our people together across all the lines that divide us amid increasing diversity into one America—our oldest and most enduring values—opportunity for all, responsibility from all, a community of all Americans leading the world toward peace and freedom and prosperity.

We began with a bold new economic course that focused on three things: shrinking the deficit; selling more American products and services around the world; and investing in our people, in the capacity of all of our people, and being determined to leave no one behind. We also put a special effort on depressed communities. We had an aggressive anticrime strategy to try to bring the crime rate down by putting more police officers on the street and keeping more kids out of trouble, taking assault weapons off the street, keeping handguns out of the hands of people with a criminal or a serious mental health history. We had an aggressive effort to help move people from welfare to work. Now, 6 years later from the time I started, almost 5 years from the time I became President, we see the results: nearly 13 million new jobs, unemployment less than 5 percent, poverty down, the biggest drop in welfare rolls in history, dramatic drops in the crime rate year after year.

Maybe even more importantly, about midway through my first term, after decades of working harder and harder for lower wages, never keeping up with inflation, millions of Americans are finally beginning to see a rise in their paychecks. And it's about time. Incomes of American families have averaged an increase of $1,600 since the beginning of our administration, but it's getting better over time because of three things.

First of all, with your help last year, we raised the minimum wage because no hard-working parent should have to try to raise a child on $4.25 an hour.

Secondly, we more than doubled the earnedincome tax credit in the economic program of 1993, which is worth, on average, over $1,000 a year in lower taxes to a family of four with an income of under $30,000 a year if they have a couple of children.

And thirdly, the children's tax credit, which was just adopted—and adopted to cover those young public employees that start out, and may be eligible for, the earned-income tax credit, too—will be worth another $500 a child to working families throughout this country.

These three things together are going to have a huge impact on the family incomes, particularly of people, let's say, in the bottom 40 percent of the income brackets in the United States.

From 1945 until the mid-seventies, all of us grew together. From the mid-seventies to the early nineties, our economy continued to grow, but because of inflation, because of foreign competition, because of all the restructuring going on in the American economy, we began to grow apart. Now we can grow together again. And I know that's what you want, and that's what I want. We've got to grow, and grow together. And that means we can't rest, because even though this is a time of extraordinary achievement and justifiable optimism for our country, we have to keep going until every single American can reap the rewards of a growing economy, and we're not there yet.

In the last budget bill, for the first time ever, we had so much increased aid to help people go to college or send their children to college— the biggest increase in 50 years since the GI bill—we can now honestly say we have now opened the doors of college education to all. But people have to walk through them in order to get the training they need to get the incomes that they want for themselves and their children.

We also are in the middle of a continuing struggle to secure the investments in the budget agreement for our schools and also to embrace the notion that we ought to have high national standards of academic excellence, which should apply to all of our children in all of our school districts—not Federal Government standards, national standards that should apply to all of our children.

We also have to pass sweeping legislation designed to continue this effort to keep tobacco out of the hands of our young children.

And we have to continue to grow the economy. There are some specific things in this budget agreement that are very important, designed to go right to the heart of the poorest communities in urban and rural America: doubling the number of community development banks that make loans to people in those neighborhoods; continuing to make sure that we have more and more empowerment zones, the program the Vice President has done such a good job on, to give people incentives to invest money where there are people who are unemployed or underemployed. That's good for our economy, to keep the jobs growing.

One other thing—and I know that we have often disagreed on this—I just want to say one more time. Our analysis is that between onequarter and one-third of our economic growth that made 13 million jobs in the last 4 years came because we are selling more American products overseas. Why? We have 4 percent of the world's population; we have 20 percent of the world's wealth. If you want to keep 20 percent of the wealth with 4 percent of the population, you have to sell something to the other 96 percent. Now, in the next 15 years, our estimates are that the developing countries of Latin America and Asia will grow 3 times as fast as the United States, Europe, and Japan. And therefore, we have to be a part of that.

The last point I want to make is—all of you know this—our markets are already among the most open in the world. They're more open than all these countries we're making agreements with. So if we agree to have equally open markets, we give up far less than they do, and we open markets largely to our high value-added products. That's why I sought the fast-track trade authority, not because I want unfair trade agreements but because I think we have earned a presumption, at least, to be taken seriously when I say to you the 220 trade agreements we have negotiated had something to do with the 13 million jobs we have and the fact that we have the most successful economy we've had in a generation.

Should there be labor and environmental standards? Should we work hard to raise labor standards for working people around the world so that it increases everyone's income? Absolutely. Should we ask people to adhere to global standards so that we can preserve the global environment? Absolutely. But that means we should, too. That means that we should, too. We can't tell another country they should clean up their sewage and clean up their water unless we're willing to clean up the global air that we—we have to do it, too. We have to do it, too.

So we've got a lot still to do. But I want to focus in the last few minutes of my talk here on what Andy talked about. I want to talk about health care: Where we are and where are we going. You know, they said if I passed my health care plan that everybody was going to go into managed care, and it would be a bad thing. [Laughter] Well, we didn't pass the health care plan, and everybody's going into managed care. [Laughter] And it's not all bad.

But also we don't have anything like the choices for health care consumers that we had in our plan. So the good news is, we've rationalized the management of the health care system. The bad news is, we don't have the standards in there and the choices and the consumer protections that we would have had.

Now, we can't go strong into the 21st century if millions of our fellow citizens still go to bed every night worrying about whether their sons and daughters and parents can see a doctor. I said if we don't do something about it, the number of people without health insurance in America will continue to rise. And sure enough, it has. Now there are over 40 million of us without health insurance.

We can't be strong in the 21st century if American patients are only a dollar sign on a ledger book. We cannot be a strong nation— to be fair, too, we can't be a strong nation unless we know that Medicare and Medicaid will last and will be relatively free of the fraud and abuse that can so easily infiltrate any big program. So we have a lot to do.

It has become commonplace to say that we have the most excellent health care system in the world, but we are not very excellent in making sure all Americans can share in it. That is what we have to focus on. And it tickled me when Andy said that Bill and Hillary would outlive Harry and Louise. I certainly hope so. [Laughter] I have to tell you, though, a lot of times in my life I've gotten beat trying to do something I thought was right. And I prefer that than not trying in the first place. I'm glad I tried to do the health care. I'm glad I tried to do that. [Applause] Thank you.

As you might imagine, I've had a lot of time to sort of Monday-morning quarterback myself and try to figure out how I could have done a better job. It is ironic that, having reduced the size of the Federal Government by 300,000 to its smallest size since Kennedy, I was accused of trying to have the Government take over the health care system; that having given more authority to the States than even President Reagan did, I was accused of trying to engage in a power grab for the Federal Government. I wasn't trying to do that. But the fact is that we have a system unlike any in the advanced world. And every other advanced country can figure out how to get health insurance to everybody, and we can't. And we wind up paying more because of it, because we don't do enough preventive health care, we don't do enough primary health care, we do too much through the emergency rooms. We have too many people with uncompensated care that the rest of us who have insurance pay for in higher rates. All because we have refused to try to rationalize this process.

Now, what I tried to do before won't work. Maybe we can do it in another way. That's what we've tried to do a step at a time until eventually we finish this. We can be very proud of the Family and Medical Leave Act. I was glad that your president mentioned that. That's the first major legislation I signed. Millions of people no longer have to make a choice between succeeding at work and home because of that. All the time, people still come up to me and talk about it—I travel around the country—just citizens come up and talk to me about their experiences under the Family and Medical Leave Act.

We can be proud that after the so-called Contract With America revolution in 1994, we didn't allow them to take away Medicaid, and we were able to preserve the social safety net. There are millions of poor children, pregnant women, disabled and older Americans who still have access to health care. A lot of them don't. A lot of them can't even vote, and they may not have a lot of political power. But you stood up for them, and I appreciate it, and I hope you're proud of it.

You can be proud that you supported and that there was enormous bipartisan support for the Kennedy-Kassebaum health insurance bill that says you can't lose your health insurance when you change jobs or just because someone in your family has been sick. That will preserve health care for enormous numbers of people, and you should be proud of that.

And you ought to be proud of the health care provisions of this last budget. The biggest increase in investment in health care for children since the Medicaid program passed in 1965 is in the balanced budget of 1997. It will permit us to insure up to half of the children who don't have health insurance. And if you'll help us, we might be able to actually insure more. Because of the 10 million children in America— 40 million people roughly don't have health insurance, actually a little more; 10 million of them are children. Of those 10 million, 3 million, believe it or not, are eligible for Medicaid right now. And they're not on it, either because maybe their parents are first generation immigrants, aren't fluent in English, no one has explained to them that they're eligible. Maybe they're people who work for low wages, but they think somehow they'll be on welfare if their children take Medicaid.

It's a lot of work, but we could actually insure more than 5 million children with the $24 billion in this bill. If we could get the 3 million kids who are Medicaid-eligible right now onto Medicaid, we could take the same money and insure far more children. And we'll be back to you on that. But we need your help.

In addition to that, this budget also provided new preventive care benefits for mammographies, to try to head off prostate cancer, which is just as prominent in men as breast cancer is in women, and had what the American Diabetes Association said was the most significant advance in the care of Americans with diabetes since insulin was discovered 70 years ago. So this is a good budget.

But we have to work now to make sure that we devise a system that actually covers new children instead of a system that permits employers to continue to drop their employees' children from insurance because they're going to be picked up in public dollars. We must not do that. We must make sure that we cover new children.

I need your help in this. We cannot waste this opportunity. We've got to work with the advocates groups, the local communities, the State governments, the health care providers. We cannot blow this. This is an enormous thing.

You know, when you think about the rhetoric of the health care debate just a couple of years ago, and now you've got 80 percent of the Congress in both Houses voting for the biggest increase in health care coverage since Medicaid passed in '65, we have come a long way. And you can be proud of that. And you can be glad that now there are Members of both parties in Congress who are willing to vote to do this.

But it is complicated when you're doing this a piece at a time. We've got to do it right so we can go on to the next step and the next step and the next step. What about all those people that retire at 55 and lose their employerbased health insurance and can't draw Medicare until they're 65? What about all those people? What about all the people who have a right to keep their health insurance when they're between jobs, but after they've been without a job for a certain amount of time, they still can't afford it? I've got a right to own a Jaguar, but I don't. [Laughter] So we've got to be careful. We've got to do this right. And you can help on this. You can really help us on this. But the children of this country have got a lot riding on us doing this right, and we need you.

Finally, let me say, we've got to take some decisive steps to deal with some of the changes that are constantly evolving in the health industry. We've got to act to protect consumers first. Whether they have traditional health care coverage or managed care, we have to make sure they don't have inferior care. That's why I appointed the nonpartisan quality commission to write a consumer's bill of rights. And let me say, I want to thank your secretary-treasurer, Betty Bednarczyk, for serving on that. She's doing a good job, and I appreciate it.

Congress has to pass some legislation. It should ban gag rules in private health care plans, just as I did in Medicare and Medicaid. It should ban these horrifying drive-through mastectomies, just as it banned drive-through baby deliveries. The First Lady and a lot of other people have worked hard on this since I called for it in the State of the Union, but Congress still has not held a hearing on this. It's time to move, and I ask you to help me get Congress to move on this.

It should be made illegal for health companies to deny or drop coverage or raise rates based on genetic information. We're going to continue with this Human Genome Project, and that's a good thing. And some day in the not-toodistant future, young mothers and fathers will bring their newborn babies home from the hospital and they'll actually have a genetic map for their kids. And 99.9 percent of the time, I guess, or at least the vast majority of the time, it will just be good news with good information. Sometimes it will be terribly sad. But even when it's sad or challenging or frightening, it will give those parents the chance to give their children a longer life or a better life. But if we're going to find this information, we can't turn around and basically say, because of the march of science we're going to even increase further the number of uninsured people in America. And who's going to take care of them?

So this is a very important issue. And again, I ask for your strong advocacy on this. Science, yes; research, yes; tell people more about the health condition of their children, yes; but don't strip them of their insurance because of this march of science.

Congress should follow the new medical privacy guidelines we issued last week and pass legislation to make sure records now stored in computers stay just as confidential as records locked in a file cabinet. I think that average Americans really worry about this. You do— don't you worry that something gets in a computer, it will be halfway around the world and somebody is going to send you something in the mail to try to get some money out of you or do something? I think people really worry about this. How can we preserve privacy and still take advantage of the modern computer technology? We want people that deal with us to take advantage of computer technology if they can serve us faster or better or cheaper. We know they can save a lot of money. But in the end, privacy is worth an awful lot, and we don't want to see computer technology take it away.

And the last issue I want to deal with, again, is to say that we will never have a health care system as strong as it can be unless we strengthen our efforts to root out fraud and abuse in the Medicare program. They amount—these kinds of practices amount to a fraud tax on all the taxpayers of the country. And for those of you who work in health care, they cost public confidence in the work that you do. I know home health care workers want to put a stop to fraud and abuse, and I look forward to working with you to do that.

We put more Federal resources into this. Convictions are up 240 percent, and we've saved the taxpayers $20 billion already, but it is just the beginning. Home health care is one of the country's fastest growing industries. We want more people to be cared for at home if they can properly be cared for at home. Every month, nearly 100 home health providers—new ones—enter the Medicare program. But there is still too much evidence of widespread fraud and abuse that has to stop.

First, we're going to keep scam and rip-off artists from getting into the Medicare system in the first place. Today I'm declaring an immediate moratorium on the admission of new home health agencies to Medicare, and during this moratorium we'll develop tough new regulations to ensure that no fly-by-night providers enter or remain in the Medicare program. Second, I'm requiring all home health agencies to reenroll every 3 years so that they, too, will abide by these standards. Third, we will double the number of audits of home health agencies currently involved in the Medicare program.

Medicare for us is a way to honor our parents and strengthen our families. I was glad to fight for the comprehensive reforms that we got in the last budget that will give more choices to Medicare customers and still keep the program strong for more than a decade. No matter what changes we make in the structure of the program, we can't maintain it for what it should be if we tolerate unacceptable levels of fraud and abuse.

Earlier today I said that you represented the future of the American labor movement and the future of America. Just look around the room, and you'll see why—people who have come together across racial, professional, geographic lines to fight for a common future. That's what we all have to do. That's why I asked the American people to join me this year in a great conversation about our racial diversity and where we're going with it. What's our unfinished business that we've been lugging around for us? What about discrimination that still exists? What about destructive attitudes that still exist? What is the unfinished racial business of America? Question one.

Question two is, what about the future? What kind of country is this going to be like when, 5 years from now, there's no group with a racial majority in our biggest State, California, and when, within 40 years, there will be no racial majority in the entire United States? Now, we can look at the census projections and tell what we're going to look like, but that's not the same thing as saying what we're going to be like.

Everything we talked about today, every single specific issue is designed again to guarantee opportunity for everybody who will work for it, to maintain the leadership of our country in the world, and to bring us together in one community of America. That's what I want you to lead for.

Don't ever be afraid to be an instrument of change. Don't ever be afraid to stick your neck out and fight for change. And don't ever be afraid to hold yourself up to the scrutiny of life and say we want to represent the future of America. You look around this room, and you know you can do it. And when you think about how you feel at your very best in your work, you think about the best days you ever have working with people that are so different from you, you never imagined you'd ever get to know them or work with them, that's the way America ought to be every day. And that's what we need to keep working for.

Thank you, and God bless you.