General Wesley K. Clark Remarks on Health Care

Portsmouth, New Hampshire
October 28, 2003

Introduction

Thank you. I'm delighted to be here today.

I would have come last week, but I heard the University of New Hampshire was overrun with Red Sox fans feeling mysteriously ill after game seven of the American League Championship Series. Interestingly enough, all of those fans reported feeling a lot better after watching game six of the World Series.

My name is Wes Clark, and I'm running for President.

I've been at this for about six weeks now. For me, the best part of the campaign has been coming to New Hampshire, getting to know you, hearing your hopes and concerns.

I've always believed that elections aren't just about what kind of policies we want to have; they're really about what kind of country we want to be. The more I travel around the country, the more I sense that the American people feel as though something has been lost the past three years. It's not just jobs - although we've lost three million, the worst record since Hoover. And it's not just the surplus - although we've gone from a $5 trillion surplus to a $5 trillion deficit in three years.

It's a sense that what makes us special as America is being lost in the world. We've always been a country that inspires others not just through the force of our arms, but through the force of our example. I'll never forget reading stories about Peace Corps volunteers finding nothing on the walls of rural huts - except portraits of John Kennedy on the walls of rural huts. Or South Africans waiting in line to vote after apartheid fell - carrying dog-eared copies of the U.S. Constitution.

That's the kind of country we have always been.

We don't want to be the kind of country where grandmothers need to travel to Canada to afford the medicine they need to stay alive.

We don't want to be the kind of country where school budgets get cut to pay for tax breaks so millionaires can have more leisure time.

And we certainly don't want to be the kind of country where our own President implies that we're unpatriotic if we question the very policies that got us into this mess in the first place.

America can once again be the country it's always been in the world. But it's not going to happen with the team we have at the White House today. I am running for President because I will offer new leadership, new ideas, and a new spirit of patriotism for a country that is desperately crying out for it today.

I call it the New American Patriotism. The New American Patriotism calls for leaders that will respect our citizens and leadership that has high expectations for our country's future.

In recent weeks, as I've defined my New American Patriotism, I've laid out the type of choices we need to make to get our country moving forward, with a plan to create jobs, cut the deficit, and promote national service. We can't afford to just talk about these choices. I served in the U.S. Army for more than three decades - and, frankly, I get things done. I am not a career politician. I'm someone who believes you must set goals and objectives and put a plan in place to reach those goals. In the army, I had to make decisions every day about the welfare, safety and security of those who served with me. You couldn't pass the buck. You had to get the job done. No delays. No excuses. No apologies. That's the same resolve I'll bring to the White House.

Today, I want to bring that resolve to an issue familiar to every American family: the challenge of paying for decent health care.

For most of us, including me, health care is a very personal issue.

It was 34 years ago this coming February - February 19, to be exact -- that I was a young army captain in Vietnam, marching through the South Vietnamese jungle. My men and I got pinned down by gunfire from a base camp. Before it was over, I had been shot four times - including my hand, my shoulder, and my leg.

I was Medivaced to Saigon. I was in serious condition, but I was lucky: there was no major bone or organ damage. I was flown to Camp Zama in Japan for surgery on my hand, because it was pretty bad. I ended up with a cast on my hand that had a hook on the end so I could pick things up. I also had a cast on my leg.

When I got home, I went through months of rehabilitation. It took me months before I could run again. And it was months more before I could shake another person's hand with a firm grip. But as busted up as I felt, I was thankful that the United States Army was with me every step of the way. They provided for every single bit of my health care - right down to the rubber ball I squeezed for nearly a year to build strength in my hand. And the reason I had such good health care is because the army understood that without adequate health care, our soldiers could not do their jobs.

It seems to me that just as our soldiers can't do their jobs without adequate health care, our families shouldn't be expected to do their best jobs without adequate health care, either.

Our nation must provide the same kind of support and access to health care for families that our army did for me and for its soldiers and that our government does for our elected officials.

We all know: we are very far from realizing that vision today.

I don't have to tell you how bad the current situation is. Here in New Hampshire, you've heard candidates talk for a very long time about the health care crisis in America. It is absolutely appalling that in the wealthiest nation on earth, nearly 44 million Americans today have no health insurance of any kind, including 8.5 million children. That's a disgrace.

We know who most of those Americans are: they are working families. They are people who bring home a paycheck every week. Nearly 20 million Americans with full-time jobs don't have health insurance. That is a disgrace. We know what happens to them. They wait until they are really sick, and end up in the emergency room. Those costs get passed on to the rest of us, to the tune of about $35 billion a year. And those are the lucky ones: the Institute of Medicine has estimated that 18,000 Americans die every year because of lack of health insurance. That's a disgrace.

These are the numbers. But I see more than numbers, more than statistics and more than trend lines. I see a parent with a sick child who knows there is nothing they can do to help.

As bad as that is, I believe there's more than one health care crisis in America today. There is the crisis of the uninsured. But there is also a quiet crisis among families who have health insurance today but are being pushed to the brink to pay for it, or who are living in fear their employer might be unable to afford offering any insurance at all. Medical expenses have been going up between 11 and 14 percent for the past four years - which is more than triple wage growth. It's no wonder that families with children are three times more likely to go bankrupt than those without children.

Just last week, Reader's Digest announced the findings of a fascinating new survey they call the Family Wellbeing Index. Among other things, they looked at the long-term debt of American families. They found that the majority of families who are heavily in debt are not families that spend frivolously at the mall. Instead, more than six in 10 American who are heavily in debt say they are there because of expensive medical bills. In fact, nearly half of all Americans say they routinely have a difficult time paying for their health care.

In other words, while much of the health care debate has focused on expanding coverage, the truth is, there is just as great a need to make it more affordable for families who already have health insurance -- as well as for businesses and federal, state and local governments who are helping families pay for it. And we've got to do it not by settling for less, but asking for a better return on our $1.5 trillion a year investment in our health care system.

No one could say that we do not have a problem in our health system when the Institute of Medicine estimates that over 98,000 Americans a year die as a result of medical errors. We would never tolerate such shortcomings in the military or in public aviation; we must be no less vigilant in our health system. Instituting aggressive error reporting and management systems would not only save lives, but would reduce medical malpractice claims and costs.

Likewise, there is no question that we could avoid expensive treatments and promote better health outcomes if we became better purchasers of health care. If we better covered and used diagnostic and prevention services, for example, we could save countless numbers of lives and dollars. Today, an estimated 17 million Americans suffer from diabetes, yet experts say that 6 million of those afflicted remain undiagnosed and, therefore, untreated. So, we are spending tens of billions of dollars for the treatment of the complications of diabetes - for heart and kidney disease, for blindness, for stroke and other conditions - but we could limit most of these ailments and their associated expense with a combination of diet, exercise and medication. Screening for high cholesterol and early diagnosis and treatment of coronary heart disease are other clear examples of smart health policy that produces improved medical outcomes and reduced costs - not to mention happier, healthier and more productive Americans.

Prevention and personal responsibility in our life choices can make a big difference, but so too can unfiltered, independent information about the best medical therapies. Patients, doctors and nurses, as well as public and private purchasers of health care, are all barraged by billions of dollars in marketing of the latest technology, therapy or medication. You have all seen the ads; you cannot pick up a magazine, turn on a TV, or read a paper without seeing them. Yet, there is precious little independent information to help make the best, most informed treatment and coverage judgments about whether newer, more colorful and definitely more expensive is necessarily better.

Now, it may surprise you to learn that when it comes to health care, this Administration doesn't have much to say. Four million Americans have been added to the ranks of the uninsured since 2000. The Administration has said nothing about it. Health care costs continue to go up by double digits. The Administration has said nothing. The economy and health costs have forced the states to propose cuts in Medicaid funding for nursing homes and roll back coverage for kids. And again, the Administration either says nothing or explicitly opposes providing any state relief. And yet, the White House claims that Democrats are the ones playing games on health care.

Someone ought to tell the Bush Administration that the Hippocratic Oath is not a license to practice hypocrisy.

My plan for health reform addresses these daunting challenges faced by our nation. It shifts the focus of the health care debate by insisting that any commitment to expanding health insurance be accompanied with a requirement to improve as well as expand coverage. It would improve health care by emphasizing prevention, medical outcomes accountability, and cost effectiveness, all the while guaranteeing universal coverage for children and access for all Americans.

The plan has three major pillars that lay the foundation for a modernized, accountable, and affordable American health care system.

The first pillar of my health plan grounds the nation's health care in prevention, management, and value.

There's a fundamental disconnect in our health care system. We have the best doctors and nurses in the world, some of the most innovative technology and ground-breaking research. But what's the point of having a first-rate system if so many Americans are shut out of it? What's the point of a system in which the cost of care is rising -- but the number of people covered is falling?

The bottom line is this: while we have the best health care deliverers in the world - we need to strengthen the delivery. That means putting clinicians in charge instead of accountants. And it means unraveling the red tape and modernizing our health care bureaucracy. You shouldn't need a PhD in paper-pushing to get the basic health care you need.

One of the great benefits to the health plan I had in the Army was that it emphasized prevention at every step along the way - from annual physicals, to cholesterol screenings, to routine check-ups. The Army recognized from the start the potential of early diagnosis and prevention to lengthen lives and reduce health care costs. Frankly, when I got out of the Army, I was surprised to learn how many health plans didn't require preventive screenings of any kind.

My plan promotes prevention, diagnosis, and management of health and disease by working to ensure that all Americans have access to and incentives to use recommended preventive services that would diagnose diseases early, improve health and constrain long-term costs.

It also reorients the health system towards payment of services that have value. My plan puts its trust in independent health clinicians rather than HMO executives or pharmaceutical company marketers to conduct clinical research comparisons to help identify what works best.

It would also evaluate and promote the proper role and use of cost sharing to reduce excessive and expensive utilization - as well as to avoid "under insurance," which can be caused by excessive deductibles or co-payments. The information produced by these independent experts - who would have no monetary conflicts -- would help all purchasers of health care make informed choices about what services produce the best medical outcomes. This would protect and promote health as well as guard against wasteful and potentially harmful spending.

As we improve care, we must be certain to make it more affordable for taxpayers, enrollees, businesses, and federal, state, and local governments. To this end, I would institute competitive bidding for Medicare services; remove legal loopholes that block high quality, more affordable generic drugs from coming to the market; promote responsible malpractice reform; and aggressively pursue and eliminate waste, fraud and abuse in the system. Where we can make our health care systems more responsive to the medical and cost needs of our people, we should not hesitate to do so.

And finally, my plan would provide financial incentives and eventually requirements for all health systems participating in federal health programs to institute the latest information technology to streamline paperwork and medical records filing, as well as to implement so-called e-prescribing technologies. These hand-held computers help make it possible for doctors to more easily and safely prescribe and dispense the most appropriate medication for all Americans.

The second pillar of the Clark health plan is to guarantee universal coverage for children and universal access to health insurance for all Americans.

As we improve our health system and make it more affordable, Americans must do their part by making a compact with one another and commit to guaranteeing that every American child through age 22 has health insurance - the age that most young people graduate college. Today, I am proposing a new, progressive tax credit that would begin where public program eligibility ends, and extend up to 500 percent of the poverty limit, which is about $90,000 for a family of four. Families could use this assistance for either Medicaid or State Children's Health Insurance Program; employer coverage; or, if they do not have access to an employer-provided health benefit, they would have access to the same plan that members of Congress have today. Whether or not a family has health care today, all eligible families would have access to a tax credit.

We provide the opportunity and the affordability, but then we demand responsibility in return. In return for this assistance, it would become the responsibility - indeed the requirement -- of young adults and parents to enroll their children in a responsible health insurance plan.

Building on my commitment to guarantee insurance coverage to every child in this great nation, my plan would also ensure that every American has access to coverage. My plan would allow Americans without access to job-based coverage to purchase health insurance through the same system that covers Members of Congress. The government would be responsible for ensuring that that the premiums paid by individuals are priced fairly and available to all. I believe this policy would especially help older adults who have diminished access to job-based coverage and increasing need for services.

Finally, the third pillar of the Clark health plan is to provide extra assistance to some of our nation's most vulnerable populations. In addition to ensuring coverage for children and access for all Americans, my plan targets financial assistance to several groups of people facing specific challenges in buying and paying for health care.

It starts with reduced premiums for low-income adults. This is a high-risk group. Under my plan, the Federal government would be required to fully fund state-based programs to extend full coverage to lower-income adults. And anyone who doesn't have access to health insurance through their employer could buy into the same health plan offered to members of Congress.

Next, I am also proposing a tax credit for workers in between jobs - because Americans shouldn't lose their coverage just because they're between jobs. In addition to the general assistance for low-income families, a 70 percent tax credit would be available to fund COBRA or Congressional coverage for workers who have temporarily been laid off.

Next, it expands health options for reservists and their families. The people suffering the worst today through the war in Iraq are those families who had to say goodbye to one another - unexpectedly - for a year or even longer. Yet, they are not covered by the same kind of health care as active duty military personnel, so in many areas of the country, only 30 or 40 percent of all doctors will take patients from the Reserves. My plan would provide the same additional kind of assistance that my plan provides for unemployed workers.

Next, my plan sets aside funding to improve access to services for veterans, provides seed money for small business purchasing groups, addresses mental health parity, and disparities in minority health care. Over the coming weeks I will offer more details on my plans in these areas.

Unfortunately, under this Administration, older Americans have become one of America's most vulnerable populations, too - starting with the cost of prescription drugs. The Administration has proposed a solution that essentially forces people into HMO's, undercutting the long term viability of the Medicare system. This threatens seniors with increases in premiums, could leave many in rural areas without proper health care, and may limit the quality and range of treatment options available. I hope that Congress can come together this year and pass a prescription drug benefit that is fair, comprehensive, and affordable.

I believe all these changes would go a long way toward creating a health care system where quality is high, where coverage is more affordable, and where all Americans will have the kind of security they need to focus on doing the best jobs they can, for their families and their country.

How am I going to pay for it? Last week, I released a detailed plan to make responsible choices that save $2.35 trillion over 10 years. This plan would provide sufficient resources to pay for my health plan, fund education and other priorities, and still make a significant down-payment on putting America on the path towards a balanced budget. In fact, we can cover more than 30 million people - including every child in America - for less than the cost of repealing President Bush's tax cuts for the wealthiest Americans, those making over $200,000 per year.

Again, it's not just a question of what kind of policies we want - it's a question of what kind of country we want to be. It's not just about matters of war and peace; it's about jobs and growth and hope right here at home. It's about taking responsibility for our shared future. It's about leadership in this time of war and global terrorism. It's about reclaiming what's been lost, but also about building a better future for all our children. That's what the New American Patriotism is all about. If you share that vision, I ask you to join this campaign, and together, we will create an America that is as good in practice as in promise once again.

Thank you.