Hillary Clinton's first Speech About Health Care Reform.

PART TWO --

We can no longer write a blank check for health care in this country. We will have to ask everyone -- workers, employers, doctors, nurses, other health care providers, hospitals -- to do their part. We'll have to tell very other aspect of the health care industry that it can no longer expect to be raising its prices and profits growing at two to three to four to five to eight times the rate of inflation. We're going to tell workers that if they do not do their part to be responsible users of health care, then we will never be able to adequately to rein-in costs. We will also have to tell companies that do not cover their workers today and therefore drive up the costs for all those other companies that do, that it is time, finally, for everybody in America to take responsibility. That has to be one of the keys of our system. There can't be anymore free lunch. There can't be anymore free health care to which people feel they are entitled. There cannot be anymore people who take advantage of the system and basically take a free ride.

We're going to tell individuals who think they can get by without coverage because they're 25 and believe they're immortal, that when they have that terrible accident or unpredicted illness and end up in the emergency room or in the ICU and stick us with the bill, that we're not going to let that go on any longer. Everybody will have to contribute to the health care system, just like in many states they have to have auto insurance. Nobody can predict when you are going to have that accident or you're going to have that illness, and it's time that everybody bears their fair share of the responsibility for taking care of those accidents and illnesses when they occur.

It is an absolutely critical part of this plan that people become responsible. Many of the problems that we are dealing with in Washington today have been made all the much harder because of years of irresponsibility at the federal level. It is time for us to go beyond partisan politics, to go beyond ideology and to say responsibility is not a Republican or a Democratic or a liberal or a conservative concept. It is at the root of what it means to be an American and we're going to start insisting upon it being placed once again on this country's agenda.

Thirdly, we are proposing a wholesale reduction in the frustrating and wasteful paperwork that eats up the health care system. When you look as Ira (Magaziner) and I have at the volumes of regulations that have been put into effect over the years, the stacks and stacks of forms, you ask yourself where did all this bureaucracy come from? The short answer is that it came from everywhere. It comes from private insurers. It comes from the government. Forms were created to make sure forms were filled out properly. It makes it impossible often for the most vulnerable people to get the care that they need. It also has undercut the delivery of care because as the number of health insurance companies grew -- today there are more than 1,500 -- so did the number of forms. The result is that instead of a system in which patient care and doctor decision-making and nurse caring drive the system, paperwork does.

Most nurses now spend nearly half of their time filling out forms. Most physicians now spend an extraordinary percentage of their income contributing to the bookkeeping and accounting necessary to fill out forms. Patients don't know how to read these bills. They don't understand these forms. Those of us who've gone to school longer than we like to admit can't understand these forms. And yet we are continuing to be deluged by them because that is the excuse for not getting to the heart of the problem. We now need to make it clear that what is going to count is quality outcomes, not paperwork processing. If we do that, then consumers will see a health care system made understandable and easy -- one insurance form for everybody, a report card for quality that is understandable so that choices can be made, no hidden fine print. Doctors and nurses will finally be able to do what they were trained and educated to do -- keeping people healthy, not filling out forms.

Again, the states are paving the way. Missouri's initiative to provide health care to children in schools will focus on making the state a primary care-giver for many children, and eliminate a lot of the unnecessary bureaucratic maneuvering and cataloging of kids that goes on now. Let's take a child as a whole person, figure out how to take care of that child. Don't divide him up into little pieces that fit into the welfare bureaucracy, the health bureaucracy, the child support bureaucracy, the education bureaucracy. That's what Missouri is trying to do. That's what this country needs to do. If we focus on preventive care and eliminate the administrative hassles that now exist, our reform efforts will work and more children will be healthier.

Fourthly, this reform will focus on addressing long term care. This is a problem that we need to get ahead of the aging curve on as soon as we can. States have a large stake in providing and paying for this country's growing need for long term care. Many will tell us to put off consideration of this issue and not to do anything. That's the way we got into all of these problems -- don't take on any hard issues, don't expend any political capital, don't make anybody mad, and maybe the voters will just think you're doing a good job. We've got to put those days behind us. If we don't begin to address long term care now, in four or eight years we will be so much further behind, it will be an extraordinary financial and human drain for us to begin then.

We have to make a start. We need to do that by building up the infrastructure in the states so that people who wish to stay in their homes and out of institutions will have that option. People who need intermediary care, whether it is adult day care or congregate housing, will have that option. As you know, individuals and families are too often bankrupt by long term care, and it is not fair to make them make that choice between money or dignity. We need a system in which we give real choices to the elderly and the disabled.

If we have an Administration and we have states that are willing to embark on this partnership together, we will create more options for community-based care, which is not only what people tell us they want, but is less expensive and will enable us to cover more people. We will expand home and community-based care in this reform proposal so that people with severe disabilities will have access to a broad array of services, coordinated by a case manager, tailored to individual needs. By expanding this availability of care, seniors and disabled citizens who can't manage on their own will remain in their own home, or their own community as long as possible.

Finally, we will improve the availability of health care in under-served urban and under-served rural areas. It will not do us any good to have a health care reform system that holds out the promise of health security if it does not deliver. There are many parts of our country that have traditionally not had adequate access to health care. I don't need to tell Governor Walters (of Oklahoma) or Governor King (of New Mexico) that a health security card alone will mean little to people unless we guarantee that the services they need will be available for them in even the most remote parts of America.

The President's plan will bolster these efforts by targeting funds for areas that are now under-served. It will strengthen the health care infrastructure in these areas by linking community-based centers to other hospitals and providers, and will offer incentives for the National Health Service Corps and other programs to encourage doctors to practice in remote parts of our country. That is one of the most cost-effective things we can do -- to encourage doctors and nurses and others to pay off their loans, to be forgiven for their loans, if they will go into areas that need their help. There is hardly a program that is more worthy of consideration than that, and it will be reinvigorated after being allowed basically to die on the vine over the last 12 years. If we make sure that all of our people are covered by integrated delivery networks like Governor Dean and others are talking about, then nobody, no matter where they live, will be without access to decent care.

For 12 years, these governors and those who serve with them and before them, have taken the lead in keeping health care on the agenda. Before my husband was elected President, he worked with the National Governors' Association to craft a bipartisan approach toward health care reform. It is that kind of attitude we need to encourage, not just at the state level, but in Washington as well. We need to end the partisanship. We need to recognize that the federal government does not have all the answers, that it needs to work with the states to solve the health care crisis. In order to do that, we need real leadership from the top. That's what this President is willing to offer. The federal government will establish the framework and set the standards. It will be up to the states to tailor the program to meet those standards and offer the guaranteed benefits in ways that each state thinks will work best for that state. We cannot do this without that kind of partnership. We need that partnership to continue what is already started, so that we can have the benefit of your advice and counsel.

There is no way that we can wave a magic wand or even pass a piece of legislation that will overnight solve all of our health care problems. Too many changes in attitudes and behavior are going to be needed. But we do know we have to take a comprehensive approach, so that we look at all these problems at one time. The President has appreciated the advice and help of the governors. We look forward to working with the governors in the weeks and months ahead, because we believe that with a health care reform plan that truly provides security for every American, we will be on the way for making it possible for this country to regain its economic leadership and its competitive position. Health care reform is part of the economic plan the President has for America. One cannot proceed without the other. Both together will not only secure security for each of us, but will insure security and leadership for this country that we all love.

Thank you very much.