ADDRESS TO THE SOUTHERN LEGISLATIVE CONFERENCE
                      GOVERNOR BILL CLINTON
                       FOUNTAINBLEAU HOTEL
                         MIAMI, FLORIDA
                         AUGUST 11, 1992


Thank you. Thank you very much. Thank you for that wonderful
reception, and thank you for giving me the chance to be here today.
I want to thank my longtime friend, John Miller, for that great
introduction, and our present speaker, John Lipton, and the
President of our Senate, Jerry Bookout, who have been my friends
and supporters, and all the members of our Arkansas legislature who
are here. Without them, it is absolutely certain that I would not
be here, because it was our partnership that enabled us to do
whatever has been done in our state over the last dozen years.

And as a lesson I think we ought to send to Washington that the
time for placing blame has come to an end, and the time for
assuming responsibility is at hand, and we need to work together,
instead of dividing our people.

I want to say to the others on this platform, Senator Hankle, and
Representative Williams, and my good friends from Florida, your
speaker, and Ron Silver, who worked so hard for me in the primary
here, and Senator Gwyn Margoles, and all of the members of the
Florida legislature here. My campaign for President really took off
on December 16, after the Florida straw poll, and without the help
of many members of the Florida legislature, I doubt very seriously
that we would have prevailed on that occasion. So I like working
with legislators, and I hope I get a chance in January to do
another job on that.

In eighty-four days, the American people will choose leaders that
will take us to the edge of the twenty-first century. We will
choose between two very different philosophies, whether we should
continue with four more years of trickle-down economics and a
limited, but out-of-control view of the national government, or
whether we ought to adopt a new direction of investing in our
people, and organizing our country in partnerships to help America
compete and win. 

But we also will choose between two very different ideas of
leadership, ways of getting things done and approaching problems.
In a way, many of the decisions we must make are those which go
beyond the traditional labels that we normally judge politics by.
They really go beyond Democrat and Republican, and left and right,
and liberal and conservative. 

After World War II we began a new era, some of you were part of it.
We had to come home and deal with the dismantling of a vast
military apparatus, and restructure our economy here, and at the
same time try to rebuild Europe and Japan in ways that helped us
all.

After the Cold War, it is important that we rebuild America. For
during this period of forty-odd years when we stood up for freedom
and democracy, and when our ideas came to triumph around the world,
all Americans could justly take pride in our bi-partisan commitment
to those values and those ideas and that victory.

But for nearly two decades, we have been in the process of losing
our economic leadership. And over the last decade, we have been in
deep trouble indeed. In 1980, we had the highest wages in the
world, and now we're thirteenth. In the last ten years, according
to our own census reports, well over half of the American people
are working harder for less money, and paying more for health care,
housing, education, and in taxes. 

We have unbelievably quadrupled our national debt since 1980, but
reduced our federal investment in economic growth in education and
economic development, in the environment, in infrastructure. We
have not kept up with other nations in those things which create
wealth, and jobs, and growth, even though we've quadrupled the
debt. 

There are new strains on state government all across America, and
all of us know. We have been asked to do more with less, and most
of us have tried to support that. As the federal government said,
"Well, we're in trouble, we want you to take over more of the
responsibility for economic development, for education, for
environmental protection, and here's less money to do it with." 

And, obviously, the greatest financial burden of all in recent
years has been the continued federal mandate in the area of health
care, without any health care cost control. So every year, we are
told by the national government, both the President and the
Congress, to cover more services through Medicaid, or cover the
Medicare co-pay of low income people. We are told by the
administration how much we have to pay providers. And we are
expected to come up with our share, even though unlike them, we
can't run deficits. Certainly, even those who can run deficits
can't really do it for more than a year without having disastrous,
or painful consequences.

All of this has occurred in an atmosphere of declining economic
growth, the lowest economic growth in the last three years since
before World War II, since the Great Depression, the first time in
American history in the last three years, when industrial output
has actually declined. 

As a result of that, you have a rising tide of poor people, not
only unemployed poor people, but working people. In 1980, twelve
percent of the work force was still in poverty. In 1990, eighteen
percent of our work force, almost one in five workers, was living
below the poverty line while going to work every day. 

This has obviously led to a huge increase in the claims against the
programs that we run, which are jointly funded by the federal and
state government--the AFDC program, welfare, the food stamp
program, the Medicaid program. Now, there's plenty blame to go
around for all this, I suppose. But do you want to blame it on
trickle-down economics, or borrow-and-spend economics?

But the main thing that I think all of us are interested in today
is, what are we going to do tomorrow? Our greatest Presidents have
taken responsibility for seeing and solving our nation's problems,
not by themselves, of course, but by charting the course to a
better future, and asking the American people to join in. Our
greatest Presidents have felt our pain, and shared our hopes, and
challenged each of us to make a personal commitment to make
tomorrow better than today.

Last week our President, Mr. Bush, spoke of an important lesson in
life that he and I, and I'm sure everyone in this room learned
growing up. And I quote, "Take blame when things go wrong, and
share the credit when things go right." He spoke of the importance
of personal responsibility, a value I believe everyone of us in
public service deeply shares. 

President Truman was the embodiment of that personal
responsibility. He had a sign on his desk that said, "The buck
stops here." 

President Eisenhower said if he were elected President, he would go
to Korea. He didn't say everybody in there now has made a mess of
it. He said, "Vote for me, and I will go to Korea."

President Kennedy took full responsibility for the fiasco in the
Bay of Pigs, even though it was an operation which began under his
predecessor.

President Theodore Roosevelt reminded us, in one of his greatest
statements, that the credit should always go to the person in the
arena, even those who failed, if they dare and fail gracefully.  

President Roosevelt, who lifted this country from the chains of his
own wheelchair in 1933, and for twelve years thereafter, once told
us that, "The only thing we have to fear is fear itself." 

One of the greatest tests, perhaps the greatest test, for the
President who will be elected in eighty-four days is whether that
person can live up to that heritage. Whether we can assume
responsibility, wade into the problems, bring people together. And
if it doesn't work, take responsibility for the failure, and go
back and try again.

Some of our problems are unprecedented. Nobody has all the answers.
But I know what we've been doing doesn't work. And I know for sure,
that the politics of blame never solved a single problem.

The other day the President's chief economic advisor, Mr. Darman,
went up to the House Budget Committee. And he was asked, "Why are
we having the worst economic performance since the Great
Depression?" And his answer was, "Well, it's easy, there are four
reasons. The banks aren't loaning enough money, the federal reserve
didn't lower interest rates quick enough, Congress won't do what we
want them to, and Saddam Hussein invaded Kuwait." Now I don't know
what that had to do with it. Other people paid for that war, but
anyway that's what he said.

So the chairman of the budget committee said, "Well, what about
you, is the administration responsible for this crisis?" Silence.
He said, "How about any responsibility? Would you believe five
percent?" No, refused to take any responsibility, blaming everybody
else. Can you imagine where this country would be today if Harry
Truman's sign said, "The buck stops somewhere else?"

And on this matter of health care, which is what I want to talk to
you about. And I must say when I agreed to do this, I did not know
that my friend, Dr. Sullivan, would be talking here before on the
same subject. He's a good fellow, he's just got a heavy load to
carry.

The other day, the President said that the health care plan that I
have offered has the compassion of the KGB, and the confidence of
the House Post Office. I got to tell you, as a person in public
life, I thought that was a pretty good line, I always appreciate
those lines. But it isn't true. And again, at a time when we ought
to be engaged in a great debate about where we're going on a
problem that is killing this country, it's as if the President were
saying that the only thing he had to fear is my opponent, and new
ideas.

Let's look at the facts, and compare where we are with where our
competitors are. And let me say, I see this as a governor, which
means, I see it from the perspective of budgets that we can't
balance without cutting services and hurting people. We've had to
do it twice this year already in our state. I see it from the
perspective of small business people, who cannot afford health
coverage for their employees. I see it from the perspective of 
manufacturers who cannot compete in the global economy because of
health care costs. I see it from the perspective of unions, eighty
percent of the strikes in America today are over health care costs,
not over wages. I see it from the perspective of people who lose
their jobs, and an explosion of part-time and temporary workers in
essentially full-time jobs, overwhelmingly because of the burden of
health care costs. Everybody's shifting these costs to somebody
else, just trying to struggle to stay alive in a chaotic
environment in America.

We are now spending thirty percent more of our income than any
nation on earth on health care. Over thirteen percent of our
national income every year going to health care. The next highest
percentage is Canada, at about nine. We'll be over seventeen
percent by the year 2000, if we don't fundamentally alter the way
we are financing, managing, and delivering health care.

Already, the average business is paying about eight percent of
payroll for health care. It will be at fifteen percent by the end
of this decade, at least, if we don't do something about health
care costs. Every year more and more people find themselves without
coverage. I understand one of the things that's said is that people
will be forced into the arms of the government, that's what's
happening today. 

People are dropping their coverage every day. And you know as well
as I do, that most people get health care even when they don't have
coverage. But what happens? They get it when it's too late, too
expensive, and the bill is paid by somebody else. But everybody
gets it, and the bill is paid.

Sixty million Americas are under-insured. Thirty-five to thirty-
eight million have none at all. And these things have a human
faith. I wish I could tell you all the stories that I've seen. 

But the other day we had a health care forum on our bus tour that
you've been reading about. We've been taking these buses into
little towns, and there's some pretty good politicians in these
little towns. We went to a town with about a hundred and fifty
people, and there was a sign that said, we weren't going to stop
here. And I saw a sign, the whole town showed up, and this guy
holds a sign saying, "Give us eight minutes, and we'll give you
eight years." And I said, I think I'll stop here.

Let me tell you the kind of things we found out. The other day in
Columbus, there was a woman there who was a Ross Perot supporter,
and had come over to supporting us. This woman had seven children,
and was either divorced or widowed, I never asked her which. But
she was the sole supporter for seven children. She had a fifty
thousand dollar a year job, which is a pretty good job in this
country. She was very proud of supporting her seven children. One
of her kids had a terrible, terrible health condition, which
required massive expenditures. And she had two heartbreaking
stories. Story number one was the only way she could get any help
for her kid was to quit her job and go on welfare, so she became
Medicaid eligible. So a proud woman with seven children went from
a fifty thousand dollar a year job to welfare. Second thing was
that the government regulations required her child to be cared for
in a way that added more than a hundred thousand dollars a year to
the taxpayers bills unnecessarily, because of the rule.

Second example, these are just people that came up on the platform.
A really attractive young African-American woman about twenty-three
years old had a beautiful child, beautiful, beautiful child with
spina bifida. The young woman had just graduated from college, had
job offers, had to turn them all down to stay on welfare because
that's the only way her kid could get taken care of with spina
bifida.

Third case, an attractive young couple with three children, the
third child born with cerebral palsy. They were insured through the
wife's medical insurance at her job, which was a community non-
profit. Twenty employees, their choice, the employer fired the
woman, and put the family without any health insurance, or have the
premiums of every single employee go up two hundred dollars a
month. Now, I guess you could make it worse, but you could sure
make it better. That's what I want you to think about.

Let's look at what the stakes are in this election. The President's
proposal is to provide for a tax deduction, a significant one, for
middle-income people. And a voucher system for low-income people,
in the hope that they could get health care. The voucher system
will cost, I think the two would cost about a hundred billion
dollars between now and 1997. 

Let's look at it this way. If a family pays three hundred dollars
a year for family health care, and the employer picks up the rest,
tax credit would be worth about four hundred fifty dollars. If
health care costs go up fifteen percent a year, and most Americans
have sustained rates of about that much over the last four years,
that that money goes away in one year. The benefit is completely
consumed by cost increases in a year. If you give vouchers, and you
give tax deductions, and it goes into the system we've got, what
happens? You're still going to have cost shifting. You have no way
of controlling costs. You're still going to have this mind-
boggling, bureaucratic mess that is the American system of health
care finance.

My point to you is that we cannot reform this system unless we are
willing to change the things that make America's health care system
more expensive than everybody else's without making us healthy.
That's what we've got to deal with.

I am convinced that we'll never get there, unless you have rigorous
insurance reform, change the way we deliver health care, reduce the
national government's micro-management of health care, and provide
a basic system of health coverage for every American. And I think
it would be much cheaper than doing anything else.

We've got to find a way to make health care a right, not a
privilege, because it's good business to do it, it's good economics
to do it. It is a sounder way to proceed. Let me be clear, so I can
answer the KGB and House Post Office lines. We've got great doctors
and nurses, and the finest medical technology in the world. 
We may never be able to get our health costs down to where a lot of
other countries are, because we invest so much in medical
technology, and because compared to other advanced countries, we
have a higher percentage of low income people, a higher percentage
of low birth-weight births, a higher percentage of people afflicted
by violence showing up at the emergency rooms with gunshots and
knife wounds, and unfortunately, too many of them are young
children, and because compared to a lot of other advanced
countries, we have a higher percentage of people with extremely
expensive maladies, including AIDS, where now we have in America
well over a million people who are HIV positive. 

But there is no question that there is, at least, eighty to a
hundred and ten billion dollars worth of money being spent in this
system that bears no rational relationship to keeping the American
people healthy, which is a phenomenal amount of money.

The first thing I ask us to do, is to get rid of the fear-
mongering, and blame-placing, and finger-pointing, and let's have
an honest discussion in this election about what the future of
American health care ought to be.

I think we ought to keep what is best about our system. The
fundamental right of people to have access to a private system of
medical care, with providers who work for themselves, and who do a
good job delivering health care. But we obviously have to change
the system. We have to begin with a system of finance. Only in
America are there fifteen hundred different health insurance
companies writing health insurance, thousands of different policies
being written, and that is overlaid on the blizzard of government
rules and regulations, different ones, I might add, from Medicare
and Medicaid.

What is the result of that? Only eighty-four cents of the private
health insurance dollar in America goes into health care. In
Europe, where it's private health insurance, ninety-five cents.
What's the difference in eighty-four and ninety-five cents? That's
eleven cents on the dollar on a five hundred and eighty billion
dollar private health insurance bill. You figure it. That's not
peanuts, folks. That is a phenomenal amount of money. 

How do you squeeze that out of the system? You have to do two
things, at least. Number one, require insurance companies to do
what they do now in Hawaii and a few other states, and that is to
rate people on broad-based community ratings. Put people back into
large pools, so that millions of people are not prevented from
changing jobs because of a sick family member or a prior health
condition. 

And let insurance companies make money the way grocery stores do,
a little bit of money on a lot of people. Because otherwise, you're
going to have more and more and more of this dividing up the health
insurance market where the very ideal thing you can do is to insure
a group of fifty twenty-five year-old women who spend two hours a
day at the gym, don't smoke, don't drink, don't eat hamburgers,
going to live forever. If you do that, you're laughing, this is the
world we talked about, I know it's funny but you laugh to keep from
crying. If you do that, then only sixty percent of the money goes
into health care, and forty percent of the money goes into profits
and paperwork. You've got to have broad-based ratings.

Second thing we have to do is to develop an all-payer system that
would have a national requirement of a basic package of benefits
that would have to be provided, either by the government, or by
private insurers, that includes preventive and primary care. If you
do that, you simplify the paperwork dramatically. Instead of having
every doctor's office keep up with thousands of different
permutations of coverages, you'd have a very simple system, much
simpler.

Now let me explain to you how important this is. In my state, and
I expect my state is low, I interviewed hundreds of doctors year
before last. The average doctor in my state is spending more than
thirty percent of their income on paperwork. In America, the
average hospital is hiring clerical workers at four times the rate
of nurses. 

A recent study done between a hospital in Canada and a hospital,
and I don't favor the Canadian system, by the way, I just want you
to get a flavor for the paperwork, a hospital in Canada and a
hospital in Boston, same size, same number of beds, same average
case load, there were six people in the bookkeeping department in
the Canadian hospital, and two hundred people in the bookkeeping
department in the hospital in Boston. This is a big deal, and it is
wrong for us to be pouring this kind of money into this kind of
system. We've got to change it.

If we do this, we can also modernize the system. We'll eventually
move to a time when all of us will be able to handle it, carry a
little health card that on a chip will have our health care
information. We'll be able to computerize the systems much better,
and eliminate billions of dollars in billing fraud every year. And
we'll be able to simplify and rationalize the system.

Next thing we need to do is to give people real incentives to go
into large health care groups, where they can choose their
providers within a large group, but where they have the option to
have managed care, and managed competition, and to pay up front for
a year's worth of health care.

I talked to a doctor, in Las Vegas the other night when I was out
there giving a speech, who's part of a health care group with
several hundred doctors in it, and their costs for their
participants has gone up or down in a range of two percent for five
years now. It can be done. We can manage the system better.

There are all kinds of other things we need to do to reduce medical
liability costs, have alternative dispute resolution mechanisms,
give doctors some accepted practice guidelines all across the
country that will raise the presumption that they perform properly,
if they follow those practice guidelines. 

We need to look, as my senator, David Pryor, has done in the
Senate, at why some drug costs go up to three times the rate of
inflation in America, and drugs made in America cost more in
America than they do in other countries, because of the marketing
practices here. We need to address that. 

There are all kinds of other issues we need to deal with, but
you've got to deal with these big issues first. The states will
have a role in this in designing the details of the package state
by state, and helping to set up state spending ceilings that we try
to achieve. But the structure has to be changed, and it has to be
changed nationally.

And let me just mention one or two other things. We have got to set
aside some of the government money to put more clinics for primary
and preventive care in poor communities, in rural areas, and in
inner cities.

Again, let me remind you that almost everybody in America gets
health care. But the people that don't have access to it get it
when it's too late and too expensive, when the cow's out of the
barn, and we spend a fortune. We ration health care in America on
the front end, not on the back end. We do a great job of spending
a fortune on people in the last six months of life, and, you know,
I'm not criticizing that. Most of that is part of our humanity.
There may be things that ought to be discussed here, but most of
that is part of our culture and our humanity. But don't kid
yourself. We ration health care in America. We ration it on the
front end by denying basic primary and preventive health care, and
that is what is costing us so much money.

Two more points I want to make about this. We've got to change, a
lot of us have responsibilities too. We've got to change our own
behavior, and that means we need really aggressive health education
programs in the work place and in the schools of this country, to
teach people what is and what is not good, and acceptable healthy
behavior, to keep us alive. And I'm not just talking about the
things that are somewhat controversial, but are life-and-death,
like parenting education, and sex education, and AIDS education.
But also what you eat and what you don't, whether you exercise or
not, how much you smoke, what you do that will either lift you up
or drag you down. 

We have got to take more responsibility for organizing our own
lives, and making this country healthy, so that we don't have to
spend money that we can avoid spending. That's not the insurance
companies' fault. That's not the doctors' fault. That's not the
hospitals' fault. We're going to have to do that.

And the final thing I want to say is there is a problem in any
national system, which is, obviously, what do you do, do you impose
a burden, if you don't have the government pay for everything
through a tax system, but everybody has to be covered to avoid cost
shifting, what do you do with small businesses that are already
operating on a thin margin? And that's a tough question.

But I want to tell you, first of all, I do not favor starting a
health insurance reform with a big tax increase on small business,
or anybody else. I think we ought to go for the savings first, re-
organize the system, take the money we're saving, and put it back
into the health care system in phasing universal coverage, phasing
it in.

Secondly, keep in mind, a lot of people are going to save money out
of this system. The people that are paying for health insurance now
will have their costs go down in future years, making the American
economy healthier and stronger.

The third thing I want to emphasize is that I think small
businesses ought to be able to be part of a very big pool, and if
the private market still doesn't work, ought to be able to pay into
a public program that has a ceiling on the percentage of their
income that has to be allocated to health care. But don't kid
yourself. 

Every one of us, even if you run a small business, and you don't
insure your employees, you're still paying for it. Look at the
deficit every year. You and your children and your grandchildren
are paying for it. Look at the unemployment rate in America. Look
at our lost productivity. Look at our lost competitiveness. Every
American is paying for the system we've got now. No one can escape
this. 

So I am very sensitive to the small business burden, and we're
going to have to work into this, but we must begin now to change.
I am convinced that if we don't do this, we're never going to be
able to restore our country's manufacturing health, got almost
eleven hundred dollars a car in health care costs now. If you want
to sell American automobiles overseas, if you want to take back
more than sixty-six percent of the American market, if you want to
spot the foreign car competitors six to seven hundred dollars a car
in health care costs, that's what we're doing today.

If you want America's manufacturing base rebuilt, if you want this
federal deficit brought down. The entitlements are killing us, it's
Medicare and Medicaid and the explosion of poverty. Contrary to
popular belief, it's not middle class people getting social
security benefits. The social security tax fund is seventy billion
dollars in surplus. It's paying for a lot of the debt. The problem
is health care costs, and the rising tide of poverty in people in
low-income areas claiming the programs that were set up for them.
We've got to deal with this.

So if you want your country's economic health restored, if you want
the tensions between labor and management reduced at a time when
it's clear that productivity requires co-operation between labor
and management, if you want a healthy citizenry, if you want a
healthy government, if you want a government that works, we've got
to take a dramatically different approach to the health care
crisis.

Let me say that if you want to be able to go back to a legislative
session, and think about how you can help education, how you can
move people from poverty to work to welfare reform, how you could
take care of some of the needs of the elderly in your state, how
you could do that even in a good year without raising taxes, we've
got to get the burden of exploding health care costs off your back.

You know as well as I do what's been going on for the last ten
years. We've been backing into universal coverage by requiring
states, through Medicaid, to cover more and more services. We've
been backing into the unfairness of shifting costs, by requiring
states to spend more and more money reimbursing providers. We've
been backing into more and more tax increases by having the
national government require the states to raise the taxes when they
don't, even though they have too. And let's quit backing into this,
and face it up front, and do something about it. And that's what I
think we ought to do.

And let me ask you one other thing. Even if you are a Republican
legislator, let me ask you this. We've seen the South come a long
way in the last few years. We've tried to open ourselves up to the
global economy. Any reasonable person would say that most of our
states have done a better job of reconciling racial tensions, and
opening up opportunities than many non-Southern states have.
Something I think most of us are pretty proud of.

And I know we've got a long way to go, and I know our region still
has a higher percentage of poor folks than other regions of the
country. I know we've got a lot of things to do. But we've made a
lot of progress.

And I want to challenge you to go home and talk to your friends and
neighbors. And make sure this next eighty-four days, an election
gets fought out on the real problems of America's future, on our
hopes and not our fears, on the new ideas we need to take us into
the future. 

You know as well as I do what's about to happen. The other side's
going to go down there to Houston. They're going to tell you that
Al Gore and I may have been born in Arkansas and Tennessee, but
we're just a bunch of crazy wild-eyed liberals. They are going to
tell you that they took us to New York City in a safe that no one
saw us in and incubated us for twenty years, and we got crazy ideas
and came home and hid them for twenty years, waiting for the
opportunity to spring them on the rest of the country once we got
in national power. That's what they're going to say.

They're going to say every speech I gave on the Fourth of July in
northeast Arkansas was a deliberate attempt to conceal my radical
impulses. And that we just can't wait to get into power in
Washington, so we can take your guns away, and trample family
values, and raise taxes on every poor, working person in America.
I can hear it now, and so can you. And the reason you're laughing
is you know I'm telling the truth.

I just want you to think about this, whatever your party, whatever
your philosophy, whatever your background. You think about what
it's like to go home every night after you've been in a legislative
session, and you've worked your heart out trying to solve a real
problem that real people have that you represent. And you ask the
people you represent not to throw their vote away. On the kind of
rhetoric that people have gotten those of us in the South to be a
sucker for over the decades.

Let's show them that there is a New South, and we're a lot smarter
than they think we are. And whoever is going to get our votes this
time will have to respond to our hopes for our children, to the
problems we really confront every day, and will have to give us a
way to win again by being one again. That's what working for us
today in all of our states. When we can be one again, when we can
work together again, when we can bring out the best, when we can
honestly sit down across the table and air our differences, when we
can imagine how far we have come, many of you in this room from
sharecropper's shacks, slums without sewage systems, when we can
think about how far we have come, that's when we're at our best.

You go home, I don't ask you to agree with me on everything, and
I'm not going to be right on everything, and I don't know
everything we should do. But I know one thing, we never got
anywhere, anywhere, anywhere in our part of the country be being
sucker-punched to appeal to our traditional values. Let us vote on
our traditional values, let us live by our traditional values, let
us lift up the whole country by starting in the South and saying,
"Give us a new direction for the twenty-first century. Give us a
real solution to our problems." Let's bring out the best in
America, and let's start it here. Thank you very much.

End of Remarks