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CLINTON LIBRARY PHOTOCOPY
�"
THE WHITE HOUSE
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•
Off~ce
[
of the. Press Secretary
For Immediate Re]ease
I
March 15, 1994
.
An Address by the First Lady
at Washington University
st. Louis, MO
I
I
Thank Jou. Thank you very much. I am just
thrilled to be here. Some of you may remember that this is
where one of the Idebates during the presidential campaign was
held, and I can remember walking in the door I walked in a
few minutes ago, Ifilled with a lot of anxiety and trepidation
over that upcoming debate. And I am so glad to be back, with
only a little leSs anxiety and trepidation, never dreaming we
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would have so many people here.
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.
I was trankly relieved when the invitation came and
they said, "But, Iyou know it is during spring break. II So I
thought, "Well, gee, you know, I could sit down and talk with
a few people about health care here at Washington University,
in·· st. Louis."
.
But it is a real pleasure to be here and to have
this opportunity, because this university and this community,
and particularly the health care center that I just visited,
is a symbol of excellence around the country. And I want to
salute one of th~ people who has made that possible over the
last years, your Chancellor, Chancellor Danforth.
(Applause. )
I know that you will miss him as he.retires. I
only wish I could have been one of the. lucky people who heard
him read a bedti~e story over the past years. It is such a
good idea I am g6ing to suggest that maybe the President try
it with some people in Washington. (Applause.)
.
I also Iwant to thank Dean Peck for opening up his
campus, for giving me the tour, and for having some of the
representatives 6f this extraordinary medical system spend
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�about an hour with me as we talked through issues of concern
and importance tol academic health centers.
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, I want ~o thank the representatives of the students
who made the presentation. You will see the sweatshirt, if
not on the front page of the newspaper at least on either me
or my husband as we attempt to get the exercise that I now
know for sure, haring been to the rehab unit, will make me
live longer if I really do it. (Applause.)
And I wlnt to join all of you in wishing the Bears
great luck in thik upcoming championship game. And I will be
rooting for you artd watching you as you go forward.
(Applause.)
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I am also grateful to know that the Hot Docs are
not a group of angry physicians (Laughter), but instead a
jazz band, and I pnlY heard a little bit because we were
waiting to come in, but I want to thank them especially for
being here and playing, and for the COs, which I will take
home and give with great delight to my husband.
It is eLciting for me to have a chance to visit
with you for a fe~ minutes about what is happening with
health care reform, and what the real attempt that the
President is maki~g would mean to you and the various
constituencies off people represented here. Because, this is
an historic oppor1tunity .
You know health care reform in our country goes
back a number of Idecades. Some have argued that the very
first proposal acjtuallY was made by Theodore Roosevelt, as
part of his platf10rm when he first ran for President and then
,renewed it when he ran again. But we certainly know that
Franklin Roosevel:t talked about it being the other part of
social security. I And your own President Harry Truman was one
of the most passionate advocates on behalf of health care
reform.
I have gone back and read the speeches that
. President Truman ~ave in 1945, and 1946, and 1974. They
could be made today. He identified the problem which, as the
Chancellor has sa1id, is how do we provide high quality health
care to all Ameriicans at an affordable cost. And Truman
argued passionate1ly, but •
unsuccessfl.llly, that the country
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•
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should move towar1d provl.dl.ng guaranteed health coverage to
all of our peoPle " .
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And then, of course, we had the changes in the
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�1960s, to provide Medicare for Americans over 65, and to
provide Medicaid!for people who were too poor to provide for
themselves. And then President Nixon recommended
comprehensive health care that was built on the employer
based system, th~ system by which most of us who are insured
receive our insut.ance benefits •
. We havJ tried to address this issue many times in
the past under pt.esidential leadership of both Democrats and
Republicans, butlwe have never been able finally to resolve
what has to be one of the most important questions for any
society: How do [we fairly allocate our health care resources
so that every citizen is guaranteed that their health care
needs will be met?
This tJme this historic opportunity is calling us.
How can we, as the richest country in the world, be the only
one of our industrialized competitors who have not figured
out how to prov1de health care to everyone of 1tS citizens?
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This !time we have enough support in the medical
community which ~ecognizes what the needs are; enough support
in the business dommunity which primarily pays the bills;
enough support ft.om leaders like your mayor who is here with
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us, and state gov,ernments around the country who also bear a
huge part of the economic burden; and enough support in
Congress and a P~esident who wants to get the job done. So
this could not b~ a ~ore timely meeting for me to give you
some sense of exactly what the President's approach would
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mean 1n your I' I
1ves.
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There Jre five major features to the President's
proposal for heallth care reform. The first is guaranteed
private insuranc~ for every American, with comprehensive
benefits that stt.ess primary and preventive health care, as
well as care for lour most acute medical needs.
The prJsident has not proposed a government health
care system. He [has proposed building on the public private
system we have in our country today, but making sure that we
guarantee privat~ health insurance to all of us.
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1m1nat e 1nsurance
Th i d "
e secon maJor p01n t ' t 0 e 1"
practices that d~scriminate against Americans. And there are
a number of those. Some Americans are unable to obtain
insurance at any Iprice, because of what are called pre
existing conditions. .
Most
~erican with
pre-existing conditions -- and
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�there are over ei:ghty million of us -- we can get insurance
but at a very high price. And so what the President wants to
do is eliminate pre-existing conditions so that all of us, no
matter whetherw~ have ever been sick before or have any kind
of ailment, will Ibe eligible for insurance at an affordable
price. That is dne of the keys of the President's approach.
(Applause. )
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And I would add, in this great university with its
extraordinary medlical system, that it is especially important
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we do that soonerl l.nstead of later i because, I was recently
at the National Institutes of Health with the new head of
that institute, D~. Harold Varmus -- who some of you may know
is a Nobel Prize rinner in science, and he was explaining,
along with his colleagues, that at the rate by which we are
learning about th1e human gene system every year, we are
discovering the g~nes that we believe are responsible for a
number of medical\ conditions, that pretty soon all of us will
know we have pre-existing conditions because of our genetic
makeup. So if wei do not reform the insurance industry very
soon none of us will be eligible for insurance, because our
gene makeup will kake us ineligible. (Applause.)
i~
There
another insurance practice that the
President wants eliminated, and that is what is called life
time limits. If you read the fine print in most insurance
policies you willi discover that after you have reached a
certain level of insurance coverage you are no longer
eligible under yorr policy for further reimbursement.
Some po~icies have life-time limits as low as
fifty-thousand dollars, others as high as a million dollars,
but those limits pome into effect when you need your
insurance the most. I have sat and talked with families who
often to their surprise discover in the midst of a medical
emergency their ihsurance has run out because they have
reached their limit.
The prebident wants' to eliminate life-time limits.
There is no reasoh you should be worrying about your coverage
when you need it fuost in your lives. (Applause.)
And thelthird practice that the President's
proposal eliminates is discriminating against older people,
in favor of young~r people. Now if you are young, as many of
our students are today, that may seem like a good deal, that
insurance would b~ much cheaper for you at twenty-five than
at fifty-five. The problem is most of you will be fifty-five
some day, and in. the present system the cost of caring for
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young people is so much less that many insurance companies
want only to fnsJre healthy young people, often·leaving older
people out of th~ insurance market all together. So that is
another discrimidatory practice that the President's proposal
would eliminate. !
So we w.ill do away with pre-existing conditions,
life time limits,l and age discrimination. (Applause.) All
of which will ma~e insurance more affordable for everyone.
(APPlause.)!
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The thi'rd point is that the President's approach
guarantees choic~ of doctor and choice of health plan. This
has been an issu~ that has probably received more
misinformation t})ian any other. Because, in the current
market place, the're is a lot of confusion about what kinds of
choice will be av'ailable to you as a consumer.
.
In facti, as we are here today, choice is
diminishing for mbst Americans. Americans are being told by
their employers, ~ho buy their insurance for them, by their
insurance compani:es if they buy ·directly, what doctors they
can see and wha1: hospitals they can use.
In my dliscussion earlier today, I talked with a
representative ofl the children's hospital here, because most
children's hospitals that I have visited throughout the
country are findihg the same thing: that more and more
insurance policie1s are eliminating them from being available
for use by patien~s. Why? Because the childrens' hospitals,
which see very si:ck children, chronically ill children, are
expensive. They have to be in order to have the
concentration of ~pecialists and technology necessary. So
many insurance po'licies are saying you cannot choose to go to
a childrens hOSPi~1 al, just as they are saying you cannot
choose to go to a university hospital, or an academic health
center because they are more expensive. They have to be more
expensive because! of th~ services they offer •.
But under the current way health care is both being
organized and devbloping, fewer and fewer Americans are being
given choice. Th~t choice is made by somebody else, for you.
Under the presidept's approach you will choose your health
plan. Not your employer, not your insurance company, and not
a government bure~ucrat. It will be your choice, and you
will make it every year. And what will be guaranteed is that
in your area, all of the physicians will be able to join the
health plans that they choose to join, so you will be able to
choose among them.
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�Additionally, every health plan will be required to
offer what is called a "point of service" option. In other
words, if you ar~ in a health plan and you develop a problem
where the specialist is in another health plan, you will be
permitted to go to that other health plan.
The reJI danger for choice is the status quo,
because if we do not reform our system more and more of you
will be told you cannot use 'a certain doctor, you cannot use
a certain hospit~l. It is the President's approach that
guarantees your freedom of choice for a doctor and health
plan, and if you value 'that, you need to support this reform.
(Applause. )
II
The fourth important point is that the President's
approach preserv~s and improves Medicare for Americans over
,
,
the age of 65. The Med~care program has been a godsend for
older Americans, IWho when it was passed in the 1960s they
were often the poorest of all Americans, often deprived
opportunities fo~ health care .for financial reasons.,
Medicare has pro~ided a base level of medical care for our
older Americans. I
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But there are two features that most people I talk
with say are mis~ing, that will be included in the
President's apprdach. The first is prescription drug costs
which are often ~uch too high for older Americans, on fixed
incomes, to be a~le to afford. And what we find is that many
older Americans do not take their prescriptions, do not get
them refilled, o~ten end up being hospitalized because they
could not maintain themselves on the medication. Medicare
pays for the hospitalization; we think it is time Medicare
starts paying fo~ prescription drug coverage for older
Americans too. (Applause.)
And thl second big problem for older Americans in
the Medicare program is there is not support for alternatives
to nursing home qare. We do not help people who want to keep
their relatives in their own home. We want to start
providing long t~rm care options, so that families will be
able to take car~ of their own relatives, they will not be
forced to put th~ir family members in nursing homes if they
can take care of [them at home with a little bit of help. It
is the right thing to do, but it is also the economically
smart decision td make.
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" Prov~ ~ng a h ome
Nurs~ng h omes are very expens~ve. d '
health aide, providing adult day care, giving some respite
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�care to the full~time caretaker of an Alzheimer's patient,
that is all much I cheaper than putting the person in a nursing
home. So let's ~tart giving alternatives that will enable .
older people to live with dignity; and not make the nursing
home the only pl~ce that we take care of older people with
medical problems 1 . (Applause.) .
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And the fifth point that I want to stress is that
Americans will b~ guaranteed· their health care coverage
through their pl~ce of employment, the way most of us get our
insurance today. I
If YOu!believe,' as the President does and as I do,
that we need to guarantee health care coverage to every
American, because until everyone is covered none of us is
secure. And let[me just stress that. Everyone of us in
this room, with ~he exception of those of you who already are
eligible for Medicare, cannot know that this time next month,
or next year youlwill be insurable at the same rate, for the
same services th~t you are today. None of us under the age
of 65 has that security.
If YOu[believe, as we do, that all of us should
there are only t~ree ways to pay for that. You can either
have what is called a single payer system, which means you
eliminate privat~ insurance and you raise the tax to
sUbstitute for premiums, and you fund the health insurance
system that way. I And there are many people who support that
approach. (Applause.) The single payer approach guarantees
that every Ameriean would have health care coverage.
The prisident rejected that approach in its means,
although he agre~s with the goal, because he believed we
should keep the public/private mixture that has served our
country well. We should build on what works and fix what is
broken, so we shbuld not eliminate private insurance, we
should extend itlto everyone ..
And, if you believe that then there are only two
ways to do that_I There is an approach called the "individual
mandate," which, like auto insurance, would require each of
you to go into the market place and buy your own insurance.
That, at least, ~ould on paper get us the universal coverage,
if you could enfrrce that individual obligation.
There are several problems with that approach. One
is we don't wantlto encourage employers who currently provide
insurance to stop doing so. And, if we pass the law which
said it is an inoividual responsibility there are employers
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�- how many it wo~ld be difficult to predict -- who will say
one of two things to themselves, "Well then I no longer have
to do this, becarlse the individual is required to do it."
Or, they might sa.y, "Well what I will do is drop my low wage
employees, becau~e the government is going to subsidize them
on the individual responsibility and I will only provide
insurance for pe6ple of professional or managerial standing."
Neither of thosejwould work very well.
What the President believes is we ought to take our
This is what some Presidents who
have come beforelhim have proposed. Each has looked at what
works. Social Security is an employer/employee based system.
Medicare is paidlfor by an employer/employee contribution.
Let's extend health care to everyone in the work place,
building on the ~mployer/employee shared responsibility.
employer/employe~ system.
Now hoJ do we make sure that·that is done fairly?
Well there are s~veral considerations that we have looked at
carefully. First, for most businesses.that currently insure
your cost will gq down, because you will no longer be paying
in your premium for businesses that do not insure and f.or
individuals who get taken care of at our hospitals but cannot
pay for themselves. Those costs have to be shifted to
somebody, and th~y usually are shifted to those of us with
insurance.
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Secondly, even if you are a small business and you
currently insurelyou are now being discriminated against in
the insurance market. You pay anywhere from thirty-five to
forty percent mo~e for your insurance than a big business, or
a government doe~ when it buys insurance. So we can lower
the cost of even IsmaIl business by making everybody share the
cost more fairly.
Now iflyou have never paid for insurance for
yourself, and you have never contributed to your employees,
yes, it is going Ito cost something. But you have had a free
ride in our medical system. Because, if I go down any street
in st. Louis or the surrounding towns here in the county, we
could point out the businesses that insure and the businesses
that don't. But Iwhen someone working at the business that
does not ·insure gets sick, they go to the same hospital, they
get taken care of. The doctors are there for them, but they
don't pay for i t J l t is being paid for by those who
currently, and irt the past, have insured.
So if Je provide discounts to small businesses, and
if we provide subsidies to low wage workers then we can make
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�insurance affordaible for even those who have never insured
themselves in th~ past. Once everybody is in the system then
we can begin to get cost under control. Because, right now
trying to contro] cost in a'system where everybody is not in
it is like holdirtg on to the balloon in one part, it pops out
somewhere else. IEverybody being in the system means the cost
can be lowered f~r everyone, because there will be no place
to shift cost and make somebody else pay for the health care
of another persort's employee or another individual.
ltd
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So gua~an ee pr1va t e 1nsurance, e I' , t'
1m1na 1ng un' f '
a1r
insurance pract:lc1es, guarantee,ing choice of doctor and health
plan, preserving and improving Medicare, and guaranteeing
insurance at thE~ fork place through shared responsibility by
employers and emp,loyees, those are the major points of the
President's plan.
'
An addiltional point, I would add because of where
we are, is the Cl~areness that the President has, of the
important work done by the acade~ichealth centers; the
research that is jdone, the application of that'research
through clinical ~ractice; the education and ,training of
physicians, nurse's I ,and other. allied personn~l.
s~stem 'th~t ~ehave
, This
built up has features that
have to be strengthened and protected, and in the President's
approach there willI be guaranteed funding for academic health
'centers, because [Of the important functions they perform for
the entire system.
And thJre will bea requirement that health plans
contract with thdse health centers, so that those health
centers will not Ibe eliminated from the provision of health
care in an effort to 'control costs, but will become the
centers of excell1ence so that we will have places in every
region where onlYI the services that, can be provided at that
level of complexity will be available. So we want to preserve
and strengthen oJr academic health centers.
.
Now 'thJs debate, as we move forward, will be filled
w1th all k1nds ofl arguments, and many of them w111 be engaged
in in very g~od f1aith, by people who see the problem and know
that it has to be solved but have different points of view.
That is what thE~ Icongressionalprocess is for. And I am very
encouraged when II see the, kind of work that is going on now
in the Congress I' IOften behind the scenes, in the committees
and the Sub-Committees, where Republicans and Democrats of
good faith workirtg toward solutions are coming together to
hammer out diffe~ences.
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�But there will always be extremes in these debates,
and there will al~ays be interest groups who, frankly, have
profited from the' status quo and do not want. reform to occur.
It will be our talsk, as citizens, to keep the debate as
honest as possibl!e, to ask the hard questions, to say how
wlll thlS affect roe? Me as a mother, me as a patlent, me as
a physician, me als a nurse. How will this change make our
I
health care system work better?
• •
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•
I am vJry optimistic about where we are in this •
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•
debate, becaus.e I: do belleve that there are enough people ln
the country who understand what is at stake. But it has to
be a debate in wHich you are engaged. And I would ask you to
. follow it closel~I" to ask what the motive or the agenda of
the person speaking is, so you can cut through the rhetoric
to try to find oJt what is really being advocated, to follow
it. closely in th~ Congress, to stay in touch with your.
members of congr~ss, .to give .them the benefit of your
thinking. . .
I
.
Because, this is not just a1debate about how we' are
going to finance /health care. It is bigger than that. It is.
a debate about wnat kind of a country we are and intend to
be.
I
�had brought him to the only place that she thought he could
get medical care) a National Guard MASH unit.
I visiled with the doctors and nurses who were so
I
pleased to be helre answering the unmet health needs.
>
This iJ not just about those people, but it is
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•
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about how we treat them and how we th1nk about them, and at
bottom, it is ab9ut us. If we move through this next year
and think about ~he people who you know, and who you see and
you hear about, and if you know that, fortunately, there, but
for the grace OflGOd,often go any of us None of us can
predict the state of our health, no one·knows when the
accident may occtir. Then we will ask the right questions,
how will we take Icare of each other? How will be better use
our resources? How will we build on what is the ·finest
health care syst~m in the world? By fixing the financing
system that is distorting it ..
ho~e
And.whJt I
is at the end of this debate· I can·
go back. to the. l~terally hundreds and hundreds. o.f.. Americans
who have shared their stories with me, who. have· told me what
it feels like. tolbe the mother of a chronically ill child
whose insurance lruns out, or to be a small business owner who
can't afford instirance and has to tell her son not to go out
for sports this year because she is afraid he might get hurt,
or the woman whose husband could afford insurance for himself
and their four children but didntt insure her because he
couldn't afford it, and she got pregnant again • she
and now
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wonders whether she can afford anesthet1c when she g1ves
birth because itlwoUld be the equivalent of a house payment
for them. Or the woman who had a breast exam and they found
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a lump, and she was referred to someone and was told that
because she didn1t have insurance they wouldn't biopsy it,
they would just watch it.
I have i
many stories,'· it is like a movie in my
head, the people lsO I see -- and I want to be able to go
who
back to them, I want to go back to this medical student I
talkedJto today, land tell her. and tell them we have now
provided health care coverage for every American, and we.have
taken a step tow~rd becoming the nation we should be.
.
(APP
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lalse .)
MR. P:EqK:
inspiring
addre~s,'
.
.
Thanks to the First Lady for an
and thank you all for coming. (Applause.)
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�
Dublin Core
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Lissa Muscatine - Press Office
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First Lady's Office
Press Office
Lissa Muscatine
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1993 - 1997
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<a href="http://clinton.presidentiallibraries.us/items/show/36239" target="_blank">Collection Finding Aid</a>
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2011-0415-S
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<p>Lissa Muscatine first served in the Clinton Administration as a speechwriter. Within the First Lady’s Office, she served as Communications Director to the First Lady.</p>
<p>Lissa Muscatine’s records consist of materials from First Lady Hillary Clinton’s Press Office, highlighting topics such as health care, women’s rights, the Millennium Council, Hillary Clinton’s 2000 Senate campaign, and deal extensively with press interviews given by the First Lady; her domestic and foreign travel; and speeches and remarks, on a wide variety of topics, given by her before and during her time as First Lady. The records include interview transcripts, press releases, speeches and speech transcripts.</p>
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FLOTUS Statements and Speeches 12/2/93 - 4/26/94 [Binder]: [3/15/94 Washington University]
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<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/Systematic/2011-0415-S-Muscatine.pdf" target="_blank">Collection Finding Aid</a>
<a href="http://catalog.archives.gov/id/7431941" target="_blank">National Archives Catalog Description</a>
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Lissa Muscatine
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7431941