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�THE WHITE HOUSE
•
Of~ice
of the, Press Secretary
1
For Internal Use Only
AprilS, 1994
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REMARKS OF THE FIRST LADY IN OKLAHOMA
TolTHE HEALTH CARE PROVIDERS
MRS. CLINTON: Thank you very much for gathering.
I want to apologiz~ for being a little bit late, but there
was such an enthusiastic welcome at the restaurant and the
people out in the driveway that we couldn't walk away. Sorry
I kept you waiting J '
~eing
,
I want tl thank Mike and Dave for
here and,
more than that, for the work.
It's a real pleasure to sit
between people who I are committed to the same kind of change
and progress and different in Washington as they are.
I also
want to thank my friend for being with me today as well.
I'm
delighted to be able to spend time with her and catch up.
I,
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I don't want to say very much.
I want. to 11sten
and try to answer questions because ,what I find as I continue
to travel around the country --, and I guess this week, if I
remember right, I're been to Chic~go, Illinois; Rochester and
Syracuse, New York; meetings in Washingtoni and now here in
- is that most I think most people are beginning to think
seriously of the p~obability at we're going to have '
significant health care reform legislation this year.
The more we can talk about what should be in there
and the more accurate information that people like yourself
and others particu~arlY interested in positions have access
to, the better thel will be and the better the final product
is going to be. So I welcome the opportunity.
I spent much
of last year gOingl around and talking with and listening
about the problems. Now we have a lot of approaches and
ideas and solutions on the table that we want to get
continuing health.
Very briefly, the • president knew that this was
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going to be a verYi challenglng enterprlse, to come forward
and seek the legi~lation, b~t felt it absolutely imperative
to get the ball rolling and be able for all of us to focus on
what the real cho]ces, were. He got some hard choices, but he
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�is beginning, I th1nk, to kind of move forward .successfully .
th
h
. . h .
T e act10n 1S now 1n
e Congress.T ere are at
least three major Jtommittees in the House struggling with the
legi~lation, two in the.Senate and others that will have
pieces of it.
Butl~hat I have been struck by is the quality
of the. debates thus far and the seriousness of purpose that
- is b~ing brought to bear on his nostalgia.
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presi~e·nt
The
has said repeatedly that he is open
and very willing t9 talk about thediffer~nt ways of
reaching the ultima~e goal. But he does· have art ultimate
goal in mind. As h~ said in his State of the Union, he
.believes for both the human and moral and ethical reasons, as
well as economic onbs, we have to insure everybody in this
countr~. 'It,is th~ ri~ht thing to do and it is the cost
~ffect1ve th1ng to tlo 1n both the short and long term.
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So very slccinctlY what he's looking for is a bill
that he can sign Wh~Ch will guarantee private insurance
coverage to every American'with a candid benefits package. I
want to stress thatl because a lot of the opposition to health
care reform is using the same language they used when
Roosevelt ~roposed ~t, wh~n Truman prop6sed it, when
Eisenhower proPosE!dl.
,
,
I ju~t go~ a load of documents'~bout President
E1senhower tak1ng on health care reform and some of the
things he said.
I bust admit I'd forgotten (inau~ible).
So
he was picking on sbme of the s~me issues.
s6 every
president, both Rep6blican and Democrats, have tried to
struggle with this ~ssue, including Kennedyj Johnson, ~ixon's
proposal for a heal~h care system, and Ji~my Carter ..•
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We haven'~ really dqne a lot except patch around
the edges and increase the mandates ' states that expend
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more money w1th less health care over the last 12 years. So
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guaranteed pr1vate ~nstirance w1th a standard set of benef1ts
which people can bu~ above if they want more.
That~s not
. going to cover ev~r~thing, but at least i t should be here for~
everyone.
Secondly, we want to eliminat~ insurance practices
that discrimin~te against individuals. That means eliminate
preexisting condit~ions, not just saying' that insurance
companies have to S~ll to you if you've got a pre~xisting
condition because they can charge an,arm and a leg, but
elimina~e preexistihg conditions as a term, for any kind of
uhderwrlting and fo~ instirance, eliminating lifetime limits
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�which are often one of the cruelest surprises for people when
they do finally ge~ sick and, and we also believe we should
eliminate age discrrmination.
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We have an old-fashioned idea that we ought to gO
. b~ck to insuring th~ way Blue Cross/Blue Shield got started
in the late 30s andl 40s where you insure the entire community
at a community rating. Everybody was in it together; the
old, the young, thel sick, the well. Everyone of us is going
to get old. Most of us at some point will get sick.
We also wlnt to guarantee choice. I want to stress
this because that'sl been one of the really big issues get the
president's plan to~ally in its reform. What is happening
right now, and we' vie heard about this from several of the
farm families, is that they are being told that under their
insurance policy th~y can only use docto~s in and health
plans in Oklahoma C11it y . If you're in Muskogee, that's not
real.
They want! to be able to have choice of doctors and
choice of health plpns. But as we sit here right now,
Oklahoma is just like every other state. It's only now
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beginning to reallyl hit you. But in any other state, fewer
than 50 percent of the insured population any long has a'
choice of doctors o~ a choice of health plans.
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It's the pe'ight of irony that the opposition to the
president's reform has viewed that we're going to take away
choice when what wei want to do is guarantee it and expand it.
I will sit here and tell you that if we do nothing, the
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current status quo is going to undermine the financial
stabili~y of a lot hf hospitals, particularly higher, first
year hospitals wherk all community hospitals are going to be
written out of the insurance plans and are going to be
eliminating from corerage doctors just left and right.
I was talking to the congresswoman from Arkansas
who told me what I thought was the most absurd story that
I've heard in a'long time. That in, Arkansas, one of the big
employers there that's on the Mississippi River had signed on
to the insurance pl~n whose only doctors were in Little Rock.
That's three hours ~way.' Memphis is across the river
(inaudible). But i~ the name of cost containment) the only
doctors these employees could use are in Little Rock. We
want a guaranteed choice to put in the hands of the
individuals so that I every year they get to choose their
doctors and their health plan.
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We also ~ant to extend health care at the
workplace. This is not a government program.
You know, I
know that it's the Isame thing that has, been saId every time
health care has come up, with an issue, people say oh,
government, socialilsts .. It is not. What we are trying to do,
is to pool people ~nto big purchasing co-ops or buyer's clubs
so they can pool tHeir dollars to get the best possible
bargain for the' pur;chase of health care, not that they get
their health care through those' buying co-ops.
It is a
financial device fOI~ maximizing your buying power, the same
thing that Dave and Mike and I get because I'm married to one
and they are federall employe'es .
. The
rnone~
that is used to provide the choices for
health plans to federal employees comes from our employer,
namely the federal ~overnment and burselves.
Ev~ry year the
federal government,' as our employer, goes out and says to the
doctors and hospit~ls and networks and HMOs and PPOs and all
the others you can ~id for our business.
But' the government
is not the doctor a~d the government is not the health plan.
It is the pass thro~gh collection proces§ing.
That's wh'at we want for ,every .state so that
everybody pools thelir dollars. Then they go into the
marketpl,ace to buy itheir health care. So every December when
the annual enrollment is up for federal, employees, we choose.
The president and I make a choice.
David and make a choice.
Mike makes a choice.
It's our choice. There's no government
doctor. There's no government health plan. That's what we
are talking about when we talk about co-op and buying clubs
for alliances.
The final point I'm making, we want to preserve and
improve Medicare. Medicare has done a very decent job of
keeping our older Atnericans out of health care crisis and.
If you go back to y6ur readings of some of the .hearings and
the testimony of thb 1950s ~hen Congress was considering
Medicare, there wer~ horribl~ stories about older people who
were denied care~nbt getting access to c~re.
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We've done a good job, but there are two things
that we been able tb deal with; One is prescription drugs
which are often onel of the biggest costs for older people.
I've met a pharmaci~t family physicians or interns.
I am
told all the time that older patients are given a
prescription when t~e pharmacists kn~w they cannot afford the
bill or if they bil[, they then sell to Medicaid.
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If they're supposed to take four a day for 10 days,
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�they take ~ne a da~1 thinking they can spread it out longer:
The latest statistics are that 23 percent of the hospital
admissions of olde~ Americans, Medicare-eligible, are due to
inadequate or, for unaffordable medication problems. So we
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pay for them when ~hey go lnto a hospltal, but we won't
support the medica~ion that will keep them out of the
hospital.
It's a Jery cost ineffective government ~ecision.
We do the same thing with long-term care.
If you
spend yourself into poverty and you qualify for a nursing
home, we'll pay for it. But if you want to stay at home with
your family and hav a visiting nurse or a piece of equipment
that will help you maintain your family connections or if you
want to go to a center during the day so your family members
can go ~ut to work, we're not going to help you with that.
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So again, we make these decisions that are just not
very. Those are the kinds of sensible ideas that we think
will help kind of g~t the financing in line with the quality
of health care in this country. We've got the best quality,
the finest doctors, I nurses and hospitals, but as I've said
many times" we have the stupidest financing system. We spend
billions and billions of dollars inappropriately and
unnecessarily on th~ngs that have nothing to do with actually
delivering health c~re to patients. That is what we want to
try to get away fro~ so that money can be spent' on health
care or even freed hp for other economic activities in our
country.
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So with that.
Q
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MRS. CLINTON:
I'm glad you asked that because we
spent a lot of time1trying to get to the bottom of that.
This is one of those issues that has so much really get as
close to what we thbught were the real problems in the system
and then tried to cbme up with some. 'You put your finger on
one of the'issues t~at we had.
t~e
Part of
problem if you look
to be fairly accurate studies to the best
spent the most time land money in both the
through the medical society trying to get
it, what' is the malpractice problem.
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at what I consider
of my knowledge
government and
to the bottom of
When you break it up, what you get are. You do
have a problem 'with I frivolous lawsuits that are ,absolutely
brought for harassment or for potential gain or for -~ you
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�know, it's like a lpttery. They are brought oftentimes by
the same lawyers against the same doctors. There is a pool
of doctors in ever1 state.
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I can't speak for Oklahoma, but in all the states
gotten good s~atistics~ there's a pool of doctors who
have more than their share of malpractice suits. There is a
group of lawyers whb are primarily the ones who bring the
frivolous cases to bourt.
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we'v~
What· do wl do to try to eliminate that? First of
all, we say that yoh've got to have a certificate of merit
from an independent I expert that you've got a working lawsuit.
Even then, though, you've got to have some kind of
alternative disputelresolution outside the court before you
can get to court. We think health plans and other entities
ought to be preventing those and that ought to be a door that
you have to open. · 1 ·
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Thirdly, ¥e think that as we're building this into
the plan, we ought to be developing standards of practice as
a presumption of bebause what you just said is absolutely .
right. The independent clinical judgment of physicians is no
longer enough to bel able to keep. That's not the way it
should be. What we want to do is have a specialty
organization to develop standards that any doctor can say I
abided by thosestahdards. Unless they overcome that
presumption, they c~n't get in the door.
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We th1nk that 1S the best way to deal w1th .the
defensive'medicine people and the malpractice people at the
same time. The state of Maine has done some real good work
in this area. we'r~ beginning to see some results. You're
aware of that.
I'm real pleased about that. They've taken a
couple of diagnoses and procedures and outlined the clinical
standards. .1 think that's working out.
We also want to limit attorney's fees.
We think
that is very importcint. Now, where we have not gone is the
recommendation thatlwe limit the level of judgment at a
federal level. ·We ~hink that every state has a different
pay. The limit in ealifornia is $250. The limit in
Louisiana is $500. IThe limit in some other states -- every
state should have their own limit.
The reasoJ we decided to do that is because in this
piece of legislatiorl, it is very hard to prove on a nationa.l
basis that there is \a big problem with big verdicts across
the nation. There are some states and some areas of states
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�that,have gone wild, but most states have stayed pretty
constant. They don't have wild out-of-the-way verdicts.
we think that ought to be a state responsibility. Most
states have already moved in that direction.
So
There's not much evidence, I must tell you, that
having a cap on tho~e damages keeps malpractice premiums down
because what happen~ is if you think health insurance costs
have gone up, malprkctice insurance costs have gone way up.
They go up based onl our studies without any direct
relationship .with virdicts. T,he y . just go up.
So there needs to be some self-insurance by
phy~icians and ther~ needs to be limits on attorney's fees.
We really believe that that combination of clinical judgment,
limiting attorney'sl fees, bars from getting into the court
unless you can over?ome three different hurdles will put a
real chill on frivolous lawsuits without eliminating the
possibility of somebodY who is the victi~ of genuine
negligence. That'slthe balance we've tried to draw.
Q Mrs. Clinton, I'd like to also say thank you for
coming to Oklahoma and spend time with us. There is so much
being said abouthe~lth care reform that ·we simply ought to
remember that the p~ysician is the focus.
The three of us
manage hospital in the metropolitan area. We choose to do
that. We like livi~g there. The doctors that come to us
.like living. Unfortunately, the incentives to come to rural
;Oklahoma are not th~re. We sure would like to see something
done relative to helping us attract physicians.
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MRS. CLINTON:
Yes, and we have some spec1f1c
provisions arid ince~tives in the president's approach and
others like Dave and • Mike who are concerned about rural .
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health care and worklng on how to make sure that we do what
you're talking aboui. There are several different elements
of this.
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The first is that if we have everybody insured, you
have a more secure financial base than you do now.
In most
rural areas, you haVe a disproportionately high number of
Medicare patients, ~edicaid patients and uninsured patients.
So it a difficult financial situation because unlike some of
your colleagues ln Tulsa, Oklahoma, you don't have
populations to shif~ costs to.
I mean, they have a much
bigger insured base Ithat they can shift costs to than you do.
So you take the burden ,of trying to balance your books with
many fewer resource~ coming in.
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�"If we have everybody insuted, we have a
reimbursement attadhed to every patient you've got. That's a
big plus., secondlY" we 'are trying to change the payment
level for Medicarelfor rural hospitals and rural states
because we don't tliink you've been treated, fairly. Thirdly,
we've got direct f~nancial incentives for physicians and
nurses to practice lin rural areas,. That is something that we
really believe in, everything from loan forgiveness, bonuses,
plus we've got a pr;ocess for funding facilities in rural
areas that we would be the essential community providers.
The only hospital ~n certain area can be permitted to shut
down if you're" goi~g to be able to provide true access under
univer~al coverage lin that area.
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Then, finally, we have incentives for physicians to
be able to band together in networks to be part of health
care. W~ actually Ihave loans for small groups of physicians
to be linked togetner so that they can compete with HMOs or
big insurance compa:nies. Also, I would add that we have some
incentives for tecHnological advances that would enable
physicians in your lpart of the state to be hooked into the
medical schools. ~Ihat, we think, holds great promi~e for not
only getting state of the art medical care out of your
communities but fO~1 support~ng your Pos~tion.
'.
I mean, lt'S not Just a questl0n of money for a lot
of physicians in rJral areas; it's working conditions ahd the
lack of peer suppo~tthat finally gets to them .. So we're
trying to figure out ways to network better. We've got money
for such technOIOg~1 that will help link up.
When I was in
Syracuse, I visited a computer project they're doing that we
see as sort of f ibe!r optics superhighway that the vice
president is very cbmmitted to as having incredibly
(inaudible) with th~ medical ramifications, to be able to get
hospitals and clinics linked up so that you literally. don't
have to move.
I personally sat in a room in Syracuse University
wi th a doctor stand,ing by me who was a pediatric
cardiologist. On tpe computer screen it would flip. The
doctor who had the baby patient would talk, to this doctor.
He could see the baby and then he could see the results of
ultrasound on the sbreen. the physician said I can see by the
way the child is mO~1 ing and what extension her arms are and I
can see through the ultrasound that this child does need to
see a specialist. ~ut I could see a child just a few hours
ago that I could te[l did not. That's what we're hope to
move for. That wou[d be lncredlble for rural hosPlt~ls.
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Q pilot administration projects figure out where
the money is coming from? The other thing is that you are
aware that we're 4~th in the country people. One of the
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things we also quadruple the nat~onal .health care serv~ce
(inaudible) be recdgnized (inaudible) both rural and inner
city must be taken care of if we're going to make this thing
work. Let me ask (inaudible).
A PARTIC1PANT:
(Inaudible)
Q Before you answer that, let me ask (inaudible)
anything to add to that?
A PARTICIPANT:' (Inaudible). She's worked 16 hours
a day 7 days a week.
I do have some resolutions from
(inaudible) concerJs about (inaudible) health care providers
(inaudible) health 'Iservice (inaudible).
I :have one other
comment of concern.
In reviewing insurance packages,
(inaudible) to f ind .out the people that are (inaudible) now
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are still not (inaudible) .
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an example, in my own family, my sister
. To give
(inaudible) had an aneurysm, had an insurance company
(inaudible) who is how (inaudible).
But fortunately,
(inaudible). They hre losing their insurance (inaudible) • .
How can you pay fori insurance when you don't have any money,
plus you've had an aneurysm, been in the hospital three
months? If she hadb,t (inaudible).
thes~ HM~S,
NOw,
after I find out (inaudible)
hospital (inaudibleO in Tulsa do not have rehabilitation for
(inaudible) patient~ and rehabs.
I mean, as a nurse, I'm
employed at a hospital (inaudible) not a rehab. A lot of
these companies selkct and have them (inaudible).
So your
age group right nowl for any (inaudible) is age 33 to 62.
This has been the (inaudible). When they have a
stroke, of course they can't get on Medicare for two years.
Then her husband isl losing his job and he's worked all his
life.
It's a real problem.
Q
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(Inaudible)?
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MRS. CLINTON: You are absolutely right. One of
the biggest reasonsjfor the health care reform is (inaudible)
people without insurance.
It's because all of us with
insurance who are s~eing benefits decrease, the cost increase
and losing benefits I because of employment changes or other
circumstances. That's what I hear.
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�I've got a million letters back at the White House.
I'd say the vast majority of them are from people who are·
insured who are co~plaining about the costs going up, about
finding their insu~ance companies cover rehab or didn't cover
preventive care or Ididn't cover something (inaudible).
So
this is really an issue that cuts across any socio
(inaudible) .
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I think that the real issue for us is (inaudible).
It's time to come p with a standard benefit package that
barely takes care df the major hospitalization and outpatient
needs that people ~ave and also through preventive care.
I
think health promo~ions, really, when you look at it closely,
has to be about pre1venti ve care because you can lecture
people all you wan~, but if they don't get the vaccination,
if they don't go ge!t (inaudible), and they don't go get the
well-child exam, wh~t good is the health promotion.
So it's
got to be both . . sol we've tried to emphasize preventive care
so that we can begin (inaudible) responsible.
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examp~e
One
we know about this is Hawaii.
Now,
people always say t6 me well, you know, Hawaii is an island.
Yes, and the cost o~ living in Hawaii, because it is an
island, is higher oh average than Oklahoma, Arkansas and most
other parts of the bountry.
But health care is lower.
It's
.because they covered everybody starting about 74 through an
employer-based Plan~ They included preventive care.
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The average Hawaiian actually goes to the doctor
more frequently than the rest of us.
But because they get
(inaudible), they dbn't get as sick as chronically as long or
hospitalization stays, so their overall costs are actually
less. Their per capita expenditure is about 9 percent as
opposed to our 14-1Y2 percent.
So preventive maintenance,
getting people to doctors, getting them to take care of
themselves is a biglpart of what we've got to decide.
Q
(Inaudible)-
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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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Clinton Presidential Records: White House Staff and Office Files
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FLOTUS Statements and Speeches 12/2/93 - 4/26/94 [Binder]: [4/8/1994 Health Care Providers, OK]
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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>
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Lissa Muscatine
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2011-0415-S-flotus-statements-and-speeches-12-2-93-4-26-94-binder-4-8-1994-health-care-providers-ok
7431941