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IPHOTOCOPV
PRESERVATION
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THE WHITE HOUSE
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Office of th~ Press Secretary
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For Immediate Release
September 16, 1993
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B¥ THE
REMARKS
FIRST LADY
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AT THE OONGREiSIONAL BLACK CAUCUS
ca1ital Hill
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2:00 A.M. EDT
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MRS. CLINTON: Tha1nk you. Thank you very much,
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Congressman Stokes, other distinguished members of Congress, and the
congressional Black Caucus. M~ny of you in this audience who are
physicians and nurses and pha~acists and medical technicians and
medical school deans and every/other representative of the health
care profession, it is a great privilege for my to be with you
because, as Congressman Stokes has said, the Congressional Black
Caucus is one of the first plares I came when I 'began to visit here
on capital Hill to learn from our representatives and senators what
they thought in terms of the ckisis facing our country with respect
to delivering quality health c;are,·and what particular issues were of
'importance to various Americans that could not be overlooked if we
were to come With. a plan that I!was truly an American solution to an
American problem.
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And I have been ~ery grateful for the assistance from
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the members of the Congressional Black.Caucus and from so many of
their staff members, both per~onal staff and committee staff. And I
am also grateful for the assi~tance of many on this podium and in
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this audience who have worked very closely with the Health .Care Task
Force.,
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What I would like to do this afternoon is to talk about
the basic prinCiples underliAing the President's health care plan,
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his commitment to them and the ways he has chosen to address them.
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As both Congressman Conyers and Congressman Scott pointed out, there
is a significant level of sU~Port in the Congress' for a single payer
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ayatem that ha. been developed iJ legi.lation of which thero aro a
number of co-sponsors. There ar~ other bills that. have been
introduced in the Congress both this session and in previous s9ssions
as members have searched to find/ways that they thought would solve
the problems that they saw.
This issue ha. been with us for many years. It goes
back at least to the time when President Franklin Roosevelt was
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attempting to legislate Social Srcurity. At that time, he also
. intended to legislate health security and could not achieve that
political objective. But ever s/ince the 1930s and every
congressional session, bills ha~e been introduced, and presidents
since Franklin Roosevelt have attempted to deal with our health care
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problems. President Truman cam~ forwa+d with a plan. Under
President Johnson we began to see Medicaid and Medicare. President
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Nixon introduced a health care feform plan. Other presidents, many
members of Congress have struggted with this issue. And yet the
problem has continued to develop.
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We are at a unique moment in history, when there is a
groundswell of desire on the pa1rt of Americans of all walks of life
to do something about our heal~h care system, and when there is a
critical'mass in the Congress, /both Democrats and Republicans, who
are finally willing to say, yes, let- us hear the people and do
something. But perhaps most i~portantly, we have a President who is
abeolutely committed to gettin~ that job done, and who is willing to
put himself and his administration on the line.
Many people have/aSked me and asked my husband since we
began this effort, why on Eart'h would you take this risk? Why
particularly, would you put ydur wife in that position? I've asked
him that, myself. (Laughter.)' And he has always, without
hesitation, said the same thirig , and it's what I agree with
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absolutely -- how can one be President today, how can one be a member
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of Congress or a United States senator, how can one be a physician or
a nurse or a businessperson o~ a mother or a father and not want to
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solve our health care problem1s once and for all? (Applause.)
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There is no reason to be in public service today that is
more important to the continJing stability, the well-being, the
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social fabric, the human quality of our country, and the kind of
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health care system we will establish and support for all of our
people.
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So to that end,1 the President believes strongly in the
following principles, and although there will be many opportunities
which will be welcomed, to slit down and work with not only members of
the Congressional Black caudus, but members of every caucus, of which
there are many as I have le~rned up here, on both sides of the aisle,
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to hammer out the best possible solution.
But there are certaJn principles that cannot be
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negotiated over. And these are t'he ones the President believes in.
Number one, we have to reach uni~ersal coverage as soon as it ia
possible to do so. Until all Americans are secure, no American is
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fully secure. Even those Americans who are currently insured -- and
that includes most of the peoPle/in this room -- we cannot with any
certainty know whether we will be insured to the same degree at the
sarnecost next year at this time~ We cannot because we cannot
predict what will happen to us, know whether we will suffer some
illness or accident, or a member/ of our family will which will
totally change our insurance siiuation.
The upcoming debate over how we will provide universal
coverage for every American is ~ot just about insuring the uninsured,
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although that is the highest moral imperative. Those who have no
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access now whatsoever have to have a right to security. But the
debate is also about the many millions who are currently insured, but
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without any certainty as to what their insurance will look like next
year.
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Every single month 2.25 million Americans lose their
insurance
2.25 million. NoJ, some may only lose it for a week,
some many lose if for . three mo~ths, some may .lose it .for a year or
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more. But that number of Americans every month is rendered insecure.
Well, first and foremost, ever~ American must have health care
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coverage, and that coverage mu~t be secure no matter who you work
for, where you work, where you/ live, or whether you have ever been
sick before. We will eliminate preexisting condition problems •. We
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will eliminate portability problems. We will eliminate job lock.
Every American because you a rei an American, not because you work for
a big or small company, or liv/le in Florida or North Dakota, you will
be insured. (Applause.)
Now, the President believes that insurance should carry
with it a guaranteed benefit paCkage so that every American will have
access to the same comprehensive benefits. And those benefits should
include primary and preventiv~ health care. We should reverse the
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bias against preventive health care and insure us against getting
sicker by making it possible Ito get care earlier and solve problems.
(Applause. )
The benefits package will include the kind of care that
the insurance packages that ~OBt large companies offer to their
employees. And it will inc1tde mental health benefits. It will
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include substance abuse bene·fits. But it· cannot, starting where we
are now, include everything ~hat you and I would perhaps like to see.
We will try to cover the den/tal care of children. We will not yet be
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�able to reach -- to cover the debtal care of adults. We will cover
mental health benefits. We won·t be able to go as far as I, and
particularly Tipper Core, would 'like to go, but we will establish the
basic principle that a comprehenlsive benefits package must include
those services that not only tra;ditiOnall Y have been left out of
insurance policies, but which w~ know will save us money if they are
included.
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We also believe that the comprehensive benefits package
that is available has to be truly accessible. It will do very little
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good if we give every American a health security card -- (Side one of
tape ends; Tape two begins) --iunless we take steps to ensure that
every American has access to the care he or she needs when that
occasion arises. So we will bel looking to provide the kind of
infrastructure in our public health and private health systems that
will make the delivery of care ~vailable to every American.
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, It is very important that we think about how
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system that we want to see developed will look to the point of view
of the patient or the provider) as many of you happen to be. Many of
us in this room will be accused in the next months of being policyI
wonks. I was in .this committee room the other day and at least one
member of the Congressional Bl~ck Caucus who is sitting up here
drilled me with five of the mo~t technical questions anybody has
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asked me ever. They were terrIfically specific, tough questions that
need to be answered. They welk wonk questions, as we say.
But when we go out to talk to our friends and neighbors,
when the members of Congress ~ohome, what people are going to want
to know is what does this do to me? How am I going to get to my
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doctor? How am I going to get the care that I need? And we have
tried to build on the system that is most familiar to most Americans.
Host Americans currently get ~heir health care at their work place if
they are insured. We intend to build on that.' Most Americans sign
up for a health insurance policy. We intend to expand on that, so
,that instead of your emPloyer/ determining what policy you will have,
the consumer will choose the ,policy that you wish to have.' You will
be the one making the choice /among the health plans in your region.
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It is similar t6 what we in the federal system currently
have. Those in Congress and/who work for the federal government are
members of a big health alliance -- the Federal Health Benefits
Croup. And every year,thosf who are in the system get a list of
what plans they should sign ~p for and then they make their choices.
Some plans might cost a litt'le bit more or a little bit less. Your
doctor may be in one insteadl of the other. Your doctor may change
from year to year so you ca~ follow him from place to place. But your
make the choice. M::: t '. Whit we want for every American.
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As it currently stands now, most employers who provide
insurance make that choice for ~he employees. 'And increasingly
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because of the pressure on costs, the choices have become more and
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more limited. So we intend to preserve choice in health plans •. And
contrary to some of the ads tha~ are currently running, that is one
of the major features of this h~alth care plan.
be~ieve
In addition, we
you can control costs in the
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health care system. Those of you who are in it know that better than
the rest of us. Controlling th10se costs will take some changes in
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behavior and some different way,/s of doing things, but there are so
many examples that I could rec~te that I've heard or that you could
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recite back to me. There are examples in the Medicare and Medicaid
system, and there are examPles/in the private insurance system. We
. know what they are. We see them all the time.
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pr~gram
If any
you
the television
this morning
where we took some of the 700,000 letters that have been written to
the White House about health c~re concerns and picked out some
representative ones and peoplJ read their letters, you remember the
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woman who said she went in for the knee operation and she got the
bill from ,the hospital and th,y had charged her $2,400 for a pair of
crutches. , And she called up her insurance company and her insurance
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company said, nOh, don't worry about it. We already paid it." She
called up the hospital and th~y said, "It's too much trouble. We
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already paid it." And as this woman said, "Was the decimal in the
wrong place? Was $2,400 paid l for a pair of crutches, but it was just
too much of a bureaucratic pa1perwork hassle to get to the bottom of
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it because there's so much money coming into this system all the time
that we just keep paying the/billS and pushing it out the other.side.
And the reverse of that is that people who make
decisions about caring for patients are having their decisions
second-guessed all the time.1 It's gotten so that many doctors I know
feel like every time they want to order a blood test or some other
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diagnostic procedure, they deed to pick up the phone and call some
800 number to some insurancJ office to ask permission of whoever it
is that answers the phone. lAnd there's been some research done
recently that people who are the other end of those phones, bless
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their hearts, they're are cferical employees, no medical training -
they pullout a chart and they say, "Let's see, now. You're in St.
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Louis and you want to do a blood test? Well, I don't know. We're
not sure we can do that." I
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mean, that's the system that we currently have.
Anytime anybody tells you ~hat the changes we want to put into place
are going to create bureau6racy and regulations, say, give me a
break. We have the most b~reaucratic system in the entire world that
is wasting billions and billions of dollars. (Applause.)
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Now, there are .a.1n98 to be had, and 1 know that .ome
people are concerned about where' those savings will come from. But
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we believe there are savings in jboth the Medicare and Medicaid
systems and in the private insurance system, without undermining the
quality of care or the accessib~lity to care. But we will never get
to those savings if we don't st~rt to think differently about how to
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better organize and deliver car~ to all people.
Additionally, we htve to finance this system fairly.
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And we have fought long and hard about that. One of the features of
HR-1200 that Congressman conyer~ and Congressman Spratt referred to
would be to have some kind of btoad-based tax that would fund
government financed health carel. That is a way of doing it.
Everybody participates, everybofY pays the same taxes.
The President believes that i f we build on the existing
premium system and we control ~he cost of premiums, and we provide
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discounts to small businesses and low-wage individuals, we will come
up with a fair financing syste~ without transferring the entire
burden from the private sectorlto the government. That's a
difference in approach that we have with the single-payor approach,
but we're all trying to get to the same place: Fair financing;
everybody pays; everybody is responsible; and a health care system
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that is, therefore, fairly fun~ed to take care of everyone.
In addition, we Jhink we've got to ensure quality. All
of this is to enhance quality.1 'fhere's no point in reforming our
health care system if we don't enhance quality. We want report cards
on health plans. We want h!,!a~th,plans to start reporting information
so that U.S. consumers can make good judgments. And more than that,
we want providers to get back/into ,making those decisions about what
is or is not appropriate care; not the bureaucrat in the insurance
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companies.
Pennsylvania, fol example, has been collecting data on a
number of operations for a nukber of years. I knew nothing about
this when I started, and I'vel,been fascinated at how some states and
local governments have tried Ito figure out what actually certain
kinds of medical care costs within the same general jurisdiction. In
Pennsylvania, for example, alcoronary bypass might cost $20,000 in
one hospital or $80,000 in another hospital.
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,Pennsylvania har gone a step further. It's looked at
quality outcomes. Do the people who get the $80,000 operation get
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better faster? Are they back on their feet sooner? The answer is
no. But very often, high prices don't equate with good quality.
They may not make a differenbe at all. Too often in our own
mentality people go to the, d'octorwho's got the fanciest office
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because they think that's the best quality doctor.
drives the biggest car.
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Or the one who
What we need to do Js to translate 900d quality
information into a format where aiverage folks like you and me can
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understand it so we can make better choices. And we need to keep
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track of quality indicators -- I~ a certain kind of procedure working
or not working? -- so that doctors can make decisions based on what
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they know exuded in 900dresearch.
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These kinds of principles about security and savin9s and
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simplifyin9 this system and ensuring quality and providing choice
among health plans and providers~ and makin9 sure that we finance it
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thorou9hly and everyone is responsible -- those are the bedrock
principles of what any reform heklth care plan has to achieve. Now,
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are there various routes to get ,there? Yes,. there are. People have
proposed different kinds of appr:oaches. And part of what the next
couple of months of debate will Ibe about is gettin9 down into the
hard work of determinin9 how an~i particular approach would actually
work and whether it's an approach that would be politically feasible
in the United States Con9ress oi in the nation at b'rge.
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But if we continuelto stress the principles-- and even
beyond the principles" if we keep in our minds the pictures of the
hundreds and thousands of peopl~ who need us to make 'these changes, I,
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am confident we can work out the details. Once we agree on the
principles, we can work out th~ detai~s. And I think weare, as a
nation and within this body of Icon9ress, movin9 tow~rd agreement on
the principles.
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I want to complim~ntthe Senate Republicans for the
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proposal they put forward yesterday., They, too, talk about reachin9
universal coverage. They, too; talk about a benefits package. They,
too, have a mandatory way of financing it. They choose to go throu9h
an individual mandate with a s6bsidy for poor people. We don't think
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that's the best way, but therej'S room for conversation back and
forth. We are at least all in the same ballpark.
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,You know, in the !last week' or two I've. g?ne 'back and
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I've read some of the editorials and some of the wr~t~ngs that faced
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us when Franklin Roosevelt introduced Social Security. And I've 90ne
back and read what was said wfien Medicare was proposed. My goodness,
the end of the world was upon/us. (Laughter.) There was no way this
great country would survive if we did somethin9 as radical as Social
Security. And, oh, 'heavens tb Betsy, there'S no way the,medical
system would survive if Older) people had access to medical care
throu9h Medicare.
We're always 90in9 to have the. naysayers.
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We're always
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~~;~: ~~ ~::: :::: ::~:~:y:~~ !;:t-I~: f~:i:~·b~U!~:e~:;r.::.~;.:!:a!~d
don't want to see any changes in it. But those people are becoming
an increasingly minor note in th~s whole symphony about change.
(Applause. )
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What we have to do together is what I'm reminded of when
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I look over and see our friend, Marie Constance Webber, one of the
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Faces of Hope that we were priviteged to meet along the campaign
trail. What we have to do together is to not lose hope thatthia
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will be accomplished. . To stick J the principles that we believe in
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and to hammer out the details together. To raise all the hard
questions among friends that we have to raise to make sure that what
~: ~~ ;~~~t;or~~n !:a!~:et~: ~:~:e~;po~~:n~fo~;e~~i~~~t,W!!~ ~~ :~rk?
approach this debate in that sp~rit, there will be no turning back
the tide of change.
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It is one of the most unique moments in history --.and
we had another one just at the ~eginning of this week. I have to
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confese, as I sat there at the ceremony at the White House watching
those two men who represent such ancient enemies commit themselves to
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working toward peace, overcoming hatred and division, and even
shaking hands, that I thought to myself if that is possible, then
health care reform is a cake wa1lk. (Applause.)
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But we cannot get/there without your counsel, your
constructive criticism, your outreached hands, your heart, your help.
And then when we do accomplish/what we have set out to do, to ensure
that no American ever again will be left out because of their
inability to afford health car~ in this country, we will have such a
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sense of accomplishment, because we will have taken one step more
toward making this country what it ought to be.
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Thank you all very much.
END
HORE
(Applause.)
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Lissa Muscatine - Press Office
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Lissa Muscatine
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1993 - 1997
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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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