Remarks to the American Association of Physicians From India in Chicago, Illinois,
June 30, 1995

Thank you so much, Dr. Khedkar. Thank you, Dr. Ahuja. And thank you, Dr. Lalmalani, for that terrific speech. I was just sitting here watching you speak with such energy and enthusiasm. And I was thinking to myself, I hope he stays in medicine and out of politics until I’m through. [Laughter] Dr. Rupani, thank you for welcoming us to Illinois. To my good friend, B.K. Agnihotri, it’s good to see you, and out of the South, where we normally see each other. We’re delighted here with the presence of the Indian Health Minister, Minister Antulay. Thank you very much for coming from such a long way. And I am especially delighted to see the Indian Ambassador to the United States, Mr. Ambassador Ray. Thank you so much. Thank you. We’re delighted to see you.

As I think all of you know. I have been very interested in education and in health care for a long time. But I must say I was certainly humbled when young Dr. Ambotti was introduced at 17 years old. Then it was whispered in my ear that his brother became a doctor at the ripe old age of 19. [Laughter] Is that right? There he is. He was so old he hardly had any years left to practice at 19. [Laughter]

That’s remarkable. You know, when I was elected Governor at 32, they said I was too young. [Laughter] When I was a college professor at 26, they said I was too young. When I was elected the third youngest President at the age of 46, they said I was too young. Where were you guys when I needed you? [Laughter] Well, your families and your friends and, indeed, all of us should be very, very proud. And congratulations to you, to both of you.

I know that Hillary would want me also to say, since I am the one doing the speaking today, that she and our daughter Chelsea had a magnificent time on their trip to India and, indeed, throughout South Asia. As I said to your board of directors a few moments ago, they came home ladened with photographs, with films, with books, with all kinds of gifts. You could go to some places in the White House and some corners, and all of you would think you were back home. You would not even recognize—[laughter]—that you were in the President’s residence.

But it was a remarkable experience for her, a transforming experience for our daughter, and a great learning experience for me by extension. I can also say I am very, very proud of the strengthening relationships between the United States and India since I have been President. We have been fortunate, thanks to the end of the cold war, to be able to bind these two great democracies more closely together, to support the economic reform efforts in India, to support a closer political relationship, to look toward a 21st century in which together we can advocate freedom for all the peoples of the world, and all the peoples of Asia in particular.

I also want to say I am deeply indebted to the Asian-Indian Americans who are serving in our administration. I cannot name them all, but I would like to mention Arati Prabhakar, who is the Director of the National Institute of Science and Technology, something important to all of you; Dave Sharma, who heads the Research and Special Programs Administration at the Department of Transportation, both of them have done a fine job; Dr. Sam Shekar, a member of AAPI, who’s the Director of the Health Care Financing Administration’s Practicing Physicians Advisory Council—we need more advice from practicing physicians and less from bureaucrats—and Niranjan Shah, who is here, is on the Goldwater Scholarship Foundation. There are others, but I want to thank all of you who have contributed to this administration.

I want to thank the AAPI for many things, for all the work you do, which your leader has already outlined, the work you have done in our country, the work you have done in India. But most recently, I am indebted to your association for your support of the nomination of Dr. Foster to be the Surgeon General. I thank you for that very much.

I think many of you could identify with him in many ways but perhaps most important that he was a man who had spent almost 40 years doing what other people talk about doing. He had brought health care to people who would not have had it otherwise. He had delivered thousands of babies. He had trained hundreds of doctors. He had actually looked many troubled young people in the eye and told them that they should stay off drugs, they should stay in school, they should not have sex, they should be against teen pregnancy, they should start a better life for themselves.

He had actually done these things. And a lot of people who condemned him, I think, missed a terrific opportunity to give a real practicing physician a chance to change the lives of more young people in America. You saw that. You stood by him. And I will never ever forget it. I thank you very much.

I also want to thank you for something else, something more profound that you do every day, many of you without even knowing it. I ran for President for two reasons. One, I thought our country was drifting and not facing the challenges of the moment and that we were at risk of raising the first generation of Americans to do worse than their parents, when it was not necessary. So I wanted to restore the American dream of economy and prosperity for those who work hard.

Second, I thought our country was on the edge of either becoming the greatest country in the world for the 21st century again or being divided in ways that will weaken us. The enormous racial and religious and ethnic diversity of America is the meal ticket of the United States to the future if we can come together, instead of permitting ourselves to be divided by those who seek short-term political advantage from the differences among us. And I want this country to pull together. And I want you to lead the way.

It is obvious that both these objectives become imperative when you consider the realities of the world we face. We are no longer divided by the cold war. The geopolitical realities of India from time to time forced you and the United States to make decisions which divided our two great democracies because of the cold war, even though we were both democracies. The end of the cold war means that we don’t have to divide the world up in that way anymore. The dawn of the information age and the technological revolution means that people can move ideas and technology and funds around the world in a split second, that all of us can move more rapidly than ever before.

Therefore, this is a time of enormous human potential. But it is also full of challenges. It is full of economic challenges, because the global economy means that if America wants to continue not only to be a wealthy country but to have everybody able to work hard and be rewarded, that all those people that live within our borders now must compete with people beyond our borders. It means education is more important than ever before. It means personal productivity is more important than ever before. It means the strength of a family’s work habits are more important than ever before if we want to lift all Americans up, because now we are not isolated behind our own borders.

That is why so many Americans are frustrated today. They see our economy growing, unemployment is down, 6.7 million new jobs. But still more than half of our working people are working longer work weeks without getting a raise, under the pressure of the global economy. So that is the irony of America. We have more new businesses in the last 2 years than at any time in our history. We have more new millionaires in the last 2 years than at any time in our history, and most people stuck in a rut. So our challenge is to keep all these good things going and lift the rest of Americans who are in the rut out of it.

The same thing is true—[applause]—thank you. The same thing is true about making the most of our diversity. The cold war is over. That means we don’t have to worry about nuclear annihilation. For the first time since the dawn of the nuclear age, there areno Russian missiles pointed at Americans, no American missiles pointed at Russians. Our space ships linked up yesterday; many of you must have seen it on television. How exciting it was. But when you take the heavy hand of authoritarianism away, you see the horrible conflict in Bosnia, where centuries old religious animosities flare up again today once there is no Yugoslavia run by a Tito to control people. Even in Russia, as it becomes more democratic, you see the ethnic fighting in a place like Chechnya consuming the energies of the nation and threatening the values of the nation.

And in our country, with no iron hand of fear of something outside us to keep us together, you see now resurgent religious and ethnic differences manifesting themselves even across the United States. This is folly. We must find a way to live together, sharing the values of the American Constitution, respecting our different religious heritages, our different ethnic heritages, our different racial heritages. We have counties in the United States now with more than 100 different ethnic groups. Los Angeles County now has 150 different. And I say good; this is good for America. This is a good thing if we can use it to come together. It means we can trade with every country in the world. It means some of us can speak to people in every place in the world.

What other nation could have done what we did in Haiti, liberating them from the long night of dictatorship, and doing it by putting 200 Americans in military uniform on the ground in Haiti to speak Creole because they were Haitian-Americans? That’s the great thing about this country.

We are a land and we are a set of ideas and convictions. We are not a single ethnic group. That is the magic of our democracy. We are a land and we are a single set of convictions, rooted in the simple but powerful words of our Constitution and its Bill of Rights, and our devotion to freedom and to competition and to openness. That is our meal ticket to the future. That is what will make it possible for us, not only to succeed economically but to live in harmony, if we can be faithful to it. And that has been the purpose of my Presidency.

Now, what I want to say to you today is to echo a few words that your leader just spoke. We are having a great debate in the United States today, largely because we are at the end of the cold war, largely because we are in a new economic time, largely because all these changes have forced Americans both to change the way they live and work and to try to think of how we should organize ourselves into the future.

And there are many people in the Nation’s Capital who believe something that I think a lot of you do not believe. And that’s one of the reasons I’m here. They say—and many of them who disagree with me would use you as an example, a good example—they would say all of the problems in America today are personal problems, individual failures; they are cultural problems. Why, if everybody would just wake up tomorrow and work hard and have a good family, we wouldn’t have any other problems. And they would say if they were here arguing, they would say, look at all those Indian doctors and their families, who come to our country: many people come to our country without any money at all, and they become very successful. Why? Because they work like crazy and they have good family values and they transmit them to their children. And I agree with that. I mean, I agree with that. By definition—you know, no one can become anything just because someone else gives them something. We all have to work and build ourselves inside. That is true; at one level that is true.

But then they take another step. And that is the debate in Washington with which I do not agree. The next step is if all of our problems are personal and cultural and can be solved by people working harder and having stronger families, we, therefore, have no problems that are economic, political, and social. And therefore, there is nothing for us to do together. No public response required. No governmental action required. Now, that is what I don’t agree with.

Our country became the strongest in the world after World War II and grew the biggest middle class in the world after World War II because we recognized that our challenge was both personal and public. And when the soldiers came home after the Second World War and built the America thatmany of you wished to come to, they did it because the Congress passed something called the GI bill of rights, which enabled them to go to school, to buy a home for the first time, that gave us over two-thirds of our people owning their own home, something unheard of in virtually any country in the world, because there was public action. So we had personal responsibility and public action.

When you go out and practice medicine to people who don’t have any way to see a doctor, unless you see them and you get paid because of Medicare or Medicaid, that’s personal responsibility by you and public action by your country. And so what I say to you is that this debate, which I, too, want you to be a part of, about the future of health care, is one facet of this huge debate we’re having in America today about how we’re going to organize ourselves for the future.

And I believe America should come down firmly on the side of saying, yes, we have to have more personal responsibility and family strength, but we also need to face our problems together, because we cannot solve the education problem unless we solve it together. We cannot solve the crime problem unless we’re all willing to make some sacrifices to solve it together. We certainly cannot solve the health care problem if we let every individual in America go his or her own way. We’re going to have a lot of older people and a lot of innocent children in dire straits in America. We need to do some things together. That is the way we’re going to succeed in the 21st century, by working together.

On health care alone, let me just make a few observations. We have a big problem in America with our budget deficit. You all know that. What I want you to know is just how big a problem it is and where it’s located. Our budget would be in balance today but for the interest we pay on the debt we ran up in the 12 years before I became President. It would be in balance today. Not only that, it’s still such a big problem that next year the interest we pay on that debt will be larger than our defense budget.

We have not increased anything much in our budget in the last few years except Medicare and Medicaid had been growing at two and three times, sometimes more than three times, the rate of inflation. Part of that is because more people have been going onto the program. Part of that is because as older people live longer and longer and longer, they have to access medical services more and more, as many of you know.

But the truth is, if we are going to have money in the United States Treasury to invest in education, to invest in technology, to invest in medical research, something you all believe in, we are going to have to reduce this——

[At this point, the sound system malfunctioned.]

Did it come on? Is it on? What about now? Can you hear me in the back?

Audience members. Yes!

The President. Someone said, no, and I’m sure glad. [Laughter] Well, anyway, I’ll talk louder, and we’ll do the best we can. Something happened to it. I didn’t touch it. It just happened. [Laughter] Eventually they’ll get it back.

If we’re going to do this, we’re going to have to bring that deficit down, which means as Dr. Lalmalani said, we’re going to have to change the way we do health care. But there is a huge difference in making a deliberate change over a reasonable period of time and just cutting the budget out of Medicare and Medicaid to meet an arbitrary date to balance the budget for an arbitrary huge tax cut to a lot of folks who don’t need that as much as they need a country with good health care, strong education, safe streets, and a balanced budget.

What I want to say to you is, yes, we will have to slow the growth of Medicare and Medicaid, but we should do it in a fair way. If you balance the budget in 10 years instead of 7, if you have a much smaller tax cut and you target it to the things we already said we believed in, child rearing and education, if we involve the physicians and other health care professionals in our country in making the decisions instead of just making arbitrary cuts in these medical costs, we can get where we need to go as a country and still provide decent health care and still provide a good quality of life and not divide our people evenfurther by income and by region and by race. Now, that’s what we can do.

A lot of you know this because of your own practice, but if we cut too much without understanding the circumstances, we will isolate more elderly people, we will isolate more racial minorities, we will disadvantage more young children who will suffer intellectually because of the health care they don’t have when they’re very young. So this is a very important part of rebuilding America.

[The sound system produced a loud feedback sound.]

Better none at all than that. [Laughter]

So I say to you, in the next 4 or 5 months, we will chart a major part of America’s health care course for the future. And my commitment to you is, I will work with you. I do not want to see these decisions made without working with you. [Applause] Thank you.

But keep in mind, the health care debate is an example of the larger debate I talked to you about. And you can have a huge impact on Members of Congress in both parties if you simply show up and say, "Look, I know America first and foremost is a place where individual effort and family values count. That’s why I am successful. But I live in the real America, not in Washington, DC. And I know we need a public response to society’s problems if more people are going to become like me." That’s what I want you to say to the Congress. And you can do that.

And then I want you to be involved. And I want you to say, don’t wait until the day before you pass this budget to point out what the changes will be in Medicare and Medicaid. Let’s say it well in advance. Don’t wait until one day or two days or even a week before and then jam it through. Let’s say right now, if we’re going to cut Medicare and Medicaid projected expenditures by the amount you say, what changes will be made in Medicare and Medicaid. Then let us tell you—I don’t want anybody to get hysterical or angry or anything—let us tell you what the consequences of those changes will be. And then let’s work together to do something that is good for America. We should do what is right here.

And it is not necessary—I will say again—it is not necessary to dramatically undermine Medicare and Medicaid. It is not necessary to hurt defenseless children or elderly people who don’t have enough to live on as it is to balance the budget. We do not have to do that. It is certainly not necessary to undermine the medical practice. It is not—also, it is not necessary to undermine the integrity of the doctor-patient relationship. It is not necessary.

And I certainly agree with you. I think—I am all for managed care plans if people voluntarily join them and if every physician who is willing to meet the requirements of the plan has a chance to practice to maintain choice for consumers.

So I want to make this point again. This budget debate, because it’s part of a larger social debate, can empower all of you as citizens far beyond voting, contributing to candidates, being active in political campaigns. This budget debate can empower you because every one of you can be heard by your Member of Congress. And you can say, "I accept what you’re saying that our problems require harder work, more discipline, stronger families. But it is not enough. It also requires us to work together. And I want to be heard in the health care debate. And I want you to enable America to balance the budget and meet its responsibilities to bring us together and move us forward." If you’ll do that, I’ll be grateful.

Thank you, and God bless you all.

Note: The President spoke at 1:35 p.m. in the Sheraton Chicago. In his remarks, he referred to Dr. Nanda Khedkar and Dr. Satya Ahuja, convention cochairmen; Dr. Gopal Lalmalani, national president; Dr. Prem Rupani, president, India Medical Association of Illinois; B.K. Agnihotri, chancellor, Southern University Law Center, Baton Rouge, LA; Indian Minister of Health and Family Welfare A.R. Antulay; and S.S. Ray, Indian Ambassador to the U.S. This item was not received in time for publication in the appropriate issue.