Donna E. Shalala, U.S. Secretary of Health and Human Services
November 17, 2000
The American Spirit
Being here today, I'm reminded that, at the turn of the last century, historian Carl Becker wrote that the Kansas spirit is the American spirit -- double distilled. The spirit Becker spoke of is the spirit of rugged individualism and restless imagination ... of self-reliance and selflessness ... of good will and good faith ... and that sustained George Washington Carver when he homesteaded here in Ness County. It's also the spirit inherent in the state motto of Kansas that tells us, "To the stars through difficulties."
I can think of no one who better personifies this true American spirit than the person we honor in this lecture series, Alf Landon. The unassuming Landon demonstrated that spirit when he modestly described himself as "an oilman who never made a million ... a lawyer who never had a case ... and a politician who carried only Maine and Vermont."
Landon also demonstrated that spirit -- in the words of another former Kansas governor, John Carlin -- "by not being a partisan." For example, while Landon undertook the daunting challenge of running against Franklin Roosevelt in 1936, he also supported many of FDR's views on the role of government. Running under the campaign slogan of "Life, Liberty and Landon," he succeeded in getting his party to go along with many of the New Deal's social welfare programs, to recognize the rights of labor unions, and to support civil rights.
And when the 1936 race was over, Landon -- who actually coined the phrase "New Frontier" -- also demonstrated the true spirit of America by equanimity -- and good humor. In a frequently played snippet of a radio interview, he dryly observed that the most remarkable aspect of his 1936 defeat was "the completeness of it all." And he liked to add that "as Main goes, so goes Vermont." He even gave his grandchildren two ponies, and named them "Maine" and "Vermont," for the only states he had won in the presidential contest. As Landon once explained to an interviewer, "With me, politics was not a vocation, but an avocation."
Alf Landon not only set an example -- he also set a benchmark for politicians who want to be both great and good. I can't help but wonder what Alf Landon would have made of our last two weeks of political excitement and uncertainty. One thing I know for sure is that the pragmatic, good humored and fiercely independent Landon would have agreed with another pursuer of the impossible -- the Man from LaMancha. The main message of Don Quixote is that the most important thing is what we do after we decide. That is certainly true for America in the 21st century.
Because I believe that no matter who we elect as our presidents throughout this new century -- regardless of their politics or parties -- they must be guided by a vision that recognizes that the common good is the highest good. It's a vision that Alf Landon who, in the words of President Reagan, "was motivated by a genuine desire to help his fellow man," would have supported. And when it comes to health care, it's a vision that requires that we meet five challenges.
First, we must focus on the problem of the uninsured. Today, over 42 million Americans, including 10.5 million rural residents and 11 million children, still have no health insurance. When this administration took office, our original goal was to insure all Americans at one time. This turned out to be politically unfeasible, not because Americans don't believe that everyone should have health insurance. They do. There is just simply no consensus on how to do it. Experience taught us that the best way to achieve universal coverage is to get political agreement -- step by step -- on first, the problem and second, the solution.
Thanks to the leadership of Senator Kassebaum and her colleague Sen. Kennedy, we began by making health care portable. Now, changing jobs or having a pre-existing condition doesn't mean losing health insurance coverage.
In 1997, the President and Congress worked together to fashion the States' Children's Health Insurance Program, or S-CHIP. The program was designed for families who earn too much for Medicaid ... too little to afford private insurance ... but just enough to fall through the cracks. Working in partnership with the states, almost 3 million children -- more than the entire population of the cornflower state -- now have good health insurance.
More recently, Congress and the President made it possible for millions of Americans with disabilities to join the workforce -- and access the American dream -- without fear of losing their Medicaid or Medicare coverage. Similarly, children who age out of foster care can now keep their Medicaid coverage until they're 21.
Yes, we've made very important progress over the last eight years, helping the uninsured get health care. And I'm happy to say that, for the first time in a decade, the number of Americans without health insurance has declined! In 1999, 1.7 million more Americans had insurance than in the previous year. Still, as a nation, when it comes to health care for all, we still have miles to go to ensure that no one is left behind, left out or left on the sidelines ... and to ensure that the poet was right when he said, "America is a willingness of the heart."
Of course, as we work to help the uninsured access health care, we must also work to eliminate racial, ethnic and geographic health disparities. That's our second challenge. Comedian Chris Rock once said, "Why should I pay taxes? I won't get the money until I'm 65. Meanwhile, the average black man in America dies at 54." Behind the joke lies a tragedy. Consider this: If you're an African-American woman, you're over 20 times more likely to be diagnosed with AIDS than a white woman. If you're an American Indian, your rate of diabetes is three times the national average. If you're a Chinese American, you are four to five times more likely to have liver cancer.
While in rural American, more than 20 million citizens have inadequate access to health services ... 10 percent of all rural hospitals closed in the 1980s ... and while only 25 percent of our nation's children live in rural areas, they account for 85 percent of all oral or dental disease. We may have the finest health care system in the world, but too many of our citizens enjoy less years in their lives ... and less health in their lives.
When it comes to improving health, America can never move ahead, if anyone is left behind. We've worked hard to lift the shadow of health disparities that fall across minority communities, as well as to close the gaps between urban and rural areas. My department's Office of Rural Health Policy is spsecifically working to improve access to primary care and preventive services in rural America through a range of programs. For example, over the past decade the office has provided incentives for medical professionals to work in rural areas ... it has supported relevant research on rural health services ... and it has awarded over 170 million in grant funding for demonstration projects that served more than 300 rural communities, and improved health care access for at least 2 million needy rural citizens. Additionally, my department's National Advisory Council on Rural Health, which is chaired by Sen. Kassebaum, recently issued a set of guidelines to help ensure that rural concerns are included in any debate on reforming the Medicare program.
These are significant accomplishments. But we all know that there's still much that needs to be done. And while we're working to close the gaps, we also need to ensure the highest quality health care for all Americans. That's our third challenge. Americans know that our health care system has no equal. They know that we have some of the finest doctors, medical schools and science in the world. But they know that it's not the best for everyone, everywhere, everyday. Patients want to see a specialist whenever needed. They want to know all medical options. They want to go to an emergency room when necessary. They want their medical records kept confidential. That's why we must continue to press for a strong, enforceable Patient's Bill of Rights -- a Bill of Rights that will ensure access, choice, privacy and recourse against shoddy care for everyone. It's what health care needs -- and what patients want.
Patients also want their medical privacy protected. That's why I will soon issue the very first federal privacy regulations for all health care records. The guiding principle is that health care information can only be used for health care purposes.
But ensuring health care quality is much more than a patients bill of rights or privacy regulations or any single measure. At its crux, quality is doing the right thing, for the right person, at the right time, and in the right way.
Four years ago the Health Care Quality Commission, created by the President and co-chaired by myself and the secretary of labor, identified three overall problems. Above all, there are simply too many errors being committed. The Institute of Medicine's report on medical errors -- To Err is Human -- indicates that between 50,000 and 100,000 hospital patients in the United States annually die from medical errors. It's the eighth leading cause of death in this country.
Additionally, there's a great deal of over and under utilization of health care services. For example, about 80,000 women get unnecessary hysterectomies every year, while an estimated 180,000 Americans die because they don't receive beta blockers after their first heart attack. Finally, as I discussed earlier, there's a tremendous variation in national, regional and local health care services offered in this country.
If we want to ensure an America where the common good is the highest good, then we must ensure the highest quality health care. Similarly, we must also ensure that no American is denied access to the miracles of modern medicine. That brings us to our fourth challenge: reforming our Medicare program for the elderly and disabled.
The difference that Medicare has made in the lives of the elderly and disabled reminds me of a story about the famous author, Somerset Maugham. Maugham was asked to address a group on his 80th birthday. When the author was introduced he began by saying, "Old age has many benefits." And he suddenly stopped. Maugham looked around. He fidgeted. He sipped some water. At last he said slowly and dryly, "Old age has many benefits ... I'm just trying to think of some."
Maugham was trying to be funny. But when he made that remark some 50 years ago, there was a sad ring of truth in his words. Old age meant poverty. Old age meant disability. And old age meant going without health insurance. In 1964, only 50 percent of seniors had insurance for hospital care. By improving access to health care, financial security and overall quality of life, Medicare -- which Alf Landon supported -- changed all of that.
But a program designed for the 20th century needs to modernize for the 21st century. We need to improve its delivery, and we need to update its benefits. No one would create a Medicare program today without including the one benefit that has become an essential element of high-quality medicine: prescription drugs. Medications are as important today as hospital care was in 1965 when Medicare was inaugurated. They can prevent, treat and cure illness. And their prudent use can help older Americans not only avoid doctor visits, but even lengthy hospital and nursing home stays. But 13 million seniors, including 50 percent of all rural beneficiaries, have no prescription drug benefit. We need a 21st century drug plan that is voluntary, accessible and affordable. It must provide meaningful protection and bargaining power for seniors, offer competitive prices and be easy to administer through the private sector. And it must maintain, strengthen and further Medicare's historic promise of providing the best health care available for America's seniors.
Our fifth -- and final -- challenge is to keep our science strong, but our ethics stronger. From the human genome to vaccine research to food safety, this century's blockbuster discoveries will come from American scientific genius, but only if it continues to receive support and assistance from policymakers, Congress and future administrations.