Mr. President, I ask unanimous consent that remarks by Ralph Neas be printed in the Record. The being no objection, the material was ordered to be printed in the Record, as follows: Remarks of Ralph G. Neas, CEO of the National Coalition…
Mr. President, I ask unanimous consent that remarks by Ralph Neas be printed in the Record.
The being no objection, the material was ordered to be printed in the Record, as follows:
Remarks of Ralph G. Neas, CEO of the National Coalition on Health Care,
the Special Otis Bowen Lecture, University of Notre Dame, March 26,
2009
Thank you. It is truly an honor and a privilege to be here
with you today as a participant in the Otis Bowen lecture
series.
I want to express my appreciation to Dr. Mark Walsh for
inviting me, and commend all the conveners and hosts of this
gathering. I congratulate Indiana University and the
University of Notre Dame for the collaboration that brought
IU's medical school to the Notre Dame campus.
I want to especially thank Otis ``Doc'' Bowen, the 44th
Governor of Indiana, and the Secretary of Health and Human
Services during the Reagan Administration. His leadership,
commitment to the public interest, and his contributions to
Indiana and the Nation are exemplary and should serve as a
model for us all to emulate.
Dr. Bowen, both Dr. Henry Simmons, the visionary founder
and president of the National Coalition on Health Care
(NCHC), and former Governor Robert Ray of Iowa, the Co-Chair
of NCHC, send their warm regards. Dr. Simmons was one of
President Richard Nixon's top health care advisors in the
early 1970s and worked on the Grace Commission which in the
1980s found that one-third of all income taxes were consumed
by waste and inefficiency. He has devoted his professional
life to improving health care for all Americans. And Governor
Ray worked with Dr. Simmons and you many times over the past
several decades. I am so proud to be working with them.
Our timing is propitious. Indeed, the conveners of this
event were prescient. We gather tonight at an extraordinary
moment in history: The Nation is facing the worst economic
crisis in more than seven decades and Americans urgently need
a better health care system; our health care system is
dysfunctional and represents an unsustainable drain on our
economy as a whole. It is inefficient and inequitable; urgent
action is required to systematically address what is an
incredibly challenging and morally troubling policy problem
affecting every American.
In short, the health care system in the United States is in
desperate need of significant reform. However, we should
emphasize at the beginning that we need an American solution.
We can and should borrow from the best of what works
elsewhere. But we should recognize our unique history and the
special characteristics of the American people.
The good news is that the President and Congress are
seriously considering health
care reform. In fact, in just the past month we have seen a
presidential address to a joint session of Congress, a
presidential budget, and a presidential summit, all
prominently featuring systemic, systematic health care
reform. In addition, the Senate and House of Representatives
have already commenced comprehensive hearings.
We must succeed. Too much is at stake: the health and well-
being of millions of American families, and the future of the
Nation's economic and fiscal health. Also at stake, I
believe, is whether we can help restore the trust and
confidence of the American people in their government.
So I cannot imagine a better time for us to be having this
conversation. And I couldn't be happier that it is happening
here. The University of Notre Dame, and people connected to
Notre Dame, have been central to my life in more ways than I
can count.
I was a student here during the 1960s. As a young person I
had watched on television as Bull Connor turned dogs and fire
hoses on civil rights marchers. I had watched Martin Luther
King champion human dignity in the face of bigotry and
violence.
Early on, I wondered whether I had a vocation to the
priesthood, but I found in Dr. King and the Kennedys an
inspiration to public service as a different kind of
vocation. And that brought me to Notre Dame. Father Ted
Hesburgh became the first of many Notre Dame role models,
teachers, and mentors who have sustained and guided me ever
since.
The last time I spoke at Notre Dame was about 25 years ago,
in 1983. I was just a short time into my tenure as executive
director of the Leadership Conference on Civil Rights, and I
was asked to address a conference for Catholic laity on work
and faith in society sponsored by the U.S. Conference of
Catholic Bishops. I believe, like the late Senator Phil Hart
of Michigan, that politics can be a high vocation--that a
politician can be a lay priest of society.
In preparing for that speech, I realized that I had learned
about human dignity and equality before God from my church
and my family long before I learned about the legal principle
of equality under the law from my college and law school
professors. Those principles have guided my life's work and
are central to what I am here to talk about today.
Another principle that has guided my political life is
bipartisanship. I had the extraordinary good fortune to work
for two remarkable Republican senators early in my public
service career--Edward W. Brooke of Massachusetts, and David
Durenberger of Minnesota. They were politicians and public
servants who were less interested in ideology and political
positioning, and more interested in moving the Nation
forward, in finding workable solutions to the Nation's
problems. They weren't just willing to work across the
partisan aisle; it was central to who they were.
These principles were at the core of my decision last month
to accept the position as CEO of the National Coalition on
Health Care. After I decided to step down as president of
People For the American Way, I had spoken with many other
health care coalitions and institutions. But I had a keen
personal and professional interest in working to achieve
health care reform in the most non-ideological and most non-
partisan way possible. And I was impressed by what a great
fit there was between the National Coalition and my skills,
background, and approach to public policy.
The National Coalition on Health Care is the largest,
broadest, most diverse coalition working to achieve
comprehensive health care reform. It is an alliance of 79
organizations representing business, unions, health care
providers, associations of religious congregations,
minorities, people with disabilities, pension and health
funds, insurers, and groups representing patients and
consumers. Our member organizations represent more than 150
million Americans. They speak for a cross-section, and a
majority, of our population.
Our board includes Frank Carlucci, who served several
Republican and Democratic presidents in a range of
intelligence, national security, and ambassadorial positions,
and Israel Gaither, the National Commander of the Salvation
Army. It includes John Sweeney, the president of the AFL-CIO,
and William Novelli, the CEO of AARP. It includes John
McArthur, dean emeritus of the Harvard Business School,
Cheryl Healton, President of the American Legacy Foundation,
and John Seffrin, CEO of the National Cancer Society. These
are organizations and leaders who individually play a major
role in our society and in public policy making. Together
they represent an extraordinary breadth of expertise and
resources.
The Coalition is rigorously nonpartisan. Former Presidents
George H. W. Bush and Jimmy Carter are our honorary co-
chairs. Former Iowa Governor Robert Ray, a Republican, and
former Congressman Bob Edgar, a Democrat from Pennsylvania
are its co-chairmen. We believe it is essential to make
reform a bipartisan process and a bipartisan achievement.
I am especially proud of two of the pillars of the
Coalition.
One of those pillars is religious organizations. The U.S.
Conference of Catholic Bishops is a member of the National
Coalition on Health Care because the Catholic tradition
affirms that access to health care is a basic human right and
a requirement of human dignity. The Catholic bishops are
joined in that belief, and in our coalition, by the Salvation
Army, the Religious Action Center of Reform Judaism, the
Presbyterian and Episcopal Churches, the United Methodist
General Board of Church and Society, and the National Council
of Churches.
The backing and active participation of these religious
communities gives us access to their networks of local
religious leaders and lay people. We are well equipped to
engage policymakers and the public on the moral poverty of
leaving millions of Americans without access to quality
affordable health care, and on the moral urgency of tackling
that problem.
Another especially significant pillar of our coalition is
the medical societies, which together represent hundreds of
thousands of doctors. They include the American College of
Cardiology, the American Academy of Pediatrics, the American
College of Surgeons, the American Academy of Family
Physicians, and the American College of Emergency Physicians.
Also included are the American Dental Education Association,
the Duke University Medical Center and Johns Hopkins
Medicine. And just yesterday the Association of American
Medical Colleges, along with the Council of Teaching
Hospitals, joined our Coalition. This is a very serious brain
trust of physicians, medical educators, and their advocates.
During the last major health care reform effort in 1993 and
1994, many of the medical societies opposed that effort. But
they working with us now, I think, for several reasons.
First, the need for reform has become increasingly obvious
and urgent to everyone who cares about making sure that
people have access to quality health care. Second, I believe
that doctors have a better view than anyone of the current
system's problems, inefficiencies, and distortions. I
remember a time in the 1980s when a rallying cry from
conservative pundits was ``let Reagan be Reagan.'' Part of
what we're trying to accomplish here is to ``let doctors be
doctors!'' More than just about anything else, doctors
want to practice medicine.
Also, this year, everyone has been invited to the table. My
own experience tells me that is how lasting progress is made.
In the early 1980s, I was selected to lead the Leadership
Conference on Civil Rights, the Nation's oldest and largest
civil rights coalition. Working with Republican and
Democratic leaders, with business and labor and public
interest advocates, we accomplished great things. The passage
of the life- and culture-changing Americans with Disabilities
Act. The strengthening of every major civil rights law with
huge bipartisan congressional majorities, and often with the
support of the business community.
That could only be accomplished by building active
alliances across party lines, engaging business and nonprofit
leaders, public officials and community activists. We had to
find ways to address each community's needs with a pragmatic
and principled eye on the ultimate goal of advancing the
common good.
The members and board of the National Coalition on Health
Care understand that all the elements of our health care
system are interdependent. So are the health care sector and
the broader economy. That is why any solution must be
systemic and system-wide if it is to be meaningful and
effective.
And that's also why reform must be accomplished now.
Let me make a case for urgency by discussing the nature of
our health care problem.
There is no question that our system produces and includes
extraordinarily gifted medical professionals. I am alive
today because 30 years ago I had access to some of the best
medical care the world has to offer.
But millions of Americans do not have affordable access to
that care. Indeed, nearly 50 million Americans do not have
health insurance--a number that grows with every layoff, or
with every employer who cuts health coverage to avoid cutting
jobs. Every 2 years, some 90 million Americans go without
health coverage. Another 20 million are underinsured.
What does that mean to individuals and families? It can be
disastrous for their physical and financial health.
People without insurance--or without sufficient insurance--
are less likely to get preventive care that will keep them
healthy. They are less likely to go to a doctor when they
become ill. Their serious illnesses are diagnosed when they
are more advanced and harder to treat. They put off
treatments they need but cannot afford.
And when they do face serious injury or illness, the cost
of treatment can be devastating to their families.
There are a lot of numbers and statistics that we use to
analyze and describe the current state of our health care
system. One that really leaps out to me--that is especially
heartbreaking--is that currently one-half of all personal
bankruptcies, and one half of all foreclosures, are caused by
an inability to pay medical expenses.
Think about what that means.
Thousands and thousands of families, already traumatized by
serious illness or tragic accident, are punished even
further. They go through a medical crisis and are forced into
a financial crisis. They say good-bye to a loved one--and are
forced out of their home. And there is no telling the toll on
communities of citizens who are sidelined--or worse--by a
condition that could have been treated less expensively and
more effectively if the cost of care had not kept people
away.
These are not just tragic stories. They are evidence of an
unforgivable level of cruelty in our current health care
system.
And, of course, all these consequences are not limited to
the uninsured and underinsured. The consequences are shared;
the burden is shared, by everyone. The costs of emergency
room care for the uninsured are shifted to other parts of the
system, to other payers. According to a study by Emory
University health care economist Kenneth Thorpe, the cost of
providing uncompensated care to uninsured patients adds more
than $1,000 per year to the average cost of employer-
sponsored family coverage.
And that leads us to the second part of the problem we must
address--the staggering cost of health care in this country,
which is growing in ways that Americans and America cannot
afford.
The cost of insurance is an increasingly heavy burden even
for those who have it. Over the past decade, employers and
workers have seen their health care costs rise 120 percent.
On the other hand, wages only increased 34 percent during the
same period (while inflation rose 29 percent). The average
cost to families rose from just over $6,000 per year to
about $12,000 per year. That is a huge amount for many
middle class families. It is an insurmountable burden for
working families.
And unless we act, it will only get worse. Richard Johnson
and Rudolph Penner of the Urban Institute projected that in
2030, out-of-pocket health care costs will consume more than
35 percent of after-tax income for older married couples.
That is more than double the 16 percent that health care
costs took from those couples in 2000.
As a Nation, we spend $2.5 trillion in health care costs
every year. That is a sixth of our national economy, or about
$6,000 per capita. That is twice as much as the average of
all industrialized countries, and 50 percent more than the
next Nation on the list. (And remember, those countries cover
all their citizens, while 15 percent of Americans have no
coverage at all.)
Costs have been consistently rising at a much higher rate
than the consumer price index. We as a Nation simply cannot
afford double-digit growth in health care costs year after
year. They make it harder for businesses to provide health
care coverage for their employees--and those employees find
it harder to pay the growing share they are asked to
contribute to that coverage.
The increasing cost to small and large businesses is a dire
challenge to their profitability, competitiveness and
survival. It drains funds from research and development,
makes it more expensive to hire new employees, and makes it
less affordable to offer workers increased wages. Increasing
costs undermine the viability of pension funds. And they
increasingly put American businesses at a competitive
disadvantage to companies abroad who have much lower health
care costs.
And the fiscal drain to state and federal governments is
ruinous. It has been estimated that by 2050, Medicare and
Medicaid combined will consume more than double their current
share of our gross national product. Our country's financial
health--as well as that of individuals, families, and
companies--requires that we get costs under control.
Closely connected to the problem of runaway costs is the
national epidemic of substandard care. It may be hard to
believe, but every year 100,000 Americans die from
preventable medical mistakes. Another 100,000 die from
infections contracted in U.S. hospitals. Millions of others
are injured or affected, with cascading consequences for
their families, their employers, their communities. It has
been estimated that preventable health care accidents,
errors, and poor quality of care are the Nation's third
leading cause of death after cancer and heart disease.
A few years ago a major study by the RAND Institute
examined the medical records of thousands of patients from 12
metropolitan areas and evaluated the care they received using
indicators of quality developed by specialty expert panels.
They found that patients got about 55 percent of recommended
care. We should not be willing to accept or tolerate this
mismatch between standards and actual practices.
And here is more evidence of the interconnected nature of
these problems. Two different research studies have estimated
that dealing with defects in the quality of our health care
could reduce the total cost of health care by 30 percent. 30
percent. That's $750 billion per year. That is a huge
financial incentive to deal with the quality of care and the
waste and inefficiencies of our current system.
So that is the outline of the health care challenge we
face--uncontrolled costs, unacceptable quality of care, and
unconscionable lack of access to care for millions of
Americans.
Acting urgently is both a moral and financial imperative.
The current economic crisis is putting more families out of
work, putting greater strain on companies that struggle to
provide health care, and putting enormous fiscal strains on
Federal and State budgets.
President Obama has called for lawmakers to take action
this year. In response, some pundits and critics have
suggested that the Obama administration is putting too much
on its plate--that it should hold off on health care reform
while it figures out how to deal with the financial crisis.
But that is not possible. Health care is such an enormous
part of the economy, is so interwoven with individual,
corporate, and governmental crises, that it is not possible
to address our economic woes without taking up health care
reform. We have reached the point where the public's most
pressing domestic concerns--economic growth, jobs, and
retirement security, and health care--are fundamentally
intertwined. The first three concerns cannot be addressed
effectively unless health care costs are contained. The cost
of doing nothing far exceeds the costs of taking action now.
And if we implement real systemic reforms now, we will save
trillions of dollars in the long run.
As economist Peter Orzag says, the road to fiscal
sustainability runs through health care reform. Ben Bernanke,
the chairman of the Federal Reserve System, puts it this
way:
``The decision we make about health care reform will affect
many aspects of our economy, including the pace of economic
growth, wages and living standards, and government budgets,
to name a few . . . As the public interest in these issues
testifies, the stakes associated with health care reform,
both economic and social, are very high.''
So, act we must. But how?
It is easy to be dismayed at the size and complexity of the
problem--and by past failures to address it. But we cannot
shy from reform. Nor can we let a political stalemate grind
the process to a halt.
I am a veteran of many difficult battles in Washington.
I've been part of them for 35 years. And I've never seen a
bigger challenge, substantively or politically.
But I am cautiously optimistic about the possibilities for
real reform this year. There exists a rare confluence of
economic, political, and historic circumstances. There is a
much broader consensus on the need for ambitious reform. And
we are seeing all the stakeholders coming to the table, not
with the goal of turning the table over and maintaining the
status quo, but to seek some kind of resolution to the
systemic problems that can no longer be denied or
rationalized away.
That's what the National Health Care Coalition is committed
to doing this year.
And, I'm proud to say, we're ready because we've already
done our homework. I've been talking a lot about the problem.
Let's talk about the solution.
The Coalition spent 18 months working with our board,
member organizations, and health care experts to reach a
consensus on principles and specifications for reform.
There's no more detailed or comprehensive proposal on the
table that I'm aware of.
The overarching requirement is that reform be both systemic
and system-wide. With that as an understanding, we have laid
out five principles for reform and specific and achievable
approaches within each category.
The first principle is coverage for all Americans. We
believe coverage should be defined clearly and
comprehensively. It should include emergency care, acute
care, prescription drugs, oral health care, early detection
and screening, preventative care (including smoking cessation
programs), care for chronic conditions, and end-of-life care.
There should be no exclusion for pre-existing conditions.
We recognize a range of options--and possible combinations
of options--can be used to achieve this goal: employer
mandates, supplemented with individual mandates as necessary;
expansion of existing public programs that cover subsets of
the uninsured; creation of new public programs targeted at
groups of the uninsured; or establishment of a universal
publicly financed system.
Participation must be universal, and there must be
subsidies provided for those least able to afford coverage.
But none of these options requires a government-run system.
The second principle is cost management. The numbers that I
talked about earlier make it clear that it will not be
possible to achieve sustainable reform without tackling the
cost issue head-on.
Cost management must be a multi-faceted undertaking. It
should include: a plan to make health insurance premiums
easier to compare by requiring insurers to establish separate
premiums for the core benefit package and any supplemental
coverage; a rational mechanism for increasing the cost-
effectiveness of capital spending; cost-sharing and other
tools to provide more and better information and incentives
for patients to make good choices about health maintenance
and care, and reduce over-use and under-use; an increased
emphasis on prevention and early detection of disease; a
commitment to improving quality of care; investment in a
health care information infrastructure; and steps to
modernize and simplify the administration, and dramatically
reduce the administrative costs of the health care system.
It is true that successful reform of all the areas we have
talked about will produce significant long-term savings. But
it is also essential to begin immediately to bend the cost
curve and slowing those double-digit increases that are
outstripping our ability to pay for them. The increases in
health care costs and insurance premiums for the core package
of benefits should be brought into line with percentage
increases in per-capital gross domestic product. And we
should aim to achieve that goal within 5 years after the
enactment of legislation.
There must be short-term cost constraints that would
include rates for reimbursing providers for care encompassed
by the core benefit package, and limits in increases in
insurance premiums for the core benefit package. We are not
advocating for cuts in reimbursement rates. But slowing the
rate of increase is vital--and will reduce the likelihood of
sudden cuts made under the stress of financial crisis.
We recommend that these efforts to manage costs be
established and administered by an independent board
chartered and overseen by Congress.
The third basic principle is one I just mentioned in terms
of cost containment--that is a national effort to improve the
quality and safety of care.
This includes accelerated development of a national
information technology infrastructure, as well as increased
emphasis on prevention and early detection of disease, and
research on comparative effectiveness and practice guidelines
to reduce waste and improve the safety and effectiveness of
health care.
The members of the National Coalition on Health Care
recommend that national practice guidelines be developed by
panels of leading health care professional based on reviews
of research on the effectiveness and impact of technologies
and treatment. Conforming to these best practice guidelines
could not only reduce unnecessary treatment and costs, but
could also help protect medical professionals against
frivolous or marginal lawsuits.
Fourth, we must make the financing of health care more
equitable and reduce or eliminate cost-shifting.
Again in this area we have identified a range of mechanisms
that could be used, individually or in some combination, to
fund the costs of necessary reforms and assuring that every
American is covered: general revenues, earmarked taxes or
fees, required contributions from employers, required
contributions from individuals and families, which would
include co-payments, deductibles, and contributions toward
premiums.
Subsidies should be provided, or financial obligations
varied, based on relative ability to pay for less affluent
individuals, families, and employers.
And fifth, we must simplify the administration of health
care. The United States spends more than any other Nation--
hundreds of billions of dollars every year--to administer our
health care system. Administrative expenses incurred by
private health insurers rose 52 percent between 1999 and
2002.
Our system's complexity is not only expensive; it is also
confusing and frustrating for patients and doctors. And its
lack of transparency undermines both accountability and the
ability of individuals and organizations to make market-based
decisions.
Assuring coverage for all Americans, and establishing a
core benefit package, would create a consistent set of ground
rules for patients, providers and payers.
An integrated technology infrastructure would not only
reduce administrative complexity and costs, but help to
reduce medical errors, protect patients' safety, and improve
outcomes.
These principles--coverage for all, cost containment,
quality and effectiveness of care, simplified administration,
and equitable financing--are interdependent. And we must deal
with them that way.
Taken together, the National Coalition on Health Care
specifications provide an ambitious and achievable guide to
our Nation's lawmakers. We know what investments and policy
changes we need to make now in order to improve access and
quality of health care in a way that the Nation can afford.
We have a road map. Now we need to keep policymakers
focused on the journey.
President Obama, who recently hosted a bipartisan summit on
health care reform at the White House--has urged Congress to
give him reform legislation this year. He has put a
significant down payment for reform in his budget.
While I do not think the Administration has yet been
ambitious enough--dealing, for example, in a realistic way
with the need to contain costs--I believe the White House has
learned important lessons from the experience of 1993 and
1994. They are including all stakeholders from the beginning.
They are putting forward broad principles and counting on
Congress to write the legislation. And they are moving in a
bipartisan fashion, inviting Republican and Democratic
congressional leaders into their conversations.
I believe bipartisanship is essential not just because we
need 60 votes in the Senate, but because a bipartisan
consensus would be good for the country as we move forward in
this enormous, and enormously important, undertaking.
We must understand fully that time is our most formidable
foe. We must achieve health care reform now, not only to
protect and advance Americans' health, but to shore up our
reeling economy. We must take advantage of the political
momentum for change. We must overcome those who might be
tempted to see the failure of reform as a political
opportunity.
Reform must be enacted this year--and as of today the year
is already almost one-quarter behind us.
In Congress, there are at least seven major committees that
have some jurisdiction and will be involved in crafting
reform legislation. That means multiple subcommittee hearings
and markups, full committee markups, House and Senate floor
debates and votes, and the House-Senate conference committee.
All of this takes time. As I tell my law school legislative
process classes, there are 100 decision-making points in the
legislative process, and each of them is a point at which
compromise can take place.
If we are to have reform enacted this year, we must have a
bill through the Senate with a bipartisan consensus by Labor
Day. So each day is enormously consequential. We have no time
for ideological warfare or partisan posturing. This truly is
a time for pragmatism to trump ideology. We need to be
focused on what works. And we cannot allow the perfect to be
the enemy of the good.
We can do this.
A few years ago, my father-in-law was in Rome. He was at
the Vatican when he collapsed with a heart problem. He was
attended to by the Pope's doctor--the finest care he could
have asked for. And when he had recovered and asked how much
he owed, the answer was ``nothing!'' His health care in Italy
was free. I know it's a simple story, and our quest for an
American solution is anything but simple, but there's no
reason we cannot achieve the same kinds of access to
affordable quality care that other nations provide.
There is another story that explains why I am so committed
to making this work--and why I have faith that it can.
In 1979, as a young man of 32, I was diagnosed with
Guillain-Barre Syndrome, a disease that paralyzes the nerves
and muscles. Over a period of weeks I became completely
paralyzed, unable to breathe on my own or move a muscle. I
was put on a respirator for 75 days, and was eventually given
general absolution when it was not clear that I would
survive.
Three of my doctors in St. Mary's hospital in Minneapolis,
Minnesota, were Notre Dame graduates, including chief of
staff Pat Barrett, who was the football team's doctor on the
road. They helped me survive and recuperate. But no one was
more important than my mother, who traveled to Minneapolis
from a suburb of Chicago and sat at my bedside, holding my
hand, for 50 of my first 100 days in the intensive care unit.
And then there was Sister Margaret Francis Schilling, a nun
who had survived Guillain-Barre 25 years earlier, and who was
celebrating her 50th anniversary as a nun in 1979, who talked
to me every day, who prayed with me every night, and who
helped save my life and renew my faith.
You can probably understand why, when given the opportunity
to be transferred to the Mayo Clinic, I told my parents that
I wanted to stay at St. Mary's. Sometimes the appearance of
near-mystical serendipity trumps all other considerations.
The experience taught me many things, most notably how
vulnerable each of us is, and how dependent we are on each
other. I had been a young hot-shot on a fast track
congressional career. I thought I could do anything. As long
as I worked hard and never gave up, I would not need anybody.
I learned the hard way how wrong I was. I learned first-hand
how quickly our lives and health can take a turn. I came out
of that experience with a renewed commitment to public
service, and with a sense of how interdependent different
vocations--like Sister Margaret's, my doctors', and mine--
could be.
After I finished my physical rehabilitation, and recovered
my physical and mental stamina, I began interviewing for
jobs. My parents, Senator Brooke, and Senator Durenberger
were all advocating that I join a law firm and begin a more
traditional way of life.
In the middle of my deliberations, John Sears, a Notre Dame
grad, a lawyer, and the former campaign manager for Ronald
Reagan, gave me contrary advice. He told me that I could join
a law firm at any time. But the Nation in 1981 was about to
begin a historic debate about civil rights, social justice,
and the role of the Federal Government. He told me that if I
had an opportunity to have a leadership position, I should
seize the moment. He told me how important it was to be on
``the front lines of history.'' Only then could you make a
dramatic difference for your family, your community, and your
country.
And that is the opportunity and the challenge that we all
face at this moment.
The great Irish poet Seamus Heaney has written:
History says, Don't hope
On this side of the grave.
But then, once in a lifetime
The longed-for tidal wave
Of justice can rise up,
And hope and history rhyme.
We all have a chance, working together, to make hope and
history rhyme.
Regardless of where you stand on the health care issues
before us, I urge you to get involved. This is a time for all
of us--of whatever vocation--to come together. We must all be
willing to sacrifice for an accomplishment that would address
a great moral failing, that would strengthen our Nation's
economy as well as its social fabric, that could point the
way toward dealing constructively with other systemic
challenges ahead.
I hope you will support the principles of the National
Coalition on Health Care. But the most important thing, in
the words of Oliver Wendell Holmes, is to ``share the passion
and action'' of one's time.
Please do not sit on the sidelines. Immerse yourself,
passionately, in this historic moment.
Please know how much it has meant to me to be here. I am
profoundly grateful for the opportunity to be with you
tonight.
Thank you.