Bill Clinton Gives Speech in San Francisco About America's Health Care System

Saturday, April 14, 2007 -- Looking dapper in a gray suit and purple tie, Bill Clinton walked onto the stage in the cavernous Bill Graham Civic Auditorium. Thousands of people in the not quite sold-out hall rose for a standing ovation punctuated with whistles and cheers. Clinton said he was glad to be back in San Francisco, and it was clear that San Francisco was delighted to have him.

He spoke briefly about his work internationally with HIV/AIDs, then settled into the main part of his talk, about troubles at home. He said there were three systemic and interrelated challenges that needed our attention.

The first challenge is that economic growth in the United States only benefits about half of the people. Despite the growth, there was an increase in the number of people who lost their health insurance, and an increase in overall inequality.

The second challenge is energy. The United States contains 4% of the world's population, but emits 25% of the world's greenhouse gasses. Clinton did say, as an aside, that Californians use only 55% as much energy as the average American. That, of course, made the California audience happy, though Clinton did say he thought we could do even better.

The third challenge is health care. It's connected to the other two problems because our health is affected by the food we eat and the air we breathe.

Clinton said our health care system is "immoral" because it doesn't cover everyone. He said it is "perversely, wildly uneconomical" because we spend more than anyone else. And he said the system is "sowing the seeds of its own destruction" because while it is "great about treating sickness, it is lousy about keeping people well," and we will end up with too many people who are ill.

He then gave a rapid-fire presentation of facts and figures:

We spend, he said, 16% of our gross domestic product on health care, more than any other country. The next highest countries are Switzerland and Canada, which spend about 11%. The difference for us between 16% and 11% would be 800 billion dollars.

84% of Americans have some form of health insurance. In every other developed country, that figure is 100%.

The U.S. ranks 37th in health care outcomes among all developed countries, and 34th in life expectancy.

34% of U.S. health care dollars are spent on administrative costs. The next highest country spends 19%. If we spent 19%, we would save 300 billion dollars. "We let the health care financing tail wag the health care dog," he said. It's a decision we have made as a country. So it is one that we can change.

He discussed the value of electronic medical records, and the problem of malpractice insurance rates, and he mentioned some possible solutions.

Lifestyle issues, he said, are key, particularly the related problems of diabetes and obesity. He said acting now would be "like turning the Titanic around before it hits the iceberg."

During the election races, he said, we are going to be hearing a lot about different ways to get to universal health care, but in reality there are only a few options.

The bottom line is we have to cover everyone, we have to bring costs into line with our competitors, and we have to have lifestyle changes.

That ended his 45-minute talk. One of the broadcasters from KCBS came onto the stage to moderate the Q&A session, which was based on pre-selected questions. The first question he asked Clinton was when he thought we were going to get out of Iraq, and how.

Clinton talked about how he hadn't believed that Saddam was an imminent threat, but that the U.N. believed Saddam had biological and chemical weapons that were unaccounted for at the time the inspectors were kicked out.

He said that it was generally assumed that the vote of Congress had triggered the war, but that wasn't so, that Bush would have gone to war anyway, and that the vote was not, as commonly believed, a war resolution. It was only supposed to kick in if the inspections failed, which, in fact they did not. Just the opposite -- Bush pulled the inspectors out in order to start the war. (Although Clinton didn't say so in so many words, the purpose of this part of his answer appeared to be to defend his wife's controversial vote on the resolution.)

The KCBS guy interrupted Clinton and repeated the question about when and how we are going to get out.

Clinton said that you can't make something like this work, although what you could do is minimize the number of people who died. (And he mentioned, in passing, that his deepest regret as President was not going into Rwanda.)

He said the problem in Iraq won't be solved until people decide that they can better solve their problems with politics than with bullets. He said it is "imperative that this year there be a substantial draw down of American troops."

The KCBS guy again interrupted, saying something about the time being short and trying to steer Clinton to another question.

Clinton drew himself up and pointed his finger at the moderator, warding off the interruption. On the jumbotron screens on the stage, it looked like a giant twenty-foot tall finger wagging. "You made a decision," he said, "at a health care conference to ask me this question -- and I am going to finish."

He said we shouldn't abandon the Kurds. Though he wanted to terminate military operations, he thought we should leave a residual force nearby. If the Sunni section of Iraq were to collapse, he said, then the locus of terrorism could shift from the Warziristan regions of Pakistan to the Sunni areas of Iraq.

The talk ended with a couple of quick questions about whether he still goes to McDonald's (only twice in the last six years) and what he thinks about saving Medicare (he recommended letting early retirees buy in to help stabilize the system).

Other events at the symposium were 17 panel discussions on health topics, two halls full of exhibits, and free health screenings. This was the third year that KCBS radio put on the symposium, called "Health etc." California Pacific Medical Center and Walgreens were sponsors.