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04/08/99
THU
14:09
FAX
001
Commencement Speech
Christy
First Lady Hillary Rodham Clinton
Harvard Medical School
June 4, 1998
Thank you. Thank you very much. Thank you, Dr. Martin, Dr. Federman, Dr. Donoff, I am
delighted to be here. I want to thank the class for extending this invitation to me. I have, as you
might expect, attended numerous commencement cercmonies in my lifetime and I must say I
have never attended one where we've already heard so many good speeches. We could quit right
now and feel that we had been in the presence of some extraordinary young people who imparted
some rather significant words of advice, and even wisdom to us. I want to commend to co-
moderators, Dr. Bryant and Dr. Somers, for this commencement ceremony (applause) and I want
to thank the student speakers. I want to thank Dr. Cook for not only reminding us that it's done,
Mom and Dad, but for showing extraordinary composure while speaking in the course of having
a helicopter take off in the background. I want to thank Dr. Babagbemi for her eloquent
description of On-Call, but even more for her understanding of what the requirements are for one
who has been blessed with the kind of education and gifts that she has on behalf of humanity.
And I want to thank Dr. Mitchell for reminding us that in life it is competence, and confidence,
and compassion that separate us as human beings from mere technicians.
Each of these student speakers has already set the stage for the graduation of this extraordinary
class. This class comes with, I'm sure, a range of emotions that we can only guess at--
exhilaration and exhaustion among them. But also, as we've already heard, a lot of gratitude for
the opportunities that they have been given. They also deserve gratitude from us for undertaking
the rigorous education which they have, for pushing themselves to the limits and now for going
into the world ready to use their talents and their education on behalf of the rest of us.
They have made many sacrifices. More than 70 percent of this class had to take out loans to
complete the degrees that they receive today. They will be paying back those loans for a number
of years, and I hope that we as a nation will continue to look for ways to provide financial
support to students such as these so that they do not have to go into the debt that these young
graduates have. (Applause) Some of these graduates, these new doctors and dentists, are the first
in their families to attend college. Some have completed their educations while they were caring
for their own families. Some are recent immigrants to our country. More than 15 percent
managed to earn additional degrees, and all of them have worked extremely hard. They deserve
this celebration by family and friends, and by alumni of these institutions who are gathered here
to pay you credit. I hope that each of you feels the competence and the confidence that you've
already heard described, because I can imagine that as you think about your new futures you've
got some questions in your mind. You're thinking about the next chapters of your lives.
Now, I don't think the food wherever you're going will be as good as the restaurants on Newbury
Street. The sleeping accommodations are not going to be exactly five-star ones. You know where
you're going, it's called internship or specialty training. As we've already heard that means a lot
of hard work and not very much sleep. And some of you in the dark of night when those beepers
go off or those phone calls come may ask yourselves, 'My goodness, am I ready for all of this?'
04/08/99 THU 14:09 FAX
002
Based on what I have learned about your class and your preparation, I think the answer is very
clear you certainly are. You are more than prepared to enter the world of medicine and
dentistry and serve your patients.
I was very impressed by the oath that the class has written, which you'll find at the end of your
program. That oath describes very well what this class of extraordinary young men and women
are committing themselves to doing. No group of new doctors and dentists has ever been better
prepared to care for their patients. No group has ever been better prepared to help us usher in the
next century, the next millennium of medicine. From the clinic to the classroom to the
community you have received a first-rate education from one of the finest schools in the world.
We've already heard about the extraordinary diversity in your class. If you think back for a
minute, a hundred or so years ago, to classes that also stood on the brink of a new century and
new discoveries, you can see starkly the differences. The doors of medical education were
virtually glued shut to women and people of color. Tuition here at Harvard was a couple of
hundred dollars and you didn't even need a bachelors degree to get into Harvard Medical School.
Until the 1870's, there were no written exams. And in fact, when President Elliott first suggested
them, there was an objection because many of the students couldn't write. Yet like you, the
students at the end of the last century had much to look forward to. When Oliver Wendell
Holmes spoke at the 100th Anniversary of the Harvard Medical School, he referred to some
things that never change, such as students sleeping in class. He noted that bleeding had almost
become an unknown procedure, and he celebrated the exciting advances in surgical anesthesia,
germ theory, and the microscope. He thought they would produce miracles that sounded as
though they would come straight from some new Gulliver's Travels.
That day that he talked, future physicians such as yourselves were staring down challenges like
cholera and typhoid. There were no antibiotics, no antiseptic surgery in America. The sanitation
conditions were horrible. But those young doctors and dentists, like you, were armed with
something very important called hope. The hope that they could write a new future for medicine
in the 20th century, and they did. Today, all of you stand on the shoulders of those Harvard
graduates and faculty who have coine before you and pioneered many of the advances that we
take for granted today. You stand on the shoulders of all the Nobel Laureates from Harvard who
have unlocked the secrets behind some of the world's greatest medical mysteries. Even today,
there are SQ many Harvard alumni here in the United States and around the world who are
working to unlock the secrets of cancer and research into sickle cell disease, working to rid the
world of AIDS and doing so much more. Now it is your turn to join them. It is your time to lead.
You've been given the chance to use your education and training during the most exciting time
ever in medicine.
Just think, who could have imagined even thirty years ago the revolutions in biology and
technology, to see change in demographics, and the shifts in the way that we fund the health care
system. All of these changes offer incredible opportunities and fundamental challenges. The real
challenge for all of you, it seems to me, is how in the midst of these truly revolutionary changes,
you can stay true to the oath you will take today to make, as you say, the health of my patients
my first concern. I know that many of you worry about this. I imagine there have been many
04/08/99 THU 14:10 FAX
003
conversations about what is happening in the health care system and how you will handle these
new challenges, how you will manage the business of medicine from compromising the
profession of medicine, how you will keep sacred the bond between patient, and doctor and
patient and dentist.
In that extraordinary oath you've written, I think that there is a pathway to the future, a pathway
that is not only one for you to follow, but for all physicians and dentists and lay people as well.
When you pledge today to promote health and prevent disease, you do so at a time when there
are extraordinary breakthroughs. You know all about them. Treatments for strokes and AIDS, the
potential to slow diseases like Alzheimers, computer technology allowing you to share lifesaving
information in real time, the mapping of the human genome that is revealing evolutionary secrets
as we discover genes that are linked to breast cancer, colon cancer, and Parkinson's Disease.
And yet, with all of these breakthroughs come some questions that each of us, and particularly
each of you, will have to address. For example, these kinds of advances don't just happen by
connert
accident or overnight. They are the result of sustained investments in research, especially in basic
science. That is why we all have a stake in supporting the President's proposal for a 21st century
research fund to increase our federal budget at NIH to historic levels. We should be increasing
our budget at NIH as much as we can, at least by 50 percent over the next five years. That would
give us the kind of investment that would enable you and your colleagues in the sciences to make
these breakthroughs real in the lives of your patients. I hope that all of us (applause) will make
clear that the United States must continue to be a leader in basic research and biomedical
research, and that the United States government must, at this point in our history, make the kind
of significant commitment that will enable us to move forward on the fronts that many of you
will work on either in the research labs or apply in your practices.
Now, these continuing advancements in research and treatment also challenge us to ensure that
our ethics keep pace with our science. We've all heard stories about people who are avoiding
critical tests that their doctors recommend, or refusing to use their insurance out of fear that they
will be discriminated against or have their privacy violated. It will do us little good if we
discover genes that cause breast cancer or colon cancer, but people are afraid to be tested to find
out if they have it because they worry that the information will cause them to lose their job or
lose their insurance. You should be able to look your patients in the eye and say 'information
about your genes will be used to heal you, not deny you a job or affordable health insurance.'
The President has asked Congress to pass legislation prohibiting the use of genetic screening
information to discriminate in health insurance and employment. The Congress should act to end
genetic discrimination now (applause) and you should be able to guarantee your patients the
privacy of their medical records.
At a time when personal health information is electronically criss-crossing the country, moving
among health plans, insurance companies, and employers with fewer federal safeguards than the
records of your video rentals, it is time to pass a law safeguarding the medical records and
information of every American. (Applause) When you take your oath and you pledge to respect
the dignity and autonomy of your patients in living and in dying, you make that promise in a
world of rapidly changing demographics. The baby boomers like me are graying. Americans are
04/08/99 THU 14:10 FAX
004
living longer with less disability. Now that is good news. It is what my husband likes to call a
high-class problem.
But, as with any nation whose population is aging, we face tough questions about how we will
provide and finance healthcare for this expanding group of older citizens. Think back. Before
Medicare was enacted, almost fifty percent of older Americans went without health insurance.
They found themselves often mired in poverty and chronic illness. People used to work their
entire lives only to enter their later years facing unthinkable choices between paying their heating
bills and their medical bills. We hear a lot of talk about what's wrong with government, but we
shouldn't forget about what we have done right. Medicare forever changed what it means to
grow old in this country and we have to make sure that it is there for generations to come. But
Medicare, like any program in the public or the private sector, must adapt to a new world. The
President worked in a bi-partisan fashion to extend the life of the trust fund as part of the
Balanced Budget Act of 1997. And the changes in Medicare included not only an extension of its
life, but more health plan choices and treatment options, and new prevention benefits like yearly
mammogram, and colo-rectal screening, and diabetes self-management.
There is now a consensus between Republicans and Democrats that we have to address the long-
term future of Medicare together. This should not be a partisan issue. Therefore, the President
and Congress have appointed a National Bi-partisan Commission on the Future of Medicare that
is scheduled to report in 1999. I hope that during the process of its deliberations and certainly in
reaction to its report that all of you, and all of your colleagues will make sure your voices are
heard, because we have to ensure that whatever changes are made are made in the best interest of
patients.
You will dedicate yourselves to the profession of medicine and dentistry at a time when
revolutions in our own health care delivery system are blurring the lines between payers, and
providers, and insurers. There are more than 160 million people enrolled in managed care plans,
an increase of 75 percent just since 1990. More physicians are forming their own health plans
and working to find new ways to share risks and control costs. There is, however, another
responsibility, that these new forms of care do not mean sub-standard care, that the bottom line
of profits never eclipses the bottom line of good medicine. And you have to be on the front lines
of ensuring that that occurs. Think about a recent statistic that came from a survey 1 read: 'Sixty
percent of Americans say they are worried, that if they were sick their health plans would be
more concerned about saving money than giving them the best treatment.' Physicians have been
on the front lines arguing against these, standing up for patients who have been denied treatments
that were recommended by their doctors. Physicians have spent countless hours on telephones
arguing with insurers to try to make sure that a patient got the care that the physician thought
necessary. We have to work to make it absolutely clear that it should be the medical professional
who determines treatment options, not a checklist administered from some office thousands of
miles away. (Applause)
Whatever kind of insurance plan any American has, that American should feel they will get
quality care. What better place to make that pledge than here at this graduation. Dr. Mitchell
Rabkin introduced the first Patients Bill of Rights here at Harvard hospital. Patients should never
04/08/99
THU
14:11
FAX
005
have to beg and plead to see a specialist they need. When an emergency arises they should get
the care whenever and wherever they need it. They should have a right to a fast and fair appeal
when they or their physician disagree with decisions about their care. Congress should pass a
Patients Bill of Rights to protect every American and pass it this year. (applause)
One of the most serious and unintended consequences of the changes in the financing and
delivery of healthcare in America is its effect on academic health centers like this one. You have
seen first-hand in your training what happens when new market forces squeeze academic health
centers. Now you have also been part of putting some good models in place here in Boston, when
managed care plans have joined forces with teaching hospitals. But the problem is one that is not
just the concern of Harvard or Harvard's graduates, but should be the concern of every
American. Because, just stop and think for a minute what our academic health centers have
meant to each and every one of us.
Academic health centers have many missions. But three of them, in particular, have helped to
make American health care the best in the world. The research mission of the academic health
center has not been replicated anywhere else and could not be. We are all grateful for the
extraordinary breakthroughs in research that have happened in the labs and clinics of academic
health centers, The mission of training young doctors, and dentists, and nurses, and other health
care professionals is also the province of the academic health center. And thirdly, the care for the
most vulnerable, whether they are vulnerable because they are poor and disadvantaged, or they
are vulnerable because they are sick and without hope, the academic health center has been there
as a place of last refuge.
Now those three missions: research, education and training, and uncompensated care for the
vulnerable, are not profitable missions. You rarely can make any money at all in the short-run,
and even the medium-run, in research. You certainly cannot make money off training young
physicians or dentists and you lose moncy when you open your doors to the most vulnerable.
Yet, in this brave new world of HMOs and health care agencies that look to the bottom line,
many academic health centers are being told, 'I'm sorry, we're not reimbursing you for these
functions which are not directly related to the patient care activities that we have listed in our
brochure. So you will not receive compensation for research, education, training. And you're just
going to have to send those poor patients somewhere else.'
That attitude fails to recognize that the reason American health care is so good is because we've
had the best research, education and training opportunities available of any country in the world.
If we squeeze out those functions, if we force places like Harvard to have to cut back on what
they do best, it is not only Harvard that will suffer, it is hospitals and patients throughout the
world. It is time for us to recognize that paying for those academic health centers and their vital
missions is in the best interest of us all. Historically, Medicare has borne a great deal of the cost,
paying directly and indirectly for graduate medical education. We should do everything possible
to continue Medicare and the federal government's commitment to academic health centers. But,
level we don't 5 them this
I believe it is also fair and appropriate for every health plan and every insurance policy to pay
something toward the maintenance of our academic health centers since we all benefit from the
work which they do on our behalf. (Applause) This is not one of those abstract debates that
04/08/99 THU 14:12 FAX
006
should only take place in Washington behind closed doors. It should be brought out in the light
of day. Those of you on the front lines of delivering high quality medicine, doing cutting-edge
research, and caring for the poorest and the sickest among us should make sure your voices are
heard.
Now, all of these issues I've just mentioned were part of the overall plan that was presented a
few years ago to reform our nation's health care system. Now clearly, that particular proposal
was not successful, but it is critical that we do not give up on what must still be done. Many
people ask me, 'Well, were you discouraged after the defeat of health care reform?' Well yes, I
was discouraged we didn't have the kind of debate that we should have had in Congress, so that
people in the country could have seen clearly what our true choices were. But, I also believe that
the debate and the effort was very important for America. We did educate ourselves about many
of the issues that you here at Harvard know so well. And we also learned that when the political
environment makes it impossible to take large steps in a direction you believe you must go, then
you have either the choice of taking smaller steps or sitting on the sidelines and doing nothing. I
come from the school of smaller steps. It is far better to try to make changes that will help at least
some people than to do nothing and help no one.
So, we've seen some progress since 1994. Thanks, for example, to the leadership of Senator
Kennedy here in Massachusetts, the Congress passed a bill prohibiting the loss of health
insurance just because of the loss of a job or a pre-existing condition. Now there are problems
with the implementation of that provision, but it is still an important step, and it is a value that
makes clear that we are moving toward ensuring that people are not wrongfully deprived of their
access to health insurance. We've also seen major legislation, the most significant since 1965, in
making it possible for uninsured children to have access to health insurance.
But, our job is far from done. We have 41 million people living without health insurance. You've
treated many of them in the hospitals where you've done your rotation and waited to be on call.
Who will take care of these people in the future? Who will ensure that they will be taken care of?
How will we pay for their care? And how will we pay for the extra costs that come when
someone is not treated for a chronic disease or turned away from the emergency room? The job
of health care reform in America cannot be done when any of our citizens' access to care
depends on the color of their skin, or the neighborhood they live in, or the amount of money in
their wallet.
Let's be clear. As a nation, we have to continue to work toward universal, affordable, quality
health care for every single American. (Applause) While all of us must continue to work toward
that day and we will do our part, it is going to be up to each of you who graduates today to
assume your place as one of the architects of this changing health care world. I'm afraid you
can't just be bystanders or kibitzers because you have the information and the experience that all
of us need. About 100 years ago, one of your predecessors said, "We are very glad to be in the
class of 1900 and not 1800, because we confidently believe we shall all witness greater triumphs
in the century now dawning." I hope each of you feels the same and I trust that in 100 years when
your successors look back at the class of 1998, they will say that, given the opportunity, you
went far beyond the instructions to do no harm at the patients' bedside. Instead, you worked in
04/08/99 THU 14:12 FAX
5
007
the service of your patients and humanity. And you worked to improve the system in which you
care for your patients.
I hope also that we'll be able to look back and see that just as medicine conquered bacteria in the
20th century that the 21 st will see the defeat of viruses; that chronic illness will be cured or
tamed; that so many of the problems we have seen in disease around the world will finally be put
at bay; that our grandchildren will have to look in history books to learn about the devastation of
cancer or AIDS. During a time of great change, there is always uncertainty about which direction
each of us individually will go and which direction collectively we will choose. We are at such a
point in your lives as you enter this system.
I am extraordinarily hopeful as I look out at these graduates, that the decisions will be made with
their guidance and expertise, and that the oath that they take today will be fulfilled in full
measure. Because after all, it is they who must ensure that above all, "the health of my patients
will be my first concern." We need your competence and your confidence, as we've already
heard. Even more, we may need your compassion--harnessed to that competence and confidence-
-and we will need your voices to ensure that what you know, what you see, what you experience
cannot be ignored as our nation debates what direction we take. And I'm confident that if we
follow your oath we will make the right decisions. Congratulations, good luck, and God speed.
End Oratory by First Lady, Hillary Clinton
060498A. WPD
Page 1
Commencement Speech
First Lady Hillary Rodham Clinton
Harvard Medical School
June 4, 1998
Thank you. Thank you very much. Thank you, Dr. Martin, Dr. Federman, Dr. Donoff. I am
delighted to be here. I want to thank the class for extending this invitation to me. I have, as you
might expect, attended numerous commencement ceremonies in my lifetime and I must say I
have never attended one where we've already heard so many good speeches. We could quit right
now and feel that we had been in the presence of some extraordinary young people who imparted
some rather significant words of advice, and even wisdom to us. I want to commend to
co-moderators, Dr. Bryant and Dr. Somers, for this commencement ceremony (applause) and I
want to thank the student speakers. I want to thank Dr. Cook for not only reminding us that it's
done, Mom and Dad, but for showing extraordinary composure while speaking in the course of
having a helicopter take off in the background. I want to thank Dr. Babagbemi for her eloquent
description of On-Call, but even more for her understanding of what the requirements are for one
who has been blessed with the kind of education and gifts that she has on behalf of humanity.
And I want to thank Dr. Mitchell for reminding us that in life it is competence, and confidence,
and compassion that separate us as human beings from mere technicians.
Each of these student speakers has already set the stage for the graduation of this extraordinary
class. This class comes with, I'm sure, a range of emotions that we can only guess at--
exhilaration and exhaustion among them. But also, as we've already heard, a lot of gratitude for
the opportunities that they have been given. They also deserve gratitude from us for undertaking
the rigorous education which they have, for pushing themselves to the limits and now for going
into the world ready to use their talents and their education on behalf of the rest of us.
They have made many sacrifices. More than 70 percent of this class had to take out loans to
complete the degrees that they receive today. They will be paying back those loans for a number
of years, and I hope that we as a nation will continue to look for ways to provide financial
support to students such as these so that they do not have to go into the debt that these young
graduates have. (Applause) Some of these graduates, these new doctors and dentists, are the first
in their families to attend college. Some have completed their educations while they were caring
for their own families. Some are recent immigrants to our country. More than 15 percent
managed to earn additional degrees, and all of them have worked extremely hard. They deserve
this celebration by family and friends, and by alumni of these institutions who are gathered here
to pay you credit. I hope that each of you feels the competence and the confidence that you've
already heard described, because I can imagine that as you think about your new futures you've
got some questions in your mind. You're thinking about the next chapters of your lives.
Now, I don't think the food wherever you're going will be as good as the restaurants on Newbury
Street. The sleeping accommodations are not going to be exactly five-star ones. You know where
you're going, it's called internship or specialty training. As we've already heard that means a lot
of hard work and not very much sleep. And some of you in the dark of night when those beepers
go off or those phone calls come may ask yourselves, 'My goodness, am I ready for all of this?'
060498A. WPD
Page 2
Based on what I have learned about your class and your preparation, I think the answer is very
clear -- you certainly are. You are more than prepared to enter the world of medicine and
dentistry and serve your patients.
I was very impressed by the oath that the class has written, which you'll find at the end of your
program. That oath describes very well what this class of extraordinary young men and women
are committing themselves to doing. No group of new doctors and dentists has ever been better
prepared to care for their patients. No group has ever been better prepared to help us usher in the
next century, the next millennium of medicine. From the clinic to the classroom to the
community you have received a first-rate education from one of the finest schools in the world.
We've already heard about the extraordinary diversity in your class. If you think back for a
minute, a hundred or so years ago, to classes that also stood on the brink of a new century and
new discoveries, you can see starkly the differences. The doors of medical education were
virtually glued shut to women and people of color. Tuition here at Harvard was a couple of
hundred dollars and you didn't even need a bachelors degree to get into Harvard Medical School.
Until the 1870's, there were no written exams. And in fact, when President Elliott first suggested
them, there was an objection because many of the students couldn't write. Yet like you, the
students at the end of the last century had much to look forward to. When Oliver Wendell
Holmes spoke at the 100th Anniversary of the Harvard Medical School, he referred to some
things that never change, such as students sleeping in class. He noted that bleeding had almost
become an unknown procedure, and he celebrated the exciting advances in surgical anesthesia,
germ theory, and the microscope. He thought they would produce miracles that sounded as
though they would come straight from some new Gulliver's Travels.
That day that he talked, future physicians such as yourselves were staring down challenges like
cholera and typhoid. There were no antibiotics, no antiseptic surgery in America. The sanitation
conditions were horrible. But those young doctors and dentists, like you, were armed with
something very important called hope. The hope that they could write a new future for medicine
in the 20th century, and they did. Today, all of you stand on the shoulders of those Harvard
graduates and faculty who have come before you and pioneered many of the advances that we
take for granted today. You stand on the shoulders of all the Nobel Laureates from Harvard who
have unlocked the secrets behind some of the world's greatest medical mysteries. Even today,
there are so many Harvard alumni here in the United States and around the world who are
working to unlock the secrets of cancer and research into sickle cell disease, working to rid the
world of AIDS and doing so much more. Now it is your turn to join them. It is your time to lead.
You've been given the chance to use your education and training during the most exciting time
ever in medicine.
Just think, who could have imagined even thirty years ago the revolutions in biology and
technology, to see change in demographics, and the shifts in the way that we fund the health care
system. All of these changes offer incredible opportunities and fundamental challenges. The real
challenge for all of you, it seems to me, is how in the midst of these truly revolutionary changes,
you can stay true to the oath you will take today to make, as you say, the health of my patients my
first concern. I know that many of you worry about this. I imagine there have been many
060498A.WPD
Page 3
conversations about what is happening in the health care system and how you will handle these
new challenges, how you will manage the business of medicine from compromising the
profession of medicine, how you will keep sacred the bond between patient, and doctor and
patient and dentist.
In that extraordinary oath you've written, I think that there is a pathway to the future, a pathway
that is not only one for you to follow, but for all physicians and dentists and lay people as well.
When you pledge today to promote health and prevent disease, you do so at a time when there are
extraordinary breakthroughs. You know all about them. Treatments for strokes and AIDS, the
potential to slow diseases like Alzheimers, computer technology allowing you to share lifesaving
information in real time, the mapping of the human genome that is revealing evolutionary secrets
as we discover genes that are linked to breast cancer, colon cancer, and Parkinson's Disease.
And yet, with all of these breakthroughs come some questions that each of us, and particularly
each of you, will have to address. For example, these kinds of advances don't just happen by
accident or overnight. They are the result of sustained investments in research, especially in basic
science. That is why we all have a stake in supporting the President's proposal for a 21st century
research fund to increase our federal budget at NIH to historic levels. We should be increasing
our budget at NIH as much as we can, at least by 50 percent over the next five years. That would
give us the kind of investment that would enable you and your colleagues in the sciences to make
these breakthroughs real in the lives of your patients. I hope that all of us (applause) will make
clear that the United States must continue to be a leader in basic research and biomedical
research, and that the United States government must, at this point in our history, make the kind
of significant commitment that will enable us to move forward on the fronts that many of you
will work on either in the research labs or apply in your practices.
Now, these continuing advancements in research and treatment also challenge us to ensure that
our ethics keep pace with our science. We've all heard stories about people who are avoiding
critical tests that their doctors recommend, or refusing to use their insurance out of fear that they
will be discriminated against or have their privacy violated. It will do us little good if we discover
genes that cause breast cancer or colon cancer, but people are afraid to be tested to find out if
they have it because they worry that the information will cause them to lose their job or lose their
insurance. You should be able to look your patients in the eye and say 'information about your
genes will be used to heal you, not deny you a job or affordable health insurance.' The President
has asked Congress to pass legislation prohibiting the use of genetic screening information to
discriminate in health insurance and employment. The Congress should act to end genetic
discrimination now (applause) and you should be able to guarantee your patients the privacy of
their medical records.
At a time when personal health information is electronically criss-crossing the country, moving
among health plans, insurance companies, and employers with fewer federal safeguards than the
records of your video rentals, it is time to pass a law safeguarding the medical records and
information of every American. (Applause) When you take your oath and you pledge to respect
the dignity and autonomy of your patients in living and in dying, you make that promise in a
world of rapidly changing demographics. The baby boomers like me are graying. Americans are
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living longer with less disability. Now that is good news. It is what my husband likes to call a
high-class problem.
But, as with any nation whose population is aging, we face tough questions about how we will
provide and finance healthcare for this expanding group of older citizens. Think back. Before
Medicare was enacted, almost fifty percent of older Americans went without health insurance.
They found themselves often mired in poverty and chronic illness. People used to work their
entire lives only to enter their later years facing unthinkable choices between paying their heating
bills and their medical bills. We hear a lot of talk about what's wrong with government, but we
shouldn't forget about what we have done right. Medicare forever changed what it means to grow
old in this country and we have to make sure that it is there for generations to come. But
Medicare, like any program in the public or the private sector, must adapt to a new world. The
[
President worked in a bi-partisan fashion to extend the life of the trust fund as part of the
Balanced Budget Act of 1997. And the changes in Medicare included not only an extension of its
life, but more health plan choices and treatment options, and new prevention benefits like yearly
mammogram, and colo-rectal screening, and diabetes self-management.
There is now a consensus between Republicans and Democrats that we have to address the
long-term future of Medicare together. This should not be a partisan issue. Therefore, the
President and Congress have appointed a National Bi-partisan Commission on the Future of
Medicare that is scheduled to report in 1999. I hope that during the process of its deliberations
and certainly in reaction to its report that all of you, and all of your colleagues will make sure
your voices are heard, because we have to ensure that whatever changes are made are made in the
best interest of patients.
You will dedicate yourselves to the profession of medicine and dentistry at a time when
revolutions in our own health care delivery system are blurring the lines between payers, and
providers, and insurers. There are more than 160 million people enrolled in managed care plans,
an increase of 75 percent just since 1990. More physicians are forming their own health plans
and working to find new ways to share risks and control costs. There is, however, another
responsibility, that these new forms of care do not mean sub-standard care, that the bottom line
of profits never eclipses the bottom line of good medicine. And you have to be on the front lines
of ensuring that that occurs. Think about a recent statistic that came from a survey I read: 'Sixty
percent of Americans say they are worried, that if they were sick their health plans would be
more concerned about saving money than giving them the best treatment.' Physicians have been
on the front lines arguing against these, standing up for patients who have been denied treatments
that were recommended by their doctors. Physicians have spent countless hours on telephones
arguing with insurers to try to make sure that a patient got the care that the physician thought
necessary. We have to work to make it absolutely clear that it should be the medical professional
who determines treatment options, not a checklist administered from some office thousands of
miles away. (Applause)
Whatever kind of insurance plan any American has, that American should feel they will get
quality care. What better place to make that pledge than here at this graduation. Dr. Mitchell
Rabkin introduced the first Patients Bill of Rights here at Harvard hospital. Patients should never
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have to beg and plead to see a specialist they need. When an emergency arises they should get the
care whenever and wherever they need it. They should have a right to a fast and fair appeal when
they or their physician disagree with decisions about their care. Congress should pass a Patients
Bill of Rights to protect every American and pass it this year. (applause)
One of the most serious and unintended consequences of the changes in the financing and
delivery of healthcare in America is its effect on academic health centers like this one. You have
seen first-hand in your training what happens when new market forces squeeze academic health
centers. Now you have also been part of putting some good models in place here in Boston, when
managed care plans have joined forces with teaching hospitals. But the problem is one that is not
just the concern of Harvard or Harvard's graduates, but should be the concern of every American.
Because, just stop and think for a minute what our academic health centers have meant to each
and every one of us.
Academic health centers have many missions. But three of them, in particular, have helped to
make American health care the best in the world. The research mission of the academic health
center has not been replicated anywhere else and could not be. We are all grateful for the
extraordinary breakthroughs in research that have happened in the labs and clinics of academic
health centers. The mission of training young doctors, and dentists, and nurses, and other health
care professionals is also the province of the academic health center. And thirdly, the care for the
most vulnerable, whether they are vulnerable because they are poor and disadvantaged, or they
are vulnerable because they are sick and without hope, the academic health center has been there
as a place of last refuge.
Now those three missions: research, education and training, and uncompensated care for the
vulnerable, are not profitable missions. You rarely can make any- money at all in the short-run,
and even the medium-run, in research. You certainly cannot make money off training young
physicians or dentists and you lose money when you open your doors to the most vulnerable. Yet,
in this brave new world of HMOs and health care agencies that look to the bottom line, many
academic health centers are being told, 'I'm sorry, we're not reimbursing you for these functions
which are not directly related to the patient care activities that we have listed in our brochure. So
you will not receive compensation for research, education, training. And you're just going to
have to send those poor patients somewhere else.'
That attitude fails to recognize that the reason American health care is SO good is because we've
had the best research, education and training opportunities available of any country in the world.
If we squeeze out those functions, if we force places like Harvard to have to cut back on what
they do best, it is not only Harvard that will suffer, it is hospitals and patients throughout the
world. It is time for us to recognize that paying for those academic health centers and their vital
missions is in the best interest of us all. Historically, Medicare has borne a great deal of the cost,
paying directly and indirectly for graduate medical education. We should do everything possible
to continue Medicare and the federal government's commitment to academic health centers. But,
I believe it is also fair and appropriate for every health plan and every insurance policy to pay
something toward the maintenance of our academic health centers since we all benefit from the
work which they do on our behalf. (Applause) This is not one of those abstract debates that
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should only take place in Washington behind closed doors. It should be brought out in the light
of day. Those of you on the front lines of delivering high quality medicine, doing cutting-edge
research, and caring for the poorest and the sickest among us should make sure your voices are
heard.
Now, all of these issues I've just mentioned were part of the overall plan that was presented a
few years ago to reform our nation's health care system. Now clearly, that particular proposal
was not successful, but it is critical that we do not give up on what must still be done. Many
people ask me, 'Well, were you discouraged after the defeat of health care reform?' Well yes, I
was discouraged we didn't have the kind of debate that we should have had in Congress, so that
people in the country could have seen clearly what our true choices were. But, I also believe that
the debate and the effort was very important for America. We did educate ourselves about many
of the issues that you here at Harvard know so well. And we also learned that when the political
environment makes it impossible to take large steps in a direction you believe you must go, then
you have either the choice of taking smaller steps or sitting on the sidelines and doing nothing. I
come from the school of smaller steps. It is far better to try to make changes that will help at least
some people than to do nothing and help no one.
So, we've seen some progress since 1994. Thanks, for example, to the leadership of Senator
Kennedy here in Massachusetts, the Congress passed a bill prohibiting the loss of health
insurance just because of the loss of a job or a pre-existing condition. Now there are problems
with the implementation of that provision, but it is still an important step, and it is a value that
makes clear that we are moving toward ensuring that people are not wrongfully deprived of their
access to health insurance. We've also seen major legislation, the most significant since 1965, in
making it possible for uninsured children to have access to health insurance.
But, our job is far from done. We have 41 million people living without health insurance. You've
treated many of them in the hospitals where you've done your rotation and waited to be on call.
Who will take care of these people in the future? Who will ensure that they will be taken care of?
How will we pay for their care? And how will we pay for the extra costs that come when
someone is not treated for a chronic disease or turned away from the emergency room? The job
of health care reform in America cannot be done when any of our citizens' access to care depends
on the color of their skin, or the neighborhood they live in, or the amount of money in their
wallet.
Let's be clear. As a nation, we have to continue to work toward universal, affordable, quality
health care for every single American. (Applause) While all of us must continue to work toward
that day and we will do our part, it is going to be up to each of you who graduates today to
assume your place as one of the architects of this changing health care world. I'm afraid you
can't just be bystanders or kibitzers because you have the information and the experience that all
of us need. About 100 years ago, one of your predecessors said, "We are very glad to be in the
class of 1900 and not 1800, because we confidently believe we shall all witness greater triumphs
in the century now dawning." I hope each of you feels the same and I trust that in 100 years when
your successors look back at the class of 1998, they will say that, given the opportunity, you went
far beyond the instructions to do no harm at the patients' bedside. Instead, you worked in the
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service of your patients and humanity. And you worked to improve the system in which you care
for your patients.
I hope also that we'll be able to look back and see that just as medicine conquered bacteria in the
20th century that the 21st will see the defeat of viruses; that chronic illness will be cured or
tamed; that so many of the problems we have seen in disease around the world will finally be put
at bay; that our grandchildren will have to look in history books to learn about the devastation of
cancer or AIDS. During a time of great change, there is always uncertainty about which direction
each of us individually will go and which direction collectively we will choose. We are at such a
point in your lives as you enter this system.
I am extraordinarily hopeful as I look out at these graduates, that the decisions will be made with
their guidance and expertise, and that the oath that they take today will be fulfilled in full
measure. Because after all, it is they who must ensure that above all, "the health of my patients
will be my first concern." We need your competence and your confidence, as we've already
heard. Even more, we may need your compassion--harnessed to that competence and
confidence--and we will need your voices to ensure that what you know, what you see, what you
experience cannot be ignored as our nation debates what direction we take. And I'm confident
that if we follow your oath we will make the right decisions. Congratulations, good luck, and
God speed.
End Oratory by First Lady, Hillary Clinton
FIRST LADY HILLARY RODHAM CLINTON
NORTHWESTERN MEMORIAL HOSPITAL
CHICAGO, ILLINOIS
APRIL 14, 1999
Thank you, Mayor Daley, for that kind introduction. I'm always
so pleased to be back in Chicago, a city so close to my own heart. But
I'm also thrilled to be here because this is a city that shows the world
what can be accomplished when the entire community -- from the top
city officials to community advocates to business leaders to parents --
comes together to improve the quality of life for all of its citizens.
Instead of being overwhelmed by the challenges before you -- Chicago
looks for -- and finds -- solutions -- whether it's turning around your
urban schools -- or addressing the ever changing health care needs of
your citizens. This remarkable new medical center of Northwestern
Memorial Hospital is a powerful tribute to your work together.
I have just come from a brief tour of some of your new facilities --
including the new emergency department -- which I've learned breaks
new ground when it comes to delivering fast diagnosis and on-site care -
- saving critical time and precious lives. I want to congratulate all of
you whose tireless work and dedication over the years have brought us
to this historic milestone in this hospital's evolution.
2
I've heard how President Mecklenburg first developed this vision
to create a full-service, integrated, "patients first" medical center for the
21 st century; and how Cathy Murray, through her tireless efforts, has
turned that vision of redevelopment into the reality we see here today. I
also want to commend everyone who has been part of this remarkable
project all along -- the academic and medical leadership; the dedicated
doctors, nurses; and administrators; everyone who day after day, night
after night, has provided such a high level of care to your patients.
I know that there has also been an outpouring of support from the
philanthropic community -- over $100 million -- underscoring the
importance that the people of this city place on this new facility and its
enormous benefits to the community.
I've heard that when Northwestern Memorial Hospital first
launched its redevelopment plans years ago -- some questioned the idea,
saying wait a minute, isn't building a major new medical center in
downtown Chicago going against the tide? Isn't the future more in
small, scattered site facilities? But all of you persevered with your
vision to design a hospital that truly meets the health care demands of
the 21st century. Today, we celebrate the fulfillment of that vision.
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Recognizing the changing landscape of health care needs, you have
built a medical center fully prepared to meet the growing demand for
outpatient care -- while also treating those who need intensive inpatient
services. By continuing your role as a community-based hospital that
reaches out into the surrounding neighborhoods, you are carrying on
your historic mission to serve Chicago's most vulnerable and at risk
population. And with everything that you do -- whether it's pull-out
beds to encourage family members to spend the night; or low windows
so patients can lie in bed and look outside.; or your health information
center, which provides care givers and patients invaluable information
about their health concerns -- you have shown us what a "Patient's
First" philosophy really means.
Academic health centers like this one play such an invaluable role -
- in state-of-the-art research; in training young doctors and nurses; and in
the care of the most vulnerable in our society. The unparalleled medical
research that takes place at hospitals like this one helps save lives every
day. It also paves the way for dramatic breakthrough cures in the 21 st
century that will changes our lives, and the health of our children and
grandchildren in ways we may not even be able to imagine today.
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I know that you have made many pioneering medical advances
here -- from being the first in the nation to do bone marrow transplants
for Lupus patients -- to using a unique new state-of-the-art machine that
enables you to treat cardiac patients who otherwise can't be treated with
traditional by-pass surgery -- to testing the most advanced digital
mammography technology to date. As a nation, we must protect and
preserve the work of these remarkable institutions through continued
financial support. This Administration is doing all it can to fulfill that
promise.
As we' ve already heard -- the entire community has been engaged
in this monumental redevelopment project. And I'm particularly
impressed with your aggressive affirmative action goals to ensure a
significant percentage of those working to build this center were
minority and women-owned enterprises. We all know that the health of
a community depends not only on good hospitals -- but on good jobs;
and greater economic opportunity. You are rightfully proud of your
contributions to "leveling the playing field" -- and I hope that other
institutions here and around the country learn from this model initiative.
5
As you have worked -- day in and day out -- to improve the health
and well being of your patients and your community -- the President
too has placed health care at the top of our nation's agenda.
We know -- for example -- that every citizen in America should
get the care and the choices that they receive at a hospital like this one.
But they don't. That's why this Administration is promoting a "patients
bill of rights." No citizen should have to plead to see a specialist. No
citizen should have to worry that they -- or their children -- can get
emergency care whenever and wherever they need it. And everyone
should have the right to a fast and fair appeal when they or their
physicians disagree with decisions about their care. You have shown
what it means to put patient's concerns above all else. I hope that
Congress agrees to put patients first as well.
We all recognize that regular, primary health care is fundamental
to good health. And the best and often the only way to ensure that care
is to provide affordable health care coverage to America's families. The
people who work at this hospital are the ones on the front lines who day
after day, night after night have to deal with emergency cases that could
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have been avoided if people had the benefits of regular, preventive care.
That's why my husband and his administration have given such
priority to expanding health care coverage for America's families. We're
deeply committed to saving Medicare -- as you know -- but we're
especially concerned about the growing number of America's children
who remain uninsured. So the President and the Congress, working
with the states, created a new program in August of 1997 to cover
millions of America's uninsured children and their parents. The
challenge for us now is to find new ways to reach children and their
parents where they live -- in their schools, hospitals, and communities --
and inform them of this new health insurance plan that we call CHIP.
Everyone has a role to play in helping us fulfill this mission.
And once again, Chicago is showing us the way. I've heard that
today and tomorrow are report card pick up days for parents at
Chicago's public schools. But thanks to an army of literally thousands
of volunteers -- parents will also pick up forms to get their children
enrolled in insurance programs. In fact, eligible parents will get help in
filling out those forms on the spot.
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This is an incredible public/private partnership with the potential
of reaching 170,000 children with on-side enrollment. It's a model for
what we can achieve when we really reach out to families and children --
and make good on the promise that the President signed into law almost
a year and a half ago.
So I want to thank all of you -- for helping to create this world-
class model for patient care in the 21 st century. But also for
demonstrating once again the extraordinary accomplishments that can be
made when the entire community comes together to improve the health
and well being of its citizens.
Thank you.
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