agreement that moved them closer to a final peace, and several hundred Jewish and Arab-American businesspeople gathered at the State Department to commit themselves to a joint effort to invest in the Palestinian areas when conditions were peaceful enough to permit a stable economy to develop. Meanwhile, the other Presidents joined me at a signing ceremony for the NAFTA side agreements in the East Room of the White House. I made the case that NAFTA would be good for the economies of the United States, Canada, and Mexico, creating a giant market of nearly 400 million people; that it would strengthen U.S. leadership in our hemisphere and in the world; and that the failure to pass it would make the loss of jobs to low-wage competition in Mexico more, not less, likely. Mexico’s tariffs were two and a half times as high as ours, and even so, next to Canada, it was the largest purchaser of U.S. products. The mutual phaseout of tariffs had to be a net plus to us.
Then Presidents Ford, Carter, and Bush spoke up for NAFTA. They were all good, but Bush was especially effective, and wittily generous to me. He complimented my speech by saying, “Now I understand why he’s inside looking out and I’m outside looking in.” The Presidents gave bipartisan gravitas to the campaign, and we needed all the help we could get. NAFTA faced intense opposition from an unusual coalition of liberal Democrats and conservative Republicans, who shared a fear that a more open relationship with Mexico would cost America good jobs without helping ordinary Mexicans, who they believed would continue to be underpaid and overworked no matter how much money their employers made out of trading with the United States. I knew they might be right about the second part, but I believed NAFTA was essential, not just to our relationships with Mexico and Latin America but also to our commitment to building a more integrated, cooperative world. Though it was becoming clear that a vote on health-care reform would not come until the following year, we still had to get our bill up to Capitol Hill so that the legislative process could begin. At first, we considered just sending an outline of the proposal to the committees of jurisdiction and letting them write the bill, but Dick Gephardt and others insisted that our chances of success would be better if we started off with specific legislation. After a meeting with congressional leaders in the Cabinet Room, I suggested to Bob Dole that we work together on legislation. I did it because Dole and his chief of staff, an impressive former nurse named Sheila Burke, genuinely cared about health care, and, in any case, if I produced a bill he didn’t like, he could filibuster it to death. Dole declined to work on drafting a joint proposal, saying I should just present my own bill and we’d work out a compromise later. When he said that, he may have meant it, but it didn’t turn out that way.
I was scheduled to present the health-care plan to a joint session of Congress on September 22. I was feeling upbeat. That morning I had signed the bill creating AmeriCorps, the national service program; it was one of my most important personal priorities. I also nominated Eli Segal, who had shepherded the bill through Congress, to be the first chief executive of the Corporation for National Service. Attendees at the signing ceremony on the back lawn of the White House included young people who had answered my call to do community service that summer; two old veterans of FDR’s Civilian Conservation Corps, whose projects still marked the American landscape; and Sargent Shriver, the first director of the Peace Corps. Thoughtfully, Sarge had lent me one of the pens President Kennedy had used thirty-two years earlier to sign the Peace Corps legislation, and I used it to bring AmeriCorps into being. Over the next five years, nearly 200,000 young Americans would join the ranks of AmeriCorps, a larger number than had served in the entire forty-year history of the Peace Corps.
On the evening of the twenty-second, I felt confident as I walked down the aisle of the House Chamber and looked up at Hillary sitting in the balcony with two of America’s most famous doctors, the pediatrician Dr. T. Berry Brazelton, a longtime friend of hers, and Dr. C. Everett Koop, who had served as President Reagan’s surgeon general, a position he used to educate the nation about AIDS and the importance of preventing its spread. Both Brazelton and Koop were advocates of health-care reform who would lend credibility to our efforts.
My confidence slipped when I glanced at the TelePrompTer to begin my speech. It wasn’t there. Instead, I was looking at the beginning of the speech to Congress on the economic plan that I’d delivered in February. The budget had been enacted more than a month earlier; Congress didn’t need to hear that speech again. I turned to Al Gore, who was sitting in his customary seat behind me, explained the problem, and asked him to get George Stephanopoulos to fix it. Meanwhile I started the speech. I had a written copy with me and I knew what I wanted to say anyway, so I wasn’t too worried, though it was a bit distracting to see all those irrelevant words scrolling by on the TelePrompTer. At the seven-minute mark, the right text finally came up. I don’t think anyone knew the difference at the time, but it was reassuring to get my crutch back.
As simply and directly as I could, I explained the problem—that our system cost too much and covered too few—and outlined the basic principles of our plan: security, simplicity, savings, choice, quality, and responsibility. Everyone would have coverage, through private insurers, that would not be lost when there was an illness or a job change; there would be far less paperwork because of a uniform minimumbenefit package; we would reap large savings through lower administrative costs, which were then significantly higher than those of other wealthy nations, and a crackdown on fraud and abuse. According to Dr. Koop, that could save tens of billions of dollars.
Under our plan, Americans would be able to choose their own health plan and keep their own doctors, choices that were vanishing for more and more Americans whose insurance was carried by health maintenance organizations (HMOs), which tried to hold down costs by restricting patient choices and conducting extensive reviews before approving expensive treatments. Quality would be assured by the issuance of report cards on health-care plans to consumers, and the provision of more information to doctors. Responsibility would be enforced across the board against health insurance companies that wrongfully denied care, providers who padded their bills, drug companies that overcharged, lawyers who brought bogus suits, and citizens whose irresponsible choices weakened their health and exploded costs to everyone else.
I proposed that all employers provide health insurance, as 75 percent of them were already doing, with a discount for small-business owners who otherwise couldn’t afford the insurance. The subsidy would be paid for by an increase in cigarette taxes. Self-employed people would be able to deduct all the costs of their health-care premiums from their taxable incomes.
If the system I proposed had been adopted, it would have reduced inflation in health-care costs, spread the burden of paying for health care more fairly, and provided health security to millions of Americans who didn’t have it. And it would have put an end to the kinds of horrible injustices I had personally encountered, like the case of a woman who had to give up a $50,000-a-year job that supported her six children because her youngest child was so ill she couldn’t keep her health insurance, and the only way for the mother to get health care for the child was to go on welfare and sign up for Medicaid; or the case of a young couple with a sick child whose only health insurance came through one parent’s employer, a small nonprofit corporation with twenty employees. The child’s care was so costly that the employer was given the choice by its insurer of firing the employee with the sick child or raising the premiums of all the other employees by $200. I thought America could do better than that. Hillary, Ira Magaziner, Judy Feder, and all those who helped them had crafted a plan that we could implement while reducing the deficit. And contrary to how it was later portrayed, health experts generally praised it at the time as moderate and workable. It certainly wasn’t a government takeover of the health-care system, as its critics charged, but that story came later. On the night of the twentysecond, I was just glad that the TelePrompTer was working. Toward the end of September, Russia dashed back into the headlines, as hard-line parliamentarians tried to depose Yeltsin. In response, he dissolved parliament and called new elections for December 12. We used the crisis to increase support for our Russian aid package, which passed the House, 321–108, on September 29 and the Senate, 87–11, on September 30.
By Sunday, October 3, the conflict between Yeltsin and his reactionary opponents in the Duma erupted into a battle on the streets of Moscow. Armed groups carrying hammer-and-sickle flags and portraits of Stalin fired rocket-propelled grenades into the building that housed a number of Russian television stations. Other reform leaders in former Communist countries, including Vaclav Havel, issued statements in support of Yeltsin, and I did, too, telling reporters that it was clear that Yeltsin’s opponents had started the violence, that Yeltsin had “bent over backwards” to avoid using excessive force, and that the United States would support him and his effort to hold free and fair elections for parliament. The next day Russian military forces shelled the parliament building and threatened to storm it, forcing the surrender of the rebellion’s leaders. Aboard Air Force One, on my way to California, I called Yeltsin with a message of support.
The battle in Moscow’s streets was the top news story across the world that night, but the news in America led with a different story, which marked one of the darkest days of my presidency and made famous the phrase “Black Hawk Down.”
In December 1992, President Bush, with my support, had sent U.S. troops to Somalia to help the UN after more than 350,000 Somalis had died in a bloody civil war, which brought famine and disease in its wake. At the
