Universal Coverage – A Call for Action

NCHC Writer
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Honorary Co-Chairman
“Universal Coverage – A Call for Action”
National Coalition on Health Care Leadership Summit
The Carter Center, Atlanta, Georgia
January 26, 2000

[Introduction and Applause]

Thank you. Well, if I heard that introduction a year ago, I might have been on the way to New Hampshire.


It must have been quite late in my campaign when I met Governor Ray because he said I had two associates with me. The first hundred or so towns and cities that I visited, I only had one person with me.

We were eagerly looking for any kind of news coverage, so if we saw somebody going down the street with a notebook in their hand, we would follow them avidly down the street, hoping it might be a reporter. Somebody with a microphone was almost unreachable, and anyone with a TV camera, we never did see them.

Jody Powell was my associate. We didn’t have any money then. Instead of staying in hotels, we stayed in private homes. Quite often they would have only one bed, so Jody and I stayed in the same bed.

The only bad thing about it was that Jody Powell snored horribly, so I had to get to sleep before Jody got there in order to get any sleep. Jody also liked to take a drink late at night, so he would make contacts that I wouldn’t otherwise make.

I remember one night he came in, though. I was already asleep. He woke me up and said, “Governor, wake up. We’re going to be on TV in the morning.” I said, “I can’t believe this. What time?” He said, “Quite early, about six o’clock.”

I said, “What kind of program is it?” “I’ll tell you in the morning,” he said. I could hardly sleep. The next morning we woke up, and on the way to the TV station in a rented car, I kept asking Jody what kind of program is it, “Is it an interview program?”

He would say, “Governor, I would rather you wait until you get to the studio.” When we got there, as Governor Ray would remember, they put a chef’s hat on my head. Jody Powell had asked me on the way, “Do you remember any recipes?” It was a cooking show!

Luckily, I remembered a very delightful recipe from my early camping out trips where you take any kind of rough fish, like a big bass or something — you might write this down — and you filet it and slice it up into little pieces, and then you soak it or marinate it overnight in A-1 sauce or Heinz 57 sauce. Then you deep fry it, and you can eat it either cold or hot.

Anyway, I made a great hit on the early morning talk show, which was probably watched by a thousand people in Iowa. I won’t give that credit to my coming in person to Iowa. Among candidates, I got 27 percent and uncommitted got 32 percent, so uncommitted really won. But anyway, I went on from there.

Now, let me express my deep thanks to Governor Ray and to Paul Rogers for helping to establish and lead this extremely important organization. I am honored that for the last ten years I, President Bush and President Ford have all served, sometimes actively, as honorary co-chairmen.

It is sobering to look back on what has happened since I left the White House in January of 1981. At that time, I think, there were 15 million Americans who didn’t have health insurance or coverage. Now there are, I understand, 44 million, including 11 million children.

We were spending then, to my dismay, $250 billion on health care. The cost was going up every year. Now we’re spending, from the last figures I saw, $1.2 trillion dollars on health care. Whether the coverage or the quality of health care has improved, in general terms, I’m not sure.

We’ve seen a frustrated effort by President Clinton and his wife to inaugurate a comprehensive health program, but the forces arose against it and it was not well conceived or presented. We still have not made any progress, basically, on comprehensive health care.

The devastating effect of someone who goes to the hospital uninsured has multiple results. The primary result is that four times as many patients who go to the hospital without insurance die as a patient who has insurance. It is not the insurance that saves them, necessarily; it is the social economic circumstances from which they come when they arrive in the hospital. They already may be malnourished, or they haven’t had adequate preliminary care, or basic instructions on what to do about their own health.

These circumstances — and I could go down a litany of statistics with which you are problem more familiar than I — are embarrassing to my country. Because, so far, we haven’t made much progress in correcting them.

There are glorious successes in genetic experiments and the evolution of new medicines, many of which are very expensive. AIDS has now swept the world; under control at least now in the United States, but rampant as a pandemic in Africa.

The Carter Center’s work is basically overseas. We have programs in 65 foreign nations, 35 of them are in Africa. In 12 of those nations where we are trying to eradicate other diseases or control them, in 12 of them the life expectancy in the last 10 years has dropped by 17 years. A baby born now can expect to live 17 years less than the child’s parents when they were born.

In one metropolitan area of Lusaka, the capital of Zambia, eight years ago we held the election there, the Carter Center did. A survey was made in the hospitals where only the more affluent mothers go to deliver their children; 23 percent of the children born in Lusaka had AIDS at birth.

I was in South Africa last month. I was informed by the officials in the airport that the present population of South Africa is 55 million. In eight years more they expect their population to be 48 million, despite a fairly high birth rate.

We haven’t yet addressed those questions overseas. Maybe one reason is we haven’t yet addressed the health program needs here. Most of our work, as I said, is overseas in Africa. We have health programs in Asia, Africa and Latin America.

Eradicating disease — we have a task force that analyzes every human illness to ascertain, with very highly qualified professional help, what diseases might theoretically or practically be totally eradicated from the face of the Earth. Smallpox is the only one so far. That was more than 22 years ago. We have identified two others: guinea worm eradication; dracoon colage, which is not known by most of you; and polio, which is known by everybody. We’re making fairly good progress on those.

The Carter Center has been in charge of the eradication of guinea worm, a terrible disease. We started ten years ago with 3.5 million people that we knew had guinea worm. We now only have 70,000, a 98 percent reduction. Two-thirds of those remaining cases are in southern Sudan, where war prevents us getting to the villages that we know have guinea worm.

Last year, the Carter Center treated 6 million Africans and Latin Americans to prevent blindness by going into the villages. We have had programs, actively, in more than 40,000 villages in the most poverty-stricken nations in the world.

We realized a few years ago that we had the same kind of problems here at home, so we organized what we called the Atlanta Project, the simplest name we could conceive.


We identified communities in this very wealthy community that were in need. We had two criteria derived from the 1990 Census. One was the percentage of families that had only one parent, mostly a mother. The other criterion was the families that had teenage mothers, some as young as 13.

We found, to our dismay, that there were 500,000 people in that region. We divided up into 20 different clusters that we called ‘cluster communities,’ each one about 25,000 people. We began to get the corporate world and the universities to join us in going into those communities and getting to know these people for the first time.

Marriott Hotels was the first one that volunteered to do this. Delta Airlines had a community; Coca-Cola Company had a community; IBM had a community; NationsBank had a community. Every one of the 20 communities had a major corporate partner — not a sponsor, but a partner.

They were amazed and we were amazed at what we found in the devastating hopelessness or despair among our next door neighbors in Atlanta that did not have the rudimentary opportunities in life that we take for granted. I think the key to it all is an effective and comprehensive health insurance program.

Why in God’s name does not every American have health insurance? That’s a hard question to answer. We here have discussed this, at least, on the democratic side of the political debates in the year 2000. One of those men will be our next President. But there’s a cacophony there. I can’t understand it, and I’m fairly well educated about the rudiments — I do not understand it at all.

At least on that side of the aisle there is a competition to see who can have the most comprehensive and the most practical program to be financed. I hope this year will be the year we will finally have a commitment, at least, to move forward. The nuances of disagreement are the things that have aborted good faith efforts in the past.

I am afraid that in the next four years — after we have discounted this eight years, and the previous four year, and the previous eight years, and the previous four years — that we will have some sort of consensus arise where political competition and negative advertising won’t subvert what we all know to be desperately needed.

Where is there a rational voice that has knowledge and integrity and access to the nation’s consciousness? I would say here, in the National Coalition on Health. I do not know anywhere else.

There is a tremendous responsibility here. In the past, this group has put forward ideas. There have been Op-Ed pieces and news stories written. I think many candidates for President and Congress in the past have listened to what we had to offer. But I think this year is one where we need to redouble our efforts.

There are some new opportunities, I think, that didn’t exist before. The enormous and rapidly growing budget surplus, where the taxes on the American people far exceed expenditures. Something is going to be done with that extra money. I hope that a top priority will be a comprehensive health program.

Last week I was in Seattle to make a speech on a very interesting subject sponsored by a group called The Progress Project. What is progress? It is a very incisive and difficult question to answer. Superficially you might say, “Well, progress in the United States is to increase our gross national product,” or “To increase per capita income, on the average.” Or, if you want to get more esoteric about it, “Increase the percentage of eighth graders who can read and write,” things of this kind.

But what is true progress? I will let you consider that. While I was out there I was meeting with Bill Gates, Jr. and Bill Gates, III, whom we all know to be the richest man in the world. He had endowed his foundation, when I was there, $17 billion. I noticed in the papers that he’s now increased it by $5 billion more. And five percent of that amount each year, under foundation law, has to be spent.

A major commitment, both Bill Gates and his father told me in a long conversation, was to improve health care in the Third World and also hopefully in this country. There is a potential reservoir of private funds. I think what Gates is doing is what Ted Turner has already done. It is an incentive to others to be generous.

The combination, I think, of potential government action, foundation support, and hopefully, an aroused public, will result in what we have dreamed about in this group, at least for the last ten years. I hope we will be successful. My heart and my commitment is with you.

I see the devastating effect of inadequacies in the American and world society. Recently I was asked to come to Taiwan and to go to Oslo, Norway, to make a speech. I was assigned the subject, “The Greatest Challenge of the Next Millenium.” I’ve thought about this a lot. I have decided that the greatest challenge in this millenium is the growing chasm that is growing between rich people and poor people.

That is a rapidly growing chasm, where most of us who are rich — and I would include everyone in this room — has very little knowledge or interest in those who are poor; who are different from us, who live in a different country, who may have a different color skin, who speak a different language.

They are the kinds of people we can exclude from the cocoon within which we enwrap ourselves. It is a natural human trait to enjoy our own security and good health, and education, and housing, and retirement opportunities.

I hope that we will break down that barrier between us and others. It is, I think, the biggest challenge for this century and for this entire millenium. I see very few signs that the trend will reverse.

One hope is in this group. Reversing the trend that I described earlier of deteriorating circumstances that surround many Americans. Americans who look upon us leaders to correct their problems and to give them new hope and a sense that their lives will improve, and if they make a decision it will make a difference, and that they can be self respected as a fellow American in perhaps the greatest nation on Earth, but still not great in the alleviation of suffering.

Thank You


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