Senator Edward M. Kennedy
John F. Kennedy Presidential Library
Boston, Massachusetts
April 28, 2002

These remarks were part of the "Challenges at Home and Abroad" forum series sponsored by the John F. Kennedy Presidential Library and Foundation.

Thank you, John Shattuck, for that generous introduction and for your dedicated and effective service as chief executive officer of the Kennedy Library Foundation. Thanks to you also, Deborah Leff, for your leadership as director of the Kennedy Library. The vision and skill that you have both shown to the Library throughout your distinguished service has allowed this magnificent institution to enhance and expand its mission as an enduring legacy for President Kennedy.

It is an honor to continue this extraordinary series of presentations. Rarely in our history have we faced the challenges -- or the remarkable opportunities for progress -- that we face today.

The tragedy of September 11th was a watershed in our nation's history. It brought us a new sense of our own vulnerability, and emphasized our interdependence with the world outside our borders. As we mourned lost lives, we also celebrated the heroism of the many Americans who responded so courageously to the tragedy.

The brave passengers of Flight 93 fought and defied the terrorists and saved the lives of thousands. Construction and health workers braved the treacherous fire and debris to rescue survivors and recover the remains of those who lost their lives. Police and firefighters, and ordinary citizens, gave their lives so that others might live. And thousands of Americans all over the country lined up to donate blood to help the victims.

I believe that the most enduring legacy of the September 11 attacks is a new sense of community among all Americans. Four hundred years ago, the poet John Donne wrote that "No man is an island." Today, our country reaffirms the truth of those words. We understand that if one of us is
hurting, all of us hurt.

This renewed national spirit leads us to reaffirm the basic social bond that unites us all. Every American should have the opportunity to receive a quality education, a job that respects their dignity and protects their safety, and health care that does not condemn those whose health is
impaired to a lifetime of poverty and lost opportunity.

Nowhere are the challenges our nation faces greater than in health care. Charles Dickens opens his novel, A Tale of Two Cities, with the classic lines, "It was the best of times, it was the worst of times...." Dickens was characterizing France and England at the end of the 18th Century, but his words apply equally well to health care in America at the beginning of the 21st Century.

Just as the 20th Century was the century of the physical sciences, the 21st Century will be the century of the life sciences. In the last century, we developed the automobile, the computer, and the rocket ship. We unlocked the secrets of the smallest atomic particles and peered into
the vastness of space.

This new century is still young, but it has already witnessed astonishing breakthroughs in medical research. Scientists have mapped the human genome -- a task that once seemed inconceivable. Cracking the code of life will have profound implications for the treatment and prevention of disease. Treatments can be prescribed based on an individual's genetic signature to prevent side effects. Diseases can be diagnosed and treated before symptoms appear.

Doctors here in Massachusetts and around the nation are learning how to regenerate or repair damaged tissue with stem cells and advanced biomaterials. Soon damaged kidneys may not require years of dialysis. A scarred cornea may not mean blindness. A severed spine may not lead to a lifetime in a wheelchair. The amazing new therapies being developed by our great research institutions and by dynamic new biotechnology firms are making health care better and safer -- and they should be available to every patient at every hospital.

Sadly, the benefits of biomedical research are not shared fairly among the nation's citizens. Instead, when it comes to the promise of health care, we are increasingly a nation divided. The fortunate few can afford the latest in medical technology and the most effective new medications, but millions of our fellow citizens are denied today's breakthrough miracle cures.

One in six citizens lacks health insurance coverage, and millions more are under-insured. Patients in HMOs and other managed care plans lack basic protections to ensure that they receive the best and most effective treatment for their illnesses. Millions of patients around the nation look to Congress for help in receiving the health care that will save or improve their lives, and we owe them that help.

It will be no surprise to this audience that I believe securing quality, affordable health insurance for every American is a matter of simple justice. Health care is not just another commodity. Good health is not a gift to be rationed based on ability to pay. The time is long overdue for America to join the rest of the industrialized world in recognizing this fundamental need.

Children should not be denied the opportunity for a healthy start in life because their parents cannot afford insurance. Families should not have to worry about paying medical bills at the same time they are struggling to cope with all the other strains that serious illness brings.

Older couples should not see the savings of a lifetime swept away by a tidal wave of medical debt. And no Americans should find that the quality of their medical care is determined by the quantity of their wealth.

But that fundamental wrong occurs every day in America, over, and over, and over again.

We made some significant steps forward over the past decade. We passed the Kassebaum-Kennedy health insurance reform program, which assures that people who change jobs are not be denied care because of a pre-existing condition. We passed the Child Health Insurance Program--CHIP--which now provides quality insurance coverage for almost 5 million low and moderate-income children. With a relatively low rate of increase in health care costs and a booming economy, the proportion of Americans with private coverage actually rose slightly in the latter part of the decade.

But even those favorable trends still leave us with 39 million uninsured Americans. Few working families are more than one pink slip or one missed pay period away from being uninsured. And now all the positive trends that contributed to modest improvements have turned negative.

After almost a decade of restraint, health insurance premiums rose 11 percent last year and are projected to grow a whopping 13 percent next year. Private employment-based health insurance coverage stabilized briefly in the 1990s, but it has started to drop again under the strain of reignited health care cost inflation and slowed economic growth.

Until recently, the decline in private insurance coverage was balanced by an expansion of public coverage, through Medicaid and CHIP. But the recession and the misguided policies of the Bush Administration are undermining public coverage at the same time that private coverage is becoming even less reliable.

States are expected to face budget shortfalls of $40 to $50 billion this year, triggering cutbacks in Medicaid. The recently passed stimulus package included new tax breaks for business proposed by the Bush Administration that will slash another $14 billion from state revenues over the next three years. At the same time, the Bush Administration has announced an aggressive waiver policy that encourages states to renege on fundamental guarantees that assure that Medicaid coverage will be adequate and affordable. The Congressional Budget Office has estimated that reduced CHIP funding over the next few years will cause 900,000 children to lose coverage. Instead of addressing this problem, the Bush Administration has actually proposed to divert funds away from CHIP.

Far from progressing toward the day when all Americans will have the health insurance coverage that should be their birthright, we seem to be drifting backwards. Urgent action is needed to put us on the right course--and we owe it to the American people to act promptly and boldly.

We need to provide immediate fiscal relief to states that agree not to cut back on current Medicaid and CHIP eligibility. Just as states and the Federal government share responsibility for financing and operating these programs, they must share responsibility for keeping them afloat in tough economic times.

Protecting what we have is critical, but it is equally critical to move forward. We need to enact incremental steps, this year, that will expand coverage to more Americans. The Senate Democratic budget resolution provides $90 billion for this purpose. President Bush, to his credit, has proposed a similar amount. The most important single step we can take will be to pass the Familycare legislation that encourages enrollment of eligible children in CHIP and Medicaid and expands eligibility for coverage to their parents. Three quarters of all uninsured children-- nearly 7 million in all--are currently eligible for CHIP or Medicaid but are not participating. One in five uninsured adults are the parents of these children. Passage of CHIP was an extraordinary bipartisan achievement. The same can be true of Familycare.

Finally, we need to begin to lay the groundwork this year for a new effort to enact a program of universal coverage. The American people have always supported assuring quality, affordable health insurance to every American. The people have always been ahead of the politicians on this issue. It is time to put this cause at the top of the national agenda once again. To begin this dialogue, I will introduce legislation in the next few weeks that will require every large employer with more than 100 workers to provide health insurance coverage to their employees and their employees' dependents. Uninsured workers in these firms account for more than a third of all uninsured workers.

For the longer term, I believe the most practical way of assuring health insurance for all is a combination of required employer-provided health insurance for workers and dependents, insurance through public programs for others, and special assistance for low-wage small businesses. The private-employment based system is still the system that provides coverage for the vast majority of the working-aged population. Most Americans who get their coverage from this source are pleased with the coverage they have. America has always had a pluralistic health system. At this time in our history, it makes the most sense to build on the strengths of that system while addressing its most serious weaknesses.

We must also give urgent attention to special health needs of our senior citizens. Thanks to Medicare, every senior citizen has health insurance coverage today. But the promise of health security that is at the core of Medicare is broken every day because Medicare does not cover prescription drugs.

Too many of our elderly citizens must choose between food on the table and the medicine their doctors prescribe. Too many of the elderly are taking half the drugs their doctor prescribes--or none at all--because they simply can't afford them.

It is long past time to pass a Medicare prescription drug benefit. It is time for Congress to listen to the American people instead of the powerful special interests. I think most Americans would agree that prescription drugs for the elderly are more important than tax breaks for the wealthy. Every senior citizen deserves the same prescription drug coverage as every member of Congress and the President.

We also know that controlling exploding health care costs is a key part of any program to improve our nation's health care system. But responding to cost growth with rationing or arbitrary cutbacks in payments to hard-pressed hospitals and physicians is the wrong prescription. What's needed is to bring our health care system out of the stone age and into the information age.

Processing a single transaction in health care can cost as much as $12 to $25. But banks and brokerages have cut their costs to less than a penny per transaction by using modern information technology. Administrative costs account for almost a third of total health care spending. That's more than $400 billion per year. Saving even twenty cents out of every dollar spent on administration in health care would save more than enough to pay for a Medicare prescription drug benefit. Cutting administrative costs to the level of other industries would save enough to finance universal health care many times over.

Savings also can be realized through preventive care and health promotion and by doing more to ensure that the best standard of care is also the typical practice of care.

Diabetes is a scourge that afflicts 17 million Americans -- but almost 6 million do not even realize they have the disease and millions more do not receive the most effective treatment. By using proven prevention and treatment programs, we could save over $50 billion annually and spare 10 million Americans from diabetes-related disability or blindness.

Stroke is our third leading cause of death and one of the greatest sources of disability. It costs us $30 billion a year. Prompt treatment can dramatically reduce disability and death due to stroke, but only a tiny minority receive the needed therapy in time. Improved public education and upgrading the competence of health care providers to treat this dreadful affliction could spare 90,000 Americans from the disabling aftermath of stroke and would dramatically reduce health care costs.

Medical errors kill as many as 100,000 Americans every year and cost our country as much as $29 billion annually. The Institute of Medicine has laid out a blueprint for reducing these errors. Now we need to make medical error reduction a national priority.

New medical technology is often identified as the culprit in health care cost increases. But in the new century of the life sciences, new medical technology can reduce medical costs at the same time that it saves and improves lives. A cure for Alzheimer's Disease would empty the nation's nursing homes. Computer systems that allow doctors to enter prescriptions into a database rather than scrawling them on a pad can sharply reduce medication errors, along with the death and disability that such errors tragically cause.

The events of September 11 have put our health care system in a new light. We know that the next deadly attack against our nation may not announce itself with a crashing impact or a terrible fireball. There is no area of vulnerability that is greater and where the need for action is more urgent than protecting our citizens against bioterrorism.

A biological attack would come like a thief in the night, spreading through the population by stealth. A massive biological attack would be like no other threat the nation has ever faced, and our defenses against it must be just as unique. The front line soldiers in the war against bioterrorism will carry stethoscopes, not guns. They will drive ambulances, not tanks. And the front lines will be hospital wards and laboratory benches, not fields and battlements.

We must equip a new army for this new kind of war. Yet our medical weapons against bioterrorism have grown rusty and our battalions are under strength.

Nothing could have demonstrated the deficiencies in our defenses against bioterrorism more clearly than the desperate scrambling provoked by the anthrax attacks last fall. The chilling reality of last fall's attacks was that a handful of letters filled with a thimbleful of powder can strain today's public health system to the breaking point.

And the next assault could involve even more deadly weapons, like drug-resistant anthrax, smallpox, or Ebola fever.

Clearly, the best defense against such attacks is to prevent them from ever occurring. We need effective intelligence-gathering to root out potential weapons factories. We need strong links with our partners in the international community to shut down illicit transfers of deadly biological materials.

Most of all, we must work with Russia to fully secure stocks of deadly biological agents and to ensure that Soviet biological weapons specialists of the former Soviet Union are not tempted to sell their secrets to rogue nations or terrorist groups. We've worked with Russia to prevent the spread of nuclear weapons, and we must work together now to prevent the spread of biological weapons.

Even with the best efforts, we may never be able to eliminate completely the chance of a biological attack. But we can -- and must -- work to minimize its consequences.

Clearly, the first step in battling is to provide resources to build up our hospitals, our labs, and our emergency response capabilities. We have made some progress with the Administration on providing the resources needed to meet this urgent requirement. But I am deeply concerned by this Administration's uneven commitment to strengthening our nation's health care system. There can be no weak links in the chain of out defense against bioterrorism. Yet, while President Bush's budget claims to provide $591 million to help our nation's hospitals prepare for this threat, that same budget cuts overall hospital funding by $2.6 billion.

We cannot allow this to happen.

In addition to providing adequate resources, we must rely on three concepts, in responding effectively to a bioterrorist attack: detection, treatment and containment.

Detecting an attack early is the key to containing it. Lost hours mean lost lives. Too often, however, as a CDC report has stated: "Global travel and commerce can move microbes around the world at jet speed, yet our public health surveillance systems still rely on a 'Pony Express' system of paper-based reporting and telephone calls."

We should improve the training of doctors to recognize the symptoms of a bioterrorist attack, so that precious hours will not be lost as doctors try to diagnose their patients. Public health laboratories need the training, the equipment and the personnel to identify biological weapons as quickly as possible.

Once an attack has been identified, we must have adequate medical supplies to contain it and treat its victims. I am proud that Massachusetts is once again leading the effort to develop new and better defenses against bioweapons. The new smallpox vaccine made in Cambridge by Acambis will give us more effective protection against this deadly scourge. Universities and biotech companies across the state are developing new ways to detect and treat biological agents.

Yet even the best defenses are useless if they cannot be deployed rapidly and effectively. We must improve our ability to distribute medical supplies and vaccines across the nation, so that deadly contagion can be contained.

Finally, we must upgrade the ability of our hospitals to respond to bioterrorism. Hospitals will be on the front lines of any major bioterrorist attack, but it will take billions in additional investment to give them the capacity we need to respond.

This new century of the life sciences offers us the promise of a better health and more active lives for millions of Americans and millions more across the world. It challenges us to ensure that all can benefit from the advances that this new century will bring. And last, it sounds a note of caution on the misuses of the very technology that can bring life and hope.

The American people have shown that they are ready for great missions that meet the demands of this new age. They are the creators of the new spirit of September 11th. Now, we in public life must match the standards that the people have set. We must strive to do what is best -- and we must measure our success by what we accomplish not just for one political party or another, not for this or that interest group, but for America and its enduring ideal of liberty and justice for all.