First Lady Hillary Rodham Clinton's
Graduation Address
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, and 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 the 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
they have been given. And they also deserve from us gratitude 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, by alumni of
these institutions who are gathered here to pay you credit. And 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. And 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?' 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. And 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 Leaureates from Harvard who have
unlocked the secrets behind some of the world's greatest medical mysteries.
And 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 else. 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 healthcare 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 conversations
about what is happening in the healthcare 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 of us 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 Alzheimer, 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 research budget to 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 bio medical 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 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. Peopleused 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. And 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 yourself to the profession of medicine and dentistry at a
time when revolutions in our own healthcare delivery system are blurring
the lines between payers, and providers, and ensurers. 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, and another
responsibility. And that is 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 changes in the delivery of health care.
Physicians have been 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 a Harvard hospital. Patients should never 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 the effect that is being
had 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 setting some good models into
place here in Boston when managedcare 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 healthcare 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 healthcare 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 so poor and
disadvantaged, or they are vulnerable because they are so sick and
hopeless, 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. And you certainly can not make money off of training young
physicians or dentists. And you lose money when you open your doors to the
most vulnerable. And yet, in this brave new world of HMOs and healthcare
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.
What that attitude fails to recognize is that the reason American
healthcare 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, than 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 should
only take place in Washington behind closed doors. It should be brought
out into the light of day. And 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 healthcare
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 healthcare 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 healthcare 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 healthcare 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 healthcare 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 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 our healthcare system. 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 that have to be made 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 that, 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
Graduation 1998
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Created: June 4, 1998