President Clinton Calls for Patients' Bill of Rights

Office of the Press Secretary

For Immediate Release May 28, 1998


Room 450
Old Executive Office Building

10:50 A.M. EDT

THE PRESIDENT: Not much left for me to say, is there?(Laughter.)

Let me say, first of all, how much I appreciate the workthat Secretary Shalala and Secretary Herman have done on our qualityhealth care commission. Dr. Benjamin, thank you for your life's workand for your leadership. Mr. Vice President, thank you foreverything you've done in the last five and a half years on healthcare. And thank you, Ricka, for reminding us of what this is reallyall about.

I have a number of things I would like to say about thisthat I hope will not be repetitive. But because of the explosion ofthe nuclear tests this morning by the government of Pakistan, I'dlike to make a brief statement about that first, since this is myonly opportunity to communicate with the media and the Americanpeople on that issue.

First, I deplore the decision. By failing to exerciserestraint and responding to the Indian test, Pakistan lost a trulypriceless opportunity to strengthen its own security, to improve itspolitical standing in the eyes of the world. And although Pakistanwas not the first to test, two wrongs don't make a right. I havemade it clear to the leaders of Pakistan that we have no choice butto impose sanctions pursuant to the Glenn Amendment as is required bylaw. (Applause.) Thank you.

Now I want to say again, it is now more urgent than itwas yesterday that both Pakistan and India renounce further tests,sign the Comprehensive Test Ban Treaty, and take decisive steps toreduce tensions in South Asia and reverse the dangerous arms race.

I cannot believe that we are about to start the 21stcentury by having the Indian subcontinent repeat the worst mistakesof the 20th century, when we know it is not necessary to peace, tosecurity, to prosperity, to national greatness or personalfulfillment. And I hope that the determined efforts of the UnitedStates and our allies will be successful in helping the parties whomust themselves decide how to define their future to defuse tensionsand avoid further errors.

Now, if I might, I'd like to say just a few words aboutwhat we have been talking about here. And we have seen the humanface of this issue in Ricka's story and in Dr. Benjamin's testimony.If you just back a step away, if you think about all the excitingthings that are happening and how the world is changing, howtechnology and globalization and scientific advances are changing theway we work and live and relate to each other, it is clear that weare living in a moment of really pivotal change in human society.

At every such moment, the trick is to take advantage ofthe changes that are positive and not be consumed by their negativeaspects. Or, to put it in another way, to meet the challenges of thefuture without giving up, but instead enhancing the most enduringvalues of the society.

Now, that's what we've been trying to do throughout thelast six years on a whole lot of issues. Yes, we balanced thebudget, and earlier than anybody thought we could, but we continuedto invest in education and health care and the environment andresearch. Yes, I want to have this surplus, but I don't want tospend a penny of it, even for things that I would like, until I knowthat we have secured the Social Security system for the 21st centuryso that when the baby boomers like me retire we don't bankrupt ourkids and keep them from raising our grandkids properly.

So you don't do the easy thing in the moment. You showa little restraint and think about the long-term interest of thecountry. You take advantage of the change of a healthier economy anda balanced budget and the surplus, but you don't just do what isright at hand. You think about the long term.

Now, yesterday we celebrated the year anniversary of ourWelfare to Work Partnership -- that's all these companies that helpus to hire people from welfare. So, yes, we said the welfare systemwasn't working and people who are able bodied ought to have to go towork but, by the way, they shouldn't wreck their responsibilities asparents. So they have to have jobs, they have to have child care,they have to have health care, they have to have transportation.

And if you think about this issue in this way, I thinkit will help us all to think about all the other challenges thatwe're facing. I mean, we've been very fortunate in America to havehad the national wealth and the infrastructure of health care thatwe've had and the huge number of dedicated people we have here --physicians and nurses and other health care providers and supportpersonnel. And because of technological and scientific advances andbecause we're learning how to do more outreach and preventive care,we now have the lowest infant mortality rate and the highest lifeexpectancy in our history.

Because of the Human Genome Project and because of themapping that it will make it possible to do for young children, weactually have people seriously saying that babies who are born at thetip end of the 20th century may actually live to see the 22ndcentury, not the 21st century. This is all great if you have accessto it.

Now, if you look at what managed care has done -- Imean, first we had a system which was basically pay as you go. Whenmy mother started being a nurse anesthetist, people didn't havemoney, there was no Medicare, there was no Medicaid. I remember onetime a fruit picker bringing her five bushels full of peaches to payfor his wife's surgery. And, you know, I was young, and I thought itwas a lot better than money. But it wasn't so good if -- youcouldn't pay your electric bill with peaches, you know. (Laughter.)

So then when went into more and more insurance. We hadMedicare, we had Medicaid, we had employer assisted insurance. Thenwe had this huge inflation in medical costs which led to two othertrends. One was, unfortunately, fewer employers covering theiremployees at work. When the Vice President and I took office, about40 percent of health care dollars were public dollars; now it's upover 45 percent. The other trend that occurred was, in an attempt topreserve the employer private based health insurance plan and nothave the whole thing go broke by having inflation go forward at threetimes the national average, new management systems were put intoplace.

So I don't think we should overlook the fact thatmanaged care was a part of a response to an unsustainable situationwith inflation and health care costs and some good came out of it.But it's like every other change -- if there are no brakes, ifthere's no value base, then the logic of the change will consumeitself. I mean that's basically the story you just heard.

So is managed care, per se, bad? No, who could say it'sbad to stop health care costs from going up at three times the rateof inflation. It was unsustainable. Eventually it would haveconsumed the whole economy. But no change is inherently good withoutbeing anchored in basic values. Now that's all this Patients' Billof Rights is about. It say, okay, go have your managed care, get ridof all the waste, be more efficient, don't let us bankrupt ourselves;but don't ever send me another story like this, I don't want to hearanymore like that. That's what this bill says.

This bill says, you know, how can you let some personwith the mentality of an accountant who will only see the number ofwhat it costs to have somebody do her surgery, who will only see thenumber at the bottom line of what the chemotherapy costs, make adecision. We're not that kind of people; we're not that kind ofsociety. And if we have to endure a smidgeon more inflation, bringit on. That's all this is about. (Applause.)

Now, let me also say one other thing. This is urgent.You know, there have been a lot of other things going on during thissession of Congress and let them go on, but there ought to be sometime taken to do the business of the American people. This isurgent. (Applause.)

How many more stories do we have to hear like Ricka'sbefore we actually act? Believe me, there's another one -- there'sone right now, just while we're sitting here, that somebody else justlike her somewhere in America going through something like she wentthrough. And it will be somebody else tomorrow and somebody else thenext day and somebody else the next day. This is not rocket science.This is a simple decision by a society to say, okay, we want all thebenefits we can possibly get from better and more efficientmanagement and cost controls, but we don't intend to chuck out thevalues that make this a decent place to live and give up all thebenefits we've gotten out of medical research and advances in thelast 30 years by just throwing it away on this kind of strangleholdtechnique. We're not going to tolerate it anymore.

Now, I think -- what I hope will happen, because all ofyou have come together here today, is that we will have, first ofall, a general feeling in the country that we have to do more on thisto get this done in this session right now; secondly, that the peoplewho are part of all your organizations or affiliates around thecountry will become more active; and thirdly -- and Secretary Shalalaand Dr. Benjamin in different ways alluded to this -- that we willhave a special increase in intensity among women in America aboutthis.

We have a report which was handed to me -- you probablysaw them hand it to me, because they forgot -- (laughter) -- on astate-by-state analysis of what this bill would mean to women. Now,in addition to the points that were made by previous speakers aboutthis, I think it's important to note that according to all theresearch that we have, three-quarters of all the health caredecisions in this country are made by women. In many householdswomen are taking care of sick children, taking them to the doctor,caring for elderly parents, paying the medical bills. Women also,unfortunately, more frequently suffer from chronic illnesses thatrequire constant and specialized medical attention. So there arespecial stakes here for the women of America.

There's another point I want to make that was mentionedby the Vice President, but I want to hammer this home. This reallyis a problem that must have a national solution. People say to meall the time, well, you know, you used to be a governor, let thestates do this or state legislation passing all the time. Well,first let me say I'm grateful for that state legislation and I thankgovernors of both parties who have supported it. Forty-four stateshave passed some kind of legislation.

But some of the states have only passed one of theprovisions of the many provisions in the Patients' Bill of Rights,first of all. Secondly, there are 122 million Americans, out of apopulation of 260 million -- 122 million of us are enrolled in plansnot fully governed by state law. For example, just take California,our most populous state. If California passed the bill now pendingin Congress, which is quite comprehensive, there would still be 13million of the 30 million Californians who'd be totally unaffected byit, as Secretary Herman said, because of the way ERISA works. Sothere has to be a national solution.

Now, all of you know that there are some pretty powerfulspecial interests who are up here working against this bill. Myanswer is the previous speaker. So I think if you go back home andyou think about this and you try to mobilize your friends and thepeople that are affiliated with it, first of all, think about howthis is a specific example of the kind of challenges we face at thismoment in our history -- all this technology, all these changes,everything going on. And it is fundamentally the test of a decentsociety and certainly a great democracy like ours that we embrace allthe changes that are going on, but we do it in a way consistent withthe basic values that got us where we are over the last 220 years.

Secondly, remember to put a human face on it. Andremember every day that goes by that this bill does not pass -- everysingle day somewhere in America there's another story like Ricka's.There ought not to ever be another one and with your help we can stopit. Thank you and God bless you. (Applause.)

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