Patients' Bill Of Rights

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President Clinton Renews His Call For A Patients' Bill Of Rights

THE WHITE HOUSE
Office of the Press Secretary
For Immediate Release September 17, 1998

REMARKS BY THE PRESIDENT
TO THE IBEW

Hyatt Regency
Washington, D.C.

10:25 A.M. EDT
THE PRESIDENT: Thank you, very much. Thank you for thewonderful welcome. You know, when I was walking out the door this morningto come over here Hillary said, "Where are you going this morning?" Isaid, "I'm going to speak to the IBEW." She said, "Boy, I like thosefolks."
(Applause.)
I cannot thank you enough for your warm welcome and for thepurpose which brings you to Washington. I would like to thank John Sweeneyfor many things, but I would especially like to thank him for theintroduction he gave Carol Hooper, not only because he told us about herlife but because he told us about the life of America at its best; peopletaking care of their families, being good citizens, doing what they can toimprove their own lives and the lives of their fellow citizens. It was avery impressive account and I thank you, Carol Hooper, for yourintroduction, for your support of this legislation and for the work youhave done for a lifetime in the IBEW. Thank you, ma'am.
(Applause.)
I am delighted to be here with Jack Berry, and Ed Hill andRick Diegel. I am especially delighted always to be on the platform withJohn Sweeney. He has given new energy, new direction, real life, realpower in the best sense to the labor movement here in Washington andthroughout this country.
I was talking with our friends in Congress on the way out herethis morning. It is wonderful to see the labor movement back, not onlyback in Washington but back in the heart of America. Average citizens whodo not belong to unions know you are on their side, too, and it means alot; and our country is better because of what has happened in the lastfour or five years.
(Applause.)
I would like to say a special word of thanks to SenatorsDaschle and Kennedy and Harkin and Rockefeller and to CongressmanMcDermott, Filner, Paxon and Meeks for being here with me today and forfighting for you every day. We need more people like them in the Congress.In a few weeks, you'll have a chance to send a few more like them to theCongress. I hope you will.
(Applause.)
I also want to thank our Labor Secretary, Alexis Herman, ourHHS Secretary, Donna Shalala and my labor advisor in the White House, KarenTramontano for not only coming here with me today but for working for youevery day. They have really, really worked hard to change the daily lifeof the government so that everybody is more oriented toward makingdecisions that have a positive impact on the ability of families to dotheir work and raise their children and live in strong and safecommunities.
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You've fought by our side for six years now, and we've gotsome pretty good results to show for it: the lowest unemployment rate in28 years -- nearly 17 million new jobs; the lowest crime rate in 25 years;the smallest percentage of Americans on welfare in 29 years; the lowestinflation in 32 years; the highest home-ownership in history; and in just acouple of weeks, for the first time in 29 years, all that red ink on thegovernment's budget will turn to black, thanks to the people here -- and Ithank them for that.
(Applause.)
We've also done a lot of good things to help the Americanpeople live their lives better. We raised the minimum wage; and I mightsay, we're going to be given the chance to do it again. Today SenatorKennedy's bill is coming up in the Senate, and he reminded me again beforewe came out here you hear all these arguments about how the minimum wagewill raise unemployment -- all that sort of stuff they say. The minimumwage has been raised five times since World War II, since 1948; four ofthose times the unemployment rate was higher than it is now; and all fivetimes, the inflation rate was higher than it is now -- 12 million peopleare out there working just like you. NObody who works for a living --nobody -- should have to wonder whether, no matter how hard they work, theystill won't be able to provide for their children, educate their childrenand have a decent life. It is time to raise the minimum wage again, and Ithink we ought to do it.
(Applause.)
Together we double the tax credit for low-income workingfamilies -- worth about $1,000 in lower taxes today to a family of fourwith an income of under $30,000. Together we made college loans moreaffordable. We've given a tax credit for the first two years of college of$1,500; and tax credits for the rest of college and for adults to go backto school. Together we passed the Family and Medical LEave Bill, andmillions and millions of families are better off as a result of it.
Together we have fought against efforts -- constant efforts inthe Congress -- to undercut worker rights. I remember last May,particularly, the pride I felt in being given the opportunity by JohnSweeney to work with you in California to get the message out that it issimply wrong to pass a ballot initiative to silence the voice of workers inthe political process; and you prevailed, and good for you.
(Applause.)
I, too, want to join John in thanking our friends in theSenate for making sure that people know that at least on our side, we thinkit's wrong to pass a salting bill to erode the rights of workers toorganize.
(Applause.)
So these are good times for the country, and that's good newsfor America and it's good news for American labor. But the question is,what are we going to do with the good times we have? All you have to do iswatch the evening news or pick up the paper to know that these areturbulent times around the world; that things are still changing at a veryrapid rate; and that the American people have a very stark decision to make-- which is whether to sit back and relax, maybe even pass up a chance tovote on Election Day, or seize on these good times and say, we thank thegood Lord and our good fortune and your hard efforts for the good timeswe've got but we know we can't sit on them, we know we can't relax.
When you have good times, you need to take the confidence theygive you, the resources they give you and look at the real challengesfacing the country and meet them. We need to make this a season of doingthings for you -- not idleness and not indulgence, but doing things foryou.
The children in this audience are going to live in a verydifferent world than we grew up in. We know right now many of the thingswe should be doing to make sure that world is a better, safer, strongerworld for ordinary people in this country and it's time we acted on it.That is the choice -- partisanship over progress, people over politics --in every issue facing the Congress and the country, that is the choice.And the people need to make their voices heard.
Let me just mention a few of them. First of all, we needto dance with what brought us to this prosperity. When I took office wehad a budget deficit of $290 billion, high interest rates, low investmentand high unemployment. Now, we have worked hard to get rid of that. Themembers of my party, I am proud to say -- and only the members of my party-- in 1993 voted for an economic plan that reduced the deficit by 92percent before the bipartisan balanced budget bill passed.
Now we're going to have a balanced budget and a surplus thisyear, and it is projected that we will have a surplus in the out yearsbecause of what we have done. That is a good thing. Now, what should wedo? Some of our friends in the other party say that well, we're projectinga surplus and it's close to the election so let's give everybody a tax cut,or let's give some people a tax cut, and as you might imagine, some morethan others.
(Laughter.)
So, in just a few moments the House Ways and Means Committeewill begin to mark up an $85 billion tax cut to drain the surplus before iteven shows up in the Treasury account. I've had a lot of interestingconversations about this. I have asked some of our Republican friends,I've said, you know, we've been waiting 29 years for this couldn't we atleast see the ink turn from red to black and then watch it dry for a minuteor two before we get carried away?
(Laughter.)
But it's election year and it's popular. But it isn'tright; and it isn't right for a couple of reasons. First of all, the worldis in a lot of financial turmoil and we need to set a standard for theworld of solid, strong economic policy to try to get the world turnedaround to make sure America's recovery is protected. And secondly, we'vegot something else that has to be done with that money first. We have toreform and save Social Security for the 21st Century. That's what we'vegot to do.
(Applause.)
I have said over and over again that if Congress sends me abill that squanders the surplus on tax cuts before we save social securityI'll veto it.
(Applause.)
Now, you're clapping is an act of good citizenship. Why?Because some of you would get something out of that. But it's wrong. Why?Because when these children are in the workforce and the baby boomers likeme are retired at present rates of participation in the work force,birthrates, immigration rates, there will only be two people working forevery one person drawing Social Security.
Now, we have three choices. We can give the money away andfool around with it -- or we actually have four choices. We can donothing, in which case we'll have two of our choices one of these daysbefore long -- we'll either have to lower the standard of living of ourseniors rather dramatically or we'll have to raise taxes so much to keepthe system as it presently is that we will undermine the standard of livingof our children and their ability to raise our grandchildren. And it'sjust wrong. I don't care how close it is to the election. It is wrong todo that until we have solved this problem.
Now, the other alternatives are, we can pass the tax cut andthen just dismantle the social security system; and there are some whowould like to do that. Or we can do the responsible thing even though it'selection season: we can modify the Social Security system; and if we startnow -- because it's going to be several years before all the baby boomersget in the Social Security system -- if we start now we can make modestchanges that will enable us to protect the retirement of the baby boomgeneration and protect the living standards of our children and theirability to raise our grandchildren. That is the right thing to do. Itseems to me to be a no-brainer.
Now, it may not be popular within a few weeks of the electionbut it is the right thing to do. And I ask you to say, we don't care howclose it is the election; we care more about our children and ourgrandchildren and the dignity of life that Social Security has brought toso many. Half the seniors in the country today would be in poverty if itweren't for the Social Security system. We want to reform it in a sensibleway and do it in a way that protects our children and our grandchildren.That's our position and we're going to stick with it.
(Applause.)
Now, the second thing we have to do is to do our part to tryto stem and limit this global financial crisis you've been reading so muchabout that's affected Japan and Asia; that is running rampant throughRussia today; that is threatening our best trading partners in LatinAmerica who have good economic policy. I gave a talk about it in New Yorkon Monday. Many people came up to me afterward, both Democrats andRepublicans saying America has to lead in this. We cannot be, to quote thewords of the Federal Reserve Chairman, Alan Greenspan, "an island ofprosperity."
About a third of our growth has come from selling things toother countries. Senator Daschle, who is as good a friend as workingpeople have in the Congress, represents a state of farmers who are interrible trouble today in part because the people in Asia cannot afford tobuy the crops grown in South Dakota.
Now, that's what this bill funding the International MonetaryFund is all about. It doesn't throw money at people who won't helpthemselves. It says if you'll do the responsible thing to restore economicgrowth in your country we'll be better off and we'll help you; not out allby ourselves but working with others. It is very important. If we wantAmerica to grow we have to be out there saying to our friends andneighbors, we want you to grow too, we don't think it would be a good thingfor America to have a good economy and everybody else to have a bad economy-- number one, because we don't feel that way and number two, becauseeventually it will come back and bite America's e economy. How many timeshave you seen that happen in the last 20 years? It's more true now thanever before.
Now, in this case the Senate has passed this bill for theInternational Monetary Fund, we're just a couple of weeks away fromCongress going home to campaign and we're still waiting after eight months.And it needs to be done.
The third thing we need to do is to remember what the mostimportant priority over the long run for America is, and that's theeducation of our people. We've opened the doors to college wider than everbefore. If you look at all the things that have been done by thisAdministration, working with our friends in Congress, it is literally truetoday that anyone who will work for it and deserves it can get a collegeeducation without going into so much debt they'll never be able to pay itoff.
But nobody thinks that we yet can say that every child inAmerica has access to the finest elementary and secondary education in theworld. We've got a program within the balanced budget for smaller classesin the early grades; funds for states that allow 100,000 teachers to takethe class size down to an average of 18; funds to help build or repair 5,00schools; funds to hook up every classroom to the Internet by the year 2000.That's what we ought to be talking about in Washington, D.C. -- somethingthat will affect the lives of the children in this country. The educationbudget needs to pass and needs to pass now.
(Applause.)
Now let's talk about the subject that you're here to talkabout -- the subject that Carol spoke so eloquently about. We have comehere to talk about health care. In 1996 you fought for and I signed theKennedy-Kassebaum law so Americans can keep their health coverage when theychange jobs or someone in their family gets sick.
Last year, I signed a balanced budget bill that helps to makesure that 5 million uninsured children -- virtually all of them inlower-income working families -- can get the medical coverage they need anddeserve: the biggest increase in coverage since Medicaid passed in 1965.
This year, we are fighting for the patient's bill of rights.Why? You heard Carol's story -- 160 million Americans are in managed care.These plans can save money and improve care. When I became President,health care costs were going up at three times the rate of inflation. Thatwas totally unsustainable. It was destroying your ability to get a raise.It was undermining the fabric of the country. We had to do something aboutit.
But like every other system, if the system becomes an end initself and you lose sight of the purpose of health care, you get introuble. That is what has happened. I have seen too many people who havehad medical procedures delayed or denied not by their physicians, but byhealth care bureaucrats because of the way these HMOs work.
I've spoken to too many doctors and nurses who aren't able togive the kind of care they're trained to give. I've heard too many storiesabout parents rushing children to emergency rooms and wondering whethertheir health care plans will cover them in that emergency room.
I asked a bipartisan panel to develop a comprehensive set ofrights for patients. I thank Bob Georgine of the Building Trades COuncilof the AFL/CIO for serving on that commission. They did a fine job. Theywere all different kinds of people from all parts of the health caresectors and all parts of the economy. They came up with a simple bottomline: the bottom line of health care must be to value patients.
Medical decisions should be made by informed medical doctors,not insurance company accountants.
Now to do that, we've got to pass a patient's bill of rights.Let me just point out that there are 43 HMOs supporting this patient's billof rights. Why? Because they are doing the right thing anyway or theywant to do the right thing and they know they're going to get the shaftwhen it comes to the bottom line, unless everybody has to do it. But thereare people in this business who know this is right.
Yesterday, as I'm sure you've already talked about, SenatorLott stopped the business of the Senate entirely, shut it all down,silenced all debate just to stop Senator Daschle and Senator Kennedy withtheir allies here from bringing up this issue for a vote. Now, can youbelieve that? Why is that? Why would they shut the Senate down? Becausewhen you go to an emergency room or an operating room or a doctor's office,nobody asks you whether you're a Republican or a Democrat.
We all get sick; we all get in car wrecks; we all have kidsthat need help. So rather than get everybody on record, put everybody onthe bottom line, see who's standing up for the HMOs or the people, theyjust silence the debate; because nobody wants to be recorded on the wrongside. So this is death by stealth.
(Laughter.)
NOw, this is something that affects you and everybody you workwith, everybody you see at your place of worship, everybody you see in allyour recreational activities, everybody in your family. This affects you.This is a big deal.
Now, obviously, the real answer -- we need more SenatorDaschles and Senator Kennedys. We need more of these congressmen here; weneed more senators like Senator Rockefeller and Senator Harkin. You'llhave a chance in November to do something about that. But this ought to be done now. This should not be a partisanissue. This is a case where Washington ought to work more like theemergency room and the operating room and the doctor's office. We couldhave had a Republican stand up here and give the same speech Carol did.This is not a partisan issue in AMerica. It is only a partisan issue inWashington. It is a practical issue in the country.
Now, I have done all I could here and I'm going to do a littlemore today. We have extended the protections of the patient's bill ofrights to people in most federal plans -- in Medicare, in the FederalEmployees Plan.
The Department of Health and Human Services has now completedall the work on proposed regulations that will extend the protections ofthe patient's bill of rights to 20 million Americans in Medicaid-managedprograms -- vulnerable children, people with disabilities, pregnant womenthat have no other way to get health care. That's a good thing to do.
With this action, we have now extended the protections of thepatient's bill of rights to health plans serving tens of millions ofAmericans. That's good. But what about the 160 million Americans out therewhom I can't reach with unilateral action? That's why we have to havefederal legislation.
Even with all the state bills that have passed, because offederal laws there are a lot of people they can't protect. If every statein the country passed bills, there would be 100 million people theycouldn't protect. There is no solution to this but a comprehensive pieceof federal legislation.
For nine months we have worked in good faith with people inboth parties. There are some Republicans -- there are a few Republicanswho are really supporting this. But they can't get by the kind of tacticswe saw yesterday.
In July, under pressure from the public, the House ofRepresentatives finally passed something they called the patient's bill ofrights; but it is hollow. It gives only false sense of security. But atleast they passed a bill. The Senate -- they don't want to be recorded onthis. THey want death by stealth.
I want you to know the difference between our bill and theRepublican bill that passed in the House and that has the support of theleadership in the Senate.
I've got a chart here and I think you can see it. You may notbe able to read it, but you get the nos and the yeses and I'll tell youwhat they say.
(Laughter.)
Our bill says that managed care accountants can't makearbitrary medical decisions that doctors ought to make, and theirs doesn't.Our bill says you ought to have a right to see a specialist if you have amedical condition that requires one, and theirs doesn't. Our bill saysthat in an emergency you ought to have the right to the nearest emergencyroom. If you walk out here and you walk across the street and you get hitby a car, do you want to have to go halfway across town if there's ahospital around the block?
Let's deal with this in very practical terms. We're talkingabout how you live now. Our bill says if you get hurt, you ought to beable to go to the nearest emergency room without worrying whether yourhealth care plan is going to cover it, and their bill doesn't.
Our bill says if your employer changes health plans, youshouldn't be forced to change your doctor if you're pregnant, if you're inthe middle of chemotherapy treatment. Now, you ever had anybody in yourfamily treated for chemotherapy? You know how long it takes; you know howyou go through the sickness; you know how you wonder if your hair's goingto fall out; you know all those things? How much worse is it if, in themiddle of the treatment, they say, I'm sorry, we've changed plans; you'vegot to change doctors?
Remember what it was like when your family had the firstchild? How would you have felt if you were six months pregnant or yourwife was six months pregnant and they say, I'm sorry, you've got to leaveyour doctor now and go see somebody else? I hope you'll like him or her.
This is real stuff. This is where people live. Our bill saysthat can't happen. That has happened in America. Our bill says no more;our bill gives you that right to stay with your doctor through theprescribed period of treatment, and their bill doesn't.
Our bill makes sure health care plans don't give doctorssecret incentives to limit care, and theirs doesn't. Our bill protects theprivacy and confidentiality of your medical records. Theirs actually makesit easier for other people to look at your medical records. You thinkabout that. I don't think that's right.
Our bill says you ought to be able to hold your health careplan accountable if it causes harm, and theirs doesn't. Let me just talk alittle about that. I've heard all this talk about how the last thing weneed is another provision and another bill in Washington that gives anybodythe right to bring any legal action. But you just think about it. Howwould you feel if I said, you've got a constitutional right to worship Godas you please; you've got a constitutional right to freedom of speech;you've got a constitutional right to associate with whomever you want;you've got a constitutional right to travel; but I really think there's toomany lawsuits in America so we're going to repeal your right to defendthose rights.
You can't protect them. It'll be on the books all right, butif somebody throws you in jail for saying something they don't like, I'msorry, you can't have any recourse. There'd be a riot in this country,wouldn't there?
Look, in a lot of these cases where people really get hurt,I've sat here and I've listened to all these stories -- all of us have.Believe it or not, finally the right medical decision is made by the HMO;but often it's too late. Why? Because they go up three layers or four andthe first two or three layers, the people there making those decisions --I've got a lot of sympathy with them -- they're not doctors and they knowone thing: they are never going to get fired, demoted or denied a raisefor saying no.
You just think about it. When those files come in, they'renever going to get in trouble for saying no. THey're just like you -- theywant to keep their job; they want to take care of their kids. Nobody'sever going to burn them for saying no. But if they say yes, uh oh.
And what do they know; how do they sleep at night? Well, theyknow up the line somewhere eventually there's a doctor who's going to makea decision, and if the right answer is yes, he'll say yes; so I better sayno so I can keep my job and get my bonus and I'll be all right. That's theway this system works.
That's fine if you've got something that somebody can diddlearound with for six or nine months. But what if you need a decision now orin 15 days or in 30 days? What if it's your family? That's what all thisis about.
I'll say again -- our bill covers every American. Their billleaves out 100 million Americans. That's what this is about.
Now, I want to thank the AFL/CIO for the grassroots effortsyou've made here. But I want to ask you to intensify your efforts. I wantyou to think about how this could affect your family. Even if you've got aplan that takes care of all this, just think about what it's like for 150million or 160 million Americans who have to live with these uncertaintiesevery single day -- to think you've got health care coverage, but maybe youdon't and it just depends on what happens to you.
The IBEW knows better. You have made a major contribution tothe prosperity and recovery of America, and I am very grateful. Nobodycould blame you if, after all the fights you've had to fight, you wanted totake a deep breath and relax. But you remember the issues I gave youtoday. There are decisions being made or not made here which will affectyour lives in the near term and have a huge impact on your children's lives-- none more immediate than this patient's bill of rights.
So go out and fight for it. And tell America, tell all yourfriends and neighbors this is not a labor issue; this is not a DemocraticParty issue; this is about what kind of country we are and what kind ofcountry we're going to be. I think you know they will stand with you.
Thank you and God bless you.