    [Public Papers of the Presidents of the United States: William J. Clinton (1997, Book I)]
    [February 20, 1997]
    [Pages 179-182]
    [From the U.S. Government Publishing Office www.gpo.gov]

    Remarks on Medicaid Patient Protection and an Exchange With Reporters
    February 20, 1997

        The President. Thank you. I was just sitting here thinking that, in
    the spirit of full disclosure, the Vice President and Secretary Shalala
    may have a particular vested interest in health care issues--that they
    both just got back from South Africa, and when they got back he got on a
    plane and went to Los Angeles to speak to the AFL-CIO convention; he got
    back at 4 o'clock this morning. And she got on a plane and went to New
    York with me to a welfare reform event. And I don't see how either one
    of them are still standing up. [Laughter] But they probably have a
    strong interest in what happened here today.
        Let me thank, if I might, first of all, all the Members of Congress
    who are here from both parties for their leadership on this issue; and
    Bruce Vladeck and Bruce Fried for what they have done; and the
    representatives of the groups over here to my right for being here and
    for supporting our endeavors.
        Today I'm pleased to announce that we're taking steps to see that
    Medicaid beneficiaries continue to get access to the fullest quality
    health care. In recent years, the medical community and the insurance
    industry have joined to reform and improve American health care, working
    with us, and much of this progress has come through managed care, which
    emphasizes prevention, provides better care, and controls costs at the
    same time, when the plans are the best and the right kind of managed
    care plans.

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        On the whole, the growth of managed care has been a good thing for
    our country. But we also know--we've seen enough to know that we have to
    make absolutely sure that this rapid transformation does not lead to a
    decline in the quality of health care.
        That's why I've been concerned about these so-called gag rules that
    some HMO's and other health care plans have, rules that restrict the
    ability of health care professionals to administer proper medical care,
    that prevent doctors and nurses from telling patients about alternate
    and sometimes more expensive care that are not covered by the plans that
    they're in. This is unacceptable. Patients in HMO's and other health
    plans should know that their doctors will give them the very best
    information, the very most complete information, the widest possible
    range of information when it comes to their treatment. And there
    shouldn't be a shadow of doubt about this.
        In December, as Secretary Shalala just said, we took action to give
    Medicare beneficiaries the right to know about their treatment options.
    Today we take the next step, acting to protect 13 million Medicaid
    beneficiaries, children, the disabled, elderly Americans. I'm directing
    Secretary Shalala to inform all State Medicaid directors that it's
    illegal for health care plans to prohibit doctors from discussing any
    treatment options with their patients. Families facing illness simply
    should not have to worry that the doctor they trust does not have the
    freedom to tell them what they need to know. Patients have the
    fundamental right to know they are getting the best medical treatment,
    not simply the cheapest.
        And this must be only the beginning. We can act today to protect
    Medicare and Medicaid beneficiaries because they are Federal programs
    and because Government is the largest purchaser of managed care in our
    Nation. But to protect 130 million Americans enrolled in managed care
    throughout the private sector, the Congress must act.
        That's why I'm so pleased that Members of Congress from both
    parties, led by those who are here with us today in the House, have come
    together with the support of doctors, nurses, health care professionals,
    and consumers to craft legislation that will ban all gag rules for all
    Americans in all HMO's and other health care plans. I urge the Congress
    to send me this legislation, and when they do, I will promptly sign it
    into law.
        The bipartisan legislation shows how we can work together as we
    continue, step by step, to give more families access to quality,
    affordable health care. I hope we can build on this record of
    accomplishment and that Congress will join me to pass a balanced budget
    that extends health care coverage to children; helps people who
    temporarily lose their jobs to keep their health insurance; covers,
    through Medicare, assistance for families with Alzheimer's victims and
    provides for annual mammograms; and that reforms Medicaid for the next
    decade. Today we built a strong foundation for the health of American
    families, and we can now make sure that it lasts for a long time.
        Let me close again by thanking these Members of Congress who are
    here and saying that while we have done the right thing for Medicare and
    Medicaid, we need their legislation to do the right thing for the
    majority of our fellow citizens who are now covered by private managed
    care plans.
        Q. Where lies the fault; is it the insurance industry?
        The President. Well, I think--what I think is we're going to have a
    continuing tension between the need for controlling costs and
    competition and managing health care, and the need to make sure that you
    don't shortcut the quality of care, which has been the hallmark of our
    medical care in America for those who had access to it.
        And what we are trying to do, and I think what these Members of
    Congress are trying to do, is to strike the right balance, to permit
    managed care to go forward and even to flourish but to try to set the
    conditions in which it will operate so that we guarantee that quality of
    care is not sacrificed.

    Mexico

        Q. Mr. President, how serious of a blow is it that Mexico's drug
    czar has been arrested, given the fact that so much of the illegal drugs
    coming into the United States comes through or originates in Mexico?
        The President. Well, I would--I think that the American people
    should have two reactions: first of all, that this is a very serious
    revelation and deeply troubling; secondly, the fact--we should be
    encouraged by President Zedillo's determination because the Government
    has taken

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    this action, the President has personally taken this action, and they've
    made it public. And they're obviously saying to the world and to the
    people of Mexico, we will not tolerate corruption if we can find it and
    root it out, even if it's at the highest level.
        So I'm troubled by it, but I'm also encouraged by the strong action
    President Zedillo has taken. And you may be sure that this will continue
    to be at the top of our agenda, and when we meet in the not-too-distant
    future, we will talk more about it. But we've worked very hard with
    Mexico. And you know, the more success we had in South America in
    shutting down routes, particularly airplane routes and, to some extent,
    overland--routes over water, the more these operations have moved into
    Mexico, which is a big country with a lot of opportunities, to find
    places that are sparsely populated to set up these transit operations
    and, to some extent, processing operations. So we have to have Mexico's
    cooperation.
        And this is a serious thing. I regret it, but, on the other hand,
    I'm very encouraged that President Zedillo has moved promptly and
    aggressively to deal with the situation.
        Q. Have you made a decision on certification?
        The President. Excuse me?
        Q. Have you made a decision on certification?
        The President. I have not, and I have not made--I don't believe I've
    been given a recommendation yet by the Secretary of State on it.
        Q. Mike McCurry said today, following on that last question, that
    this incident would be a factor in the decision whether or not to
    certify. Why will it be a factor, and how so?
        The President. Well, first of all, let me reiterate, there is a
    process for doing this that has not been completed, and I have to get
    the recommendation first. But as I say, as a factor in the certification
    decision, I would imagine it is a mixed factor. On the one hand, it's
    troubling because we knew and it's been widely reported that local
    police organizations at various places in Mexico are highly vulnerable
    to all the money that was being thrown at them from the drug lords. And
    the military had been thought to be an antidote to that, a
    counterweight. So it's troubling.
        But on the other hand, I'll say again that they have not fooled
    around with this. When the President discovered it, he's taken strong
    action. It's been very public. It's been non-apologetic. And so I'm
    encouraged by that. So I would think that this would cut both ways on
    the certification question.

    China and Cabinet Nominees

        Q. Mr. President, do you see any change in policy with China now
    that Deng is dead?
        The President. We expect basic continuity here. The Chinese, perhaps
    mindful of some of the problems they've had in their long history in
    transitions--Deng Xiaoping set in motion a process which has been well
    underway for more than 2 years now. And I think that that is something
    that we can all appreciate, that there has been a basic continuity
    there.
        So I think that our policy is the right policy. We will continue to
    engage strongly with China. I look forward to all the meetings which are
    going to occur, including Secretary Albright's trip and then the Vice
    President's trip later and then the exchange of visits by the two
    Presidents. The policy we are following of engaging with China, to work
    where we agree and to honestly air our disagreements and work through
    them, is the right policy for the people of the United States and,
    indeed, for the world in the 21st century. If you imagine what the world
    will look like 30 years from now, 40 years from now, we can do nothing
    other than what we are doing. It is the right thing to do.
        Let me just make one other comment here, because this came up at the
    last press briefing I had, about the status of our nominations for the
    Cabinet in the Senate. I have been gratified by the treatment that the
    Cabinet members who have been confirmed have received by both parties
    and the prompt dealing with their nominations. I said something about
    Mr. Lake when I last was with the press.
        The only other comment I want to make today is there has still not
    been a hearing scheduled for Alexis Herman. I think that is a big
    mistake. She enjoys wide support among labor--the labor unions endorsed
    her yesterday strongly--and she has wide support among business. I don't
    know that there's ever been a person nominated for Secretary of Labor
    that had as much broad support in the business and the labor
    communities. She's clearly well-qualified. If anybody wants to vote
    against her for whatever reason, they're plainly free to do that, but
    she deserves a hearing, and if she gets a hearing, she's going to be
    confirmed. And I think Senator Jeffords is a good man and a fair man,
    and

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    I believe he will give her a hearing. But it's imperative that it be
    done. It's now midway through February, and I think it's time to get on
    with this.
        Thank you.

    Note: The President spoke at 11:05 a.m. in the Oval Office at the White
    House. In his remarks, he referred to Bruce Vladeck, Administrator,
    Health Care Financing Administration; Bruce Fried, Director, HCFA Office
    of Managed Care; Gen. Jesus Gutierrez Rebollo, Director of Mexico's
    National Institute to Combat Drugs, dismissed for allegedly protecting a
    Mexican drug trafficker; President Ernesto Zedillo of Mexico; Deng
    Xiaoping, former President of China; and Anthony Lake, nominee for
    Director of Central Intelligence.