    [Public Papers of the Presidents of the United States: William J. Clinton (1998, Book I)]
    [March 9, 1998]
    [Pages 338-343]
    [From the U.S. Government Publishing Office www.gpo.gov]

    Remarks to the American Medical Association National Leadership
    Conference
    March 9, 1998

        Thank you very much for that warm welcome. And thank you, Dr. Wootton. He was giving his talk, and I was
    listening, and I was thinking: I agree with all that; there's nothing
    left for me to say. If I knew a couple of funny stories, I could just
    tell them and leave and thank you for the opportunity. [Laughter]
        Dr. Dickey, congratulations on being the
    president-elect. Dr. Reardon, thank you for
    serving on the Advisory Commission on Consumer Protection and Quality.
    Dr. Smoak, thank you for telling me
    there's nothing incompatible between a doctor named ``Smoke'' and a
    campaign

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    against tobacco. [Laughter] Dr. Jensen,
    ladies and gentlemen.
        I am honored to be here and to be working with the AMA on so many
    important fronts. We have, in the past, sometimes had honest differences
    on policy but have always agreed on our profound obligation to the
    health of our Nation's families. We're walking together in a step-by-
    step approach to health care reform, expanding the promise of new
    medical technologies, extending health care opportunities to the most
    vulnerable Americans.
        Together we've helped Americans to keep their health coverage when
    they change jobs or someone in their families gets sick. And in last
    year's balanced budget agreement we helped to make sure that up to 5
    million uninsured children will get the medical coverage they deserve
    and the help they need, with the biggest increase in health coverage for
    children since 1965.
        We have worked to increase medical research and to support greater
    efforts at preservation and care for conditions from breast cancer to
    diabetes. Last year, in our balanced budget plan, the diabetes component
    was said by the American Diabetes Association to be the most important
    advance in the treatment and care of diabetes since the discovery of
    insulin.
        We found the right family doctor for America, Dr. David Satcher, our new Surgeon General. Last month
    your voices were strong and united in support of his nomination, and I
    thank you, and America's families thank you. The lesson of these
    endeavors is that when we work together, we can get things done.
        This is a very great moment for America on the edge of a new
    century, a new millennium, and a completely new economy and new global
    society. We see dramatic changes in the way our people work and live and
    relate to each other and the rest of the world. Our economy is the
    strongest it's been in a generation. In 5 years, we have 15 million new
    jobs, the lowest unemployment rate in 24 years, the lowest inflation
    rate in 30 years, the highest homeownership rate in the history of the
    country. Our social problems are on the mend. Crime is at its lowest
    rate in 24 years. The welfare rolls are the lowest in 27 years. Teen
    pregnancy and out-of-wedlock births are declining. Our leadership is
    unrivaled around the world as we work for peace and freedom and
    security.
        Still, as I said in the State of the Union Address, these good times
    do not give us the opportunity to rest or withdraw. Instead, if we are
    wise, we will use this as a time to act and to build, to secure our
    prosperity and strengthen our future, first of all, by not spending this
    budget surplus we waited 30 years for before it exists and putting
    Social Security first, saving Social Security for the 21st century so
    that the baby boom generation does not either bankrupt Social Security
    or bankrupt their children and their retirement. That's what we should
    do before we spend that surplus.
        This is a time to widen the circle of opportunity. That's what we're
    doing with adding 5 million children to the health care rolls. In spite
    of the fact that we have a 4.6 percent unemployment rate, there's still
    neighborhoods, mostly in urban America, sometimes in rural America,
    where the recovery has not yet been felt. And our greatest opportunity
    to continue to grow the economy with low inflation is to bring the
    miracles of free enterprise and high technology into these neighborhoods
    that have not yet felt them.
        We also have to look at our long-term challenges. And I'll just
    mention two or three that go beyond health care but will affect you,
    your children, and your grandchildren. First, as the recent
    international math and science test results for seniors showed, we may
    have the best system of college education in the world, and we have now
    opened the doors of college to everyone with tax credits and
    scholarships and work-study provisions and community service provisions,
    but no one seriously believes we have the best system of elementary and
    secondary education in the world. And we must keep working to raise
    standards and increase accountability and increase performance until we
    do have the best system of elementary and secondary education in the
    world.
        Second, we have to recognize that what you do for a living, worry
    about people's health, is going to increasingly be affected by global
    development. Global travel patterns have given us something called
    ``airport malaria'' now, a phenomenon no one ever knew about. And we
    have to recognize furthermore that a lot of what we deal with in health
    care will be affected by the overall condition of the environment.
    That's why the issue of global climate change is so important. We have
    malaria now at higher altitudes than ever before recorded because of

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    climate change. A lot of you are probably noticing, as you hear from me,
    that your allergies are a little worse in the springtime with El Nino--
    even in Washington, when you don't think it could ever be any worse than
    it is normally. So we have to deal with the climate change issue.
        We have to deal with the problems of weapons of mass destruction.
    Even as we reduce the nuclear threat, we see on the horizon the prospect
    that small-scale nuclear weapons or biological or chemical weapons in
    the hands of terrorists, drug traffickers, organized criminals, rogue
    states, could change the whole future of security for our children. We
    have to cooperate more with other countries for peace and prosperity
    around the world.
        In a few days, I'm going to Africa, and I will be the first sitting
    American President ever to visit the nations in Africa where I'm going
    to visit. But they're a big part of our future, economically,
    politically, and in terms of our shared concerns over health and
    environmental matters.
        Now, I'd like you to see the particular issues I want to discuss
    today in this larger context. Are we doing what we should be doing to
    prepare this country for a new century, to widen the circle of
    opportunity, to strengthen the bonds that unite us together, to
    reinforce our values, to make our freedom mean more in the future? All
    of these issues should be seen against that background.
        This is a moment of great promise, but it's also a moment of great
    obligation. Every American decisionmaker, including all the Members of
    the Congress but all the rest of us as well, must decide whether we
    believe that, because when times are good, the easiest thing to do is to
    relax, enjoy it, express relief.
        If anybody told me the day I took office as President that in 5
    years the stock market would go from 3200 to 8500 and we'd have 15
    million new jobs and almost two-thirds of the American people would be
    in their own homes, and all the other things, I would have said,
    ``Maybe, but probably not.'' Having achieved that, and having stepped on
    all the hot coals that were necessary to get from where we were then to
    where we are now, it is easy for people to say, ``Well, let's relax.''
    That would be a terrible mistake. That's the number one message I have
    today. We have to move. Prosperity and confidence give us the freedom of
    movement that we have to seize. We have to move. This is not a time to
    sit still. It's a time to bear down and go forward, and we need your
    help.
        Now, there are fewer than 70--70--working days left in Washington
    before Congress adjourns. Now, this is an election year, and the work
    schedule is always somewhat shorter in an election year, and that's
    understandable. But it's unusually limited this year. How will the 105th
    Congress go down in history? I want it to go down in history as a
    Congress that saved lives by passing the Patients' Bill of Rights, by
    passing tough and sweeping tobacco legislation, by passing the Research
    Fund for the 21st Century with its big increase in medical research, and
    extending health care coverage to those who presently are uninsured.
    That's what I want this Congress to go down with.
        The next 70 days will tell the tale. Will this Congress go down in
    history as one that passed landmark legislation to save lives and
    strengthen America for the new century, or one that was dominated by
    partisan election year politics?
        The calendar tells us that this is an election year. That's a good
    thing; we need one every now and then. [Laughter] Have the debates and
    have the discussion. But as I have told every Member of Congress in both
    parties with whom I have discussed this, no matter how much we get done
    this year there will still be things at the end of the year on which
    honorable people in both parties disagree, more than enough over which
    to have an honest, fruitful, meaty election. This election should not be
    allowed to obscure the fact that the American people want it to be not
    only an election year but a productive legislative year for the health
    and welfare of our country and our future.
        Dr. Wootton has already talked about the Patients' Bill of Rights,
    but I want to say a few things about it. Because my mother was a nurse
    anesthetist, I grew up around doctors from the time I was a little boy.
    They were the first professional people that I ever knew. Most of them
    were the kind of people we'd all like our children to grow up to be.
    They were hard-working, able, kind, caring people. Most doctors today
    are, as well. But the world of medical practice is very different today
    than it was 40 years ago, when I first started looking at it though the
    eyes of a child--not altogether worse, of course. There are many things
    that are better. We have higher life expectancy, the lowest infant
    mortality rate we've ever recorded,

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    the highest rate of childhood immunization, dramatic advances in
    medicines and medical technologies and all kinds of treatments.
        We also have more than 160 million Americans in managed care plans.
    And while there have been some problems with them, all of us have to be
    glad when health care costs don't go up at 4 or 5 times the rate of
    inflation.
        Still, it's often harder for you just to be doctors. When a doctor
    spends almost as much time with a bookkeeper as with a patient,
    something is wrong. If you have to spend more time filling out forms
    than making rounds, something is wrong. And most important to me, when
    medical decisions are made by someone other than a doctor and something
    other than the best interests of the patient is the bottom line, then
    something is wrong. I think we should have a simple standard:
    Traditional care or managed care, every American deserves quality care.
        We all have our stories, and yours are more firsthand and perhaps
    fresher than mine. But I never will forget reading a few weeks ago about
    a woman who worked in an oncologist's office to verify insurance
    coverage and get authorizations for medical procedures, who told us the
    story of a 12-year-old boy with a cancerous tumor in his leg. The doctor
    wanted to perform a procedure to save the boy's leg, but the health plan
    said no. It seems that for that condition, the only approved procedure
    was amputation. And that was the only procedure the plan would pay for.
    The child's parents appealed the decision, but they were turned down.
    They appealed again and were turned down again. Only when the father's
    employer weighed in did the health plan change its mind. By then, it was
    too late, the boy's cancer had spread, and amputation was the only
    choice left. Of course, it was covered by the health plan.
        That is a choice no family should have to make. If the doctor had
    been able to do the right thing, the child would have been better off,
    and the system would have been better served.
        We have the best trained, best skilled doctors in the world, the
    best medical education, the best medical technology. We're all getting a
    lot smarter than we used to be about prevention. The first thing your
    president said to me is, ``I'm a cardiologist. Take this golf club, and
    stay in good shape.'' [Laughter] We're getting better at it. But it is
    madness to strain at a gnat and swallow a camel. And it happens, over
    and over and over again.
        There are no fewer than 500 stories that could come up in this
    audience right now, within a half an hour, not all that different from
    the one I just told. That is what we seek to address. That's what the
    Patients' Bill of Rights is all about, to put medical decisions back
    into the hands of doctors and their patients. I have already acted, as
    your president said, to ensure that Federal employees and their
    families, military personnel, veterans and their families, everyone on
    Medicare and Medicaid, altogether about a third of our people, are
    covered by the Patients' Bill of Rights.
        And across our Nation, State legislators and Governors, both
    Republican and Democratic, are doing what they can. Forty-three States
    have enacted into law one or more of the basic provisions of the
    Patients' Bill of Rights. But State laws and the patchwork of reforms
    can't protect most Americans. At least 140 million of them are without
    basic protection. That's why we need the Federal Patients' Bill of
    Rights with the full force of Federal law.
        The Hippocratic oath binds doctors, and I quote, ``to follow that
    method of treatment which according to my ability and judgment I
    consider for the benefit of my patient.'' That is your responsibility,
    and should be your patient's right: to know all the medical options, not
    just the cheapest; primary care when possible, specialists when
    necessary. That's why the Patients' Bill of Rights lifts the gag order
    on our Nation's doctors and allows patients to follow your best
    recommendations by appealing unfair decisions by managed care
    accountants.
        Patients also should have a right to keep their medical records
    confidential. Doctors must feel free to write down the whole truth
    without it ending up on the Internet or in the hands of employers and
    marketing firms or increasing a patient's insurance rates. Again, the
    Hippocratic oath says, ``all such shall be kept secret.'' That's why the
    Patients' Bill of Rights safeguards the sanctity of the doctor-patient
    relationship.
        Patients have a right to emergency services wherever and whenever
    they need it. And when the EMT's are wheeling a new arrival into the
    emergency room, the last thing you or the patient should have to worry
    about is the fine print on the health plan.
        Again I say, there are less than 70 days remaining in this
    legislative session, but there is

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    broad bipartisan support in this Congress for this legislation. We have
    acted in our administration; States have acted; the AMA has acted. You
    must impress upon the Congress the urgency of passing this legislation.
    Believe me, a majority of the Congress, a huge majority in both Houses
    and Members of both parties, are for this. It is just a question of
    mustering the will to get the job done and going through some of the
    very difficult issues around the edges that have to be resolved. But
    there is utterly no reason not to do this this year. You can get it done
    if you work at it.
        The other great issue before the Congress in health care is, of
    course, tobacco. Now, you're right, Dr. Wootton, I did read ``The Journal of the American Medical
    Association'' special edition on tobacco. I read it all from start to
    finish. And it was a great service to me and to the American people, and
    I thank you very much for it.
        Again, you can argue about some of the fine print, but the big
    picture is clear: Every single day, even though it is illegal in every
    State in America, 3,000 kids start to smoke; 1,000 of them will die
    earlier because of it. This amounts to a national epidemic and a
    national tragedy. You know as well as I do that more people die from
    smoking-related illnesses every year than from most other things that
    cause death in America put together. As physicians, you also know that
    in the end, the only way that we have to deal with this today with
    absolute conviction is with preventive care: Don't do it in the first
    place.
        Now, for more than 5 years, we have worked to stop our children from
    smoking before they start. We launched a nationwide campaign with the
    FDA to educate children about the dangers of smoking, to reduce access
    of children to tobacco products, to put a stop to tobacco companies that
    spend millions mass-marketing to our young people.
        Last fall I asked the Congress to pass comprehensive, bipartisan
    legislation to reduce teen smoking by raising the price of cigarettes up
    to a dollar and a half a pack over the next several years, imposing
    strong penalties on tobacco companies that keep on advertising to
    children, and giving the FDA full authority to regulate children's
    access to tobacco products.
        If we do this, we can cut teen smoking by almost half in 5 years. We
    can stop almost 3 million children from taking that first drag. We can
    prevent almost 1 million premature deaths. But again, the clock is
    ticking.
        And yes, there are lots of complicated issues. You know, because
    this is a five- or six-part package, there are several committees and
    subcommittees involved. And because there is some controversy around the
    edges about how much money should be raised how quickly from the tobacco
    tax and what it should be spent on, there are some difficult issues to
    be resolved. And yes, I know that there are only 70 days. But if we know
    that the lives of 1,000 children a day are at stake, how can we walk
    away from this legislative session without a solution to the tobacco
    issue?
        There are two other issues I'd like to mention to you. The first
    relates to Medicare. This week--or, excuse me--last week, I attended the
    first meeting of the Bipartisan Medicare Commission appointed by the
    leaders of the House and the Senate and the White House to look for
    long-term reform for Medicare for the 21st century. As you know, we have
    secured the Medicare Trust Fund for another decade with some very
    difficult decisions. But there are a lot of unresolved issues out there,
    and in some ways the complexity of the Medicare problem is greater than
    the complexity of the Social Security problem. At least it has to be
    dealt with sooner in time. So I want to urge your support for the
    Medicare Commission and your involvement in it.
        I also have made a specific proposal with regard to Medicare that I
    believe should be passed this year without regard to the work of the
    Medicare Commission, and I ask you to carefully review it, and I hope
    you'll support it. It would give a vulnerable group of Americans,
    displaced workers 55 and over--people who either voluntarily take early
    retirement and they're promised health care but the promise is broken,
    or people who are laid off and they can't find another job and they lose
    their job-related health insurance--and other seniors, principally
    people who are married to folks who lose their old health insurance
    because they start being covered by Medicare, but they're not old enough
    to be on Medicare so they lose the family coverage and they don't have
    anything--it would take this group of Americans and give them the chance
    to buy into Medicare at cost.
        The Congressional Budget Office just reported that the policy will
    cost even less and will benefit even more people than we in our

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    administration had estimated, and agreed with us that it will have no
    burden whatever on the Medicare Trust Fund. It will not shorten the life
    of the Trust Fund, nor will it complicate in any way our attempts at the
    long-term reform of Medicare. We're talking about somewhere between
    three and four hundred thousand people that are just out there, that had
    health insurance and now don't have any, at a particularly vulnerable
    time in their lives. So I hope you will support that.
        The second thing I'd like to ask for your support for involves a
    project that Hillary has worked very
    hard on to sort of leave some gifts for our country in the new
    millennium. The project motto is ``Honoring our past, and imagining our
    future.'' Among other things, we're working with the Congress to get the
    funds necessary to save, for example, the Star-Spangled Banner, which is
    in terrible shape. We need to spend, believe it or not, $13 million to
    restore the flag, and to make sure that the 200 years of lighting don't
    destroy the Declaration of Independence and the Constitution and the
    Bill of Rights, and to try to get every community in the country to find
    those things in each community which are most important to their history
    and save them.
        But we're also looking at the future. And perhaps the most important
    thing about the future-oriented nature of this project is the Research
    Fund for the 21st Century, which has a huge increase in research for all
    forms of scientific research and development but especially have the
    largest increase in funding for the NIH in history and doubling the
    funding for the National Cancer Institute.
        We are on the verge of unlocking a number of medical mysteries, as
    you know. Last year, for example, we had the first sign of movement in
    the lower limbs of laboratory animals with severed spines. The human
    genome project is proceeding at a rapid pace, with implications which
    still stagger the imagination. Again I say, we have the money to do
    this. We can do this within the balanced budget. And while there may not
    be time to resolve every issue I'd like to see resolved in this
    Congress, we should nail down now this Research Fund for the 21st
    Century. There has been terrific support in the Republican as well as in
    the Democratic caucuses. This has not been a partisan issue. It is just
    the question of getting the job done in the next 70 days.
        So while you're here, let me say again, a big part of building
    America for the 21st century is building a healthier America and
    building an America where people feel secure with the health care they
    have, and they feel it has integrity. We need the Patients' Bill of
    Rights. We need action on the tobacco front. We need reform of Medicare,
    long term. We need to help these people that are falling between the
    gaps because they're not old enough yet. And we need to continue in an
    intensified way our commitment to research. Let us take the benefit of
    our prosperity and finally having a balanced budget and invest the kind
    of money in research that we know--we know--will ensure benefits beyond
    our wildest imagination.
        We can do all this in the next 70 days, but to do it we'll have to
    do it together. I need your help. Your patients need your help. Your
    country will be richly rewarded if you can persuade the Congress to act
    in these areas.
        Thank you, and God bless you.

    Note: The President spoke at 11:58 a.m. in the ballroom at the Sheraton
    Washington Hotel. In his remarks, he referred to the following American
    Medical Association officers: Dr. Percy Wootton, president; Dr. Nancy
    Dickey, president-elect; Dr. Thomas Reardon, chairman of the board; Dr.
    Randolph D. Smoak, Jr., vice chairman of the board; and Dr. Lynn E.
    Jensen, chief executive officer and interim vice president.