    [Public Papers of the Presidents of the United States: William J. Clinton (1998, Book I)]
    [May 28, 1998]
    [Pages 846-849]
    [From the U.S. Government Publishing Office www.gpo.gov]

    Remarks on the Patients' Bill of Rights
    May 28, 1998

        Not much left for me to say, is there? [Laughter]
        Let me say, first of all, how much I appreciate the work that
    Secretary Shalala and Secretary
    Herman have done on our quality health care
    commission. Dr. Benjamin, thank you for your
    life's work and for your leadership. Mr. Vice President, thank you for everything you've done in the last 5\1/2\
    years on health care. And thank you, Ricka, for
    reminding us of what this is really all about. I have a number of things
    I would like to say about this that I hope will not be repetitive.

    Detonation of a Nuclear Device by Pakistan

        But because of the explosion of the nuclear tests this morning by
    the Government of Pakistan, I'd like to make a brief statement about

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    that first, since this is my only opportunity to communicate with the
    media and the American people on that issue.
        First, I deplore the decision. By failing to exercise restraint and
    responding to the Indian test, Pakistan lost a truly priceless
    opportunity to strengthen its own security, to improve its political
    standing in the eyes of the world. And although Pakistan was not the
    first to test, two wrongs don't make a right. I have made it clear to
    the leaders of Pakistan that we have no choice but to impose sanctions
    pursuant to the Glenn amendment as is required by law. [Applause] Thank
    you.
        Now I want to say again, it is now more urgent than it was yesterday
    that both Pakistan and India renounce further tests, sign the
    Comprehensive Test Ban Treaty, and take decisive steps to reduce
    tensions in South Asia and reverse the dangerous arms race.
        I cannot believe that we are about to start the 21st century by
    having the Indian subcontinent repeat the worst mistakes of the 20th
    century, when we know it is not necessary to peace, to security, to
    prosperity, to national greatness or personal fulfillment. And I hope
    that the determined efforts of the United States and our allies will be
    successful in helping the parties who must themselves decide how to
    define their future to defuse tensions and avoid further errors.

    Patients' Bill of Rights

        Now, if I might, I'd like to say just a few words about what we have
    been talking about here. And we have seen the human face 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 exciting things that are happening
    and how the world is changing, how technology and globalization and
    scientific advances are changing the way we work and live and relate to
    each other, it is clear that we are living in a moment of really pivotal
    change in human society.
        At every such moment, the trick is to take advantage of the changes
    that are positive and not be consumed by their negative aspects or, to
    put it in another way, to meet the challenges of the future without
    giving up but, instead, enhancing the most enduring values of the
    society.
        Now, that's what we've been trying to do throughout the last 6 years
    on a whole lot of issues. Yes, we balanced the budget, and earlier than
    anybody thought we could, but we continued to invest in education and
    health care and the environment and research. Yes, I want to have this
    surplus, but I don't want to spend a penny of it, even for things that I
    would like, until I know that we have secured the Social Security system
    for the 21st century so that when the baby boomers like me retire we
    don't bankrupt our kids and keep them from raising our grandkids
    properly.
        So you don't do the easy thing in the moment; you show a little
    restraint and think about the long-term interest of the country. You
    take advantage of the change of a healthier economy and a balanced
    budget and the surplus, but you don't just do what is right at hand. You
    think about the long term.
        Now, yesterday we celebrated the year anniversary of our Welfare to
    Work Partnership--that's all these companies that help us to hire people
    from welfare. So yes, we said the welfare system wasn't working and
    people who are able-bodied ought to have to go to work, but by the way,
    they shouldn't wreck their responsibilities as parents. 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 think it will help
    us all to think about all the other challenges that we're facing. I
    mean, we've been very fortunate in America to have had the national
    wealth and the infrastructure of health care that we've had and the huge
    number of dedicated people we have here, physicians and nurses and other
    health care providers and support personnel. And because of
    technological and scientific advances and because we're learning how to
    do more outreach and preventive care, we now have the lowest infant
    mortality rate and the highest life expectancy in our history.
        Because of the human genome project and because of the mapping that
    it will make it possible to do for young children, we actually have
    people seriously saying that babies who are born at the tip end of the
    20th century may actually live to see the 22d century, not the 21st
    century. This is all great, if you have access to it.
        Now, if you look at what managed care has done--I mean, first we had
    a system which was basically pay as you go. When my mother started being
    a nurse anesthetist, people didn't have

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    money; there was no Medicare; there was no Medicaid. I remember one time
    a fruit picker bringing her five bushels full of peaches to pay for his
    wife's surgery. And you know, I was young, and I thought it was a lot
    better than money. [Laughter] But it wasn't so good if--you couldn't pay
    your electric bill with peaches, you know. [Laughter]
        So then we went into more and more insurance. We had Medicare; we
    had Medicaid; we had employer assisted insurance. Then we had this huge
    inflation in medical costs which led to two other trends. One was,
    unfortunately, fewer employers covering their employees at work. When
    the Vice President and I took office, about 40 percent of health care
    dollars were public dollars; now it's up over 45 percent.
        The other trend that occurred was, in an attempt to preserve the
    employer, private based health insurance plan and not have the whole
    thing go broke by having inflation go forward at 3 times the national
    average, new management systems were put into place. So I don't think we
    should overlook the fact that managed care was a part of a response to
    an unsustainable situation with inflation and health care costs, and
    some good came out of it. But it's like every other change: If there are
    no brakes, if there's no value base, then the logic of the change will
    consume itself. I mean, that's basically the story you just heard.
        So is managed care, per se, bad? No. Who could say it's bad to stop
    health care costs from going up at 3 times the rate of inflation? It was
    unsustainable. Eventually it would have consumed the whole economy. But
    no change is inherently good without being anchored in basic values.
        Now, that's all this Patients' Bill of Rights is about. It says:
    Okay, go have your managed care; get rid of 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 hear any more like that. That's
    what this bill says. This bill says, you know, how can you let some
    person with the mentality of an accountant who will only see the number
    of what it costs to have somebody do her surgery, who will only see the
    number at the bottom line of what the chemotherapy costs, make a
    decision? We're not that kind of people. We're not that kind of society.
    And if we have to endure a smidgen more inflation, bring it on. That's
    all this is about.
        Now, let me also say one other thing. This is urgent. You know,
    there have been a lot of other things going on during this session of
    Congress, and let them go on, but there ought to be some time taken to
    do the business of the American people. This is urgent.
        How many more stories do we have to hear like Ricka's before we
    actually act? Believe me, there's another one; there's one right now,
    just while we're sitting here, that somebody else just like her
    somewhere in America going through something like she went through. And
    it will be somebody else tomorrow and somebody else the next 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 the benefits we can
    possibly get from better and more efficient management and cost
    controls, but we don't intend to chunk out the values that make this a
    decent place to live and give up all the benefits we've gotten out of
    medical research and advances in the last 30 years by just throwing it
    away on this kind of stranglehold technique. We're not going to tolerate
    it anymore.
        Now, I think--what I hope will happen, because all of you have come
    together here today, is that we will have, first of all, a general up
    feeling in the country that we have to do more on this to get this done
    in this session right now; secondly, that the people who are part of all
    your organizations or affiliates around the country will become more
    active; and thirdly--and Secretary Shalala and Dr. Benjamin in different
    ways alluded to this--that we will have a special increase in intensity
    among women in America about this.
        We have a report which was handed to me--you probably saw them hand
    it to me, because they forgot--[laughter]--on a State-by-State analysis
    of what this bill would mean to women. Now, in addition to the points
    that were made by previous speakers about this, I think it's important
    to note that according to all the research that we have, three-quarters
    of all the health care decisions in this country are made by women. In
    many households, women 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 that
    require constant and specialized medical attention. So there are special
    stakes here for the women of America.

    [[Page 849]]

        There's another point I want to make that was mentioned by the Vice
    President, but I want to hammer this home. This really is a problem that
    must have a national solution. People say to me all the time, ``Well,
    you know, you used to be a Governor. Let the States do this; there's
    State legislation passing all the time.'' Well, first let me say I'm
    grateful for that State legislation, and I thank Governors of both
    parties who have supported it. Forty-four States have passed some kind
    of legislation. But some of the States have only passed one of the
    provisions of the many provisions in the Patients' Bill of Rights, first
    of all. Secondly, there are 122 million Americans, out of a population
    of 260 million--122 million of us are enrolled in plans not fully
    governed by State law. For example, just take California, our most
    populous State. If California passed the bill now pending in Congress,
    which is quite comprehensive, there would still be 13 million of the 30
    million Californians who'd be totally unaffected by it, because as
    Secretary Herman said, because of the way ERISA works. So there has to
    be a national solution.
        Now, all of you know that there are some pretty powerful special
    interests who are up here working against this bill. My answer is the
    previous speaker. So I think if you go back home and you think about
    this and you try to mobilize your friends and the people that are
    affiliated with it, first of all, think about how this is a specific
    example of the kind of challenges we face at this moment in our
    history--all this technology, all these changes, everything going on.
    And it is fundamentally the test of a decent society and certainly a
    great democracy like ours that we embrace all the changes that are going
    on, but we do it in a way consistent with the basic values that got us
    where we are over the last 220 years. Secondly, remember to put a human
    face on it, and remember every day that goes by that this bill does not
    pass--every single 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 stop it.
        Thank you, and God bless you.

    Note: The President spoke at 10:50 a.m. in Room 450 of the Old Executive
    Office Building. In his remarks, he referred to Ricka Powers, breast
    cancer patient who introduced the President; and Regina Benjamin, M.D.,
    member, board of trustees, American Medical Association.