[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 [[Page 339]] 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 [[Page 340]] 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, [[Page 341]] 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 [[Page 342]] 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 [[Page 343]] 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.