[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 
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 

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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 
    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 
    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 
    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 
    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 
    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 
    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 
    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 
    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 
    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 
    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.