[Public Papers of the Presidents of the United States: William J. Clinton (1998, Book II)]
[August 10, 1998]
[Pages 1416-1420]
[From the U.S. Government Publishing Office www.gpo.gov]

[[Page 1416]]

Remarks on the Patients' Bill of Rights in Louisville, Kentucky
August 10, 1998

    The President. Thank you. Thank you, Dr. Peeno. Thank you, Dr. 
Peters. I must say, after they have spoken there hardly needs to be much 
else said. I was profoundly moved, as I know all of you were, by what 
both these fine doctors said, and I thank them for giving their time and 
their lives to the work that they have discussed with us today. Yes, 
let's give them another hand. I thought they were great. [Applause] 
Thank you.
    Thank you, Mr. Mayor, for your warm welcome and your leadership. 
Thank you, my good friend, Senator Ford, for all the years of wise 
counsel and advice, for your work for Kentucky, for its communities, its 
farmers, its people. Thank you, Governor Patton, for your friendship and 
for working for the education and health of your children. Thank you, 
Congressman Baesler, for voting with us and supporting the Patients' 
Bill of Rights, along with Senator Ford, for both of them.
    I'd like to thank your Lieutenant Governor, and doctor, Stephen 
Henry, for being here today; and State Auditor Edward Hatchett; 
Secretary of State John Brown; my good friend Judge Dave Armstrong from 
the same little patch of ground that I'm from in Arkansas. I'd like to 
thank our Director of Personnel Management, Janice Lachance, for coming 
down with me here today. And I'd like to thank all of the health care 
professionals who are here.

Embassy Bombings in Kenya and Tanzania

    Ladies and gentlemen, before we begin, I would like to just ask you 
to permit me to say a few words about the terrible tragedy that occurred 
at our Embassies in Tanzania and Kenya. Our hearts are heavy with the 
news that now 12 Americans, brave people who were working to build a 
better world and represent all of us abroad, have lost their lives. 
Somewhere around 200 Africans have died in those bombs now. We mourn 
their loss. We extend our sympathies to their loved ones. To the nations 
of Kenya and Tanzania, we thank them for their friendship to us. We 
grieve for the loss of their citizens.
    I would just like to ask all of you to take just a few seconds of 
silence in their honor.

[A moment of silence was observed.]

    We go forward now. You should all know that our teams are on the 
ground in Africa. They're tending to the wounded. They're providing 
security. They are searching and finding evidence. We will do whatever 
we can to bring the murderers to justice.
    I must have said this 100 times or more since I've been President, 
but I want to say it again because it bears special meaning today. The 
world we are living in and the world we are moving toward will allow us 
to move around the world more rapidly and more freely than ever before 
and to move information, ideas, and money around the world more rapidly, 
more freely than ever before. It will be a global society that I am 
convinced will bring all Americans our Nation's best years. But there 
has never been a time in human history when we have been free of the 
organized forces of destruction. And the more open the world becomes, 
the more vulnerable people become to those who are organized and have 
weapons, information, technology, and the ability to move.
    We must be strong in dealing with this. We must not be deterred by 
the threat of other actions. There is no way out if we start running 
away from this kind of conduct. We have to build a civilized, open world 
for the 21st century.
    Now, back to the important business at hand. For 5\1/2\ years now, I 
have had the great honor of serving you and working with others to 
strengthen America for a new century, a global information age. We have 
tried to look ahead with new ideas relevant to the times, but based on 
our oldest values of opportunity for all citizens, responsibility from 
all citizens, and a community of all our citizens.
    Thanks to the hard work, ingenuity, and civic spirit of the American 
people and to this new direction in policy, this is a time of great 
prosperity and profound national strength for America. We have a lowest 
unemployment in 28 years, the lowest crime rate in 25 years, the 
smallest percentage of our people on welfare in 29 years, the smallest 
Federal Government in 35 years, the highest homeownership rate in

[[Page 1417]]

history. Wages are rising at twice the rate of inflation. We have, as 
the Governor said, provided for the opportunity for health insurance for 
5 million uninsured children. We have provided HOPE scholarships, worth 
about $1,500 in tax credits a year for the first 2 years of college, tax 
credits for other years of college, interest deduction on--tax 
deductions on the interest on student loans, more Pell grants, more 
work-study positions to open the doors of college to everyone.
    Compared to 5\1/2\ years ago, our air and water are clearer; our 
food is safer; there are fewer toxic waste dumps. And soon--soon--we 
will have the first balanced budget since Neil Armstrong walked on the 
Moon in 1969.
    Now, here's the problem with that. Usually, in our personal lives, 
our family lives, our work lives, and a nation's life, after a series of 
difficult years, when times get good you want to say, ``Thank goodness. 
I'm tired. I need a rest. I want to sit back and enjoy this. I've been 
working like crazy for years, and now things are good. Give me a break. 
Let me have a break.'' [Applause] And you agree, see?
    That is the natural human tendency; that would be a mistake. Why? 
The world is changing very rapidly, as we see every day in the way we 
work and live and relate to each other and the rest of the world. If 
someone had told you 5 or 6 years ago that today Japan would be having 
the problems it's having, would you have believed that? I say that not 
critically; it is a great country full of brilliant people, and they 
will come back. But it is a reminder that things change in a hurry and 
we must always be ready.
    I think you can overdo sports analogies, but I can't resist one 
since I'm in Kentucky. [Laughter] The way the world works today is like 
the last 10 minutes of a basketball game between two really talented 
teams. Now, you think about last season and what the Kentucky Wildcats 
did to people who sat on the lead. Now, think about it. How many games 
were you behind in that you won? You can't afford to do it. The world is 
changing, so we should take the confidence, the resources, the good 
fortune that we gratefully have now and use it to meet the big 
challenges still facing the country. That is very important.
    We've got to continue to work on economic growth, to stay with the 
strategy of fiscal discipline and open trade and investment in our 
people that has brought us this far. And we have to prove we can extend 
the benefits of this recovery to people who haven't felt it yet, from 
the inner cities to Appalachia.
    We have to continue to lead the world toward peace and freedom. We 
can't withdraw from the world. Witness the events of the last few days. 
We have to stand against the spread of chemical, biological, and nuclear 
weapons. We have to stand against the reach of international 
organizations of crime and terror and narcotrafficking. We have to stand 
against the destruction of racial and ethnic and religious hatred, 
against the threat of global environmental and health challenges.
    Here at home we have to honor our obligations to future generations. 
And the most important thing we should do is to set aside every penny of 
the surplus we're going to have on October 1st until we have saved the 
Social Security system for the 21st century when the baby boomers 
require it.
    We have to make sure all of our people have a chance in tomorrow's 
world by making our elementary and secondary schools the best in the 
world. We need smaller classes, more highly trained teachers. We need 
modernized schools connected to the Internet. We need schools where 
there is discipline and good behavior and no gangs, guns, and drugs.
    We need high standards and accountability and great flexibility in 
meeting them. We need to prove we can protect our environment and still 
grow our economy. We have to continue to prove we can reach across the 
lines that divide us in this increasingly diverse country and be one 
    A good way to view this moment in history, I believe, is through the 
lens of the First Lady's theme that she came up with for our Millennium 
Project as we look toward how we will mark the changing of the centuries 
and the changing of 1,000 years: ``Honor the past; imagine the future.'' 
That's what we should be doing.
    We have come here today to talk about a very important part of one 
other big challenge we face: how we can put progress over partisanship, 
people over politics, to expand access to quality health care to every 
American. Nothing is more critical to the securities of our families, 
the strength of our communities. Health is something we take for granted 
until we or our loved ones don't have it anymore. But people like the 
two fine doctors who talked to us deal

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with folks like that every day. It isn't a partisan issue, and I 
appreciated the fact that they made that clear. You know, when someone 
gets sick and comes in to see one of these two doctors and fills out a 
form, there is no box that says, ``Republican, Democrat, or 
    Health care is being revolutionized in America. Most of the changes 
are good. Stunning biomedical breakthroughs pose the possibilities of 
vaccines or cures for our deadliest enemies, from diabetes to AIDS to 
Alzheimer's. Before you know it, this genome project will be finished, 
and we'll be able to decode the genetic structure of every person. 
Mothers will know when they bring their babies home from the hospital 
what the potential problems are that those babies have, and some of it 
will be troubling to know, but most of it will be good because they'll 
be able to avoid all kinds of problems that might otherwise have come to 
their children.
    It will be unbelievable what's going to happen to health care in the 
21st century. There have already been examples of nerve transplantations 
in laboratory animals where their spines have been severed and now their 
lower limbs are moving again. It will be an amazing time.
    The trick is how to extend affordable coverage of all these miracles 
and basic preventive health care to all Americans. That's really how the 
managed care revolution began. You know, when I became President, for 
the last 10 years health care costs had been going up at 3 times the 
rate of inflation. We were spending approximately 4 percent more of our 
national income--and at the time, that was about $240 billion a year--
than any other country on Earth on health care, even though we were one 
of the few industrialized countries that still have a significant 
percentage of our people without any health insurance. That was an 
unsustainable trend.
    Since 1990 the number of people in managed care has nearly doubled. 
Today most Americans, 160 million of us, are in managed care plans. And 
as has already been said, I think, on balance, there have been a lot of 
good things to come out of managed care to make it more affordable, more 
accessible, to make the resources go further. But you've heard these 
doctors say that some very, very costly errors have been made by putting 
the dollar over the person.
    I'll never forget the people that I have met and the stories they've 
told me. I met a woman named Mary Kuhl, from Kansas City, whose husband 
died. He needed specialized, urgent heart surgery. By the time he got 
the clearance to get it, it was too late. I met Mick Fleming, whose 
sister died of breast and lung cancer after she was denied treatment 
that she was later determined to have been entitled to. I met a billings 
manager that the doctor referred to, who herself bears the scars of 
having to turn away patients. I think in some ways, of all the people 
that have talked to me, she was the most moving of all, because she had 
to deliver the ``no'' face to face.
    Now, when the bottom line is more important than patients' lives, 
when families have nowhere to turn, when their loved ones are harmed by 
bad decisions, when specialist care is denied, when emergency care is 
not covered, we have to act. That's why you heard, at the grassroots 
level in America, Republicans and Democrats, conservatives and liberals, 
even people who think normally the Government should not do anything 
that can fairly be done by the private sector, have developed this 
overwhelming grassroots consensus that we need a Patients' Bill of 
Rights in America.
    I've done what I could administratively, and some of you are 
probably covered by decisions that I and my administration have made. I 
acted to extend the protections of the Patients' Bill of Rights to 85 
million Americans who get health care through Federal plans. In June we 
extended it to 40 million people who receive Medicare. Last month we put 
in place new rapid appeals for the 3 million veterans who receive health 
care through the Department of Veterans Affairs. Last week the 
Department of Defense issued a directive to all military bases 
throughout the world, extending protections to 8 million service men and 
women and their families at nearly 600 hospitals and clinics all around 
the globe.
    We are already extending many patient protections, such as the right 
to a specialist and continuity of care, to Federal workers. And that's 
why Janice Lachance is here with me today, because we are announcing 
that we are now requiring that 350 health plans that serve Federal 
employees to repeal the gag rules that keep doctors from telling 
patients all their health care options, not just the cheapest ones.

[[Page 1419]]

    Now, a lot of States are acting in this area, too. Kentucky has a 
patients' bill of rights. But I can tell you because of the way the laws 
work, there is no substitute for a national law. We cannot provide 
protection for all Americans. We will leave many, many tens of millions 
behind unless we have strong, bipartisan legislation that covers every 
    Now, for 9 months, I've worked in good faith with lawmakers of both 
parties to pass a strong, enforceable, bipartisan bill of rights. We are 
fighting for a bill supported by both Democrats and Republicans, and 
again, I thank Wendell Ford and Scotty Baesler for their support.
    Now, for 9 months, the leadership of the majority party in Congress 
has resisted taking any action at all. They have listened to those with 
an interest in preserving the status quo, rather than the clear call of 
the public interest we have heard echoing across this hall today. Now 
public demand is rising, and the Republican leadership has discovered 
the need to act. So the House passed a plan last month, and the Senate 
Republicans have offered a similar bill. But these bills would give 
patients and their families a false sense of security.
    You've already heard some of the comments. But this is very 
important, that when everybody is calling for a Patients' Bill of Rights 
and both parties pushing proposals, how can the American people know 
what a real one is? Well, that's what this chart is about over here. And 
maybe--Jerry, would you hand me the chart? You don't have to bring the 
stand; just bring that chart up here. I'll hold it. He said he's the 
Vanna White of Louisville here. [Laughter] I'm not going to discuss 
that. [Laughter]
    I want you to look at this, because that's what this is all about. A 
real Patients' Bill of Rights at least continues and should strengthen 
the medical privacy provisions in place today. In the age of computer 
databases and the Internet, we should strengthen the privacy of medical 
records. Don't you want yours private? Don't you? [Applause] I have a 
proposal that would do this.
    The House Republican bill would dramatically increase the number of 
people who can see your medical records without your knowledge or 
consent. It overturns privacy protections already on the books in 20 
States, including Kentucky. The bill would just wipe them from the 
books, and that is wrong. So here's the first test, protecting medical 
privacy laws: the Republican plan, no; our bipartisan proposal--and I 
should say we do have Republican support, including a fine doctor from 
Iowa, Dr. Ganske, in the Congress, for the bipartisan bill.
    Second, a real Patients' Bill of Rights will guarantee the right to 
see specialists that you need. To reap the full rewards of modern 
medicine, you must have the ability to see, for example, a neurologist 
or a cardiologist if that is what is medically indicated. The 
congressional bills don't give you that right. Ours does. That's the 
second no-yes.
    The third issue, a real Patients' Bill of Rights guarantees you 
won't lose your doctor in the middle of a medical treatment even if your 
employer switches health plans. This is a big deal! This is a big deal! 
Now, the GOP leadership bills don't do that. An insurance company could 
switch obstetricians in the 6th month of pregnancy or drop your 
oncologist in the middle of chemotherapy just because your employer 
switches plans.
    A real Patients' Bill of Rights makes sure that health plans don't 
secretly give incentives to doctors to limit medical care. Now, the 
Republican leadership plan would permit that. Ours would not.
    A real Patients' Bill of Rights guarantees you the right to 
emergency room care when and where you need it. When you are wheeled 
into an emergency room, you shouldn't have to start negotiating with 
your health plan.
    This is the financial incentive; this is keeping your doctor through 
critical treatments--no, yes; no, yes. Emergency room--theirs, no; ours, 
    A real Patients' Bill of Rights holds health care plans accountable 
for the harm patients face if they are denied critical care. Now, that's 
important. If a doctor denies you the health care you need, you can get 
help to pay for lost wages or medical costs today. If an HMO denies you 
the care you need, under the congressional leadership bill, you won't 
get any help at all. Now, if you have rights with no remedies, are they 
rights? How would you feel--what would you say to me?
    What they're saying is, ``Oh, this bipartisan bill, they have all 
these remedies, and it's just going to be a mess with a bunch of 
lawyers. Isn't that awful?'' And a lot of people say, ``Well, I don't 
like lawyers. I don't like lawsuits. Who wants to be in court?'' Sounds 
pretty good.
    Let me ask you this: How would you react if I gave a speech tomorrow 
that said, ``My

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fellow Americans, I love the Bill of Rights. I love the freedom of 
speech, the freedom of assembly, the freedom of religion, the right to 
travel. I love all those Bill of Rights. But I don't like all these 
lawsuits. We got too many of them in America. Therefore, I have proposed 
to amend the Constitution so that no one can ever sue to enforce the 
right to free speech, free assembly, free practice of religion, or any 
other of the rights that have kept our country strong for 220 years.'' 
You would say----
    Audience members. No way! [Laughter]
    The President. So when you talk about remedies, do you have rights 
without remedies? I think we've seen enough there. That's a big issue.
    A real Patients' Bill of Rights should apply to every plan, every 
single one. The Republican plan leaves out--listen to this--as many as 
100 million people, many of them working for small businesses; 100 
million people would still be under the present system, 100 million 
people who need our help. It is wrong. If we're going to do this, I 
don't want to leave 100 million Americans behind, and I don't think you 
do either, even if you would be covered. That's not right.
    So you need to remember here, it isn't the title, ``Patients' Bill 
of Rights''; it is the specifics. What are the specifics? Medical 
privacy: yes on our bill, no on theirs. Access to specialists: yes on 
our bill, no on theirs. Assuring that accountants don't make arbitrary 
medical decisions: yes on our bill, no on theirs--a big deal to doctors, 
because they know what happens to patients. Providing real emergency 
room protections: yes on our bill, no on theirs. Holding health plans 
accountable if patients are harmed: yes on our bill, no on theirs. 
Protecting patients from secret financial incentives: yes on our bill, 
no on theirs. Keeping your doctor through critical treatments--huge 
issue--I saw a lot of you nodding your heads when I said that you'd lose 
your doctor in the middle of your treatment: yes on our bill, no on 
theirs. And then covering all health plans, that is, all Americans: yes 
on our bill, no on theirs.
    That's what's at issue. This is not about politics. This is not 
about party. This is about a crying need for the American people, and 
it's time we did the right thing. We ought to do it now, in September, 
when Congress comes back.
    I want to thank the American Medical Association, the American 
Nurses Association, the American College of Emergency Room Physicians, 
and so many others. I have to tell you, we need a bill of rights, not a 
bill of goods. We need a law, not another loophole. If I get that other 
bill of rights, I will be forced to veto it, and I will.
    Now, I will say again, this is not a partisan issue any place in the 
country but Washington, DC. I believe Republicans and independents are 
just as much for this bill out here in the real world as Democrats are. 
Nothing should be less partisan than the quality of health care our 
people receive. We're a little more than 500 days from that new 
millennium, but there's only a handful of days left in this session of 
Congress. We cannot let this moment of opportunity be remembered as a 
time of missed opportunity.
    Think of what I said about the basketball game. Think about how fast 
things are changing. Think about how fast things can change in your 
life, in your family's life, in your business' life, and in the life of 
our Nation. Now is the time to say, we thank God for the good fortune we 
have, but we are using it to look forward to the future, to make a 
better future, to meet the big challenges of this country. And we ought 
to begin next month, when Congress returns, with the Patients' Bill of 
    Thank you, and God bless you all.

Note: The President spoke at 11:35 a.m. at the Commonwealth Convention 
Center. In his remarks, he referred to Dr. Linda Peeno, cancer survivor, 
who introduced the President; Dr. Kenneth Peters, president, Kentucky 
Medical Association; Mayor Jerry E. Abramson of Louisville; Gov. Paul E. 
Patton and Lt. Gov. Stephen L. Henry of Kentucky; Kentucky State Auditor 
Edward B. Hatchett, Jr.; Kentucky Secretary of State John Y. Brown III; 
Judge/Executive David L. Armstrong, Jefferson County Commission; and 
Janice R. Lachance, Director, Office of Personnel Management.