[Public Papers of the Presidents of the United States: William J. Clinton (1998, Book II)]
[November 2, 1998]
[Pages 1960-1963]
[From the U.S. Government Publishing Office www.gpo.gov]



Remarks on the Patients' Bill of Rights
November 2, 1998

    Thank you so very much, Mrs. Jennings, for coming here with your son 
amidst your evident pain to share your experience with us. Thank you, 
Dr. Weinmann, for sharing your experiences with us. If you would do that 
every day until we pass a bill, you can drink my water every day. 
[Laughter] I loved it. [Laughter]
    Thank you, Dr. Beverly Malone. Thank you, Secretary Herman, for the 
work you and Secretary Shalala did. Thank you, Deputy Secretary Gober; 
Director of OPM Janice Lachance. I'd also like to thank Linda Chavez-
Thompson, the executive vice president of the AFL-CIO; Gerry McEntee, 
the president of AFSME; Bill Lucy, the secretary-treasurer of AFSME; 
John Sepulveda, the Deputy Director of OPM; and Rudy de Leon, the Under 
Secretary of Defense, for being here. And a special word of appreciation 
on this day before the election to Congressman Eliot Engel, one of the 
great supporters of the Patients' Bill of Rights from New York City. 
Thank you, sir, for being here.

Iraq

    Let me say, before I begin, a few words about the situation in Iraq 
which has been dominating the news--and I haven't had a chance to talk 
to the American people through the press in the last couple of days.
    Saddam Hussein's latest refusal to cooperate with the international 
weapons inspectors is completely unacceptable. Once again, though, it 
will backfire. Far from dividing the international community and 
achieving concessions, his obstructionism was immediately and 
unanimously condemned by the United Nations Security Council. It has 
only served to deepen the international community's resolve.
    Just a short while ago, I met with my national security team to 
review the situation and discuss our next steps. Iraq must let the 
inspectors finish the job they started 7 years ago, a job Iraq promised 
to let them do repeatedly.
    What is that job? Making sure Iraq accounts for and destroys all its 
chemical, biological, and nuclear weapons capability and the missiles to 
deliver such weapons. For Iraq, the only path to lifting sanctions is 
through complete cooperation with the weapons inspectors, without 
restrictions, runarounds, or roadblocks.
    In the coming days, we will be consulting closely with our allies 
and our friends in the region. Until the inspectors are back on the job, 
no options are off the table.

Patients' Bill of Rights

    Now let's talk about the Patients' Bill of Rights and what it means 
to the citizens of our country. A day from now, tomorrow, starting early 
in the morning, Americans from all walks of life will have a chance to 
exercise their right to vote. When citizens go to the polls tomorrow--
and I hope very large numbers of them will--they will bring to bear 
their deepest hopes and concerns about their own families, their 
children, and our Nation. The choices Americans make tomorrow will have 
a profound effect on the future of our country.
    This is not an ordinary time, and therefore it is not an ordinary 
election. We can have

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progress on health and a Patients' Bill of Rights, or more partisanship; 
progress in education and students in smaller, more modern classrooms 
rather than trailers, or more partisanship; progress towards saving 
Social Security for the 21st century, or more partisanship.
    Perhaps there is no choice more stark than the one presented by the 
stories we have heard today, for we believe that a Patients' Bill of 
Rights offers protections every American deserves. We believe such a 
bill must be strong and enforceable and safeguard the security of 
patients and their families.
    We need a bill of rights that says medical decisions should be made 
by informed doctors, not accountants; that specialists should be 
available whenever a doctor recommends them; that an emergency room 
coverage should be available wherever and whenever it is needed; that 
medical records should remain private; that no one can be forced to 
change doctors in the middle of treatment because an employer changes 
plans; that when people are harmed they have a right to hold the HMO 
accountable.
    We have worked hard to extend these rights to as many people as we 
could through the use of executive authority. In February I asked all 
Federal agencies that administer health care--that's Medicare, Medicaid, 
the Federal employee plan, the Department of Defense, and the Veterans 
Administration--to do everything they could to provide these 
protections. Today the Vice President sent me a report on their 
progress. It is considerable. Through executive action we're doing 
everything we can to extend the protections of the bill of rights to 
Americans who get their health care through federally funded plans. As 
the report shows, we have done so while avoiding any excessive cost or 
burden on these plans. Still, the executive action alone cannot protect 
the millions and millions of Americans--160 million total--in managed 
care plans.
    Now, these plans can save money. They can actually improve the 
delivery of care if the management is done properly. When I became 
President, I'd like to remind all of you--it was a long time ago now, 6 
years; it's hard to remember sometimes--inflation in health care was 
increasing at about 3 times the national rate of inflation. It was 
becoming unsustainable for employers, for employees, for families. And 
so some management changes were in order.
    But one of the things that we have learned--and I thought the doctor 
stated it very well--is that whenever any kind of management change or 
market-oriented change is instituted, if you're not careful, the 
technique itself, the management itself, or the bottom line, the money-
saving itself completely swallows up the original purpose of the 
enterprise. The purpose of managed care is to deliver quality health 
care to everyone who needs it, in the most efficient way, at the lowest 
available cost, consistent with quality health care. The purpose of 
managed care is not to cut the costs as much as you can, as long as it 
still looks like you're giving health care, whether you are or not.
    And that is the dilemma that I appointed this Commission on Consumer 
Rights in Health Care to consider, that Secretary Herman and Secretary 
Shalala cochaired. We had business people on it. We had medical people 
on it. We had Republicans and Democrats on it.
    And let me say to you that--I want to say this as strongly as I 
can--the stories you heard from this doctor today, the heartbreaking 
story you heard from Mrs. Jennings today, they are not isolated stories. 
They are not, unfortunately, exceptional stories. There are stories like 
this all over the country. And I, frankly, have heard too many of them. 
I've heard too many doctors tearing their hair out. I've seen too many 
nurses literally crying, talking to me about the people they've been 
required to turn down care to. We have seen too many families that have 
lost a loved one either because of denial or delay, which as you heard 
in the case of Mrs. Jennings can be the same thing.
    And I would also like to point out that there were 43 managed care 
organizations who supported our Patients' Bill of Rights, 43 companies 
who were up front enough to come forward and say, ``Look, we either are 
doing this or we want to do it, but we don't think we should be put out 
of business for doing the right thing and people who are doing the wrong 
thing should be rewarded.''
    So, what are we to do? Unfortunately, insurance company accountants 
or bogus procedures are not the only thing delaying the Patients' Bill 
of Rights now. The Republican leadership in Congress delayed it all year 
long. For a full year we worked with lawmakers of both parties in good 
faith to try to craft a bill that would genuinely protect patient's 
rights. And to be fair, I want to make full disclosure on this eve of

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the election, we had a handful, a bare handful, but we did have a 
handful of Republicans who were willing to support it.
    But in the House, they offered a bill, which I'll talk more about it 
in a minute, which didn't provide any of the protections, really, that 
the commission recommended and didn't cover 100 million people with what 
little it did provide. In the Senate, they brought the bill up, and the 
members in the other party that were in hotly contested races were, in 
effect, permitted to vote for the bill with us, and they still had 
enough votes to kill it. It was so cynical. And it's hard to be cynical 
once you hear the kind of stories we've heard today.
    It was, to be sure, a profitable decision. The people who wanted the 
bill killed have spent vast sums of money attacking people like 
Congressman Engel. Now, he doesn't have a strong opponent and couldn't 
be defeated in his district, so he could be here with us today. But 
Congressman Frank Pallone from New Jersey, simply because he had the 
audacity to support this bill and say there should be no more Mrs. 
Jennings, a man representing a single congressional district found 
himself the target of ads run on New York television during the World 
Series. You know how expensive those are? [Laughter] The World Series--
we're beaming it to you, New Jersey. We'll show these Congressmen, if 
they have the audacity to stand up and say we should be held accountable 
in the court of law like anybody else, that we ought to put the quality 
of health care first; we'll show them. Now, that's what this is about.
    Now, let's look at the facts. Let's look at the facts. Look at this 
chart. I've shown this chart before, but this is a day before the 
election. I want the people of this country to see this chart. I don't 
want any smokescreen. I've seen some of these ads that members of the 
other party ran about how they're really for this Patients' Bill of 
Rights, and it made me think that ours wasn't strong enough. And I 
looked at the ad, and then I went back and looked at their bill. So I 
think we need to look at their bill one more time.
    We say that medical decisions should be made by doctors, not 
accountants. Ours guarantees that; theirs doesn't. We say that there 
should be a guarantee of direct access to specialists if your primary 
doctor recommends it. Ours guarantees that; theirs doesn't. We say there 
should be real emergency room protections. Let me stop and say what that 
means. That means if you get hit by a car and you're in an emergency, 
you ought to go to the nearest emergency room, not one halfway across 
town if you're in a big city because it happens to be covered. That may 
not seem like a big deal to you, but just imagine, have you ever been in 
New York City traffic or Los Angeles traffic? This is a big deal. This 
is a huge deal. This is not some idle talk here. This is not political 
rhetoric. This is a huge thing. Anybody that's ever been with a loved 
one in the back of an ambulance struggling to get to a hospital knows 
this is a huge deal.
    We say you ought to keep your doctor through critical treatments. 
That's a guarantee of ours. What does that mean? It means if you're 
pregnant and your employer changes providers while you're pregnant, you 
can't be forced to get another obstetrician. Those of you who have had 
children, remember, how traumatic would that have been--seventh month of 
your pregnancy, say, ``I'm sorry. Here's Dr. Smith. Get to know him.'' 
Even worse, chemotherapy--almost all of us have had somebody in our 
family now have chemotherapy treatment. Just think how traumatic it is--
you sit there; you worry about the person that you love going through 
chemotherapy; you watch their hair fall out; you see the loss of 
appetite; you try to make jokes about it--and be told in the middle of 
the treatment you have to change doctors. It's a big issue. This is not 
just a word on a chart here. This is a big human issue.
    Protecting patients from secret financial incentives--you heard the 
doctor, what he said. Certainly, there should be no money going to 
doctors in HMO's for making cost-cutting decisions. Protecting medical 
privacy laws, holding health plans accountable for harming patients, and 
covering all health plans--their bill, what little it did cover, didn't 
cover 100 million Americans.
    Now, that's what is at issue here. This is a very practical bill. It 
is very important. And I will say, it should not be a partisan issue. 
Believe you me, this is not a partisan issue in any community in 
America, except Washington, DC. I have no idea what political party Mrs. 
Jennings belongs to. I don't know if the doctor has ever voted for a 
Democrat in his life. [Laughter] I don't know. I know nothing about 
that. This is not a political issue. When you haul into an emergency 
room, nobody asks you--and you fill

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out all those forms, there is not ``Republican,'' ``independent,'' 
``Democrat'' on it. You don't check that. This has nothing to do, 
ordinarily, with partisan politics.
    And I will say again, I believe we ought to save money. I worked for 
6 years here to get this budget balanced, to get it in surplus. We 
eliminated hundreds of programs. But we didn't stop trying to invest in 
education and research or Head Start. I believe they ought to save all 
the money they can on the health care system. But you should not have a 
system where you get in trouble for taking care of people and where, in 
the first line of contact, you will never get in trouble for saying no.
    That's the last point I want to make about this. And the doctor 
implied this; I want to make it explicit. Put yourself, every one of 
you, in a position--suppose you weren't a doctor. Suppose you were 
somebody with a BA in accounting, and you got a degree, and you're 25 or 
28 years old; you get a degree, working for these health maintenance 
organizations, and you review these claims in the first position. What 
do you know? First of all, you'd like to keep your job. It's a nice 
place. You've got health benefits. [Laughter] You get 2 weeks--no, 
listen, think about that. You get 2 weeks' vacation. And you've never 
looked at Mrs. Jennings; you don't know her husband; you don't have to 
go home at night with their faces burned in your brain. What do you 
know? You know you will never get in trouble for saying no. That's the 
incentive. You won't lose your job if you say no every time. Why? 
Because eventually they'll kick it up to somebody who will eventually 
get it right, and if they're a doctor, they'll eventually get it right. 
The problem is, you just heard today one gripping example of what 
``eventually'' can mean, in the life of the Jennings family.
    That is why we need the roadmap. That's why we need the law. We 
shouldn't depend upon the roll of the dice about whether every person 
who reviews every one of these cases in every one of these plans all 
across America is willing to risk his or her job in the first instance, 
every time, to try to resolve doubt. And some of them don't even have 
enough knowledge to know what to do, trying to second-guess the doctors. 
This is a big deal, practically.
    I've heard all these arguments about how, well, you don't want too 
many lawsuits, and all that. Now, I'm sympathetic to that; everybody is. 
But look, under the law today, one of our wits said on our side the 
other day, the only people in Washington who can't get sued anymore are 
foreign diplomats and HMO's. [Laughter] Now, nobody wants an unnecessary 
lawsuit. But people have to be held accountable in these cases so that 
we can change the incentives.
    So I ask you all to think about this. And I ask the American people 
to think about it. Again, it should not be a partisan issue. It has been 
made a partisan issue not by us but by those who would not join us. 
There was a bipartisan makeup on this commission that came up with this 
recommendation. And I promise you, in every hospital in America today 
there is a bipartisan makeup in the hospital beds as you walk up and 
down the halls and in every nursing station.
    This should be an American issue. Look folks, we've got to fix this. 
And this election, in no small measure, will be a referendum on whether 
we will put people over politics, the public interest over special 
interest, the health of our people over a very short-sighted definition 
of the bottom line.
    Again I say, I hope the American people will go to the polls 
tomorrow in large numbers, and I hope they will vote in a way that sends 
a signal loud and clear that America needs a real Patients' Bill of 
Rights. I hope the Americans who see this will remember Frances 
Jennings, will remember Dr. Weinmann, will remember Beverly Malone, will 
remember the people who give care and the people who need it, and 
remember what this is all about.
    Thank you very much.

Note: The President spoke at 2:07 p.m. in the East Room at the White 
House. In his remarks, he referred to Frances Jennings, who introduced 
the President and whose husband died as a result of a delayed health 
care decision; Dr. Robert Weinmann, Mr. Jennings' physician; Dr. Beverly 
Malone, president, American Nurses Association; Gerald W. McEntee, 
president, and William Lucy, international secretary-treasurer, American 
Federation of State, County, and Municipal Employees (AFL-CIO); and 
President Saddam Hussein of Iraq.