    [Public Papers of the Presidents of the United States: William J. Clinton (1999, Book I)]
    [April 9, 1999]
    [Pages 530-533]
    [From the U.S. Government Publishing Office www.gpo.gov]

    Remarks on the Patients' Bill of Rights in Philadelphia, Pennsylvania
    April 9, 1999

        Thank you, Joan, for making the trip up
    here and for your very, very moving account of your experience. I want
    to thank all of you who have come here today: John Sweeney; and Congressmen Brady,
    Borski, and Fattah; Congresswoman DeLauro; my
    good friend Congressman Dingell, who flew up
    with me this morning; and Congressman Dave Bonior.
        I'd like to thank the other Members of Congress who are here:
    Congressmen Ron Klink and Joe Hoeffel, from Pennsylvania; Congressmen Donald Payne and Rob Andrews from
    New Jersey; Congresswomen Carolyn Maloney, Carolyn McCarthy, Congressman
    Joe Crowley from New York; Congressman Ted
    Strickland from Ohio. That's a pretty
    impressive group, and we had Congressman Pallone here a little earlier, from New Jersey. I thank them all.
        I also want to thank Judy Lichtman
    from the National Partnership for Women and Families; Ron
    Pollack and Families USA; Fran
    Visco and the National Breast Cancer
    Coalition; Beverly Malone and the American
    Nurses Association. And there are 150 other provider, consumer, and
    patient organizations, all of them working for the Patients' Bill of
    Rights. I thank them all. That's very, very impressive.
        I want to thank the local Pennsylvania leaders who are here: Senator
    Schwartz; Senator Fumo; former Congresswoman Marjorie Margolies-
    Mezvinsky; Representative Bill
    DeWeese, the Democratic House leader. And
    I think the city council president is here, Anna Verna, and other members of the Philadelphia City Council. I
    thank them all for coming.
        But I want to say a special word of congratulations to the
    mayor. This is the last year of his term.
    You know, I was a Governor for a dozen years, and I loved every day of
    it. And in the late 1970's and early 1980's, most of the new ideas for
    what we should be doing as a people were coming out of the Governors'
    mansions of the country. In the 1990's, most of the new ideas and most
    of the innovations have come out of the mayors' offices. There's not a
    better mayor in America than Ed Rendell, and I'm very proud of him. I
    also want you to know that he has worried me to death on a number of
    issues for Philadelphia--[laughter]--but none more than the Philadelphia
    Navy Yard. And I am so glad we got that worked out, so that the city can
    be--[applause]----
        And you know, I've been working on this Patients' Bill of Rights for
    a long time. And I've listened to all the Members of Congress speak, to
    my good friend John Sweeney, to the
    mayor, and to Joan, and--did you watch the Oscars? You know, where Benigni,
    that great Italian actor, says--the second time they called him up, he
    said, ``This is a terrible mistake. I used up all my English!''
    [Laughter] They used up all my English! [Laughter] They have said
    everything that needs to be said.
        But I would like to make a couple of points, to hammer home what
    this is about and why we're here. First of all, we're here in
    Philadelphia, as has been said, not only because it is the home of the
    Constitution, the Declaration of Independence, the Bill of Rights; it
    was also, interestingly enough, the home of the very first petition
    drive. Back in 1701, the citizens of Philadelphia launched what I think
    was the first successful petition drive in the New World, when they
    asserted and won the full and unfettered right to practice whatever
    religion they chose.
        Philadelphia, thanks to Ben Franklin, was the home of America's
    first hospital, later America's first medical school and first nursing
    school, still

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    one of the most important medical centers not only in the United States
    but in the world.
        Now, this petition, as Rosa DeLauro said when she gave you the right
    address, is a little bit more modern. But we have to do it. And I'd like
    to say why and what the larger stakes are, and go back over this one
    more time.
        Why are we having to do this petition? I mean, this is a bill
    supported by over 70 percent of the American people and by almost equal
    margins, in every research document, almost equal margins, by
    Republicans and Democrats and independents. As a matter of fact, it is
    virtually the only issue that I have worked on in the last 5 years where
    there is almost no difference by party in levels of support, except in
    Washington, DC.
        Now, why is that? That's because the people who are against it,
    basically the large HMO's, the insurers, have got the ear of the
    congressional majority, and they have a lot of political influence. And
    how Washington works, for good or ill, is that--people say, ``Well, who
    cares if there are a lot of people for it; this is not very high up on
    their scale. The economy's doing fine. Most people are all right. There
    aren't all that many stories like Joan's. We'll
    let this slide.''
        Now, that's what's going on here. We need this petition drive
    because unless there is a clear, unambiguous signal from the people of
    the United States--not just that we want this, not just that we need
    this, not just that we believe in this--the organized forces of the
    status quo will do nothing. They will say, ``Oh, well, the President
    went to Philadelphia, and he brought all the Congress Members here. And
    there were 100 Members of Congress around the country, but they probably
    can't break through on the evening news tonight because of Kosovo.
    That's another excuse we'll have to let this thing slide.''
        You know, this is the kind of thing you can do when you're not
    running for office anymore. You can be more frank with people.
    [Laughter] I'm just telling you, that's what's going on.
        Now, I have talked about this until I am blue in the face. I have
    met with people like Joan, and I have heard these stories. And I want
    you to know that I feel a special responsibility to do this, because I
    don't oppose all managed care. I think managed care has done some good
    in this country. Health care costs were going up at 3 times the rate of
    inflation when I became President. It was going to bankrupt the country.
    We should want all organizations, including health care organizations,
    run as efficiently as possible. But every organization that forgets its
    primary purpose is doomed to fail. The primary purpose is not to deliver
    cheap health care; the primary purpose is to deliver quality health care
    as inexpensively as possible.
        Now, I wish we had somebody here representing the other side,
    standing here beside another microphone. Here's what they would say.
    They'd say, ``Well, Mr. President, that's very compelling, and you got a
    nice applause line. But the truth is, there are just hard decisions, and
    you've got to decide whether you want to bankrupt us or not, and this
    Patients' Bill of Rights will bankrupt us.'' So let me make a
    countercase.
        Here's what we asked for in the bill. Number one, the right to have
    a specialist when you need it. That's Joan's story, right? She got the
    specialist, all right, after she lost her sight. I've sat with people
    who got the specialist after their loved one lost their life or when it
    was too late to do the medical procedure. Because the way these things
    are organized--you heard John talk about his doctor friend who got
    fired--if you're down the chain in the review process in one of these
    organizations, you just know one thing: You are never going to get in
    trouble for saying no.
        You know, put yourself in the position of a young person working for
    an HMO; suppose you've got a little kid; suppose you're worried about
    your Christmas bonus; suppose you've got to save your job. You will
    never get in trouble if you say no, because you say, ``Well, they can
    always appeal it to somebody else higher.'' So delay is one of the
    biggest problems here--the right to see a specialist when you need it.
        The right to emergency room care, wherever and whenever you need it.
    I know you find this hard to believe if it's never happened to you, but
    Philadelphia's a pretty big city, with a lot of hospitals; if you get
    hurt on one side of Philadelphia, and the hospital that your HMO works
    with is on the other side, they can go past three hospitals after you've
    been hit by a car. That's wrong. You know, that may not seem like a big
    deal unless that happens to you, but that's wrong.
        The right to have your doctor level with you and discuss all your
    treatment options.

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        The right to a timely and independent appeals process.
        The right to hold your plan accountable if it causes you or a loved
    one harm.
        The right to know--this is a big deal--the right to know that you
    won't be forced to switch doctors in the middle of a treatment, like a
    pregnancy or a chemotherapy treatment. That may seem unbelievable, but a
    lot of employers, particularly smaller employers--to be fair to them,
    they have to change their providers from time to time. They're always
    struggling to try to get affordable coverage. All we say is, ``Okay,
    nobody wants to stop you from changing your providers, but if one of
    your employees is 7 months into a pregnancy, or another one is halfway
    through a chemotherapy treatment, then the provider, the new provider
    can't force them to change the people that are giving them the health
    care.'' It seems to me that this is basic human decency.
        Now, we have worked hard to do our part and to try to honestly
    explore the contention of the opponents of this bill that this is going
    to cost them too much money. We are the single largest buyer, the
    Federal Government, of private health insurance. Today--today--we are
    completing the process of giving the 9 million men, women, and children
    who receive their health benefits through the Federal Government all the
    vital patient protections recommended by the Health Care Quality
    Commission. We're informing--listen to this--all 285 companies who
    provide coverage for Federal employees that if they want to do business
    with us, they've got to add the last two of our protections.
        We've already imposed the rest of the requirements; now we're saying
    you can't make people switch doctors in the middle of treatment, and you
    have to provide full disclosure of what the plans cover, what incentives
    are offered to doctors, and how satisfied other patients have been with
    their care.
        Now, here is the important point. This is the answer to the
    opponents of our bill. A new analysis by the Office of Personnel
    Management--Janice Lachance, the head of
    that office, is here with me today--shows that providing all these
    protections--listen to this--all these protections will cost less than
    $1 per person per month--less than $1 per person per month. I think that
    is worth it to stop the story that Joan just told us, and the hundreds
    of stories around this country.
        Now, today, the Republican leadership in the House is not even
    debating a comprehensive bill. In the Senate the leadership plan does
    not ensure access to specialists, does not prevent the health care plans
    from forcing you to change doctors in mid-treatment, does not give you
    adequate recourse if your health plan fails to provide adequate care,
    and because it applies only to self-insured plans, actually leaves more
    than 120 million patients without all these guarantees.
        Now, this is a clear choice. But again, I say, this does not need to
    be a partisan issue. This is not a partisan issue anywhere in America
    but Washington, DC. I've heard tell that most doctors are Republicans,
    but the AMA is for this. The Nurses Association is for this. The health
    care providers are for this. And I'm telling you, a lot of us who have
    supported the idea of more efficient management of the health care
    system are for it. What is the purpose of the health care system? It is
    quality health care at the least cost.
        Now, let me just ask you one last thing. Everybody says, anybody
    says, ``Well, one of the things that worries me about the modern world
    is that we're going to leave people behind.'' Well, I've been working
    for 6 years to stop that. You heard the mayor mention Chaka
    Fattah's work with us to try to make sure all
    of our kids can go to college. We changed the law so that we wouldn't
    leave anybody behind; everybody could afford to go to college.
        We talked about this part of Philadelphia being in the empowerment
    zone. We are now offering to Congress a new market initiative to bring
    jobs to the poorest part of America by giving people who invest in those
    areas the same incentives we give them if they invest in some other
    country--to have the same incentive to invest in America and create
    jobs, to close the job gap in America.
        So we've got to close the education gap; we've got to close the job
    gap; we've got to close the technology gap. But this is closing the
    health care gap. Do you know what would happen to me this afternoon if I
    started having the symptoms Joan did? Do you have any idea what would
    happen to me? Within 15 minutes, I'd be on a helicopter; within half an
    hour I'd be there. I would have whatever specialist was needed, and I
    would get it. And when I'm gone from the Presidency, because I'll have a
    good pension, and if, God willing, I stay healthy, a decent income, the
    same thing would happen.

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    Maybe it would take an hour longer. Not a month longer. [Laughter]
        Now, we can laugh about this, because sometimes it hurts too much to
    cry. But I am telling you, the political reality is that the system
    believes it can resist the opinion and the desire of the American
    people. That is what this petition drive is all about.
        And don't you think it won't make a difference. This could be a good
    education for a lot of people all over America. They could teach people
    how to use the Internet for the first time by putting their name on this
    petition. We ought to have schoolchildren doing it. We ought to have
    civic clubs doing it. We ought to have religious organizations doing it.
    People ought to be accessing--this could be their first experience on
    the Internet
        But the reason we are here, the true, honest-to-goodness reason
    we're here is that everybody knows we need to do it; we have now proved
    we can afford to do it; the whole country is for it; the system in
    Washington is resisting it; and the people still rule if they will make
    their voices heard loud enough. Stand up and be heard.
        Thank you.

    Note: The President spoke at 1:57 p.m. in the Great Hall at Memorial
    Hall. In his remarks, he referred to Joan Bleakly, a patient who was
    denied access to a specialist; John J. Sweeney, president, AFL-CIO;
    Judith L. Lichtman, president, National Partnership for Women and
    Families; Ronald F. Pollack, vice president and executive director,
    Families USA; Frances M. Visco, president, National Breast Cancer
    Coalition; Beverly L. Malone, president, American Nurses Association;
    State Senators Allyson Y. Schwartz and Vincent J. Fumo; State
    Representative H. William DeWeese, Democratic House leader; Anna C.
    Verna, president, Philadelphia City Council; Mayor Edward G. Rendell of
    Philadelphia; and actor-director Roberto Benigni.