    [Public Papers of the Presidents of the United States: WILLIAM J. CLINTON (1999, Book II)]
    [September 8, 1999]
    [Pages 1502-1506]
    [From the U.S. Government Publishing Office www.gpo.gov]

    Remarks on Health Care
    September 8, 1999

        Thank you very much. Dr. Copeland;
    Mrs. Copeland; Secretary Shalala, thank you for your outstanding leadership; Surgeon
    General Satcher; OPM Director
    Lachance; to all the advocates here for
    seniors, for children, for people with disabilities; representatives of
    the various health care organizations.
        I am of the opinion that there's really not much left for me to say.
    [Laughter] You know, since I've been in this office and this wonderful
    old house, I've tried to use this room as sort of a classroom for
    America, to bring people here who actually have firsthand experience of
    the challenges we face, the opportunities we have, and to try to provide
    them this microphone and these cameras and this bully pulpit to speak to
    America and to bring more of America here to Washington, DC.
        We've had a lot of very moving events here, but Dr.
    Copeland, I don't think anybody has ever
    done a better job of bringing the reality of what it's like to deal with
    the health care challenges of ordinary people from all walks of life on
    a daily basis as you have today. And I thank you very much for that.
        Secretary Shalala talked quite a bit about the record we have worked
    hard to establish here on health care issues. I want to thank two people
    who aren't here today: first, my wife, because of the role Hillary played in extending health
    insurance coverage to 5 million children, and now we have all the States
    signed up for the Children's Health Insurance Program; and I want to
    thank the Vice President for the critical
    role he has played in fighting for the Patients' Bill of Rights, for our
    long-term care

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    tax credit, for our plan to strengthen Medicare and to include
    prescription drug coverage. And I appreciated the agenda he set out
    yesterday for expanding affordable health care to children and families
    who don't have it in the 21st century, something that I still believe
    needs to be done.
        You know, I heard quite a bit about Dr. Copeland before he came here, and one of the things I heard is that
    his youngest daughter, who just started
    college a week ago, is such a good student, she's already been
    guaranteed admission to medical school. If somebody had figured out a
    way for me to get around organic chemistry, I might have had a different
    career. [Laughter] That's a wonderful achievement.
        But the truth is, there are doctors all across our country today who
    having given their lives to the health of their patients, have genuine
    reservations about whether their children should go into medicine. They
    feel that for all the miracles of modern medicine, doctors are too often
    hamstrung by accountants, and too often the needs of their patients
    don't come first. You just heard a pretty good accounting.
        I know that you, Doctor, are overjoyed
    that your own child wants to be a doctor,
    because you know that we have the power to do what it takes to put
    patients first again, which means you have faith in the health of our
    political system.
        There are a lot of pessimists who think that nothing's going to
    happen here this fall, that the parties are just going to fight and
    maneuver and get ready for next year. I think they're wrong. For one
    thing, ever since we've had this divided Government, we normally have to
    wait until the 11th hour for really good things to happen. I've grown
    used to it. As I said a couple of days ago, it is now 10:30; we're ready
    for the 11th hour. [Laughter]
        But after years of debate and genuine disagreement on a lot of these
    issues, I think a new and increasingly bipartisan consensus is emerging
    on the importance of giving patients the health and privacy protections
    they need, on strengthening and modernizing Medicare, on saving
    teenagers from the ravages from tobacco, on expanding health care
    coverage for uninsured children, and empowering adults with disabilities
    and making long-term care more affordable. But this growing bipartisan
    consensus will amount to little if the Republican leadership refuses to
    schedule a vote on the health care legislation. If they permit the
    votes, this fall could be one of the most important ones for health care
    reform in many, many years. If there is nothing but delay, it's just
    like delaying a patient; it will only make the cure harder. Sooner or
    later, we're going to have to face up to all these issues. We ought to
    do it sooner rather than later. It's a simple choice, familiar to every
    doctor: act early, prevent problems; or act later, at greater cost, with
    more heartbreak and human loss.
        The American people are counting on all their leaders, of both
    parties, to take the wise former course. First and foremost, the
    Republican leaders must make the responsible choice to protect 160
    million Americans who rely on managed care, with a strong and
    enforceable Patients' Bill of Rights. In August Representatives
    Dingell and Norwood introduced a bipartisan bill that rejects the wholly
    inadequate, watered-down approach taken by the Senate. It now has a
    clear majority support in the House of Representatives. That means both
    Republicans and Democrats are for it.
        The Republican leaders, therefore, owe it to the American people to
    schedule a vote on this bill. They must not give in to pressure to tack
    on extraneous provisions that would jeopardize the remarkable bipartisan
    consensus, in the hope that they can make it so bad that I will have to
    veto it, and then claim it's not their responsibility after all.
        The American people deserve the right to see a specialist. They
    deserve the right to go to the nearest emergency room if they're hurt in
    an accident. They deserve the right to maintain the same doctor during
    pregnancy or chemotherapy treatment. They deserve the right to an
    internal and an external review process; the right to know that their
    doctor can openly discuss the best treatment options, not just the
    cheapest; the right to hold health plans accountable for bad decisions.
        More than 200 health care and consumer organizations strongly
    support these protections. Estimates based on Congressional Budget
    Office figures show that the protections would cost no more than $2 a
    month a policy.
        Now, as you all know, all of you in this room, I have already
    established these protections by Executive order for everybody under a
    Federal health care plan, and our costs are less than $1 a month a
    policy. Now, whether we're right

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    or they're right, it's a small price to pay for peace of mind and
    quality health care.
        Second, I challenge the Republican leadership to join with me to
    work out a plan to strengthen and modernize Medicare for the 21st
    century. For more than three decades, Medicare has been a lifeline to
    dignified retirement. You heard what the doctor said about his own
    patients. But with people living longer and the retirement of the baby
    boomers approaching, the Medicare Trust Fund is scheduled to become
    insolvent in 2015. Now, keep in mind there will be twice as many people
    over 65 by 2030 as there are today.
        Today, anybody that lives to be 65 has a life expectancy of 82. By
    then, it will be considerably higher. By then, there will only be about
    two people working for every one retired. We have got to do this now,
    when we have the funds to do so.
        I've asked Congress to dedicate more than $300 billion of the
    projected surplus over the next 10 years to take the Trust Fund out past
    2025. That's the longest it's been in a long, long time. But we need to
    do it, with the retirement of the baby boomers approaching.
        I challenge Congress to introduce new mechanisms of competition, to
    improve quality, to control costs. I've challenged Congress to modernize
    Medicare by helping seniors and people with disabilities pay for
    prescription drugs. I have also set aside a fund to deal with the
    Medicare problems that we now have because of the budget decisions made
    in the '99 balanced budget act, which have imposed severe problems on a
    lot of our teaching hospitals, some of our therapy services, and other
    problems of which many of you in this room are quite familiar.
        Before the August recess, Senator Roth, the chairman of the Senate Finance Committee, committed
    to mark up a Medicare reform package by early October. I salute him for
    that. With the leadership of Senator Roth and Senator
    Moynihan, we can get a bipartisan
    consensus on what to do about Medicare. I don't expect them to agree
    with everything I want to do. What I want them to do is sit down and
    talk with me, and let's agree on the objectives. We have to lengthen the
    life of the Trust Fund. It is irresponsible for us to leave here with
    the Trust Fund scheduled to go out of money in 2015, with this projected
    surplus. It is irresponsible for us to leave here without dealing with
    the plain problems being faced today because of Medicare financing
    difficulties. And I strongly believe it is irresponsible for us to leave
    here without providing for some prescription drug coverage.
        If we were designing Medicare today, there's no way in the wide
    world we'd have a Medicare program without some prescription drug
    coverage. And you know as well as I do that these medicines are going to
    do more and more and more, if properly taken, to lengthen the life and
    improve the quality of life, of people, and eventually to cut the cost
    of hospitalization and other more extensive interventions. So we ought
    to do this now. This should not wait 2 more years. We should do it now.
        The third thing I ask the Republican leadership to join me on is to
    make a responsible choice to protect the sanctity of medical records.
    You know, to the average person, this seems like a no-brainer, a lay-
    down. It's actually quite a hot issue, because there are people who do
    not want to protect the sanctity of medical records. But as more and
    more of these records are stored electronically, the threats to our
    privacy will only increase.
        We know that protecting medical records has been a genuine priority
    for leaders in both parties. But the longstanding deadline for action by
    Congress came and went more than 2 weeks ago. If Congress does not soon
    pass legislation to protect patient records, I will honor the pledge I
    made to the American people in the State of the Union to do so through
    executive action. If need be, I will issue these new protections this
    fall. We should not delay this anymore.
        But again, I don't want this to become a fight either between the
    executive and the legislative branch, or between the two parties. I
    would far rather have legislation so that the American people can look
    to Washington and see people in both parties saying that your medical
    information belongs to you and you alone. Only you can control how it is
    used.
        The fourth challenge I want to issue to the leadership is to make
    sure that we make the responsible choice to allow people with
    disabilities to keep their health insurance when they go to work.
        Now, there is huge bipartisan support for this. Last June the Senate
    unanimously adopted the bill, sponsored by Senators Jeffords and Kennedy,
    Roth and Moynihan, that would finally

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    end the system that says to people with disabilities: If you want to go
    to work, you've got to give up your health insurance and, therefore,
    you'll have to spend more every month than you can possibly make.
        Now, we have worked hard to end the disincentives that for too long
    kept people on welfare out of the work force. These disincentives are
    even more severe for people with disabilities, with serious health care
    problems.
        I met a man in New Hampshire a few months ago who, if he had to pay
    his own health bills, would have had bills of $40,000 a year, and he
    desperately wanted to take a $28,000 job. Now, we're out the $40,000
    anyway. Forget about the human impact on his life and his community and
    his family. Wouldn't you rather have the man making $28,000 and giving
    some of it back in taxes as a productive citizen, having him out there
    as a role model, having people see what people can do if given the
    chance to live up to their God-given abilities? This is foolish. It is
    time to schedule a vote on the work incentive improvement act in the
    House of Representatives.
        Now, the bill has 231 cosponsors in the House, so it's got
    bipartisan support. Now, most of you here know what the problem is. This
    bill costs money; under our budget rules, we have to pay for it. I gave
    them a way to pay for it; they don't like my way to pay for it. I say,
    ``Okay, if you don't like my way, bring me another way.'' But we can't--
    when a bill gets this kind of support in Congress--and believe me,
    instead of 231, the number would be 400 in the House if we didn't have
    this dispute. They don't like the way I want to pay for it. Okay, it's a
    big government; there are lots of options. [Laughter]
        But any way to pay for this within reason is better than letting one
    more year go by where people have to give up a precious year of their
    life when they could be working and being fulfilled and making a
    contribution to our country when it will not cost us, really, any more
    money.
        So I say, I understand what the problem is. We'll be reasonable.
    We'll work with you. But we cannot walk away from this session of
    Congress without passing this legislation. It will change the lives of
    tens of thousands, hundreds of thousands of Americans, with one simple
    bill.
        Fifth, I challenge the Republican leaders to make the responsible
    choice to prevent yet another generation of children from being lured
    into smoking and becoming addicted to it. More than 400,000 Americans
    each year die of smoking-related diseases; almost 90 percent of them
    started smoking as teenagers. All the studies confirm that the price of
    cigarettes is one of the most effective ways to prevent kids from
    starting to smoke in the first place.
        My balanced budget raises the price by 55 cents a pack. It's good
    health policy; it's good fiscal policy. It will help us to save the
    Social Security Trust Fund, and it will allow us to honor our
    commitments by aiding both parents and children. For these reasons,
    Congress should side with America's families, and not with the tobacco
    lobby. We don't want to let another opportunity go up in smoke.
        Sixth, I challenge the Republican leaders to make the responsible
    choice to expand health coverage for the children of working families.
    Today, as I said, with the approval of the plan submitted by Washington
    and Wyoming, all 50 States and territories have now joined the
    children's health insurance initiative. Unfortunately, even with full
    participation from the States, there are still, literally, millions of
    children who are eligible for help who have not begun to receive it; and
    other children, like legal immigrants and foster children turning 18,
    who also need coverage.
        Once again I ask the Congress to fully fund the initiative that I
    gave them to help the States provide the coverage to the kids. We did
    this initiative together. When we passed the bipartisan balanced budget
    bill, it had heavy majority support from both parties in both Houses,
    heavy majority support in both parties in both Houses. And this was one
    of the things that I think all the Members were most proud of.
        Now, we've got a million and a half kids signed up, and we've
    appropriated money for 5 million kids. And we've simply got to do more
    to sign these children up. This is a modest cost for a huge return.
        Seventh, I asked the Republican leaders to make the responsible
    choice by helping families cope with the strains of long-term care. In
    our balanced budget--in the balanced budget, having nothing to do with
    the surplus or the tax cut or any of that, I proposed a tax credit and
    other initiatives aimed at helping elderly, ailing, and people with
    disabilities or the families who care for them to deal with the cost of
    long-term care. This will become a bigger and bigger challenge as
    America ages. People will want to

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    make different kinds of choices based on the facts of their family
    situation or the facts of the problems of people needing long-term care.
    That's why I believe the best thing we can do for them now is to give
    them a tax credit. It is a good beginning, and I hope we can pass it.
        Finally, I ask the leaders to join with me in choosing wisely to
    continue to invest in public health. I'm talking about investing to
    begin closing the devastating health gaps we see that Surgeon General
    Satcher has done so much work on in Native
    American, African-American, Hispanic, and other communities; investing
    and treating and preventing mental illness; investing in the National
    Institutes of Health and the Centers for Disease Control.
        Now, usually, I don't give a talk with eight points--[laughter]--
    because I'm always--you give a test, and people are lucky to remember
    four. But I felt better after the Doctor
    went over most of them. [Laughter] I felt like it was almost a
    prescription after he got through. This is not a laundry list. They are
    like eight panels of a protective umbrella for America's future. They're
    connected; they work together; they'll help millions of Americans
    weather the many changes in our health care system and the inevitable
    changes in their own lives.
        Health care cannot be a partisan issue. It hasn't been, and it
    shouldn't be. I was glad to hear the doctor say that he was referring to his Republican and Democratic patients.
    You know, every time I give this talk, I say that no one asks you--when
    you show up at the doctor's office and you fill out those endless forms,
    there's no box for Republican, Democrat, or independent. [Laughter]
        And we see now in Washington a mood change that has already been out
    there for a long, long time in the country. You see it in the people
    coming over for the Patients' Bill of Rights; in the people saying,
    ``Yes, we want to provide the opportunity for people with disabilities
    to go to work.'' You see it in the efforts we have with children's
    health insurance.
        So I am optimistic about the future. I think the Copelands'
    daughter will have a good time being a
    doctor, just like her father did. I think
    we will make meaningful progress in this session. The bipartisan votes
    are out there. Nothing can stop it unless the votes aren't scheduled or
    we decide not to talk. We've got to schedule the votes, and all of you
    know I'm always willing to talk. [Laughter]
        Thank you, and God bless you.

    Note: The President spoke at 2:57 p.m. in the East Room at the White
    House. In his remarks, he referred to Dr. Lanny R. Copeland, president,
    American Academy of Family Physicians, his wife, Mica, and their
    daughter, Mary Anne.