    [Public Papers of the Presidents of the United States: WILLIAM J. CLINTON (1999, Book II)]
    [July 9, 1999]
    [Pages 1174-1178]
    [From the U.S. Government Publishing Office www.gpo.gov]

    Remarks on the Patients' Bill of Rights in Torrance, California
    July 9, 1999

        Thank you very much. Well, good morning, and I want to thank Tecla
    Mickoseff for welcoming us here to Harbor-
    UCLA. Thank you, Ethel, for your powerful
    statement out of your personal experience. I want to thank my old friend
    Jack Lewin for, as usual, making the case. We're
    used to being in fights where the evidence is overcome by political
    power. [Laughter] But we're determined to reverse it in this case.
        I want to thank Congresswoman Juanita Millender-McDonald; my friends Zev Yaroslavsky and Yvonne Burke and
    the mayors and other local officials who are here. I thank the leaders
    of the health care groups that are here, both consumers and providers.
    Thank you, Reverend Jackson, for coming. We're
    glad to see you this morning.
        I have a couple of things I want to say about health care and about
    how this Patients' Bill

    [[Page 1175]]

    of Rights issue fits into our larger responsibilities to deal with the
    health of the American people. I have just finished a trip across our
    country, from Appalachia to the Mississippi Delta to the Pine Ridge
    Indian Reservation to inner-city neighborhoods in East St. Louis,
    Illinois; south Phoenix; and Los Angeles. The purpose of this was to
    shine a spotlight on the opportunity which exists in areas that our
    prosperity has completely passed by.
        It was a remarkable 4 days, and I came in contact with all the
    health issues that you would be concerned about in the process of
    pushing an economic agenda. For one thing, when we left Washington and
    arrived in Appalachia and arrived in the Mississippi Delta and arrived
    in East St. Louis and arrived in Phoenix, in all those places, it was
    100 degrees. [Laughter] It was cool in Dakota when we got there at
    night, but the next day it was a mere 94.
        And I'm very worried, I must say--I want to say this today--I've
    been very concerned because a lot of poor people depend upon the LIHEAP
    program, the low income health assistance program, to pay for air-
    conditioning or get fans in the summertime. And I have today directed
    the appropriate people in our Federal Government to expedite the
    analysis we're required to do about the effects of the recent heat wave
    on the need for emergency assistance under this program. We could lose a
    lot of people who won't even get to the emergency room if we don't do
    it. So I do want you to know that I hope the message will go across the
    country to the places I visited and the other places that we know this
    is going to be a problem.
        When we went on this tour, we saw an awful lot of problems, and we
    saw a lot of promise, enough promise to convince us all that we actually
    can succeed in building a bridge to the 21st century that all Americans
    can walk across. When we give economic opportunity to all, we're helping
    to build that bridge. When we give all of our kids a world-class
    education, we're helping to build that bridge. When we're dealing with
    health care challenges, we're helping to build that bridge.
        Jack mentioned the Medicare proposal that I have made to stabilize
    the Medicare Trust Fund until 2027, provide a prescription drug benefit
    that we can afford, and provide much more preventive services, which I
    think are very, very important. There's a fundamental difference.
        Now, how does the Patients' Bill of Rights fit into all of this? I
    feel in a way that I have a special right, if you will, to advocate for
    this bill because I have defended the role of managed care in our health
    care system for years. When I became President, health costs had been
    going up at three times the rate of inflation for many years. And all of
    us knew it was totally unsustainable, that eventually, if it kept going
    up at three times the rate of inflation, we'd be spending all our money
    on health care.
        We all knew that was completely unsustainable and that there was
    nothing wrong with managing a system properly so that you could, at the
    lowest possible cost, achieve the objective, which was the highest
    possible quality of health care. And yes, at the margins, there will
    always be tough decisions, but fundamentally, no one who both believes
    in the American health care system and the professionals who provide
    that health care and who believes in proper management, believes you
    should sacrifice basic quality of care to the decision made by an
    accountant to make the bottom line of an HMO bigger. The purpose of
    managed care is to enhance quality of care by making it as affordable as
    possible, not to undermine quality of care by making the people who
    provide managed care as profitable as possible, and it's very important.
    There's a fundamental difference.
        So, as has already been pointed out, I asked the Congress a year and
    a half ago to pass a strong, enforceable Patients' Bill of Rights, with
    all the things you've heard about: the right to see a specialist, the
    right to emergency room care at the nearest emergency room, the right
    not to have to change health care providers in the middle of treatment,
    the right to enforce accountability for harmful decisions. And I have
    used my authority as President, as you said, not only to cover by
    Executive order those people on Medicare with the protections of the
    Patients' Bill of Rights, but also those people on Medicaid, those
    people served by the Veterans' Administration, and the people in the
    Federal health insurance plan, the Federal employees and their families.
        And I want to just tell you that we actually now have some
    experience with the Patients' Bill of Rights. You know, the HMO's say,
    well, this all sounds very good, but we can't afford it, and if you--and
    they always try to make you think only of yourself, your healthy self--
    if you, your healthy self--[laughter]--who never

    [[Page 1176]]

    gets sick but has to pay health insurance, give these Patients' Bill of
    Rights to them, all those sick people, you--your healthy self--will have
    to pay more for health insurance, and oh, how terrible it will be.
    That's their argument, right?
        Well, we actually have done this now, and we have evidence--and
    sometimes evidence overcomes interest groups in Washington, so let's
    talk about the evidence. Our evidence is that when we put the Patients'
    Bill of Rights into the Federal employees' health plan, it raised the
    cost of health insurance by less than a dollar a month.
        Now, I'm going to go over this one more time. You've already heard--
    I'm going to go over it one more time, and I'm going to ask every
    American if he or she wouldn't be willing to pay something in that range
    on the off-chance that their healthy self might not always be that way
    and out of a genuine concern for our fellow citizens and an
    understanding that the wealth and power and strength and quality of life
    of our country depends in no small measure on the continued advances in
    the health of all Americans.
        And yes, some States have done some things in this area. But until
    Congress acts, there will be more than 100 million Americans who won't
    have these full protections. I can only give it to 85 million by
    Executive order. So next week, at long last, the Senate is going to take
    this up. I'll say more about that in a moment, but thank goodness, the
    Senate finally is going to take this up.
        Last year all year, the leaders of the Senate kept us from bringing
    the bill up, and there's a good reason why they did: They're not for it,
    but they know they can't afford to be caught being against it. We have
    200--200-plus medical and consumer groups are for the Patients' Bill of
    Rights. The American Medical Association has allies it has never had
    before. [Laughter] This is a very big tent. And there is only one group
    on the other side, the health insurers. It's 200 to one, but the one is
    a big one, and so far has had enough support in the majority party in
    the House and the Senate to keep this from coming up.
        But if you go out in the country, I have said this over and over and
    over again, if you go out in the country, this is not a partisan issue,
    because Republicans get sick just like Democrats. Even stubborn
    independents sometimes get sick. [Laughter] And when you walk into the
    emergency room--I would really like to know whether she's got a form she
    fills out in the emergency room that has a check for political party.
    [Laughter] ``Now, before I give you this medicine, are you a
    conservative or a liberal?'' [Laughter] You know, we're laughing about
    this, but it makes a very important point. This is not a partisan issue,
    this is not even a philosophical issue, not anywhere in the wide world
    but Washington, DC.
        If you explained all the options to all the people in all the
    communities of this country, I promise you over 70 percent of
    Republicans, Democrats, and independents--you know, when you got above
    those stratospheric numbers, maybe there would be some partisan
    difference--but you'd have over 70 percent of all groups for this. How
    can it be that, for over a year, the American people have been deprived
    of even a full debate on this in the United States Senate?
        Well, as I learned and Jack learned back in
    1993 and '94, these folks have a lot of clout. But let's forget about
    the politics and look at the facts. I want to run through this; look at
    this chart over here. I wish every American could just have this chart
    at home. If I had the ability, through the Internet, to send this to
    every American, I would do it.
        Our plan says, if you need to see a specialist, you can't be denied
    the right to see a specialist. Their plan doesn't give you that right.
        Our plan says, if you get hit driving out of this event today, on a
    hot Saturday morning in Los Angeles, you ought to be able to go to the
    nearest emergency room, not show up there and be told you've got to
    drive 25 miles to one that your plan covers. This is a real issue, as
    you know.
        Our plan says--and I was so glad to hear you mention this--that if
    you're being treated with chemotherapy or if you're six months pregnant
    and your employer changes providers, you should be able to stay with the
    physicians that are treating you until the treatment is completed--
    hugely important issue that most Americans are not aware of.
        Our plan assures HMO accountants don't make arbitrary medical
    decisions. Now, let me just say, I've listened to a lot of stories about
    this. I've done a lot of research on this. A lot of times, the HMO
    decisionmaking tree--you finally get high enough to get a doctor who
    makes the right decision, and it's too late.

    [[Page 1177]]

        And I've said this over and over again--I'm actually sympathetic
    with a lot of people at the first line of decisionmaking in the HMO.
    Why? They're not doctors, and they're never going to get in trouble with
    the company for saying no. Right? They know--I'm sympathetic with them.
    A lot of them, they're making a modest income, they're looking forward
    to their Christmas bonus, they want to please their employer like we all
    do. You're my employer; I want to please you. [Laughter] We're all like
    that. And these young people who are working in these companies, they
    know they are not going to get in trouble for saying no, because they
    know if they say no, the decision can always be kicked upstairs, and
    maybe it's three levels upstairs, but eventually, somebody who actually
    understands this is going to make a decision. And if they say yes, then
    they won't get in trouble for having said no; but, ah, if they say yes,
    and somebody above them says, ``You should have said no,'' they can get
    in a world of trouble.
        So we try to fix that here and change the incentive so that there is
    no institutional bias to deny quality care. Should the health plans be
    held accountable? I think so. The framers of the Constitution understand
    that a right without a remedy is not a right at all. And should they
    cover all health plans? Absolutely. The other bill leaves out 100
    million folks.
        So that's what this is about. The ``yeses'' and the ``noes.'' It's
    simple evidence. It's about how people live. And yes, the health
    insurance association may have some of its profit margin squeezed. And
    yes, they may have to have modest increases, like we did--the Federal
    employees' health plan--I'll tell you it's less than a buck-a-month
    policy. That's what our experience is. But isn't it worth it to allow
    the system to work, to keep the benefits of managed care without having
    to shoulder these enormous burdens, these heartbreaking burdens?
        I don't know how many people I have seen--I've seen nurses who work
    for doctors in their offices, who have to make the calls to the HMO's to
    get told no, break down and cry, telling me stories of people that they
    couldn't take care of. You know, these are not just isolated anecdotes.
    This is a systematic problem in American health care, and once we fix
    it, all the people will be happy. The HMO's will do just fine, and
    they'll be happy we did, and people will wonder what in the wide world
    we were doing all those years not providing these basic protections.
        Think of how you'd feel if you were a doctor. You'd spend all those
    years going to medical school, all those years in residency, you go all
    those years without any sleep, and you're finally out there giving
    health care, and all of a sudden you're told, here's a strait-jacket
    we'd like you to wear to work every day and still figure out how to make
    these people well. I mean, this is a big, big, big issue, and it should
    not be played out in a partisan, political, or special-interest
    atmosphere. Shouldn't we err on the side of health? What are we afraid
    of?
        I saw today an amusing article in the paper which said that the
    leaders of the majority party had decided that instead of bringing up
    their bill and having to deal with 20 of our amendments, which would put
    people--force them to put their Members on record being against these
    things, they would bring up our bill and just beat it, in the hope that
    then there would be no specific record of accountability.
        I thought to myself, what kind of a weird world am I living in? If
    this was just about something we had an emotional opinion about, and we
    were on different sides, I would think that would be a clever thing to
    do, and that's just politics. This is not whether you've got an
    emotional thing. This is about whether some people live and some people
    die. This is about whether people get well or they don't. This is about
    whether people feel at least comfort when they're dealing with the
    challenges of life or they're just knotted in anxiety all the time. This
    is about whether all these doctors, these nurses, these health care
    professionals wake up every day happy to go to work because they think
    they're going to be able to do their job or they're waiting for the
    other shoe to fall every single day because somebody is trying to
    strangle their ability to make decent decisions. This is, in other
    words, not a typical political decision. This is about life and the
    quality of life and the fundamental decency of our society.
        We should err on the side of humanity. We should err on the side of
    quality health care. We have evidence now from our own experience that
    we can well afford to do this. And this is an idea whose time has long
    since come, and there are Members of Congress in the Republican Party,
    as well as the Democratic Party, who support this, who just want a
    chance to

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    vote for it and bring the benefits of it to the American people.
        You know, it's like anything else. You can argue against anything on
    the grounds that it's not perfect. Well, if we never did anything
    because it wasn't perfect, we'd never do anything, and America wouldn't
    be here celebrating the 21st century. We wouldn't be around after 223
    years. The Constitution wasn't perfect. It had to be amended.
        So it is not an argument to vote against this bill, that it might
    not be perfect, that there might be some unforeseen consequences that we
    might have to fix. We take our cars to mechanics to fix things that
    aren't perfect, but we don't stop buying cars and go back to walking
    around. [Laughter] I mean, none of these arguments make any sense at
    all.
        We have to put people and principle and evidence ahead of raw
    political influence. Democracy has to work.
        So, I thank you for being here. Remember, we're all preaching to the
    saved in this room today. Reach out to other Members of Congress. Send a
    note or an E-mail today or Monday morning to every House Member that
    represents anywhere around here, and both your Senators are for this
    bill; that's great. Send it to Senators from other States. Give people a
    chance to do the right thing. Tell them what's at stake.
        If people will listen to their hearts and their heads, we'll prevail
    next week.
        Thank you, and God bless you.

    Note: The President spoke at 10:54 a.m. in the Parlow Auditorium at the
    Harbor-UCLA Medical Center. In his remarks, he referred to Tecla
    Mickoseff, administrator, Harbor-UCLA Medical Center; Ethel Edmond,
    registered nurse, King Drew Medical Center; Jack Lewin, executive vice
    president and chief executive officer, California Medical Association;
    Los Angeles County supervisors Yvonne Brathwaite Burke, 2d district, and
    Zev Yaroslavsky, 3d district; and civil rights leader Jesse Jackson. The
    President also referred to the Low Income Home Energy Assistance Program
    (LIHEAP); and his memorandum of February 20, 1998, on compliance of
    Federal agencies with the Patients' Bill of Rights (Public Papers of the
    Presidents: William J. Clinton, 1998 Book I (Washington: U.S. Government
    Printing Office, 1999), p. 260).