[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).