    [Public Papers of the Presidents of the United States: WILLIAM J. CLINTON (2000, Book I)]
    [June 13, 2000]
    [Pages 1135-1138]
    [From the U.S. Government Publishing Office www.gpo.gov]

    Remarks on Proposed Medicare Prescription Drug Benefit Legislation
    June 13, 2000

        Well, Ruth, this is the most laughs we've
    had in this room in a long time. [Laughter] You can come back tomorrow
    and the next day and the next day. [Laughter]
        She made the trip all the way from Idaho
    here. She had bad weather in Chicago last night. This is hard. She went
    to a lot of trouble to

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    come here. Let's give her another hand. Let's thank her very much.
    [Applause]
        I want to thank Secretary Shalala for
    her work on this. And Congressman Strickland,
    thank you, sir. And I especially want to thank Senator Max
    Baucus, who has been on this issue of the
    particular impact of the prescription drug problem on rural seniors for
    a very long time now.
        I'd also like to introduce the other Members of Congress who are
    here from rural America: behind me, Congressman John Baldacci from Maine, Congressman Marion Berry from Arkansas, Congressman Leonard Boswell from Iowa, Congressman Chris John from Louisiana, Representative Paul
    Kanjorski from Pennsylvania,
    Representative David Minge from Minnesota,
    Representative Ciro Rodriguez from Texas,
    Representative John Tanner from Tennessee,
    Representative Jim Turner from Texas, and
    Representative Bud Cramer from
    Alabama. I think that's everybody. Let's give them a hand. They're all
    on our side. [Applause]

    Patients' Bill of Rights

        We're involved in two or three great health care issues here in this
    millennial year, and I want to talk about, obviously, the one that we
    came to talk about, but there was a very important decision yesterday by
    the Supreme Court on HMO's that I would like to just mention briefly.
        We--those of us that have been pushing a strong Patients' Bill of
    Rights--believe Americans should have the right, even if they're in
    HMO's, to see a specialist, to go to the nearest emergency room, to
    maintain continuity of care if they change jobs--if they're in a cancer
    treatment, for example, or in the process of having a baby--and they
    have a right to hold their health plans accountable.
        But yesterday the Supreme Court--I've got this headline here that's
    in all the papers--``HMO Ruling Passes Debate Back to Congress.'' The
    Supreme Court ruled yesterday, I believe unanimously, what we all knew,
    which is that only Congress can provide to the American people in HMO's
    a comprehensive Patients' Bill of Rights.
        Now, we've been fighting this battle a long time. And there's,
    obviously, I think--there's a clear majority in the House for a good
    bill, and we failed by only one vote in the Senate this week. We think
    there's a majority there, if we can ever get a clean shot. So we're
    going to keep working. But I just want to emphasize, the Supreme Court
    now has removed any doubt that this can be handled anywhere but
    Congress.

    Medicare Prescription Drug Benefit

        Now, the same is true about dealing with this prescription drug
    issue. They have become an indispensable part of modern medicine. But
    more than three in five seniors in America on Medicare now lack
    dependable insurance coverage for the drugs that could lengthen and
    enrich their lives. And as the report we're releasing today shows, the
    situation of rural seniors is even worse.
        Now, you heard Ruth talk about her situation. We know that rural
    seniors have a harder time getting to a doctor or a pharmacy. They're
    just further away. We know they're much less likely to have HMO's or
    other insurers willing to offer reasonably priced coverage; they don't
    have economies of scale. Yet, more often they are in poor health and in
    need of prescription drugs than their urban and suburban counterparts.
        As a result, rural seniors and rural people with disabilities spend
    25 percent more out-of-pocket for the prescriptions they need. They are
    60 percent more likely not to get those drugs at all. You remember what
    Ruth said, that she knew people who could not afford to fill the
    prescriptions their doctors had ordered them to take. And it is
    important to emphasize that, depending upon the size of the monthly
    bill, this could be true not only for low income seniors but also for
    middle income seniors.
        This report could not be more timely, because we--you can't go vote
    yet; I'm nearly done. [Laughter] This is amazing to me that we're even
    having this debate. We've got a strong economy. We've got a big
    projected surplus. We know that the surplus will be revised upward by
    some amount in the so-called midsession review that's coming just a few
    days from now. Now, there is no excuse not to do this right, not to
    provide prescription drug coverage under Medicare.
        If we were starting Medicare all over again, everybody knows we'd do
    it. It's just that it was created in 1965 as basically a problem for
    serious medical emergencies and for doctors, for hospitals. In the last
    35 years there's been a sea change in what pharmaceuticals can do to
    keep people healthy, to keep people living, to keep people out of the
    hospital. So the real question is, are we going to do now what we

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    would have done in 1965 if we'd have the tools then that we have now,
    and are we going to do it in the right way and provide it as an optional
    benefit to all the people on Medicare? That's what we think we ought to
    do.
        And I believe it's very important that we not provide a prescription
    drug benefit that is some sort of faint hint at doing what needs to be
    done and that would wind up being nothing more than a broken promise to
    a lot of our seniors. I think we need a bottom-line, simple,
    straightforward plan that all seniors have a chance to buy into. You
    heard Ruth say she didn't mind paying a little bit of a co-pay, making a
    contribution. But people like her need access to this plan.
        Now, my budget proposal would extend the lifeline of optional
    prescription drug coverage to all seniors by allowing them to sign up
    for drug coverage through Medicare. No matter where they live, how sick
    they are, they would pay the same premiums. The plan would use price
    competition, not price controls, to give seniors everywhere the best
    prescription prices. It would help cover the expenses of seniors who
    face catastrophic costs and is part of an overall plan that would
    strengthen and modernize Medicare to keep it efficient and solvent, to
    add more years to the Trust Fund so that we can begin to absorb the baby
    boom generation.
        There's growing bipartisan support for prescription drug action this
    year, and that's good. But I'm quite concerned that the proposals the
    House Republicans intend to put forward today won't help the Americans
    who need it the most. Today--and let me just describe why, and think
    about the story you just heard Ruth Westfall tell. Today's report on the
    special needs of rural seniors makes it clear that we need a benefit
    that's available for all older Americans. My understanding is that the
    latest Republican proposal relies on a private insurance model that has
    already failed rural Americans.
        You just heard her say that she couldn't afford Medigap. And there
    are tons of people in this country who can't afford the Medigap
    insurance policy. Most people with gray hair out in this audience are
    now nodding their head vigorously; I hope the press has picked that up.
    Rural Americans, by and large, can't afford Medigap insurance. It makes
    no sense to use something that's failing today as our model for
    tomorrow, especially when we do not have to do it.
        We ought to ensure that any plan benefits the people who need
    prescription drugs as much as it benefits the companies who sell the
    drugs. We have reached across party lines before. We passed the Kennedy-
    Kassebaum bill to allow people to take their health insurance with them
    when they change jobs. We passed the Children's Health Insurance Program
    as part of the 1997 Balanced Budget Act, which has provided millions of
    children in lower income working families access to health insurance. We
    can do this.
        But there's no point in telling the American people we're doing
    something that turns out to be a fraud. And there's no point in
    pretending that only poor seniors need this help. That is not true. This
    is a need that's out there for people, based on the size of their
    medical bills as much as on the size of their monthly income check. And
    to say, well, we're going to spend a little bit of money and take care
    of the very poorest seniors, but anybody else we're going to put in some
    private insurance market that is already a proven failure--that the
    insurance companies themselves, to their credit, say will not work--is a
    bad mistake.
        I think we ought to be helping people like Ruth Westfall. I sat there listening to her talk. She said she was
    proud of the life that she and her husband built. They worked hard so
    that they wouldn't have to depend on other people, so they wouldn't be a
    burden on other people. I can tell you that that story is a story that
    the baby boom generation wants to tell when we all get retired. And as
    the oldest of the baby boomers, I can tell you it's a story that we
    worry about all the time not being able to tell, because there are so
    many of us.
        Now, there's no point in letting politics or ideology get in the way
    of the manifest need of the seniors of this country and the disabled
    Americans who have access to Medicare to get these prescription drugs.
    And we're not broke now. I've worked real hard for 7\1/2\ years to make
    sure I didn't leave us broke when I finished. We've got a good surplus.
    And if we were in deficit and trying to do this, I could understand why
    we would say, ``Well, we can't help everybody, so we'll just help a
    few.'' But that's not the situation. We can afford to do this right. And
    we must not pass a plan that claims to offer something to everybody and
    is a false hope to most and, therefore, inadequate.

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        So I want to ask you all to remember this fine woman that hauled herself all the way here from Idaho. And
    she's still vigorous. She's still got a lot to give, and there's
    millions like her out there, and we owe it to them to do the right
    thing. And I want you to stick with these Members of Congress behind me.
    I thank them for being here. Let's get this done this year.
        Thank you very much.

     Note:  The President spoke at 10:15 a.m. in Presidential Hall in the
    Dwight D. Eisenhower Executive Office Building. In his remarks, he
    referred to Medicare recipient Ruth Westfall, who introduced the
    President.