[Public Papers of the Presidents of the United States: WILLIAM J. CLINTON (2000, Book II)]
[July 6, 2000]
[Pages 1386-1391]
[From the U.S. Government Publishing Office www.gpo.gov]



Remarks at the University of Missouri in Columbia, Missouri
July 6, 2000

    Thank you very, very much. I want to begin by thanking President 
Pacheco and Chancellor Wallace. I'm delighted to be here. I want to thank the doctors 
and nurses who are here. And

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I want to say a special word of thanks to Doug Bouldin. I wish he could make that talk personally to every 
Member of the United States Congress. That was very moving, and I thank 
him.
    I want to thank the other officials who have joined us here: 
Attorney General Jay Nixon; 
Secretary of State Rebecca McDowell Cook; State Auditor Claire McCaskill; Speaker of the House Steve Gaw; 
and Representative Harlan and the other 
members of the legislature that are here. And Mayor Hindman and members of the city and county council who are 
here, I thank you all for joining me. And of course, a special word of 
thanks to Governor and Mrs. Carnahan for their friendship through the years and their 
leadership on this issue.
    I must say I'm glad to be here. The last thing--when I got up this 
morning, very early in New York, to come here, the last thing my wife 
said to me was, she said, ``You know, I went to Columbia once. It's a 
beautiful place. You'll have a good time.'' So I told Hillary, I said, 
``Well, you made the decision about how you're going to spend this year. 
I'm going to Columbia and have a good time.'' [Laughter] It was great.
    I understand that in addition to the history lesson we got about the 
University of Missouri, that this university also began the tradition of 
homecoming. I always feel at home when I'm here in Missouri, so I like 
that, and I wanted to mention it.
    I'd like to say, too, how much I appreciate the opportunities that 
I've had to work with the leaders and the people of this State over the 
years during the terrible floods along the Mississippi, and then when we 
were promoting welfare reform. I came here more often than to any other 
State during the 3\1/2\ year battle we had to pass meaningful welfare 
reform legislation because I thought that Governor Carnahan had done the best job of any Governor in any State in 
showing how to do the right kind of welfare reform.
    We've worked together in education, in fighting crime, and, 
obviously now, in ensuring quality health care. And I'd just like to 
say--because I don't know how many more times I'll be in Missouri when 
I'm President--[laughter]--that before I was President, for a dozen 
years I was a Governor of your neighboring State. It's a great job. It's 
like being president of a State without all the perks and without all 
the hassles. [Laughter] And I served with 4 Missouri Governors and over 
150, believe it or not, other Governors across America. And Mel 
Carnahan is clearly one of the very best 
Governors I ever served with, and I thank him.
    When I knew I was coming here--there are so many things that I want 
to talk about here at the university. I wanted to talk a little bit 
about increasing college access. We have now 10 million people taking 
advantage of either the HOPE scholarship or the lifetime learning tax 
credit. We reformed the student loan program. In 7\1/2\ years, students 
have saved $8 billion on student loan repayments. We've increased the 
Pell grant a lot, and now I'm trying to convince the Congress to let 
college tuition be tax deductible up to $10,000 a year. And I hope we 
can do that.
    But the president talked about the importance of research, and we 
have tried to support basic research for our colleges and universities 
and through our national laboratories, and I could talk about that until 
tomorrow morning. But I'll just mention one thing to lead into why we're 
here.
    I had the profound honor last week, along with Prime Minister 
Blair of Great Britain, to announce the 
completion of the first rough sequencing of the human genome. Now, this 
is a truly extraordinary thing that will change the lives of people who 
deliver health care.
    Before you know it, young mothers will go home from the hospital 
with little genetic maps of their kids' lives. And it will be kind of 
scary in some ways. It will say, well, unfortunately, your child has a 
greater propensity to develop this or that problem. But it will also 
say, if you do the following five things, you can cut the risk by two-
thirds.
    We will see the combination, the continuing combination of the 
information technology revolution with the revolution in genetics so 
that most of my friends in the field believe that within a few years, 
we'll be able to develop digital chips to replicate the failures of 
nerve cells, even in the spinal column, so that people confined the 
wheelchairs will be able to walk again. We will see--people completely 
paralyzed will be able to regain the movement of their limbs. I believe 
that children born sometime within the next 10 years will probably have 
a life expectancy of somewhere around 90 years. And sometime in the 
first few decades of this century, we'll have children born who, if they

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can manage to avoid accidents or other unnatural causes of death, will 
have life expectancies of 100 years. Now, that's the good news.
    But the reason we're here today is that we have to run our health 
care systems consistent with our values. And if we're going to have all 
these advances, they have to be implemented in a way that all Americans 
can be treated fairly, equally, and have access to the benefits of 
everything from emergency room care to basic care to specialized care. 
That's what this whole debate's about.
    Let me say to you, I feel a special responsibility here because I 
think, in general, managed care can be a good thing. That is, when I 
became President, the price of health care was going up at 3 times the 
rate of inflation every year. We were spending 4 percent more, and still 
are, of our gross national product on health care than any other country 
in the world, and it was obvious that we had to manage the system 
better.
    But it's equally obvious that you can't turn the fundamental life-
and-death decisions about the quality of health care over to people who 
are managing for things that have nothing to do with whether the patient 
turns out healthy or not. And that's what this whole thing is about.
    It's about how to strike the right balance toward saying, ``Yes, 
health care is like any other big enterprise. Of course you should have 
prudent management. Of course we should avoid wasting any money. Of 
course we should do the very best we can to run it. But let's not forget 
why all these people are doing this, why they've got their white coats 
on. It's to help people stay well and to help them get well if they get 
sick or to help them recover if they're injured.''
    The reason we need the Patients' Bill of Rights is because we are 
awash in examples, which Doug just gave us a couple of, of the forest 
overcoming the trees. We have lost the forest for the trees, over and 
over and over again. That's why we're here.
    Now, as has already been said by the previous speakers, I wanted to 
come here because Missouri has passed a strong law, and you proved it 
wasn't a partisan issue in the heartland. It's amazing how many issues 
that are partisan issues in Washington aren't partisan issues once you 
get 5 miles outside of DC. [Laughter]. But survey after survey after 
survey shows that more than 70 percent of all Americans, whether they 
identify themselves as Republicans or Democrats or independents, support 
a strong, enforceable Patients' Bill of Rights. And therefore, in 
Washington, we have an obligation to pass it and not to pass less than 
that just because the organized interest groups are trying to prevent it 
up there.
    Here's the state of play and why I wanted to come here to highlight 
this. We are so close. The Norwood-Dingell bill, a bipartisan bill, 
passed the House with a lot of votes to spare. We had virtually every 
Democrat for it, and a fair number of Republicans voted for it. We had a 
good bipartisan group. Then the bill was taken up in the Senate, and we 
came within one vote of having enough to pass it. We had all the 
Democratic Senators. And Senator McCain--once 
again proving his independence--Senator Specter, Senator Fitzgerald, and 
Senator Chafee voted for it. So we're one 
vote away. And that's very important. And I came here because I don't 
think we ought to stop one vote short.
    I don't know how many health care professionals I've heard tell 
stories like the one Doug Bouldin just told me. I don't know how many 
people I've heard--I saw a nurse once who was trying to explain to me 
what she had to go through calling HMO's to get approval for health 
procedures that the doctor for whom she worked wished to perform that 
were blatantly self-evident and how many times she'd been turned down 
and how many times it was her unhappy duty to go tell the patient that 
once again he or she had been shafted. And I'll never forget that woman 
just weeping. She literally could not complete what she had worked so 
hard on to tell me. And I've seen it over and over and over again.
    Now, I have done all I can do through executive action. I issued an 
Executive order to extend the Patients' Bill of Rights safeguards to the 
85 million Americans who get their health care through Federal plans, 
through Medicare, Medicaid, the veterans' system, the Federal health 
insurance plan. We have provided similar patient protections to every 
child covered under the Children's Health Insurance Program. But I've 
done all I can. The Governor and the State 
Legislature in Missouri, they've done all they can. But I want to 
explain clearly again why we need Federal legislation and why only 
Congress can close the loophole.

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    In spite of your strong law, which is as good as any in the country, 
more than one million Missourians do not have patient protections today 
because they are in plans that are outside the jurisdiction of State 
law, under Federal law. Now, only Federal legislation can fix that. The 
House-passed bill, the Norwood-Dingell bill does it. And the protections 
are listed here on the chart.
    First, it must protect every American in every health plan. The bill 
that the Senate did vote on--that the majority passed, but they know is 
dead on arrival--excludes over 135 million Americans. It covers fewer 
than one in 10 people in HMO's. I mean, why are we doing this, anyway?
    So when you hear people say, ``Well, I support a Patients' Bill of 
Rights,'' the operative word in that sentence is ``a'' as opposed to 
``the.'' The difference in the one-letter word and the three-letter word 
is 135 million of your fellow citizens. This State has established 
strong safeguards, but not everybody is fortunate enough to live in 
Missouri. There are a lot of States that haven't done this.
    Now, we have recognized that, on certain fundamental things, there 
should be national action--that's Social Security, Medicare, 
environmental standards, the civil rights laws. We have said, in certain 
fundamental areas, a patchwork is not enough; there ought to be a floor 
on which every American can stand and through which no American falls. 
That's what this bipartisan bill does.
    The second thing, the Patients' Bill of Rights must ensure access to 
specialists. Under the Senate bill--the one that passed, not the one 
they beat by a vote--you might have the right to see a cancer 
specialist, but the nearest doctor your plan may offer could be 100 
miles away, or you might have to wait 2 weeks to see the person that's 
listed. That's wrong. The bipartisan bill ensures real access in a 
timely fashion to specialists, and if you or your family has ever needed 
one, you know how important that is.
    The third thing the bill does is to ensure access to the nearest 
emergency room care, and you just heard that story. Now, you've got to 
understand, this is not an exceptional story. This is not a story that 
happens to people in small towns, and, ``Oh my goodness, our plan just 
didn't happen to cover''--you know, we've heard stories from people that 
live in big cities in this country where somebody gets hit by a car on a 
crowded city street where there's a traffic jam everywhere, and they go 
past three hospitals before they get to the one that's covered for the 
emergency room.
    This is not--Doug did not make up this 
story. I know you know he didn't make it up, but he did not make it up 
as a representative story. This is not some bizarre accident. This 
happens all the time, all over America. And most people don't know it, 
and when they hear it, they can't believe it. But it is true.
    Now, the Senate bill, as Doug said, allows plans to saddle patients 
with an extra charge if they don't first call their health plan for 
permission before they go to an emergency room. Now, I feel quite 
confident that whoever wrote that has never been hit in a crosswalk by a 
passing car. ``I have three broken ribs. My nearest relative is 500 
miles away. I also have a concussion, but could you please wait before 
you put me in that ambulance and let me call my health plan?'' 
[Laughter]
    We're laughing because we don't want to cry, but this can be a life-
or-death decision. You know it, and I know it. No one in an emergency 
should have to think twice about going to the nearest hospital. We just 
need to get over this.
    Fourth, a real Patients' Bill of Rights must ensure access to 
clinical trials. This is also very important. Only the bipartisan bill 
provides coverage for all clinical trials, from cancer to heart disease 
to Alzheimer's to diabetes. This is going to get to be more and more 
important. You're going to have an explosion of chemical trials as a 
result of advances coming out of the human genome project, and people 
shouldn't be denied the right to get a new lease on life because they 
happen to be in an HMO. That's not right.
    Fifth, and fundamentally, patients must be able to hold health plans 
fully accountable for harmful decisions. The Governor alluded to this, 
but--and I'm not sure even he knows this because it was just released 
today--but listen to this. A new analysis released today by a number of 
prominent legal scholars concludes that the Senate bill would be even 
worse than the current law, because it would effectively wipe out 
protections that States like Missouri have already passed and replace 
them with provisions that would make it more difficult to hold plans 
accountable for harmful decisions. In other words, when they voted to 
pass that bill, they voted to weaken the law you have already passed. So 
they voted to cast away vital protections that

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the Governor and the State legislature fought 
so hard to give your families. That's not a step forward; it's a leap 
backward.
    Now, the bipartisan bill, here's what it says. It doesn't say we 
want everybody to go file a lawsuit. That's not what it says. It says 
courts should be a last resort. There should be reasonable protection 
for companies and health plans that do the right thing, but if a health 
plan can be clearly proved to have caused harm, families simply must 
have the right to hold the insurance company accountable. A right 
without a remedy is not a right.
    We need a real Patients' Bill of Rights with real accountability and 
real rights, not one that just provides cover for the special interests. 
We don't need more cover for them. We need more health care coverage for 
the American people.
    I want to say one other thing for the skeptics who will hear about 
this, because I know I'm largely preaching to the choir here. People 
say, ``Oh, this is fine, but what does it cost? Does it cost 
something?'' Yes, it costs something. Do you know what it cost the 
Federal health plans when I ordered all these protections I just told 
you? I issued an Executive order, and we put it into the Federal health 
plans. Do you know what it costs? Less than $1 a month a policy.
    The congressional majority's own research service, that are the 
people that basically are against this, their own people say that the 
costs would be less than $2 a month a policy. Now, I'd pay $1 or $2 a 
month on my policy to know that you could go to the nearest emergency 
room if you got in an accident. And I think you'd feel the same way 
about your friends and your neighbors. I would pay. So all of this 
business about how the cost is going to bankrupt the country and add to 
new health care costs, it is simply not so. And we have got to be clear 
about that.
    Now, we are so close. We're one vote away. We have to overcome all 
the maneuvering power that the interest groups have through their 
influence with the leadership in the Senate, but we're one vote away. We 
can enact a strong, enforceable Patients' Bill of Rights this year. More 
than 300 health and consumer groups have endorsed it.
    I've done everything I could to try to avoid making health care a 
partisan issue. We have passed bipartisan health care legislation to 
allow people to take their health insurance from one job to another, to 
have portability. We have enacted bipartisan legislation to provide for 
children's health insurance for low-income people that aren't poor 
enough to be on Medicaid. We've approved a measure that allows people 
with disabilities to keep their Government-funded health care if they go 
into the work force. It's been a godsend. It hasn't cost you a penny as 
a taxpayer, and it's put a lot more people in the work force, making 
money and paying taxes themselves.
    We have proved over and over again we could do this. And this whole 
thing is being hung up, with 70 percent of the American people on the 
other side, because one group of interests do not wish to be held 
accountable, like all the rest of us are, if they cause injury, because 
they don't want to give up the right to tell you which specialist to 
see, whether you could see one, and which emergency room you can visit. 
It doesn't make any sense.
    So I'm honored to be here. I thank you all for what you have done 
and for once again having the Show Me State show the way. But I want you 
to think about the million Missourians who aren't covered by your own 
law, and the 135 million of your fellow Americans who wouldn't be 
covered by that Senate bill that poses as a Patients' Bill of Rights. 
And I want you to think about the one vote standing between all America 
and the kind of health care system we need. All we need is one vote, and 
we can change America for the better.
    Thank you, and God bless you.

Note: The President spoke at 11:45 a.m. in Jesse Auditorium. In his 
remarks, he referred to University of Missouri President Manuel T. 
Pacheco; University of Missouri at Columbia Chancellor Richard Wallace; 
family nurse practitioner Doug Bouldin, who introduced the President; 
State Representative Timothy Harlan; Mayor Darwin Hindman of Columbia; 
Gov. Mel Carnahan of Missouri and his wife, Jean; and Prime Minister 
Tony Blair of the United Kingdom. The President also referred to 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).

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