[Public Papers of the Presidents of the United States: WILLIAM J. CLINTON (2000-2001, Book III)]
[December 20, 2000]
[Pages 2750-2752]
[From the U.S. Government Publishing Office www.gpo.gov]



Remarks on the Issuance of Final Regulations on Protection of




Medical Records Privacy
December 20, 2000

    Thank you. Well, first, I want to thank Janlori Goldman for her wonderful remarks and for her ongoing work in 
the area of health privacy. I thank the representatives of the doctors, 
nurses, consumers, and privacy community who are here today and who add 
input into this effort.
    I would like to thank my great friend Senator Pat Leahy for being here and for his strong support of 
privacy issues in the United States Congress. As others have said, I 
want to thank the entire team of people who worked on this. They worked 
on this issue for months and months and months. They worked hard. Some 
of them worked, I might add, at great personal sacrifice to themselves, 
because of developments unrelated to this issue, to get this out, 
because they believe so strongly in what they were doing. And I also 
would like to thank my Chief of Staff, John Podesta, who has been a fanatic on this issue in the best sense. 
[Laughter]
    Now, I want to thank all the folks at HHS for--Donna 
Shalala went over just some of the things 
that we have done in this administration over the last 8 years, thanks 
to all of you at HHS. And she said you were beginning to feel like 
Nebraska. [Laughter] But look, there's a big difference.
    You know, they say that because of the 24-hour news cycle, we're all 
in a permanent campaign. And when you're in a permanent campaign, it's 
hard to take the time to go to someplace you have no chance of winning--
Nebraska--[laughter]--or someplace you have no chance of losing--the HHS 
Building. Right? So--[laughter].
    I might say, just parenthetically, I had a wonderful time in 
Kearney, Nebraska, and in Omaha, and you would be amazed at all the 
letters I've gotten. I have already received more letters than I thought 
there were Democrats in the State of Nebraska. [Laughter] It was quite 
wonderful. So I'm grateful.
    I want to thank all of you, and especially Donna Shalala, for these last 8 years. I believe that Donna Shalala 
is a superb leader, a great administrator, always full of energy. You 
will be happy to know, and not surprised, that she has steadfastly 
defended the people who work at the Department of Health and Human 
Services in pitched battles at the White House over various issues.
    You guys have so much responsibility over so many things; every day 
you get a new chance to wreck an administration. [Laughter] The fact 
that you somehow managed to avoid doing so, and along the way to get us 
up to record levels of childhood immunization, to get the number of 
people without health insurance going down for the first time in a dozen 
years, to involve women and seniors in clinical trials to an 
unprecedented extent, to add 24, 25 years to the Medicare Trust Fund and 
2.5 million kids to the ranks of insured, and do so many other things, 
to be a positive force in the welfare reform movement, is a real tribute 
to you, but I think, also, to Donna Shalala 
and her remarkable tenure as the leader of this Department.
    And she makes it fun, you know? Now 
she's going to become president of the University of Miami. We're just 
sort of a way station on her move south. She was at Wisconsin and then 
here and then going to Miami. I think you can confidently predict two or 
three things that will flow out of her tenure there: She will improve 
the academic quality of the institution; the football team will get even 
better--[laughter]; and they will do whatever is necessary to clarify 
the voting procedures in Dade County.
    Look, we're having a good time today, but I want to take a moment to 
be very, very serious. We say that we are a free nation in a world 
growing increasingly free. And in so many ways, that is literally true. 
During the period in which I was President, I was fortunate

[[Page 2751]]

enough to serve here at a time when, for the first time in all of human 
history, more than half the people on the globe live under governments 
of their own choosing.
    Now, that's a wonderful thing. That's one manifestation of freedom. 
Then, there's free speech, the freedom of the press, the right to 
travel, and also, I might add, minority rights of all kinds, 
restrictions on the ability of government to compromise the fundamental 
interests and rights of those who may not agree with the majority.
    But we must never forget, in this age of increasing interdependence, 
fueled by an explosion in information technology that is completely 
changing the way we work and live and relate to each other, that 
increasingly, we will have to ask ourselves: Does our freedom include 
privacy? Because there are new and different ways for that privacy to be 
restricted.
    In 1928 Justice Brandeis wrote his famous words saying that privacy 
was ``the right most valued by civilized people,'' and he defined it 
simply as the right to be left alone.
    Nothing is more private than someone's medical or psychiatric 
records. And therefore, if we are to make freedom fully meaningful in 
the information age, when most of our stuff is on some computer 
somewhere, we have to protect the privacy of individual health records.
    The new rules we release today protect the medical records of 
virtually every American. They represent the most sweeping privacy 
protections ever written, and they are built on the foundation of the 
bipartisan Kennedy-Kassebaum legislation I signed 4 years ago.
    This action is required by the great tides of technological and 
economic change that have swept through the medical profession over the 
last few years. In the past, medical records were kept on paper by 
doctors and stored in file cabinets by nurses; doctors and nurses, by 
and large, known to their patients. Seldom were those records shared 
with anyone outside the doctor's office.
    Today, physicians increasingly store them electronically, and they 
are now obliged to share those records in paper or electronic form with 
insurance companies and other reviewers. To be sure, storing and 
transmitting medical records electronically is a remarkable application 
of information technology. They're cost-effective; they can save lives 
by helping doctors to make quicker and better-informed decisions.
    But it is quite a problem that, with a click of a mouse, your 
personal health information can be accessed without your consent by 
people you don't know, who aren't physicians, for reasons that have 
nothing to do with your health care. It doesn't take a doctor to 
understand that that is a prescription for abuse.
    So, the rules that we release today have been carefully crafted for 
this new era, to make medical records easier to see for those who should 
see them and much harder to see for those who shouldn't. Employers, for 
instance, shouldn't see medical records, except for limited reasons, 
such as to process insurance claims. Yet, too often they do, as you just 
heard.
    A recent survey showed that more than a third of all Fortune 500 
companies check medical records before they hire or promote. One large 
employer in Pennsylvania had no trouble obtaining detailed information 
on the prescription drugs taken by its workers, easily discovering that 
one employee was HIV positive. That is wrong. Under the rules we 
released today, it will now be illegal.
    There's something else that's really bothered me too, for years, and 
that is that private companies should not be able to get hold of the 
most sensitive medical information for marketing purposes. Yet, too 
often, that happens as well. Recently, expectant mothers who haven't 
even told their friends the good news are finding sales letters for baby 
products in their mailboxes. That's also wrong. And under these new 
rules, it will also be illegal.
    Health insurance companies should not be able to share medical 
records with mortgage companies who might be able to use them to deny 
you a loan. That actually happens today, but under these rules, it will 
be illegal. Health insurance companies shouldn't be able to keep you 
from seeing your own medical records. Up to now, they could. Under these 
rules, they won't be able to do that anymore.
    Under the rules being issued today, health plans and providers will 
have to tell you up front who will and won't be allowed to see your 
records. And under an Executive order I am issuing today, the Federal 
Government will no longer have free rein to launch criminal prosecutions 
based on information gleaned from routine audits of medical records.
    With these actions today, I have done everything I can to protect 
the sanctity of individual

[[Page 2752]]

medical records. But there are further protections our families need 
that only Congress can provide. For example, only new legislation from 
Congress can make these new protections fully enforceable and cover 
every entity which holds medical records. So I urge the new Congress to 
quickly act to provide these additional protections.
    For 8 years now, I have worked to marry our enduring values to the 
stunning possibilities of the information age. In many ways, these new 
medical privacy rules exemplify what we have tried to do in this 
administration and how we have tried to do it. We can best meet the 
future if we take advantage of all these marvelous possibilities but we 
don't permit them to overwhelm our most fundamental values.
    I hope that these privacy rules achieve that goal. And again, let me 
say, for this and so much more, I am profoundly grateful to the people 
who work here at HHS, the people who work with them at OMB and in the 
White House. In this action, you have done an enormous amount to 
reassure and improve the lives of your fellow Americans.
    Thank you very much.

Note: The President spoke at 12:46 p.m. in the Great Hall at the 
Department of Health and Human Services. In his remarks, he referred to 
Janlori Goldman, director, Health Privacy Project, Georgetown 
University. The Executive order on the privacy of protected health 
information in oversight investigations is listed in Appendix D at the 
end of this volume.