[Weekly Compilation of Presidential Documents Volume 33, Number 47 (Monday, November 24, 1997)]
[Pages 1868-1872]
[Online from the Government Publishing Office, www.gpo.gov]

<R04>
Remarks Announcing the Health Care ``Consumer Bill of Rights and 
Responsibilities''

November 20, 1997

    Thank you very much, first of all, Peter, for your outstanding 
remarks and the power of your example. And I accept your offer to play 
golf. [Laughter]
    I thank all the Commission members and the members of the staff for 
a truly remarkable piece of work. And I'd like to say a special word of 
appreciation to Secretary Shalala and Secretary Herman, who cochaired 
the Commission and who, I believe, did a remarkable job, and I thank you 
very much. I thank the Vice President for his work in overseeing this 
effort and for his concern.
    This whole health care issue is very personal to me and to our 
family, to the First Lady. When I was running for President, I met 
person after person after person who had a cost, a quality, or an 
accessibility issue with the health care system. But long before that, 
as a Governor in what my opponents used to call a small southern State, 
I had the great gift that representing a small population gives you, of 
knowing a high percentage of the people who hired me, from all walks of 
life and all social strata, from all different circumstances.
    And I just kept--I had such ambivalent feelings. I could see in my 
own State that we had the finest health care system in the world. I saw 
miracle after miracle after miracle; I saw person after person given a 
chance to reconstitute his or her life, and then all these terrible 
problems arising from the cost or the quality or the accessibility 
issues.
    So we've worked very hard on them. The Vice President mentioned the 
quality issues. I would also like to say, this has been a very good year 
across the board for American health care. In the balanced budget bill 
we have $24 billion to provide health insurance to another 5 million 
children, about half of those who don't have health insurance--something 
that has become very important because the number of uninsured Americans 
has continued to rise since 1993. Ironically, even as the percentage of 
people in the work force eligible to purchase health insurance with the 
involvement of their employers has gone up, because of prices the 
coverage has gone down.
    We had a significant step in reforming the Medicare program to add 
many years of life to the Trust Fund and provide more choices, including 
preventive care to Medicare recipients and earlier tests for 
mammographies for younger Medicare-eligible women. We had what the 
American Diabetes Association

[[Page 1869]]

called the most significant advance in the care of diabetes since the 
discovery of insulin 70 years ago, in this bill. We will--in a day or 
so, I'm going to sign the bill reforming the Food and Drug 
Administration and its procedures. The FDA, I might point out, has 
already won an award for its groundbreaking work in accelerating the 
approval of drugs while continuing to meet safety standards to try to 
increase the availability of possibly life-saving medication more 
quickly.
    So a lot of good things happen. Yesterday I signed an adoption bill 
which was the product of an overwhelming bipartisan consensus in 
Congress which will revolutionize adoptions, including adoptions of 
children with special needs, which also will have a terrific health 
impact on some of the most vulnerable children in this country. So I 
want you to see this Commission's work against that backdrop. There is 
an emerging consensus in America that while people may not have wanted 
to bite the whole apple at once in 1994, almost the whole populace wants 
to keep nibbling away at the apple until we actually have solved the 
problems of cost, accessibility, and quality for all responsible 
American citizens.
    What this Commission has done today with their health care consumer 
bill of rights is a truly extraordinary thing--all the more 
extraordinary because the Commission actually represents all walks of 
life and all the different financial equities in the health care debate 
in America. And again, let me say, I thank you very much. We will be 
much closer to making these rights reality for every American because of 
the courage of the Commission and because of the composition and the 
broad experience of the different Commission members.
    Throughout our whole history, our strength has come from our 
families, from our individual citizens, from our continuing commitment 
to redefine and expand the parameters of opportunity and freedom, and at 
the same time, to do it in a way that brought us closer together as a 
society instead of dividing us further. Those values were in America's 
Bill of Rights, and they are certainly in this health care consumer bill 
of rights.
    Today, our families face so much change and, of course, the changes 
in the way we work, the way we live, the way we relate to each other and 
the rest of the world are quite profound. I think, in a major way the 
mission of our administration here must be to try to help America 
prepare for these changes so that we can expand the opportunities they 
present and adequately meet the challenges they present, and so that we 
can go forward together.
    Health care is changing dramatically, as we all know. The Vice 
President detailed some of those things. And we have worked hard to help 
people deal with these changes. Now, there are still particular problems 
that plainly require specific solutions. Millions of Americans have seen 
their health plans convert to HMO's and new kinds of health insurance. 
In many cases, managed care does bring lower costs and improved 
preventive care, and the health care industry, I believe, as a whole 
truly shares our goals of improving quality. And I have never been one 
who believed that improving efficiency involved the sacrifice of quality 
and, often, not even a sacrifice of quantity.
    Our administration has reduced the size of the Federal Government by 
300,000, eliminated a few hundred programs and several thousand pieces 
of legislation, and I have yet to have a single American citizen come up 
to me and say, why did you get rid of this or that. So we believe that 
you can have efficiency and improve quality and often improve the sheer 
volume of service as well. That's one of the things that technology 
makes it possible for us to do.
    Still, I think it's fair to say that almost every family feels some 
insecurity at the scope and pace of change in the world, including the 
scope and pace of change in the health care industry. And very often 
people feel actually lost because they have come up against this change 
in a way that is, to be charitable, not positive.
    There are so many people in this country that because of these 
changes feel like they're always going to be on the losing end of cost-
cutting and quality issues in every sector of life, maybe even where 
they work, and they certainly are most frightened of it when it comes to 
health care, even more frightened

[[Page 1870]]

than when it comes to their own job, I think, because with the 
unemployment rate being low and real flexibility in American labor 
markets, Americans have proved that they are incredibly resilient at 
getting new jobs, and increasingly, those new jobs are as good or better 
than the ones they lost, something that was not true just a few years 
ago. But when it comes to health care, you can't be sure of that kind of 
recovery, and no matter how much confidence you have in your own 
resilience, somebody else has got to help you.
    So even if we are trying to give Americans more job security in a 
changing environment by keeping unemployment low and intensifying our 
efforts to help people if they do lose their jobs to get better skills 
and find a job that is as good or better, we have got to recognize that 
the elemental insecurity that a loss of confidence in the quality, the 
accessibility, or the affordability of health care can breed in our 
society is staggering. The flip side of that is that if we can address 
those concerns, the increased confidence people have in the stability of 
the society as it affects their family and their lives will make them 
immeasurably more able to deal with the challenges of technology and 
globalization and change that no one can repeal.
    So I don't think it is possible to minimize the peripheral impacts, 
positive impacts of having the right kind of consumer bill of rights in 
health care and how much it will do to the sense of stability people 
feel on the job; how much it will do to increase employee productivity 
when they're not worried about their husband or their wife who got 
cancer 3 years ago, or if they're not worried about what's going to 
happen if their kid is in a car accident, like Peter was. If they know 
that at least they're going to have the best chance they can get, it 
will have a terrific impact to stabilize and sort of harmonize our 
society in ways that I think will be immensely positive for the economy. 
And obviously, the business leaders on this Commission agree.
    Now, consider the consumer protection issue in the larger context. 
Today, Americans receive consumer protection when they purchase cars, 
use credit cards, buy toys for their children. All this Commission is 
recommending is that we extend that kind of protection when a person 
visits a doctor, checks into a hospital, or buys into a health plan. 
Whether it's traditional health care or managed care, we have to make 
sure it's not inferior care. There are basic standards that I believe 
every American should be able to count on wherever they live, whatever 
their needs. Those standards ought to be the right of every citizen.
    Here is what the health care consumer bill of rights says: You have 
the right to be informed about your health plan in plain English. You 
have the right to choose the right doctor for the right type of care; 
the right to medical services in an emergency wherever and whenever the 
emergency arises; the right to know all your medical options, no matter 
how much they cost; the right to respectful care and equal treatment at 
every health care facility by every health care provider; the right to 
know your medical records are confidential and only used for legitimate 
purposes; the right to express your concerns about the quality of care 
you receive and to take action when that care is inadequate.
    This consumer bill of rights, as has already been said, is the 
product of a broad consensus from a broad group of business leaders and 
health insurers, working people and health advocates, doctors and 
nurses. There are still those who oppose it and that is their right. But 
this is a case where the national interest must prevail over the narrow 
interest, where the family's interest must prevail over the fear of 
change.
    I ask those who are afraid, on the other side, to balance in their 
equation the fear that has been in the hearts of all the Americans who 
have confronted the health care system without this consumer bill of 
rights. We all have to bear our fair share of the uncertainty of change 
if we are all going to feel secure in the face of the future. And that 
seems to me to be the best argument that we can take to those who do not 
yet agree that this is the right thing to do.
    These protections, in fact, are long overdue, and now we have to act 
to make them real for all Americans. Some will require Federal standards 
to be implemented. Where they do, I challenge Congress to make them the 
law of the land. There will be no more important tests in the coming 
months

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of our commitment to strengthen our families. And I look forward to 
working with Congress.
    You heard the Vice President say there's broad bipartisan support 
for moving forward here. But we shouldn't wait for Congress to act, 
especially when it's not necessary. So today I am acting within my power 
as President to implement the rights to the extent that I legally can. 
I'm directing every Federal agency that administers or manages health 
plans to adopt the protections of the consumer bill of rights, and to 
report back to the Vice President about where they need legislation to 
do so. With this step we can ensure better quality health care for tens 
of millions of Americans, including all Medicare and Medicaid 
beneficiaries, and all Federal employees. And I challenge all private 
health plans to adopt the consumer bill of rights voluntarily, to give 
their members greater confidence and security.
    In that connection, I want to thank GTE and one of our Commission 
members, an officer of GTE, Randy McDonald. They are the first large 
company to guarantee the consumer bill of rights to all the 400,000 
people on their health plan, employees and their family members. It's an 
extraordinary step. And if they can do it, others can follow. I don't 
know if Randy is here today, but if he is, will you stand up? Thank you 
very much. God bless you.
    Finally, it would be wrong for us to end this without acknowledging 
that there can be no rights without responsibilities; that our community 
can only go forward when there is a corresponding responsibility for 
every opportunity and every right.
    The new world of health care offers greater choice and more 
fundamental opportunities for health than ever before. And today we 
outlined the rights that every American should have in dealing with that 
health care system. But every American also has an enhanced obligation 
to take an active role in his or her own health care and to take 
responsibility for his or her own health. We spend a lot of money in 
this country every year that we wouldn't spend if we'd just go through 
the day in a sensible way every day. And we have to acknowledge that, 
and we cannot blame the health insurance industry or the health care 
providers or anybody else in the wide world for the burdens we impose on 
ourselves for the extra cost, the lower income, the reduced productivity 
that are the direct result of daily choices made by individual citizens 
that they do not have to make in the way they live their lives, and we 
ought to be honest about that.
    And we should never point the finger at other people when we have 
problems until we have first examined ourselves and what we have to do. 
And I know a lot of companies are looking at ways to reward responsible 
behavior and ask that some payment be made for that behavior that 
imposes costs on society as a whole. That's a large part of what we're 
attempting to do in settling this issue of the marketing and selling of 
tobacco to young people in America in ways that violate our laws. So I 
think that has to be a part of this; we can never lose sight of it.
    When President Kennedy proposed a consumer bill of rights over 30 
years ago, he said, ``Under our economic as well as our political form 
of democracy, we share an obligation to protect the common interest in 
every decision we make.'' I am convinced, as I have said repeatedly, 
that the coming years will be a time of remarkable breakthroughs in 
science and medicine, remarkable breakthroughs in the space and in the 
ocean, remarkable breakthroughs in the structure of human genes. There 
will also be a time of remarkable opportunity to relate to other people 
around the world, economically and culturally. They can be, this next 50 
years, the best half-century human society has ever known. But we have 
to look after the common interest. No matter how individualized our 
computers, our telephones, our fax machines, our self-employment--no 
matter what happens, we will still have to protect the common interest 
if we want to have safe streets, good education, good health care, a 
clean environment, and a healthy economy.
    Today, by standing up for individual rights, this Commission has 
advanced the common interest, and America will be much better for it.
    Thank you very much.

Note: The President spoke at 12:11 p.m. in Room 450 of the Old Executive 
Office Building. In his

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remarks, he referred to Peter Thomas, Chair, Subcommittee on Consumer 
Rights, Protections, and Responsibilities, who introduced the President. 
The Office of the Press Secretary made available the report of the 
Advisory Commission on Consumer Protection and Quality in the Health 
Care Industry, entitled, ``Consumer Bill of Rights and 
Responsibilities.'' A tape was not available for verification of the 
content of these remarks.