[Weekly Compilation of Presidential Documents Volume 34, Number 22 (Monday, June 1, 1998)]
[Pages 991-994]
[Online from the Government Publishing Office, www.gpo.gov]

<R04>
Remarks on the Patients' Bill of Rights

May 28, 1998

    Not much left for me to say, is there? [Laughter]
    Let me say, first of all, how much I appreciate the work that 
Secretary Shalala and Secretary Herman have done on our quality health 
care commission. Dr. Benjamin, thank you for your life's work and for 
your leadership. Mr. Vice President, thank you for everything you've 
done in the last 5\1/2\ years on health care. And thank you, Ricka, for 
reminding us of what this is really all about.

Detonation of a Nuclear Device by Pakistan

    I have a number of things I would like to say about this that I hope 
will not be repetitive. But because of the explosion of the nuclear 
tests this morning by the Government of Pakistan, I'd like to make a 
brief statement about that first, since this is my only opportunity to 
communicate with the media and the American people on that issue.
    First, I deplore the decision. By failing to exercise restraint and 
responding to the Indian test, Pakistan lost a truly priceless 
opportunity to strengthen its own security, to improve its political 
standing in the eyes of the world. And although Pakistan was not the 
first to test, two wrongs don't make a right. I have made it clear to 
the leaders of Pakistan that we have no choice but to impose sanctions 
pursuant to the Glenn amendment as is required by law. [Applause] Thank 
you.
    Now I want to say again, it is now more urgent than it was yesterday 
that both Pakistan and India renounce further tests, sign the 
Comprehensive Test Ban Treaty, and take decisive steps to reduce 
tensions in South Asia and reverse the dangerous arms race.
    I cannot believe that we are about to start the 21st century by 
having the Indian subcontinent repeat the worst mistakes of the 20th 
century, when we know it is not necessary to peace, to security, to 
prosperity, to national greatness, or personal fulfillment. And I hope 
that the determined efforts of the United States and our allies will be 
successful in helping the parties who must themselves decide how to 
define their future to defuse tensions and avoid further errors.
    Now, if I might, I'd like to say just a few words about what we have 
been talking about here. And we have seen the human face of this issue 
in Ricka's story and in Dr. Benjamin's testimony. If you just back a 
step away, if you think about all the exciting things that are happening 
and how the world is changing, how technology and globalization and 
scientific advances are changing the way we work and live and relate to 
each other, it is clear that we are living in a moment of really pivotal 
change in human society.
    At every such moment, the trick is to take advantage of the changes 
that are positive

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and not be consumed by their negative aspects or, to put it in another 
way, to meet the challenges of the future without giving up but, 
instead, enhancing the most enduring values of the society.
    Now, that's what we've been trying to do throughout the last 6 years 
on a whole lot of issues. Yes, we balanced the budget and earlier than 
anybody thought we could, but we continued to invest in education and 
health care and the environment and research. Yes, I want to have this 
surplus, but I don't want to spend a penny of it, even for things that I 
would like, until I know that we have secured the Social Security system 
for the 21st century so that when the baby boomers like me retire we 
don't bankrupt our kids and keep them from raising our grandkids 
properly.
    So you don't do the easy thing in the moment; you show a little 
restraint and think about the long-term interest of the country. You 
take advantage of the change of a healthier economy and a balanced 
budget and the surplus, but you don't just do what is right at hand. You 
think about the long term.
    Now, yesterday we celebrated the year anniversary of our Welfare to 
Work Partnership; that's all these companies that help us to hire people 
from welfare. So yes, we said the welfare system wasn't working and 
people who are able-bodied ought to have to go to work, but by the way, 
they shouldn't wreck their responsibilities as parents. So they have to 
have jobs; they have to have child care; they have to have health care; 
they have to have transportation.
    And if you think about this issue in this way, I think it will help 
us all to think about all the other challenges that we're facing. I 
mean, we've been very fortunate in America to have had the national 
wealth and the infrastructure of health care that we've had and the huge 
number of dedicated people we have here, physicians and nurses and other 
health care providers and support personnel. And because of 
technological and scientific advances and because we're learning how to 
do more outreach and preventive care, we now have the lowest infant 
mortality rate and the highest life expectancy in our history.
    Because of the human genome project and because of the mapping that 
it will make it possible to do for young children, we actually have 
people seriously saying that babies who are born at the tip end of the 
20th century may actually live to see the 22d century, not the 21st 
century. This is all great if you have access to it.
    Now, if you look at what managed care has done--I mean, first we had 
a system which was basically pay as you go--and my mother started being 
a nurse anesthetist; people didn't have money; there was no Medicare; 
there was no Medicaid. I remember one time a fruit picker bringing her 
five bushels full of peaches to pay for his wife's surgery. And you 
know, I was young, and I thought it was a lot better than money. 
[Laughter] But it wasn't so good if--you couldn't pay your electric bill 
with peaches, you know. [Laughter]
    So then we went into more and more insurance. We had Medicare; we 
had Medicaid; we had employer assisted insurance. Then we had this huge 
inflation in medical costs which led to two other trends. One was, 
unfortunately, fewer employers covering their employees at work. When 
the Vice President and I took office, about 40 percent of health care 
dollars were public dollars; now it's up over 45 percent. The other 
trend that occurred was, in an attempt to preserve the employer, private 
based health insurance plan and not have the whole thing go broke by 
having inflation go forward at 3 times the national average, new 
management systems were put into place.
    So I don't think we should overlook the fact that managed care was a 
part of a response to an unsustainable situation with inflation and 
health care costs, and some good came out of it. But it's like every 
other change: If there are no brakes, if there's no value base, then the 
logic of the change will consume itself. I mean, that's basically the 
story you just heard.
    So is managed care, per se, bad? No. Who could say it's bad to stop 
health care costs from going up at 3 times the rate of inflation? It was 
unsustainable. Eventually it would have consumed the whole economy. But 
no

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change is inherently good without being anchored in basic values. Now 
that's all this Patients' Bill of Rights is about. It says: Okay, go 
have your managed care; get rid of all the waste; be more efficient; 
don't let us bankrupt ourselves; but don't ever send me another story 
like this. I don't want to hear any more like that. That's what this 
bill says. This bill says: You know, how can you let some person with 
the mentality of an accountant who will only see the number of what it 
costs to have somebody do her surgery, who will only see the number at 
the bottom line of what the chemotherapy costs, make a decision? We're 
not that kind of people. We're not that kind of society. And if we have 
to endure a smidgen more inflation, bring it on. That's all this is 
about.
    Now, let me also say one other thing. This is urgent. You know, 
there have been a lot of other things going on during this session of 
Congress, and let them go on, but there ought to be some time taken to 
do the business of the American people. This is urgent.
    How many more stories do we have to hear like Ricka's before we 
actually act? Believe me, there's another one; there's one right now, 
just while we're sitting here, that somebody else just like her 
somewhere in America going through something like she went through. And 
it will be somebody else tomorrow and somebody else the next day and 
somebody else the next day. This is not rocket science. This is a simple 
decision by a society to say: Okay, we want all the benefits we can 
possibly get from better and more efficient management and cost 
controls, but we don't intend to chunk out the values that make this a 
decent place to live and give up all the benefits we've gotten out of 
medical research and advances in the last 30 years by just throwing it 
away on this kind of stranglehold technique. We're not going to tolerate 
it anymore.
    Now, I think--what I hope will happen, because all of you have come 
together here today, is that we will have, first of all, a general up 
feeling in the country that we have to do more on this to get this done 
in this session right now; secondly, that the people who are part of all 
your organizations or affiliates around the country will become more 
active; and thirdly--and Secretary Shalala and Dr. Benjamin in different 
ways alluded to this--that we will have a special increase in intensity 
among women in America about this.
    We have a report which was handed to me--you probably saw them hand 
it to me, because they forgot--[laughter]--on a State-by-State analysis 
of what this bill would mean to women. Now, in addition to the points 
that were made by previous speakers about this, I think it's important 
to note that according to all the research that we have, three-quarters 
of all the health care decisions in this country are made by women. In 
many households, women are taking care of sick children, taking them to 
the doctor, caring for elderly parents, paying the medical bills. Women 
also, unfortunately, more frequently suffer from chronic illnesses that 
require constant and specialized medical attention. So there are special 
stakes here for the women of America.
    There's another point I want to make that was mentioned by the Vice 
President, but I want to hammer this home. This really is a problem that 
must have a national solution. People say to me all the time, ``Well, 
you know, you used to be a Governor. Let the States do this'' or ``State 
legislation passing all the time.'' Well, first let me say I'm grateful 
for that State legislation, and I thank Governors of both parties who 
have supported it. Forty-four States have passed some kind of 
legislation. But some of the States have only passed one of the 
provisions of the many provisions in the Patients' Bill of Rights, first 
of all. Secondly, there are 122 million Americans, out of a population 
of 260 million--122 million of us are enrolled in plans not fully 
governed by State law. For example, just take California, our most 
populous State. If California passed the bill now pending in Congress, 
which is quite comprehensive, there would still be 13 million of the 30 
million Californians who'd be totally unaffected by it, because as 
Secretary Herman said, because of the way ERISA works. So there has to 
be a national solution.
    Now, all of you know that there are some pretty powerful special 
interests who are up here working against this bill. My answer is the 
previous speaker. So I think if you go back home and you think about 
this and you

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try to mobilize your friends and the people that are affiliated with it, 
first of all, think about how this is a specific example of the kind of 
challenges we face at this moment in our history--all this technology, 
all these changes, everything going on. And it is fundamentally the test 
of a decent society and certainly a great democracy like ours that we 
embrace all the changes that are going on, but we do it in a way 
consistent with the basic values that got us where we are over the last 
220 years. Secondly, remember to put a human face on it, and remember 
every day that goes by that this bill does not pass--every single day 
somewhere in America there's another story like Ricka's. There ought not 
to ever be another one, and with your help we can stop it.
    Thank you, and God bless you.

Note: The President spoke at 10:50 a.m. in Room 450 of the Old Executive 
Office Building. In his remarks, he referred to Ricka Powers, breast 
cancer patient who introduced the President; and Regina Benjamin, M.D., 
member, board of trustees, American Medical Association.