[Weekly Compilation of Presidential Documents Volume 34, Number 29 (Monday, July 20, 1998)]
[Pages 1392-1395]
[Online from the Government Publishing Office, www.gpo.gov]

<R04>
Remarks on Proposed Patients' Bill of Rights Legislation

July 16, 1998

    Thank you very much, all of you, for your obvious passion and 
concern for this issue. I thank Senator Daschle and Congressman 
Gephardt. I thank Congressman Ganske for his very moving and highly 
illustrative argument. I don't think any of you will ever forget it. I 
thank Barbara Blakeney and Dr. Smoak for their strong representation of 
health care providers throughout our country. I thank all the health 
care advocates who are here today, all the Members of Congress, 
especially I

[[Page 1393]]

thank also Senator Kennedy and Congressman Dingell, and Secretary 
Shalala and Secretary Herman who cochaired our quality health care 
commission that produced our recommendation for a health care bill of 
rights for patients.
    Let me say, first of all, I hope that the presence of Congressman 
Ganske and Congressman Forbes will be appreciated not just by Democrats 
on Capitol Hill but by Republicans out in America. I don't believe this 
is a partisan issue any place but Washington, DC. I've tried for years 
to talk them out of it, but I think most doctors are still Republican. 
[Laughter] I've tried for years to turn them around, but most voters in 
most parts of my country still vote Republican. But when you show up at 
a hospital in an emergency room, or you test positive on a biopsy, 
nobody asks you what political party you belong to.
    You know, this period and the period in which we're about to enter 
in the 21st century will be looked at 100-200 years from now, the last 
50 years and the next 50 years, as one of the most remarkable times in 
human history for advances in health: average life expectancy going up; 
the quality of our lives improving, not only because we're learning to 
manage our own lives better but because of immunizations against dreaded 
childhood diseases, organ transplants, bioengineered drugs, promising 
new therapies for repairing human genes.
    And it is, indeed, ironic that at this moment when medicine is 
becoming more and more successful, and, I might add--we talk about the 
work of nurses and other medical professionals--when we're more and more 
knowledgeable about how to get the benefits of medicine to people 
everywhere and technology is making it possible to bring them to rural 
areas, for example--that this aspect of the medical system is so 
desperately in need of repair.
    Now, I have always tried to say at every one of these events that 
managed care has not been an unmixed curse for America. There was a 
reason that we developed managed care systems. Health inflation was 
going up at 3 times the rate of inflation in our economy. It was simply 
unsustainable. And there were management economies which could be 
achieved just by running the system better. But what's happened is that 
the imperatives of managed care have overtaken the objective of the 
health system so often that often doctors are hamstrung, patients are 
alienated, and as you've heard, lives are endangered.
    Our job, representing all the American people, is not to abolish 
managed care. Our job is to restore managed care to its proper role in 
American life, which is to give us the most efficient and cost-effective 
system possible consistent with our first goal, which is--managed care 
or regular care, the first goal is quality health care for the American 
people. That is our job.
    And I just want to--the previous speakers have talked very movingly 
about examples and about the specific provisions of the bill. There's no 
need in repeating all that, but I would like to make two points very 
briefly. Number one, the panel of people from whom we heard yesterday--
Dr. Smoak referred to them--are not atypical. The woman who told me that 
she and her husband were celebrating their 25th anniversary and she 
realized he had a terrible heart problem, and the doctor recommended a 
certain procedure and it was delayed and delayed and delayed until 
finally it was too late, and so when he was 45 years old he collapsed in 
his own yard and died in her arms--at 45. The man who talked about his 
wife having a serious medical condition; she had a difficulty when they 
were in Hawaii on vacation; the doctor pleaded to perform the necessary 
procedure in Hawaii. The HMO said, ``No, put her on a plane''; make her 
fly 4,000 miles or however many miles it is back to the United States. 
And so she died on the way, because her system couldn't stand the 
pressure of the transatlantic plane flight. The man who talked about how 
he lost his sister to cancer because the only thing that had a chance to 
save her life was denied until finally it was too late to do and, oh, 
then got approved.
    I think, in a way, the most moving witness we had yesterday was a 
women who works in a doctor's office and handles the insurance claims 
and has to get the approval from the insurance companies for the 
procedures. She just broke down and started crying because she said, 
``You can't imagine how awful it is.

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I'm the one who has to look into the eyes of all those patients and tell 
them `no' or `not yet' or `maybe' when my doctor is saying `now, yes, 
immediately.' ''
    So the first point I want to make is these stories are not examples 
that we've all seen in other areas--and everyone who's elected is guilty 
of using them--these are not isolated anecdotes. These are 
representative examples of systematic abuse. That's the first point. 
Don't let anybody tell you--[applause].
    Now, second point I want to make is, we have to have comprehensive 
national legislation. That is one of the biggest problems with the bill 
offered by the Republican leadership: it covers too few people. It is 
not true that you can leave this issue up to the States. We have to have 
comprehensive, national legislation.
    I've already signed an executive memorandum to extend the protection 
of the Patients' Bill of Rights to the 85 million Americans who are 
enrolled in Federal health plans or covered by Federally funded plans. 
But as all the doctors, the nurses, the benefit managers--25 progressive 
HMO's have endorsed this legislation. Why? Because they know we have to 
have national, comprehensive legislation.
    Today we are going to have some more evidence of it. Families USA 
will release a report showing that most States that have acted have 
enacted only a few of the basic protections for patients, and not a 
single State in America has passed all the protections contained in the 
Patients' Bill of Rights. Americans deserve a bill that provides all the 
protections for all the people. It requires a national solution.
    Now, the bill sponsored by Representatives Dingell and Ganske and 
Senators Kennedy and Daschle does that, and you've already heard what 
their provisions are. I want to make one last point because I expect, as 
we see the debate unfold in the few next weeks, this will be one of the 
major sticking points. Some people will come to us, and they say, 
``Okay, we'll be for all the substantive positions in your bill, or most 
of them, as long as you don't give the patients a right to sue or some 
other enforceable legal right.'' And that will be appealing when a lot 
of people hear it, because people say, ``Gosh, I don't want--I can't 
imagine--I don't want any more lawyers; I don't want any more lawsuits; 
I don't want any more problems like that.''
    But let me say again, the thing that struck me yesterday at this 
hearing that we had at the AMA building was in three cases where people 
died, in all three cases, what the doctor told the patient the patient 
needed was ultimately approved. And in all three cases, it was approved 
so late that it was too late to do the procedure. So they died anyway. 
So you can write all the guarantees you want into the law here in 
Washington, and if nobody can enforce them, the delay in the system will 
still cause people to die. We have to do something about this.
    Now again I say to you, we need to do this for America. We need to 
do everything we can to stop this from being a partisan political issue, 
because it isn't anywhere but Washington. It's a people issue. It's 
about the integrity of the health care system. It's about how people 
feel about our country.
    We've got a lot of young people here, working here, probably some of 
them just for the summer, in Washington. I hope when they leave here and 
they go back to whatever else they're doing, they'll feel better about 
America than they did when they came here. And I hope they'll 
communicate that to other people all around their communities or their 
universities or wherever they are.
    How do you think the people yesterday who were telling me their 
stories feel about America? This is not even about just health care; 
this is about how American citizens feel about our country. Are we a 
fair place? Are we a decent place? Are we a place where everybody 
counts? This is a huge issue. And we must do everything we can to make 
it a bipartisan issue or a nonpartisan issue, to put progress ahead of 
partisanship. That's how we achieved a balanced budget. That's how we 
achieved the Kennedy-Kassebaum bill. That's how we got the Senate to 
pass the Chemical Weapons Convention and the expansion of NATO.
    In the end, all the really big, important things we do around here 
are when we behave here the way the American people behave every day 
wherever they live, doing

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whatever they're doing. And that's what we have to do on this issue. 
This is a huge thing for millions and millions and millions of 
Americans. But for all of us--for all of us--even if we live our entire 
lives and never get sick, we should always remember the picture that Dr. 
Ganske showed us and the story he told, because if you love America and 
you believe in the promise of America, everyone of you, without regard 
to your party or your philosophy, has a personal, deep, vested interest 
in seeing every child like that treated with the dignity that we say in 
our Constitution and Bill of Rights is the God-given inherent right of 
every person on Earth.
    Thank you, and God bless you.

Note: The President spoke at 12:45 p.m. in the Dirksen Senate Office 
Building. In his remarks, he referred to Barbara A. Blakeney, second 
vice president, American Nurses Association; and Randolph D. Smoak, Jr., 
M.D., chairman, American Medical Association.