[Weekly Compilation of Presidential Documents Volume 35, Number 36 (Monday, September 13, 1999)]
[Pages 1705-1710]
[Online from the Government Publishing Office, www.gpo.gov]

<R04>
Remarks on Health Care Legislative Priorities

September 8, 1999

    Thank you very much. Dr. Copeland; Mrs. Copeland; Secretary Shalala, 
thank you for your outstanding leadership; Surgeon General Satcher; OPM 
Director Lachance; to all the advocates here for seniors, for children, 
for people with disabilities; representatives of the various health care 
organizations.
    I am of the opinion that there's really not much left for me to say. 
[Laughter] You know, since I've been in this office and this

[[Page 1706]]

wonderful old house, I've tried to use this room as sort of a classroom 
for America, to bring people here who actually have firsthand experience 
of the challenges we face, the opportunities we have, and to try to 
provide them this microphone and these cameras and this bully pulpit to 
speak to America and to bring more of America here to Washington, DC.
    We've had a lot of very moving events here, but Dr. Copeland, I 
don't think anybody has ever done a better job of bringing the reality 
of what it's like to deal with the health care challenges of ordinary 
people from all walks of life on a daily basis as you have today. And I 
thank you very much for that.
    Secretary Shalala talked quite a bit about the record we have worked 
hard to establish here on health care issues. I want to thank two people 
who aren't here today: first, my wife, because of the role Hillary 
played in extending health insurance coverage to 5 million children, and 
now we have all the States signed up for the Children's Health Insurance 
Program; and I want to thank the Vice President for the critical role he 
has played in fighting for the Patients' Bill of Rights, for our long-
term care tax credit, for our plan to strengthen Medicare and to include 
prescription drug coverage. And I appreciated the agenda he set out 
yesterday for expanding affordable health care to children and families 
who don't have it in the 21st century, something that I still believe 
needs to be done.
    You know, I heard quite a bit about Dr. Copeland before he came 
here, and one of the things I heard is that his youngest daughter, who 
just started college a week ago, is such a good student, she's already 
been guaranteed admission to medical school. If somebody had figured out 
a way for me to get around organic chemistry, I might have had a 
different career. [Laughter] That's a wonderful achievement.
    But the truth is, there are doctors all across our country today who 
having given their lives to the health of their patients, have genuine 
reservations about whether their children should go into medicine. They 
feel that for all the miracles of modern medicine, doctors are too often 
hamstrung by accountants, and too often the needs of their patients 
don't come first. You just heard a pretty good accounting.
    I know that you, Doctor, are overjoyed that your own child wants to 
be a doctor, because you know that we have the power to do what it takes 
to put patients first again, which means you have faith in the health of 
our political system.
    There are a lot of pessimists who think that nothing's going to 
happen here this fall, that the parties are just going to fight and 
maneuver and get ready for next year. I think they're wrong. For one 
thing, ever since we've had this divided Government, we normally have to 
wait until the 11th hour for really good things to happen. I've grown 
used to it. As I said a couple of days ago, it is now 10:30; we're ready 
for the 11th hour. [Laughter]
    But after years of debate and genuine disagreement on a lot of these 
issues, I think a new and increasingly bipartisan consensus is emerging 
on the importance of giving patients the health and privacy protections 
they need, on strengthening and modernizing Medicare, on saving 
teenagers from the ravages from tobacco, on expanding health care 
coverage for uninsured children, and empowering adults with disabilities 
and making long-term care more affordable. But this growing bipartisan 
consensus will amount to little if the Republican leadership refuses to 
schedule a vote on the health care legislation. If they permit the 
votes, this fall could be one of the most important ones for health care 
reform in many, many years. If there is nothing but delay, it's just 
like delaying a patient; it will only make the cure harder. Sooner or 
later, we're going to have to face up to all these issues. We ought to 
do it sooner rather than later. It's a simple choice, familiar to every 
doctor--act early, prevent problems; or act later, at greater cost, with 
more heartbreak and human loss.
    The American people are counting on all their leaders, of both 
parties, to take the wise former course. First and foremost, the 
Republican leaders must make the responsible choice to protect 160 
million Americans who rely on managed care, with a strong and 
enforceable Patients' Bill of Rights. In August

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Representatives Dingell and Norwood introduced a bipartisan bill that 
rejects the wholly inadequate, watered-down approach taken by the 
Senate. It now has a clear majority support in the House of 
Representatives. That means both Republicans and Democrats are for it.
    The Republican leaders, therefore, owe it to the American people to 
schedule a vote on this bill. They must not give in to pressure to tack 
on extraneous provisions that would jeopardize the remarkable bipartisan 
consensus, in the hope that they can make it so bad that I will have to 
veto it, and then claim it's not their responsibility after all.
    The American people deserve the right to see a specialist. They 
deserve the right to go to the nearest emergency room if they're hurt in 
an accident. They deserve the right to maintain the same doctor during 
pregnancy or chemotherapy treatment. They deserve the right to an 
internal and an external review process; the right to know that their 
doctor can openly discuss the best treatment options, not just the 
cheapest; the right to hold health plans accountable for bad decisions.
    More than 200 health care and consumer organizations strongly 
support these protections. Estimates based on Congressional Budget 
Office figures show that the protections would cost no more than $2 a 
month a policy.
    Now, as you all know--all of you in this room--I have already 
established these protections by Executive order for everybody under a 
Federal health care plan, and our costs are less than $1 a month a 
policy. Now, whether we're right, or they're right, it's a small price 
to pay for peace of mind and quality health care. [Applause] Thank you.
    Second, I challenge the Republican leadership to join with me to 
work out a plan to strengthen and modernize Medicare for the 21st 
century. For more than three decades, Medicare has been a lifeline to 
dignified retirement. You heard what the doctor said about his own 
patients. But with people living longer and the retirement of the baby 
boomers approaching, the Medicare Trust Fund is scheduled to become 
insolvent in 2015. Now, keep in mind there will be twice as many people 
over 65 by 2030 as there are today.
    Today, anybody that lives to be 65 has a life expectancy of 82. By 
then, it will be considerably higher. By then, there will only be about 
two people working for every one retired. We have got to do this now, 
when we have the funds to do so.
    I've asked Congress to dedicate more than $300 billion of the 
projected surplus over the next 10 years to take the Trust Fund out past 
2025. That's the longest it's been in a long, long time. But we need to 
do it, with the retirement of the baby boomers approaching.
    I challenge Congress to introduce new mechanisms of competition, to 
improve quality, to control costs. I've challenged Congress to modernize 
Medicare by helping seniors and people with disabilities pay for 
prescription drugs. I have also set aside a fund to deal with the 
Medicare problems that we now have because of the budget decisions made 
in the '99 Balanced Budget Act, which have imposed severe problems on a 
lot of our teaching hospitals, some of our therapy services, and other 
problems of which many of you in this room are quite familiar.
    Before the August recess, Senator Roth, the chairman of the Senate 
Finance Committee, committed to mark up a Medicare reform package by 
early October. I salute him for that. With the leadership of Senator 
Roth and Senator Moynihan, we can get a bipartisan consensus on what to 
do about Medicare. I don't expect them to agree with everything I want 
to do. What I want them to do is sit down and talk with me and let's 
agree on the objectives. We have to lengthen the life of the Trust Fund. 
It is irresponsible for us to leave here with the Trust Fund scheduled 
to go out of money in 2015, with this projected surplus. It is 
irresponsible for us to leave here without dealing with the plain 
problems being faced today because of Medicare financing difficulties. 
And I strongly believe it is irresponsible for us to leave here without 
providing for some prescription drug coverage.
    If we were designing Medicare today, there's no way in the wide 
world we'd have a Medicare program without some prescription drug 
coverage. And you know as well as I do that these medicines are going to 
do more and more and more, if properly taken, to lengthen the life and 
improve the quality

[[Page 1708]]

of life, of people, and eventually to cut the cost of hospitalization 
and other more extensive interventions. So we ought to do this now. This 
should not wait 2 more years. We should do it now. [Applause] Thank you.
    The third thing I ask the Republican leadership to join me on is to 
make a responsible choice to protect the sanctity of medical records. 
You know, to the average person, this seems like a no-brainer, a lay-
down. It's actually quite a hot issue, because there are people who do 
not want to protect the sanctity of medical records. But as more and 
more of these records are stored electronically, the threats to our 
privacy will only increase.
    We know that protecting medical records has been a genuine priority 
for leaders in both parties. But the longstanding deadline for action by 
Congress came and went more than 2 weeks ago. If Congress does not soon 
pass legislation to protect patient records, I will honor the pledge I 
made to the American people in the State of the Union to do so through 
executive action. If need be, I will issue these new protections this 
fall. We should not delay this anymore.
    But again, I don't want this to become a fight either between the 
executive and the legislative branch, or between the two parties. I 
would far rather have legislation so that the American people can look 
to Washington and see people in both parties saying that your medical 
information belongs to you and you alone. Only you can control how it is 
used.
    The fourth challenge I want to issue to the leadership is to make 
sure that we make the responsible choice to allow people with 
disabilities to keep their health insurance when they go to work.
    Now, there is huge bipartisan support for this. Last June the Senate 
unanimously adopted the bill, sponsored by Senators Jeffords and 
Kennedy, Roth and Moynihan, that would finally end the system that says 
to people with disabilities: If you want to go to work, you've got to 
give up your health insurance and, therefore, you'll have to spend more 
every month than you can possibly make.
    Now, we have worked hard to end the disincentives that for too long 
kept people on welfare out of the work force. These disincentives are 
even more severe for people with disabilities, with serious health care 
problems.
    I met a man in New Hampshire a few months ago who, if he had to pay 
his own health bills, would have had bills of $40,000 a year, and he 
desperately wanted to take a $28,000 job. Now, we're out the $40,000 
anyway. Forget about the human impact on his life and his community and 
his family. Wouldn't you rather have the man making $28,000 and giving 
some of it back in taxes as a productive citizen, having him out there 
as a role model, having people see what people can do if given the 
chance to live up to their God-given abilities? This is foolish. It is 
time to schedule a vote on the ``Work Incentive Improvement Act'' in the 
House of Representatives.
    Now, the bill has 231 cosponsors in the House, so it's got 
bipartisan support. Now, most of you here know what the problem is. This 
bill costs money; under our budget rules, we have to pay for it. I gave 
them a way to pay for it; they don't like my way to pay for it. I say, 
``Okay, if you don't like my way, bring me another way.'' But we can't--
when a bill gets this kind of support in Congress--and believe me, 
instead of 231, the number would be 400 in the House if we didn't have 
this dispute. They don't like the way I want to pay for it. Okay, it's a 
big government; there are lots of options. [Laughter]
    But any way to pay for this within reason is better than letting one 
more year go by where people have to give up a precious year of their 
life when they could be working and being fulfilled and making a 
contribution to our country when it will not cost us, really, any more 
money.
    So I say, I understand what the problem is. We'll be reasonable. 
We'll work with you. But we cannot walk away from this session of 
Congress without passing this legislation. It will change the lives of 
tens of thousands, hundreds of thousands of Americans, with one simple 
bill.
    Fifth, I challenge the Republican leaders to make the responsible 
choice to prevent yet another generation of children from being lured 
into smoking and becoming addicted to it. More than 400,000 Americans

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each year die of smoking-related diseases. Almost 90 percent of them 
started smoking as teenagers. All the studies confirm that the price of 
cigarettes is one of the most effective ways to prevent kids from 
starting to smoke in the first place.
    My balanced budget raises the price by 55 cents a pack. It's good 
health policy; it's good fiscal policy. It will help us to save the 
Social Security Trust Fund, and it will allow us to honor our 
commitments by aiding both parents and children. For these reasons, 
Congress should side with America's families, and not with the tobacco 
lobby. We don't want to let another opportunity go up in smoke.
    Sixth, I challenge the Republican leaders to make the responsible 
choice to expand health coverage for the children of working families. 
Today, as I said, with the approval of the plan submitted by Washington 
and Wyoming, all 50 States and territories have now joined the 
children's health insurance initiative. Unfortunately, even with full 
participation from the States, there are still, literally, millions of 
children who are eligible for help who have not begun to receive it; and 
other children, like legal immigrants and foster children turning 18, 
who also need coverage.
    Once again I ask the Congress to fully fund the initiative that I 
gave them to help the States provide the coverage to the kids. We did 
this initiative together. When we passed the bipartisan balanced budget 
bill it has heavy majority support from both parties in both Houses. 
Heavy majority support in both parties in both Houses. And this was one 
of the things that I think all the Members were most proud of.
    Now, we've got a million and a half kids signed up, and we've 
appropriated money for 5 million kids. And we've simply got to do more 
to sign these children up. This is a modest cost for a huge return.
    Seventh, I asked the Republican leaders to make the responsible 
choice by helping families cope with the strains of long-term care. In 
our balanced budget--in the balanced budget, having nothing to do with 
the surplus or the tax cut or any of that, I proposed a tax credit and 
other initiatives aimed at helping elderly, ailing, and people with 
disabilities or the families who care for them to deal with the cost of 
long-term care. This will become a bigger and bigger challenge as 
America ages. People will want to make different kinds of choices based 
on the facts of their family situation or the facts of the problems of 
people needing long-term care. That's why I believe the best thing we 
can do for them now is to give them a tax credit. It is a good 
beginning, and I hope we can pass it.
    Finally, I ask the leaders to join with me in choosing wisely to 
continue to invest in public health. I'm talking about investing to 
begin closing the devastating health gaps we see that Surgeon General 
Satcher has done so much work on in Native American, African-American, 
Hispanic, and other communities; investing and treating and preventing 
mental illness; investing in the National Institutes of Health and the 
Centers for Disease Control.
    Now, usually, I don't give a talk with eight points--[laughter]--
because I'm always--you give a test, and people are lucky to remember 
four. But I felt better after the Doctor went over most of them. 
[Laughter] I felt like it was almost a prescription after he got 
through. This is not a laundry list. They are like eight panels of a 
protective umbrella for America's future. They're connected; they work 
together; they'll help millions of Americans weather the many changes in 
our health care system and the inevitable changes in their own lives.
    Health care cannot be a partisan issue. It hasn't been, and it 
shouldn't be. I was glad to hear the Doctor say that he was referring to 
his Republican and Democratic patients. You know, every time I give this 
talk, I say that no one asks you when you show up at the doctor's office 
and you fill out those endless forms--there's no box for Republican, 
Democrat, or independent. [Laughter]
    And we see now in Washington a mood change that has already been out 
there for a long, long time in the country. You see it in the people 
coming over for the Patients' Bill of Rights; in the people saying, 
``Yes, we want to provide the opportunity for people with disabilities 
to go to work.'' You see it in the efforts we have with children's 
health insurance.

[[Page 1710]]

    So I am optimistic about the future. I think the Copelands' daughter 
will have a good time being a doctor, just like her father did. I think 
we will make meaningful progress in this session. The bipartisan votes 
are out there. Nothing can stop it unless the votes aren't scheduled or 
we decide not to talk. We've got to schedule the votes, and all of you 
know I'm always willing to talk. [Laughter]
    Thank you, and God bless you.

Note: The President spoke at 2:57 p.m. in the East Room at the White 
House. In his remarks, he referred to Dr. Lanny R. Copeland, president, 
American Academy of Family Physicians, his wife, Mica, and their 
daughter, Mary Anne.