Health Care For American Families

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President Clinton Calls For Steps To Improve Health Care For American Families

THE WHITE HOUSE
Office of the Press Secretary
For Immediate Release March 9, 1998

REMARKS BY THE PRESIDENT
TO THE AMERICAN MEDICAL ASSOCIATION
LEADERSHIP CONFERENCE

Sheraton Washington Hotel
Washington, D.C.

11:58 A.M. EST
THE PRESIDENT: Thank you very much for that warmwelcome. And thank you, Dr. Wootton. He was giving his talk and Iwas listening, and I was thinking, I agree with all that, there'snothing left for me to say. If I knew a couple of funny stories Icould just tell them and leave and thank you for the opportunity.(Laughter.)
Dr. Dickey, congratulations on being thePresident-elect. Dr. Reardon, thank you for serving on the AdvisoryCommission on Consumer Protection and Quality. Dr. Smoak, thank youfor telling me there's nothing incompatible between a doctor named"Smoke" and a campaign against tobacco. (Laughter.) Dr. Jensen,ladies and gentlemen.
I am honored to be here and to be working with the AMAon so many important fronts. We have, in the past, sometimes hadhonest differences on policy, but have always agreed on our profoundobligation to the health of our nation's families. We're walkingtogether in a step-by-step approach to health care reform, expandingthe promise of new medical technologies, extending health careopportunities to the most vulnerable Americans.
Together we've helped Americans to keep their healthcoverage when they've changed jobs or someone in their families getssick. And in last year's balanced budget agreement we helped to makesure that up to 5 million uninsured children will get the medicalcoverage they deserve and the help they need, with the biggestincrease in health coverage for children since 1965. (Applause.)
We have worked to increase medical research and tosupport greater efforts at preservation and care for conditions frombreast cancer to diabetes. Last year in our balanced budget plan,the diabetes component was said by the American Diabetes Associationto be the most important advance in the treatment and care ofdiabetes since the discovery of insulin.
We found the right family doctor for America, Dr. DavidSatcher, our new Surgeon General. (Applause.) Last month your voicewere strong and united in support of his nomination, and I thank you,and America's families thank you. The lesson of these endeavors isthat when we work together we can get things done.
This is a very great moment for America on the edge of anew century, a new millennium, and a completely new economy and newglobal society. We see dramatic changes in the way our people workand live and relate to each other and the rest of the world. Oureconomy is the strongest it's been in a generation. In five years,we have 15 million new jobs, the lowest unemployment rate in 24years, the lowest inflation rate in 30 years, the highest homeownership rate in the history of the country. (Applause.)
Our social problems are on the mend. Crime is at itslowest rate in 24 years. The welfare rolls are the lowest in 27years. Teen pregnancy and out-of-wedlock births are declining. Ourleadership is unrivaled around the world as we work for peace andfreedom and security.
Still, as I said in the State of the Union address,these good times do not give us the opportunity to rest or withdraw.Instead, if we are wise, we will use this as a time to act and tobuild, to secure our prosperity and strengthen our future, first ofall, by not spending this budget surplus we waited 30 years forbefore it exists, and putting Social Security first -- saving SocialSecurity for the 21st century so that the baby boom generation doesnot either bankrupt Social Security or bankrupt their children andtheir retirement. That's what we should do before we spend thatsurplus. (Applause.)
This is a time to widen the circle of opportunity.That's what we're doing with adding 5 million children to the healthcare rolls. In spite of the fact that we have a 4.6 percentunemployment rate, there's still neighborhoods, mostly in urbanAmerica, sometimes in rural America, where the recovery has not yetbeen felt. And our greatest opportunity to continue to grow theeconomy with low inflation is to bring the miracles of freeenterprise and high technology into these neighborhoods that have notyet felt them.
We also have to look at our long-term challenges. AndI'll just mention two or three that go beyond health care, but willaffect you, your children, and your grand children. First, as therecent International Math and Science Test results for seniorsshowed, we may have the best system of college education in theworld, and we have now opened the doors of college to everyone withtax credits and scholarships and work-study provisions and communityservice provisions. But no one seriously believes we have the bestsystem of elementary and secondary education in the world. And wemust keep working to raise standards and increase accountability andincrease performance until we do have the best system of elementaryand secondary education in the world. (Applause.)
Second, we have to recognize that what you do for aliving, worry about people's health, is going to increasingly beaffected by global development. Global travel patterns have given ussomething called airport malaria now, a phenomenon no one ever knewabout. And we have to recognize furthermore that a lot of what wedeal with in health care will be affected by the overall condition ofthe environment. That's why the issue of global climate change is soimportant. We have malaria now at higher altitudes than ever beforerecorded because of the climate change. A lot of you are probablynoticing as you hear from me that your allergies are a little worsein the springtime with El Nino, even in Washington, when you don'tthink it could ever be any worse than it is normally. So we have todeal with the climate change issue.
We have to deal with the problems of weapons of massdestruction. Even as we reduce the nuclear threat, we see on thehorizon the prospect that small-scale nuclear weapons or biologicalor chemical weapons in the hands of terrorists, drug traffickers,organized criminals, rogue states could change the whole future ofsecurity for our children. We have to cooperate more with othercountries for peace and prosperity around the world.
In a few days I'm going to Africa and I will be thefirst sitting American President ever to visit the nations in Africawhere I'm going to visit. But they're a big part of our future,economically, politically, and in terms of our shared concerns overhealth and environmental matters.
Now, I'd like you to see the particular issues I want todiscuss today in this larger context. Are we doing what we should bedoing to prepare this country for a new century, to widen the circleof opportunity, to strengthen the bonds that unite us together, toreenforce our values, to make our freedom mean more in the future?All of these issues should be seen against that background.
This is a moment of great promise, but it's also amoment of great obligation. Every American decision-maker, includingall the members of the Congress, but all the rest of us as well, mustdecide whether we believe that, because when times are good theeasiest thing to do is to relax, enjoy it, express relief.
If anybody told me the day I took office as Presidentthat in five years the stock market would go from 3200 to 8500 andwe'd have 15 million new jobs and almost two-thirds of the Americanpeople would be in their own homes, and all the other things, I wouldhave said, maybe, but probably not. Having achieved that, and havingstepped on all the hot coals that were necessary to get from where wewere then to where we are now, it is easy for people to say, well,let's relax. That would be a terrible mistake. That's the numberone message I have today.
We have to move. Prosperity and confidence give us thefreedom of movement that we have to seize. We have to move. This isnot a time to sit still. It's a time to bear down and go forward,and we need your help. (Applause.)
Now, there are fewer than 70 -- 70 -- working days leftin Washington before Congress adjourns. Now, this is an electionyear, and the work schedule is always somewhat shorter in an electionyear, and that's understandable. But it's unusually limited thisyear. How will the 105th Congress go down in history? I want it togo down in history as a Congress that saved lives by passing thePatient's Bill of Rights -- (applause) -- by passing tough andsweeping tobacco legislation -- (applause) -- by passing the ResearchFund for the 21st Century with its big increase in medical research,and extending health care coverage to those who presently areuninsured. That's what I want this Congress to go down with.(Applause.)
The next 70 days will tell the tale. Will this Congressgo down in history as one that passed land mark legislation to savelives and strengthen America for the new century; or one that wasdominated by partisan election year politics?
The calendar tells us that this is an election year.That's a good thing -- we need one every now and then. ((Laughter.)Have the debates and have the discussion. But as I have told everymember of Congress in both parties with whom I have discussed this,no matter how much we get done this year there will still be thingsat the end of the year on which honorable people in both partiesdisagree -- more than enough over which to have an honest, fruitful,meaty election. This election should not be allowed to obscure thefact that the American people want it to be not only an electionyear, but a productive legislative year for the health and welfare ofour country and our future. (Applause.)
Dr. Wootton has already talked about the Patient's Billof Rights, but I want to say a few things about it. Because mymother was a nurse anesthetist, I grew up around doctors from thetime I was a little boy. They were the first professional peoplethat I ever knew. Most of them were the kind of people we'd all likeour children to grow up to be. They were hard-working, able, kind,caring people. Most doctors today are as well. But the world ofmedical practice if very different today than it was 40 years ago,when I first started looking at it through the eyes of a child -- notaltogether worse, of course. There are many things that are better.We have higher life expectancy, the lowest infant mortality ratewe've ever recorded, the highest rate of childhood immunization,dramatic advances in medicines and medical technologies and all kindsof treatments.
We also have more than 160 million Americans in managedcare plans. And while there have been some problems with them, allof us have to be glad when health care costs don't go up at four orfive times the rate of inflation.
Still, it's often harder for you just to be doctors.When a doctor spends almost as much time with a bookkeeper as with apatient, something is wrong. (Applause.) If you have to spend moretime filling out forms than making rounds, something is wrong.(Applause.) And most important to me, when medical decisions aremade by someone other than a doctor, and something other than thebest interests of the patient is the bottom line, then something iswrong. (Applause.) I think we should have a simple standard:traditional care or managed care, every American deserves qualitycare. (Applause.)
We all have our stories, and yours are more firsthandand perhaps fresher than mine, but I never will forget reading a fewweeks ago about a woman who worked in an oncologist's office toverify insurance coverage and get authorizations for medicalprocedures, who told us the story of a 12-year-old boy with acancerous tumor in his leg. The doctor wanted to perform a procedureto save the boy's leg, but the health plan said no. It seems thatfor that condition, the only approved procedure was amputation. Andthat was the only procedure the plan would pay for. The child'sparents appealed the decision, but they were turned down. Theyappealed again and were turned down again. Only when the father'semployer weighed in did the health plan change its mind. By then, itwas too late, the boy's cancer had spread, and amputation was theonly choice left. Of course, it was covered by the health plan.
That is a choice no family should have to make. If thedoctor had been able to do the right thing, the child would have beenbetter off, and the system would have been better served.
We have the best-trained, best-skilled doctors in theworld, the best medical education, the best medical technology.We're all getting a lot smarter than we used to be about prevention.The first thing your President said to me is, "I'm a cardiologist,take this golf club and stay in good shape." (Laughter.) We'regetting better at it. But it is madness to strain at a gnat andswallow a camel. And it happens, over and over and over again.
There are no fewer than 500 stories that could come upin this audience right now within a half an hour not all thatdifferent from the one I just told. That is what we seek to address.That's what the Patient's Bill of Rights is all about -- to putmedical decisions back into the hands of doctors and their patients.I have already acted, as your president said, to ensure that federalemployees and their families, military personnel, veterans and theirfamilies, everyone on Medicare and Medicaid -- altogether about athird of our people -- are covered by the Patient's Bill of Rights.
And across our nation, state legislators and governors,both Republican and Democratic, are doing what they can. Forty-threestates have enacted into law one or more of the basic provisions ofthe Patient's Bill of Rights. But state laws and the patchwork ofreforms can't protect most Americans. At least 140 million of themare without basic protection. That's why we need the federalPatient's Bill of Rights with the full force of federal law.(Applause.)
The Hippocratic Oath binds doctors -- and I quote -- "tofollow that method of treatment which according to my ability andjudgment I consider for the benefit of my patients." That is yourresponsibility, and should be your patient's right -- to know all themedical options, not just the cheapest; primary care when possible,specialists when necessary. That's why the Patient's Bill of Rightslifts the gag order on our nation's doctors and allows patients tofollow your best recommendations by appealing unfair decisions bymanaged care accountants.
Patients also should have a right to keep their medicalrecords confidential. (Applause.) Doctors must feel free to writedown the whole truth without it ending up on the Internet or in thehands of employers and marketing firms or increasing a patient'sinsurance rates. (Applause.)
Again, the Hippocratic Oath says, all such shall be keptsecret. That's why the Patient's Bill of Rights safeguards thesanctity of the doctor-patient relationship. Patients have a rightto emergency services wherever and whenever they need it. And whenthe EMTs are wheeling a new arrival into the emergency room, the lastthing you or the patient should have to worry about is the fine printon the health plan. (Applause.)
Again I say, there are less than 70 days remaining inthis legislative session, but there is broad bipartisan support inthis Congress for this legislation. We have acted, and ouradministration. States have acted. The AMA has acted. You mustimpress upon the Congress the urgency of passing this legislation.Believe me, a majority of the Congress, a huge majority in bothHouses and members of both parties, are for this. It is just aquestion of mustering the will to get the job done and going throughsome of the very difficult issues around the edged that have to beresolved. But there is utterly no reason not to do this this year.You can get it done if you work at it. (Applause.)
The other great issue before the Congress in health careis, of course, tobacco. Now, you're right, Dr. Wootton, I did readThe Journal of the American Medical Association special edition ontobacco. I read it all from start to finish. And it was a greatservice to me and the American people, and I thank you very much forit.
Again, you can argue about some of the fine print, butthe big picture is clear: Every single day, even though it isillegal in every state in America, 3,000 kids start to smoke; 1,000of them will die earlier because of it. This amounts to a nationalepidemic and a national tragedy. You know as well as I do that morepeople die from smoking-related illnesses every year than from mostother things that cause death in America put together. Asphysicians, you also know that in the end, the only way that we haveto deal with this today with absolute conviction is with preventivecare: don't do it in the first place. (Applause.)
Now, for more than five years, we have worked to stopour children from smoking before they start. We launched anationwide campaign with the FDA to educate children about thedangers of smoking, to reduce access of children to tobacco products,to put a stop to tobacco companies that spend millions mass-marketingto our young people.
Last fall, I asked Congress to pass comprehensive,bipartisan legislation to reduce teen smoking by raising the price ofcigarettes up to $1.50 a pack over the next several years, imposingstrong penalties on tobacco companies that keep on advertising tochildren, and giving the FDA full authority to regulate children'saccess to tobacco products.
If we do this, we can cut teen smoking by almost half infive years. We can stop almost 3 million from taking that firstdrag. We can prevent almost 1 million premature deaths. But again,the clock is ticking.
And, yes, there are lots of complicated issues. Youknow, because this is a five or six-part package, there are severalcommittees and sub-committees involved. And because there is somecontroversy around the edges about how much money should be raisedhow quickly from the tobacco tax and what it should be spent on,there are some difficult issues to be resolved. And, yes, I knowthat there are only 70 days. But if we know that the lives of 1,000children a day are at stake, how can we walk away from thislegislative session without a solution to the tobacco issue?(Applause.)
There are two other issues I'd like to mention to you.The first relates to Medicare. This week -- or, excuse me -- lastweek, I attended the first meeting of the bipartisan MedicareCommission appointed by the leaders of the House and the Senate andthe White House to look for long-term reform for Medicare for the21st century. As you know, we have secured the Medicare trust fundfor another decade with some very difficult decisions. But there area lot of unresolved issues out there, and in some ways the complexityof the Medicare problem is greater than the complexity of the SocialSecurity problem. At least it has to be dealt with sooner in time.So I want to urge your support for the Medicare Commission and yourinvolvement in it.
I also have made a specific proposal with regard toMedicare that I believe should be passed this year without regard tothe work of the Medicare Commission, and I ask you to carefullyreview it and I hope you'll support it. It would give a vulnerablegroup of Americans, displaced workers 55 and over -- people whoeither voluntarily take early retirement and they're promised healthcare but the promise is broken, or people who are laid off and theycan't find another job and they lose their job-related healthinsurance -- and other seniors, principally people who are married tofolks who lose their old health insurance because they start beingcovered by Medicare, but they're not old enough to be on Medicare sothey lose the family coverage and they don't have anything -- itwould take this group of Americans and give them the chance to buyinto Medicare at cost.
The Congressional Budget Office just reported that thepolicy will cost even less and will benefit even more people than wein our administration had estimated, and agreed with us that it willhave no burden whatever on the Medicare trust fund. It will notshorten the life of the trust fund, nor will it complicate in any wayour attempts at the long-term reform of Medicare. We're talkingabout somewhere between 300,000 and 400,000 people that are just outthere, that had health insurance and now don't have any -- at aparticularly vulnerable time in their lives. So I hope you willsupport that.
The second thing I'd like to ask for your support forinvolves a project that Hillary has worked very hard on to sort ofleave some gifts for our country in the new millennium. The projectmotto is "honoring our past and imagining our future." Among otherthings, we're working with the Congress to get the funds necessary tosave, for example, the Star-Spangled Banner, which is in terribleshape. We need to spend, believe it or not, $13 million to restorethe flag -- and to make sure that the 200 years of lighting don'tdestroy the Declaration of Independence and the Constitution and theBill of Rights; and to try to get every community in the country tofind those things in each community which are most important to theirhistory and save them.
But we're also looking at the future. And perhaps themost important thing about the future-oriented nature of this projectis the Research Fund for the 21st Century, which has a huge increasein research for all forms of scientific research and development, butespecially has the largest increase in funding for the NIH in historyand doubling the funding for the National Cancer Institute.
We are on the verge of unlocking a number of medicalmysteries, as you know. Last year, for example, we had the firstsign of movement in the lower limbs of laboratory animals withsevered spines. The Human Genome Project is proceeding at a rapidpace, with implications which still stagger the imagination. Again Isay, we have the money to do this. We can do this within thebalanced budget. And while there may not be time to resolve everyissue I'd like to see resolved in this Congress, we should nail downnow this Research Fund for the 21st Century. There has been terrificsupport, in the Republican as well as in the Democratic caucuses.This has not been a partisan issue. It is just the question ofgetting the job done in the next 70 days.
So while you're here, let me say again, a big part ofbuilding America for the 21st century is building a healthierAmerica, and building an America where people feel secure with thehealth care they have, and they feel it has integrity. We need thePatient's Bill of Rights. We need action on the tobacco front. Weneed reform of Medicare long-term. We need to help these people thatare falling between the gaps because they're not old enough yet. Andwe need to continue in an intensified way our commitment to research.Let us take the benefit of our prosperity and finally having abalanced budget and invest the kind of money in research that we know-- we know -- will ensure benefits beyond our wildest imagination.
We can do all this in the next 70 days, but to do itwe'll have to do it together. I need your help. Your patients needyour help. Your country will be richly rewarded if you can persuadethe Congress to act in these areas.
Thank you and God bless you. (Applause.)