Patients' Bill of Rights

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President Clinton Speaks About Patients' Bill of Rights

THE WHITE HOUSE
Office of the Press Secretary
(Louisville, Kentucky)
For Immediate Release August 10, 1998

REMARKS BY THE PRESIDENT
AT PATIENTS' BILL OF RIGHTS EVENT

Commonwealth Convention Center
Louisville, Kentucky

11:35 A.M. EDT
THE PRESIDENT: Thank you. Thank you, Dr. Peeno.Thank you, Dr. Peters. I must say, after they have spoken therehardly needs to be much else said. I was profoundly moved, as Iknow all of you were, by what both these fine doctors said, and Ithank them for giving their time and their lives to the work thatthey have discussed with us today. Yes, let's give them anotherhand. I thought they were great. (Applause.) Thank you.
Thank you, Mr. Mayor, for your warm welcome and yourleadership. Thank you, my good friend, Senator Ford, for all theyears of wise counsel and advice, for your work for Kentucky, forits communities, its farmers, its people. Thank you, GovernorPatton, for your friendship and for working for the education andhealth of your children. Thank you, Congressman Baesler, forvoting with us and supporting the patients' bill of rights, alongwith Senator Ford, for both of them. (Applause.)
I'd like to thank your Lt. Governor and Dr. StephenHenry for being here today; and State Auditor Edward Hatchett;Secretary of State John Brown; my good friend, Judge DaveArmstrong from the same little patch of ground that I'm from inArkansas. (Applause.) I'd like to thank our Director ofPersonnel Management, Janice LaChance, for coming down with mehere today. And I'd like to thank all of the health careprofessions who are here. (Applause.)
Ladies and gentlemen, before we begin, I would liketo just ask you to permit me to say a few words about theterrible tragedy that occurred at our embassies in Tanzania andKenya. Our hearts are heavy with the news that now 12 Americans-- brave people who are working to build a better world andrepresent all of us abroad -- have lost their lives. Somewherearound 200 Africans have died in those bombs now. We mourn theirloss. We extend our sympathies to their loved ones. To thenations of Kenya and Tanzania, we thank them for their friendshipto us. We grieve for the lost of their citizens.
I would just like to ask all of you to take just afew seconds of silence in their honor. (A moment of silence isobserved.) Amen.
We go forward now. You should all know that ourteams are on the ground in Africa. They're tending to thewounded; they're providing security; they are searching andfinding evidence. We will do whatever we can to bring themurderers to justice. (Applause.)
I must have said this 100 times or more since I'vebeen President, but I want to say it again because it bearsspecial meaning today. The world we are living in and the worldwe are moving toward will allow us to move around the world morerapidly and more freely than ever before and to move information,ideas and money around the world more rapidly, more freely thanever before. It will be a global society that I am convincedwill bring all Americans our nation's best years. But there hasnever been a time in human history when we have been free of theorganized forces of destruction. And the more open the worldbecomes, the more vulnerable people become to those who areorganized and have weapons, information, technology and theability to move.
We must be strong in dealing with this. We must notbe deterred by the threat of other action. There is no way outif we start running away from this kind of conduct. We have tobuild a civilized, open world for the 21st century. (Applause.)
Now, back to the important business at hand. Forfive and a half years now, I have had the great honor of servingyou and working with others to strengthen America for a newcentury, a global information age. We have tried to look aheadwith new ideas relevant to the times, but based on our oldestvalues of opportunity for all citizens, responsibility from allcitizens, and a community of all our citizens.
Thanks to the hard work, ingenuity, and civic spiritof the American people and to this new direction in policy, thisis a time of great prosperity and profound national strength forAmerica. We have a lowest unemployment in 28 years, the lowestcrime rate in 25 years -- (applause) -- the smallest percentageof our people on welfare in 29 years -- (applause) -- thesmallest federal government in 35 years -- (applause) -- thehighest home ownership rate in history. (Applause.) Wages arerising at twice the rate of inflation. We have, as the Governorsaid, provided for the opportunity for health insurance for 5million uninsured children. We have provide Hope Scholarships,worth about $1,500 in tax credits a year for the first two yearsof college -- (applause) -- tax credits for other years ofcollege; interest deduction on -- tax deductions on the intereston student loans; more Pell Grants; more work-study positions toopen the doors of college to everyone.
Compared to five and a half years ago, our air andwater are cleaner, our food is safer, there are fewer toxic wastedumps. And soon -- soon -- we will have the first balancedbudget since Neal Armstrong walked on the moon in 1969.(Applause.)
Now, here's the problem with that. Usually, in ourpersonal lives, our family lives, our work live and a nation'slife, after a series of difficult years, when times get good youwant to say, thank goodness, I'm tired, I need a rest; I want tosit back and enjoy this; I've been working like crazy for yearsand now things are good -- give me a break, let me have a break.(Applause.) And you agree, see?
That is the natural human tendency; that would be amistake. Why? The world is changing very rapidly as we seeevery day in the way we work and live and relate to each otherand the rest of the world. If someone had told you five or sixyears ago that today Japan would be having the problems it'shaving, would you have believed that? I say that not critically-- it is a great country full of brilliant people and they willcome back. But it is a reminder that things change in a hurryand we must always be ready.
I think you can overdo sports analogies, but I can'tresist one since I'm in Kentucky. (Laughter and applause). Theway the world works today is like the last 10 minutes of abasketball game between two really talented teams. Now, youthink about last season and what the Kentucky Wildcats did topeople who sat on the lead. (Applause.) Now, think about it.How many games were you behind in that you won? You can't affordto do it. The world is changing, so we should take theconfidence, the resources, the good fortune that we gratefullyhave now and use it to meet the big challenges still facing thecountry. That is very important.
We've got to continue to work on economic growth tostay with the strategy of fiscal discipline and open trade andinvestment in our people that has brought us this far. And wehave to prove we can extend the benefits of this recovery topeople who haven't felt it yet from the inner cities toAppalachia. (Applause.)
We have to continue to lead the world toward peaceand freedom. We can't withdraw from the world -- witness theevents of the last few days. We have to stand against the spreadof chemical, biological, and nuclear weapons. We have to standagainst the reach of international organizations of crime, andterror, and narco-trafficking. We have to stand against thedestruction of racial and ethnic and religious hatred; againstthe threat of global, environmental, and health challenges.
Here at home we have to honor our obligations tofuture generations. And the most important thing we should do isto set aside every penny of the surplus we're going to have onOctober 1st until we have saved the Social Security system forthe 21st century when the baby boomers require it. (Applause.)
We have to make sure all of our people have a chancein tomorrow's world by making our elementary and secondaryschools the best in the world. (Applause.) We need smallerclasses, more highly-trained teachers. We need modernizedschools connected to the Internet. We need schools where thereis discipline and good behavior and no gangs, guns, and drugs.(Applause.)
We need high standards and accountability, and greatflexibility in meeting them. We need to prove we can protect ourenvironment and still grow our economy. We have to continue toprove we can reach across the lines that divide us in thisincreasingly diverse country and be one America.
A good way to view this moment in history, Ibelieve, is through the lens of the First Lady's theme that shecame up with for our Millennium Project as we look toward how wewill mark the changing of the centuries and the changing of athousand years: Honor the past, imagine the future -- that'swhat we should be doing. (Applause.)
We have come here today to talk about a veryimportant part of one other big challenge we face -- how we canput progress over partisanship, people over politics, to expandaccess to quality health care to every American. Nothing is morecritical to the securities of our families, the strength of ourcommunities. Health is something we take for granted until we orour loved ones don't have it anymore. But people like the twofine doctors who talked to us deal with folks like that everyday. It isn't a partisan issue and I appreciated the fact thatthey made that clear. You know, when someone gets sick and comesinto see one of these two doctors and fills out a form, there isno box that says, Republican, Democrat or independent.(Applause.)
Health care is being revolutionized in America.Most of the changes are good. Stunning biomedical breakthroughspose the possibilities of vaccines or cures for our deadliestenemies, from diabetes to AIDS to Alzheimer's. Before you knowit, this Genome Project will be finished and we'll be able todecode the genetic structure of every person. Mothers will knowwhen they bring their babies home from the hospital what thepotential problems are that those babies have, and some of itwill be troubling to know, but most of it will be good becausethey'll be able to avoid all kinds of problems that mightotherwise have come to their children.
It will be unbelievable what's going to happen tohealth care in the 21st century. There have already beenexamples of nerve transplantations in laboratory animals wheretheir spines have been severed and now their lower limbs aremoving again. It will be an amazing time.
The trick is how to extend affordable coverage ofall these miracles and basic preventive health care to allAmericans. That's really how the managed care revolution began.You know, when I became President, for the last 10 years healthcare costs had been going up at three times the rate ofinflation. We were spending approximately 4 percent more of ournational income -- and at the time that was about $240 billion ayear -- than any other country on Earth on health care, eventhough we were one of the few industrialized countries that stillhad a significant percentage of our people without any healthinsurance. That was an unsustainable trend.
Since 1990, the number of people in managed care hasnearly doubled. Today most Americans, 160 million of us, are inmanaged care plans. And, as has already been said, I think, onbalance, there have been a lot of good things to come out ofmanaged care, to make it more affordable, more accessible, tomake the resources go further. But you've heard these doctorssay that some very, very costly errors have been made by puttingthe dollar over the person.
I'll never forget the people that I have met and thestories they've told me. I met a women named Mary Kuhl fromKansas City whose husband died. He needed specialized, urgentheart surgery. By the time he got the clearance to get it, itwas too late. I met Mick Fleming, whose sister died of breastand lung cancer after she was denied treatment that she was laterdetermined to have been entitled to. I met a billings managerthat the doctor referred to, who herself bears the scars ofhaving to turn away patients. I think in some ways, of all thepeople that have talked to me, she was the most moving of all,because she had to deliver the "no" face to face.
Now, when the bottom line is more important thanpatients' lives, when families have nowhere to turn, when theirloved ones are harmed by bad decisions, when specialist care isdenied, when emergency care is not covered -- we have to act.That's why you heard, at the grass-roots level in America,Republicans and Democrats, conservatives and liberals, evenpeople who think normally the government should not do anythingthat can fairly be done by the private sector, have developedthis overwhelming grass-roots consensus that we need the apatients' bill of rights in America. (Applause.)
I've done what I could administratively, and some ofyou are probably covered by decisions that I and myadministration have made. I acted to extend the protections ofthe patients' bill of rights to 85 million Americans who gethealth care through federal plans. In June we extended it to 40million people who receive Medicare. Last month we put in placenew rapid appeals for the 3 million veterans who receive healthcare through the Department of Veterans Affairs. Last week theDepartment of Defense issued a directive to all military basesthroughout the world, extending protections to 8 million servicemen and women and their families at nearly 600 hospitals andclinics all around the globe.
We are already extending many patient protectionssuch as the right to a specialist and continuity of care tofederal workers. And that's why Janice LaChance is here with metoday, because we are announcing that we are now requiring that350 health plans that serve federal employees to repeal the gagrules that keep doctors from telling patients all their healthcare options, not just the cheapest ones. (Applause.)
Now, a lot of states are acting in this area, too.Kentucky has a patients' bill of rights. But I can tell youbecause of the way the laws work, there is no substitute for anational law. We cannot provide protection for all Americans.We will leave many, many tens of millions behind unless we havestrong, bipartisan legislation that covers every American.
Now, for nine months, I've worked in good faith withlawmakers of both parties to pass a strong, enforceable,bipartisan bill of rights. We are fighting for a bill supportedby both Democrats and Republicans -- and again, I thank WendellFord and Scotty Baesler for their support.
Now, for nine months the leadership of the majorityparty in Congress has resisted taking any action at all. Theyhave listened to those with an interest in preserving the statusquo rather than the clear call of the public interest we haveheard echoing across this hall today. Now public demand isrising and the Republican leadership has discovered the need toact, so the House passed a plan last month and the SenateRepublicans have offered a similar bill. But these bills wouldgive patients and their families a false sense of security.
You've already heard some of the comments. But thisis very important, that when everybody is calling for a patients'bill of rights and both parties pushing proposals, how can theAmerican people know what a real one is? Well, that's what thischart is about over here. And maybe -- Jerry, would you hand methe chart? I'll hold it. He said he's the Vanna White ofLouisville here. (Laughter.) I'm not going to discuss that.(Laughter and applause.)
I want you to look at this, because that's what thisis all about. A real patients' bill of rights at least continuesand should strengthen the medical privacy provisions in placetoday. In the age of computer databases and the Internet, weshould strengthen the privacy of medical records. Don't you wantyours private, don't you? (Applause.)
I have a proposal that would do this. The HouseRepublican bill would dramatically increase the number of peoplewho can see your medical records without your knowledge orconsent. It overturns privacy protections already on the booksin 20 states, including Kentucky. The bill would just wipe themfrom the books and that is wrong. So here's the first test --protecting medical privacy laws: the Republican plan no; ourbipartisan proposal -- and I should say we do have Republicansupport, including a fine doctor from Iowa, Dr. Ganske in theCongress -- for the bipartisan bill.
Second, a real patients' bill of rights willguarantee the right to see specialists that you need. To reapthe full rewards of modern medicine you must have the ability tosee, for example, a neurologist or a cardiologist if that is whatis medically indicated. The congressional bills don't give youthat right; ours does. That's the second no-yes.
The third issue -- a real patients' bill of rightsguarantees you won't lose your doctor in the middle of a medicaltreatment even if your employer switches health plans. This is abig deal -- this is a big deal. (Applause.) Now, the GOPleadership bills don't do that. An insurance company couldswitch obstetricians in the sixth month of pregnancy or drop youroncologist in the middle of chemotherapy just because youremployer switches plans. A real patients' bill of rights makessure that health plans don't secretly give incentives to doctorsto limit medical care. (Applause.) Now, the Republicanleadership plan would permit that; our's would not.
A real patients' bill of rights guarantees you theright to emergency room care when and where you need it. Whenyou are wheeled into an emergency room, you shouldn't have tostart negotiating with your health plan. (Applause.) This isthe financial incentive. This is keeping your doctor throughcritical treatments -- no, yes; no, yes. Emergency room --their's no, our's yes. A real patients' bill of rights holdshealth care plans accountable for the harm patients face if theyare denied critical care. Now, that's important. (Applause.)
If a doctor denies you the health care you need, youcan get help to pay for lost wages or medical costs today. If anHMO denies you the care you need, under the congressionalleadership bill, you won't get any help at all. Now, if you haverights with no remedies, are they rights? How would you feel--what would you say to me -- what they're saying is, oh, thisbipartisan bill, they have all these remedies, and it's justgoing to be a mess with a bunch of lawyers. Isn't that awful?And a lot of people say, well, I don't like lawyers, I don't likelawsuits, who wants to be in court? Sounds pretty good.
Let me ask you this: How would you react if I gavea speech tomorrow that said, my fellow Americans, I love the Billof Rights. I love the freedom of speech, the freedom ofassembly, the freedom of religion, the right to travel -- I loveall those Bill of Rights. But I don't like all these lawsuits.We got too many of them in America. Therefore, I have proposedto amend the Constitution so that no one can ever sue to enforcethe right to free speech, free assembly, free practice ofreligion, or any other of the rights that have kept our countrystrong for 220 years. You would say --
AUDIENCE: No way! (Laughter.)
THE PRESIDENT: So when you talk about remedies, doyou have rights without remedies? I think we've seen enoughthere. That's a big issue. (Applause.)
A real patients' bill of rights should apply toevery plant, every single one. The Republican plan leaves out --listen to this -- as many as 100 million people, many of themworking for small businesses -- 100 million people would still beunder the present system; 100 million people who need our help.It is wrong. If we're going to do this, I don't want to leave100 million Americans behind, and I don't think you do either,even if you would be covered. That's not right. (Applause.)
So you need to remember here, it isn't the title,"patients' bill of rights," it is the specifics. What are thespecifics? Medical privacy: yes on our bill, no on theirs.Access to specialists: yes on our bill, no on theirs. Assuringthat accountants don't make arbitrary medical decisions: yes onour bill, no on theirs -- a big deal to doctors, because theyknow what happens to patients. Providing real emergency roomprotections: yes on our bill, no on theirs. Holding healthplans accountable if patients are harmed: yes on our bill, no ontheirs. Protecting patients from secret financial incentives:yes on our bill, no on theirs.
Keeping your doctor through critical treatments --huge issue -- I saw a lot of you nodding your heads when I saidthat you'd lose your doctor in the middle of your treatment --yes on our bill, no on theirs. And then covering all healthplans, that is, all Americans: yes on our bill, no on theirs.
That's what's at issue. This is not about politics.This is not about party. This is about a crying need for theAmerican people, and it's time we did the right thing. We oughtto do it now, in September when Congress comes back. (Applause.)
I want to thank the American Medical Association,the American Nurses Association, the American College ofEmergency Room Physicians, and so many others. I have to tellyou, we need a bill of rights, not a bill of goods. We need alaw, not another loophole. If I get that other bill of rights, Iwill be forced to veto it -- and I will. (Applause.)
Now, I will say again, this is not a partisan issueanyplace in the country but Washington, D.C. I believeRepublicans and independents are just as much for this bill outhere in the real world as Democrats are. Nothing should be lesspartisan than the quality of health care our people receive.We're a little more than 500 days from that new millennium, butthere's only a handful of days left in this session of Congress.We cannot let this moment of opportunity be remembered as a timeof missed opportunity.
Think of what I said about the basketball game.Think about how fast things are changing. Think about how fastthings can change in your life, in your family's life, in yourbusiness's life, and in the life of our nation. Now is the timeto say, we thank God for the good fortune we have, but we areusing it to look forward to the future, to make a better future,to meet the big challenges of this country. And we ought tobegin next month, when Congress returns, with the patients' billof rights.
Thank you and God bless you all. (Applause.)