Remarks by the President on the Patients' Bill of Rights
                              THE WHITE HOUSE

                       Office of the Press Secretary
                           (Columbia, Missouri)
      For Immediate Release                              July 6, 2000

                            REMARKS BY THE PRESIDENT
                        ON THE PATIENTS' BILL OF RIGHTS

                          University of Missouri
                                 Columbia, Missouri

11:45 A.M. CDT

     THE PRESIDENT:  Thank you very, very much.  I want to begin by
thanking President Pacheco and Chancellor Wallace. I'm delighted to be
here.  I want to thank the doctors and nurses who are here.  And I want to
say a special word of thanks to Doug Bouldin.  I wish he could make that
talk personally to every member of the United States Congress.  That was
very moving, and I thank him.  (Applause.)

     I want to thank the other officials who have joined us here --
Attorney General Jay Nixon; Secretary of State Rebecca McDowell Cook; State
Auditor Claire McCaskill; Speaker of the House Steve Gaw; and
Representative Harlan and the other members of the legislature that are
here.  And Mayor Hindman and members of the City and County Council who are
here, I thank you all for joining me.

     And, of course, a special word of thanks to Governor and Mrs. Carnahan
for their friendship through the years and their leadership on this issue.

     I must say I'm glad to be here.  The last thing -- when I got up this
morning, very early in New York, to come here, the last thing my wife said
to me was, she said, you know, I went to Columbia once, it's a beautiful
place.  You'll have a good time.  (Applause.)  So I told Hillary, I said,
well, you made the decision about how you're going to spend this year.  I'm
going to Columbia and have a good time.  (Laughter.)  It was great.

     I understand that, in addition to the history lesson we got about the
University of Missouri, that this University also began the tradition of
homecoming.  (Applause.)  I always feel at home when I'm here in Missouri,
so I like that and I wanted to mention it.

     I'd like to say, too, how much I appreciate the opportunities that
I've had to work with the leaders and the people of this state over the
years -- during the terrible floods along the Mississippi; and then when we
were promoting welfare reform, I came here more often than to any other
state during the three-and-a-half-year battle we had to pass meaningful
welfare reform legislation, because I thought that Governor Carnahan had
done the best job of any governor in any state in showing how to do the
right kind of welfare reform.  (Applause.)

     We've worked together in education, in fighting crime and, obviously,
now, in ensuring quality health care.  And I'd just like to say -- because
I don't know how many more times I'll be in Missouri when I'm President --
(laughter) -- that before I was President, for a dozen years I was a
governor of your neighboring state.  It's a great job, it's like being
President of a state without all the perks and without all the hassles.
(Laughter.)  And I served with four Missouri governors and over 150,
believe it or not, other governors across America.  And Mel Carnahan is
clearly one of the very best governors I ever served with.  And I thank
him.  (Applause.)

     When I knew I was coming here -- there are so many things that I want
to talk about here at the university.  I wanted to talk a little bit about
increasing college access.  We have now 10 million people taking advantage
of either the HOPE Scholarship or the Lifetime Learning tax credit.  We
reformed the Student Loan Program.  In seven and a half years, students
have saved $8 billion on student loan repayments.  (Applause.)

     We've increased the Pell Grant a lot, and now I'm trying to convince
the Congress to let college tuition be tax-deductible up to $10,000 a year.
And I hope we can do that.  (Applause.)

     But the President talked about the importance of research, and we have
tried to support basic research for our colleges and universities and
through our national laboratories, and I could talk about that until
tomorrow morning.  But I'd just mention one thing to lead into why we're

     I had the profound honor last week, along with Prime Minister Blair of
Great Britain, to announce the completion of the first rough sequencing of
the human genome.  Now, this is a truly extraordinary thing that will
change the lives of people who deliver health care.

     Before you know it, young mothers will go home from the hospital with
little genetic maps of their kids' lives.  And it will be kind of scary in
some ways, it will say, well, unfortunately, your child has a greater
propensity to develop this or that problem.  But it will also say if you do
the following five things, you can cut the risk by two-thirds.

     We will see the combination, the continuing combination of the
information technology revolution with the revolution in genetics so that
most of my friends in the field believe that within a few years, we'll be
able to develop digital chips to replicate the failures of nerve cells,
even in the spinal column, so that people confined the wheelchairs will be
able to walk.  (Applause.)

     We will see -- people completely paralyzed will be able to regain the
movement of their limbs.  I believe that children born sometime within the
next 10 years will probably have a life expectancy of somewhere around 90
years.  And sometime in the first few decades of this century, we'll have
children born, and if they can manage to avoid accidents or other unnatural
causes of death, will have life expectancies of 100 years.  Now, that's the
good news.

     But the reason we're here today is that we have to run our health care
systems consistent with our values.  And if we're going to have all these
advances, they have to be implemented in a way that all Americans can be
treated fairly, equally, and have access to the benefits of everything from
emergency room care to basic care, to specialized care.  That's what this
whole debate's about.  (Applause.)

     Let me say to you, I feel a special responsibility here because I
think, in general, managed care can be a good thing.  That is, when I
became President, the price of health care was going up at three times the
rate of inflation every year.  We were spending 4 percent more, and still
are, of our Gross National Product on health care than any other country in
the world.  And it was obvious that we had to manage the system better.

     But it's equally obvious that you can't turn the fundamental life and
death decisions about the quality of health care over to people who are
managing for things that have nothing to do with whether the patient turns
out healthy or not.  And that's what this whole thing is about.

     It's about how to strike the right balance toward saying, yes, health
care is like any other big enterprise; of course, you should have prudent
management; of course, we should avoid wasting any money; of course, we
should do the very best we can to run it; but let's not forget why all
these people are doing this, why they've got their white coats on -- it's
to help people stay well and to help them get well if they get sick, or to
help them recover if they're injured.

     The reason we need the patients' bill of rights is because we are
awash in examples, which Doug just gave us a couple of, of the forest
overcoming the trees.  We have lost the forest for the trees, over and over
and over again.  That's why we're here.  (Applause.)

     Now, as has already been said by the previous speakers, I wanted to
come here because Missouri has passed a strong law, and you proved it
wasn't a partisan issue in the Heartland.  It's amazing how many issues
that are partisan issues in Washington aren't partisan issues once you get
five miles outside of D.C.  I don't know -- (laughter.)  But survey after
survey after survey shows that more than 70 percent of all Americans,
whether they identify themselves as Republicans or Democrats or
independents, support a strong, enforceable patients' bill of rights.  And,
therefore, in Washington, we have an obligation to pass it, and not to pass
less than that just because the organized interest groups are trying to
prevent it up there. (Applause.)

     Here's the state of play and why I wanted to come here to highlight
this.  We are so close.  The Norwood-Dingell bill, a bipartisan bill,
passed the House with a lot of votes to spare.  We had virtually every
Democrat for it and a fair number of Republicans voted for it.  We had a
good bipartisan group.  Then the bill was taken up in the Senate and we
came within one vote of having enough to pass it.  We had all the
Democratic senators. And Senator McCain, once again proving his
independence, Senator Spector, Senator Fitzgerald, and Senator Chafee voted
for it.  So we're one vote away.  And that's very important.        And I
came here because I don't think we ought to stop one vote short.

     I don't know how many health care professionals I've heard tell
stories like the one Doug Bouldin just told me.  I don't know how many
people I've heard -- I saw a nurse once who was trying to explain to me
what she had to go through calling HMOs to get approval for health
procedures that the doctor for whom she worked wished to perform that were
blatantly self-evident, and how many times she'd been turned down, and how
many times it was her unhappy duty to go tell the patient that once again
he or she had been shafted.  And I'll never forget that woman just weeping.
She literally could not complete what she had worked so hard on to tell me.
And I've seen it over and over and over again.

     Now, I have done all I can do through executive action.  I issued an
executive order to extend the patients' bill of rights safeguards to the 85
million Americans who get their health care through federal plans --
through Medicare, Medicaid, the veterans' system, the federal health
insurance plan.  We have provided similar patient protections to every
child covered under the Children's Health Insurance Program.  But I've done
all I can.  The Governor and the State Legislature in Missouri, they've
done all they can.  But I want to explain clearly again why we need federal
legislation and why only Congress can close the loophole.

     In spite of your strong law, which is as good as any in the country,
more than 1 million Missourians do not have patient protections today
because they are in plans that our outside the jurisdiction of state law,
under federal law.  Now, only federal legislation can fix that.  The
House-passed bill, the Norwood-Dingell bill does it.  And the protections
are listed here on the chart.

     First, it must protect every American in every health plan.  The bill
that the Senate did vote on -- that the majority passed, but they know is
dead on arrival -- excludes over 135 million Americans.  It covers fewer
than one in 10 people in HMOs.  I mean, why are we doing this, anyway?

     So when you hear people say, well, I support a patients' bill of
rights, the operative word in that sentence is "a" as opposed to "the."
(Applause.)  The difference in the one-letter word and the three-letter
word is 135 million of your fellow citizens.  This state has established
strong safeguards, but not everybody is fortunate enough to live in
Missouri.  There are a lot of states that haven't done this.

     Now, we have recognized that on certain fundamental things, there
should be national action.  That's Social Security, Medicare, environmental
standards, the civil rights laws.  We have said in certain fundamental
areas a patchwork is not enough;  there ought to be a floor on which every
American stand and through which no American falls.  That's what this
bipartisan bill does.

     The second thing, the patients' bill of rights must ensure access to
specialists.  Under the Senate bill -- the one that passed, not the one
they beat by a vote -- you might have the right to see a cancer specialist.
But the nearest doctor your plan may offer could be 100 miles away. or you
might have to wait two weeks to see the person that's listed.  That's
wrong.  The bipartisan bill ensures real access in a timely fashion to
specialists.  And if you or your family has ever needed one, you know how
important that is.  (Applause.)

     The third thing the bill does is to ensure access to the nearest
emergency room care -- and you just heard that story.  (Applause.)  Now,
you've got to understand, this is not an exceptional story.  This is not a
story that happens to people in small towns, and, oh my goodness, our plan
just didn't happen to cover -- you know, we've heard stories from people
that live in big cities in this country where somebody gets hit by a car on
a crowded city street where there's a traffic jam everywhere, and they go
past three hospitals before they get to the one that's covered for the
emergency room.

     This is not -- Doug did not make up this story.  I know you know he
didn't make it up, but he did not make it up as a representative story.
This is not some bizarre accident; this happens all the time, all over
America.  And most people don't know it, and when they hear it, they can't
believe it.  But it is true.

     Now, the Senate bill, as Doug said, allows plans to saddle patients
with an extra charge if they don't first call their health plan for their
permission before they go to an emergency room.  Now, I feel quite
confident that whoever wrote that has never been hit in a cross-walk by a
passing car.  (Applause.)  "I have three broken ribs, my nearest relative
is 500 miles away; I also have a concussion, but could you please wait
before you put me in that ambulance and let me call my health plan?"

     We're laughing because we don't want to cry, but this can be a life or
death decision.  You know it and I know it.
No one in an emergency should have to think twice about going to the
nearest hospital.  We just need to get over this.

     Fourth, a real patients' bill of rights must ensure access to clinical
trials.  This is also very important.  Only the bipartisan bill provides
coverage for all clinical trials, from cancer to heart disease to
Alzheimer's to diabetes.  This is going to get to be more and more
important.  You're going to have an explosion of chemical trials as a
result of advances coming out of the Human Genome Project, and people
shouldn't be denied the right to get a new lease on life because they
happen to be in an HMO.  (Applause.)  That's not right.

     Fifth, and fundamental, patients must be able to hold health plans
fully accountable for harmful decisions.  (Applause.)  The Governor alluded
to this, but -- and I'm not sure even he knows this because it was just
released today -- but listen to this.  A new analysis released today by a
number of prominent legal scholars concludes that the Senate bill would be
even worse than the current law, because it would effectively wipe out
protections that states like Missouri have already passed, and replace them
with provisions that would make it more difficult to hold plans accountable
for harmful decisions.

     In other words, when they voted to pass that bill, they voted to
weaken the law you have already passed.  So they voted to cast away vital
protections that the Governor and the State Legislature fought so hard to
give your families.  That's not a step forward, it's a leap backward.

     Now, the bipartisan bill, here's what it says.  It doesn't say we want
everybody to go file a lawsuit.  That's not what it says.  It says courts
should be a last resort; there should be reasonable protection for
companies and health plans that do the right thing; but if a health plan
can be clearly proved to have caused harm, families simply must have the
right to hold the insurance company accountable.  A right without a remedy
is not a right.  (Applause.)

     We need a real patients' bill of rights with real accountability and
real rights, not one that just provides cover for the special interests.
We don't need more cover for them, we need more health care coverage for
the American people.  (Applause.)

     I want to say one other thing for the skeptics who will hear about
this, because I know I'm largely preaching to the choir here.  People say,
oh, this is fine, but what does it cost?  Does it cost something?  Yes, it
costs something.  Do you know what it cost the federal health plans when I
ordered all these protections I just told you -- I issued an executive
order and we put it into the federal health plans - do you know what it
costs?  Less than $1 a month a policy.

     The Congressional Majority's own research service, that are the people
that basically are against this, their own people say that the costs would
be less than $2 a month a policy.  Now, I'd pay $1 or $2 a month on my
policy to know that you could go to the nearest emergency room if you got
in an accident.  And I think you'd feel the same way about your friends and
your neighbors.  (Applause.)  I would pay.

     So all of this business about how the cost is going to bankrupt the
country and add to new health care costs, it is simply not so.  And we have
got to be clear about that.

     Now, we are so close.  We're one vote away.  We have to overcome all
the maneuvering power that the interest groups have through their influence
with the leadership in the Senate, but we're one vote away.  We can enact a
strong, enforceable patients' bill of rights this year.  More than 300
health and consumer groups have endorsed it.

     I've done everything I could to try to avoid making health care a
partisan issue.  We have passed bipartisan health care legislation to allow
people to take their health insurance from one job to another, to have
portability.  We have enacted bipartisan legislation to provide for
children's health insurance for low-income people that aren't poor enough
to be on Medicaid.  We've approved a measure that allows people with
disabilities to keep their government-funded health care if they go into
the work force.  It's been a Godsend; it hasn't cost you a penny as a
taxpayer, and it's put a lot more people in the work force, making money
and paying taxes themselves.

     We have proved over and over again we could do this.  And this whole
thing is being hung up, with 70 percent of the American people on the other
side, because one group of interests do not wish to be held accountable,
like all the rest of us are, if they cause injury; because they don't want
to give up the right to tell you which specialist to see, whether you could
see one, and which emergency room you can visit.  It doesn't make any

     So I'm honored to be here.  I thank you all for what you have done and
for once again having the Show Me State show the way.  (Applause.)  But I
want you to think about the million Missourians who aren't covered by your
own law, and the 135 million of your fellow Americans who wouldn't be
covered by that Senate bill that poses as a patients' bill of rights.  And
I want you to think about the one vote standing between all America and the
kind of health care system we need.  All we need is one vote and we can
change America for the better.

     Thank you and God bless you.  (Applause.)

     END  12:10 P.M. CDT

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