Transcript: Clinton speaks on patients' bill of rights

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Transcript: Clinton speaks on patients' bill of rights

July 9, 1999

July 9, 1999
Web posted at: 4:40 p.m. EDT (2040 GMT)

PRESIDENT CLINTON: Thank you. Thank you very much. Thank you.

(APPLAUSE)

Thank you very much. Thank you.

Well, good morning. And I want to thank Feckla Mikelseff (ph) for welcoming us here to Harbor (ph) UCLA. Thank you, Ethel, for your powerful statement out of your personal experience.

I want to thank my old friend Jack Lew for, as usual, making the case. We're used to being in fights where the evidence is overcome by political power.

(LAUGHTER)

But we're determined to reverse it in this case.

I want to thank Congresswoman Juanita Millender-McDonald, my friends Ev Arisloski (ph) and Yvonne Burke (ph) and the mayors and the other local officials who are here.

I thank the leaders of the health care groups that are here, both consumers and providers. And thank you, Reverend Jackson for coming. I'm glad to see you this morning.

(APPLAUSE)

I have a couple of things I want to say about health care and about how this Patients' Bill of Rights issue fits into our larger responsibilities to deal with the health of the American people.

I have just finished a trip across our country from Appalachia to the Mississippi Delta to the Pine Ridge Indian Reservation to inner city neighborhoods in East St. Louis, Illinois, South Phoenix and Los Angeles. The purpose of this was to shine a spotlight on the opportunity which exists in the areas that our prosperity has completely passed by.

It was a remarkable four days. And I came in contact with all the health issues that you would be concerned about in the process of pushing an economic agenda.

Well, one thing, when we left Washington and arrived in Appalachia and arrived in the Mississippi Delta and arrived in East St. Louis and arrived in Phoenix, in all those places it was 100 degrees.

(LAUGHTER)

And it was cool in the Dakotas when we got there at night, but the next day it was under (ph) 94.

And I'm very worried, I must say, that -- I want to say this today. I've been very concerned because a lot of poor people depend upon the LAIHE (ph) Program, the Low-Income-Health Assistance Program, to pay for air conditioning or get fans in the summertime. And I have today directed the appropriate people in our federal government to expedite the analysis we're required to do about the effects of the recent heat wave on the need for emergency assistance under this program.

We could lose a lot of people who won't even get to the emergency room if we don't do it, so I do want you to know that I hope the message will go across the country to the places I've visited and the other places that we know this is going to be a problem, and we're going to deal with it.

(APPLAUSE)

When we went on this tour we saw an awful lot of problems and we saw a lot of promise, enough promise to convince us all that we actually can succeed in building a bridge to the 21st century that all Americans can walk across.

When we give economic opportunity to all, we're helping to build that bridge. When we give all of our kids a world-class education, we're helping to build that bridge. When we're dealing with health care challenges, we're helping to build that bridge.

Jack mentioned the Medicare proposal that I have made to stabilize the Medicare trust fund till 2027, provide a prescription drug benefit that we can afford, and provide much more preventive services, which I think are very, very important.

Now, how does the Patients' Bill of Rights fit into all of this?

I feel, in a way, that I have a special right, if you will, to advocate for this bill because I have defended the role of managed care in our health care system for years.

When I became president, health insurance -- health costs have been going up at three times the rate of inflation for many years and all of us knew it was totally unsustainable.

That eventually it kept going up at three times the rate of inflation, we'd be spending all our money on health care. We all knew that that was completely unsustainable.

And that there was nothing wrong with managing the system properly so that you could, at the lowest possible cost, achieve the objective which was the highest possible quality of health care.

And, yes, at the margins there will always be tough decisions, but fundamentally no one can both believe in the American health care system and the professionals who provide that health care who believes in proper management believes you should sacrifice basic quality of care to the decision made by an accountant to make the bottom line of an HMO bigger.

The purpose of managed care is to enhance quality of care by making it as affordable as possible. Not to undermine quality of care by making the people who provide managed care as profitable as possible.

(APPLAUSE)

And it's very important, it's a fundamental difference.

So, as has already been pointed out, I asked the Congress a year and a half ago to pass a strong, enforceable Patients' Bill of Rights with all the things we've heard about: the right to see a specialist, the right to emergency room care at the nearest emergency room, the right not to have to change health care providers in the middle of treatment, to right to enforce accountability for harmful decisions.

And I have used my authority as president, as you said, not only to cover by executive order, those people on Medicare with the protections of the Patients' Bill of Rights, but also there's people on Medicaid, those people served by the Veterans Administration, and the people in the federal health insurance plan, the federal employees and their families.

And I want to just tell you that we actually now have some experience with the Patients' Bill of Rights. You know, the HMOs say: Well, this all sounds very good, but we can't afford it, and if you -- and they always try to make you think only of yourself, your healthy self -- if you, your healthy self...

(LAUGHTER)

... who never gets sick but has to pay health insurance, give these patients' bill of rights to them, all those sick people, you, your healthy self, will have to pay more for health insurance and, oh, how terrible it will be. That's their argument, right?

Well, we actually have done this now, and we have evidence. And sometimes evidence overcomes interest groups in Washington, so let's talk about the evidence. Our evidence is that when we put the Patients' Bill of Rights into the federal employees health plan it raised the cost of health insurance by less than a dollar a month.

Now, I'm going to go over this one more time, you've already heard it. I'm going to go over it one more time and I'm going to ask every American if he or she wouldn't be willing to pay something in that range on the off chance that their healthy self might not always be that way and out of a genuine concern for our fellow citizens and an understanding that the wealth and power and strength and quality of life of our country depends in no small measure on continued advances in the health of all Americans.

Now, since...

(APPLAUSE)

And yet some states have done some things in this area, but until Congress acts, there'll be more than 100 million Americans who won't have these full protections. I could only give it to 85 million by executive order.

So next week at long last the Senate's going to take this up. And I'll say more about that in a moment. But thank goodness the Senate finally is going to take this up. Last year, all year the leaders of the Senate kept us from bringing the bill up. And there's a good reason why they did. They're not for it, but they know they can't afford to be caught being against it.

(LAUGHTER)

We have 200 -- 200 plus medical and consumer groups are for the Patients' Bill of Rights.

The American Medical Association has allies it has never had before.

(LAUGHTER)

This is a very big tent. And there's only one group on the other side -- the health insurers. It's 200 to one. But the one is a big one. And so far, it's had enough support in the majority party in the House and the Senate to keep this from coming up. But if you go out in the country, I have said this over and over and over again, if you go out in the country, this is not a partisan issue. Because Republicans get sick just like Democrats. Even stubborn Independents sometimes get sick.

(LAUGHTER)

And when you walk into the emergency room, I would really like to know whether she's got a form she fills out in the emergency room that has a check for political party.

(LAUGHTER)

"Now before I give you this medicine, are you a conservative or a liberal?"

(LAUGHTER)

You know, we're laughing about this, but it makes a very important point. This is not a partisan issue, this is not even a philosophical issue, not anywhere in the wide world but Washington, D.C.

If you explained all the options to all the people in all the communities of this country, I promise you over 70 percent of Republicans, Democrats and Independents -- you know, when you got above those stratospheric numbers, maybe there would be some partisan differences -- but you'd have over 70 percent of all groups for this (ph).

How can it be -- how can it be that for over a year, the American people have been deprived of even a full debate on this in the United States Senate? Well, as I learned and Jack learned back in 1993 and '94, these folks have a lot of clout.

And let' forget about the politics and look at the facts. I'm going to run through this (OFF-MIKE).

I wish the American -- every American could just have this chart at home. If I had the ability through the Internet to send this to every American, I would do it.

Our plan says, if you need to see a specialist, you can't be denied the right to see a specialist. Their plan doesn't give you that right. Our plans says, if you get hit driving out of this event today on a hot Saturday morning in Los Angeles, you ought to be able to go the nearest emergency room not show up there and be told you got to drive 25 miles to one that your plan covers. This is a real issue, as you know.

Our plan says, and I'm so glad to hear you mention this, that it -- if you're being treated with chemotherapy or if you're six months pregnant and your employer changes providers, you should be able to stay with the physician that's treating you until your treatment is completed.

Hugely important issue that most Americans are not aware of. Our plan...

(APPLAUSE)

Our plan assures HMO accountants don't make arbitrary medical decisions.

Now, let me just say, I've listened to a lot of stories about this, I've done a lot of research on this. A lot of times the HMO decision making tree you finally get high enough to get a doctor who makes the right decision and it's too late.

And I've said this over and over again, I'm actually sympathetic with a lot of people at the first line of decision making in the HMO. Why? They're not doctors and they're never going to get in trouble with a company for saying no. Right?

They know -- I'm sympathetic with them. You know, they're -- a lot of them are -- they're making a modest income, maybe they're looking forward to their Christmas bonus, you know, they want to please their employer like we all do. You're my employer, I want to please you.

(LAUGHTER)

We're all like that. And these young people who are working at these companies, they know they are not going to get in trouble for saying no. Because they know if they say no the decision can always be kicked upstairs. And maybe it's three levels upstairs, but eventually somebody that understands this is going to make a decision and if they say yes then they won't get in trouble for having said no.

But, ah, if they say yes and somebody above them say you should have said no, they could get in a world of trouble. So we try to fix that here and change the incentive so that there is no institutional bias to deny quality care.

Should the health plans be held accountable? I think so. The framers of the Constitution would understand that a right without a remedy is not a right at all. And should they cover all health plans? Absolutely. The other bill leaves out 100 million folks.

So that's what this is about, the yes's and the no's. It's a simple evidence (ph). It's about how people live.

And yes, the Health Insurance Association may have some of its profit margin squeezed. And yes, they may have to have modest increases like we did, the federal health employees plan. I'll tell you, it's less than a buck a month for a policy. That's what our experience is.

But isn't it worth it to allow the system to work? To keep the benefits of managed care without having to shoulder these enormous burdens, these heartbreaking burdens? I don't know how many people I have seen. I've seen nurses who worked for doctors in their offices who have to make the calls to the HMOs to get told no, break down and cry telling me stories of people that they couldn't take care of.

You know, these are not just isolated anecdotes. This is a systematic problem in American health care. And once we fix it, all the people will be happy. The HMOs will do just fine, and they'll be happy we did, and people will wonder what in the wide world we were doing all those years not providing these patient protections.

Think of how you'd feel if you were a doctor, you spent all those years going to medical school, all those years in residency. You know, you go all those years without any sleep, and you're finally out there giving health care and all of a sudden you're told, here's a straitjacket we'd like you to wear to work every day and still figure out how to make these people well.

I mean, this is a big, big, big issue. And it should not be played out in a partisan political or special interest atmosphere. Shouldn't we err on the side of health? What are we afraid of?

(APPLAUSE)

So...

(APPLAUSE)

I saw today an amusing article in the paper which said that if the leaders of majority had decided that instead of bringing up their bill and having to deal with 20 of our amendments, which would put people -- force them to put their members on record being against these things, they would bring up our bill and just beat it; in the hope that then there would be no specific record of accountability.

I thought to myself, what kind of a weird world am I living in if this is just about, you know, something that you -- we had an emotional opinion about and we were on different sides, I would think that would be a clever thing to do and that's just politics.

This is not whether you've got an emotional opinion. This is about whether some people live and some people die. This is about whether people get well or they don't. This is about whether people feel at least comfort when they're dealing with the challenges of life or they're just not at an anxiety all the time. This is about where all these doctors, these nurses, these health care professionals wake up everyday, happy to go to work because they think they're going to be able to do their job or they're waiting for the other shoe to fall every single day because somebody's trying to strangle their ability to make these decisions.

This is, in other words, not a typical political decision. This is about life and the quality of life and the fundamental decency of our society. We should err on the side of humanity, we should err on the side of quality health care.

We have evidence now from our own experience that we can well afford to do this. And this is an idea whose time has long since come.

So -- and there are members of Congress in the Republican Party, as well as the Democratic Party, who support this, who just want a chance to vote for it and bring the benefits of it to the American people.

You know -- let me just -- it's like anything else. They -- you can argue against anything on the grounds that it's not perfect. Well, if we never did anything because it wasn't perfect, we'd never do anything and America wouldn't be here celebrating the 21st century. We wouldn't be around here for 223 years.

The Constitution wasn't perfect.

It had to be amended. So it is not an argument to vote against this bill that it might not be perfect, that there might be some unforeseen consequences that we might have to fix it.

We take our cars to mechanics to fix things that aren't perfect, but we don't stop buying cars and go back to walking around.

(LAUGHTER)

I mean, what is this? None of these arguments make any sense at all.

(LAUGHTER)

We have to put people in principle and evidence ahead of raw political influence. Democracy has to work.

(APPLAUSE)

So, I thank you for being here.

Remember we're all preaching to the same (ph) in this room today. Reach out to other members of Congress. Send a note or an e-mail today or Monday morning, every House member that represents anywhere around here.

Both of your senators are part of this bill. That's great. Send it to senators from other states. Give people a chance to do the right thing. Tell them what's at stake.

If people will listen to their hearts and their heads, we'll prevail next week. Thank you and God bless you.

(APPLAUSE)

END

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