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REMARKS BY:  DONNA E. SHALALA, SECRETARY OF HEALTH AND HUMAN SERVICES
PLACE:       NURSES AND HEALTH PROFESSIONALS/AMERICAN FEDERATION OF TEACHERS CONFERENCE, WASHINGTON, DC
DATE:        APRIL 17, 1998

Thank you, Candice. Let me also thank my friend, Sandy Feldman, president of the American Federation of Teachers, for inviting me to take part in your 20th anniversary celebration. Sandy and I have been friends for years, and I was glad to see her take the helm at the American Federation of Teachers ... because -- like old friends usually do -- Sandy certainly has taught me a thing or two about life.

Certainly all of you -- the chief guardians of patient care -- have taught America's families a thing or two about our health, our lives, ourselves. And as we all know, you've also taught America's doctors that they would be lost without you. And in your work, you teach us every day about the lengths of human kindness ... the strength of human character ... and the true definition of what it means to care. So let me begin today by saying, thank you. Thank you for your sharp minds, your watchful eyes, your loving hands, your nerves of steel -- and of course, your hearts of gold.

Right now, millions of Americans are getting a back-stage look at your work and challenges, thanks to a recent book on the bestseller list, called Life Support: Three Nurses on the Front Lines. The author, Suzanne Gordon, brings us face to face with three remarkable nurses in Boston. Ellen, who bicycles through poor neighborhoods to visit elderly patients at home. Nancy, who brings technical skill -- and the human touch -- to high-tech medical procedures. And Jeannie, who helps prepare new doctors and nurses to better serve their patients. Three very different stories...three very different women...three very different jobs. But there's a common thread running through their lives. Each of these remarkable women brings not only her training and knowledge, but also herself, to her work. Each lives and breathes the "Nightingale Pledge" -- an everyday devotion to the welfare of patients -- putting their needs first.

But we all know that today, you're facing tough, new challenges in fulfilling the "Nightingale Pledge." Because as Shakespeare noted in A Comedy of Errors, "There is something in the wind." And it's the winds of change that are sweeping the world of medicine and stirring revolutions...Revolutions in patient care that have led to shorter hospital stays and more emphasis on home health care...Revolutions in technology and biomedical research that are yielding new treatment options, but also new ethical dilemmas...And, of course, revolutions in the delivery of health care. Nobody needs to tell you how the face of medicine has changed. Or about the new hurdles you face to putting patients first. Or that we must never let spirit of the Nightingale's Pledge be diminished. We must ensure the winds of change do not sweep away what's most sacred in medicine. Instead, we must harness those winds to make sure our medical system remains the best in the world for every American...every day...everywhere.

That's why the President has called for a Patients' Bill of Rights. A bill of rights to guarantee health care quality for everyone-no matter where they live...who they are...or who they see. As the chief guardians of patient care, the Patient's Bill of Rights will change your lives-because it will change the future of health care. And because you -- the women and men on the front lines of patient care -- will be helping to keep our medical system the very best in the world. And also because you, our nurses and health professionals, had a seat at the table and a voice in the process that led to the Patient's Bill of Rights. That's one reason why -- as Candice Owley said -- the Commission was indeed, "the right prescription at the right time."

We appreciate your support, because what you think about the Commission and its work certainly speaks volumes.

And we will need your support, because when the Commission delivered the Patient's Bill of Rights to the President last November, that was just the beginning.

Now we must make it happen -- for all Americans.

We know there's a lot of support out there -- when a movie character complains about her HMO and the audience erupts in applause, it's a modern version of the Boston Tea Party.

Our challenge is to guarantee to health care consumers what the original Bill of Rights in our Constitution guarantees to all Americans -- our basic well being.

The Patient's Bill of Rights calls for quality...access...choice...privacy...and recourse for shoddy care.

It echoes elements of your own "Health Care Quality First" campaign, especially its goal to "promote and defend high standards of quality, access and choice."

And the Patients' Bill of Rights is based on one very sound premise:

That every type of health insurance, whether managed care or fee for service, Medicare or employee sponsored, PPO or HMO, must deliver high quality health care...for every American...every day...everywhere.

To support this premise, the Patients' Bill of Rights lays out eight basic principles.

Principles which you already support and fight for.

First, consumers have the right to have information they need to make knowledgeable choices.

They have a right to know what's in a health plan and what's excluded...which doctors are in a plan's network....and how they can appeal a decision to deny coverage.

The Patients' Bill of Rights also says that consumers have the right to greater choice in health care-a goal that you've strongly advocated.

Ironically, today we have more treatment options but fewer choices.

Employers have cut the number of insurance plans they offer and choice of doctors has been reduced.

It seems that the spirit of Henry Ford may be haunting some aspects of health care.

When Ford was making the model T, he once remarked, "A customer can have a car painted any color he wants-so long as it's black."

A lack of choice is irritating in cars...but it's downright unacceptable in health care.

The Patients' Bill of Rights also says that you have the right to choose a specialist for the care you need-and the right to emergency care whenever and wherever the need arises.

You and I both know that if you're experiencing chest pains, you should go to the nearest hospital emergency room.

But too many health plans have been denying claims for emergency care when the chest pains turned out to be a false alarm -- sticking people with a huge medical bill.

In other words, the good news ... quickly became bad news.

If we want to improve our nation's health, then people can't be reluctant to enter a hospital-simply because they're afraid they won't be able to afford the admission price.

Like the original Bill of Rights in the Constitution, the Patients' Bill of Rights says that consumers have the right to free speech in health care.

That means doctors must be able to communicate freely about treatment options, alternatives, risks, benefits, and consequences-without gag rules or contractual agreements.

Your "Health Care Quality First" campaign is right on target when it calls for "full, complete and prompt disclosure of health conditions and treatment alternatives with patients."

The Patients' Bill of Rights also demands mutual respect and nondiscrimination in the health care industry and in insurance enrollment-regardless of race, sex, age, or sexual orientation.

Equality in heath care also means genetic equality-that means there must be no discrimination based on a person's genetic makeup.

Our scientists are making remarkable progress in identifying genetic predisposition to disease.

But this good news on disease should never be bad news for your health insurance coverage.

The Patients' Bill of Rights also says that Americans have a right to privacy in health care-that means a patient's health records must be kept confidential.

Ever since I was a young woman, I've had this indelible memory of my medical records being locked away in a file cabinet in my family doctor's office.

Today, my medical records are probably zipping around computer networks all over the country -- I have no idea who may be up-loading or down-loading them.

Ironically, we have federal laws that protect the privacy of our motor vehicle records, our credit card records and even our video store records-but not our health care records.

We are challenging Congress to pass legislation right away to ensure our privacy.

Our health records should be used to heal us-not reveal us.

Echoing the original Bill of Rights, the Patient's Bill of Rights also says that consumers have the right to due process in health care-that means they have recourse to challenge decisions made about their care.

Finally, like the original Bill of Rights in the Constitution, the Patients' Bill of Rights says that along with rights come responsibilities.

This means Americans must take care of themselves by exercising, and by working with you -- our health care professionals -- to make healthy decisions for their lives.

Keeping healthy is the bottom line in the Patient's Bill of Rights.

But as our Founding Fathers knew, a bill of rights isn't worth the paper it's printed on-without a way to guarantee it.

In the case of the US Constitution, the courts protect our rights as citizens.

But when it comes to our rights as health care consumers, President Clinton has taken a bold and significant step to guarantee our rights.

By executive order -- by the stroke of his pen -- the President has guaranteed that everybody in a federal health insurance plan is covered by the Patients' Bill of Rights.

That's 80 million Americans -- one third of all Americans.

That includes every federal employee ... every veteran and all their families ... all of our military personal ... and of course, everyone on Medicare or Medicaid.

That's fully one-third of all Americans who will now have the right to know all medical options; to choose a specialist; to keep medical records confidential.

But the impact goes well beyond these 80 million Americans -- the ripple effect is like a tidal wave.

Because we are using the vast purchasing power of the federal government to raise the standards of the American health care system for good.

We're saying to any prospective insurer, that if you want to play in the federal system, you must pledge to uphold the Patients' Bill of Rights.

For those Americans not in the federal system, we need Congress to pick up its collective pen -- to follow the President's example and finish the job-by extending the protections of the Patients' Bill of Rights to the remaining two-thirds of our citizens.

Our message to Congress is this: Guarantee the rights of patients now.

But guaranteeing patients' rights is only the first step in ensuring the quality of our health care.

As the poet said, we still have miles to go before we sleep.

Because for all the strengths in our health care system, there are still too many errors committed in the health care system.

A landmark study by Harvard's own Dr. Lucian Leape found that an average of one million patients are injured in hospitals every year due to avoidable errors-and an estimated 180,000 die as a result.

There also is a great deal of over- and under-utilization of health care services.

For example, one in five hysterectomies may be inappropriate.

While an estimated 18,000 Americans die annually because they don't receive beta blockers after their first heart attack.

Finally, as documented by Dartmouth's Dr. John Wennberg, there is tremendous variation in national, regional and local health care services offered in this country.

But let me emphasize that all three of these problems are systemic.

They are not caused by inept practitioners or evil managers or any other individuals.

And quality problems certainly don't arise out of the movement toward managed care.

In fact, by collecting and analyzing data on the health of the population they serve, managed care has helped to move quality measurement forward by quantum leaps.

Let me be perfectly clear here-I was actually in a managed care plan more than 25 years ago, long before most people ever even heard of the concept.

And I believe that, when done right, managed care can provide a seamless system of care from prevention to primary care to patient management.

But-like every aspect of our health care system-we must protect what works in managed care, while addressing the problems that, quite frankly, worry too many consumers.

So our Commission also developed a blueprint to improve health care quality across America, and to specifically address the problems we identified.

One, to reduce the underlying causes of illness, injury, and disability.

Two, to expand research on new treatments and their effectiveness.

Three, to ensure the appropriate use of health care services.

Four, to reduce health care errors.

Five, to address oversupply and undersupply of health care resources.

And six, to increase patients' participation in their own care.

We also called for development of uniform national measurement standards so that health care plans can compete on quality-not just on cost.

But, of course, this isn't a job for government alone.

We certainly need the health care community to work with us to improve medical outcomes-and we're going to help you do this.

The President has called for the largest budget increase in history for scientific and medical research.

This "Research Fund for America" will provide new funds to measure and improve health care quality.

And today, I would like to announce that our Agency for Health Care Policy and Research is awarding eight quality grants totaling seven million dollars over five years.

These grants will help us begin to find new ways to measure and compare the quality of care, and they focus on a range of areas from nursing home care, to stroke prevention, hip replacement, hysterectomies, and jaundice in newborns.

But of course, information about quality is not enough.

Quality health care ultimately depends on watchful eyes, loving hands, nerves of steel -- and of course, hearts of gold.

In other words, quality depends on you-the health care professionals who have played the leading role in ensuring quality since the days of Florence Nightingale.

We need nurses and other health professionals to take the lead in helping us not only measure the quality of care-but also to help us improve the quality of care.

We need your spirit of the Nightingale Pledge ... your intellect and imagination ... your compassion and commitment ... your experience and ethics.

I challenge you to harness the winds of change in health care, so that you'll be able to give your patients the best care modern medicine can provide.

I challenge you to fight any attempts to sacrifice the art of medicine to the business of medicine.

I challenge you to never allow the sacred duty of putting the patient first to be swept out of the halls of medicine.

And I challenge you to continue to bring not only your knowledge, but your character and your humanity, to medicine.

I've no doubt that you can do it...that you must do it...that you will do it.

And by doing so, you'll help ensure that the tradition of compassion is never lost to the technology of change...you'll help ensure that a patient's primary "life line" remains as close as his nurse's call button...and you'll help ensure that our health care system remains the best in the world for every American...every day...everywhere.

Congratulations on your 20th anniversary, and thank you.