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pd31mr97 Letter to Congressional Leaders on Cuba...

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best deal for our families. Whether they have traditional health care or 
managed care, none of our people should ever have inferior care.
    I am proud that the Medicare and Medicaid programs have taken the 
lead in responding to the quality concerns of both patients and health 
care providers, as Secretary Shalala has just described. But we're 
learning the defining, measuring, and enforcing quality is far from a 
simple task. There are many complicated issues. They require thoughtful 
study. And not surprisingly, there are many areas where broad-based 
consensus on how best to proceed does not yet exist.
    That is why I decided late last year to establish the Advisory 
Commission on Consumer Protection and Quality in the health care 
industry. Today I am happy to introduce the members of that Commission 
to the American people. They are a highly distinguished, broad-based, 
and diverse group. They represent consumers, business, labor, health 
care providers, insurers, managed care plans, State and local 
governments, health care quality experts. Their specialties are wide-
ranging, including care for children, the elderly, women, people with 
disabilities, mental illness, or AIDS. This Commission includes some of 
the best health care policy minds in our Nation and a lot of people with 
hands-on experience. Its task will be as challenging as it is critical.
    Today, to assure that they get busy right away, I am charging the 
Commission to develop a consumer bill of rights so that health care 
patients get the information and care they need when they need it. Let's 
assure that patients and their families: first, that the health care 
professionals who are treating them are free to provide the best medical 
advice available; second, that their providers are not subject to 
inappropriate financial incentives to limit care; third, that our 
sickest and most vulnerable patients, frequently the elderly and people 
with disabilities, are receiving the best medical care for their unique 
needs; fourth, that consumers have access to simple and fair procedures 
for resolving health care coverage disputes with plans; fifth, and 
perhaps most important, that consumers have basic information about 
their rights and responsibilities, about the plans--the benefits the 
plans offer, about how to access the health care they need, and about 
the quality of their providers and their health care plans.
    I'm delighted that the Secretary of Health and Human Services and 
the Secretary of Labor will take on the task of being the Commission's 
cochairs. I look forward to reviewing their first report at the end of 
the year and their final report next March.
    The need for this Commission is real. It is urgent. It will give us 
a roadmap to help us make our way through the time of rapid change we 
now see in our health care system. There are few people in the Nation 
better suited to the task than the members of this Commission. And 
again, let me say, I want to thank them for their commitment to serve. 
And to all the rest of you, let me say one of the things--one of the 
many things I have learned in the last 4 years as President, is that a 
distinguished commission, broadly based with a clear mandate, can make a 
profound positive difference for our country.
    In the health care related areas, I ask you to think of only two. 
Think of the work done by the Gulf War Commission and what we now know 
that we did not know when they started to meet and work. Think of the 
remarkable work done by the Commission that dealt with those who were 
exposed to human radiation experiments just a few decades ago here and 
the work that they have done.
    There is a peculiar way in which the citizens of the United States, 
when brought together around a clear mandate interfacing with their 
Government and with the private sector, can do more than either the 
Government or the private sector could do alone.
    And so again, let me say, I'm very hopeful about this Commission. I 
look forward to their progress on the consumer's bill of rights. I look 
forward to all the work that they do. And I ask you to join me in 
thanking them for their willingness to serve.
    Thank you very much.

Note: The President spoke at 2:32 p.m. in the East Room at the White 
House. In his remarks, he referred to Cynthia Metzler, Acting Secretary 
of Labor.

[[Page 417]]

[Weekly Compilation of Presidential Documents]

[Page 417-420]
Monday, March 31, 1997
Volume 33--Number 13
Pages 399-427
Week Ending Friday, March 28, 1997
Remarks on the National Cancer Institute's Recommendations on 
Mammography and an Exchange With Reporters

March 27, 1997

    The President. Secretary Shalala has just briefed me on the National 
Cancer Institute's new recommendations on mammography. These 
recommendations, based on the latest and best medical evidence, give 
clear, consistent guidance to women in our national fight against breast 
cancer. Breast cancer is the most commonly diagnosed cancer among women. 
It affects one in eight women in their lifetimes, and has touched the 
families of nearly every American, including my own.
    We may not yet have a cure for breast cancer, but we do know that 
early detection and early treatment are our most potent weapons against 
this dread disease and we know that mammography can save lives. That is 
why it's important to send a clear, consistent message to women and to 
their families about when to start getting mammograms and how often to 
repeat them.
    After careful study of the science, the National Cancer Advisory 
Board has now concluded that women between the ages of 40 and 49 should 
get a mammography examination for breast cancer every 1 or 2 years, in 
consultation with their doctors. The National Cancer Institute has now 
accepted these recommendations. Now women in their forties will have 
clear guidance based on the best science, and action to match it.
    Today I am taking action to bring Medicare, Medicaid, and the 
Federal employee health plans in line with the National Cancer 
Institute's recommendations. First, in the Medicare budget I am sending 
to Congress today I am making annual screening mammography exams, 
beginning at age 40, a covered expense without co-insurance or 
deductibles. Second, Secretary Shalala is sending a letter to State 
Medicaid directors urging them to also cover annual mammograms beginning 
at 40 and assuring them that the Federal Government will pay its 
matching share if they do so. And today I am directing the Office of 
Personnel Management to require all Federal health benefit plans to 
comply with the National Cancer Advisory Board's recommendations on 
mammogram screenings, beginning next year.
    The Federal Government is doing its part to make sure women have 
both coverage and access to this potentially lifesaving test. I want to 
challenge private health insurance plans to do the same. They, too, 
should cover regular screening mammograms for women 40 and over.
    Finally, we know there has been much discussion on this issue and a 
lot of confusion. That is why we are launching a major public education 
campaign to make sure every woman and every health care professional in 
America, that all of them are aware of these new recommendations. This 
is a major step forward in our fight against breast cancer.
    In addition to Secretary Shalala, I want to thank National Cancer 
Advisory Board Chairperson, Dr. Barbara Rimer, and all the members of 
the Board, along with the NCI Director, Dr. Richard Klausner, for the 
fine job that they did in producing these recommendations.
    I also want to thank the First Lady, who could not be with us here 
because of her visit to Africa. She has devoted countless hours to 
educating women about the importance of mammography, and this is a happy 
day for her. She has especially tried to educate older women to take 
advantage of the Medicare coverage of mammograms, because we know that 
too few of them still do. And that's the last point I would like to 
make. These guidelines and this coverage, it's all very good, but unless 
women are willing to actually take advantage of the coverage, we won't 
have the full benefit of the recommendations and the findings that have 
been made.
    Now I'd like to turn the microphone over to Secretary Shalala to 
make a few comments.

[At this point, Health and Human Services Secretary Donna Shalala made 
brief remarks.]

Heaven's Gate Mass Suicide

    Q. Mr. President, do you have any comment on the mass suicide in 
    The President. Well, of course, all I know is what I read about it 
this morning and what I saw last night reported. But it's heart

[[Page 418]]

breaking; it's sickening; it's shocking. I think it's important that we 
get as many facts as we can about this and try to determine what, in 
fact, motivated those people and what all of us can do to make sure that 
there aren't other people thinking in that same way out there in our 
country, that aren't so isolated that they can create a world for 
themselves that may justify that kind of thing. It's very troubling to 
me. But I don't think I know enough to make a definitive comment about 

Democratic Party Finances

    Q. Mr. President, switching gears on another subject, the Democratic 
Party emerged from this most recent election in the aftermath of all of 
these fundraising problems--it seems to be in pretty bad shape 
financially--enormous debt that they can't repay. What, if anything, can 
you do about this, and how much responsibility do you have to try to get 
the Democratic Party back into shape?
    The President. Oh, a lot, and I have been doing a lot, and I will do 
more. We knew that we would have to spend--last year when it became 
obvious that our congressional candidates were going to be outspent, 
massively, we did everything we could to raise a good deal of money at 
the end. But the committees and the Democratic Committee went into debt 
with money that they could legally borrow in the hope of trying to be 
competitive. They actually did a pretty good job. They were still 
outspent, I figure, in the last 10 days, 2 weeks, probably 4 or 5 to 1 
in all of the contested races. But we knew that would happen, and we 
knew it would take some time to pay it back. But I'm not particularly 
concerned about it. I think we will pay it back. And it was, I thought, 
    Keep in mind, we were at the bottom of the barrel in November of 
'94, and in 1995, we did a good job, I think, of building our party back 
and showing what the clear differences were between the two parties. And 
the previous leadership of the party deserves a lot of credit. We got up 
to a million small donors, and they're coming back now. They're 
beginning to make their contributions, and that's very encouraging. So I 
think we'll get there. I'm not particularly concerned about it.
    We made a deliberate decision to kind of downplay the Inaugural and 
not to try to tie too much of that to fundraising, so we're going to 
have to work harder this year. But I've been doing some work, as you 
know, and I will continue to do more.
    Q. Do you think Governor Romer has second thoughts about some of the 
changes that previously eliminating contributions from subsidiaries of 
foreign companies and also non-U.S. citizens? He seems to be having some 
second thoughts about some of those proposals you made over the past few 
    The President. Well, let me say, I still don't believe--I think, on 
balance, it's better policy to say that people who can't vote shouldn't 
contribute. In terms of the subsidiaries, the real problem there is the 
law says if the money is made in the United States, it can be given in 
the United States. The problem is, how do you ever know that? And so I 
think that he was trying to bend over backwards to get us off on the 
right foot.
    But I'd be willing to talk to him about it. But the main thing is 
we're just going to have to get together and work hard and rally our 
troops and remind them of what we're trying to do here, how we're trying 
to balance the budget, what we're trying to do for education, what we're 
trying to do to move the country forward and get the efforts going. 
We've had several successful events this year. We just have to do more. 
And we knew--what you have to do after an election, when we saw all this 
third party money and all these other things coming down the pike, we 
wanted to give our Members of Congress a chance to be competitive, and 
so we undertook to do so. And I'm glad we did, but we're just going to 
have to work double hard now to pay the money back, and we'll do that. 
We'll pay our debts, and we'll make our budget this year.

Ambassador Ross and Vice President Gore

    Q. Have you received any updates from Ambassador Ross or the Vice 
    The President. Yes.
    Q. And what have they been?
    The President. Well, Ambassador Ross had a very good meeting with 

[[Page 419]]

Arafat, and he's proceeding now on his trip. And I don't have anything 
else to tell you, but he was encouraged by the response of Chairman 
Arafat to the matters that we discussed here before he left.
    I started the day this morning with physical therapy and a talk with 
the Vice President in China, which was also good therapy. [Laughter] And 
he said to me that in every aspect, his trip had gone quite well and 
better than he had anticipated, and he was anxious to get back and give 
me a report on all the issues that we're concerned about. But I think 
the trip has been a real validation for our strategy of engagement with 
China, of taking our agreements, our disagreements, our matters of 
common interest, our matters of concern directly to them. And he is very 
pleased with the results so far, and I certainly am very pleased with 
the work he's done, with the speech he gave on human rights and with all 
the work that he's done in China so far. I'm encouraged about it. I 
think the trip has been well worth making.

FBI and Alleged Chinese Efforts To Influence the 1996 Election

    Q. Have you seen that Janet Reno gave Louis Freeh a ringing 
endorsement this morning--every confidence in his leadership at the FBI?
    The President. Well, as I said--of course, she works with him every 
day, and that's why I said yesterday what I did. I was troubled by the 
headline in the New York Times story, but I did not know the facts. And 
I think it's important for me not to assume that someone has done or 
failed to do something that's adverse to the national interest before I 
know it's true. And she's the one that has to make those calls. And as 
she said in her comments, the system that we have--the President 
appoints the Director of the FBI, but the FBI is a part of the Justice 
Department. It's a part of the justice system. And whenever you have 
dual responsibilities in the Government, you're going to have some time 
when you've got to make a close call.
    And I still don't know--as I said, I just literally don't know--I 
could actually tell you whether I agreed or disagreed, if I knew what--
if and what information had not been forthcoming to the National 
Security Council. I do believe that there should be a--that doubt should 
be resolved in favor of disclosure to the National Security Council of 
essential national security information. But the Attorney General has to 
resolve those things. And I trust her to do it. And so, what she said is 
fine by me.
    Q. Is there a problem if the President of the United States--a lot 
of Americans simply don't understand--the President of the United States 
says, ``I don't know that there's a problem because I haven't 
necessarily been given''----
    The President. Well, I think there is. Yes, I think there is. If I 
knew that one existed, I would agree that there was a problem. But I 
don't know it. And I'm still not sure that there was. I just have to--I 
have to trust the Attorney General to make sure that the National 
Security Council gets the information that we need to make good national 
security judgments here. I think, for example, in the Khobar Towers 
incident, there is absolutely not a shred of evidence that there's 
anything that we have been denied. And so, if I knew that there was and 
I knew what it was and I thought there was a mistake, I'd be happy to 
say that there's an honest disagreement here, but I just don't know that 
there is one.

Ambassadorial Nominations

    Q. Has your administration been hamstrung in terms of ambassadorial 
appointments, appointments at the State Department and so forth because 
of all of these investigations on the campaign?
    The President. No, not at all. As a matter of fact, we've been 
working on getting ready for the next round of ambassadorial 
appointments. I approved a small number of them, oh, probably a couple 

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