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 Home > News & Policies > June 2001
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For Immediate Release
Office of the Press Secretary
June 27, 2001

Press Gaggle
Ari Fleischer
Office of the Press Secretary

10:09 A.M. EDT

     MR.  FLEISCHER:   Good  morning.  The President had his usual round of intelligence  briefings  this  morning.  He had other briefings on domestic and economic policy matters, which I want to talk about in just a second.

     The  President  at 2:45 p.m. today will host a meeting with a group of moderate  House  Republicans  to  talk about patients' bill of rights.  The President continues to work closely with the Senate and the House trying to secure  an  agreement  so  that the bill that Congress passes can indeed be signed into law, and so that patients can get the protections they deserve. We will provide you a list of who is coming as soon as we get a little more finality  to  it.   But by and large, it's going to be a group of moderates from the House who are very committed to getting something done.

     Q    Is the Speaker among them?

     MR. FLEISCHER:  No, the Speaker will not be one of the atteendees.

     Q    About how many, Ari?

     MR.  FLEISCHER:   About 16.  And the reason I want to wait on the list is  because  it always depends on congressional schedules.  I don't want to indicate  somebody's  coming  until  they're  definite  and confirmed.  But moderates --

     Q    What do you mean --

     MR.  FLEISCHER:   Moderates?   A  lot  of people who are supportive of Norwood-Dingell,  who  are  supportive  of  the  Hastert-Fletcher approach, people who want to work for compromise to get things done.

     Q    Will Norwood be there?

     MR. FLEISCHER:  Again, I want to take a look at the list and get it to you in final form.

     Q    Was he invited?

     MR. FLEISCHER:  I'm going to get you the list in final form.

     Q    You say people who are supportive of both bills?

     MR.  FLEISCHER:  Hang on.  I have a ritual here.  I have to finish the schedule.   And then the President will depart this evening at 6:00 p.m. or 6:10  p.m.  depart  for  the  President's  Dinner at the Convention Center. Shoot, I heard it was black tie and boots.  I forgot my boots.

     Also the President spoke to Leader Daschle this morning, called him to thank him for agreeing to schedule the defense supplemental bill this week. As  you  know, that's something that I discussed in here yesterday, and the President  is pleased because this is necessary to get the funding done and agreed  to,  so  it can be signed into law, so it makes a difference to the men and women of the military, so that the benefits of the supplemental can be received this fiscal year.

     Finally, the President is disappointed in the action that was taken in the House yesterday concerning Mexico and trucking.  The President believes that  we  can  have safe transportation of Mexican trucks within the United States, in accordance with the NAFTA agreement.  He thinks the action taken yesterday  was  wrong,  and  he  looks  forward  to working with members of Congress in the conference committee to reverse that action.

     Q    Will he veto, in case of passage?

     MR. FLEISCHER:  There is no discussion of that.  This is one amendment to a larger appropriation bill.  The President thinks the action was wrong, and he's going to work to reverse it.

     Q     Would he be amenable to tougher requirements for Mexican trucks, as has been talked about --

     MR. FLEISCHER:  Well, the Department of Transportation has announced a series  of  steps  to  ensure  that  the  transportation issues are handled safely.  And he's confident that we can have Mexican trucking in the United States in a safe manner.

     Q    Ari, should the transportation bill come down with that amendment attached to it, will he veto the overall bill?

     MR.  FLEISCHER:   Why don't you ask me after the conference. Let's see what the results are.

     Q    Has this come up with the Teamsters?

     MR. FLEISCHER:  That's the -- that's been the longstanding view of the President.   The  President  articulated  that position in the campaign, he articulated  it  earlier  this  year, when the Department of Transportation announced  their  regulations,  and  he  was disappointed in the action the House took.  So the President's view on this has been long known.

     Q    What effects would not having it --

     MR. FLEISCHER:  It's also inconsistent with NAFTA.

     Q     What  effect would not having it have on NAFTA, or have on trade relations with Mexico?

     MR. FLEISCHER:  Would not having it?

     Q    Of not allowing the trucks in.

     MR. FLEISCHER:  You mean if the House action prevails?

     Q    Yes.

     MR. FLEISCHER:  That it's inconsistent with NAFTA.

     Q     But  what effect will this have with trade -- on trade relations with Mexico?

     MR.  FLEISCHER:   Well,  anything that's inconsistent with NAFTA would present a trade problem with Mexico.

     Q     Would  the Mexicans have some recourse in terms of being able to impose sanctions?

     MR. FLEISCHER:  You'd have to go to the USTR for any of those specific legal  remedies.   But  the  President  thinks that should be averted.  The President  thinks  that  we  can  welcome  our  neighbors  to the south, in accordance with our agreements, and that it can be done in a manner that is -- protects the travelers within our country.

     Q    Are you confident you can overturn this move by the House?

     MR.  FLEISCHER:   Well, the President's going to work -- the President is  going  to work hard to do so.  He thinks that this is a matter of right or wrong, and this action was wrong.      Q    Will he be calling Fox, the President that is?

     MR. FLEISCHER:  No.  Go ahead.

     Q     --  appropriations bill.  There are over 1,000 earmarks in there for  highways,  aviation  and  transit,  and  they've  earmarked all of the discretionary  money  that DOT would have had to use for airport congestion around  the  country.   And I'm just wondering if the administration really cares about that?

     MR.  FLEISCHER:   Yes, there's a SEP that has been circulated on that. I'd refer you to the SEP.

     Q    Ari, the meeting this afternoon, is this an acknowledgment by the White  House that if you really do want to compromise, both sides are going to have to move toward the center?

     MR.  FLEISCHER:   There's  no question about it.  When it comes to the patients'  bill  of  rights, you have some who want to turn our health care system into a system in which people have less coverage, and attorneys have more fees.  You have some who don't want a patients' bill of rights at all. And  you  have  the President who is in the middle, who is trying to bridge that  gap,  who is trying to make people come together, so a compromise can be achieved.

     If you look at the patients' bill of rights, there are two sections to it.   One  deals  with  real  people  patients'  protections.   There is no question  in  anybody's  mind  -- in most people's minds, that those can be signed  into  law.   There  are  some  Republicans  who  oppose those.  The President differs with those Republicans.

     There's  another  section  of  the bill that deals with liability, and you'll  see  a  series  of  amendments  in  the Senate now on the liability questions,  that can address the concerns that the President has.  If those concerns  can  be  addressed,  than  the  meat of the bill, which is giving patients  protections  in  their dealings with HMOs, can and will be signed into law.

     And  that's the good news that the Congress should concentrate on, and that's the message that the President is going to give to the House members who  come  up here today, that there is so much that they agree on, why let these  provisions  dealing  with  legal liability go too far, and therefore derail  the  chances of an agreement and the chances of compromise?  And be very  careful, the President will say, because you risk letting -- throwing people  off  of  their  insurance  if you go too far on the legal liability side.

     And there's an area in the middle, and the President occupies it.  And his  goal  is  to  bring  people together.  And Senator Breaux is a part of this,  and  several  others,  so  that  the  bill  can get signed into law. Congress  has a golden opportunity, if they would only compromise.  And the President hopes Congress will not loose that opportunity.

     Q    Part of what you're suggesting would seem to indicate a lessening or  a  reduction  of the possible penalties for HMOs that don't treat their people  right.   If  you  back-peddle  it  that  much, aren't you in effect eliminating  the possibility of penalties, and giving the HMOs no incentive to take care of their people decently?

     MR.  FLEISCHER:  The current bill penalizes people who have insurance, particularly companies where they will loose their insurance if lawyers can collect  $5  million  fees  by  suing indiscriminately and in a manner that subverts the real meaning of patient protections into lawyer protections.

     Q    Five million dollar fees, or --

     MR. FLEISCHER:  Five million dollar cap.

     Q     What about the incentives for HMOs to take care -- to give their customers  the medical care that they're entitled to?  What's the incentive for an HMO if there's no penalty?

     MR.  FLEISCHER:   The  penalty doesn't go against the HMO.  It's a fee and it's a reward that goes to lawyers.  That's the whole part of the bill. HMOs  under  the  bill  are  required to cover, in certain instances -- for example, if you wanted to go a -- if you needed to go to an emergency room, under  the  bill  that  the  President supports, and under all legislation, there's  universal agreement that you should not have to automatically call an 800 number before going to an emergency room.

     What's holding that up from becoming law?  These legal provisions that don't  have  to  do  with patients, they have more to do with lawyers.  Why shouldn't  that  become  law?  Now that's what you're talking about.  Those are the protections for patients.

     Q    There are lots of laws that make --

     MR. FLEISCHER:  The President is calling for a lower cap.      Q    In punitive?

     MR. FLEISCHER:  Non-economic damages.

     Q     No, but punitive is different, and you know that.  And your bill doesn't  want  any punitive.  What about lower than $5 million?  Is there a compromise   there,  something  between,  say,  500,000  which  I  know  is non-economic.  But would the White House accept punitive damages in a final bill if it were lower than $5 million?

     MR.  FLEISCHER:   The  White House -- the President wants to work with members of Congress to set that at the appropriate level.

     Q     Well,  Ari, you're saying that the President's in the middle.  I mean, what do you mean by that?  Does that mean that he would go beyond the caps that on the --

     MR. FLEISCHER:  Just like I said, there are some people who don't want a  patients' bill of rights at all, and have worked for years to defeat it.

     Q    Republicans -- would it have to be Republicans --

     MR.  FLEISCHER:   There  are others.  Yes, they're Republicans.  There are  others who are less interested in an agreement, and more interested in a  political veto strategy.  And it's an interesting test of the leadership in  the  Senate.  And the President hopes that the Senate and others in the Senate,  the rank and file members of the Senate, will be willing to find a way to get an agreement so that the bill can be signed into law.

     Q    -- the Daschle conversation?

     MR.  FLEISCHER:   No, the Daschle conversation really did focus on the defense stuff, and some other matters.

     Q    What other matters?

     MR. FLEISCHER:  We're going to leave it as a private conversation, but patients' bill of rights was not a prominent part of the call.

     Q    Ari, has there been a decision on the Yugoslav donors conference, if  the  U.S. will attend, and if there has been -- or when do we expect it to be announced?

     MR. FLEISCHER:  Mary Ellen, do you have anything on that?      MS. COUNTRYMAN:  I'm sorry, one more time?

     MR. FLEISCHER:  Yugoslav donors conference.

     MS.  COUNTRYMAN:   Oh, State Department may have some announcement for you today.

     Q    On patients' bill of rights, one more question.  Is the President showing  any more openness to the possibility of patients being able to sue in  state  court?  Is that something we're seeing a little more openness on the President's part now?

     MR. FLEISCHER:  The Fletcher-Hastert approach provides some measure of flexibility.   Appropriately  so,  when it comes to state court and federal court.   And,  as  I indicated yesterday, there are several provisions that honor the President's principles and there are several bills that honor the President's principles and that bill is one of them.

     Q    So you would identify the ability to sue in state court as one of those platforms on which the President was willing to compromise?

     MR.  FLEISCHER:  The President is willing to work with the Congress on these  liability  issues.  The question is, is the Congress willing to work with the President?

     Q     Ari,  that  provision  does  say  that  as  long as external and internal  full  process has been exhausted, then in certain instances, it's okay to go to the state court.

     MR.  FLEISCHER:   Well,  the  President  wants to avert -- and this is where this becomes either a lawyers' bill or a bill that can be signed into law -- is a situation in which the independent review organization does not really exist, that people go right from denial of care to court.

     And the problem with that is, if you go right from denial of care into court,  you  don't get your care.  No court settles matters that fast.  The first  thing  you have to do is hire a lawyer.  It takes months and months, if not years and years.  And that's not health care; that's lawyer care.

     But  if  you  have an independent review organization first set up, so that the system focuses on, after denial of care, an immediate system where you  don't  have to hire a lawyer but you have a prompt, independent review of  a  decision  made  by an HMO to deny care, and the people who make that review  are medical professionals, that's the best way to reverse the HMO's action  and  get people the health care they need.  Going right to court is the  wrong  solution  and  that's  the  problem  the President has with the lawyers' bill.

     Q     What  is  the  HMO's incentive to do what the -- what either the bill  says or what the independent review says, if there is no penalty that faces them --

     MR.  FLEISCHER:   The  penalty  would  be -- this is why the President differs  with  some  Republicans  -- the President does believe that people should  have  the  right  to  go  to  court  after  an  independent  review organization completes its review if the care, the order of the IRO, is not accepted  by the HMO, if they refuse to provide the service required.  Then the President believes that person should be entitled to go to court --

     Q    State court?

     MR.  FLEISCHER:   -- because, in this case the HMO did wrong.  Federal court.

     Q    The Fletcher one is for state.  The entire process --

     MR.  FLEISCHER:  As I indicated, the President -- the Fletcher-Hastert provision  is much more complicated than just state.  It is a state-federal approach, it's a combined approach, and it's very complicated.

     The  President  believes  the  federal court is the preferred approach because  the  provision  under  law  that  has  allowed insurers to provide insurance  to so many tens of millions of people through the private sector is  a  federal  statute, ERISA.  And by having a federal statute that gives employers  the tax advantages and the protections to offer insurance, which is what is an incentive that got people their insurance in the first place, to  subvert  that through a system of 50 different state suits will make it harder  for  employers  to offer insurance, not easier.  That's the core of the President's concern.

     But,   as   you  pointed  out,  there  is  flexibility  here,  as  the Hastert-Fletcher approach indicates.  Is there equal flexibility offered to the  President  in the Congress?  There are some people in the Congress who want  a  veto.   They  are  not  interested  in  a  solution.  They are not interested  in  getting  patient  protections.  They are more interested in politics than progress.

     And  if  the Congress puts progress before politics, this bill can get signed  into  law.  But if the Congress puts politics before progress, then patients will get denied their protections.

     Q     Ari,  isn't it true, though, that the reason you could sign onto Hastert-Fletcher is because it puts enough hurdles in the way that very few people will get into state court?

     MR.  FLEISCHER:  Actually, John, if you look at the states where there is independent review organization review and then a legal remedy, very few people  do go to court because the IRO works.  It should not be the purpose of  a  health  care  bill  to  put people into court.  Court takes forever. Court means you have to hire a lawyer, not a doctor.

     It  should not be the purpose of any health care legislation to set up a  shortcut  to  the courthouse.  A shortcut to the courthouse means people get  bogged  down  and mired in lengthy legal reviews where the first thing they have to do is hire a lawyer.

     Q     But  it has also historically provided the incentive for HMOs to cease  and  desist  from the kinds of practices that got them into court in the first place?

     MR.  FLEISCHER:   This is exactly why the preferred approach should be IRO.   And if the HMO does not honor the obligations imposed on them by the IRO, the person shall have the right to go to court.

     Q     There  are  a  couple  of cases in California where the level of damages  was  a  disincentive  for the HMO to continue along those lines of practices that it had engaged in previously.

     MR.  FLEISCHER:   And  there  are  millions of cases across the nation where  the costs of court have driven up premiums, have driven up insurance and  therefore make it harder for people to get insurance.  It's a question of  balance  and  the  President is seeking to strike that balance.  Is the Congress?

     Q     What's  to  say that the IROs aren't going to -- if this becomes law,  then  you'll  have  a  whole  lot  of  people doing these independent reviews,  and  that  will take up a lot, a lot, a lot of time, just like it would have in the court.

     MR.  FLEISCHER:  Nothing is like in the court.  Nothing is like hiring an attorney and having juries and judges.

     Q     Maybe this should be an opportunity for someone to discuss maybe fixing  the  court system, or some sort of balance in the court system that it takes forever --

     MR.  FLEISCHER:   We'll  be  happy  to  take  that  one up next.  Last question.

     Jacob had his hand up before.

     Q     Thank  you.   All I want to know is, do you say the President is going  to fight to try to reverse the vote in the House.  But that vote was massively  against,  two to one.  And I know the Senate hasn't taken up the vote yet.  But how can the President reverse such a large margin?

     MR. FLEISCHER:  Keep your eye on it.  The President believes in it and we  will  see what happens.  But you know where the President stands and we will have this conversation again in a matter of weeks.

     Q     Ari,  do you want to try the Middle East?  There is a perception today  that  Israel  and  the  U.S.  are a little further apart, are not as close,  after  the meeting between the President and Mr. Sharon than before that meeting.  What is the view of the White House?

     MR.  FLEISCHER:  Secretary Powell is in the region now.  There will be additional  conversations  had.  And the President remains committed to the Mitchell Committee report which has also been accepted by the parties.  And so, as always, the issues involving peace in the Middle East are not simple and the President is going to continue his efforts.

     Q     The  Mitchell  Report  --  for  instance,  doesn't speak about a pre-cooling off period, which Mr. Sharon insisted on yesterday.

     MR. FLEISCHER:  But it does talk about an unconditional cease-fire.

     Thank you very much, everybody.

                             END             10:29 A.M. EDT

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