Remarks at the Children's National Medical Center - Pres William J. Clinton - September 17, 1993

Weekly Compilation of Presidential Documents, Sept 20, 1993 by Bill Clinton

Thank you. Well, Dr. Beard, I promise to free you of the paperwork if you will promise not to use your free time to run for President. [Laughter]

Mr. Brown and Ms. Freiberg, Dr. Beard, to all of you who helped to make our visit here so wonderful today, I want to thank this Children's Hospital for bringing us together this morning, for giving us a chance to see some of your patients and their parents and their friends and to witness the miracles you are working. I want to thank Ben Bradlee and Sally Quinn for calling Al and me and telling us to hustle more money for the hospital.

In my former life, when I was a Governor, my wife and I worked very hard for the Arkansas Children's Hospital. Some of you know it's one of the 10 biggest hospitals in the country, and every year we finished first or second in the telethon, even though we come from a small State. There's a lot of grassroots support for people who are doing what you're doing.

We built a tertiary care nursery at our hospital with State funds, the first time anything like that had been done. And I have spent countless hours in our Children's Hospital at home with my own daughter, with the children of my friends, sometimes their last day, sometimes their best day. And I am profoundly grateful to you.

I think the people in the press and maybe some others might have wondered today why in the wide world we would come to a children's hospital, with all of its gripping, wonderful, personal stories, to have an event about bureaucracy and paperwork. After you listen to a nurse say why she couldn't care for a sick child and a doctor plead for more time to be a doctor, maybe you know. There is an intensely human element behind the need to reform the system we have.

When we were upstairs and Dr. Grizzard and Ms. Mahan were showing us some forms, we looked at four case files that they said had 14,000 worth of work in them that were absolutely unrelated to the care of the patient. The doctor said he estimated that each doctor practicing in this hospital, 200 in total, spent enough time on paperwork unrelated to patient care every year to see another 500 patients for primary preventive - care times 200. You don't have to be a mathematical genius to figure out that's another 10,000 kids who could have been cared for, whose lives could be better.

People say to me, how in the world do you expect to finance universal coverage and cut Medicare and Medicaid? Let me say first of all, nobody's talking about cutting Medicare and Medicaid; we're talking about whether it doesn't need to increase at 16 percent or 12 percent or 15 percent a year anymore. And it wouldn't if we had some simplification so people could spend the time they have already got on this Earth doing what they were trained to do.

I've got a friend who is a doctor that I grew up with who happens to live in the area, who calls me about once every 3 months to tell me another horror story. And the other day, he called me and he said, "You had better hurry up and get this done." He said, "You know, I'm in practice with this other guy. We've got all of these people doing paperwork. Now we've hired somebody who doesn't even fill out any forms. She spends all day on the telephone beating up on the insurance companies to pay for the forms we've already sent in. We actually had to hire somebody to do nothing but call on the phone." He said, "I'm lost in a fun house here." [Laughter] He said, "I went to medical school to try to practice medicine. Now I've got to hire somebody who does nothing but call people on the phone to pay the bills they're supposed to pay, after I've spent all this time filling out these forms?"

People complain about doctor fees going up. I'll give you one interesting statistic. In 1980, the average physician in America took home 75 percent of the revenues that were generated in a clinic. By 1990, that number had dropped from $.75 on the dollar to $.52. Where did the rest of it go? Right there. Most of it went to forms.

Now you know, when we were up in that medical records room, we saw all these forms. We were told that by the time the room was done, the room was already too small because the paper kept coming faster than you could make space for it in this hospital. A lot of you are nodding about that. Now they have records flowing on into a room that is beneath us in the garage, and these files are still growing at the rate of 6.5 feet a week.

We know, of course, from what Dr. Beard and Ms. Freiberg said that that's just some of the story. There are departments in this hospital that spend all their time trying to satisfy hundreds of different insurers. There are 1,500 in America, by the way. No other country has that many. This hospital I think deals with over 300. Each of them want a slightly different piece of information and in slightly different way; so that even if you try to have a uniform form, it's not uniform by the time you finish customizing it.

How did this happen? Hospitals like this one treat people who are most vulnerable, weak, ailing, and in pain. To make sure that sick patients were getting the best care, Government regulators and private insurers created rules and regulations, and with them came forms to make sure you were following the rules and regulations. To make sure doctors and nurses then didn't see the patients that were getting the best care too often, keep them in the hospital too long, or charge them too much, there were more rules and regulations and along with them, more forms.