NATIONAL PERFORMANCE REVIEW
Reinventing Government Event withHealth Care Financing Administration
Old Executive Office Building
Washington, D.C. July 11, 1995
VICE PRESIDENT GORE: Thank you very much.
Thank you very much. Thank you very much, Steve, and ladies and gentlemen, thank you.
I would like to say to the First Lady a word of thanks for the partnership we have enjoyed and the work that leads up to today's announcement. I want to thank Donna Shalala for doing such an outstanding job on so many things -- and we recently
returned from Moscow, where we were working on the binational commission there. To Bruce Vladock and his staff, many of whom are represented here today, my thanks for the very hard work that went into this. To the members of the National Policy Council, thank you very much for the recommendations, the hard work, the good ideas, the
encouragement, and the enthusiasm that make today possible.
I want to also thank Dr. Steve Gleason. He and I go back aways. He was a member of an elite group of Iowa Gore supporters in 1988.
VICE PRESIDENT GORE: And -- it's no secret I ran for President in 1988, although it seemed like one at the time.
VICE PRESIDENT GORE: I learned a lot. It was a character building experience.
VICE PRESIDENT GORE: I learned a lot of new jokes.
VICE PRESIDENT GORE: If you use a strobe light, it looks like Al Gore is, moving.
VICE PRESIDENT GORE: Al Gore is so boring, his Secret Service code name is "Al Gore."
VICE PRESIDENT GORE: It's all right. I, I'm used to it by now.
VICE PRESIDENT GORE: I've heard most of them. Every time I hear a new one, I always have the same reaction, though. "Very funny, Tipper."
VICE PRESIDENT GORE: In any event, Steve Gleason was part of that hardy band, and really deserves a lot of credit for my whole campaign strategy in 1988.
VICE PRESIDENT GORE: I want to thank the members of the National Performance Review staff, our Reinventing Government Operation who are here,
and the First Lady's team, which has worked so hard, who have worked so hard on this. And I'd also like to acknowledge one other person who is present, one among you, a doctor who is very close to me and my family, and when I was growing up, he took care of me and my sister, and he used to give me a choice when I came in, three, four, five years old. He said, "I have two kinds of shots here. You can have the kind that hurts or the kind that doesn't hurt."
Which did I choose?
VICE PRESIDENT GORE: I always wondered what the kind that hurt really did feel like --
VICE PRESIDENT GORE: -- if the kind that didn't hurt felt like that. But --
VICE PRESIDENT GORE: When my mother suffered a heart attack last week, he was there, very quickly at the hospital near our home town to help save her life, and she went down to the -- to Nashville to the Vanderbilt Hospital for a series of tests at his direction, and he's a very person to our family, and I want to acknowledge Dr. Gordon Petty, who is here. So -- stand up, Gordon. I want you to --
VICE PRESIDENT GORE: Thank you.
He -- we flew in this morning about, between 1:00 and 2:00 a.m. I have spent the last six days in Vanderbilt Hospital with my mother, and I appreciate your kind words, Mrs. Clinton, and I want you all to know that the President came by my mother's hospital room yesterday morning when he came down for a conference in Nashville, and on strict instructions from the First Lady he worked into the hospital carrying a container of my mother's favorite soup that she had had at the First Lady's luncheon a few weeks back, and she's been bragging on it since then, and the First Lady found out about that, and said, "You have to take that soup," and he did, and it was great.
VICE PRESIDENT GORE: And she's -- she's been enjoying that. And, incidentally, when I told her after the President called and said he was coming to visit, I told her he was coming, and the first thing she said was, "Well, now, son, will he have had breakfast before he gets here?"
VICE PRESIDENT GORE: And she started looking around the hospital room to what -- where she could fix -- annd she had some sliced peaches waiting for him. They swapped soup for peaches.
I want to -- I want to thank the First Lady also for the heroic work that identified so many of the problems that we are beginning to address with the announcement today. I read an interesting magazine article, incidentally, a couple of weeks ago in the New Republic, a magazine that received an award, partly based on a huge article lambasting the President's health care plan that Mrs. Clinton presided over.
And in reviewing the award, the magazine went back and looked at the article that had earned the award, and in a rather remarkable mea culpa, devoted a great deal of space to admitting that most all of the criticisms and charges in the original article were wrong. And that there had been a lot of misunderstandings, and so forth.
Anyway, the more people look at a great deal of the work that was done by many of you, and others who helped the First Lady in analyzing the problems facing our health care system, the more they say, "Hey. This really needs attention." And what our Reinventing Government Task Force did in this area was to look at a lot of the problems they had identified, look at a lot of the solutions they had suggested. We talked with many of you, and this is one in a series of results that come as a -- as a consequence.
You know, the description of -- your description, Steve, of the attestation form reminds me of the Henny Youngman joke, about the man who goes to his doctor, and he says, "Doc, it hurts when I do this." And the doctor says, "Don't do that."
VICE PRESIDENT GORE: Well, that's common sense at work, and --
VICE PRESIDENT GORE: So when you tell me that signing the physician attestation wastes time and money and makes you mad, my response is, "Don't do that."
VICE PRESIDENT GORE: That's the common sense cure. Don't sign it any more. We are officially cancelling the regulation that requires these forms. You don't have to fill them out any more. It's gone. It's history.
Last year, HCFA cancelled the regulation, saying that doctors had to sign a similarly
irritating form every year. It acknowledged the penalties for cheating on Medicare, and now it is time to get rid of the so-called attestation form for each Medicare patient who is
discharged from a hospital. So we're, we're doing that.
The doctor is supposed to certify that one of his diagnoses or charges are fraudulent before the hospital can send in the claim. Now, is that crazy, or what? Do we really think that if -- for purposes of argument --
VICE PRESIDENT GORE: -- if, if -- if the doctor were a crook, do we really think that he would, having been confronted by that intimidating physician attestation form --- an, the very name makes a charlatan shudder.
VICE PRESIDENT GORE: Do we really think that this doctor would suddenly have a change of heart and say, "Aha. I'm going to come clean now. It's all over. It's all over."
VICE PRESIDENT GORE: And more to the point, is it really the official opinion of the U.S. government that the vast majority of doctors and hospitals in this country are crooks? Well, I know a lot of doctors, and my view of doctors is shaped by my experience with Gordon Petty, as Americans know their own doctors.
My family has trusted him with our lives, most recently in the past week.
And so when I talk to Gordon Petty about unnecessary paperwork, I think of the amount of paperwork that has to be done in connection with cases like my mother's case. Doctors ought to be able to spend more time with the patients and less time with the paperwork.
So we're relegating the physician attestation form to the trash heap of yesterday's
government. From now on, we will start with trust, instead of mistrust. We'll start from the assumption that the vast majority of America's doctors and hospitals are honest people, and reputable institutions, not dens of thieves.
And, by the way, each year, America's doctors have had to sign eleven million of those forms, and even if each one only took one minute to look over and sign, that would still add up to 200,000 hours of doctor time that can now be devoted to patients instead of paperwork. And of course, much more than one minute is involved when you count all of the people that have to be involved in the process.
Hospitals will save time and money, too. They used to have messengers driving around town with the forms, tracking down signatures. One hospital I heard about held an occasional physician amnesty day --
VICE PRESIDENT GORE: And enticed the doctors with free brownies to come in and sign the forms. And I -- I'm sorry if our common sense regulatory reform is messing up a good thing there. I don't know.
VICE PRESIDENT GORE: A few weeks ago, President Clinton announced the progress that we have made with regulatory reform. When he informed the Congress and the country that sixteen thousand pages of federal regulations are being eliminated outright, and another 31,000 pages are being dramatically changed and infused with a new
spirit of partnership and common sense.
That kind of regulatory reform is the right way to change government, and not the wrong way. Public opinion poll after public opinion poll shows that most Americans do want less government interference, a smaller government, yes.
And we're making it less intrusive, and smaller. In fact, because of President Clinton's initiatives, by the end of next year, we will have a smaller bureaucracy in the federal government than at any time since President John Kennedy's administration. We're downsizing by more than ever in history.
But it's equally true that most governments do -- most Americans do not want to give up completely on government. There is a difference between getting rid of it and fixing it. It's a little like the difference illustrated in the story that Lloyd Benson used to tell about the veterinarian and the taxidermist who went into business together and put a sign outside the establishment that said, "Either way, you get your dog back." There is a difference. We want to fix it, and not stuff it as a trophy.
Most Americans believe, as President Clinton and we believe, that government is the way a free people work together to solve the biggest national problems that cannot be solved by individuals working alone. But if government does not work well, if it never seems to solve the problems that it sets out to solve -- problems like crime or poverty, disease or ignorance, threats to our security, our economy, our environment -- then Americans loose faith in government. And when we do that, we're losing confidence in our own ability to work together as a free, self-governing people.
And that is the crisis of confidence we face today. Thirty years ago, when Americans were asked by pollsters if government could be trusted to do the right thing most of the time, 75 percent answered yes. Today, less than 20 percent answer yes to that same question. And the change from 75 to 20 has been among Democrats
and Republicans, conservatives and liberals, members of every ethnic, racial, religious
group, and every age group. It's across the board.
So we have to restore America's faith in self-government, our faith in our own ability to solve national problems. That's why we have to make government work better, and cost less. That's why President Clinton has insisted on the work of reinventing government.
And, of course, listening to the First Lady and Dr. Gleason describe this particular problem rings a lot of bells with me, because two years ago when President Clinton asked me to undertake the challenge of reinventing government, we heard similar problems identified in many areas of government activity. Lots of attention to red tape, but little interest in results. Lots of mistrust and confrontation, but very little partnership and
teamwork. Long on rules, but short on common sense.
And just as the First Lady learned about the real problems and how to fix them, from
physicians like Dr. Gleason and his colleagues who are kind enough to join us here today, our reinventing government team has also found that the best ideas about how to make government work better land cost less come from the people on the front lines who do the real work day in and day out. We've listened to them carefully about reinventing
the rest of government, and we are listening to you doctors and other medical professionals about how to fix government's role in health care.
The parallels are really striking. Take on the job worker's safety, for example. Government regulation has helped to make the work place safer, but our new approach is making big improvements for workers, with fewer costly hassles for business
owners. It's based on partnership among labor, management, and government, with the common goal of healthy workers in a growing economy.
And the new focus is on results. How do you reduce the number of accidents on the job? The focus shouldn't be on how many fines are levied, how many penalties are assessed. That's the wrong measure.
And the same kind of results-oriented partnership needs to be used in every aspect of the government. President Clinton, the First Lady, and the entire Administration are making that kind of change in the area of health care, because we agree with you, that government should be in your corner, and not in your face.
We don't, however, agree with the majority of Congress that the only solution is a meat axe. In short, we don't need what the butcher ordered; we need what the doctor ordered.
And so here are some of the new ideas that we're putting into practice at the Health Care Financing Administration. HCFA is spending less time writing rules and more time listening to its customers, and understanding their problems; reaching agrement on common goals. In other words, their new method is, "Communicate, don't dictate."
HCFA is going to stop mailing its customers reams and reams of bewildering data. If you're ever been on the receiving end of Medicare or Medicaid, you know what I mean. And instead, HCFA will make sure that people get only the information
that they need, and that they get it in a way that ordinary human beings can understand. In other words, they will attempt to educate, not inundate.
And instead of just regulating, HCFA is going to innovate. And by that, I mean that
government is going to focus more on getting better and better results, which come from innovation. We will stimulate innovation, and we will reward innovation. We'll be paying less and less attention to making sure that processes conform with the
regulations, because we believe that results are more important than red tape.
We've already told you that the physician attestation form is history. Here are some other examples of the changes HCFA is making.
HCFA will be changing the way they make sure that laboratory tests are accurate. For example, instead of scheduling regular, on-site inspections, we will turn attention away from the labs with consistent, solid track records of high quality and concentrate more instead on the labs that need improvement. That's a common sense change.
Also, we will stop wasting money regulating lab tests that are done by machines that we know have a consistent record of producing the same results over and over and over again, without mistakes. We will count on the time tested technology, unless there is some evidence of a problem. There's simply no need to fill out paperwork and undergo time-consuming procedures to check machine outcomes that are -- that never vary.
And HCFA has come up with better ways to insure that Medicare patients get top notch care, ways focused on results rather than red tape. Instead of holding frequent inspections to make sure that all the proper procedures are being followed, and all the paperwork is being filled out, and all the workers have the specified experience and
college degrees, we'll start checking to see how the patients are doing, whether the results are being reached, or not.
And we'll let everyone know which facilities produce excellent results. That way,
government can help consumers make informed choices.
For example, there are some procedures, like dialysis, where the results can be measured by products in the blood, by looking at the blood chemistry. That is a better measure of the results of how the institution, how the procedure is working, than whether or not all of the individuals attempting to produce that result have filled in every form and all of the paperwork that is -- that is required. Just go straight to the results.
Again, comparatively, we -- to use the example of job safety -- we found that we were measuring the number of fines, and we were getting a lot of fines. When we started finding ways to measure a reduction in the number of injuries on the job, the fines became irrelevant, in many cases, and they started focusing on the results.
We want health care professionals and individuals, when they have to be held accountable within government programs, to be held accountable for the results, not for the process, and the paperwork, and the bureaucracy, and the red tape.
For nursing homes that care for the mentally ill, we're cutting out the duplicate
requirements for initial and annual patient assessments. One regulation requires the
assessments if funding comes from Medicare or Medicaid. Another regulation requires states to do a second set of assessments, just because the patient is in a nursing home. We want states to spend their health care money on first-class care, not on federal second-guessing.
And to make life simpler for doctors and their administrative assistants, we will have all insurance companies that cover federal workers use the standard Medicare claim form. You don't -- you won't need to learn yet another different set of paperwork rules for each different company, and there may be 300 or more involved.
So these are some of the changes that we're making. But this is not the end of it. We will keep listening, and keep changing, keep learning, and keep restoring faith in government.
As the First Lady pointed out, when it comes to reinventing government, health care is no different from any other national problem. We need faith that we can solve our problems together working, where necessary, through self-government. And in order to regain that faith, we need to make government work better and cost less. That's what
President Clinton's team is all about: making government work better and cost less. That is, and always will be, the right way. Thank you for making it work. We appreciate it.
[End of proceedings as recorded.]