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President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry

Final Meeting
Thursday, March 12, 1998


(10:05 a.m.)

Secretary Shalala: Welcome to the tenth and final meeting of the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry. It's a pleasure to see all of the commissioners and members of our fan club here today. Let me say a couple of things.

First, it really is an exciting day, not only because we're going to finish, but because there's been an extraordinary year of very hard work. I've chaired a lot of commissions, I've worked with a lot of commissions, I don't think I've ever worked with a commission in which the members have worked harder or been more enthusiastic. I think the quality of the report that we're going to present to the President and to the Vice President is a reflection of that hard work and thoughtfulness.

I want to obviously thank Janet and the staff, and I'll have some things at the end of our meeting to say about the quality and the kind of vision and leadership that Janet and her colleagues have brought to this enterprise, and I'm sure all of you will. I'm going to leave time at the end of the meeting for all of us to make our final comments, and it will be a final going around the room so everyone can make final comments on the work of the commission.

Let me also thank the audience. I actually have recognized people. Many of you have in may ways been to as many meetings as the members of the commission have on assignment for your various organizations. And I think the fact that we have had so many observers here on a regular basis has actually made a difference in terms of the continuity of the kinds of advice that so many of the organizations have given us and individuals have given us on the commission's work.

Let me say that we're going to do a couple of things today. First, a final reading of the last chapter, which has been a chapter difficult to pull together.

Secretary Herman.

Secretary Herman: Good morning.

Secretary Shalala: But as a professor of public policy and since all of you are pros you know that each issue has its own timing. What we've been able to do, I think, is a giant step in moving the agenda on quality and consumer rights literally a giant step. Some of the issues we're ready to move right into legislation. Clearly the patient's rights, we're prepared, some of it, to move into legislation, some of it to move in regulation. It certainly lit a fire under the government's own programs.

On other issues we were able to provide detailed guidance to public policy makers, and in particular to the private sector in terms of the kinds of institutions that ought to be standing at the end of the day to provide leadership.

On some issues we were only able to outline what the terms of the debate ought to be, or even just raise the issue, and there should be no apologies for that. It's not unusual in public policy when you take on a major set of issues for some of them to be ready to move where there is consensus and even when it's hard consensus that we were able to put on. And others where we can simply raise the issues and wait for another day, although hopefully not too far along, where others can, and many people in this room will participate in those broader debates, can reach a consensus. So the fact that the final report has major issues at different stages of development is what I would describe as normal.

The important thing, as the true historians of these issues like Don Berwick will tell you, is we actually are moving a major area of public policy forward dramatically. We have gotten the attention of the policy makers, we have gotten the attention of the private sector, which is struggling to deal with many of these issues along with those of us that work on the government programs.

This is the first time we have convened all of the stakeholders in a civilized debate to see how far we can move the agenda together. And we have been sensitive to the needs of people in the health care system, some of whom have not been served well by the health care system, although not necessarily by any particular form of organization of the health care system.

As all of you know, I have been as hard-nosed about fee for service as I have been about closed end HMOs, and I think we all should continue to do that because we must hold the entire health care system to a very, very high standard. I believe this is a remarkable report put together by the most thoughtful group of individuals that I've ever worked with in health care, and I look forward to both finishing the chapter and as well as getting a chance to hear what all of you might say about both what we've done and what we need to do in the future.

Secretary Herman, would you like --

Secretary Herman: No. I will only just echo what you've just said, Secretary Shalala, to say that this is a very historic day, and I look forward to the completion of our work today. And I want again to thank all of the commission members in advance for their contributions to what is an extraordinary product.

You know, down home in Alabama we'd say this is a glory hallelujah day, and that's really how I feel about where we are at this point in time. So I am looking forward to the completion of our work and especially now getting on with the concluding business in chapter ten.

Secretary Shalala: Thank you very much.

Let me say that we've also done all of this in the sunshine. Whoever thought that you couldn't follow the FACA rules and actually produce genuine substance ought to come and look at this commission as a model. And the leadership of Janet Corrigan and her colleagues has been critical in that.

And, Janet, why don't I turn the meeting over to you. Just by noting again what I said at the beginning and that is I was very reluctant when the President made the appointment with the idea of Cabinet officers chairing a private commission. I didn't know how it would work. In some ways we're worse than politicians, getting us to spend more than 15 minutes sitting still on a subject is extremely difficult. Let me say that my long-time friendship with Secretary Herman has made this much easier and frankly it's been good for me, so to dig deeply into an issue with a lot of very good coaches.

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