REMARKS BY:	DONNA E. SHALALA, SECRETARY OF HEALTH AND HUMAN SERVICES
PLACE:		Feinberg Memorial Lecture, Northwestern University, Chicago, Illinois
DATE:		October 24, 1999

As I was preparing to join you today, I was reminded that Victor Hugo once wrote that we "live in the age of revolutions" From my vantage point, I know that nowhere is that more true than in medicine. But despite the incredible advances we've all seen, I'm convinced that the principal health care challenges facing our society haven't really changed since the time of Vesalius, Pasteur and Koch. I think Dr. William Mayo put it best when he said: "The three challenges [of health care] are to honor those who came before us, to help those who are with us, and to prepare those who will come after us."

While those challenges remain constant, what has changed is how each generation decides to meet them. Today, I want to discuss with you how-I believe-we as a society must meet those health care challenges in the new century. And as Northwestern doctors, researchers-and graduates-I think you have a special role to play in shaping our response to them. You are privileged to have one of medicine's finest credentials-but I believe that, along with that privilege, comes a special responsibility. Yes, a responsibility to serve -- but also a responsibility to lead and guide the medical profession to provide today's answer to Mayo's challenges.

The first challenge is to honor those who came before us. As we enter a new century, that must begin by ensuring that the promise of Medicare is never broken. The difference that this single program has made in the lives of America's seniors reminds me of a remark by the great writer, Somerset Maugham. Asked to give a speech on his 80th birthday, Maugham noted, "Old age has many benefits." He then paused for a very long time. Finally, he began again, "Old age has many benefits-I just can't think of any." Maugham was trying to be funny. But at the time, there was a sad ring of truth in his words. Before Medicare, growing old meant poverty.and, too often, a retirement into a life of sickness and disease. Medicare changed that equation forever. In fact, since Medicare became law the poverty rate among senior citizens has dropped by nearly two-thirds.

But ensuring that the promise of Medicare is never broken requires that we act now to reform and strengthen the system. That's why the President's Medicare reform plan is so critically important. It modernizes the benefit package; it makes the program more competitive and efficient; and it strengthens Medicare's financing.

Let me describe this in a little more detail. When we talk about modernizing Medicare's benefits, that means-above all-that we must include the one benefit that has become an essential element of high- quality medicine: a prescription drug benefit.

Today, thirteen million Medicare beneficiaries-including half of all rural beneficiaries-have no prescription drug coverage. Who are they? They're individuals like Hanna Bratman. Hanna lives right here in Chicago. And, like many Americans, Hanna suffers from asthma. Hanna can control it with inhalers, but there's a problem -- a big one. Hanna's medication costs her $2,800 a year -that's about ten percent of her annual income-and not one penny of it is covered by Medicare. A prescription drug plan isn't only good medicine. It's prudent policy. But, even more, it's compassionate government. And, in the 21st Century, I believe it's not an option, but an obligation.

That's why our Medicare reform plan provides all Medicare beneficiaries with access to affordable, comprehensive -- voluntary -- coverage for prescription drugs.

Our plan will also help make medical care more accessible to those who need it-- by including a Medicare buy-in proposal for vulnerable Americans ages 55 to 65. Along with our efforts, to make the program more competitive and efficient, these measures will modernize Medicare for the future. Our plan is the right prescription for what ails Medicare-and it will allow us to meet Dr. Mayo's challenge of honoring those who came before us.

Mayo's second challenge was to help those who are with us. I think that begins by recognizing the risk that medicine faces of sacrificing privacy and quality on the altar of efficiency. Do we want affordable, efficient health care? Of course we do. But we also want health care that's accountable. After all, today we live in a world dominated by microprocessors, cellular communications, and the Internet. It's fast. It's informative. It's efficient. But it also a poses a danger to our privacy. Undeniably, one of the defining problems of the new century will be to continue our technological progress in medicine-while safeguarding the privacy of our medical records.

Because today it doesn't matter whether you have a family history of breast cancer.or if you've been prescribed anti-depressant drugs.there is no federal law telling health care professionals-and payers- what they can and cannot do with that information. That means the potential for abuse is enormous. And that's why we called on Congress to pass legislation this year to protect the privacy of medical records. We pointed out that, if we don't act now, public distrust could deepen to the point where even more citizens stop disclosing vital information to their physicians. That could easily result in Americans going without treatment for mental illness .avoiding certain diagnostic procedures.and refusing to take-part in clinical trials.

Under the Health Insurance Portability and Accountability Act-also known as the Kassebaum-Kennedy law-Congress had until August to pass a comprehensive medical privacy bill. Well, Congress didn't meet its deadline. Kassebaum-Kennedy did give me legal authority to act if Congress didn't-and we're drafting regulations to be released later this fall. However, that authority is not comprehensive and we still need Congress to finish the job.to pick up its collective pen and create lasting legal protections for the privacy of all medical records. These protections must ensure that-with only limited exceptions-a patient's personal information should be used only for health care-not for purposes like hiring and firing. And they must ensure that if you receive medical information legally, you are legally obligated to take real steps to keep it out of the wrong hands.

But we must also balance our protection of privacy with other national priorities. For example, public health agencies must be able to use health care records to warn us-and protect us- from outbreaks of infectious disease. By instituting the proper legal protections, we'll ensure that our health care records are used to heal us-and not reveal us.

But the drive for efficiency doesn't only raise questions about protecting privacy. It also challenges us to safeguard the very quality of care that Americans receive. What's quality health care? Any physician can answer that: It's doing the right thing, for the right person, at the right time, and in the right way. But changes in the way America delivers health care have made it more and more difficult for physicians to do right by their own patients. A recent survey by the Kaiser Family Foundation and the Harvard School of Public Health found that 87 percent of doctors report that their patients were denied coverage for health services that doctors believed were needed over the last two years. They reported something else, too: that 48 percent of doctors surveyed exaggerated the severity of a patient's condition to get them the coverage for the care they believed was needed. That's part of the reason why America needs a comprehensive "Patients' Bill of Rights."

As I'm sure you're aware, the U.S. House of Representatives recently passed a "Patient's Bill of Rights'- sponsored by Congressmen Norwood and Dingell-that we endorsed. The Norwood-Dingell bill guarantees access.choice.quality.and recourse for inappropriate coverage decisions by insurance plans. It protects both patients and providers. And it will help ensure that insurance plans are both affordable and accountable. But we have a long way to go before this bill becomes the law of the land, and we'll need the continued support of the health care community to make that happen.

We'll also need the health care community to help meet Dr. Mayo's third-and final-challenge: To prepare those who will come after us. With all the revolutions in every field of human endeavor, the single best way to prepare future generations is to ensure that they're ready for science and technology and health in the 21st century. That's why we're undertaking the Human Genome project.

The Genome project is our 20th and 21st century equivalent of the Age of Exploration. We're mapping the human body just as 15th century explorers mapped the world. And as we begin to unlock the body's mysteries, we're discovering better treatments for illnesses ranging from cancer to periodontal disease, and we're empowering people to make better decisions about their health. Of course, as we create a genetic map, our challenge is to ensure that genetic information is never used to deny jobs or health insurance.

Preparing for the 21st Century is also why we've doubled funding for the National Institutes of Health over the past six years. Unfortunately, that's not enough. Unless we simultaneously deal with the training and education of the next generation of clinicians and researchers, we'll have a fist full of dollars and no one to take it. That's also true of necessary investments in laboratories, information systems, research centers and-- of course--our academic health centers. Our academic health centers are a national treasure--the envy of the world. They're the places where we'll train the next generation of researchers, doctors and public health professionals. And they're the places where citizens least able to care for themselves go for health care.

If we want to preserve our academic health centers--and if we want to fully prepare for the 21st century--we need more than the political will. We need a public that understands that investing in science and technology and health is important to their future. We also need a scientifically literate society that's capable of understanding our changing.complicated.cutting-edge world. Unfortunately, we don't have it. And-unless this situation changes-our nation just won't be able to compete internationally in the new millennium. That's why every American leader-from the Cabinet to the college campus-must be an advocate for greater scientific literacy.

I know that Northwestern has always been on the cutting-edge of preparing today's students for tomorrow. That's why you've been a recognized leader in the continuing reform of medical education for more than a century. And that's why, today, you offer your students training in subjects like "Medical Informatics"- the science of managing medical data using computer technology.

In our increasingly high-tech world, citizens who are informed about what's going on in genetic research or biomedical engineering will make better decisions-especially health care decisions-for themselves, their families and their nation.so all medical schools have an important stake in this issue.

Four years ago, I told the National Academy of Sciences that we're facing nothing less than a crisis in science education. But science education continues to lag behind-and we need to take concrete steps to rectify this situation. We need colleges and universities to require sufficient science and math at the undergraduate level. And we need more innovative programs like those offered at Chicago's own "Leon Lederman Science Education Center." The Center's mission is to improve science teaching and learning in primary and secondary schools through such innovative projects as "Saturday Morning Physics" for students and "Summer Science Adventures" for teachers.

Of course, if we really want to improve science education, we need a school curriculum-starting in pre- K-that taps into our children's natural curiosity. That's why I'm so pleased to announce today that NIH is launching a major new Curriculum Supplement Series for grades K through 12. The series will be distributed to teachers across the country--free of charge--to improve science literacy. We already know that children are fascinated by science fiction--this program will help fascinate them with science fact.

We must start working toward science literacy now--because change can't happen overnight.I'm reminded of a conversation I had when I was in Japan earlier this year. I was admiring an absolutely stunning Japanese garden--a place where every flower and plant seemed to exist in sublime harmony. As I was complimenting the gardener on his work, I asked him his secret for achieving such beauty. He simply answered, "Well, we've been working on it for a thousand years." That's the kind of commitment we need to scientific literacy.

But as important as I believe science literacy is, I don't want to leave you with the impression that the mere accumulation of scientific knowledge is enough. It never is. Scientific knowledge-in fact all knowledge-must be tempered by human values, human compassion, human decency.and the same spirit of generosity that was the hallmark of Frances Feinberg.

In many ways, these same qualities are necessary to meet the challenges of honoring those who came before us.helping those who are with us.and preparing those who come after us. But I've no doubt that by working together-and with the doctors, researchers and graduates of Northwestern helping to lead the way-we'll meet those challenges-And so help ensure that the 21st century will be remembered as a time of health and hope.of promise and possibility.of medical miracles and scientific marvels. That's my revolutionary vision of the future-and I know it's one that all of you share.