Remarks to the American Medical Association's House of Delegates Meeting in Atlantic City, New Jersey.

Dr. Bornemeier, all of the distinguished guests on the platform, and all of the distinguished delegates to this convention:

I very much appreciated that reference by Dr. Bernemeier to the year 1966. Let me say he had a lot more confidence in my future then than I had, I can assure you. I recall, too, the pleasure that I have had in addressing the AMA on another occasion in Atlantic City, in 1951. Some of you will be old enough to remember that. I was then just a Senator. So this makes the third time that I have had the privilege to address this organization in this session.

In doing a little checking with regard to when Presidents--at least that means Presidents of the United States; I understand all of these front rows are either presidents or past presidents of AMA-but in checking the record I find that as far as Presidents of the United States are concerned, in the 120 years of this organization only four have had the privilege of addressing you. The last time was President Eisenhower in 1959. I am honored to be here as President, after having had the opportunity to address you as a Senator, as a former Vice President, and now as the Chief Executive of the Nation.

It is very important that a President of the United States speak to this organization. The Presidents of the United States should, it seems to me, find more opportunities, perhaps, than four in 120 years to come before this organization for reasons that I will cover in my remarks today, because this is a very important organization.

I am referring to matters going far beyond the special competence, the technical competence, represented in such degree in this room. For example, just yesterday, as some of you may have noted in the press, my wife and I celebrated our 31st wedding anniversary. It was a very inexpensive celebration. Normally we go out on such occasions. In this case we stayed in and watched television and watched a rerun of our daughter's wedding at the White House.

On that occasion, as I was thinking of that 31st wedding anniversary and pulling together my remarks today, I was reminded of a story which is probably very old to an organization of doctors, about a doctor who is celebrating one of his wedding anniversaries. He was trying to get out of the house for his weekly bridge game. And he told his wife that he just had a call from a patient and he would have to leave. She said, "But, dear, is it serious? Is it important?" And he said, "Oh, it is very serious and very important. There are three doctors there already." [Laughter]

What that, of course, brings home to us is, when you have any gathering of doctors, it is a very serious occasion and a very important occasion. So this gathering of far more than four, of thousands of doctors from all over America, is important. It is important for reasons that I think, perhaps, we can find as we study the history of America and go even further back than that.

Disraeli once said that "the health of the people is really the foundation upon which all their happiness and all their powers as a state depend."

That profound statement is one that we should consider today, and we should think of health in a much broader context than simply the physical health to which you have devoted your lives. I am happy for this opportunity to salute this profession which has contributed so much to the health of the American people and to the strength of this Nation.

America is a strong country. It is a good country. And one of the reasons it is a strong and a good country is because it is a healthy country, and we appreciate what you have done to make it a healthy country.

You should take pride in those accomplishments-all Americans should. For we can never hope to repair any weaknesses that may exist in American medicine unless we fully appreciate its towering strengths.

One of the strengths of American medicine has always been that it has had a restless and inquiring spirit. All of you are aware of this. This spirit was summed up in a statement which the distinguished physician Charles Mayo made years ago about his equally distinguished brother, Will. He was "filled," said Charles, "with the genius of finding opportunities." The same point was made more recently by Dr. Jonas Salk when he said, "The greatest reward for doing is the opportunity to do more."

As we look at the current picture of health care in this country, we see many opportunities "for doing more." Those opportunities have been recognized by this organization. You have spoken to them in your resolutions. You will be considering them in your meetings at this convention. Among them--the opportunities for doing more, problems to provide opportunities and their solutions--are these: There are too few doctors in some areas as you know, too many in others. We see a growing need for more health personnel, more efficient training. We have too many doctors spending too much time on routine tasks that others could help them with. We recognize the growing menace of malpractice suits which force every doctor to look upon his patients as potential plaintiffs.

As we look at American medicine we also see a need to place more emphasis on primary care, on preventive medicine, on outpatient treatment. And we see that despite our considerable progress in this area, in the field of voluntary health insurance, financial considerations still deny quality care to many Americans while the dark threat of catastrophic costs still imperils most of our people.

These are challenges. We can be grateful that our country now has entered into a period of productive discussion about the best ways of meeting them.

I say to this organization that I am sure many of you are concerned about what may come in the future in the reform of health care systems. But I say: Welcome this debate. You should join it. We need you to join it. We need your assistance in it. It will be a great debate. It will be a strong one. It will be one that will command the attention of the country in the weeks and months and, perhaps, for years ahead.

I noted with interest that your new president, Dr. Hall,¹ for several years has been the boxing and wrestling commissioner of the State of Nevada. Well, you need a boxing and wrestling commissioner in this debate that is coming in, I can assure you. For out of this time of discussion and decision will surely come a whole new era in the history of American health care.

¹ Dr. Wesley W. Hall, president-elect of the American Medical Association.

Last February, I offered my own contributions to this discussion, a wide range of proposals that I have discussed with some of your leaders. And these proposals are designed to balance growing demand for care with a growing supply of services. They are founded on the principle that we cannot simply buy our way to better medicine.

It is very easy sometimes to think that the plan that costs the most will help the most, but often the situation is just the opposite. In fact, I believe that the most expensive plan that has been offered in the current discussion on health care in Americana plan for nationalized compulsory health insurance is the plan that would actually do the most to hurt American health care in this Nation.

This is not a new position for me. I made the same general statement in my speech in 1951 to this organization and in 1966. Let me give you the reasons why I have reached this conviction. The conviction is strongly held, as I am sure is the conviction held by those who advocate this plan.

First of all, if this plan went into operation, by fiscal year 1974 it would cost the Federal Government over $77 billion. Let's bring it down to matters that all of us can better understand. It would drive the health share of the Federal budget to nearly 25 percent. In other words, 25 percent of the total Federal budget would be going for health care. And that would mean that we would limit our ability for handling other social problems.

Our present Federal health programs, if continued, would cost the average family in America an estimated $405 per year by 1974. My plan would increase that cost, but increase it only to $466 per year. Under the nationalized compulsory health insurance program, the average household's, the average family's, American Federal tax bill for health programs alone would be tripled to $1,271 a year.

Nationalized health insurance would exact a very high price from our people in terms of dollars and cents. These figures demonstrate that point. But, in my opinion, it would exact an even higher price, a price in terms of the quality of American medicine. On that score, let me just speak as a layman. When I am sick, I want to be able to get a doctor. But above everything else, I want a doctor who is a good doctor. I am interested in quality as well as the ability to provide for a doctor.

When the Government pays all the bills for health care, then the Government becomes the only party with a strong interest in restraining costs. This inevitably means that Government officials would have to approve hospital budgets. They would have to set fee schedules. They would have to take other steps that would eventually lead to the complete Federal domination of our medical system. Now that is the road that some advocate. I think it is the wrong road.

Rather than freeing the doctor so that he can do more to help his patients, nationalized health insurance would burden him with the dead weight of more bureaucracy, more forms, more red tape. I know what kind of forms and red tape that many of you have to fill out now.

Just let me again speak as a layman. When I go to a doctor, when I am sick, I want him to worry about me and not to be worrying about some form he has to fill out for the Government.

Rather than expanding the range of choice--and we all believe that that is certainly something we want in our society-for doctors and patients, it would severely narrow that range. Rather than encouraging more responsibility at the local level, it would concentrate more responsibility in Washington. Rather than stimulating competition and diversity, it would dull the incentive to experiment and innovate.

The Administration's Health Insurance Partnership would build on the strengths of the present health care system. Nationalized health insurance would tear that system apart.

America's health care system needs reform. You have recognized that. But we can never improve our country's medical system by working against our country's medical profession. Other nations that have gone down this road have found this out. No system of health care will ever work unless the doctors of the Nation make it work. We need your help to make it work and in developing a system. So let us work together for a system--a system that will continue to provide for choice, that will continue to provide for quality, and one that at the same time will deal with the pressing problems of costs in an effective way that will not destroy quality, a problem which all of us are deeply aware of.

I would like to talk to you today about another subject, a challenge in the health care field related to it very directly, a problem which I note again that you are taking up in your general sessions, in fact, this afternoon.

I refer to the problem of drug abuse. Drug abuse, I have said recently, is America's public enemy number one. It is the greatest of all present threats to our social future. Oh, we used to be able to brush it off. We used to say it is a ghetto problem, or it is a black problem, or it is a problem of the poor and the depressed and the rest.

But today it is no longer just a ghetto problem. It is no longer just a problem that primarily affects those that are nonwhite, or the poor, because its impact cuts across all social and economic lines in our country.

It has moved from the ghetto to the suburbs, from the poor to the upper middle class and the upper class in terms of economic income. It afflicts the rich and the poor, the blacks and the whites, the servicemen and the civilians, and the ghettos and the suburbs. It spreads like a plague throughout our society. It erodes our Nation's strength. It destroys our Nation's spirit. And, worst of all, it undermines our Nation's future.

I had a letter recently from a man who said that we are in danger of losing "a whole generation of Americans to drugs."

Two years ago I recommended a series of new laws to crack down on drug abuse, particularly in the enforcement field. Those laws passed the Congress last fall; they are beginning to prove their value. But more is needed, particularly in the field of rehabilitation.

That is why I have launched a totally new program for a total offensive--worldwide, nationwide, and through all segments of society--against drug abuse.

The program I announced includes strong efforts to cut off the supply of dangerous narcotics at their source in other countries. It more than doubles our budget for rehabilitation. It moves against drug abuse in the military. It sets up a new command post on drugs in the Executive Office of the President.

The President has many responsibilities. There are probably too many responsibilities that come to his desk. But this problem is so serious that I feel that the President must take personal command and personal responsibility. And that is what I have done.

That is why I have named as head of this new office in the White House one of the great experts in this field, a man, Dr. Jerome Jaffe, of great experience in Illinois. I think he represents the best of America's medical profession. He is tough. He is no nonsense. But he is also a man who is compassionate. He understands the problem. There is one assignment I have given, among many others. Believe it or not, there are nine Federal agencies that work in the field of drugs in the United States in drug abuse, and too often I have found, over the past 2 years, that those agencies are competing with each other for personnel, competing with each other for attention, competing with each other before Congressional committees for funds.

And I have given one instruction to Dr. Jaffe that I have ordered him to carry out without any question, and that is this: The Government agencies, the nine of them in this field, are going to quit fighting each other and start fighting the problem a little more.

Now, the offensive that I have mentioned in drug abuse places new emphasis on education because that, of course, is the most important of all. We can stop the source of supply in one country; it moves to another. We can have stronger enforcement and people will go around it if the demand is great enough and if people !are willing to pay. We can have rehabilitation but then that is probably too late if the problem goes that far.

So we need education--education as to the dangers of drug abuse. And this is an area where human resources are going to make the difference. But the effectiveness of education depends ultimately on communication, on the trust that grows up between one human being and another. What is a good educator? Well, he must combine compassion with firmness, a sense of authority with a sense of sympathy, a capacity for discipline, a capacity for involvement.

I just described you. That is what doctors are. These are virtues you possess. They are values that you and your profession prize. And that is why I look to the medical profession, and all America looks to the medical profession, for leadership in this field of education in drug abuse.

Let me treat two aspects of the problem, one that is somewhat in your field. And if I step over the bounds of my own competence, I, of course, will expect you to correct me in any resolutions that you adopt.

First of all, let me point out the link, and I believe there is a link, which exists between the inappropriate use of drugs within the medical context and the abuse of drugs outside that context. Consider these facts for a moment: In the last 4 years alone, the production and distribution of tranquilizers in our country has doubled. During 1970, 5 billion doses of tranquilizers, 3 billion doses of amphetamines, 5 billion doses of barbiturates were produced in this country. Listen to this: The estimate is that 50 percent of the amphetamines and barbiturates were diverted into illegal sales. So there is the problem in terms of education as well as enforcement.

Tranquilizers, amphetamines, and barbiturates, as you know, are known as psychotropic or mind-altering drugs. It is estimated that one-third of all Americans between the ages of 18 and 74 used a psychotropic drug of some type last year. And little wonder for there were enough drugs of this type available last year to medicate every adult in the United States at very high dosage rates for more than 11 days.

Now, what does all this mean? What it means is that we have created in America a culture of drugs. We have produced an environment in which people come naturally to expect that they can take a pill for every problem--that they can find satisfaction and health and happiness in a handful of tablets or a few grains of powder.

We have got to face up to the fact that within this climate it is altogether too easy for the abuse of drugs--not the prescription, now, and the use, but the abuse of drugs will flourish in that kind of a climate, in a climate where individuals believe, because of inadequate education, that they can take a pill for every problem.

The medical profession was among the first to recognize this problem, to identify-as one of its causes--the fact that many physicians are prescribing drugs too often, too easily.

A number of voices from your community have suggested recently that certain drugs may have become a crutch for some doctors as well as their patients, masking but not correcting more basic physical and emotional problems.

I noted with interest that your own Council on Drugs spoke to this subject only a few weeks ago. And I have noticed, too, that many doctors are now moving to strictly limit their prescriptions of such substances. And I will hope--and I say this respectfully in an area where you are the experts and I am not--but I hope you will continue to give careful consideration to this matter, for your role in shaping this country's basic attitude toward drugs will be decisive.

Let me turn now to a second way in which doctors can help. I want to ask your help, I ask the help of the doctors of this Nation, in a program of education, educating our people in the proper role of drugs and drug information, drug counseling, in drug treatment.

Years ago, you will remember that when most Americans lived in small towns we looked to the family doctor for guidance not just with regard to our physical health but in many other aspects of life. It may have been somewhat easier for many doctors to utilize their enormous potential as effective teachers in our society because of that situation that existed then.

I remember my own doctor, a family doctor, Dr. Thompson, of Whittier, California. He was a fine doctor, but he was a community leader, and when he spoke on issues, we listened. When he came out to our school to speak on the problems of health and other related problems, we listened, we paid attention, we followed his advice. Some doctors still play this role today. You do it voluntarily. You contribute enormously of your time without compensation in educating America in these and other fields. But more doctors need to be playing it. We need you, especially in the field of drug education.

I have met recently in this field with the leaders of the Advertising Council, with the leaders of the television and radio industries, with the leaders of opinion makers, editors, publishers, and so forth throughout this country, and they have enlisted in this battle.

But no one, believe me, no one can have more effect when he or she speaks out than a doctor on this issue of drug abuse. You speak with greater authority, because you speak about the power of drugs to save life--and we must look to that, the tremendous progress that we have made in that field--but also the power to destroy it.

Rather than preaching moralistically about the sinfulness of drugs, you can teach realistically about their physical and psychological impact, and you can bring tremendous credibility to this undertaking. Many doctors have been moving in that direction.

I noted, for example, that in Arizona, the Maricopa [County] Medical Society has pulled together an impressive drug control program for Phoenix, and I am happy to see that this Association has been actively encouraging such efforts. It has developed education materials to help local physicians as they go out to wage war against drugs in the schools and churches and neighborhoods of America.

We ask for a part of your time every day in this field if it can be effectively used. The time has come for a greater effort, and that is why I ask for your help and the help of this organization. I realize that you have engaged in many enterprises of this type for which the Nation is in your debt. I know that one outstanding voluntary effort, the AMA Volunteer Physicians for Vietnam--and I have met several of your members who have gone to Vietnam, given of their time and their effort for the purpose of carrying out what is called a project--Project Vietnam--and its purpose is to improve medical care in that country for the people of that country. It has had very great success.

Now, as our attention begins to center again on domestic challenges, the AMA can once again render outstanding service at a point of critical need by helping to develop what I would like to call Project USA, a project which would marshal the tremendous energy, the brains, the dynamism, the leadership---the leadership--of the doctors of this country in an all-out battle against drug abuse; and against it in terms of educating particularly the young people of this country about it.

The best way to end drug abuse is to prevent it, and America's doctors are the indispensable frontline soldiers for success in this all-important battle.

I began these remarks today by saying that the doctors of America have done a great deal for their country. But I also noted that the greatest reward for doing is the opportunity for doing more. There is much to be done in this Nation--in the fight against drugs, which I have covered, and in other areas.

And once again, Americans are looking to the doctors of their land for leadership. We are looking to the doctors of this land for leadership beyond the reform of our health care system in which you will provide leadership--and you should, because it affects you directly--beyond drug abuse, which is so closely related to your profession, where I am sure you will provide leadership.

America at this time needs leadership from those in the medical profession, and your wives, the AMA Auxiliary that I know is meeting here in Atlantic City with you--all across this country, not simply in the areas that affect you directly but in the area of national problems.

I know that many of you are sorely concerned whenever anybody suggests that you get into politics, and I do not speak in any partisan sense. I am not concerned about whether you are in politics in one party or the other. The main thing is to be in. Oh, I have heard a doctor say on occasion, "I am only interested in my profession; I am not interested in politics."

Let me tell you something: He had better get interested in politics or he won't have any profession to be interested in.

And I am not referring just to politics to defend your profession. You should do that. Defend what is best in it. Correct what needs to be corrected. But I am referring to politics in the broader sense of leadership.

Let me put it in historical perspective. One hundred and ninety years ago America was one of the weakest countries in the world, militarily, and one of the poorest countries in the world, economically. But it was a country that was rich in spirit, and thereby caught the imagination of the world and has held it ever since. Today America is the strongest nation in the world, militarily, and the richest nation by far, economically. The major problem we have to ask ourselves as Americans is: At a time when we are rich in goods and strong in arms, are we poor in spirit?

I don't think so. As I go across this land I am always reassured as I see so many Americans that have a deep conviction about the goodness of this country, who give of their time and their efforts to make it a better country, who are proud of what this Nation has done for its own people and what it has done in its leadership abroad. And yet, of course, there are other voices that are heard throughout the land: those that run America down, those that say our system is rotten, those that say that America is an ugly country, those who say wouldn't it be well if some other nation were in a position of leadership and therefore follow with the proposition that America withdraw into itself and get away from the position of world leadership in which it presently finds itself, with that leadership thrust upon it--not sought, but thrust upon it because of the accidents of history, the fact that in the free world there is no other nation rich enough or strong enough to assume that position of leadership.

What does all this have to do with doctors? Very simply this: In a community, a doctor is listened to. He is listened to about the health, of course, of his patients. But an individual can be physically healthy and he can be without any health in a moral, in a spiritual sense, without character. A nation can be physically strong and unless it has moral character and stamina and faith in itself, and confidence, that nation is weak in a way that it cannot compensate with all the physical strength in the world.

So we go back to the early days of this Republic 190 years ago--weak, poor, but strong in spirit. And here is America-rich, strong. Question: Are we weak in spirit?

And the answer, of course, will be found not simply in what a President says or a Senators--and we have some distinguished Senators here--or a Congressman or a Governor. But it comes from leaders throughout the country like yourselves. That is why when I speak of politics, I do not speak in a partisan sense. I do not speak in the special sense in which you are concerned about what government is going to do to the medical profession. But I speak in this sense: You know what a good country this is. You know what a great education you have. You know that when somebody is really ill, that the best medical care in the world is here and not in some other country, generally speaking.

You know that as far as this system that has been run down so much around the world--that when you go around the world to all the other countries, they look to America, and the traffic, where there is traffic, is usually all one way. They are coming this way, they are not going the other way, when people have a choice.

You know that this system of government that we have talked about and this economic system has its faults. There are too many poor people in America. There is too much discrimination and prejudice and all these other problems. But look at America's strengths. Look at the fact that there is more freedom, more opportunity, there is more income, even for the poor, because of the wealth of our country, than there is in 85 percent of the rest of the world.

So here we stand, looking at America. Let us examine its faults. Let us correct them. We need your help in your special field. But let us also recognize that in this particular period of this Nation's history-and this was not true 190 years ago---the health of America in this broader sense, not just physical but moral and spiritual and mental---that health will determine whether peace and freedom survives in the world.

We have no choice in the matter. And if you ask yourself the question: If America does not have the role of world leadership, what other nation do you want to have it?

I should say the world can be fortunate that America, with its faults--and we have made many in foreign policy through our history--with its faults, let's look at the strengths. We have been in four wars in this century--World War I, World War II, Korea, and now Vietnam. We have made our mistakes, but, to the great credit of America--and this can be said proudly and should be said by any American Americans have fought and died not for an acre of territory, not to get domination over any other people, but for the right of other people to enjoy the freedom and the peace that we want, and this is something we must demand.

And so to the American Medical Association, representing brains, representing tremendous competence, representing also leadership, the best educations that America can provide, I ask you today to join, to give a little more of your time than you have, not only in working for your profession--that must come first but also in serving your country, providing the leadership that this country craves for in every community of the Nation.

The health of America is in your hands, and by its health, I speak not just of its physical health--its mental health, its moral health, its character. Meet that challenge.