Remarks to the San Diego Rotary Club in San Diego, California

Thank you all very, very much for that welcome. And Governor Wilson, Pete, thank you for that introduction, for being at my side in so many battles that I think affect this country. May I also salute Secretary Lou Sullivan, our distinguished Secretary of HHS who is sitting here, who came with me today; the Surgeon General, Surgeon General Novello is here somewhere out in the audience, sitting right over here; and next to her, Bill Roper, who is the head of the CDC, the Center for Disease Control, in Atlanta; and Dr. James Mason, who is our Assistant Secretary of HHS for Public Health.

So, you are surrounded, literally surrounded by health experts, our very best. And they are awful good, and I'm proud to be working at their side as we come to grips with some of these problems facing our Nation in health care.

May I also salute the Members of Congress who are here: Representative Duke Cunningham, over here; Duncan Hunter I believe is with us, too; Bill Lowery and Ron Packard, somewhere modestly in the crowd. We've got a wonderful representation from this broad area in Washington, DC.

And may I thank Craig Evanco, the president of this Rotary Club, for assembling such a distinguished group at an awkward time, I'm sure, for some. But in any event, I'm just delighted to be here. And let me salute all, ladies and gentlemen.

It's a pleasure to be in San Diego. I've always loved it, been here many, many times. This is where I set sail for overseas way back in 1944, and this is where I returned to from overseas. And ever since then I've been coming here a great deal. It's a truly American jewel. And thank you for the privilege of visiting this beautiful city on the Pacific once again.

I know that the eyes of the sailing enthusiasts are again on San Diego this year with the America's Cup competition. And if you run low on wind -- [laughter] -- no, we've got a surplus back in Washington, and we'd be glad to help out. [Laughter] But good luck on all of that.

Earlier today -- and I apologize for keeping you all waiting by some 15 minutes, I'm afraid -- but I visited a catalyst of caring, something that I'm sure everyone in this Rotary Club that believes in service is proud of, the Logan Heights Family Health Center, founded by one Laura Rodriguez, what we call a Point of Light, one of San Diego's true Points of Light. And I saw the families and the children and watched one little guy get immunized there. Later, I had a chance to talk with the parents and community leaders about how greater immunization can increase illness prevention.

This morning, like immunization, I will try to be brief, and also like immunization, I will try to keep the pain to a minimum. I was so moved by that warm response to just being here that I'm sorely tempted to give a flamboyant political speech here today. [Laughter.] But I'm going to resist that because I think we've got a lot to get done for the country in health care, and I want to talk to you about that subject and discuss how prevention can achieve a priceless gift, good health in America. So let me begin, then, with an equation: Good health equals a change in the health care system plus a change in the way we act.

This country has the best health care system in the world, the best. The quality of health care in America is unrivaled. You couldn't tell it from some of the political criticism, but it is unrivaled. So, that's not the problem. Rather, the problem is, first, that too many Americans are excluded, leaving one-seventh of our people without health insurance coverage. And second, millions of Americans fear losing access to coverage when they change jobs or develop illness. This is absolutely unacceptable for the United States of America, and it's got to stop. Finally, health care costs too much. And this year, listen to this number now, this year Americans will pay more than $800 billion for health care, one-tenth of all we spend. The health of our economy and the health of our Nation cannot afford it. We've got to do something about it. And now is the time to start.

Imagine: Let's say you're making do, just getting by in your current job that offers health care for your disabled child. Let's say you get offered a better job with a higher salary. You want to take it. You need to take it. But you can't take the chance that it won't cover your child. That is not the American way. I know we can do better, and my plan does. We've got to roll up our sleeves and meet this challenge head on.

Affordability, access, portability: These are the issues we've got to address. So yesterday in Cleveland, I announced a pioneering plan to do just that, to stabilize costs, ensure access, and free workers from the fear of losing coverage. My plan will preserve what works and reform what doesn't work. It consists of four points, and I ask you to support this plan and help me make the best system in the world even better.

First, our plan will make health insurance more accessible by making it more affordable for millions of low- to middle-income families. For low-income families, I want a health insurance credit of up to $3,750 a year to help them buy insurance; for middle-income, a tax deduction up to the same amount.

Second, we will cut health care costs by making it more efficient. Studies show that the larger the group being insured, the lower the cost per individual. So, we will create what we call health insurance networks that help companies band together and cut administrative costs.

And the third point will also lower costs. We must reform medical malpractice litigation. Today we have too many malpractice suits driving up costs for a doctor, a nurse, or a hospital stay. And I might say parenthetically, this malpractice suit is just a symptom of what's happening all across the business spectrum in this country and in the eleemosynary area, like in a Little League. We've got too darn many lawsuits out there, very candidly. A recent study found that, listen to this one, that in 1989 the cost of defensive medicine, just for physicians' expenditures, to be over $20 billion, or nearly 18 percent of their total costs.

I don't want to get into trouble with the Bar Association -- [laughter] -- but I once quoted to someone that line, "An apple a day keeps the doctor away." He says, "What works for lawyers?" [Laughter] But this is a very serious point, and here's what will work for America: Let's spend as much time building a better health system as we do wrestling with our legal system. We'd do better caring for each other if we stop solving problems by suing each other.

And that brings me to point four. We will cut the outrageous growth of Federal health programs. Listen carefully to what I've said: We will cut the growth of health programs like Medicare so that we can protect the benefits. Our reform program will cut costs, ensure choice, and give everyone, rich or poor, sick or healthy, access to health care.

And yet there are those who, like an old dog, refuse to learn new tricks. Instead of a better health care system, they demand a nationalized health system. Very candidly, you want to call it what it is, that means a socialized system. Let me tell you straight, I will not allow those people to give America a prescription for failure. I am going to fight against a nationalized, socialized medicine approach for this country.

Folks who want national health care are the same people who said that Tony Gwynn would never amount to much of a hitter. [Laughter] Now, they can't see the future. They think socialized medicine -- everything provided by the Government, totally Government-controlled medical care -- is just the ticket for health care in America. And what they're not saying is it's also the ticket for treatment waiting lines.

Anyone who's spent months checking the mail for that income tax refund, or tried to track down a missing Social Security check, or wasted a day in line at the department of motor vehicles is going to think long and hard before they let the Government play doctor. Some say nationalized health care would serve everyone. Sure it would, yes, just like a restaurant that serves bad food but in very generous proportions. [Laughter]

Look at countries where socialized medicine violates the number one rule of the medical profession, "Do no harm." They can tell you, nationalized health care is a nationalized disaster. And it's true, socialized medicine plans have increased exports to our country. But what are the exports? I'll tell you: Patients coming here for prompt surgery and the finest care in the world, doctors coming here for better working conditions.

As long as I am President, we are not -- again, I want to repeat it -- we are not going to go down the road of nationalized health care. And nor will we jump from the frying pan into the fire. I oppose the other Government-takeover plan. They call it "pay or play," where employers are forced either to accept a health insurance plan or pay a payroll tax and join the Government plan.

The "play or pay" choice costs jobs and money. And it reminds me of the guy with the gun in your back, who says, "Your money or your life." Jack Benny used to respond by saying, "I'm thinking. I'm thinking." [Laughter] Well, we'd better think long and hard about a "pay or play" plan that would make us pay and pay and pay and drive a lot of small businesses out of work, out of business in the first place. And I'm not going to let Congress try to cure America's health and care ailments by binding wounds in redtape.

I have proposed a plan that is sensible, and really it will work. And I ask you to help, too. One of the best ways is keeping people healthy, keeping them healthy. So, let me talk just a minute about how we must also change the way we act. And in this field I again salute Dr. Sullivan, our Secretary of HHS, who's been way out in front of the power curve on this concept. If you'll forgive me for altering an old saying, Pete used it a minute ago, "A pound of prevention is worth a ton of cure."

My good friend Lou, Dr. Sullivan, has said better control of fewer than 10 risk factors could prevent up to 70 percent of premature deaths, one-third of all cases of acute disability and two-thirds of all cases of long-lasting disability, and yes, many, many AIDS cases. If you exercise and eat right and don't smoke or abuse drugs and drink less and avoid risky sexual behavior, you'll live longer. And America will live better. Let's change the behavior that costs society tens of billions, this is no exaggeration, tens of billions of dollars in lost earnings and productivity, treatment related programs, accidents, and certainly crime. Maybe I am a little old-fashioned, but I believe personal responsibility has a lot to do with making America a better country.

And now, let's also act through another prevention measure, immunization. With health care costs stretched to the limit, we can't afford not to immunize our youngest children. And last June, Secretary Sullivan and I announced our administration's immunization initiative. And our goal was simple, to bring immunization to every American child. This effort pays huge dividends. Every $1 spent for immunization now for measles, mumps, and rubella saves an estimated $14 later on.

Consider two facts. Two years ago, measle cases soared to a high of 27,000. In 1989 to '90 alone, measles caused 130 deaths, 60 percent of which were children under 5 years of age. Because of our immunization initiative we now have a national blueprint to bring this needless and tragic story to a speedier end. But we're also working on immunization's equivalent of putting a man on the moon, the one-time, all-in-one vaccine that immunizes a child against all vaccine-preventable childhood diseases.

You know, since September of 1991 there's not been a single reported polio case in the Americas. Now, that's an extraordinary immunization accomplishment. But we've got to do better. And that's why we've more than tripled the dollars for Federal immunization efforts since I took office in 1988 -- '89, January -- [laughter] -- from $98 million to $297 million for 1992. And our work will only be complete when we eradicate these terrible diseases not only from our neighborhoods but from the world's as well.

Let me tell you a story about a family right here in San Diego. Michael and Barbara Baines had always watched closely over the health of their children. And last year they were preparing for the holidays, but they were not prepared for the news, their two littlest stricken by whooping cough. Thank God, 2 1/2-year-old Kensington has now left the hospital, and little 18-month-old Colleen has stabilized. And as Michael and Barbara prayed, they asked that other parents would not make the same mistake. And said Michael, "You can't fight something you can't see. You've got to have them immunized; give them as much protection as you can as early as you can."

It's because of families like the Baineses that I put forth this message: We need improved immunization. We also need earlier immunization not merely of school-age kids, where immunization approaches 100 percent, but of our smallest victims, where a year of wait can be a year too long. Kids need to be completely vaccinated in the first and second years of life. Yet immunization rates at 2 years of age are only 50 percent in many States and often as low as 10 percent in some of the inner cities. We have to change that, and I am determined that we will.

It won't be easy to immunize every child. And yet the Government will do its part. And the private sector needs to do its part as well. We need to help it try creative ideas like one-stop shopping for health care and escorted referral for express lane immunization at the clinics. And finally I ask each of you, mothers, fathers, spouses, friends: Call your health official or physician. Join groups which encourage childhood immunization. Please, please, make sure your child is immunized.

I have outlined today a reform program to make health care accessible and affordable. It's a program which rejects outright the dead end of Government-controlled, of socialized medicine, a program which will be good medicine for the American economy and the American people. And so, please help me take this message to the Congress: "He who has health has hope, and he who has hope has everything." I need your support. I need you to be involved. And let's bring quality health care to every American.

You know, when I was little, I read a quote by Saint Francis of Asissi. "Give me a child until he is 7," he wrote, "and you may have him afterward." Through a better system and better behavior, we can ensure that the future will have our children afterward, hoping, building, dreaming, as Americans always have and as Americans always will.

Thank you very, very much. And may God bless the United States of America. Thank you.