[Public Papers of the Presidents of the United States: George H. W. Bush (1992, Book I)]
[February 6, 1992]
[Pages 205-209]
[From the U.S. Government Publishing Office www.gpo.gov]



Remarks to the Greater Cleveland Growth Association in Cleveland, Ohio

February 6, 1992
    Thank you very much for that welcome back to Cleveland. And first 
let me thank Dick Pogue, the chairman of the Greater Cleveland Growth 
Association, and all who help make this wonderful forum possible. I'm 
pleased to be back here in Cleveland, the capital city of the north 
coast. Hello to Bob Horton, who I understand not only warmed up the 
crowd but made it very difficult for me to come on as the next speaker. 
I salute what he and so many other business leaders in this community 
have done and are doing.
    You always get this feeling of cooperation between the business 
community and the government of Cleveland, the city government. I had 
that when I first came here and Mayor Ralph Perk was in office, and 
particularly did I get that feeling when George Voinovich came in as 
your mayor and energized this place to a fare-thee-well. And business 
pitched right in. And you have this wonderful community spirit that this 
organization really epitomizes, Dick. And I am grateful to be here. And 
so let me get on with just saying I'm very pleased to have been 
introduced by George Voinovich, the great Governor of this State now. 
And may I salute Mike DeWine, who is over here, the Lieutenant Governor.
    We've got some other friends with us, too. I know that Bob Taft is 
out here, the secretary of state. Three distinguished Members of the 
United States Congress came with us, Ralph Regula, Mike Oxley, and Dave 
Hobson. And I'm sure I'll forget somebody, but nevertheless I see our 
State senate president, Stan Aronoff, sitting over here. So that takes 
care of it. We've got good representation from Ohio's government; we've 
got representation from the wonderful congressional delegation; and we 
have outstanding representation here from the medical community and, of 
course, from the business community at large.
    Good things are happening here for the Cleveland Cavs. [Laughter] In 
fact, I told the Governor I was going to be speaking today about the 
number one health issue on every Clevelander's mind. He said, ``Mr. 
President, Mark Price's left knee is just fine.'' [Laughter]
    People who know northern Ohio know that this region's on the move. 
In addition to the world-renowned Cleveland Clinic, now the city's 
number one employer, northern Ohio is also home to some of the most 
innovative approaches to health care. COSE and Cleveland Health Quality 
Choice are pioneers. Communities across the country can follow your lead 
to create workable 
solutions to health care challenges. 
And I had a briefing in Washington

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from the leaders of these organizations, and that really is why I've 
chosen to come to Cleveland this morning to address the health care 
crisis in our country and lay out my four-point program for 
comprehensive health care reform.
    Reform is urgent for more reasons than one. Right now, far too many 
Americans are uninsured, and those who are insured pay too much for 
health care. And we're going to do something about that.
    The one thing this crisis isn't about, and I was reminded of this in 
my visit to the hospital just now, the one thing it is not about is the 
quality of care. American health care is first-rate. It is the best in 
the entire world. And right now, the vast majority of Americans have 
access to that health care system. But the cost has skyrocketed from $74 
billion in 1970 to $800 billion today. And if we keep going at the same 
rate, that $800 billion will double to $1.6 trillion by the year 2000.
    These numbers alone would make the case for reform. They tell us 
there's a connection we simply can't ignore between what we pay for 
health care and the long-term health of our economy. But cold statistics 
don't show us the worry that people feel, the all-too-familiar fear 
about what happens to their health care if they change jobs or, worse 
still, if they lose their jobs. And in these hard times, we simply 
cannot accept the fact that one in every seven Americans is uninsured.
    There's a better way. And my plan puts the emphasis on expanding 
access while preserving the choice people now have over the type of 
health care coverage and health care they receive. My plan will give 
Americans a greater sense of security, help ease the fears that so many 
Americans have that changing jobs will cost them their health coverage. 
And the key here is portability, changing the system to ensure people 
that they will always have access to health insurance no matter where 
they work. And finally, my plan will cut costs. It helps us make health 
insurance more affordable, and more affordable means more accessible. My 
plan will preserve what works and reform what doesn't. Above all, it 
will ensure every American universal access to affordable health 
insurance.
    We stand at a crossroads. We can move forward dramatically to reform 
our market-based system, or we can force ourselves to swallow a cure 
worse than the disease. Some people have scribbled out a prescription 
for disaster. They want to nationalize our health system, put the 
Government in control of the system: Well, you let Government control 
the prices, let Government ration the kind of health care people get, 
let Government tell people looking for care how much they'll get, what 
kind, and when.
    Nationalized systems cover everyone. But keep in mind the drawbacks 
that come with a nationalized system: Long waiting lists for surgery, 
shortages of high-tech equipment responsible for so many of the miracles 
of modern medicine. Let me cite just one example for you. The Cleveland 
Clinic performs 10 coronary bypass surgeries a day, I'm told, high-tech, 
high quality surgery without any wait. But if you live in British 
Columbia, the wait for coronary bypass surgery is 6 months. It's no 
wonder so many people from abroad come to American hospitals for 
surgery.
    When you nationalize health care, you push costs higher, far higher. 
Some studies estimate that nationalized health care would cost the 
average American family a huge new tax burden; for the Nation, a 
staggering $250 billion to $500 billion a year in new taxes. Such a 
massive tax increase is simply unacceptable, and the American people 
should not be asked to accept it. And for that price, you get the worst 
of both worlds: No one has an incentive to control costs, and everyone 
pays.
    But there are other proposals out there that sound simple but are 
every bit as harmful. One's called ``play or pay.'' Each employer must 
play, provide insurance for employees, or pay a payroll tax to finance 
Government health coverage. Business men and women tell me horror 
stories about health care costs spiraling out of control. Well, ``play 
or pay'' will leave a lot of small businesses, businesses struggling on 
the edge of survival right now, with a tough choice. They can cut 
workers' wages to pay 
for mandated health care; they can fire 
some workers to cover the workers they 
keep; or they can raise prices and pass

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along the cost to the consumer. Some studies put the cost in jobs lost 
under ``play or pay'' as high as half a million or more. Lower wages, 
lost jobs, higher costs: Any way you look at it, that's the wrong choice 
for America.
    Step away from the rhetoric, strip it out of there, and ``play or 
pay'' just creates a back-door route to nationalized health care. And it 
encourages employers to stop offering benefits, throw the problem in the 
Government's lap, and dump millions of fully insured workers into a 
public plan like Medicaid. And because the new employer taxes in ``play 
or pay'' don't pay for the program, the American taxpayer will obviously 
foot the bill. And I am not about to let that happen. You won't hear 
this from the people pushing ``play or pay.'' Ask them about the side 
effects of their proposal, and they'll say, ``Take two aspirin, and call 
me after the election.''
    I don't believe people want to be shoveled into some new health care 
bureaucracy. They want good health. A large part of the answer is 
prevention. And every one of us can make changes in our behavior to 
reduce the risk of disease and illness. And pardon me for being just a 
little bit old-fashioned, but what we're talking about is behavior: 
drugs, alcohol abuse, risky sexual behavior. You know what I'm talking 
about. And there's nothing wrong discussing that, trying to do better in 
this field. Tomorrow, in San Diego, I'll focus in more detail on the 
ways prevention can help people live healthier lives and help keep our 
economy healthy, too.
    But today I want to focus on the health care system, on this 
comprehensive, market-based reform plan I have. The fact is, we do not 
have to create a new Government bureaucracy to give Americans access to 
affordable, quality health care. We need a system that delivers, a 
system that works for America, a system that puts quality care within 
reach of every American family.
    Our system should be built on choice, not central control. It should 
keep costs down and open up access. But above all, it should allow all 
Americans to rest secure when it comes to health care, to ease their 
worry that if they change jobs, if they or their kids develop serious 
health problems, they'll still be able to count on the coverage they 
need. Now, my comprehensive four-point plan meets every one of these 
commonsense tests. And here's how it works.
    Point one, we will make health care more accessible by making health 
insurance more affordable. For low-income individuals and families, I 
propose a health insurance credit, up to $3,750 a year to guarantee 
people, even people too poor to file taxes, the ability to purchase 
private health insurance. That will give these families a certificate or 
voucher, to be used strictly for health care, worth more than $300 a 
month. They can use it to buy into the plan their employers offer but 
they could never afford, or they can shop for whatever private plan 
suits them best. That's the American commitment to choice at its best.
    For middle-income individuals and families, I propose a health 
insurance tax deduction of $3,750. American families with incomes under 
$80,000 will receive new help from either the credit or the tax 
deduction. Let me tell you what that means: new help to purchase health 
insurance for 95 million Americans. And once again, this insurance will 
be portable. People who change jobs would have insurance regardless of 
their health, and this is important, or regardless of their family's 
health. But best of all, my plan will bring health care coverage to 
almost 30 million uninsured Americans, security to people who for far 
too long have had to do without. That's the first point in this four-
point plan, access.
    Point two, we will cut the runaway costs of health care by making 
the system more efficient. Today, I'm asking you to learn a new acronym, 
HIN, health insurance networks. Insurance costs obey the law of large 
numbers. The larger the group being insured, the lower the cost per 
individual. Pooling lowers insurance costs and significantly cuts 
administrative costs. HIN's will provide incentives for small companies 
to do what Cleveland's COSE group has done when it brought 10,000 small 
businesses together to make a joint purchase of health care. The Nation 
should listen and follow.
    Another way to drive costs down: Make everyone a better health care 
consumer. Right now, most people pay more attention

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to the price of toothpaste then the comparative costs of health care. 
People don't waste much time thinking about the costs of their care, but 
in the end we all pay the price. We need to follow the lead of 
initiatives like Cleveland Health Quality Choice, programs that give 
people shopping for health care a kind of blue book for medical costs. 
Innovations like these will help all of us keep the costs of quality 
health care as low as possible.
    Point three, we will wring out waste and excess in the present 
system. We've targeted medical malpractice for reform. It is time to put 
an end to these astronomical, sky's-the-limit lawsuits. You shouldn't 
have to pay a lawyer when you go to the doctor. And our doctors, the 
most able and dedicated in the world, shouldn't be living in fear of 
these outrageous lawsuits. And high malpractice premiums mean higher 
doctors' bills, higher hospital costs, costs passed along not only to 
the patient but to every American taxpayer.
    Now, I have challenged the health insurance industry to cut redtape, 
to share common forms, to simplify and speed up claims processing. And 
here's a challenge for the next 4 years: There is no reason almost all 
health insurance claims can't be processed electronically. That single 
step would eliminate a mountain of health care paperwork and pare back 
costs.
    We've got to attack the excesses of mandated benefits. When States 
now order health insurers to cover 1,000 different types of treatment, 
something's gone wrong. Next thing they'll be covering manicures for 
Millie. [Laughter] It's gone too far. And I think everybody knows it. 
And we should challenge the States to do something about the excessive 
mandates that shoot these costs right up through the roof.
    Fourth and finally, we will get the growth in Government health 
programs under control. Right now, Government health care programs can 
claim a dubious distinction: They are the fastest growing parts in the 
Federal budget. For those of you interested in history, go back and 
listen to what was said about these programs at their inception. Go back 
and hear the rhetoric on the floor of the United States Congress. And 
now compare that to what actually has happened in these costs. This year 
alone, this year alone, let me repeat that, Medicaid costs will increase 
by 38 percent. We will not, repeat, not cut benefits. We can make real 
savings simply by reducing this huge rate of increase. We must bring 
runaway costs under control. Smart, sensible efficiencies will help our 
reform plan pay for itself.
    The Federal Government should also give States flexibility to design 
these new universal access programs for the poor, programs that will 
provide quality services to all their citizens. I've just met with 
Governor Voinovich and the rest of the Governors. Regardless of party, 
Democrat or Republican, it doesn't matter, they want flexibility. And we 
must give it to them. Right here in Ohio, your Governor has proposed 
health care reforms that will do for this State what we want to do on 
the Federal level. States should be able to use new Federal resources to 
design programs that work, not some one-size-fits-all solution imposed 
by Washington, DC.
    Providing affordable care, efficient care, wringing out excess and 
waste, and controlling Federal growth. These four points will create the 
kind of market-based reform plan that will give Americans the kind of 
health care they want and deserve and put an end to the worry that keeps 
them awake at night.
    Remember what people want. People want quality care, care they can 
afford, and care they can count on, care they can rely on. I keep coming 
back to what works for this country. Think about the challenges that we 
face as a Nation. Anyone who is concerned about competitiveness has to 
see controlling health care costs as key to a healthy economy. We've got 
to make certain our reform corrects our weaknesses without destroying 
our strengths. When we talk about health care, we're talking about 
matters of the most personal nature, in some cases literally life and 
death and decisions that go with it. We don't need to put Government 
between patients and their doctors. We don't need to create another 
wasteful Federal bureaucracy. As President I simply will not let that 
happen.
    We need commonsense, comprehensive health care reform, and we need 
it now.

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And my plan I really believe is the right plan, a plan that meets our 
obligation to all Americans by putting hope and health within their 
reach.
    Cleveland has led the way. Your hospitals, COSE, citizens in this 
community are way out front for these principles. And it's most 
appropriate that I give this speech to the Nation on health care reform 
right here in this city that is leading the way.
    Once again, my thanks for this warm Cleveland welcome. May God bless 
you all and the United States of America. Thank you very, very much.

                    Note: The President spoke at 12:36 p.m. at the 
                        Stouffer Tower City Plaza Hotel. In his remarks, 
                        he referred to Robert B. Horton, chairman of 
                        British Petroleum, and Mark Price, a member of 
                        the Cleveland Cavaliers basketball team. He also 
                        referred to the association's Council of Small 
                        Enterprises (COSE).