[Public Papers of the Presidents of the United States: George H. W. Bush (1992, Book I)]
[May 13, 1992]
[Pages 759-763]
[From the U.S. Government Publishing Office www.gpo.gov]



Remarks to the Health Care and Business Community in Baltimore, Maryland

May 13, 1992
    Thank you, Dr. Heyssel, for that introduction. I understand that 
you'll be retiring in a few weeks as CEO of Johns Hopkins Health System, 
after 20 years of building bridges with this marvelous community. I got 
briefed on this, and I'm told that you'll leave a great legacy, that new 
outpatient clinic which bears your name and opens for business on 
Monday, a well-deserved tribute to a great man.
    We also have with us today my top adviser on health and our head of 
HHS, Dr. Lou Sullivan; where's Lou? Right over behind me--who you met 
earlier on. But I just want to say what a joy it is to have him at my 
side as we try to come up with better answers for America's health care. 
He's doing a superb job there. And I want to

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single out also another that has been at my side all day and is an awful 
lot of the time, that I have great respect for, and that's Governor 
Schaefer, the Governor of your State, who is with us here today. We also 
have several members of the legislature, the city council from 
Baltimore. I'm glad to see Mr. Winters, an old friend who's CEO of the 
Prudential. And he's been to the White House to discuss the future of 
our Nation's health care with me. And then of course, Barbara Hill, 
you'll get around her for about 5 minutes, and you're semi-exhausted. 
The energy and the enthusiasm that she brings to this health plan is 
simply contagious. I have a much better feeling what it's all about just 
by being around Barbara Hill. Thank you very much for a great day.
    I don't know whether it's appropriate or not to be discussing 
medical care here at Dunbar, the home of the Dunbar Poets, but 
nevertheless, to all at Dunbar, my sincere thanks. And with their 
unbeaten streak, maybe Pete Pompey should become my adviser on health 
care as well as on fitness. [Laughter]
    But I was interested to hear about the school's cooperative health 
studies with Johns Hopkins, which is not only on a summit in Baltimore 
but is at the summit of medical excellence for our whole country. It's 
terrific that nearly 20 percent of Dunbar's student body is involved in 
this health studies program, 20 percent. And I also want to recognize 
another institution that calls Dunbar home, Sojourner-Douglass College, 
for its strong commitment to the Baltimore community.
    Before sharing with you a few observations on health care, let me 
just touch on an issue that I know is of concern to all Americans, 
everyone concerned about conditions particularly in America's inner 
cities, with special reference in these remarks to Los Angeles. In 
addition to FEMA, the emergency management, and to SBA, the Small 
Business Administration's assistance, the Federal Home Loan Bank System 
is going to make available $600 million to finance the rebuilding of 
housing and businesses in Los Angeles. These loans, made through the 
Community Investment Programs, are good news for the people who lost 
homes and jobs as well as the owners who lost businesses due to the 
unrest out there. It's one way that we can underscore the fact that we 
are serious about helping Los Angeles recover. I think the Nation is 
focusing on how well all levels of government come to bear on helping in 
the recovery and the re-stimulation of the community there in Los 
Angeles.
    Beyond our urgent emergency aid, we have got to take action to bring 
hope and opportunity to Los Angeles. But it's not just Los Angeles, it 
is to all American cities. Yesterday we had a good meeting with the 
congressional leaders, Republican and Democrat. We outlined, or I did, a 
six-point plan for a new America: Our ``Weed and Seed'' crime 
initiative, weed out the criminals, seed the neighborhoods so that you 
can have hope and opportunity there. Our HOPE initiative, it's a 
homeownership, housing initiative. I think enterprise zones we've heard 
a lot of talk about, but when we were out in California, the community 
leaders all urged that we try this concept of enterprise zones to 
attract like a magnet, draw business and opportunity into the 
communities. Fourth, and a little longer run answer, is education 
reform. I'm kind of preaching to the choir right here in Dunbar on that 
one because there's an awful lot of innovation going on in Baltimore in 
the schools and in Maryland generally. But education reform is 
essential. Welfare reform, I think, is essential. And then, of course, a 
strong jobs program for city youth across the country.
    So these are the ingredients or the tools that we are going to try 
to work with. I'd like to use this opportunity to report to the American 
people that yesterday's meeting put partisanship aside, and I am very 
hopeful that we can get something done for this country. I am pleased 
with the early reaction, as I say, but now the thing is to follow up and 
push ahead.
    Now, to the reason that's brought us all together. I really had a 
wonderful experience here spending some time four blocks over in the 
East Baltimore Medical Center. It is a terrific example for the rest of 
the country. And the rest of the country can follow this example. It's 
based on a special

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kind of public-private partnership, and the kind that we've been 
advocating, in this case among Johns Hopkins, the Pru, the Prudential 
Insurance Company, the State of Maryland, and the Federal Government. 
It's that broad a partnership.
    This problem-solving partnership advances what's known as 
coordinated care, the future of health care in this country. Thanks to 
this partnership, this is the largest, the largest and fastest growing 
HMO in Maryland. It was there, 8 years ago, that Hopkins helped pioneer 
the concept of a Medicaid HMO. And it's great to see EBMC's success 
because it proves what I strongly believe, that we can meet the 
challenge of controlling health care costs while providing the finest 
quality service. When I think of Johns Hopkins, I think of the quality 
of medical care, the quality of research, and we must not adopt a plan 
that diminishes the quality of American health care. So I congratulate 
you. For while this HMO saves members, employers and government money, 
health care stays first-rate, and it's a great example.
    The key to this center's success, especially for Medicaid patients, 
is that coordinated health care makes creative approaches possible. It 
provides quality care at lower cost with an emphasis on, and we saw it 
right there, prevention. It's just plain common sense. We're better off 
keeping people healthy rather than treating them after they're sick.
    Just Monday, Lou Sullivan and I met with some leaders on our effort 
to improve infant health and immunization. There's nothing that makes 
the case for coordinated care like seeing these healthy kids. Preventive 
medicine improves the quality of life for patients and certainly saves a 
lot of unnecessary expenditures. Coordinated care can work for all 
Americans. But it's especially important for Medicaid recipients. It 
ensures they get care when they need it, where they need it, and that 
they get it in a cost-effective way. EBMC proves this is a viable 
alternative to the opposite of coordinated care, that fee-for-service 
system.
    It also means better care for a kid who steps on a rusty nail out on 
Orleans Street. Before belonging to a coordinated care center, he would 
have gone to Hopkins emergency room. They'd be seeing him for the first 
time so they wouldn't know his background; they wouldn't know if he'd 
had a tetanus shot or if he were allergic to, say, penicillin. They'd 
have to spend that time and money doing unnecessary tests, maybe double 
treatment. But now when he shows up at his center's urgent care unit, 
they just check his history and treat him faster and at a fraction of 
the cost.
    I am excited to see so many pieces of this comprehensive health 
reform program that we are promoting already successfully at work right 
here at EBMC. I introduced a plan February 6 to address the twin 
challenges of expanding access and of containing cost, while building on 
the strengths of this present health care system. I was determined to 
treat the root causes of our problems, not just the symptoms. Above all, 
our plan is inspired by the words of physician Frederick Banting, ``You 
must begin with an ideal and end with an ideal.''
    In the greatest, most technologically advanced Nation on the face of 
the Earth, there is no reason that one of seven Americans has no health 
insurance. And what we must do is clear. We must guarantee every 
American access, access to affordable health insurance.
    Let's face it. We are in a peculiar year, in an election year, when 
all kinds of crazy things happen out there. And it seems like everyone's 
got a prescription for health care. And yes, people want quality care 
they can afford and rely on. But we don't need to put the Government 
between the patients and their doctors. And we don't need to build a 
whole new Federal bureaucracy. We need commonsense, comprehensive health 
care reform, and we need to start on it right now.
    Sure, the other approaches can sound great, but you've got to look 
at what you really get. National health insurance, believe me, means 
more taxes, long lines, long waiting lists, and here's a matter of great 
concern to people that are in this area of 
excellence, lower quality care. Their idea 
for cost control is flat out what you call price fixing, an idea we know 
just simply will not work. Look at Medicare, which adopts set prices for 
many seniors' health

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services. But Medicare inflation far outstripped private health care 
inflation in the seventies and the eighties, and it is still growing at 
12 percent. The national rate of inflation, thank heavens, is far below 
12 percent, and cost containment is not its strong suit. Price fixing by 
Congress has never worked before, and in my view, it simply will not 
work.
    The so-called--we were talking about this coming in over in the 
car--the so-called ``play or pay'' approach, in my view, is equally 
unsound. Even many proponents admit that it will melt down into national 
health insurance within a few years. It does nothing to address the cost 
problem, where patients don't know or care how much health plans cost, 
nothing except to once again try to fix the prices. It's a package full 
of empty promises. Our comprehensive reform plan is based on these 
commonsense principles: Competition, consumer choice, quality, I come 
back to that, and efficiency.
    Now while most people in this country are provided the highest 
quality health care in the world, millions of others are uninsured. And 
those are the ones we've got to worry about. They are the ones that must 
be covered. And we must make people aware of the costs and varying 
quality of care, so they'll be better consumers. But there will always 
be a limit to how cost-sensitive we can make people. When a kid falls 
off a bike or cracks his head, not many parents question the cost of a 
CAT scan or an MRI; their kid's health is too precious to bargain over.
    So the competitive answer must be to group our consumers together. 
We must combine small employers, who often pay the bills, and 
individuals into large, educated, informed purchasing groups that can 
drive efficiencies back into the health care system. These health 
insurance networks are going to pool, what we call pooling. They will 
pool consumer information. They will pool risk, and they will pool 
purchasing power to make the system more responsive to the demands of 
the consumer. Our plan will dramatically reform our market-based system. 
It will ensure that quality care is within reach of every American 
family, and it will preserve choice. It will keep costs down, and we 
believe that it will keep access up.
    First, the plan will cut the runaway costs of health care by making 
the system more efficient. We'll call for innovative approaches like the 
one we see here in east Baltimore. Secondly, it will wring out waste and 
excess. Third, it will control Federal growth, since health care is the 
fastest growing part of the Federal budget. And fourth, my plan will 
make health care more accessible by making it more affordable. We'll 
provide up to $3,750 in health insurance credit or deductions for low- 
and middle-income families--they have to use that to purchase 
insurance--and guarantee access to insurance for all low-income 
Americans. These credits, combined with market reforms, will bring 
health insurance to approximately 30 million now uninsured Americans.
    Maryland is already getting on board this voucher approach with 
bipartisan legislation. The Maryland State House, I'm told, has outlined 
a standard health package to cover all low-income Marylanders through 
tax credits. The proposal to implement this tax credit plan passed the 
house a few weeks ago and is being reviewed in the legislature this 
year. Under my plan, this type of low-income credit would be available 
in all States, and Maryland would have the ability and financial help it 
needs to make this reform into a living reality.
    I've proposed the most comprehensive health care package out there. 
And now is the time to challenge the Congress and to see if it's 
interested in this kind of real reform. Ours is a plan that will 
fundamentally restructure, and this is the point, restructure health 
care in America.
    There are steps we can and must take right now. Part of our plan 
entails significant reform of the insurance markets, for which there is 
a strong bipartisan support. Senator Bentsen, Chairman Dan Rostenkowski 
of the Ways and Means Committee, Senate Republicans, the House 
Republican task force all support very similar reforms that with certain 
changes, some modification, can and should be passed immediately. 
Congress must begin to move now. Even if all they do this year is just 
pass our insurance market reform, we'll at least get a

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start on changing the system. These reforms will go a long way toward 
curing the inequities in cost and coverage under existing health 
insurance practices.
    There's another bipartisan reform package out there. It was proposed 
by Senator Pat Moynihan and Senator Dave Durenberger, and that is in 
most respects consistent, it is, with my plan and would promote much 
greater use of coordinated care in Medicaid. East Baltimore knows that 
this works. We must make it easier for the rest of the country to follow 
your pioneering road to better health care. In fact, as part of our plan 
for comprehensive reform, I want to make coordinated care the norm, not 
the exception, for Medicaid. We must work together now to pass these 
reforms that will provide literally millions of Americans with 
affordable health coverage for the first time and then get a leg up on 
that comprehensive reform.
    Our plan does everything the Government can and should do to ensure 
the quality of life of each citizen of this great land. It doesn't 
promise the Moon. It does something more important: It really 
guarantees, it promises the future. Reform is never easy, but in health 
care I think, wherever you're coming from, I think everybody would agree 
health care reform is a must. And we will deliver what we say we can, 
competition, competition-driven, market-based reform, and we'll deliver 
it proudly.
    This is kind of a second unveiling of our overall program, but it 
seemed most appropriate to bring out these specifics here in Baltimore, 
an area where you've had so much innovation, so much excellence, so much 
success. So I just want you to know we're serious about this. We are 
going to continue to push for it, and we must get started right now.
    I have learned a lot today, and I am very grateful to those who have 
shown me what is going on in this exceptional health care facility. I've 
always had great respect for what is going on in Johns Hopkins, this 
institution of excellence in every category.
    So as I conclude, let me say, I am not pessimistic about our ability 
to help those people who need help in terms of health care. We can get 
the job done. I will now be trying to work with our hands extended in a 
nonpartisan or in a bipartisan mode to see if we can't make things a 
little better for the people, some of whom I saw here today.
    Thank you all very much for listening. And may God bless the United 
States.

                    Note: The President spoke at 3:30 p.m. at Paul 
                        Laurence Dunbar High School. In his remarks, he 
                        referred to Dr. Robert M. Heyssel, president, 
                        Johns Hopkins Health System; Robert C. Winter, 
                        chairman and chief executive officer, the 
                        Prudential Insurance Co.; Barbara Hill, 
                        president, Prudential Health Care Plan of the 
                        Mid-Atlantic; and Pete Pompey, athletic director 
                        and basketball coach at Dunbar High School.