    [Public Papers of the Presidents of the United States: George W. Bush (2003, Book I)]
    [January 16, 2003]
    [Pages 57-63]
    [From the U.S. Government Publishing Office www.gpo.gov]

    Remarks at the University of Scranton in Scranton, Pennsylvania
    January 16, 2003

        Thank you all. Please be seated. Thanks for coming, and thanks for
    the warm welcome--inside. [Laughter] It's great to be back in Scranton,
    Pennsylvania, home of a lot of really fine people and a great
    university.
        And I want to thank the University of Scranton for the hospitality.
    I want to thank Father Joe McShane for
    opening up this wonderful facility for me, and a lot of members of the
    congressional delegation have come and the great Secretary of Health and
    Human Services, Tommy Thompson.
        I appreciate you all putting up with us and giving me a chance to
    talk about a significant problem which faces America.

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    And that problem is the fact that our medical liability system is
    broken, and therefore, a lot of Americans don't have access to
    affordable health care. And I'm here to declare in Pennsylvania, I
    intend to work with Congress to do something about it and fix the
    problem.
        And we're going to need your help. Democracy can respond. People in
    Washington tend to respond when the people speak. [Laughter] So I'm
    going to spend a little time today encouraging you and those who may be
    watching on TV to start speaking on your behalf, to make sure that you
    can afford health care in America.
        I'm traveling today with some mighty fine folks. One person decided
    to go back to Washington to represent Pennsylvania's interest on the
    Senate floor. He flew up with me. I talked to
    him about this issue, and that's Senator Arlen Specter. I want to thank
    him for his friendship. It looks like they're finally getting organized
    in the United States Senate. And they might start voting on the
    appropriations bill for '03, which would be helpful. [Laughter]
        I also was traveling with Jim Greenwood. I'm honored that Jim was on the plane. Jim was a sponsor
    in the House of Representatives of the legislation which I'm going to
    talk to you about today and which I hope I'm able to sign into law this
    year, to help the doctors and patients in the State of Pennsylvania. I
    appreciate you.
        Paul Kanjorski is here as well, the
    Member of the United States House of Representatives. Paul, I'm honored
    you are here. The issue we're talking today about is not a Republican
    issue. It's not a Democrat issue. It's an issue which affects people
    from all walks of life, and it's an issue which must be solved.
        A man who used to represent Scranton is Don
    Sherwood--I appreciate Don and his friendship--thank you for coming.
    With us as well is two other fine members of the congressional
    delegation from Pennsylvania, Todd Platts and
    Pat Toomey, and I want to thank you guys
    for being here today.
        I'm honored that the mayor of Scranton, Chris Doherty, is here with us. Mr. Mayor, thank you. He was
    standing out there in the cold, waiting for Air Force One. That's beyond
    the call of duty, I want you to know. [Laughter] But thank you, sir.
        I appreciate so very much the attorney general of the State of
    Pennsylvania, my friend Mike Fisher. I'm glad
    you're here, Mike. John Perzel is here,
    from--representing the House of Delegates, along with the senators and
    members of the House from this part of Pennsylvania. I'm honored you
    guys are here. Thank you for coming. Thank you for your interest in this
    issue.
        Today when I arrived, I met Ed Gilmartin.
    He's what we call a USA Freedom Corps greeter. He is a volunteer with
    the Goodwill Industries of Northeastern Pennsylvania. I want to thank Ed
    for coming. I want to thank him for working with Goodwill. He is a
    reminder that while one of us can't do everything to help heal the hurt
    of America, each of us can do something to help make somebody's life in
    your community a better place, and that, as we continue our struggle
    against people who are evil who would want to hurt America, that we can
    do so not only through the use of our great military, but we can do so
    by doing some good in our communities in order to fight evil. Each of us
    can do some good by loving a neighbor just like you'd like to be loved
    yourself.
        See, we've got some big problems in this country. I'm here to talk
    about one problem, but we've got some others. One is, how best to secure
    the peace. And one way to secure the peace is never to forget what
    happened to us on September the 11th and hunt the killers down, one by
    one, and bring them to justice, which is what America is going to do.
        We will continue to confront problems before they become acute. We
    understand that the world was changed on September

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    the 11th. Oceans no longer protect us from threats that may mass
    overseas. And that's why I've been clear about my desire to keep the
    peace by confronting Mr. Saddam Hussein. It's
    his choice to make. It's up to Mr. Saddam Hussein to do what the entire
    world has asked him to do. The world overwhelmingly, through the U.N.
    Security Council, said, ``Mr. Saddam Hussein, disarm for the name of
    peace.'' It's his choice to make. So far, the evidence hasn't been very
    good that he is disarming, and time is running out. At some point in
    time, the United States' patience will run out. In the name of peace, if
    he does not disarm, I will lead a coalition of the willing to disarm
    Saddam Hussein. We will deal with those problems overseas, and we will
    deal with the problems we have at home as well.
        We've got an economy that is not as strong as it should be, and
    therefore, I've proposed to Congress ways to strengthen the economy,
    starting with this principle: It is best to let Americans have more of
    their own money if you're worried about economic vitality.
        If you want people to find work, if you're worried about somebody
    looking for a job, like I am, the best way to encourage economic growth
    is to let people have more of their own money. And one of the lessons
    that I keep trying to explain to Washington--and, of course, these
    Members don't need to hear it--is that the money we spend in Washington
    is not the Government's money; it's the people's money.
        I look forward to working with Congress. I look forward to working
    with Congress to create an environment in which the small businesses
    grow to be big businesses, in which the entrepreneurial spirit is strong
    and, most importantly, in which people who are looking for a job can
    find work.
        But the problem I want to talk today is the problem with our health
    care system. I hope you're as proud of our health care system as I am. I
    mean, we're great at what we do. We've got great doctors in America,
    incredibly skilled, well-trained, compassionate people who care deeply
    for their patients. We've got great nurses in America, people who love
    their patients. We've got fine hospitals, fine researchers. We're on the
    leading edge of technological change in this country. We make new
    discoveries all the time. We develop new cures, and therefore, we
    develop new hopes for people who are sick. We're good at what we do, and
    I'm proud of the health care system of America.
        But we've got some problems. And one of my jobs is to talk plainly
    about the problems and encourage people to find solutions to the
    problems and then get them to act. We've got a problem because too many
    of our citizens go without health care. That's why I proposed refundable
    tax credits to empower people to be able to have the capacity to get
    into the marketplace to purchase health care.
        We've got a lot of people who go to emergency rooms for primary
    care, which strains our emergency rooms. It makes it hard on the
    community hospitals. That's why I'm for community health centers,
    realistic, smart ways to make sure people can get primary health care
    who don't have it.
        Our seniors need to have a reformed Medicare plan which includes
    prescription drugs. We've got a system that's stuck in the past.
    Medicare is stuck. Medicine has become modern, and Medicare hadn't. And
    it seems like to me a good place for Congress to start is to take a look
    at their own health care system. They've got choice in the system.
    Congressmen and Senators and their staffs can pick and choose the plan
    that meets them best. It seems to me a good principle for our seniors,
    to trust our seniors to make the right decisions for them.
        And medical care is expensive. Out of $100 spent in this country,
    $11 goes to pay for health care. Costs are rising at the fastest rate in
    nearly a decade. I mean, that's a problem. Most costs in our economy are
    pretty well under control. Inflation

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    is low, but that's not the case in health care. And we need to do
    something about it, before people get hurt.
        Health care costs rise for a lot of reasons. Research is costly.
    Technologies cost money, and they're expensive. And some of the costs
    are necessary, but there are some costs that are unnecessary as far as
    I'm concerned. And the problem of those unnecessary costs don't start in
    the waiting room or the operating room; they're in the courtroom. We're
    a litigious society; everybody is suing, it seems like. There are too
    many lawsuits in America, and there are too many lawsuits filed against
    doctors and hospitals without merit.
        And one thing the American people must understand is, even though
    the lawsuits are junk lawsuits and they have no basis, they're still
    expensive. They're expensive to fight. It costs money to fight off a
    junk lawsuit. And oftentimes, in order to avoid litigation and
    oftentimes to cut their costs, docs and therefore the companies that
    insure them just settle. See, so even though there's no merit, in order
    just to get rid of the thing, they just say, ``Okay, let's just pay you.
    We'll get you out of the way. Instead of maybe suffering the
    consequences of a lousy jury and a lousy verdict, just pay them off.''
    That is expensive to the system when it happens time and time and time
    again, like it's happening in America today.
        And what's happening is these rates for insurance are going out of
    sight. And doctors need insurance to practice. Today I met with a lot of
    great health-givers and healers, decent people, compassionate Americans
    who love their patients. These are docs--I met with some patients as
    well--talking about the effects of this litigious society we have. And I
    heard stories about people not being able to pay their premiums. See,
    that means that health care is no longer accessible to too many of our
    citizens. When a doc can't pay the premiums and therefore can't
    practice, somebody is going without health care. It strains the system.
        So what happens is, doctors say, ``Well, gosh, I can't afford it
    here in Pennsylvania. I'm moving. I'll just take my heart and my skills
    to another community where I can afford it.'' But when that happens,
    somebody hurts. Somebody doesn't have the care. Some mom fixing to have
    a baby wonders out loud--when she wonders out loud whether or not the
    doc is going to be there to deliver the baby, it's a--we heard a story,
    by the way, about that. It's a sad situation. There's a lot of
    uncertainty in our society. Lawsuits run up the costs for you, the
    patient. But they also create a sense of uncertainty in America for
    people who need the stability of good care.
        I had a chance to, when I talked to the docs, to talk about people
    who literally had tears in their eyes when they described their
    situation. Debra DeAngelo and her
    husband are leaving Scranton to go to
    Hershey. They wanted to stay here in Scranton. They were raised in
    Scranton. I met one of Debra's patients who really needs her to be in
    Scranton. They chose so because they can get their insurance there, and
    they can't here.
        This insurance issue is creating a problem in our communities all
    across America. People are having to move. People who don't want to move
    have to move in order to stay in business to be able to do their job.
        Jack Brooks is a respected pathologist at
    the University of Pennsylvania Hospital. He was there today. He went to
    Buffalo. He moved back to his State, but he was turned down by three
    insurers when he came back to Pennsylvania. The fourth insurer's quote
    was just too high. He couldn't afford it. Jack Brooks has never had a
    claim filed against him. He's one of your leading docs here in the State
    of Pennsylvania. He's one of your best assets. He's never been to the
    courthouse. And yet, because the system is broken, he couldn't afford to
    be in Pennsylvania. Fortunately, he got some

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    insurance through a hospital. He couldn't do it on his own. You've got a
    problem here in this State.
        Greg Przybylski was here. He's a brain
    doctor. He has been moving from Pennsylvania to Illinois to New Jersey
    because the costs were too high. He can't stay in business. He can't do
    what he was trained to do and loves to do, which is to treat patients.
    He talked about--when he was living in Chicago, he talked about a
    patient of his who had incredible complications. The guy couldn't find
    help in Pennsylvania, so the man drove all the way out to Chicago to be
    treated by Greg. That says a lot about Greg. It says a lot about his
    patients. And unfortunately it says something bad about the health care
    system, when liability costs are such that you can't get the kind of
    care that you need in Pennsylvania.
        You're not alone, though. It's not just your State that's got a
    problem. We heard from an OB/GYN in the State of Florida about how she
    couldn't get insured. In Nevada, pregnant women sometimes have to leave
    the State to find a doctor. One woman called more than 50 local doctors
    and couldn't find one to serve her. So she's going to go to Utah to have
    her baby.
        I was down in Mississippi recently to talk about this issue. There's
    a doc and his wife, who's also a doctor, who came from up north down to
    Mississippi in the Delta region of that State. And the Delta region has
    got a lot of people who hurt, a lot of people who are needy, a lot of
    people who need health care. And they went, not to build a giant
    portfolio of wealth; they went because they got great hearts. They heard
    a calling. They heard--he would have attributed it to the Almighty.
    Having watched him, I would have attributed it to the Almighty, too. He
    has got a fantastic heart to him. I could see that he was inspired. He
    told me he's leaving the Delta because the trial lawyers ran him out. He
    couldn't practice medicine without getting sued.
        Something's wrong with the system. And a broken system like that,
    first and foremost, hurts the patients and the people of America. Twenty
    percent of hospitals nationwide have had to cut down on certain
    services, on delivering babies or neurosurgery or cardiovascular surgery
    or orthopedic surgery. That's a fact. So the problem is not only for
    Pennsylvania; it's a problem for our country.
        And there's another cost driver. And if you're worried about getting
    sued all the time, then there is the natural tendency to practice what
    they call defensive medicine. In other words, you order tests that
    someone may not need, to protect yourself in a court of law. And that's
    costly, and that's one of the main reasons why costs are going up. These
    lawsuits have got a lot of effects on our country, and we've just got to
    understand that.
        This is an incredibly important issue for States. I obviously hope
    the State of Pennsylvania is able to address it. That can happen in the
    statehouse. When I got to Washington, I said, ``That's an important
    issue for the States.'' And then it didn't take me long to realize, this
    is an important issue for the Federal Government too, and I'll tell you
    why. The direct cost of malpractice insurance and the indirect cost from
    defensive medicine raise the Federal Government's health care cost by at
    least $28 billion a year. Malpractice, defensive practice of medicine
    affects Medicare, Medicaid, veterans' health, Government employee costs.
    It affects the Federal Government. Therefore, it is a Federal issue.
        It is a national problem that needs a national solution. And here it
    is. First, let me just say this as clearly as I can: We want our
    judicial system to work. People who have got a claim, a legitimate
    claim, must have a hearing in our courts. Somebody who has suffered at
    the hand of a lousy doc must be protected. And they deserve a court that
    is uncluttered by frivolous and junk lawsuits. If they prove damages,
    they should be able to recover the

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    cost of their care and recovery and lost wages and economic losses for
    the rest of their life. That's fair. That is reasonable. And that is
    necessary for us to have confidence in the medical system and in the
    judicial system.
        Yet, for the sake of affordable and accessible health care in
    America, we must have a limit on what they call non-economic damages.
    And I propose a cap of $250,000. Otherwise, if not, excessive jury
    awards, like those in Pennsylvania, and those I was just--one was just
    described to me--today a guy held up a full-page ad in your newspaper
    paid for by the excessive jury award. [Laughter] Excessive jury awards
    will continue to drive up insurance costs, will put good doctors out of
    business or run them out of your community, and will hurt communities
    like Scranton, Pennsylvania. That's a fact. And that's why we need a cap
    on non-economic damages, and that's why we need a cap on punitive
    damages as well.
        As I mentioned to you--and it's important for our citizens to
    understand--it is the fear of unlimited non-economic damages and
    punitive damages that cause docs and the insurance carriers to
    unnecessarily settle these cases. See, you can pretty well blackmail a
    doctor into settlement if you continue to throw lawsuit after lawsuit,
    and the system looks like a giant lottery. [Applause] Thank you.
        There needs to be other reforms as well. A lot of times, these
    lawyers will sue everybody in sight in order to try to get something. In
    cases where more than one person is responsible for a patient's
    injuries, we need to assign blame fairly. We need joint and several
    liability reform in our medical liability system.
        We need to make sure that doctors can take care of their patients
    without fear that their advice will be used against them some day. It's
    hard to believe a system--you hear a lot about the doctor-patient
    relationship. It's an incredibly important relationship, in order to
    make sure we have a health care system that functions well. And yet
    imagine a system where docs can't share information amongst each other,
    much less talk to your patient, for fear that what they say will be used
    them in court one day.
        The system is not balanced, if that's the case. The system is not
    fair. The system doesn't need to have a relationship with the doc and
    the patient for fear of what is said will be used by a lawyer to sue
    them. That's why we need these reforms, for the good of the country.
        We got the bill passed out of the House, thanks to Jim and the members of the delegation here. And I want
    to thank you for your leadership and your vote. And the Senate didn't
    act on it, so we've got to start over. And I'm ready to start over.
        And the time is getting worse. That's what people have got to
    understand up there in Washington--or over there in Washington--down
    there in Washington--whatever. [Laughter] Thought I was in Crawford for
    a minute. [Laughter]
        And this is--I repeat, this is a national problem, and we just
    cannot allow a bunch of needless partisanship to prevent a good, solid
    solution from going forward. And let me say one other thing. This
    problem won't be solved by just throwing money at the problem. This
    problem will be solved by getting at the source of the problem, which
    are the frivolous lawsuits.
        If you're looking for solutions in Pennsylvania, look at States
    which have done a good job of helping the patient out. California is one
    example. More than 25 years ago, they passed a law that caps damages
    from malpractice suits. And the law has worked.
        Let me tell you a startling statistic. Reports from Philadelphia say
    that juries there have awarded more in malpractice damages than the
    entire State of California did over the last 3 years. That says two
    things: California's law is what people in your statehouse ought to look
    at, and you've got a problem in Pennsylvania.
        There was a good news story in Mississippi. I went down there and--
    it wasn't

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    because of me, it was because the doctors and the citizens understand
    the cost of a trial system gone awry, and they got themselves a law. And
    they got a medical liability law. They put caps, real caps. Guess what
    happened? In some counties, the malpractice claims rose dramatically
    before the law came into effect. [Laughter] Now, what does that tell you
    about the system? It tells you the system is less about justice and more
    about something that looks like the lottery, is what it looks like to
    me. And with the plaintiffs bar getting as much as 40 percent of any
    verdict, sometimes there's only one winner in the lottery.
        We need reform. You need reform in Pennsylvania, and we need reform
    all across America, and we need a law coming out of the United States
    Congress. It's a law that recognizes the centerpiece of good health care
    is to worry about your patient, the American people. It's a law that
    will recognize that an affordable and accessible health care system can
    best be had if we limit the caps--put caps on non-economic and punitive
    damages. That's what it understands.
        Congress needs to act on this law. Congress needs to listen to the
    people and not make excuses as to why they can't get something done. I
    believe we'll get something out of the House. I believe we'll get us a
    good law out of the House, and then the Senate must not fail its
    responsibilities to the American people again.
        And you can help. Every State's got them a couple of Senators--
    [laughter]--and they need to hear from you. I consider your two Senators
    allies, but they need to hear from you. Every State--people who are
    concerned in every State about whether or not they're going to have
    affordable health care or health care at all need to contact the people
    that represent them. See, democracy can work. Democracy makes a
    difference. When the people speak, the folks in Washington, DC, listen.
    And I'm here to ask you to join in this important cause, for the sake of
    people you care about, your loved ones and your neighbors and the people
    in your communities.
        No, we've got a lot of problems facing America. We've got the
    responsibility to make the world more peaceful. We have the
    responsibility to make sure our homeland is secure. We've got the
    responsibility to make sure every child is educated. We have a
    responsibility to make sure our health care systems work. We've got a
    lot of problems. But I'm going to tell you something about this country.
    In my mind, there is no doubt that we won't solve these problems,
    because this is the greatest nation, full of the finest people, on the
    face of the Earth.
        Thank you for coming. May God bless. Thank you all.

    Note: The President spoke at 12 noon in the William J. Byron Recreation
    Center. In his remarks, he referred to Joseph M. McShane, S.J.,
    president, University of Scranton; Pennsylvania State Representative
    John Perzel; and President Saddam Hussein of Iraq. The Office of the
    Press Secretary also released a Spanish language transcript of these
    remarks.