[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.