[Public Papers of the Presidents of the United States: George W. Bush (2005, Book I)]
[January 5, 2005]
[Pages 8-15]
[From the U.S. Government Publishing Office www.gpo.gov]



Remarks Following a Discussion on Medical Liability Reform in 
Collinsville, Illinois
January 5, 2005

    The President. Thank you all. Please be seated. Thanks for coming 
out to say hello. It's great to be in southern Illinois. I appreciate 
the chance to come to Madison County. I'm honored to be the first 
sitting President to visit the city of Collinsville. I'm sorry 
Laura is not with me.
    Audience members. Aw-w-w! [Laughter]
    The President. That is generally the reaction. [Laughter] I was 
hoping she and I could go look at the Catsup 
Bottle. [Laughter]
    Thanks for waiting on me. I had a visit with some of the--some folks 
from the area here, a neurosurgeon, a cardiologist, the administrator of 
a hospital, ob-gyn, a patient, all about the health care crisis that 
exists here in this part of the world. And that's what I'm here to talk 
about. I'm here to talk about how we need to fix a broken medical 
liability system.
    I want to thank all the good folks who provide health care for the 
folks in this part of the world, the nurses, the docs, the 
administrators. Thank you all for coming. Thanks for your compassion. 
Thanks for your care. Thanks for taking an active interest in an 
important issue that faces not only this part of the world but the 
country. But really what I'm here to do is to make--say as clearly as I 
can, the United States Congress needs to pass real medical liability 
reform this year.
    And there's no doubt in my mind we have a strong ally in this issue 
in the great Speaker of the House of Representatives from the great 
State of Illinois, Denny Hastert.
    And I want to thank Congressman John Shimkus for his leadership not only on this issue but on other 
issues. It's good to be with his wife, Karen, 
again, sons, David, Joshua, and Daniel. Nice to see you 
boys. And you brought Mom and Dad. Your mom is probably telling you what 
to do, just like mine is. [Laughter] You're probably listening about 
half the time, just like I am. [Laughter] Welcome.
    I'm also proud to be traveling today with a great Congressman from 
Peoria, Illinois, Ray LaHood. Thank you, sir. 
Appreciate you coming.
    The State Treasurer of Illinois has joined us, Judy Baar 
Topinka. Appreciate you. Tom Cross is here. He's the minority leader in the house. I'll tell 
you what he's doing in the house of representatives for the State of 
Illinois: He is leading the medical liability reform effort. And I want 
to thank you, Tom, for taking a strong role. Appreciate you coming.
    I know the mayor is here. Mr. Mayor--yes, he's here, Stan 
Schaeffer. I appreciate you coming, Mr. 
Mayor. Appreciate you being here. I usually like to give mayors 
unsolicited advice: Fill the potholes. [Laughter] You've probably got 
some advice for me: Pass the highway bill. [Laughter]
    I want to thank those of you who are working on this medical 
liability issue here in the State of Illinois. I appreciate your 
efforts. Look, it's about time the medical profession gets involved. 
It's about time you let people know what's on your mind. It's time to 
make sure that the issue comes to the forefront not only at the Federal 
level but at the local level as well.
    I want to thank Connie Bergmann. I met 
Connie. She came out to the airport--airbase, and--kind of airbase-
airport combo, I guess it is. She is a volunteer for the American Red 
Cross. The reason I bring her up is, every stop I make in America I like 
to herald a citizen who's taken time out of his or her life to volunteer 
to make the country a better place. See, the great strength of America 
is not our military

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might, and it's certainly not the size of our wallets. The great 
strength of America lies in the hearts and souls of our fellow citizens, 
people who are willing to love a neighbor just like they'd like to be 
loved themselves, people who are willing to take time to volunteer to 
make America a better place. And Connie Bergmann is such a person. And I 
want to thank you for serving the Red Cross.
    And speaking about the Red Cross, the International Red Cross is 
doing heroic work in a part of the world that has suffered incredible, 
incredible death and destruction. The American people express our 
sympathy to the victims of the tsunami disasters.
    Yesterday I spoke to Secretary of State Colin Powell and Governor Jeb Bush of Florida, who 
I sent on a delegation--with a delegation to assess the relief 
operations. And they reported in that the devastation is beyond 
comprehension. They also reported in that they will come back with an 
assessment about how we can more effectively help. But they also 
reported that our military is doing heroic work in helping to save life. 
They're flying rescue missions 24 hours a day. They're making a huge 
difference in the people's lives over there by delivering supplies 
directly to those in need. Our Government has not only stepped up with 
the use of military assets, but we have pledged $350 million in disaster 
assistance to help the people over there who are suffering.
    There's huge generosity here in America as well. As you know, I 
tapped a couple of ex-Presidents--[laughter]--number 41 and number 42, 
to help out. I asked them to help, and they are. My dad and President Clinton 
have graciously given of their time to help make sure that people know 
there is a need and to make sure the 
donations are properly channeled into 
programs that work. If you want to help, get on the Internet for the 
USA--www.usafreedomcorps.gov. There's a place to help. And on that web 
page, you'll find different agencies which are doing the good work.
    What I don't want is, I don't want people to be sending money to 
places that aren't really doing the job. We don't need to support 
organizations that aren't effectively delivering compassion and help. 
And so on this web page, you'll find a way to help, if you so desire to 
do so. What they tell me is, the most important contribution a person 
can give is cash, and let the agencies on the ground be able to use that 
cash to best meet the needs of those who have suffered.
    I want to thank all the Americans who thus far have been 
participating in this urgent cause. You're showing the true strength of 
America through your good heart.
    I don't know if you know this: This is my first trip after the New 
Year. And it's good to come here to Illinois. I'm rested and ready to 
continue to serve to be your--to continue to be your President and to 
serve the people of this country. And we've got a big agenda item--a big 
agenda and a series of items that we'll be dealing with.
    First of all, we're going to win the war on terror. We've still got 
to--we will be steadfast. We will be resolved. We'll be wise. We won't 
give in to these people. We have a duty in your Government to protect 
the American people. So the second big task at hand is to make sure we 
do everything we can to protect our homeland. And I will assure you I 
will continue to work to spread freedom and democracy and, therefore, 
peace in parts of the world that are desperate for freedom, democracy, 
and peace.
    We're going to work with the Congress to be wise about how we spend 
your money. We're going to keep your taxes low so this economy continues 
to grow. We're going to continue to work with our farmers and ranchers 
to make sure they can sell the products overseas, in markets where 
people need food and beef and pork. We're going to work to pass a 
national energy

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plan. We're going to work to cut our deficit in half over the next 5 
years.
    And I look forward to working with members of both political parties 
to do something about our health care system. First, it is important for 
Americans to understand we have the best health care system in the 
world. And we need to keep it that way. We've got the best hospitals, 
both urban and rural. We've got the world's most talented and 
compassionate doctors and nurses. And we've got the world's--and we lead 
the world in innovative research. We're on the cutting edge of change. 
We're saving lives through our research. Americans should be proud of 
our medical system, and we all must be grateful for those who work hard 
to provide compassion and care.
    Our health care system faces serious challenges. We all know that. 
The cost of health care is rising rapidly, and that burdens our 
families. It hurts our small businesses. It makes it harder for the job 
creators to expand the job base. Too many Americans are left struggling 
to find affordable health care. And so I think we need to take practical 
steps to make sure this health care system of ours is more affordable 
and available, and we've got to take those steps this year.
    To improve health care in America, we need to expand the use of 
health savings accounts. It's a product that lets you save tax-free for 
routine medical care while keeping affordable coverage against major 
illness. Small businesses must be allowed to join together, to pool risk 
so they can buy insurance for their employees at the same discounts that 
big businesses are able to do.
    To address the cost of medical care, we need to apply 21st century 
information technology to the health care field. We need to have our 
medical records put on the IT. We need to make sure that we speed up the 
delivery and arrival of cheaper generic drugs to help control costs. We 
want to make sure our Medicare system still allows seniors to have 
choice in the system.
    There's a lot we can do. We've got to make sure we expand community 
health centers around our country to provide care for the poor and the 
indigent. And we've got to make sure low-income children are enrolled in 
government health care programs so they receive the care they need. 
These are practical steps to help people be able to find health care at 
affordable prices and, at the same time, make sure the health care 
system is not run by the Federal Government but by patients and doctors.
    To make sure our health care system works the way we want it to 
work, we've got to address the root causes of rising medical costs. Part 
of addressing those costs can be achieved by introducing information 
technology. Part of addressing those costs can be achieved by 
introducing generic drugs faster, just like I mentioned.
    Some of the cost increases in our health care system are necessary 
and worthwhile. After all, research into new treatments requires major 
investments. World-class medical technology is expensive. In other 
words, to stay on the leading edge of medicine, it costs money. And I 
suspect somebody whose life has been saved by the latest technology is 
going to say that cost increase was necessary. But some costs are not 
necessary. And that's what the American people must understand and 
Members of the United States Senate and the United States House must 
understand.
    Many of the costs that we're talking about don't start in an 
examining room or an operating room; they start in a courtroom. What's 
happening all across this country is that lawyers are filing baseless 
suits against hospitals and doctors. That's just a plain fact. And 
they're doing it for a simple reason: They know the medical liability 
system is tilted in their favor. Jury awards in medical liability cases 
have skyrocketed in recent years. That means every claim filed by a 
personal-injury lawyer

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brings the chance of a huge payoff or a profitable settlement out of 
court. That's what that means. Doctors and hospitals realize this. They 
know it's expensive to fight a lawsuit, even if it doesn't have any 
merit. And because the system is so unpredictable, there is a constant 
risk of being hit by a massive jury award. So doctors end up paying tens 
of thousands or even hundreds of thousands of dollars to settle claims 
out of court, even when they know they have done nothing wrong.
    That's what's happening in the system today. It's a system that's 
just not fair. It's costly for the doctors. It's costly for small 
businesses. It's costly for hospitals. It is really costly for patients.
    When those providing insurance have to pay the bills for enormous 
jury verdicts or out-of-court settlements, they have to raise premiums 
on physicians they cover. Specialists in high-risk practices like ob-gyn 
or neurosurgery are particularly vulnerable to lawsuits, so their 
premiums rise the fastest. You're about to hear a couple of stories of 
folks in this area who can testify to that fact.
    Because junk lawsuits are so unpredictable, they drive up insurance 
costs for all doctors, even for those who have never been sued, even for 
those who have never had a claim against them. When insurance premiums 
rise, doctors have no choice but to pass some of the costs on to their 
patients. That means you're paying for junk lawsuits every time you go 
to see your doctor. That's the effect of all the lawsuits. It affects 
your wallet. If you're a patient, it means you're paying a higher cost 
to go see your doctor.
    If part of the national strategy has got to be to make sure health 
care is available and affordable, health care becomes less affordable 
because of junk lawsuits. And that's what the people of southern 
Illinois and the people of America must understand, that every time you 
read about big jury verdicts or out-of-court settlements or lawsuits 
being filed here or there, you're paying for it.
    For some physicians, even raising costs for patients isn't enough to 
afford the premium increases caused by these lawsuits. And so physicians 
are faced with a terrible choice: give up medicine entirely, or to move 
to another place where they can afford to practice medicine. And that 
problem affects all doctors, from family practitioners in rural towns to 
surgeons in big-city hospitals.
    In 2003, almost half of all American hospitals lost physicians or 
reduced services because of medical liability concerns. Think about 
that: One-half of all American hospitals lost physicians. Over the past 
2 years, the liability crisis has forced out about 160 physicians in 
Madison and St. Clair counties alone. When doctors move or close their 
practices, guess who suffers: the patients, the people who live in these 
good towns in this part of the world. Pregnant women have to travel 
longer distances for checkups. Accident victims lose critical minutes in 
transit to faraway emergency rooms. New residents, people you're trying 
to get to come and live in your communities, have a hard time finding 
doctors willing to accept extra patients. And that causes the quality of 
life in your community to deteriorate. It's a problem that we must 
address.
    America's health care professionals should be focused on fighting 
illnesses, not on fighting lawsuits. Junk lawsuits change the way docs 
do their job. Instead of trying to heal the patients, doctors try not to 
get sued. Makes sense, doesn't it? If you're worried about getting sued, 
you're going to do everything you can to make sure you don't get sued. 
That's why doctors practice what's called defensive medicine. That means 
they're writing prescriptions or ordering tests that really aren't 
necessary, just to reduce the potential of a future lawsuit.
    They have specialists who stop taking emergency room calls. Doctors 
turn away patients with complicated, life-threatening

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conditions because they carry the highest risk for a lawsuit. Defensive 
medicine drives a wedge between the doctors and the patients, and 
defensive medicine is incredibly costly for our society. Altogether, 
defensive medicine drains some 60 to 100 billion dollars from the 
economy. Defensive medicine raises medical bills for patients and 
increases insurance costs for employers, and it takes money away that 
small businesses could use to invest and expand.
    This liability system of ours is, what I'm telling you, is out of 
control. And you have people in this area and the doctors in this area 
understand what I'm talking about. A recent study ranked Madison County 
the number one place in the country for trial lawyers to sue. And that's 
a ranking I'm sure you'd like to get rid of. And those of you traveling 
in from St. Clair County aren't doing much better. [Laughter] St. Clair 
is ranked the second county in America where you're likely to get sued. 
In other words, if you see a team of trial lawyers spending a lot of 
time in the Collinsville area, you can be pretty sure they're not 
looking for horseradish. [Laughter]
    Let me share some of the stories of the folks I met with today. I 
think this will help clarify what I'm trying to say to you. Dr. Chris 
Heffner is with us. He's a neurosurgeon from 
Belleville Memorial and St. Elizabeth Hospitals. Raise your hand, Doc. 
He is one of only two neurosurgeons still practicing south of 
Springfield, Illinois. You've got two people in the area. In just 2 
years, his annual premiums have more than doubled from $131,000 a year 
to $265,000 a year. And at the same time, his amount of insurance 
coverage has been cut in half.
    A few years ago, Chris decided that 
closing his head trauma part of his practice was the only way he could 
afford to stay in this area. He told me he loves living here in this 
part of the world. He likes to raise his family here. He and his wife 
made a tough decision to stay here, in spite of the fact that his 
premiums doubled and he got half the coverage. And so the only way he 
could stay here and to provide a level of care that he wants everybody 
to have was to cut out part of his practice. He still treats dozens of 
patients with spinal cord injuries, but now brain trauma victims in 
southern Illinois have to be airlifted across the river to St. Louis. He 
said, ``It's very distressing. I spent years of training to do brain 
surgery. It's a big part of my life. I made a commitment to stay here, 
but I had to make adjustments to keep the ax from falling.'' The system 
needs to be fixed.
    Dr. Greg Gabliani is with us. He's from 
Alton, and he is a cardiologist. He was raised in Quincy, and he moved 
to Madison County in 2001, even though his colleagues warned him about 
the medical liability crisis here. In 3 years, his premiums have risen 
from $12,500 to $60,000 a year--3 quick years. Last year he had to stop 
performing certain procedures to bring his costs under control. He said, 
``You either have to change the nature of your practice, or you have to 
leave.'' He didn't want to leave, so he's having to cut back on his 
services. We've got a problem, folks.
    I met with Bob Moore. He's the CEO of Red 
Bud Regional Hospital. That's big Bob. He's a father of six, I want you 
to know. [Laughter] His hospital has a long tradition of delivering 
babies, but this past November, he made the difficult decision to close 
his ob unit. The malpractice--see, he had the--they employ the doctors 
in his hospital. They become the employer. They're going to cover the 
insurance for them, and it doubled from $150,000 to $270,000--more than 
doubled. They're paying $270,000 a year now. That's a lot for a little 
hospital in a small town. Maybe for a big hospital, it's not a lot, or 
for those of us who are used to dealing with the Federal budget, it's 
not a lot. [Laughter] It's a lot for a small town hospital.
    Red Bud used to handle 120 deliveries a year. But now a lot of the 
women have to drive an hour to get to an ob unit. He

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said, ``You wouldn't get an ob-gyn to come here. It's affecting rural 
medicine.'' ``It'' happens to be the medical liability crisis, is 
affecting rural medicine. Lawsuits are affecting rural medicine. It's a 
societal issue that has to be dealt with. I couldn't put it any better, 
Bob. It is a societal issue that we must deal with. It is a quality of 
life issue. We don't want our little towns being--not having any health 
care. We want people who live in rural America, like Crawford, Texas--
[laughter]--to be able to get--to have a quality of life--[applause].
    Leslie Scariano is with us. She is an 
ob-gyn from Alton. She spent her entire career as a doctor in southern 
Illinois, and she has never been sued. She is a good doc. She shut down 
her practice on December the 31st of this year because her premiums have 
skyrocketed out of control. That means she couldn't afford to stay in 
practice. She had a choice to make: quit practicing medicine, or go 
broke. She said, ``I don't want to quit practicing medicine and I'm not 
going broke, so I'm going to move to Colorado.'' You lost a good soul 
from this part of the world because the system is out of control. 
Leslie's premiums will be about 80 percent lower in Colorado than here 
in Illinois.
    I met with Kim Vogel, who is right with us--
yes, there she is. She was one of Leslie's 
patients. She's expecting her second child early next month--like, soon. 
[Laughter] When she found out she was pregnant last year, Kim started 
seeing the ob-gyn that delivered her daughter, Katie. That ob-gyn moved to Tennessee. Then she started seeing 
Leslie. Leslie is moving to Colorado. Kim is now on her third ob-gyn, 
and she's worried about it. She said, ``I understand the doctors' 
position. I don't blame them. But as a patient, I see them leave and I 
think, what am I going to do now, and where does that leave me? I feel 
like I've lost control over how my pregnancy will go.''
    Unfortunately, this is not just a story confined to this part of the 
world. This is a story of pregnant moms all over America who are 
wondering whether or not they're going to be able to find good quality 
health care for their child and themselves. I've come to this part of 
the world because I want to assure you that, one, I understand the 
problem and I intend to work with Congress to do something about it.
    You know, when I was the Governor of Texas, I felt that we could 
solve medical liability issues at the State level. And there was two 
things wrong with that strategy. One is that a State would pass good 
medical liability reform, and all the trial lawyers would do is go to 
the State that has lousy medical liability law. So you're not solving 
the problem, you're just shifting the problem. You're making the quality 
of life issue go from one area--the deterioration of quality of life 
issue go from one area to the next. That didn't seem to make any sense.
    But the other thing I discovered is that because of medical 
liability problems and lawsuits and increasing premiums and the 
defensive practice of medicine, your Federal budget spends $28 billion a 
year, extra money. See, we have to pay for Medicaid and Medicare and 
veterans' benefits. The rising cost of health care, the number of 
lawsuits, the defensive practice of medicine is driving up the cost to 
our taxpayers. Medical liability reform is a national issue, and it 
requires a national solution.
    So I went to Congress with some proposals that I think are fair, 
proposals that will build confidence in the judicial system. Nobody 
likes to come to a part of the world that says the judicial system is 
out of control, and people lose confidence in it. We've got to have 
confidence in the fairness of our system. We want people who are harmed 
to be able to get--have their day in court and get fair treatment in the 
courts of law. But we want--we don't want a system that's so tilted the 
other way that it runs good doctors out of business and makes it hard 
for hospitals to deliver care.

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    I believe a victim of a legitimate medical error should be allowed 
to collect full economic damages, 100 percent of the cost of their 
medical care and recovery plus economic losses for the rest of their 
life. Seems to be fair, if you get hurt. And when appropriate, injured 
people should be allowed to collect reasonable noneconomic damages. And 
in the case of truly egregious wrongdoing, patients should be entitled 
to punitive damages. But there needs to be some reason when it comes to 
noneconomic damages in the system, and that's why I proposed a hard cap 
of $250,000 on noneconomic damages.
    Interestingly enough, the State of California has a cap on 
noneconomic damages that was enacted in 1975. Patients in that State see 
their claims settled a third faster than in States without those limits. 
In other words, patients are treated more fairly where there's a cap. 
And since 1975, insurance premiums for California doctors have become 
much more affordable premiums than anywhere else in the country--than in 
most States. Caps on noneconomic damages work. It's a good idea, and the 
Congress ought to adopt them.
    We have another problem with our legal system, and that is trial 
lawyers sometimes sue all the doctors involved in the patient's case 
even if most of the doctors have nothing to do with the patient's 
injuries. It's simply unfair to punish doctors who have done nothing 
wrong. And so to make sure doctors and hospitals are treated fairly, 
Congress needs to pass joint and several liability reform.
    I think the people are beginning to understand the importance of 
this issue. I know you do. I know the people of this part of the world 
understand it, because you see firsthand what happens when the system 
gets out of control: 160 docs leave 2 counties. People understand that 
no patient has ever been healed by a frivolous lawsuit; no small 
business has ever grown because of a frivolous lawsuit; the cause of 
justice is never served by frivolous lawsuit.
    I know you're serious about this liability issue here. I talked 
about it everywhere I went on the campaign--nearly everywhere I went on 
the campaign trail, and I believe the voters made their position clear 
on election day about medical liability.
    The House passed a good medical liability reform bill last year. I 
want to thank the two Members of Congress for working on it. The Senate 
failed to get the job done. Well, the new Congress is starting over, you 
know. We've got a new chance to get something done for the--on behalf of 
the American people. Both Houses will have a fresh opportunity to 
address this issue. I'm looking forward to working with the leadership 
of the House to get the bill moving. It's important for the United 
States Senators from this State and other States to recognize the 
significance of the problem and get a meaningful, real medical liability 
bill to my desk so I can sign it in the year 2005.
    Junk lawsuits affect more than just the medical field. According to 
a recent study, frivolous litigation has helped drive the total cost of 
our tort system to more than $230 billion a year. That's the equivalent 
of $3,200 for every family of four. The lawsuit burden falls especially 
hard on small businesses. And yet small businesses are the engine of 
job--are the engines of job creation in our country. Seventy percent of 
all new jobs in America are created by small businesses. The tort costs 
in America are now far higher than in any other major industrialized 
nation. Think about that. We live in a competitive world. This is a 
global economy, and so our tort system has become a needless 
disadvantage for American manufacturers and entrepreneurs.
    And so here are some actions Congress can take as well. To protect 
small businesses and workers, we need to change the way we handle class-
action lawsuits. Interestingly enough, this is another problem you know 
well in Madison County. The

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number of class actions filed here increased by over 5,000 percent 
between 1998 and 2003, even though the vast majority of defendants named 
in those suits are not actually from Madison County. Think about that. 
These massive interstate class actions clog your local courts. They hurt 
the honest workers and communities of the businesses targeted by the 
class-action lawyers. The proper place for large interstate class 
actions to be tried is not in a local court but rather in a Federal 
court, which are designed--[applause]. I look forward to working with 
both bodies and members of both parties to get good class-action reform 
out of the Congress this year.
    I'll also work with Congress to reform asbestos litigation. Asbestos 
lawsuits in southern Illinois and elsewhere have led to the bankruptcy 
of dozens of companies and cost tens of thousands of jobs. Many asbestos 
claims are filed on behalf of people who are not sick. The volume of 
asbestos lawsuits is beyond the capacity of our courts to handle, and it 
is growing. More than 100,000 new asbestos claims were filed last year 
alone. Congress has begun considering options to improve the current 
system for handling asbestos lawsuits. They need to act and get the job 
done. I look forward to signing an asbestos reform in 2005.
    I think we're sent to Washington to solve problems, not to pass them 
on to future Congresses. I believe we are called to do the hard work to 
make our communities and quality of life a better place. And it's hard 
work for some in Congress to stand up to the trial lawyers. I understand 
that. But all we're asking for is fairness. We want our doctors treated 
fairly. We want the hospitals treated fairly. And most of all, we want 
the patients and the American people treated fairly.
    And I appreciate you all giving me a chance to come by and talk 
about the vital issue of legal reform. I intend to go back to Washington 
here shortly, and when I see Members of the Congress as I work this 
issue, I'm going to say, ``I spoke to the good folks of southern 
Illinois. They understand the problem, and they expect you, Members of 
the United States Senate and the United States House of Representatives, 
to get the job done.''
    Thanks for coming by to say hello. I hope you and your families have 
a blessed and healthy 2005. May God bless you all.

Note: The President spoke at 1:13 p.m. at the Gateway Center. In his 
remarks, he referred to Tom Cross, minority leader, Illinois House of 
Representatives; and Mayor Stan Schaeffer of Collinsville, IL.