Next cheapest is the State government can buy vaccines in bulk. The next cheapest is the Federal Government can buy even bigger vaccines. If we buy through a Federal Agency about 40 percent of the vaccines in the country and then we give them out to the States, and then the States would have good public health networks. They give them out, and those shots are the cheapest of all. But even cheaper than that are some of these same vaccines made by American companies sold in foreign countries. Now, that all sounds terrible. Let me say one or two things, since I've been fighting with the drug companies, in defense of them. They're a very important part of our economy. They do a wonderful job in finding new drugs to solve problems. They have to spend a fortune to do all the research and development. The problem is that to sell those vaccines in other countries, these other countries are tougher on them, and because they want everybody immunized, they drive down the cost of the vaccines. So Americans are paying the whole research and development costs for people who benefit from these drugs all over the world, because the companies can't collect other places. Another problem is that we have more lawsuits in this country, so we add about $4 a vial to the vaccines to put into a fund against the possibility that some child might have a reaction. So they would always be somewhat more expensive. But we have got to find a way to work with the drug companies. They do very well, I want to emphasize. They are some of our best companies. But we've got to find a way to deal with these two huge problems. One is older people, particularly, paying huge prices for drugs that have been developed for some time, that are not experimental drugs. I think we'd all admit we should pay more for experimental drugs. That's got all the research cost in it. And the second is, children in America paying more for vaccines than children in other countries, even though they were made here. And we're trying to work through that, and I think we're going to make some progress on it. Health Care Reform Q. Mr. President, I am one of those family doctors who you were speaking about, and I have a couple of questions. One is, in your address to the joint session of Congress, nothing was mentioned about tort reform. And I'm very concerned about that, because of the malpractice crisis and the liability costs in malpractice insurance. The second thing is, our local medical society has reviewed at least four plans put forward by organized medicine: the American Academy of Family Physicians and so on. Are you going to look cians' ideas as you're formulating the poliat those programs and incorporate physi cies? The President. Absolutely. And we will also bring doctors into the process. But let year there were two major suggestions made me answer the second question first. Last for health care reform by physicians groups: the American College of Physicians and the American Academy of Family Practice. A more modest, but still significant program, was offered by the American Medical Association. And the American Nurses Association put out a very interesting plan. And I think all of those things should have a big influence on what we do, because in the end it's the doctors and the other health care providers that have to live with whatever system we put out. So the answer to your question is yes, those suggestions, and in particular the two you mentioned, are being taken very seriously. Second, on cutting the cost of malpractice, fact that my State had the second lowest malthat's a big issue with me. I'm proud of the things we did was to pass a law enabling the practice rates in the country. And one of the court to fine anyone who brought a frivolous tort suit, if it was judged to be frivolous. That the lawyer himself or herself could actually be fined. Not a big fine, but it had a real impact. The other thing I think that has real promise is an experiment that I believe is now being tried in Maine and one or two other places, which really relates to family practitioners, because we cannot get medical reform in this country unless family practitioners, family doctors, feel freer to set simple fractures, to get back into the business of delivering babies, to do that whole range of things. The thing that a lot of people are working on now is being able to say to doctors in small towns and rural areas, for example, here are a set of accepted practice guidelines for this procedure or that procedure. If you can show that you have followed these guidelines, that will raise a presumption against malpractice for you. I think that has real promise. The third thing in really expensive areas is-we might all look at what's been done in the vaccine area that really worked, where people just pay a fee into a fund and a big national fund is set up. And if there's a problem you go against that fund, you don't have to go through a whole prolonged lawsuit with an insurance company, a lawyer, a doctor, and all the lawyers and all that. That's something else that I think we need to look at to see if that might have more general application. Economic Plan Q. During the campaign, Ross Perot spoiled me with flip charts, pointers, and poster board. I'm a simple woman. What I need to hear from you is, over the next 4 years, how much spending cuts, dollar-wise, will we see? How much total revenue will be brought through our taxes, through the increase in our taxes? And what percentage of that is going towards new programs. In other words, we're hearing tax and spend, the old Republican motto about the Democrats. I want you to show me in a simple manner exactly the dollar figures that we'll look at over the next 4 years. The President. I don't know if I can do the math in my head right now for 4 years, but I will tell you, basically, the tax bill goes from about $20 billion to about $75 billion over the next 4 years; the spending cuts go up to more than that in the fourth year. In the early years there are more tax increases than spending cuts; in the later years there are far more spending cuts than tax increases. At the end, they're about the same. The net aggregate reduction in the deficit over 4 years is about $320 billion, over 5 years is at $475 billion less debt than we would otherwise have. In the fourth year of the budget, which is the one that we all target on under the Federal system, the deficit will go down $140 billion a year in that year. Essentially, there will be a net increase in that fourth year in spending of about $26 billion a year. That is, there's about $40 billion more in spending, net new spending, all targeted toward things like the college loan program, Head Start, new technologies, and jobs and about $15 billion in additional tax incentives to businesses to reinvest in new jobs. So that's what the net new spending is. But if you look at it total in the first 4 years, the spending cuts and the revenue increases are about equal. If you string it out for 4 more years, if we really change the spending habits of the country, the spending cuts are far greater than the tax increases. And I've got a little chart. I'll send it to you, and you can see exactly how much year by year in each of the three categories. Let me just make this point on the spending cuts. I have spent a month during which we have worked almost around the clock trying to get a handle on this budget. The Federal budget is put together in a way that I don't think is very good, and it doesn't resemble any business budget or any State or local budget you have ever seen. Let me give you an example. I wrote a letter to the Agency that is supposed to be helping me put together the budget-a memo-and I said, here are about 30 questions I want answered. One question was, how much more money are we collecting a day than we were 5 years ago in tax money, and how much of revenue has grown in each of the last 5 years? You know what the answer was that I got back from the Agency? “Federal revenues as a percentage of our gross national product are slightly smaller than they were 5 years ago." So help me, that was the answer I got back, I promise. In other words, just to your point, we were taking more money in and tax revenues had grown less fast than the economy. But what difference did that make; we had more money. They didn't even answer the questions. I'll send you the exact chart. But it's basically 50-50 spending cuts, revenue increases for the first 4 years, spending cuts swamped revenue increases in the second 4 years and will go much more if we adopt a new health care control plan. And the investment increases are significant but modest. They reflect a big change in the spending priorities. One of the things I'm trying to do is change; Government is great at starting things and bad at stopping things. So we're still, believe it or not, you're still paying for a bicentennial commission. That was over in 1976. And there are lots of things. It's a little bit of money, but you can't justify it. It's just terrible. And there's a lot of stuff in there like that. So what I'm trying to do is to flush that out, reduce consumption, and increase investment so that we can put some people to work. That's what I'm trying to do. And I'll send you the chart. When I spoke on Thursday night I tried to give the exact numbers in the last, but I will be glad to—I mean, that chart was in the book that we presented to the Congress. And I was hoping that it would be run in all the newspapers in the country, because there is a chart in the book we released to the press on Thursday morning. Anybody who wants that chart, I'll be glad to give it to you. Let me make one final point about that: I have no interest in raising a penny in taxes if we're not going to do the cuts. I don't want to get a deal where we're going to raise the money and not do the cuts. Not a penny. The second point is, I don't have any pride of authorship in this. I've been working on this like crazy for 4 weeks. There must be people who know more about some of these things than I do. And I have invited all the people in the Congress, Republicans as well as Democrats, and all the people in the country to help us find more. I'm more than open to it. But I have to say, too, there are some tough decisions involved in the cuts. As you know, there is a uranium enrichment facility in this congressional district not far from here. And one of the things we've concluded is that there are only two in the country, and both are running at about half capacity-with the projected need going down-is that we will have to close one of those. So there are tough decisions involved in this. There are a lot of tough decisions that have to be made in this cut area. But if anybody's got any more ideas about how we can cut more, I'd like to have them. And then the young man in the turtleneck next to you. Health Care Reform Q. Mr. President, I'm Mayor of a small town. We have two employees. About the last 8 years, health insurance went from $400 a month to $1,500 a month for two employees. If you can have Hillary get this health insurance in line, it will help our little village. Plus, I'm on economic development in our country, and our biggest employer makes television sets. And if that health care comes down, it will sure help those stay in business, too. So tell Hillary to keep on it. And if you get that down, we'll send her a big thanks. The President. Thank you. Let me say, this is a subject, probably a whole subject for another town meeting. But let me say that one of my biggest problems with a lot of you will be-in dealing with health care, is this. If you ask the American people a question about health care-are we spending too much or too little-a lot of people will say we're spending too little. Why? Because they feel insecure about losing their health insurance. Or because, like your mother, they're spending too much out of pocket. So if you ask the American people are we spending too much or too little, a lot of people say too little. That's wrong. We're spending too much and on the wrong things. That young doctor that stood up here, I'll bet you anything more than 30 percent of his gross income goes to paperwork. Right? We are the only country in the world where you have 1,500 separate health insurance companies writing thousands of policies with every doctor's office and every hospital in America having to keep up with them. Just for example, the average country we complete with of every dollar people spend on health care, 95 cents on the dollar goes to health care, a nickel to run the administrative programs. In America, it's more like 86 cents. You figure out what 9 cents on the dollar is-or 11 cents on the dollar-for an $840 billion health bill, or if you take the Government out of it, about $600 billion. You just figure it out. It's lots of money. Tuition Tax Credits Q. Yes, Mr. President. I'm John Cooper, and I go to a private school. And in years past we have not had any support from the Government with funds. And I was just wondering if you had a plan that will help pay for some of the taxes that we have. And I was wondering, if you don't have one, why not? The President. I'll tell you why not. I don't, and I'll tell you why not. When I was a boy, I went 2 years to a private school, to a wonderful Catholic school. And we paid tuition. And my folks were not wealthy. They were working people when we did it. And I was living way out in the country and we moved to a new community and we just didn't know anything about the school. And I've always treasured that experience. But I don't believe, particularly right now, that we can afford to give tuition tax credits or other breaks to fund private schools, even though I support the competition private schools give to public schools. And I'll tell you why. Q. Mr. President The President. Let me tell you why. Even though I'll bet you anything you've raised more money in this State to put into this school system we're in right now, the United States today is behind at least eight of its major competitors in the percentage of our income we spend on kindergarten through 12th grade education. And we have more problems in our schools than most of our competitors, because we have more income diversity and more racial and ethnic diversity, and a lot of our schools are located in places where there are a lot of tough economic problems. So I don't think we can afford to do that now. I wish I could tell you what you want to hear, but I just don't agree with it. Mayor Joe Sulzer. Mr. President, I'm sorry, but we have time for only one more question over here. And then we'll have a special presentation. And then we would ask everyone to remain seated as the President leaves. Thank you. Participation in Government The President. May I ask a question? May I ask you something before we get off, Mayor? These things always work like this. We could stay here till the cows come home to do this. And I love this. And you've been great. But I want to—[applause]—I want to say-wait a minute. I want to make two points, and then I'll answer the last question, whichever, whoever the Mayor designates to be the last question. The first is that one of the things I've been really proud of in the last month-it proved the election worked, it proved all the town meetings worked, it proved the Ross Perot charts worked, it proved the whole thing worked-is that the volume of our mail and telephone calls is running at historic highs in the White House. That means the American people—a lot of its people who disagree with me, a lot of its people who agree, a lot of its people who are just asking honest questions-but my point is, it means people believe maybe their Government can be made to work for them again, and maybe we can be accountable again. So a lot of you have questions you haven't gotten answered today. I would encourage you to write to us. I have reorganized the White House Correspondence Office. I've tried to put a number of people there who really understand the issues that I believe in and the things that we care about. We're trying to minimize the number of just formal form letter; that's different. But, I mean, responses we give unless people send us a people that really write us. So I would encourage you to do that. that I want to encourage you to continue to The second thing I want to do is to say hold me and everybody else accountable and ask the tough questions. I don't think it was all that easy for that young man to stand up tion because he knew he had a different posithere and ask the question he asked on abortion than I did, and I was proud of him for doing that, and I think you should be, too. And believe me, none of us have all of the answers. This is a new and uncharted time. And I want to encourage you to continue to believe in your country and to participate in this. Hold our feet to the fire, but try to make it a constructive thing. This is an exciting time for this country and it's sort of a make-or-break time, I think, and I'm doing the best I can and I think you are, too. And if we keep doing that, I think the chances are we're going to come out okay. I think I can say for the other elected officials here, I'll bet you they're pretty proud of their constituents in Ohio after this town meeting. Who is last, Mayor? Who did you select, Mayor? Mayor Sulzer. Right over there, Mr. President. Education Reform Q. Mr. President, I'm a sixth grader at Smith Middle School, and I'm wondering, do any parts of your education plan deal with children my age? The President. Good for you. Okay. The answer is, yes, but most of them don't. And let me tell you why-the answer is yes, they do. We emphasize more funds and more efforts in math and science education, for example. And I have asked the Congress to give the Education Department some funds that will enable us to target learning strategies in elementary and junior high and high school that work, and try to get schools to repeat them. Do you know that every problem in American education has been solved by somebody, somewhere? I mean, this is not like looking for a cure for some disease we haven't found a cure for yet. What we are not good at in American education is taking what works in one place and putting it in place of another. So the two major things are, we're trying to repeat education strategies that have given young people in the sixth grade great performance in some places, we want to try to put them in all the schools in the country. And secondly, we're going to make a special effort on math and science education. Now, let me answer the other question. Most of the funds that I have recommended in education, most of the effort will be going to try to make sure kids get off to an equal start in school: fully funding the Head Start program, supporting schools and their preschool programs, trying to make sure that child nutrition and child health care is good, and then when children leave school, trying to make sure that they have a vocational program, a job training program, a college program to go to. Why? Because over 90 percent of the cost of the public schools, kindergarten through 12th grade, comes from the State and local level. I can have an impact on your education only if we focus on a few issues where we can really help, like: How do you get more computers in schools, how do you do better with math and science? But most of the money comes from the State and local level. Whereas, a lot of what we have to do for children before they start school and after they graduate from high school has to come from the national level, and that's why we do it that way. Thank you very much. You were great. NOTE: The President spoke at 9 a.m. at Chillicothe High School. In his remarks, he referred ent of schools; Vernal G. Riffe, Speaker, Ohio to Mayor Joe Sulzer; Richard Cline, superintendHouse of Representatives, and Melissa Hagen, student council president. These remarks were not received in time for publication in the appropriate issue. Remarks on the Economic Plan in Thank you very much, my good friend, James Roosevelt, who has likewise been an inspiration to me over the years, and who knows and cares a great deal about a subject that we must all come to grips with this year, the crisis in health care; to Senator Pat Moynihan, one of the most productive people in public life in the 20th century in America. And Mrs. Cuomo, I'm delighted to see you here, and we wish Governor Cuomo good health. He might have thought to himself on deciding whether to do the responsible thing and take to his sick bed today that he's probably heard this speech before, and he's probably given it before. [Laughter] I can't tell you how grateful I am to your Governor for his support and his wise counseling. We had a delightful time in the White House, Hillary and I and Governor and Mrs. Cuomo, not very long ago. It's something I will treasure for a long time. I'm glad to see Lieutenant Governor Lundine and attorney general Abrams and Mem |