"....We have a problem in health-care, which is accentuated by the fact that people who were still adolescents, at the time that the Cuban missile crisis occurred, at the time that Kennedy was assassinated, at the time that the Indo-China war officially opened, are now, in their fifties or sixties, some coming into that, and they're beginning to experience some of the health-care problems which come about the time you reach 50 or so, at least for many people. They're therefore experiencing some of the health-care problems which many of my generation are also experiencing.
"The health-care system is breaking down.
"Also at the same time, we have returning from wars in Afghanistan, and Iraq, or not yet returning, or never to return, members of not only the regular military services, but the Reserves and the National Guard, who are coming back, a large number of them, with various injuries, other health problems, some severe trauma cases, being hidden, being deprived of the care they need. So health care is an extremely important problem, on which the next President must act, on those matters which the present incumbent President fails to act upon.
"One of the first actions I shall take therefore, is to act to reopen fully, D.C. General Hospital, as a full-service, public hospital.
"At the same time, I shall issue a recommended piece of legislation to the Congress, which will restore--it will be about a five- to seven-page paper to be legislated up, not longer, which will restore the Hill-Burton legislation, and will repeal the HMO legislation which was installed in 1973 by the Nixon Administration.
"I shall also take immediate action, within the power of the Executive, and by proposed legislation to the Congress, to fully reactivate the Veterans Hospital System.
"I shall also take similar action to re-energize the public health system, which used to be a system under which people who wished to become physicians, could, by volunteering for this program, and being qualified, would receive a medical education, under the condition that at some time, they would perform a certain amount of public service as employees of the government, or others in the public health system. Some of our prison doctors and so forth went through that route. This is also an institution which protects us, on things that fall between the cracks, such as epidemics, local crises, emergencies; and the staff of the public health system has been cut back. I would propose to restore that, and re-energize it, for the needs we have today, particularly where the cracks arise in the health-care system, this is the institution which should look into the matter, and make a recommendation, or even act.
"We need to respond, as I said, to the problems of our aging population, which includes not only those of my generation and slightly older, but those who are now in their fifties. We find friends, in their fifties and early sixties, dying, or facing very severe health-care problems. We find, that under the present arrangement, when they go into a hospital or seek care, they're placed in jeopardy, unnecessarily, by the kind of new rules which have been introduced, and the progressive deterioration of our health-care system, under the impact of HMOs.
"We have to make reforms in this direction. We have to, among other things, ensure that there is no criterion for delivery of medical care, except the decision of a physician. We must eliminate the HMO provision, under which the physician is given the right to only make a checklist of care you receive, and deliver that amount of care only in the amount prescribed by some accountant in some firm, not a medical professional. That must end. We must restore physicians' rights to do whatever they think is necessary to assist a patient.
"Now, this goes to something else, as well. It goes to preventive medical care. As a former Surgeon General discussed this matter with me, and I took that instruction from her as a charge, which I'm now delivering here: The problem we have, is, that, under the Roosevelt Administration--Franklin Roosevelt--and afterwards, we had an improvement in life expectancy in this country. As a result of that, people live long enough, to get some of the diseases of aging--increase in cancer, other kinds of disease, which go with the aging process. Therefore, we have a new category, in the past decades of health care, of kinds of medical needs which did not exactly exist, in periods where life expectancy was shorter.
"Therefore, the emphasis has to be placed now, on preventive health care. This means, provisions that we make in the interest of public health, to protect people from these risks. And also, that means that we must give the physician the opportunity, when treating a patient, to make recommendations to that patient, and to prescribe measures to be taken, either as medical advice or actual prescribed care, which will help that person to avoid the penalties of some of these sicknesses. Actually the cost, to society, of giving the physician and medical facilities, the freedom to make these kinds of decisions and take these kinds of actions, will cheapen the cost of health care. Because preventive health care, where it's appropriate, is a lot less expensive, than waiting for the catastrophe, which an HMO finally acknowledges to exist.
"So therefore, physicians' rights: freedom from having accountants run medical practice, is an essential measure, on which I would act, {on the first hour} I were in the White House.
"We also need a special investigation on diseases of aging of tissue. This is a frontier, which affects not only the aging, but in the history of mankind, study of the things that happen to people as they become older, are valuable in our approach to the problems of people {when they are younger}. If you catch a disease in the period of old age--such as cancer, cancer research, which used to be considered largely a disease of old age, and so forth--the work that you do on that, then enables you to deal with other areas of care, frontiers of care, where you have failed previously. And therefore, that must be part of our program."