This is a tough session. There are going to be no winners on any of these issues, and President Bush was very aware of that. He was very, very far from an absentee president. I don’t think anybody could have possibly worked harder at his job than President Bush, studying every issue in almost Carter-like fashion. At Camp David on the weekends, he was up at 5 o’clock in his library studying these issues.
He was not an absentee president, but what you learn down in Washington is that the president is not a king. The president has virtually no ability to do anything in Washington without the permission of the Congress. Now, most presidents gravitate late in their careers to foreign affairs because that is where they have some authority. We’re talking about domestic issues here. Ed Derwinski mentioned the antagonism within Congress when we were there. We had a heavy Democratic majority to fight, and Mitchell and Gephardt were very dedicated opponents of President Bush, and even in the far reaches of my office down in the White House, I could feel the frank unpleasantness there.
Now, let me take the four speakers and make some comments. Lou Sullivan’s tenure at HHS was marked by the fact that he had to approach the health care financing problem. It was the most important thing we had to deal with. I am not going to go into it in any detail at all because we have Gail Wilensky and Bill Roper, who are infinitely more sophisticated in this. I’ll give you a simple equation, though: Whenever you look at health care financing, you have to balance cost, access, and quality. Now, you have a beautiful example of what’s happened with the rush to control costs. The HMOs are now giving you drive-by mastectomies and going home after you deliver babies after a couple of hours. They are sending cardiac care people home in two or three days after open-heart surgery. A hip goes home in two or three days. I am a clinician, and I’ve spent my life taking care of patients, and I can tell you that this isn’t going to last long because you, the patients, are going to massively retaliate against this approach to cost control.
Why didn’t we do more about it from the beginning? It was a subject of conversation between all of us in John Sununu’s office on a weekly or a daily basis. Why did we not do more? You have to look at the money. The focus here at Hofstra in most of the meetings I have been to have been on this budget thing of 1990, have been on the problems with cost controls—in every aspect of our government spending. When you’re talking about producing the kind of health care access that the public wants—and that, hey, we wanted—you’re talking about hundreds of billions. And we have cabinet officers fighting in the cabinet room for 10 percent of that. We don’t have the money to do that. And as you can see, the Clinton administration—if you can call what they have done progress, I would disagree with you. This HMO situation now has robbed quality out of the health care delivery system. An aphorism: Action in any given direction does not equate with progress.