Presidential Guest Speaker-Rep. Newt Gingrich
Feb. 23, 1996

Introduction by James W. Strickland, MD, 1995 Academy president.

It is our privilege and pleasure this morning to have with us Newt Gingrich, the Speaker of the United States House of Representatives. A native Georgian, actually born in Harrisburg, Pennsylvania, Congressman Gingrich got his Bachelor of Arts at Emory University, his Master of Arts at Tulane University, and his PhD at Tulane in Modern European History in 1971. He was a history professor at West Georgia College, Carrolton, Georgia until 1978; a representative from the State of Georgia from 1978 until now; Minority Whip in 1989 and elected Speaker of the House of Representatives in 1995. He's written a number of books that you're all familiar with including Quotations from Newt and Contract with America and To Renew America in several different editions. And you all know the rest. Newt Gingrich has amazed everyone with his courage and his leadership and he has successfully championed the Contract with America in the House of Representatives. So it's without further ado that I introduce the Speaker of the United States House of Representatives, Newt Gingrich.

Applause.

Thank you all very much for allowing me to come here today and, welcoming me. This is the first time I've walked into a room where somebody walked up to me and said that they were delighted I was here, and if I have any problems with my knees they'd be glad to take care of it for free.

Laughter.

Ah, I've been in a number of places where people have suggested that they would give me knee problems if I didn't shut up.

Laughter.

So this was sort of a welcome change.

I am really delighted to have a chance to chat with you all. This is a very, very important audience of people who are well educated and have the ability to take a long view or you could not have gotten through med school and your residencies and internships. So I realize that I can talk to you about a longer period of change and about a lot of different things. I want to focus on health care and where we're at, but before I do that, I could hardly come here in the middle of the primary season without at least making a comment or two about what you're seeing on television.

I think it's fascinating to watch, because I think as, as so often happens the liberal media is missing the message. The real issue in the primaries is, "Why are people protesting?" If you look at the votes that are being cast in the Republican primaries, it's clear that there's a broad range of desire to send a signal to the national elite. And there's this sort of mystical sense of focusing on the messengers and being worried. You can see all these liberal columnists gathering and worrying each other about it, but let me suggest to you three examples that are totally practical. And they're not mystical, they're not complicated. They're as practical as somebody walking into your office with a broken arm and saying that they don't feel right and having you say, "Well, yes, your arm is broken, and "Thank God, I thought maybe I was psychosomatic." I mean, number one, if you are a high school graduate and a male, your constant dollar pre-tax income has gone down 16 percent in the last 16 years. Now, if you think that's your future and you're looking out and saying to yourself, "How do I feel - more anxiety ridden or more secure?"

It is perfectly reasonable for a citizen to say the information age is frightening and I'm not sure how I'm going to have job security, and I don't like the fact that my income is going down. If you're a female high school graduate your income went down about 4 percent in the same period, and it is actually lower than the males, because it started at a lower base. So in the first place, we have a huge number of people who are high school graduates whose income is going down, because the information age has disadvantaged them and we have an inflexible, rigid bureaucracy based in Washington, DC that doesn't realize you had better be designing lifetime learning, and we ought to be saying to all those folks, "Here's how we're going to upgrade your life. Here's how we're going to increase your productivity. Here's why you have a better future." So first of all, I would say to that block of voters, "Boy are they right." They have every reason to be anxiety ridden.

There's a second group that's virtually all of us. Last year was the lowest...the smallest increase in benefits and income in 15 years. So if people say to you, "I don't feel like I'm getting ahead." Guess what? And this, by the way, in both cases, the numbers I'm giving you are pre-tax. So it doesn't count the FICA tax increase. It doesn't count the tax increase on gasoline. It doesn't count the income tax increase, if you're in the right bracket. It doesn't count the tax increase on social security retirees. It doesn't count the state tax increases. It doesn't count the local tax increases. So if you are a normal person in a normal community, working your tail off, trying to raise your family, trying to pay for your house and you're feeling squeezed, this is not a psychological problem.

Laughter.

You are accurately reflecting the fact that the liberal welfare state has failed. It is not delivering goods and services in an efficient way at an economical cost and you're in fact suffering from an increasing government take of your money while your chance to earn money is going down.

Now, there's a third factor. You've got all sorts of high school graduates in their thirties, forties and fifties who did everything America told them to do. Some of you may feel like this some days. They went out and they studied hard, they worked hard, they joined a corporation, they began to make progress. They wake up in the morning and they see a major corporation announcing laying off 30,000 people. This leads them to a certain sense of anxiety. This is not stupidity on their part. It is not something they should be lectured about..."Don't be worried." They should be told, "You're right." The combination of the Information Age and the world market means that we have a tremendous number of changes going on in America. Now the question's simple. You can't avoid the changes. Those people who'd like to turn back the clock and hide, that's not going to happen. You can't avoid the changes. The question is, "Can you design an American policy so we enter the information age and we enter the world market while helping Americans or do Americans have to pay in insecurity and in quality of life, and in take-home pay in order to enter the Information Age in the world market?"

I represent a movement which believes that we have every opportunity to dramatically improve life for virtually all Americans if we do a couple basic things. And so I want to say to every voter who feels like protesting this year, "You should." I have a very strong bias, you should decide that the welfare state has failed, that in fact, we don't need to have more litigation, more regulation and more taxation, and that you would be protesting...

(Interruption by applause)...

...But I also have to report to you, I'm Speaker of the House. We passed litigation reform. It was vetoed by President Clinton. We passed a balanced budget, which would have lowered interest rates. It was vetoed by President Clinton. We passed tax cuts for middle class working families so that they get to keep the money to raise their own children instead of letting the bureaucrats have the money. It was vetoed by President Clinton. We passed welfare reform so able-bodied adults would actually work if they got money. It was vetoed by President Clinton. We passed tax incentives in order to create jobs and increase savings. It was vetoed by President Clinton. If a voter wants to get up somewhere in America and say, "I don't like the way Washington works," I'm with them! I'm not going to say, "Oh, please understand will you." I'm going to say, "You're damn right, you ought to be mad about it. It is ridiculous and we ought to change Washington."

Applause.

And I would point out to them that on November 5th we have a constitutional rendezvous with destiny and we get to choose. And every citizen who's anxiety ridden ought to make sure they're registered to vote and ought to vote. And every citizen who's worried about a job ought to make sure they're registered to vote and ought to vote. And every citizen who is sick and tired of turning on the television and having some lawyer sit there and say, I think one of the most destructive things happening in America today, you've all seen these ads. "Hi, have you sued anyone recently?"

Laughter.

...If you haven't why don't you bring your Rolodex down to the office at lunch.

Laughter.

No society can afford to commercially encourage conflict. It is insane what we're doing in our legal system. It is wrong. It is a violation of the traditions of our system...

(Interrupted by applause)

...But let me just say to all of you, when the president has dinner with the trial lawyers and then vetoes a bill that everyone thought he was going to sign, don't kid yourselves. The trial lawyers understand that their future is dependent on rigging the game so they can have their hand in your pocket. And they are prepared to spend millions this fall to make sure that the Democrats take back the House and Senate, to make sure that they keep a president who will veto litigation reform. And they're in alliance with the unions who've announced in the last few weeks the most extraordinary open public commitment to buy the Congress in American history. The unions are going to have a meeting in March to formally approve a plan to put 100 paid, full-time organizers per union...for the unions in districts to basically buy House seats. And every one of you who want's litigation reform, and every one of you who wants to see the Stark Regulations repealed, and every one of you who wants to see us have a tax code that makes sense, and every one of you who wants to see us have a system where you get to focus on being a doctor instead of being a petty bureaucrat and red-tape collector for the federal government, you have a personal, vested interest in this election, because the trial lawyers and the unions understand if they don't buy this election and we have one more honest election on top of 1994, that by sometime in 1997 you're going to get malpractice reform. You're going to get reform of the federal bureaucracy. You're going to get litigation reform across the board. You're going to get tax reform. And the results are going to be less power in Washington and fewer bureaucrats and more power back home and the trial lawyers and the unions are terrified that if the American people have a fair election with a fair amount of information that they're going to actually choose freedom over bureaucracy. And frankly, I think they're exactly right. If we have a fair chance, we're going to change things and it's going to be for the better. Now, let me just focus on health care for a few minutes and then I'll take questions, but I want to share with you why I am so convinced it's going to be better.

There's an article in this morning"s Atlanta paper, page E1. This is the headline - New Device Allows Quadriplegics to Write with Eyes. "French researchers have developed a device they hope will end the isolation of quadriplegics who can't communicate. It allows them to write with their eyes. As the patient looks at a special keyboard, a laser-guided camera records the gaze of the patient's eye moving from letter to letter. The camera feeds the selected letters into a computer and the text appears instantaneously on a computer screen. Within a year, researchers expect that the Delta Vision Device will be fine-tuned to allow paralyzed people to turn on the TV, the radio or the lights, shut the door or even log to the Internet. It'll do it all by simply gazing at a control panel."

Now, all of you in your professional life see changes on this scale happening all the time. You realize that in microsurgery in a whole range of breakthroughs, in telemedicine, we are on the edge of a revolutionary increase in our capacity to help people. This doesn't mean people's lives will automatically be better, because people have an inordinate capacity to avoid progress if they want to...

Laughter.

...But we will in fact have remarkable progress. However, that progress in many ways will be slowed down by the government. I think there are five large changes coming for the 21st century health care.

The first is the rise of molecular medicine. We're moving into what I think will be known as "The Age of Molecular Medicine." As the human Genome project continues to develop more and more information many of our core understandings of how humans function, what is going on, are going to change. That's frankly going to mean, I think, lifetime learning for medical professionals and I think it's going to mean a dramatic overhaul of our approach to public health and our understanding of what can happen with people. But it's an extraordinary opportunity and it means that we're going to cure an awful lot of diseases and take care of an awful lot of conditions that historically were a mystery.

The second breakthrough is the rise of telemedicine. We have a program at Emory University working with doctors in Russia and in Georgia who are developing programs particularly involved in heart disease. There's a doctor at UCLA that performs surgery in Beijing from his laboratory in Los Angeles. There are programs where the Mayo Clinic is now going into North and South Dakota. All of you are aware of the scale of change going on with telemedicine and it's going to raise fascinating questions. If the specialist is in one state and the patient's in another state, the current pattern has been you move the patient. They fly to you. But if, in fact, the patient can stay at home and communicate with you, and you can do a lot of your assessments electronically, where are you practicing medicine? Whose laws are you under? Which liabilities apply? And I think we're going to have all deal with a tremendous opportunity for rural America, I think, it means a dramatic expansion of the quality of health care that can be made available almost overnight. And it means a very different structure of relationships where virtually every rural facility will be tied in to some kind of central system and will be able to get the best experts in the world for rural citizens, who normally in the past have not had that opportunity without tremendous travel.

For people who have unique rare diseases or unique rare problems, it's going to mean an ability to reach out to an expert on a world-wide basis within a very few years. And all of you know from just the cellular phones you carry and from your own ability to dial direct almost every where in the planet that the kind of challenges we had thirty years ago, which are still locked in most of our memories in almost all over administrative systems, are in fact, electronically diminishing. Their ability to be anywhere on the planet talking with somebody else anywhere on the planet has become dramatic.

The third area, building on the age of molecular medicine and the rise of telemedicine is going to be the rise of expert systems. Now my mother-in-law is in her eighties, and she is a diabetic, twice a day, she tests herself and gives herself the insulin she needs based upon what she learns from her own self testing. We're going to see more and more effort at independent living. My guess is by 2020 the number of people in nursing homes will be going down, not up and that the habit will be for people to find ways through the facility of expert systems to maintain themselves at home, without having to go into the hospital or without having to go into nursing homes. All of those things are going to dramatically expand and they're going to lead to huge fights, frankly, as professionals argue over what you can learn from a computer and what you have to see a doctor or a lawyer or other expert about. But the potential is enormous. It also again means that we're going to have to re-train ourselves, because the fact is you're going to see a world-wide explosion of medical knowledge and your ability to check in this week to find out the state-of-the-art this week is going to go up, which is also going to mean the obligation to check in is going to go up. Now we're going to have a substantial increase in permanent on-going electronic networking and reassessment of what we know.

Those by the way, I believe, the combination of the rise of molecular medicine, the rise of telemedicine and the rise of expert systems give America a chance, if we will quit looking at health care as a problem, and correctly look at health care as an opportunity, it gives us a chance to be the highest value contributor on the planet so that in the 21st century you buy American products in health care including personal services from physicians, exactly the way in the mid 20th century you bought American manufactured commodities whether it was automobiles or other things. The great age of American professional services is going to be in the early 21st century and as people get wealthier world-wide their willingness either to travel to America to get health care or their willingness to use health care by long distance is going to keep going up.

As one example, Northwestern fills a Boeing 747 every weekend in Tokyo to take people to Minneapolis to go to the Mall of the Americas. Now a planet where people will fly that far to buy Nikes...

Laugher.

...Is a planet where if we offer the best liver service and we offer the best heart service and we offer the best service in cancer, it will be astonishing. Note this, by the way, none of our government statistics accurately capture this. If a Saudi prince comes to the Cleveland Clinic and rents two floors of a neighboring hotel for his family, it is recorded in current statistics as an increase in health care and therefore a problem. It is in fact, of course, an increase in foreign exchange earned by the United States and is fully as valuable as selling a computer or automobile or a ton of steel. Yet, it's not captured at all. And the fact is if you go to Michigan, somebody told me there's one hospital in Michigan which is now one-third filled with Canadians, and if the Canadians continue to maintain a bureaucratic government health system, it will presently be filled with two-thirds Canadians. There are hospitals in Florida that have annual winter surges of elective surgery for Canadians. And the fact is that on a national basis all of you know people who have done a lot of work on people who are not U.S. citizens who came to the U.S. to pay good currency to get the best care in the world. That was listed by Health and Human Services as a problem.

I would suggest to you that we want to, in fact, think through and maybe we want to move health care out of Health and Human Services into the Department of Commerce in order to emphasize that this is the greatest opportunity for job increases and that's good, not bad.

(Applause).

Our fourth breakthrough is going to be in entrepreneurial marketing and many of you are already involved in this. Regina Hurtslinger at the Harvard School of Business is the best writer on this, and I think it tells you a lot that Regina Hurtslinger is an accounting professor who approaches health care as a business. She's not in public health. She's not in public administration. So she doesn't think of problems. She thinks of opportunities. And her argument is quite simple, that there are new approaches, new methods, new ways of organizing services that are going to dramatically improve the access to health care, that are going to lower cost. My favorite example is the program that is done by International Paper which goes into a community, finds the cost of every service from every doctor and every hospital, pays 100 percent of the median cost in the community and then gives that information to their employees and says if you need this particular services, here's everybody who does it. Here's what they charge. Here's their background in terms of education. You pick the one you want, you can go anywhere. It is self-managed care rather than bureaucratically managed care and yet it's care with knowledge as the base of the care.

Applause.

And that model is neither the traditional model in which the doctor tells you nothing until you get the bill, nor is it the government model where the government takes care of everything and then you get the taxes, nor is it the HMO model where the insurance company basically manages the system. It's a model which allows independence to stay with the client or with the patient, but with a great deal more knowledge then they historically had, and it's worked for International Paper very well, and it's actually lowered their costs.

Finally, I think you're going to see a dramatic increase in the focus on wellness as the baby-boomers get older. Now the fact is the baby-boomers have always been focused on whatever age they were. When they were in first grade it was very important to be in first grade. When they were in high school it was very important to be teenagers. As they get older they are going to resist the idea that aging means they have to cease being very active and you're going to see, I think, a tremendous explosion in aging, in self-education and in the desire for wellness. Dr. Levitan in Washington is working on a project for example, in diabetes education. It makes the point that by good education and good habit, you can lower the cost of dealing with diabetes. Yet the government policy today is to pay $35 dollars for one educational visit and then say to people on Medicare, "We will not pay again until you need your leg amputated." So in effect we say, "Only if you get sick enough to be truly expensive will we pay for it, but we won't pay the preventive care that would stop you from being sick enough to be truly expensive." There's no system other than the federal bureaucracy that would think that made common sense. And so we need to look at how do we maximize the opportunities for preventive education, for wellness and for insisting that the patient has some responsibility for their health.

Applause.

This model that says I want to be 70 pounds overweight, drink a quart of hard liquor a day, pay no attention to exercise and then tell you it's your obligation to make me healthy is exactly parallel to the welfare system. It doesn't work. You can not have total irresponsible humans enjoying the benefits of responsibility. And if that's a cultural issue...

Applause.

...Then we have to be honest about it.

Let me very briefly just focus on a media practical legislation. We increased funding this year for the National Institutes of Health and for the Center of Disease Control. Our reasoning was very simple. We believe we're on the edge of the Age of Molecular Medicine. We think basic research is right and we want to continue to spend what we think is fair for the federal government to be a significant provider of resources for basic research in this country and we think all of us profit from basic research...

Applause.

...We think that is a good thing to do.

Applause.

We are pursuing a reform of the Food and Drug Administration. We believe the Food and Drug Administration has been a case study in the bureaucratic trial lawyer model of adversarial litigation and red tape.

Applause.

It now operates to slow down the introduction of new technology. Slow down the introduction of new drugs. Slow down the development of biotechnology. Increase the cost of all of those and do it with the government as the adversary of progress rather than the facilitator of progress. And the Food and Drug Administration should be thoroughly overhauled from the ground up and should get a commissioner who actually believes in health care and is actually in favor of American jobs.

Applause.

I want you to know that the House Republicans are totally, unequivocally committed to malpractice reform. We're going to send malpractice reform back to the president...

Applause.

...The current model of litigation hurts America because it forces you and your patient to see each other as potential adversaries when in fact, you want to see each other as colleagues pursuing better health. It is exactly wrong psychologically and therefore has to be replaced with a system which is much more collegial and much more mediation oriented and which you only get law suits under egregious cases because literally, it's not just that it's costing you money, it's not just that it's in fact an absurdity for this society to make its own health care expenses greater, but it creates exactly the wrong psychological relationship in that you've got to enter the room worrying about a potential lawsuit when we want you to enter a room worrying about the patient and their health. That's how big the difference is.

Applause.

We will pass a bill this year which eliminates pre-conditions for everybody currently in the insurance system and guarantees portability so if you change jobs you will not have to worry about getting insurance and we think that is going to dramatically improve proper support.

Applause.

Now let me say very directly, there's been a lot of talk about the Kassebaum-Kennedy Bill. I like the Kassebaum half of the bill.

Laughter.

...But I do not believe that the Kennedy half of the bill is going to pass. It's a back-door entry to Clinton care. We are not going to accept it in the House and if we go to conference, we're going to pass portability and we're going strengthen the free market, but we're not going to allow Teddy Kennedy to sneak in a big major step towards bureaucratic control over the health care in this country. That will not happen when we go to conference.

Applause.

We should pass capital gains tax cuts for the very practical reason that we want to increase the amount of savings. We want to increase the amount of investment. We want to increase the job creation. And I bring it up at a medical meeting because biotechnology needs more capital if we're going to dominate the world biotechnology markets to create jobs in the United States in a cutting edge industry so you have the highest value-added jobs in the world with the highest take home pay. The goal is to have more investment in America and you do that by cutting the capital gains tax, not by increasing taxes, and you do it by having the private sector invent new jobs, not by having the bureaucracy. The president talks about investment, let me be very straight, we believe in investment, but if we're apt to choose between gambling on Bill Gates and gambling on Robert Reich...

Laughter.

...We know which one creates jobs and which one kills jobs and that's why we want to see the private sector create the maximum number of new jobs in the health revolution that's coming.

Applause.

We are going to continue to work to repeal the regulations that people like Pete Stark and Henry Waxman put into law. The fact is those regulations are anti-consumer, anti-patient, anti-doctor.

Applause.

And for those of you who wonder what's at stake this November, remember that Chairman Bliley is a lot better than Chairman Dingell. That Chairman Bilirakis is a heck of a lot better than Chairman Waxman and that Chairman Thomas is infinitely better than Chairman Stark. And that that changes a tremendous amount about whose agenda, whose focus and whose direction is going on, and these are not small decisions. These are literally going to change the fabric of your life, of your profession, of your income, and of your family's future.

We're going to continue to work for Medicare Plus. We believe that it is vital to establish provider-sponsored networks so that there is a doctor/hospital base system competing head-to-head with the HMOs. We think that gives the consumer far better choices, and in rural America we think it is the only way to have a network of care because we don't think that the HMOs will ever be able to go in to the most rural parts of the country. But we want to provide doctors and hospitals an alternative to contracting with insurance companies for organized care.

Applause.

We also want to create medical savings accounts. We believe that whether it's in Medicare for senior citizens or it's in the general system, we will pass a medical savings account tax bill this year. We believe that you ought to have the right to have a high catastrophic where you basically get to keep the money if you take care of yourself and where you get to have a savings account that bills up and the interest bills up and if you do have a health problem you've got the money there to take care it. It lowers health costs. It increases consumer choice. It eliminates both the government and the insurance bureaucracies and it returns health care to a relationship between the patient and the doctor rather than having a third party who doesn't get the care, doesn't provide the care, and just messes up the system with more paperwork.

Applause.

Finally, we believe...and if I could ask you to do one thing coming out of this meeting, both personally and as an association, it would be to get across the following simple message to everyone you know. The Republican Medicare Plus Program saves Medicare, which is currently loosing $13 million dollars a day. The Clinton administration was wrong last year. They said in April 3rd of last year Medicare would start to lose money this year. It began losing money last year. They were off by $4,900,000,000 dollars on their estimate. And in fact, Medicare is loosing money earlier and faster than they said it would. We had the guts to step up to the table and to say we'll do something about Medicare. We invented Medicare Plus, which allows senior citizens to have the same right to choose as everyone else and takes power away from the Washington bureaucrats and returns it to seniors and the local health professionals. And we're proud of Medicare Plus. Medicare Plus was doing fine until the labor unions, the trial lawyers and the Democrats began running thirty-second commercials that are factually false. Those commercials said, "We cut Medicare." I want to give you the numbers. I hope you'll share them with everybody you know and I hope the Academy will do something in a serious way just to help educate the American people so we can have an honest debate based on honest numbers.

Last year we spent $4,800 dollars per senior citizen on Medicare. At the end of our seven year Medicare Plus Program to save Medicare, we spent $7,100 dollars per senior citizen on Medicare. Most of you will probably notice that if you went to the IRS and you said your income had gone from $4,800 dollars to $7,100 dollars, and since it had been cut you didn't owe any taxes.

Laughter.

They would not accept that. Because they would not accept that $4,800 to $7,100 is a cut. They would insist it was an increase. In fact, it's a $2,300 dollar per senior citizen, per year increase. Every time we do a poll and senior citizens learn the facts, and they realize that we have an increase in Medicare spending, they decide they like Medicare Plus to give power back home, to take it away from Washington bureaucrats. And every time that they are told a lie, and 40 percent of the country believes we actually go from $4,800 down, they get scared, legitimately. So we need your help to simply tell the truth about Medicare Plus.

Finally on Medicaid, we returned a great of power to the states. All of you know that Medicaid has been red-tape ridden, that it is very bureaucratic, that there is a great deal of fraud, and that the fact is that the federal government can't manage these system very well from Washington. We believe as a general principle that it is better to run things back home than it is to run them in Washington. We believe that in Cobb County, Georgia, Cobb County citizens looking at Cobb County probably know more about Cobb County than a Washington bureaucrat who has never visited Georgia, but once read a National Geographic magazine.

Laughter.

This is a very big change for the country. When we talked with the governors, they told us that they thought they could save $133 billion dollars at the federal level and $100 billion dollars at the state level if they were allowed to run the system. In New York State, alone, Governor Pataki said he thought he could save $45 billion dollars for the state taxpayers of New York in addition to savings at the federal level. We've discovered in negotiating in Washington that the word "savings" does not exist in the lexicon of Washington bureaucrats and so there's an automatic presumption that if you do something better, if you manage it better, it you have more effective systems that doesn't count. It's either an increase or it's a cut. We increase Medicaid in the Medigrant Program but we do not increase it as much as the liberals would have. And I would just ask all of you to look at the program we're offering and we think you'll agree that it gives you more local input and more local flexibility, less Washington red-tape and less bureaucracy.

Let me just say in closing, that I really appreciate you letting me come here today. I'm an optimist. I think we're on the edge of a revolution in opportunities and health. I think we're on the edge of a revolution in opportunities in job creation. But I think part of it is we've got to get out of this mindset that thinks of health care as a problem and move into a mindset that thinks of health services as an opportunity. I think that we should recognize that in the 21st century we can create more American jobs with higher take home pay, providing more sophisticated services and if we see our job as serving the world, given the declining cost of information and the declining cost of travel, we are going to be astonished at how many people can earn a great living in the U.S. and frankly, if half or a third of the successful people in the planet decide that they want to come to America for the best health care in the world and they bring their money with them and they come and provide, you know, we understand it's terrific if somebody arrives to go to Disney World. We think that's wonderful, so tourism is good. But literally our current statistics misreport what's happening because every person who shows up in America goes to MD Anderson, for a heart operation is listed as though it was an American problem, when in fact, it may well be a Brazilian or a German or a Venezuelan opportunity. So I think we've got to re-think and re-approach what we're doing and recognize that if we do it right, not only will you earn a terrific living, but so will all the nurses, so will all the therapists, so will all the analysts, so will all the people who provide the materials. And in fact, the medical technology field, the pharmaceutical field, the biotechnology field working with organized medicine, working with hospitals that are willing to be entrepreneurial may in fact, provide one of the major centers of employment in a positive way, providing the best care on the planet for more people who show up and who are delighted to be here. I think that's the kind of future we need to work on together. We look forward, as long as I'm Speaker, to working with you to creating that kind of an America where we collaborate we're not adversaries, where we have less litigation, less regulation, and less taxation so we have more freedom to create a better future for our children and our grandchildren.

Thank you for allowing me to be here and to speak with you today.

Applause.

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Last modified 27/September/1996