General Wesley Clark
Dartmouth-Hitchcock Medical Center Grand Rounds

(As prepared for delivery) Lebanon, NH January 9, 2004 It's great to be here with all of you today at this fine institution. Before I begin my remarks, I'd like to take a moment to make a few brief acknowledgements.

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I'd first like to recognize Dr. C. Everett Koop. As we all know, Dr. Koop was a truly pioneering Surgeon General, tackling some of our toughest public health issues with the kind of courage and candor that raised the bar for all who followed. I also want to acknowledge Dr. Joe Jacobs, a great health care leader in Vermont. I'm glad he could be with us today. And finally, I want to recognize Dr. Doug White and Dr. Steve Joseph who have played an important role in my campaign.

Now, I've got to tell you, I was pretty excited when I received an invitation to come speak to you today. And a couple of weeks ago, when I saw my own doctor back home in Arkansas, I told him that I was going to be up on stage for the Grand Rounds here at Dartmouth-Hitchcock. Never one to mince words, he just smiled, shrugged his shoulders, and said: "Well, Wes, I suppose it's better to be the presenter at one of their Grand Rounds than the subject of one of their CPC's."

In all seriousness, it's an honor to be here today, especially in this capacity. Dartmouth-Hitchcock Medical Center is truly a world-class institution that is changing the face of modern medicine - in the classroom and in the clinic - here in America and around the globe.

For example, the work of Dr. Jack Wennberg and his team has been central to our thinking on how to reform our health care system. And I know that just a few weeks ago, three staff members from DHMC flew halfway around the world to aid the victims of the earthquake in Iran.

It's that kind of leadership, that kind of commitment, that makes this hospital great. And I commend you for it.

I'm here today because I'm worried about the future of America's health care system.

We have the best health care system in the world - if you can afford it. But today, 44 million Americans can't. And that's unacceptable.

We have the most talented, innovative scientists in the world. But today, your hands are too often tied by a president who's put right-wing ideology above crucial biomedical research. And that's unacceptable.

We have the best doctors and nurses in the world. But today, too many of you are demoralized and dissatisfied. Buried in paperwork, forced into assembly-line practices where every decision you make is questioned by bureaucrats who've never seen or spoken to the patients whose lives they hold in their hands. Bureaucrats who think that five extra minutes spent explaining a procedure or reassuring a family is wasted time. Bureaucrats who don't understand that medicine isn't a business - it's a calling.

And today, our health care system is in critical condition. It's failing doctors, and it's failing patients. Premiums have risen 40% in the last three years, and so has the number of uninsured - by 4 million people. Minority health care disparities still persist: today, the African American uninsured rate is nearly twice as high as in the white population. And today, while the United States ranks first in health care spending - we're ninth in life expectancy and 28th in infant mortality.

The stark fact is that today in America, we have a 20th century health care system that cannot live up to the demands of 21st century medicine. And we simply cannot continue down this path.

That's what I want to talk to you about today - about what we must do in the coming decade to bring our health care system into the 21st century.

This is something I've been talking a lot about over these past few months, starting back in October, when I introduced my health care plan. My plan addresses the twin health insurance crises in America: the rising cost of health insurance and the rising number of the uninsured. My plan will cover an additional 30 million Americans - including every single American child up to the age of 22. And it will combat the minority health disparities that continue to plague us.

Since then, I've also introduced my plans to fully fund veterans health care. To double our investment in tackling the global AIDS crisis, while fully funding Ryan White for people here in America. And to create a comprehensive, meaningful, affordable prescription drug benefit.

Today, I'd like to touch on a different set of issues, starting with one that affects tens of millions of Americans - and that's how we can bring mental health care into the twenty-first century.

Forty years ago, one of my heroes, President John F. Kennedy, fought to create community mental health centers to replace the grim institutions providing care back then. And he made a public statement that was nothing short of revolutionary for the time. He said: "It is time for the treatment of the mentally ill to move into the mainstream of health care."

We've certainly made a lot of progress since then - but we're still far from living up to President Kennedy's vision.

An estimated one in five Americans has a diagnosable mental illness, and mental illness is the number one reason for hospital admissions nationwide. So I simply cannot understand why we continue to treat mental illness differently than other illnesses. When you're sick - whether it's with depression or cancer; alcoholism or heart disease - you deserve compassionate, appropriate treatment with no strings - and no stigma - attached.

That means making mental health benefits parity one of our highest health care priorities. Insurers should not be allowed to carve up, cap, or otherwise selectively limit mental health benefits. That's why I fully support the bi-partisan Wellstone-Dominici Mental Health Equitable Treatment Act that would stop health plans from treating mental health benefits differently from other benefits.

But parity isn't enough. You don't have to be in psychiatry to know that mental illnesses respond best when diagnosed and treated early. So we've got to make greater investments in identifying and treating mental illness at its earliest stages, especially among children. That means instituting more comprehensive mental health programs in our schools and bolstering social services and drug treatment programs in our communities.

But today, I think we also need to realize that broader coverage for health care isn't going to mean much if we don't have the best delivery of that care.

And that's what I want to talk about next - about how we treat some of our most important health care providers - our nurses - and their role in a 21st century health care system.

But before I say another word, I first want to ask all of the nurses here today to stand up so that we can give you a round of applause for the outstanding work you do every day. Dartmouth-Hitchcock was the only hospital in New Hampshire to achieve Magnet status for nurse excellence from the American Nurses Credentialing Center. That's a testament to your good work, and I commend you for it.

I know first-hand the difference that quality nursing can make. 34 years ago, when I was a young army captain in Vietnam, I was taken down by enemy fire. I was shot four times - in my hand, my shoulder, and my leg. I spent months back home recovering - learning to run again, learning to shake hands with a firm grip.

It wasn't easy, but I was lucky. I had great doctors. And I had terrific nurses. Nurses who worked with me every day and always took the time to explain what was going on. Nurses who pushed me and refused to let me get discouraged, no matter how tough things got.

I saw then that nurses are truly the frontline of our health care system. And studies show that good nursing reduces hospital stays and cuts down on complications. But today, long hours, low wages, and poor working conditions have driven too many of our best nurses out of the profession.

The resulting shortage is nothing less than a health care crisis - a crisis that's only going to get worse in the coming decades. By the year 2020 - just when many of the baby boomers will be needing extra care - 44 states and the District of Columbia expect to have nursing shortages. All told, we're going to have a shortfall of 800,000 nurses.

It is very clear that we need to take bold action. And we need to take it now.

First, we've got to take real steps to improve working conditions for our nurses. That means putting an end to mandatory overtime, because it's not just unfair - it's unsafe. It means implementing whistleblower protections, so that nurses can speak out about dangerous conditions without fear of retaliation. And it means instituting a federally-mandated nurse-to-patient ratio. A number of states have done so, and it's high time the federal government did too.

We also need to give our nurses the authority they need to do their jobs. That means fully utilizing our nurse practitioners, especially in underserved areas. And it means ensuring that nurses are involved at all levels of management in our hospitals, especially when it comes to decisions about their working conditions.

And if we really want to solve the nursing crisis in the long-term, we've got to do more to support nursing recruitment and education. Funding the Nurse Reinvestment Act to help more people attend nursing school and improve nursing education is a good first step.

But even if we've got the broadest coverage and the best care money can buy, it's not going to amount to a whole lot if we can't provide the treatments and cures our patients need.

And that brings me to third issue I want to address today: supporting research.

If we truly want to bring our health care system into the 21st century, then we need to support 21st century research. And one of the most serious obstacles to 21st century research is the wrong-headed, ill-advised restrictions on stem cell research.

All of us here know that these tiny cells may hold the key to curing diabetes, Parkinson's, Alzheimer's and so many other debilitating illnesses. But today, our President is holding this potential hostage, cutting off some of the most promising research, depriving us of some of the most urgently-needed cures.

When President Bush announced his policy, he claimed that we had more than sixty stem cell lines, and his HHS Secretary assured us that they were "robust and ready for research." We know now that they weren't being straight with us. When Bush announced his policy, only a handful of lines were available for research. And today, only twelve of those stem cell lines are available - not enough to support the kind of research we want to do.

So right now, across America, lives hang in the balance, and families pray for cures that researchers - their hands tied by our President's policy - cannot pursue.

President Bush talks a lot about valuing life. But the stark fact is that his stem cell policy jeopardizes it. I think that someone ought to explain to our President that the Hippocratic Oath is not a license to practice hypocrisy. Limiting stem cell research is not compassionate. It's not conservative. It's heartless, it's reckless, and it's wrong.

And as President, I intend to put it right. Today, I pledge to you that as President, I will never put ideology over science. I will never play politics with your patients' lives. And I will make it one of my first acts as President of the United States to lift President Bush's stem cell restrictions once and for all.

Of course, just as we did under the Clinton Administration, we need to uphold the highest ethical standards for our stem cell research. We've got to have strict controls on what research we fund and how we obtain our stem cells. While we know that research on human stem cell lines has the potential to do great good, it also has the potential for great harm if taken too far. That's why I strongly support passage of the Human Cloning Ban and Stem Cell Research Protection Act.

Finally, before I open up the floor to questions, I want to talk about one of the most important steps we can take to move our health care system into the 21st century - and that is reorienting it toward value, accountability and prevention.

One of the great benefits of the health plan I had in the Army was that it emphasized prevention every step of the way - from annual physicals, to cholesterol screenings, to routine check-ups. The Army understands that prevention isn't just good medicine - it's good economics too.

And frankly, when I got out of the Army, I was surprised to learn how many health plans didn't require preventive screenings of any kind. Today, many health care plans take a reactive, instead of a preventative approach. And it simply isn't working.

Just take the example of diabetes. An estimated 17 million Americans suffer from diabetes, yet experts say that 6 million of those afflicted remain undiagnosed and, therefore, untreated. So we're spending tens of billions of dollars to treat the complications of diabetes - heart and kidney disease, blindness, stroke and other conditions. But we could limit most of these ailments and their associated expense with a combination of diet, exercise and medication.

The bottom line is that today, in the twenty-first century, we should be getting a lot more bang for our health care buck. We know we can have a health care system that provides the highest quality care at a reasonable cost. We've seen it in projects like Paul O'Neill's Pittsburgh regional health initiative. The key to this kind of 21st century system is prevention. And that is the centerpiece of my health care plan.

I will establish an Independent Commission to determine the value of health services and benefits - particularly ones geared toward prevention - and to promote those that are most effective. This Commission will be comprised of scientists, health care economists, health care providers, and patients. And let me be very clear about who will not be on this Commission: HMO executives will not be on it. And pharmaceutical company marketers will not be on it either.

The Commission will use cutting-edge science and clinical research to identify best practices, and they will submit their recommendations to Congress. Congress will then take a simple up or down vote on whether all federally funded programs - from Medicare to the Federal Employees Benefit Plan - should adopt these recommendations.

Ultimately, I'm hoping that if the government takes the lead in implementing the Commission's recommendations, the private sector will follow suit, bringing their practices in line with the best possible evidence based medicine.

In addition, my plan promotes the increased use of technology to reduce medical errors, save money, and make doctors' and nurses' lives easier. Too many health care providers today feel like they need a degree in paper-pushing just to sort through the piles of forms on their desks. My plan promotes increased use of electronic medical records, computer-aided decision tools, reminder systems for patients and other systems that will streamline health care and end the paper chase once and for all.

Bringing our health care system into the 21st century isn't going to be easy. But medicine has always been a future-oriented profession. There is a wonderful restlessness about this profession - a refusal to be content with one technique or treatment when you know there might be something better around the next corner. Whether it's discovering the X-ray, eradicating polio, or sequencing the human genome - you're always looking over the next horizon and pushing the next frontier.

Modernizing the American health care system is going to take a higher standard of leadership. One that puts America's interests above the special interests. One that promotes open, honest government, and holds its leaders accountable, with real, measurable goals. Leadership not just for the next election, but for the next generation.

I'm running for president to bring that kind of leadership back to the White House. To make the tough choices about health care and the many other pressing issues we face. Working together, we can turn our health care system around, and build a better America.