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"So having shared with you our observations and recognizing the magnitude and the inter-relatedness of the cost, coverage, and quality problems we face, and the failure of all the existing and presently proposed strategies to deal with it, what reforms do we feel will be necessary?

Well, we have concluded that the solution is going to require a comprehensive strategy that effectively integrates federal, state and private sector policies and achieves all of those goals. We must achieve universal coverage. After ten years of effort and looking here and elsewhere, we have found no voluntary mechanism that will achieve that. We must create a massive effort, public and private, to improve the quality of all care and to eliminate that waste of hundreds of billions of dollars and the unnecessary carnage that it causes.

We must develop a mechanism to control total health system cost, not just for Medicare, not just for the big buyers, but for everybody. And to stop the national shell game of cost shifting which currently is the mode of operation. And obviously, we have to create a viable, fair, sustainable system to finance care. Having done those things, we've automatically accomplished the last objective which is to administratively simplify the most complex, non-user- friendly system on the face of the earth.

This year, the Area Health Education Center Program celebrates its 30th year, continuing to fund initiatives to recruit and retain underrepresented minority students in the health professions.

As you can see, the subject of this conference, cost containment, is one, but only one of the essential goals. Why do they all have to be attained as hard as that will be to do? Because, as I said earlier, the problems are inextricably intertwined. You can't solve one without addressing them all. It's a vicious cycle. Without system-wide cost containment strategies, you can neither assure, afford nor sustain universal coverage. Without universal coverage, you cannot assure quality. And in the absence of quality, you cannot contain your costs or, most importantly, make rational payment decisions...

In addition, without universal coverage, you can neither create a truly competitive market-based system, make the system less complex, stop risk selection and cost shifting, nor most importantly, achieve a level playing field of equitable financing.

And remember, those who advance the managed competition hypothesis honestly told us a decade ago that it could not work without mandatory universal coverage.

Now, we recognize that to achieve those ambitious reforms is not going to be easy... We have to get the public and our political leaders to understand that there is a great deal of unfinished business in health care. We are convinced that health care will be the transcendent domestic issue in our society in this decade. And in our coalition meeting just two days ago in Washington, we unanimously committed ourselves to do everything we can to make this our highest priority over the next two years.

So, to conclude, given our assessment, what are our answers to the three major questions we've talked about these two days: Should health care costs be contained? They must be, because unless they're contained, none other than the wealthy can be assured they will have coverage when they need it or continue to be able to afford that which they now have.

Question two. Can health care costs be contained without harming patients? Absolutely, but not with the strategies we're currently using, or currently contemplating.

Question three. Must the system be restructured? Yes, from top to bottom.

Question four. What will be necessary to control costs? These major national policy changes and the abandonment of a bankrupt piecemeal strategy we've been utilizing for 40 years.

A difficult task, monumental, but one that we are convinced must be completed, because otherwise our great grandchildren will be sitting in this room attending not the 9th but the 109th Princeton Conference and a topic of which will be "Why didn't we do what was necessary sooner?" So, I guess you can subtly show that we reject the piecemeal approach that this society is trying to implement. And frankly, we would also, I guess, object to those people who say, 'Because it's going to be hard, we shouldn't try.' That's a self-fulfilling prophecy."

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