Summary

This speech was given to the University of Montana, Presidential Lecture Series 2007-2008, in Missoula, Montana on October 9, 2007. America is number one in many things but not all things. As a result, while Americans have a right to be proud, we should never be arrogant. Unfortunately, the world has seen more than a little American arrogance of late, both domestically and internationally. That must change. After all, whether we're talking about safeguarding public health, protecting the environment, or combating international terrorism, the United States can't go it alone. We're going to have to partner for progress on these and other types of issues, which have no geopolitical boundaries. While America is a great nation, we face a range of large and growing sustainability challenges that too few policymakers are taking seriously. In so many areas--fiscal policy, foreign policy, health care, education, energy, the environment, immigration, our infrastructure, and Iraq-- we're on an unsustainable path. First, since America's most valuable asset is its people, I'll start with education. The United States now has the best higher education system in the world. Unfortunately, we're not even in the top 20 nations in math and science scores at the high-school level. This represents a huge problem in a knowledge-based economy. If our country expects to maintain its standard of living, we're going to have to stay competitive on measures like innovation, productivity, and product quality. Fixing our K-12 education system will require radical reform and concerted efforts by all levels of government and all sectors of our economy. We must move beyond rhetoric and start delivering real results for a broader spectrum of the American population. Second, our nation's fiscal outlook. While short-term federal deficits are coming down, we face large and growing longer-range deficits and debt burdens due primarily to the retirement of the baby boom generation and rising health care costs. The retirement of the boomers will begin in three months, and when boomers begin to retire en masse it will bring a tsunami of spending that could swamp our ship of state.

To help save our future, we must impose tough budget controls, reform Social Security, Medicare, and Medicaid, and re-prioritize and constrain other spending. We also need to engage in comprehensive tax reform that will not undercut our economic growth or competitive advantage while raising additional revenues. We must do all of these things and the sooner the better because time is working against us and our debt clock is ticking. Our health care system is badly broken. We're now number one in the world in health care spending and obesity--facts that don't bode well for our wallets or our waistlines. Despite spending huge amounts on medical care, the United States has above average infant mortality, below average life expectancy, and much higher than average medical error rates for an industrialized nation. We also have the largest percentage of uninsured individuals of any major nation. Comprehensive health care reform will probably need to occur in installments over a number of years. Our goals should be fourfold: First, provide universal access to basic and essential health care. Second, impose limits on federal spending for health care. Third, implement national evidence-based medical practice standards to improve quality, control costs, and reduce litigation risks while avoiding heroic measures. And finally, take steps to ensure that all Americans assume more personal responsibility and accountability for their own health and wellness. In our constitutional democracy, it's "we the people" who are ultimately responsible and accountable for what does or does not happen in the capitals around our country. As a result, all of us must be informed and involved in order to make a difference.