Statement on Signing the
State Comprehensive Mental Health Plan Bill
I
am today signing S. 1744, an omnibus health measure, with mixed feelings. On
the one hand, I warmly endorse provisions of this legislation permitting the
export of unapproved drugs and biologicals under
certain conditions and repealing the Federal health planning authorities. These
are changes in the law my administration has long sought. On the other hand, I
have serious reservations about the portion of the bill that would establish a
Federal vaccine injury compensation program. The administration has also
objected to other portions that create a new program of State mental health
planning grants and enact superfluous new authorities such as that for
Alzheimer's disease research, education, and information dissemination activities.
The
centerpiece of S. 1744 is title I, which allows the export of drugs and biologicals awaiting approval in the
It
is also with great pleasure that I can finally lay to rest the Federal health
planning authorities. I have sought their repeal since I assumed office. These
authorities, while perhaps well intentioned when they were enacted in the
1970's, have only served to insert the Federal Government into a process that
is best reserved to the marketplace. Health planning has proved to be a process
that was costly to the Federal Government, in the last analysis without
benefit, and even detrimental to the rational allocation of economic resources
for health care.
As
noted, however, I do have serious reservations about title III of S. 1744,
which creates the framework for a vaccine injury compensation program and a
national vaccine program. Title III would establish a court-administered
program to compensate persons who suffer an injury as a result of receiving a
childhood vaccination. Although the goal of compensating those persons is a
worthy one, the program that would be established by title III has serious
deficiencies.
The
administration has been greatly concerned for some time that unpredictable tort
liability has caused many vaccine manufacturers to abandon production of
childhood vaccines. Last year we proposed legislation to address the liability
concerns underlying this serious problem so that vaccine manufacturers can
produce these vital vaccines without jeopardizing the viability of their
companies. Title III addresses only the worthy purpose of compensating persons
who may have been injured by a childhood vaccination. Even in this regard,
however, it suffers from substantial deficiencies. For example, under this
title there continues to be the opportunity for very substantial and
inequitable differences in liability judgments awarded similarly situated
plaintiffs. Another serious deficiency of title III is that it would create a
program administered not by the executive branch, but by the Federal judiciary.
This is an unprecedented arrangement that represents a poor choice to ensure a
well-managed and effective program.
A
major factor in my decision to approve S. 1744 despite the serious deficiencies
in title III is that the bill provides that the vaccine compensation program
established in that title will not be effective until a separate measure
funding the program is enacted. This provision offers the opportunity to ensure
that any funding measure enacted by the next Congress to implement the
compensation feature of title III will not call for any part of the cost to be
borne by the Federal taxpayer, and will also include certain key corrective
program changes addressing the problems I have noted. In this regard, title III
should be modified to ensure that childhood vaccines will be available to all
American children. Second, there should be an acceptable resolution to the
separation of powers concerns raised by the bill, resulting in a structure
compatible with the inherent responsibilities of the executive and the
judiciary in the administration of entitlement programs. Third, any acceptable
measure to implement a vaccine compensation program should structure the
program so that no funding will be provided from the Treasury of the
In
addition to my concerns regarding title III, I also have reservations about
titles IV and V of S. 1744. Title IV, which is concerned with certain aspects
of medical malpractice, has been modified and improved substantially from
earlier versions. Nevertheless, I am concerned that the provisions of this
title may increase anticompetitive behavior among physicians, raise the cost of
health care, and reduce its quality. At my request, Secretary of Health and
Human Services Bowen has established a task force that is examining the whole
range of issues related to medical malpractice, and I look forward to his
additional recommendations early next year.
Title
V requires States to develop and implement comprehensive mental health services
plans. States that do not submit such plans or fail to implement such plans
would not be eligible to receive funding under the Alcohol, Drug Abuse, and
Mental Health Services Block Grant. These provisions not only intrude into
traditional State responsibilities and prerogatives concerning health care
regulation but also undermine States' flexibility regarding the provision of
specified health care services. The provisions are also unnecessary since the
Public Health Service Act already permits States to use block grant funds to
prepare comprehensive mental health services plans.
Despite
these concerns, I believe that the benefits of S. 1744 outweigh its defects;
and therefore, with some reluctance, I am approving the bill.
Note:
S. 1744, approved November 14, was assigned Public Law No. 99 - 660.