I am deeply concerned about our national priorities, and I want to take advantage of this public policy dinner to suggest that we redirect our efforts and recast our national debate to address more accurately our most urgent problems. 

I don't mean to be partisan in my comments, but no one should be surprised if I speak from a conservative perspective and as a Republican. And I want to concede at the outset that we Republicans have contributed to the situation that concerns me tonight. Specifically, I am concerned that as a nation we have relegated foreign and defense policy to last place on the public agenda--at the precise moment when the world is most in need of American leadership. 

As a result of the end of the cold war, the breakup of the Soviet empire, the demise of communism, and the speed and success of our efforts to roll back Saddam Hussein's aggression in the gulf, we have concluded that the world is a safe place, one that no longer requires the attention of the American people. We are justified, according to this view, in dramatically scaling back our military capabilities and can now refocus our time and our resources on domestic matters. We have turned inward as a nation and signed on to the proposition that the only truly important matters on the public policy agenda are domestic issues. 

The manifestations of these developments are all around us:

• in public opinion polls that place foreign policy and defense issues at the absolute bottom of items that concern us;
• in a presidential campaign a year ago in which there was almost no discussion of national security matters;
• in an administration that prides itself on its domestic priorities and seeks to keep international issues on the back burner;
• in a president who has made only one major foreign trip during his first year in office and who has yet to set foot in Europe some eleven months into his term;
• and finally in a remarkable report that appeared recently in the New York Times that Secretary of State Warren Christopher had "summoned up the courage" to insist that the president spend at least one hour a week with his national security advisers.

Before you conclude that I am being unduly harsh on my Democratic friends, let me point out that we Republicans bear part of the responsibility for this state of affairs. We are the ones who acquiesced last fall in the Democrats' assertion that the 1992 campaign for the presidency should address domestic issues only. We bought off on the notion that the public didn't want to hear about foreign policy and national security issues. Having given up our chance to remind the voters of our success at managing international affairs, we then failed to persuade them that we Republicans were better suited to manage domestic affairs.  

But our first failing was in allowing ourselves and the American people to be lulled into a false sense of security--into believing that all is right with the world and that the end of the cold war as we've known it for the last forty years meant it was safe to devote all our time and attention to domestic pursuits. As a result, we've lost our focus, and there is now a lack of understanding of what's at stake in the international arena.  

As a result of the 1992 election, we now have:

• an administration with little or no experience at coping with international crises;
• a president with no background and little time for managing foreign affairs;
• and--as in the past--a rapid dismantling of our military capability and undermining of our capacity to influence events out of a false sense of security that threats to our existence are a thing of the past!  

In many ways, the problem comes down to leadership. Real leadership isn't just a matter of giving the people what they think they want. Oftentimes it involves telling the people things they don't want to hear--and then showing the courage and commitment needed to bring them along. That's what presidential leadership is all about. 

The world is still a very dangerous place. The breakup of the old order is continuing. Moreover, as events of the last few years demonstrate, political trends can quickly and unexpectedly reverse themselves. Unable to eliminate risks, we must hedge against the unexpected. 

In Moscow there is a revolution in progress. It isn't over yet. The forces set in motion by the collapse of the old communist system are enormous, and no one has any idea where they will take us.  

Twice within the past two years, efforts at counterrevolution have been launched by the Old Guard--efforts aimed at reversing or slowing the pace of reform. Fortunately, both failed; but in my view both attempts were very close-run things. It wouldn't have required much--a change in timing, a delay in troop deployments, a less successful defense of the television station--to place Mr. Rutskoi in charge in Moscow tonight. And each time there is a political struggle in Moscow in the years ahead, it will not just be about who gets that big fancy office in the Kremlin--it will also determine who will have operational control over the world's largest inventory of nuclear weapons. 

As I look at Russia tonight, I see a political system that is in a state bordering on chaos, with no consensus on the form or authority of political institutions by which they will govern themselves. In the former Soviet Union, armed conflicts periodically erupt in Uzbekistan, Tadjikistan, Moldova, Armenia, Azerbaijan, and Soviet Georgia. Few of their economies show any sign of recovery from seventy years of communist mismanagement. 

Millions of Russians live as unwelcome minorities in the non-Russian republics, and Foreign Minister Kozyrev has laid claim to the right for Russia to intervene to keep the peace in the "near abroad" and to have the United Nations pay for it. Frankly, there are regions of the former Soviet Union where we might welcome Russian intervention to restore order--better Russian intervention than Iranian intervention. But clearly there are republics where Russian intervention would be of grave concern to the rest of the world and where it could be the pretext for civil war.  

Consider Ukraine. I think Zbignew Brzeznski has stated it well--that peace and stability in the European part of the old Soviet Union and therefore in Europe itself may well depend upon whether or not the Ukranians make it. A successful Ukraine--successful economically and politically--is likely to retain its independence and sovereignty. But a Ukraine that is not able to implement strong, viable political and economic reforms is doomed to fail. And a seriously weakened or collapsing Ukraine may well generate irresistible demands in Moscow for some future Russian government to reassert control over Kiev.  

Needless to say, the possibility of open conflict between Russia and Ukraine has grave ramifications not only for the nations of Central and Eastern Europe but for the entire world. In my opinion, the world will be coping with the consequences of the breakup of the old Soviet Empire well into the next century--and will require the utmost in skill and diplomacy if we are to avoid major disasters.  

If you are not suitably sobered by the dire circumstances that could flow from events in the former Soviet Union, then perhaps you will be impressed with the growing crisis in North Korea--with the possibility that the heavily militarized, unpredictable, and perhaps nuclear-armed North Koreans may lash out as the world seeks to cope with the problem on the Korean peninsula. 

I want to give credit to President Clinton for reaffirming the commitment of the United States to the safety and independence of the Republic of Korea. I hope the administration will be able to mount the kind of effort that will resolve the crisis. Yet I'd be more comfortable if the administration had previously demonstrated an ability to pursue a consistent and coherent policy in coping with international crises. So far the administration's efforts in Somalia, Haiti, and Bosnia have not been confidence-inspiring for our allies--nor have they instilled respect in our adversaries. 

As a nation we cannot afford to assign these problems a low priority--nor can we afford to further reduce our capacity for shaping these events by unwisely dismantling our essential military capabilities. Now more than ever, strong presidential leadership--backed up by a supportive Congress--is needed to reaffirm existing friendships, to adapt old security arrangements to new circumstances, and to take advantage of the rapid turn of events to consolidate and expand the zone of peace and the reach of the world's democracies. We dare not allow national security matters to fall to last place on our list of public policy priorities. 

Here at home I also believe our public policy priorities are misplaced. The administration clearly has assigned first priority to gaining congressional approval of national health care legislation. We have been told repeatedly that we have a "crisis in health care" in this country. We have been told that our health care system is inefficient, too expensive, and not of the same quality as those of other major industrialized nations. Finally, President Clinton has said that the American people are "choking" on our health care system. 

I disagree. I think the crisis the president and the first lady perceive is a manufactured crisis. I don't believe there is a crisis in our health care system. On the contrary, I am firmly convinced that we have the best health care system in the world.  

Does that mean it's perfect? No, it does not. Does that mean that there is no room for improvement in the quality of our health delivery system? Certainly not.  

Does that mean we should stick with the status quo and resist all efforts at reform? Absolutely not. It does mean that I fundamentally disagree with the Clintons' assessment of our existing health care system. And I strenuously object to the notion that it is in such a state of disrepair that radical surgery is needed to fix it. Indeed, it's my view that the so-called crisis in health care has been constructed to justify the radical restructuring of one-seventh of our national economy and a vast expansion in the role and power of the federal government. 

By any objective measure our health care system is a phenomenal success story. Let's look at some of the results:

1. We now have the highest life expectancy in our history. People are living longer: on average, nearly thirty years longer than at the turn of the century.
2. Infant mortality is at an all-time low--and it's declined every year for the last thirty years.
3. The incidence of death from heart disease--the nation's number one killer--dropped by 39 percent from 1970 to 1989.
4. The incidence of death from stroke--the number three killer of Americans--plunged 58 percent over the same twenty years.
5. And just last week it was announced that we have discovered a link between certain forms of cancer and a particular gene. The discovery will ultimately result in a test that will save tens of thousands of lives per year.

Not bad for an inefficient, corrupt, bureaucratic system. Obviously somebody is doing something right.  

There has been a great deal of attention focused on the 37 million Americans who do not have health insurance, and that's appropriate. But it is essential not to misrepresent or misuse that figure. It is important to know what it does not include. It does not include any elderly, because all of our senior citizens are insured through Medicare. It does not include many of the poor, because they are covered by Medicaid. And it does not mean there are 37 million Americans without health care, because most of them who are not insured do nonetheless receive care when they need it. They receive care gratis from physicians and hospitals, or they pay cash, or the costs are shifted to those of us who can afford to pay. The notion that there are millions of Americans without access to health care is simply not true. 

We have been told by the administration that we are being ripped off by the pharmaceutical companies, ripped off by the insurance industry, ripped off by physicians and hospitals. Now, the health industry probably has its fair share of unscrupulous operators. But to malign an entire industry with the broad brush of condemnation is uncalled for.  

The fact is that many of the people and organizations involved are truly our best and brightest. They have been responsible for the phenomenal progress we've made in the health field. They have raised billions of dollars from private investors to fund some of the most productive, creative, and innovative firms in the world. And many of our health care professionals are among the most dedicated and hard-working people in the nation. 

If we want to search for villains in the health care field, the first suspect should be the federal government. No institution contributes more to the inefficiencies and waste that President and Mrs. Clinton condemn than the federal government. Congress has consistently responded to the demand for fiscal restraint in health programs by continuing to provide the full range of services to beneficiaries, while at the same time reducing the funds available to pay those who provide those services. The result: Uncle Sam pays only a portion of the true cost of the Medicare and Medicaid programs.  

The rest has to be absorbed by the health care providers or shifted to the rest of us who have private insurance. It is hardly surprising that some of us are deeply suspicious of any proposed solution that would vastly expand the responsibilities and authority of the federal government in the health care field. 

We can all agree that we want to work to reduce costs, to find ways to deliver health care more efficiently, but most of us would not want to do so at the expense of quality or freedom of choice. Nor would I want to be told by the government that some artificial "global budget" limits what I can spend on health care. Why should Washington dictate how much I spend for my family's health care? 

Much of the increased cost of health care is due to advances in technology. Thirty years ago if you developed kidney disease, you died. Today, you can get dialysis treatments--at a cost of about $80,000 per year. 

Treatments and technology that weren't available anywhere in the world a few years ago are widely available across the country today. We have been very successful at distributing the latest techniques and technology throughout the nation so that the quality of care in Casper, Wyoming, is as good as it is in New York City or San Francisco or Washington, D.C. That costs money--but most of us believe it's a good investment. 

It would help the quality of the debate if the administration were more precise in its choice of rhetoric used to describe the problem and its proposed solutions. I can remember when taxes were called "revenue enhancements." The administration has achieved a whole new level of obfuscation by calling this health care tax of 7.9 percent on employers a "mandate." And their credibility isn't helped by arguing that one of the biggest, most expensive programs in history should be "off budget"! 

At a time when we are faced with rising federal deficits in the future, driven by uncontrolled entitlement programs, can we really afford to enact a huge new entitlement program providing national health care without any idea of its ultimate costs? Does anyone believe the administration's claim that it can vastly expand the scope of our national health care system, lengthen the list of benefits provided, give broadened authority to the federal government, create an entire new system of bureaucracy, and reduce the overall costs of health care?  

I don't. I don't believe the Clintons have any idea what the true long-term cost of their proposal would be. But I do know that once we have created a huge new entitlement program, we will never be able to undo it. It will be with us forever. 

If there is no "crisis" in health care, there are areas of domestic policy where we do have systems in "crisis." I am referring in particular to the crisis in our inner cities, to the fact that every year thousands of our young men slaughter one another--sometimes over drugs, sometimes over nothing more than a pair of sneakers--and cause the tragic deaths of hundreds of innocent bystanders. 

Why are such individuals on the street in the first place? Part of the answer is that we have a criminal justice system that failed to obtain convictions in 75 percent of the murders in our nation's capital over a recent three-year period. A criminal justice system that hands out lengthy prison sentences to law-enforcement officials who use excessive force in the line of duty but releases career criminals and repeat offenders back into our communities where they commit unspeakable crimes against our children, that is a system in crisis! 

Hopefully we will make progress in the year ahead in improving our health care system and restoring order to the streets of our inner cities. I hope that in the rush to deal with the so-called crisis in health care, we will not destroy the 90 percent of the system that does provide high-quality care to the vast majority of Americans in order to "fix" the 10 percent that is in need of repair. 

One of the good things about being out of office these days is having the time to do things that simply haven't been possible in recent years. This past summer I drove eight thousand miles across the country, by myself, deciding on the spur of the moment which route to follow, stopping at the McDonald's hamburger joints and the truck stops, hitting some of the back roads as well as the interstates. Along the way, I made a few speeches, visited with friends, and caught up on my fly fishing. 

I came away from that experience feeling good about America. I was persuaded that in spite of our problems, the basic fundamentals of our society remain strong. Every day millions of Americans in thousands of communities all across the land go to work, raise their families, build their businesses and farms, contribute to their churches, and accept personal responsibility for what happens in their lives and in the lives of their families. That is our great strength as a nation, that and the freedom each of us enjoys to pursue our dreams. 

Those of us who participate as public officials in the business of governing the nation need to remember our obligation to those millions of Americans. As we set the national agenda and determine our public policy priorities, we must guard against the temptation to substitute our judgment for the judgment of our citizens. We must avoid the trap of thinking any group of government officials, no matter how well intentioned, is justified in restricting the right of our people to make the important decisions about their lives for themselves.  

We need a government that will get its own house in order so that the functioning of the federal government will not be a drag or an impediment to the progress the American people will otherwise attain for themselves. We need to avoid policies that interfere with the miracle of the marketplace. 

Government should be in the business of conducting its affairs so as to avoid stifling the creativity and the entrepreneurial genius of the American people. It should seek to foster innovation and growth by providing incentives to encourage savings and investment and capital formation. Government should not stifle our private sector through overregulation or excessive taxation.  

We should seek to extend the benefits of the free enterprise system around the world by aggressively pursuing expansionist trade policies. That offers the best hope for the success of the economies of the newly emerging democracies. And the success of their economic experiments with capitalism is likely to determine the outcome of their experiments with democracy.  

Finally, it is more important than ever that our president be a foreign-policy president, that he be actively engaged in the business of shaping world events, that national security issues be right at the top of our national agenda, and that we constantly remind ourselves that peace and freedom in the world will continue to depend upon U.S. leadership backed up by U.S. military capability. 

I think it will be a tremendous stride forward the day government once again provides security for both our neighborhoods and our nation as a whole and then stands back as the genius of the American people makes America the envy of the world.

Richard B. Cheney is the recipient of the AEI Francis Boyer Award for 1993.