    [Public Papers of the Presidents of the United States: George W. Bush (2002, Book I)]
    [February 11, 2002]
    [Pages 205-212]
    [From the U.S. Government Publishing Office www.gpo.gov]

    Remarks at the Medical College of Wisconsin in Milwaukee, Wisconsin
    February 11, 2002

        Well, thank you very much, Tommy; I
    appreciate your introduction. Your heart may be in Wisconsin, but you've
    got to keep your address where it is right now. [Laughter] I'm counting
    on you. He's doing a fabulous job. I love Wisconsin for a lot of
    reasons. One, you produced Thompson. I love you so much I even come in
    the winter, which is hard for a Texan. [Laughter]
        It is an honor to visit this distinguished place of learning which
    trains so many outstanding physicians. I happen to know something about
    Wisconsin doctors. I'm pretty familiar with them. After all, the White
    House physician is Colonel Richard Tubb, raised
    right here in Wisconsin. He's not only a fine doctor; he fortunately got

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    special instructions on pretzel-related conditions. [Laughter] My advice
    is, swallow after you chew. [Laughter]
        But the Medical College of Wisconsin represents the future of health
    care, here and throughout our country. It's a fitting place to address
    the great opportunities and challenges that the future will bring our
    country. Our health care system is in need of important reform and on
    the verge of amazing discovery. We must seize the moment for the benefit
    of all Americans.
        And that's why I want to thank Scott McCallum for welcoming me here, and I appreciate his leadership
    for the State of Wisconsin. I want to thank the members of the
    congressional delegation, Barrett,
    Petri, Ryan,
    Sensenbrenner, for coming, as
    well. It's good to see all of you. I'm looking forward to working with
    you to do what's right for the citizens in terms of health care.
        I appreciate Michael, his leadership,
    and his hospitality. I want to thank the docs who gave me a briefing.
    And I want to thank all of you for your warm welcome.
        I want to talk about two things, and they both have to do with the
    challenges we face. I briefly want to talk a little bit about the
    challenge we face abroad. And then I want to talk about the challenge we
    face at home, particularly with health care.
        First, the enemy made a bad mistake. They don't understand us. Let
    me rephrase that--they didn't understand us. They do now. We are
    patient. We're resolved people. But we are absolutely determined to
    defend freedom.
        I'm pleased to report that out of the evil have come some good, one
    of which is that in Washington, there is no difference between
    Republicans and Democrats as to who is the most patriotic or who wants
    to win the most. All of us want to win the war against terror, for which
    I am grateful.
        But I want to tell you all that we're just beginning, that I see
    this as a unique moment in history. And this Nation must seize the
    moment. And it's this: Either we defend freedom, so that our children
    and grandchildren can grow up in a peaceful world, or we blink. And if
    we blink, the rest of the world will blink as well. I don't believe we
    have that luxury. I believe we must find terror wherever it hides and
    bring it to justice.
        And so the Afghan theater is the first theater in the war against
    terror, and we've done a lot in a quick period of time. I laid out a
    doctrine that said, if you harbor a terrorist, if you feed a terrorist,
    if you hide a terrorist, you're just as guilty as the terrorists. And
    the Taliban found out what I meant. Not only have we thrown them out,
    but in doing so, we liberated--we liberated women and children from the
    clutches of one of the most barbaric regimes in the history of mankind.
        I'm proud of our military. And for those of you who have got a
    relative in the military, thank you, and I know you're proud of that
    relative, as well.
        There's a lot of focus on one individual in this war on terror, but
    this is much bigger than one person. Oh, the guy, he can hide, and he
    can run, but there's no cave deep enough for the arm of justice of the
    American people. And it's just a matter of time. I have no artificial
    date deadlines. I really don't care if it's tomorrow or a month from now
    or a year or a couple of years. But Mr. bin Laden is going to meet his fate.
        And in the meantime, the United States of America will continue to
    rally our coalition, to continue to cut off money from terrorist
    organizations, continue to share intelligence so we can react better,
    continue to defend our homeland, and continue to insist that freedom-
    loving nations find, incarcerate, and bring to justice anybody who would
    harm America, our allies, and our friends.
        There was some concern amongst some that the farther we got away
    from the horrible day of September 11th, America would waver in our
    determination. They

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    don't need to be concerned. We are determined. We are patient. We are
    tough. We're compassionate. We will not yield to terror.
        There are a lot of challenges we face. We fight a recession. I'm
    optimistic we'll recover. But one of the big challenges is our health
    care system. I like to put it this way: We face a huge challenge of
    making sure that we're still the world's greatest health care system.
    That's our challenge. How do we maintain our edge? How do we make sure
    the American people get the best health care in the world?
        And it starts by making sure that we attract the best and brightest
    to the medical profession. And that can start with the President saying,
    thank you for dedicating your lives to such a great calling. America
    appreciates the fact that you've chosen a profession that is so profound
    and so important. It's a model of service and excellence. And the
    achievements of our medical professionals set the standards for the
    entire world.
        Life expectancy in America today is 8 years longer than it was in
    1950 and 29 years longer than it was in 1900. That's a lot of progress.
    And for millions, those extra years are more active and more healthy
    than anybody could have imagined. We're making great progress against
    many diseases, such as breast cancer and colon cancer and childhood
    leukemia. The death rate from coronary disease is down 40 percent since
    1980. Our country leads the world in Nobel Prizes for science and
    medicine and in the invention of new drugs and medical devices.
        I truly believe that this progress is one of America's greatest
    contributions to mankind. It is a tribute to the outstanding efforts of
    the medical profession and to a system of private medicine that
    encourages innovation and rewards hard work.
        Yet our doctors and patients know that our system is far from
    perfect. Too many patients feel trapped by the system, with decisions
    about their health dictated by HMOs or Government bureaucracies. Too
    many doctors feel buried in paperwork. I've heard it said that some
    doctors feel they don't practice medicine, they practice insurance. At
    the same time, health care costs are rising sharply, and many people
    worry they won't be able to afford the treatments they need. Some
    procedures are overused, often as defensive measures to avoid
    litigation. And about 40 million Americans still have no health
    insurance at all.
        We must reform health care in America. We must build a modern,
    innovative health care system that gives patients more options and fewer
    orders and strengthens the doctor-patient relationship.
        Government has got to take an active role in reform. Yet it's
    important that Government's role is not to centralize, nor is
    Government's role to control the delivery of medicine. Other nations
    have tried this route, and it has led to long waits for treatment, low-
    quality care, and lagging technologies. And for many patients, their
    experience with centralized Government-controlled medicine leads them
    somewhere else, often right here to America, where they can get the
    treatment and care they need.
        The role of Government in health reform is to fix the system where
    it's failing, while preserving the quality and innovation of a private,
    patient-centered medical system. All reform should be guided by some
    goals.
        The first goal: All Americans should be able to choose a health care
    plan that meets their needs at affordable prices. When people have good
    choices, when people are given different options, health plans have to
    compete for business, which means higher quality and better coverage.
        Most Americans get their health care coverage at work. Yet, higher
    costs are causing some employers to cut back on benefits or insist that
    the employee pay more, especially if they want to choose their own
    doctor or to avoid the complications of managed care. Many families end

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    up in a health plan whose monthly premium puts a strain on their budget,
    and when they require care, they find what they need really isn't fully
    covered.
        So here's what I propose: I propose we give workers more choice. I
    propose we reform the system to make the system more individualized by
    creating personal health accounts. Instead of paying a large premium
    every month for services you may not use, I believe we ought to have an
    account that allows a person to pay a much smaller premium for major
    medical coverage and then put the savings into a health account, tax
    free.
        The money is your money. It's your money in the health account, not
    the Government's money. And you can use it for whatever health care need
    that arises. If you don't use it, it's yours to keep. And the more
    affordable--and for the more affordable premium, you also get
    catastrophic care, protection in case of serious illness.
        The tendency for Government is one size fits all. If part of reform
    is to restore the patient-doctor relation and to give patients more
    choices, we have to change the tax system, too, and allow for patients
    to make decisions that is in their best interests.
        I also propose to help workers get better and more affordable
    choices in health plans at work. Now, some large companies are--you're
    okay; you've got some choice. But many small businesses are unable to
    afford health insurance. And so--and that's because there's not much
    purchasing power. A stand-alone small business does not have purchasing
    power in the marketplace. Either they can't afford to cover, or they
    have to allow their employees to settle on a high premium, high-dollar
    single plan.
        And so what I propose is that we ought to allow employers to pool
    together, through an industry association or perhaps the Chamber of
    Commerce, so that they can get the best deal for their workers, just as
    large corporations are allowed to do.
        Too many workers get no coverage at all through their jobs. This is
    especially true among minorities, part-time employees, and seasonal
    workers. For those with limited means, my budget will provide new
    credits to afford health coverage, up to $1,000 for an individual or
    $3,000 per family. And they won't have to wait for tax time to get these
    health credits. We'll make them immediately available for qualifying
    families, giving them the help they need when they need it. And at the
    same time, we'll work with our Nation's Governors to create purchasing
    groups to negotiate with insurers for the people who use these health
    credits.
        In other words, people who don't have insurance must be given
    incentive to purchase insurance; the States can help them pool, in order
    to get decent--decent coverage; but it's not a Government program. In
    other words, we trust the people. The Government incents individuals to
    make decisions in the marketplace. If the goal is to increase quality
    care by encouraging individual choice and a doctor-patient relationship,
    health credits is one way to help the uninsured do so.
        I also strongly believe that the legislation that I proposed to help
    unemployed workers makes a lot of sense. And it's this: As soon as a
    person qualifies for unemployment benefits, the Government would cover
    60 percent of the cost of continuing their health care. That's a proper
    role for the Federal Government. The role of the Federal Government is
    to help people who have been unemployed, not only with benefits but also
    with their health care costs.
        And the same principle of encouraging choice and helping people help
    themselves must apply as well to two Government-sponsored programs,
    Medicaid and Medicare.
        Medicaid and the SCHIP program provide essential coverage for low-
    income families and seniors and persons with disabilities. These
    Americans also deserve more

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    choices. My budget gives States more flexibility to provide better
    options in Medicaid and SCHIP and makes additional funds available for
    States to improve the coverage.
        And the Medicare program is a source of security and dignity for
    tens of millions of our seniors. It is an incredibly important
    commitment that our Federal Government has made. I strongly support
    Medicare because it is so crucial in the lives of older Americans, but I
    understand that Medicare is antiquated. It has not kept pace with
    advances in medicine. For instance, when Medicare was established in
    1965, health care usually meant hospital care. Today, we understand how
    important it is to prevent people from getting sick in the first place;
    yet Medicare does not fully cover preventive medicine.
        In the past 37 years, many new medicines have arrived to replace
    invasive treatments and surgeries. These drugs can be more effective
    than surgery and are far less expensive. A serious stomach ulcer, for
    instance, once required a lengthy stay in the hospital and many
    thousands of dollars in medical bills. Today, the ulcer can be cured
    with prescriptions costing only hundreds of dollars. Yet Medicare would
    only cover the surgery, not the prescription.
        We must bring Medicare into the 21st century, to expand its
    coverage, to improve its services, to strengthen its financing, and to
    give seniors more control over the health care they receive. I think
    we're making progress in Washington, progress toward convincing the
    Congress that all wisdom doesn't exist in Washington bureaucracies when
    it comes to health care for the elderly. We've got Republicans and
    Democrats and an independent from the United States Senate working on
    Medicare reform.
        Seniors who are happy with the current system should be able to keep
    the coverage just the way it is. In other words, if there is a senior
    living in America who says, ``I love Medicare just the way it is,''
    nothing changes, and that's an important--it's important for a lot of
    Americans to hear that. But all seniors should be offered different
    options, a range of options from which to choose, in both the private
    sector and private markets, as well as a better Government plan with
    better Medigap options. And all of these choices--all of them, however,
    must include prescription drug coverage.
        The second goal of reform is quality, the ability for a patient to
    get the best care from the doctor of our choice.
        Managed care plans have done a lot to make health care more
    affordable for many people. They can also unfairly deny coverage and
    step between the doctor and the patient. When such basic rights are
    lost, they've got to be restored by law. And that's why I urge Congress
    to get a Patients' Bill of Rights to my desk.
        We're close to an agreement on this issue. I've given a message to
    Congress: Please send me a bill that protects all patients, not just a
    fortunate few. Send me a bill with comprehensive patient protections. No
    one should be charged extra, for example, for simply visiting the
    nearest emergency room. No one should have to run a bureaucratic
    gauntlet before he or she can see a specialist. And if health plans deny
    care, every patient should have the right to a prompt review by an
    impartial panel of doctors.
        Finally, we should be serving the interests of the patients, not the
    self-interest of trial lawyers. There will always be matters that can
    and will be resolved in a courtroom, but with a strong review process,
    most disagreements between patients and health plans will end up in
    medical care, not in the courtroom.
        Needless litigation does not--needless litigation does incredible
    harm to our health care system. It costs everyone time and money,
    especially patients who need care quickly, and can destroy the bond of
    trust between physician and patient. Frivolous lawsuits drive up
    insurance premiums for everybody and discourage employers

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    from offering employee coverage at all. It is really important to
    remember that we want to help doctors to heal, not encourage lawyers to
    sue.
        And the hostile legal atmosphere that doctors face is adding to
    costs and undermining the quality of health care in practical ways. At
    some hospitals, for instance, doctors have worked closely with one
    another to cut the rate of infection after surgery by more than half.
    Yet when they discuss that information openly or put it on a paper for
    the benefit of others, they also put themselves at risk of a lawsuit. We
    actually have a system that penalizes doctors for trying to prevent
    errors and avoid complications in patient care. And that doesn't make
    much sense. These good-faith efforts do not deserve the punishment of a
    lawsuit, and Congress needs to do something about that.
        When it helps patients, information must be broadly shared. In the
    Medicare system, we're giving people more information on the quality of
    nursing homes all across the country, and we plan to do the same thing
    throughout the health care system. Increased reliance on information
    technology will not only lower costs, it also holds great promise for
    detection and treatment and the development of new cures for disease.
    Personal medical information, however, must always be strictly
    confidential. A patient's right to privacy must be protected, and we
    will enforce those protections.
        My final goal in health care reform is to make sure Government acts
    where it should, providing a strong health care safety net and promoting
    research on the frontiers of science. The Federal Government has
    accepted these responsibilities, and we must fulfill them.
        Many of the poor and uninsured, including legal immigrants, are
    outside our system of health care entirely. Their neighborhoods often
    have few health care professionals or facilities. They have little or no
    access to preventive care, and most treatment takes place in an
    expensive emergency room.
        Around the country, more than 3,000 community health centers are
    fighting these problems by giving immunizations, providing prenatal
    care, and treating illness before they become medical emergencies. I
    strongly support these community health centers because they're
    compassionate. They are compassionate; they are cost effective; and
    America needs more of them. And so I've set this goal: We need 1,200
    more community health centers over the next 5 years to make sure our
    Government fulfills its commitment to the needy.
        The Federal Government has a large role in medical research, as you
    well know here. And that role is now urgent. In response to the threats
    facing our Nation, we've committed more than $2 billion to develop new
    tests and new treatments for bioterror weapons. This research is not
    only important for the immediate, but it is likely to produce new
    insights into the treatment of diseases such as tuberculosis, malaria,
    HIV/AIDS. Our massive effort to ensure the safety of our people will
    improve the health of our people.
        The National Institutes of Health is one of the most successful
    Government undertakings in our history. The work of the NIH has helped
    us defeat a long list of diseases and dangers to public health. Now, as
    scientists begin to read the codes of life itself, we are nearing
    incredible breakthroughs in the fight against disease. We may, in our
    lifetime, lift from humanity the curse of cancer.
        This is a moment of great national challenge, and the work of the
    NIH has become even more urgent and promising. I'm asking Congress to
    give strong support to the NIH. And my budget achieves the goal I set
    out when I sought the vote, and that is, we will have doubled the NIH
    goal at the end of the year 2003.
        Science is--on the very sources--is closing in on the sources of
    sickness and disease. By 2010, scientists predict, genetic tests will
    allow individuals to know if they

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    are predisposed to certain conditions. Within 20 years, targeted drug
    and gene therapies will be available for diabetes and hypertension and
    other diseases.
        As we pursue the promise of these projects, we must also be alert to
    their dangers. Genetic information should be an opportunity to prevent
    and treat disease, not an excuse for discrimination. Just as we
    addressed discrimination based on race, we must now prevent
    discrimination based on genetic information.
        There is another danger to guard against, the use of genetic
    research to threaten the dignity of life itself. The powers of science
    are morally neutral, as easily used for bad purposes as good ones. In
    the excitement of discovery, we must never forget that mankind is
    developed--is defined not by intelligence alone but by conscience. Even
    the most noble ends do not justify every means. Life itself is always to
    be valued and protected. In biomedical research, we're dealing with the
    very makings of life, and the law must be firm and clear in restraining
    the reckless and protecting the voiceless.
        These are the goals of health care reform, principles to make a good
    system even better. We'll put our trust in the choices of patients and
    the decisions of doctors, the surest way to better coverage and better
    care. We'll protect patients and doctors from unfair treatment and
    unreasonable lawsuits. And Government will fulfill its unique
    responsibilities to provide a health care safety net and conduct the
    research that holds such great hope for all of us. With these reforms,
    new breakthroughs in medical research will reach the patients who need
    them, quickly and at the lowest cost possible.
        I believe America can achieve anything it sets its mind to. I
    believe--I don't believe--I know we're going to win the war against
    terror. And I know if we honor our professionals and honor our patients
    and recognize the limited role of Government, if we trust Americans to
    make the right choices for their lives, we'll have the health care
    system that remains the envy of the world. There's no doubt in my mind
    that with the right reforms, the right philosophy, a philosophy of
    trust--trust in people--that America will remain on the cutting edge of
    medicine. And as America remains on the cutting edge of medicine,
    America will be the promised land for all of us.
        It is such an honor to be here. I want to thank the youngsters who
    are going to be docs. I want to thank you for your service. Give them an
    ``A'' for attending, for sitting through this lecture. [Laughter] But I
    do appreciate it. And I also appreciate your professors. And I
    appreciate the chance to come and share with my fellow citizens about
    the future of health care in America.
        May God bless you all.

    Note: The President spoke at 2:52 p.m. in the Alumni Center. In his
    remarks, he referred to Gov. Scott McCallum of Wisconsin; T. Michael
    Bolger, president and chief executive officer, Medical College of
    Wisconsin; and Usama bin Laden, leader of the Al Qaida terrorist
    organization. The Office of the Press Secretary also released a Spanish
    language transcript of these remarks.

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