    [Public Papers of the Presidents of the United States: George W. Bush (2003, Book I)]
    [March 4, 2003]
    [Pages 236-242]
    [From the U.S. Government Publishing Office www.gpo.gov]

    Remarks to the American Medical Association National Conference
    March 4, 2003

        Thanks for such a warm welcome. I appreciate the invitation. I'm
    honored to be with so many of our Nation's fine physicians and their
    loved ones.
        You've come to our Capital when this Government faces many critical
    issues. You're here at an historic time. We have got a lot of
    responsibilities here in Washington. We have the responsibility to
    defend the American people against the threats of a new era. We have a
    responsibility to win the first war of the 21st century, and we're
    working hard to win that war.
        Over the weekend, American and Pakistani authorities struck a
    serious blow to Al Qaida by arresting Khalid Sheikh Mohammed, Sheik the top operational planner, the top killer of
    the Al Qaida network. The man who masterminded the September the 11th
    attacks is no longer a problem to the United States of America.
        It's a different kind of war than we're used to in America. It's a
    war that requires patience and focus. It's a war in which we will hunt
    down those who hate America, one person at a time. The terrorists are
    learning there is no place safe for them in this world. They're
    discovering that justice can arrive by different means, at any hour of
    the day or night. They're discovering the meaning of American resolve,
    our deep desire to defend our freedom and to keep the peace.
        It is important for our fellow citizens to recognize life changed on
    September the 11th, 2001. Obviously, it changed in a tragic way for
    those who lost loved ones as a result of the coldblooded attacks on our
    people. But we learned a harsh lesson, and that is, oceans can no longer
    protect us from those who hate America and what we stand for. And
    therefore, it's important for the United States to take every threat
    which may gather overseas seriously, that we can no longer pick or
    choose whether a threat requires our involvement. If we

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    see gathering threats which can harm the American people, we must deal
    with them.
        We're dealing with Iraq because the dictator of Iraq has got weapons of mass destruction. He's used weapons
    of mass destruction on his own people. He can't stand America. He can't
    stand our friends. He can't stand our allies. He's got connections to
    terrorist networks. The first war of the 21st century requires the
    United States to work with international bodies to deal with these
    threats, and we will continue to do so.
        I went to the United Nations to remind them that that body has a
    responsibility to make sure its words means something. I reminded them
    that for 12 long years the United Nations has asked Saddam to disarm because he's dangerous. We went and got
    another resolution almost 4 months ago, unanimously approved by the
    Security Council, which said clearly, ``Saddam, you must disarm.''
        The choice is Saddam Hussein's to make.
    It is his choice to determine whether there's war or peace. It is his
    choice to decide whether to listen to the demands of the free world. But
    no matter what his choice may be, for the sake of peace, for the sake of
    freedom, for the sake of security of our people, Saddam Hussein will be
    disarmed.
        We have a responsibility to create jobs and increase the momentum of
    our economy. The role of Government is not to create wealth but an
    environment in which the entrepreneurial spirit of America can flourish.
    That's why I'm working with Congress to accelerate tax relief which
    they've already passed, to get rid of the double taxation of dividends,
    to encourage investment. The more money people have in their pockets,
    the more likely it is they'll demand a good or a service. And when they
    demand a good or a service, in the marketplace somebody will provide
    that good or a service. And when they do, somebody in America is more
    likely to find work.
        And today I've come to discuss another responsibility, which is to
    improve the health care in America. Our vision, our goal is a system in
    which all Americans have got a good insurance policy, in which all
    Americans can choose their own doctor, in which seniors and low-income
    citizens receive the help they need, in which--the system is one in
    which the patient-doctor relationship is the center of good medical
    care.
        This vision stands in stark contrast to the Government-run health
    care ideas, the ideas in which the Federal Government decides care, the
    Federal Government rations care, the Federal Government dictates
    coverage, a vision which, in my judgment, will stifle innovation, stifle
    quality, and run up the costs on the patients of America.
        We have a lot of work to do on this important issue, but I believe
    the job can get done. That's why I've advanced this agenda. Speaker of
    the House Denny Hastert  Dennis is committed to
    working toward positive reforms. In the United States Senate, there's a
    new majority leader. He knows a few things about
    doctors and patients and their relationships.
        I'm here to ask for your help and let you know that we're going to
    seize the moment and work with people in both parties to achieve
    meaningful reform that meets the vision that will make health care
    positive and optimistic and hopeful for all our citizens.
        And so, I want to thank you for letting me come. I appreciate Yank
    Coble.  Jr. They told me a guy from Jacksonville,
    Florida, named Yank was going to introduce me. [Laughter] I asked him,
    ``Why Yank?'' He said he didn't have enough time to explain it.
    [Laughter]
        I'm honored that Tommy Thompson is
    here. Tommy's doing a fine job.
        Today we've got a Member of Congress with us from the State of
    Pennsylvania, and that's Congressman Jim Greenwood. I'm honored you're here, Jim. I appreciate your

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    dogged determination to pass medical liability reform.
        I want to thank Mike Maves and Ed
    Hill,  Edward all the members of the American Medical
    Association Board of Trustees, and thank you all for coming.
        Americans are proud of their doctors and proud of their nurses,
    proud of the medical professionals in our country. Our Nation has the
    finest medical professionals in the world. You are more than members of
    a profession; you are each living out a great calling. You show your
    concern for patients through years of training and lifetimes of
    commitment to the well-being of others. I appreciate the work you do.
    And I want to thank you for your skill, your talent, and your
    compassion.
        America has the best health care system in the world. We have
    outstanding medical schools, great hospitals, brilliant researchers.
    We're on the leading edge of new technologies. We're closing in on cures
    to some of the most feared diseases of mankind. I'm optimistic about our
    future. That's why I worked with Congress to make sure that the National
    Institutes of Health received record-level amounts of funding, so that
    we can be on the leading edge of change, so that we can deal with
    problems that years ago seemed insurmountable, so that people can live
    better lives. Yet amidst the optimism, it's important for us to
    recognize there are serious challenges that we have in health care, and
    we must confront them now and not wait.
        Too many of our citizens go without health care. I propose
    refundable tax credits to help low-income people purchase their own
    health insurance. Too many of our citizens use expensive emergency rooms
    as their main source of health care because they have no other options.
    We need to make sure those folks have preventative care and treatment
    before they go to the emergency room. And that's why I proposed and
    Congress passed increased funding for community and migrant health
    centers all across the country.
        The cost of health care is rising at the fastest rate in more than a
    decade. There are reasons why there are rising costs. Research is
    costly. New technologies are expensive, and they're worth the expense.
    When you save lives with technologies, it's worth the expense. But other
    rising costs are unnecessary. And the problem doesn't start in the
    waiting room or in the operating room. It starts in the courtroom. We
    have a problem in America. There are too many frivolous lawsuits against
    good doctors, and the patients are paying the price.
        Even the most frivolous of lawsuits can be expensive. A doctor and
    his or her insurance company must spend money to fight the frivolous
    lawsuit or, in many cases, settle it to get rid of it. Either way,
    premiums go up. Either way, the patient pays. When liability premiums
    get too expensive, some docs stop seeing patients.
        If one of the goals of a good health care system is for it to be
    affordable and accessible, and if lawsuits are running up the cost of
    medicine and/or driving docs out of business because the practicing of
    medicine is too expensive, we've got to do something about it. We've got
    to make sure that the stories I hear about are remedied with good law.
        I was in Scranton, Pennsylvania, and met Debra DeAngelo, a fine lady. She's got a great safety record in her
    pain management clinic. She loved living in Scranton because that's
    where she was raised. She wanted to practice her talents with the people
    with whom she was raised. Her liability insurance became so expensive
    that she couldn't practice medicine in Scranton, Pennsylvania, anymore,
    and she shut down her clinic, which employed 10 and served 2,000
    patients.
        In describing her story, she was
    heartbroken that she couldn't practice where she wanted to practice. She
    wasn't heartbroken for herself; she was heartbroken for the patients for
    whom she had great concern and great care. She and her family moved

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    to Hershey, where she's working for a hospital which is covering her
    insurance needs. Scranton, Pennsylvania, lost a fine person because
    liability insurance drove her out of town. No good doctor should be
    forced to leave a community they know and serve simply because of the
    costs of insurance.
        Many doctors serve their fellow humans in some of the most
    compassionate ways. I went down to Mississippi, met a man who had moved
    to Mississippi to provide health care for some of our most neediest
    citizens, health care in the Delta region of Mississippi, part of our
    country where we need docs--people need help. And he told me about what
    it was like to try to practice medicine in a compassionate way. He had
    heard a calling, and he went to serve his fellow humans. But liability
    insurance drove this Good Samaritan out of the State. He's now, I think,
    practicing up in North Dakota or Minnesota. There are some people who
    hurt who are lucky to have this good doctor in their midst.
        There's a story about the lady--and this happens all the time--in
    Nevada named Ruth Valentine. She's pregnant.
    She called more than 50 local doctors, and she couldn't find anybody in
    Nevada to serve her. So she went to Utah, where she's staying with
    friends until she has her baby. No family in America should face this
    kind of stress or worry during one of life's most vulnerable moments.
        These are just a handful of the stories, which are true and real and
    happening all across our country. Twenty percent of the hospitals in
    America have had to cut down on certain services, delivering babies or
    neurosurgery or orthopedic surgery, because a handful of lawyers have
    targeted these procedures for frivolous lawsuits.
        At the same time, doctors in hospitals are overusing certain tests
    and treatments as defensive measures to avoid litigation. A recent
    survey of doctors showed the extent of defensive medicine in America.
    Eight out of ten doctors say they have ordered more tests then they need
    to. Three of four refer patients to specialists more often than they
    believe is medically necessary. Four out of ten prescribe antibiotics
    more often then they think is needed. All of this defensive medicine is
    rising costs for patients, for States, and for the Federal Government.
        The direct cost of liability insurance and the indirect cost from
    defensive medicine raise the Federal Government's health care costs by
    more than $28 billion a year. When the Federal Government gets hit by
    higher medical costs, the taxpayers foot the bill. This is a national
    problem; something which affects our budget so significantly requires a
    national solution.
        We want our legal system to work for our patients. We want people to
    have a day in court. Anyone who is harmed at the hands of a doctor
    should have a hearing. That's what we want for the justice system. They
    should be able to recover the full cost of their care and other economic
    losses. If harmed by a doc, they ought to be able to recover their
    economic costs, economic losses. They should be able to recover
    noneconomic damages as well. But for the sake of the system, noneconomic
    damages should be capped at $250,000.
        If harm is caused by serious misconduct, patients should also be
    able to seek reasonable punitive damages. Without fair and reasonable
    limits, the legal system looks more and more like a lottery. And with
    the trial lawyers getting as much as 40 percent of the awards and
    settlements, it's pretty clear who's holding the winning ticket.
    American courts should not be serving the self-interest of personal
    injury lawyers; they should be serving the cause of justice and the
    needs of Americans' patients.
        Last year, thanks to Jim Greenwood
    and other Members of Congress, the House of Representatives passed good
    medical liability reforms, but the Senate failed to act. Since then, the
    problem has only gotten worse. We need to pass medical liability reform
    through both Houses. You need to contact your Senators. It doesn't
    matter

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    what political party they're in; you need to contact them. You need to
    explain the problem in clear terms. I want to sign good medical
    liability reform this year.
        Our legal system must address medical errors as well. One of the
    best ways to serve patients is to avoid errors and prevent complications
    before they become injuries. Doctors and hospitals are constantly
    looking for ways to improve patient safety.
        Patient safety is improved when doctors and nurses exchange
    information about problems and solutions. Yet, in the litigious society
    in which we live, many doctors are afraid to discuss these efforts
    openly because they're afraid of getting sued. Doctors don't want to put
    anything on paper to improve health care quality because it might be
    given to a lawyer who is fishing around for a lawsuit. I'm going to ask
    Congress to pass a law to make sure that information developed for the
    safety and care of patients is not used by lawyers against doctors and
    hospitals.
        Patient safety also improves when doctors can have access to health
    records without delay. When a patient has a medical emergency far from
    home, the attending physician should have quick access to that person's
    medical records. Yet the health care industry, while progressing in many
    areas, has lagged in information technology.
        Right now, as you all know better than most, health care records are
    kept in different formats--believe it or not, a lot of times on paper--
    [laughter]--in files--[laughter]--that can get lost. [Laughter] In the
    budget for next year I propose an increase of 53 percent for funding to
    help hospitals use information technology to keep better records, to
    share that information with doctors so we can continue to improve
    patient safety.
        Tommy Thompson and his Department are
    leading the way, and they're making good use of information technology.
    For example, they're using information technology for an online
    comparative guide to nursing homes. It's a good use of the Internet.
    It's a good way to speak directly to the consumers of America. Families
    are now able to compare nursing homes to one another. That makes sense.
    There's nothing like enhancing quality by holding people to account.
    They're able to compare on measures such as infection rates or how well
    patients are progressing in getting on their feet. It's the practical
    way to use the information technology.
        And that's important, particularly for nursing homes, because our
    Nation has accepted a special responsibility for the health of senior
    citizens, to make sure that the years of retirement are not years of
    hardship, needless hardship. Our Medicare system is a binding commitment
    of a caring society. We must renew that commitment by providing the
    seniors of today and tomorrow with preventative care and the new
    medicines that are transforming health care in our country.
        When President Lyndon Johnson signed Medicare into law 38 years ago,
    he promised a system that would bring the healing miracle of modern
    medicine to senior citizens. In 1965, modern medicine almost always
    meant physician care inside a hospital. Now modern medicine offers much
    more: drug therapies, new medical devices, disease screening, and
    preventative care. All seniors and disabled citizens on Medicare should
    have access to these advantages. They do not.
        Compared to people with private health plans, Medicare patients have
    limited choices. Medicare will pay a doctor to perform a heart bypass
    operation but will not pay for drugs that could prevent the need for
    surgery. Medicare will pay for an amputation but not for the insulin
    that could help diabetes patients avoid losing their limbs. Medicare
    will pay for chemotherapy and cancer surgery, but after private insurers
    made annual mammograms a standard benefit, it took 10 years for Medicare
    to do the same and then only because the United States Congress passed a
    law. Seniors should not have to wait for an act

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    of Congress to get effective, modern health care.
        Medicare does not protect our seniors from overwhelming hospital
    bills. If you have to go to a hospital, Medicare charges you an $840
    deductible. After 2 months, you are charged $210 a day. After 3 months,
    Medicare charges $420 a day. And after 5 months, Medicare leaves you
    with the whole bill.
        By comparison, a standard plan for Members of the United States
    Congress and other Federal employees charges a copayment of $100 when
    you enter the hospital and not a dollar more, no matter how long you
    have to stay. Medicare is supposed to protect the savings of our
    seniors. In many cases, it doesn't.
        I recently went out to Grand Rapids, Michigan, and met Pat
    Wahl. She suffers from rheumatoid arthritis. That
    requires expensive medicine. She lost her husband in the year 2000. She
    lost his health coverage. She had to depend entirely on Medicare. Soon
    her medical bills began to exceed her income, and she was forced to sell
    her house.
        This is an incredibly sad story, when you think about it; certainly
    sad listening to Pat in Grand Rapids. They're
    unnecessary stories. We can and we must improve Medicare and protect our
    seniors from runaway health care costs.
        Medicare reform is a large and complicated task. People have strong
    opinions on this matter, and we will need broad cooperation to move
    forward. We're working closely--I say ``we''--my administration and
    Tommy and members of my staff and members
    of his staff are working closely with good and serious-minded leaders in
    both Houses, leaders such as Senators Frist and
    Grassley and Breaux, Speaker Hastert,  Dennis and
    Congressmen Thomas and Tauzin. J.
    ``Billy'' We share a basic commitment to get something done,
    and we share a commitment to these goals of reform.
        A modern Medicare system must offer more choices and better benefits
    to every senior--all seniors. All seniors should have help in buying
    prescription drugs. Those who can least afford them should have extra
    help. Seniors should be protected from out-of-control premium increases.
    And all seniors should be able to chose the health care plan that best
    fits their needs without being forced into an HMO.
        The element of choice is essential. When a bureaucracy is in charge
    of granting benefits, new benefits usually come slowly and grudgingly,
    if at all. When insurance providers compete for a patient's business,
    they offer new treatments and services quickly. If they don't, the
    patient--the customer--will look for better services elsewhere. Because
    it is in the best interests of providers to have healthy customers,
    patients will get the quality care they need.
        The framework for Medicare reform I'm releasing today would give
    seniors the freedom to select one of three broad opportunities. First,
    seniors who are happy with the current Medicare system should be able to
    stay in the system and receive help for prescription drugs. To reform
    the current system, I propose we issue a discount card that will reduce
    the cost of prescription drugs for every senior by 10 to 25 percent. We
    will provide an annual $600 subsidy to low-income seniors to pay for
    prescription drugs. And we will set annual limits on the amount seniors
    will have to spend out of pocket on drugs at no additional premium.
        Second, seniors who want more coverage will be able to choose an
    enhanced form of Medicare. This option will include full coverage for
    preventative care, a comprehensive prescription drug benefit, protection
    against high out-of-pocket costs, and extra help for low-income seniors
    to be able to get the drug benefit. Seniors will be able to choose their
    specialists, their hospitals, and their primary doctors. The fee-for-
    service arrangement would offer seniors similar kinds of choices now
    enjoyed by the Members of Congress, who are given a broad choice among
    competing health

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    care plans. What is good for the public servants, including Members of
    the House and Senate, is good for America's seniors.
        Third, seniors who want the kind of benefits available in managed
    care plans, including prescription drug coverage, will have that choice
    as well. This option would place seniors in an affordable network of
    doctors, provide drug coverage, and allow seniors to keep their out-of-
    pocket costs to a minimum.
        Moving toward this system will take time, and as we make these
    changes, all American seniors will receive a prescription drug discount
    card to use right away. And low-income seniors will be eligible
    immediately for the annual $600 Medicare prescription benefit.
        Leaders of both political parties have talked for years about this
    issue, about adding a prescription drug benefit to Medicare. And the
    time for action is now. The budget I submitted will commit an additional
    $400 billion over that which we have already committed to, over the next
    decade to implement this vision of a stronger Medicare system. We are
    committed to reform; we are committed to funding the reforms.
        We have a responsibility--the docs, those of us in elected office,
    America's seniors--to work together to make sure Medicare fulfills its
    promise for this generation and for generations to come.
        Our Medicare system depends on the skill and dedication of
    physicians. You know that. And that dedication should be fairly
    compensated. As Yank  Jr. mentioned, we work with
    Congress to protect doctors from deep cuts in Medicare disbursements.
    Effective this past Saturday, instead of a 4.4-percent reduction in
    Medicare payments, docs will receive a 1.6-percent increase. This
    increase is a sign of confidence in our doctors, and I hope that all of
    you will show your confidence in Medicare by staying in the system.
    Medicare needs you. Our seniors need you.
        Whether the issue is reforming Medicare, enhancing patient safety,
    or correcting abuses in the legal system, the stakes are high. We must
    make sure that the choices of patients and the judgment of doctors are
    at the center of American health care. We must preserve the great
    innovation and quality of private medicine. We must keep our commitments
    to the elderly, and help bring the healing miracle of modern medicine to
    the people who need it in our time.
        All of you as members of the medical profession exercise that
    healing power and uphold a great trust. I appreciate the work you do.
    You have my respect. And in the days ahead, I look forward to working
    with you on these needed reforms. May God bless your work. And may God
    continue to bless America.

    Note: The President spoke at 10 a.m. in the International Ballroom at
    the Washington Hilton Hotel. In his remarks, he referred to President
    Saddam Hussein of Iraq; and Dr. Yank Coble, Jr., president, Dr. Michael
    D. Maves, executive vice president, and Dr. J. Edward Hill, chair of the
    board of trustees, American Medical Association. The Office of the Press
    Secretary also released a Spanish language transcript of these remarks.