[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.