    [Public Papers of the Presidents of the United States: George W. Bush (2003, Book II)]
    [November 25, 2003]
    [Pages 1613-1619]
    [From the U.S. Government Publishing Office www.gpo.gov]

    Remarks at Spring Valley Hospital in Las Vegas, Nevada
    November 25, 2003

        Thank you for the warm welcome. It's great to be here in Las Vegas,
    the great State of Nevada. I'm sorry I don't get to spend the night
    here. [Laughter] They say the nightlife is pretty active. [Laughter]
    It's a great part of our country. Thanks for your welcome.
        I also appreciate the Spring Valley Hospital Medical Center team for
    hosting us. It's not easy to have the President of the United States
    come. It seems like the entourages are quite large these days.
    [Laughter] So I appreciate the hard work in facilitating my visit.
        It's amazing that this facility is not only--is not yet 2 months
    old, yet it is providing a really good record of care and compassion,
    thanks to the good docs and nurses

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    and CEOs and aides who work here. I want to thank you for caring about
    your fellow citizens with good, decent health care.
        Today--speaking about good, decent health care--today we had a major
    victory to improve the health care system in America. The United States
    Senate has joined the House of Representatives in passing historic
    reform of Medicare that will strengthen the system, that will modernize
    the system, that will provide high-quality care for the seniors who live
    in America.
        I want to thank and congratulate the Members of Congress for their
    hard work. You see, we have a responsibility in Washington, DC, to solve
    problems, not to pass them on. And today the United States Congress met
    its responsibility. We inherited a good Medicare system. It has worked,
    but it was becoming old and needed help. Because of the actions of the
    Congress, because of the actions of members of both political parties,
    the Medicare system will be modern, and it will be strong.
        I appreciate Karla Perez for hosting us
    here. She had a very good visit about health care needs in this
    community and around our country. Karla is an impressive CEO and
    managing director, and I'm really glad she invited me here. I want to
    thank Alan Miller, Mike Marquez, and Dan McBride for
    their leadership as well.
        I appreciate so very much your fine Governor, Kenny Guinn, for showing up today. Governor, it's great to see
    you. He's a close friend, as is Dema. The
    Governor and I both married very well. [Laughter] Laura sends her love to both of you. [Laughter]
        Two Members of the United States Congress from Nevada are with us
    today, Congressman Jim Gibbons and Congressman
    Jon Porter. They supported this piece of
    legislation. They support a lot of good legislation. And I'm proud of
    your work, and I appreciate your courage in doing the right thing for
    America's seniors--by the way, not only the seniors today but those of
    us who are going to be seniors. I also want to welcome Trent
    Franks from the great State of Arizona, friend,
    a man who also supported Medicare reform. He and his wife Josie are here to join us today, and I'm honored that you
    all would come over from Arizona to say hello.
        I want to thank the Nevada attorney general for joining us, Brian
    Sandoval. I appreciate members of the
    statehouse for being here. I'm glad Darlene Ensign is with us, the Senator's
    good wife--for joining us. Most of all, I'm really glad you all are
    here, and thanks for letting me come by to say hello.
        Today when I landed, I met Maria Konold-Soto. She's a--where is Maria? Oh, there's Maria, yes. What
    Maria does is she volunteers in your community on the Medical Reserve
    Corps. Perhaps you've heard about it. It is a chance to help our
    communities prepare for a potential emergency. Notice I said
    ``volunteers.'' A lot of times people talk about the strength of the
    country in terms of our military might or the size of our wallets. The
    strength of America is the heart and souls of our fellow citizens who
    are willing to volunteer to make their communities a better place.
        I know a lot of the docs here provide a lot of care for people who
    hurt. That's part of making America a compassionate place. Maria is part of making America a compassionate place.
    All of you who volunteer, I want to thank you very much for the job you
    do. If you're interested in being a patriotic American, love a neighbor
    just like you'd like to be loved yourself, and you'll make a significant
    contribution to our country.
        This Nation's health care is great. We've got the best health care
    in the world, and we need to keep it that way. We've got a great health
    care system because of our docs--well trained, decent, caring people who
    practice medicine. We've got a great health care system because of our
    nurses who work hard to provide compassionate care. We've got the best
    research in the world. We're on the leading edge of change in America.

    [[Page 1615]]

        But we've got to keep the system vibrant. And we must keep it the
    best in the world, which we intend to do in Washington, DC. We started
    that by making sure our seniors have got a modern system. The Medicare
    system, first of all, is an essential commitment of the Federal
    Government. Our Federal Government has made a commitment to our seniors
    that we will provide them an up-to-date, decent health care system. It's
    a basic trust that has been upheld throughout the generations. And we're
    keeping that trust by making sure the system works, by making sure that
    our seniors are well treated.
        In recent years, Medicare has not kept up with the advances of
    modern medicine. In other words, it hasn't met the trust that the
    Federal Government has promised to our seniors. Remember, when Medicare
    was passed in 1965, health care meant house calls and surgery and long
    hospital stays. And the system was designed to meet the health care
    delivery systems of the day.
        Modern medicine today now includes preventative care, outpatient
    procedures, and at-home care. Many invasive surgeries are now
    unnecessary because of the new prescription drugs which are being
    developed. Many Americans have coverage for these new forms of health
    care, and that's positive, and we need to keep it that way. Yet seniors
    who rely exclusively on Medicare do not have the coverage for many of
    the new treatments and do not have coverage for prescription drugs. In
    other words, medicine changed, and Medicare didn't. And as of today,
    Medicare is changing.
        Let me give you an example of the need for modernization. The health
    care providers here know these examples only too well. Medicare is
    willing to pay $28,000 for a hospital stay for ulcer surgery. But it
    won't pay the $500 for the anti-ulcer drugs that would keep the senior
    out of the hospital in the first place. Those examples--or that example,
    like many others, says to me we had a problem with the Medicare system.
    It doesn't make any sense to pay the 28,000 at the end of the process
    but not the 500 up front to keep the 28,000 from happening in the first
    place.
        Medicare should cover medications to keep our seniors out of the
    hospitals. The new bill does this. The important part of the reform is
    to recognize that medicine has changed. It will save our Government and
    the taxpayers money by providing prescription drugs early so we don't
    have to pay for it in long hospital stays or invasive surgeries.
        Most seniors have got some form of prescription drug coverage from a
    private plan, and that's important. It's a fact of life here in America.
    Those plans, however, are becoming less available. We've got to make
    sure the private sector remains vibrant. The bill I'm about to describe
    to you does that.
        Medicare was very slow to take advantage of new medical advances,
    besides prescription drugs. In other words, you had to go through a
    bureaucracy in order to get certain procedures covered. Bureaucracies
    don't move very quickly. They tend not to be very sympathetic
    organizations. They're not consumer-driven. They're process-driven.
    They're hidebound by rules and regulations. The docs here know what I'm
    talking about. You get to deal with bureaucracies. It must be a
    frustrating experience. Sometimes it's a frustrating experience to try
    to change bureaucracies.
        The Medicare plan that I'm going to sign understands that a lack of
    competition meant that there was no real need to provide innovation. And
    so we're helping to change the system by giving seniors more options and
    more choices. See, Members of Congress have got choices. They get to
    choose from a health care plan, and it works quite well. The three
    Congressmen here would tell you they're probably pretty satisfied with
    the plan, if they've chosen to be in it. In other words, you get to
    choose.
        This new Medicare bill I'm going to sign says seniors are plenty
    capable of making

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    choices themselves. I used to say, ``If it's good enough for the Members
    of Congress to have choice, it ought to be good enough for the seniors
    in America to have choice.'' Now they're going to have choice, thanks to
    the bill I'm going to sign.
        It's going to take a while for this piece of legislation to kick in.
    It's going to take about 2 years to get all the reforms in place. But
    within 6 months of the law being signed, our seniors will start to see
    real savings in health care costs because seniors will be eligible for a
    drug discount card that will save them between 10 to 25 percent off
    their regular drug costs. And low-income seniors will receive up to $600
    a year to help them with their drug costs in addition to the card. Their
    card will serve as a transition to the reforms that are inherent in the
    Medicare legislation.
        When the full drug benefit arrives in 2006, all seniors will be
    eligible for prescription drug coverage for a monthly premium of about
    $35. The result is that for most seniors without coverage today, the
    Medicare drug plan will cut their annual drug bills roughly in half.
    That's positive news for America's seniors.
        It's positive news for Joyce and J.C.
    Pearson. J.C.'s from Tennessee, by the way, and
    he reminded me that without Tennessee, Texas wouldn't have been much.
    [Laughter] He reminded me more than once, I might add. [Laughter] The
    Pearsons are--live on a tight budget. They spend about $300 a month for
    prescription drugs. Under the new Medicare reform bill passed today,
    they will save $1,800 a year. Joyce said they can use that money. She
    said it's going to come in handy in their retirement years.
        Seniors with the highest drug bills will save the most. Seniors with
    the greatest need will get the most help. Low-income seniors will pay a
    reduced premium or no premium at all and lower or no copayments for
    their medications.
        Under the new reforms, seniors, as I mentioned, will have choices.
    You see, some seniors don't want to choose, and I can understand that.
    In other words, people who are on Medicare just don't want to be
    confronted with a choice, and the system in the bill we passed
    recognizes that. You can understand why. The person is up in years, and
    it's pretty comfortable. They don't want to have to change. Change makes
    some people nervous, and we understand that. And so, should seniors want
    to stay in traditional Medicare and receive a prescription drug benefit,
    they will now be able to do so. That's one of the key reforms in the
    bill.
        But other seniors want to choose. They want to be able to make a
    selection based upon their own particular needs. Some might want
    protection from high out-of-pocket medical expenses. Some might want
    expanded coverage for hospital stays. Some might want to be able to pick
    a plan that better meets their own individual needs. And under this law,
    choices will be readily available for our seniors, and that's an
    important part of reform. Because, you see, when seniors or any citizen
    makes a demand, the system responds. If there is a demand-driven system,
    it means the doctor-patient relationship is going to be more firm, and
    it means people will have better choices to meet their own particular
    needs. Some seniors may want the coverage that comes with managed care
    plans, Medicare+Choice.
        Bob May is with us today. Bob is a World War II
    veteran. He is what I would call a solid citizen. Bob said, you know,
    his wife--who unfortunately passed away recently--and he sat down and
    analyzed, made a choice. He said, ``We weighed the pros and the cons
    about what health care plan would fit our needs.'' I want you to hear
    that carefully. Bob and his wife sat down and said, ``Here's the pluses
    and the minuses.'' In other words, he's plenty capable of making a
    choice. He didn't need the Government telling him how to choose what
    health care plan best met his needs. And so he chose Medicare+Choice,
    and it works, he said. Under the law,

    [[Page 1617]]

    Medicare+Choice will be strengthened, not starved. It is a viable option
    for our seniors around the country. In other words, people will have
    more control over their health care options, and health care plans will
    start competing for their business. And that's positive, positive for
    the consumers, positive for the seniors of America.
        There are other important reforms in this bill. When seniors sign up
    for Medicare, they will get a complete health examination so that
    doctors can know their health needs from the start. We're finally
    beginning to focus on preventative care. It makes sense to include
    preventative care in any health care reforms. The health care providers
    here know that better than anybody.
        The bill provides incentives for companies to keep the existing
    coverage they provide for senior retirees. There was some concern in
    Washington--a legitimate concern, as far as I'm concerned--that a
    Medicare reform plan would encourage employers to not do their
    responsibility to their former retirees. This bill addresses that. Two
    out of every three seniors is now covered by some form of private
    coverage, and the bill addressed the issue to make sure that that
    coverage is still a viable alternative in the marketplace.
        Every American, old and young, will be able to have a health savings
    account. They will be able to put money aside tax-free to help their
    families with medical expenses. Medical savings accounts are important
    part of reform. Medical savings accounts trust the consumers, provides
    incentives for people to make wise choices, and helps to maintain the
    doctor-patient relationship.
        This bill helps rural hospitals. This would not qualify as a rural
    hospital here. [Laughter] But rural hospitals need help to continue to
    serve our country. This bill sets fair reimbursement rates for doctors
    serving Medicare patients. This is a good bill, and I'm looking forward
    to signing it.
        Last Saturday's vote in the House and today's vote in the Senate
    marks an historic moment, a bipartisan achievement that all Americans
    can be proud of. Year after year, the problems in Medicare system were
    studied and debated, and yet nothing was done. As a matter of fact, they
    used to call Medicare ``Medi-scare'' for people in the political
    process. Some said Medicare reform can never be done. For the sake of
    our seniors, we've gotten something done. We're acting. We acted on
    principle in Washington, DC. We'll provide new treatments and new
    choices. We'll get prescription drug coverage they deserve. We'll keep
    our commitment to Medicare to better the lives of the American seniors
    for generations to come.
        I appreciate the hard work of the Members of the Congress. It's a
    tough bill. People worked hard on it. A lot of people searched their
    soul on this complex and important piece of legislation, but they stayed
    after it, stayed focused on the people. A lot of Members put politics
    aside, which we need to do in Washington, DC, when we're talking about
    the people's business.
        I appreciate the seniors and the seniors' groups, such as the AARP,
    who lobbied hard on behalf of a modern Medicare system. People made
    their opinions known. They let the Members know where they stand. And it
    worked, and it helped. And I'm honored to put my signature on this
    historic piece of legislation.
        Another topic of conversation came up at our roundtable discussion,
    and that was the effect of junk lawsuits on the delivery of health care
    in America and in Nevada. You see, one of the things we must work for is
    a health care system which is affordable and available. Junk lawsuits,
    the threat of junk lawsuits, drive up the cost of health care and run
    good docs out of the system.
        It's important for our fellow citizens to understand the effect of
    junk lawsuits. You see, docs who are threatened and are constantly sued,
    even though their practice is a good, strong, excellent practice, resort
    to what's called defensive medicine. They

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    order procedures and tests that may not be needed but are--provide
    protection in the court of law. You see, if you think a lawyer is simply
    fishing for a rich settlement, is constantly looking over your shoulder,
    you'll end up practicing what's called defensive medicine. Docs are
    afraid to give their patients certain advice. In other words, the
    doctor-patient relationship is disrupted for fear that that advice will
    be used against them in the court of law. This problem not only affects
    the doctors; it affects the patients as well. See, it's running up the
    cost of medicine. It affects a person's ability to deliver good, quality
    health care.
        Donna Miller is an ob-gyn specialist here
    in Vegas. Dr. Miller has seen her premiums go up about $28,000 last
    year, to about $72,000 this year. She thinks they're headed to about
    $100,000 this year. You know what I'm talking about, about premium
    increases. It's a system that reflects lawsuit after lawsuit after
    lawsuit. And Dr. Miller's patients pay the price. These junk lawsuits
    are driving up the cost of medicine.
        Here's what she says. She says, ``You got
    into medicine to take care of people and to spend time with your
    patients. With the premiums going up the way they are, you can't do
    that.'' She told me about the colleagues who have left Nevada. I
    remember when your trauma center shut down here. It made national news.
    It's a clear sign that you've got an issue here that must be dealt with,
    because the people who are affected are the people of Nevada.
        It means that women who want to have their babies delivered in
    Nevada are having a hard time finding a doc; that's what it means. And I
    met Jill Forte today, a proud mother. She found
    out she was pregnant with her second child. She called her doctor. The
    doctor told her that because of insurance costs, she could no longer
    deliver her baby. So she started calling around. She was told the same
    thing--I think she told me, about five different docs. She considered
    going to California. Fortunately, she was able to make a connection
    through a friend for a local doc to take her case. But you see--and let
    me tell you what she said. She said she was in
    total shock. She didn't know what was going on until it happened.
        Looking for a doctor, worried about finding a doctor when you're
    pregnant, is a stress that is an unnecessary stress. It's a stress
    caused by frivolous and junk lawsuits. It doesn't make any sense to have
    a society that sues so often that expectant mothers are worried about
    finding a doctor. We've got to do something about this in America.
        There's a cost to the Federal Government because of the frivolous
    and junk lawsuits and the defensive practice of medicine. It is
    estimated that the defensive practice of medicine raises the Federal
    budget by $28 billion a year. You see it from Medicare, Medicaid,
    veterans' health benefits, for example. The junk lawsuits affect our
    budget. Therefore, I view this as a national problem which requires a
    national solution. We need a system where patients who are harmed have
    their day in court, where they can collect damages to cover their
    injuries or recovery or rehabilitation and loss of income. If you've
    been harmed by a bad doc, you deserve your day in court. Frivolous
    lawsuits, by the way, that clog the courts make it very difficult for
    someone with a legitimate claim to get into the court. When patients can
    prove they were harmed by a doctor's egregious behavior, they should be
    able to collect reasonable punitive damages.
        There needs to be a $250,000 cap on noneconomic damages. I laid out
    this proposal to the Congress. The House of Representatives responded in
    a positive way, and I want to thank the Members here for voting the
    right way. The bill is stuck in the Senate. You need to contact a
    Senator in the State of Nevada and let them know
    you're interested in national medical liability reform. The Senators
    must understand that nobody in America has ever been healed by a
    frivolous lawsuit. For the sake of the patients in this State

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    and for the doctors in this State and for the patients and docs around
    the country, we need medical liability reform now. And the Members of
    the Senate must understand, this is a compelling national issue, and I
    will keep it on the front burner until we get the problem solved.
        Finally, yesterday I was in Fort Carson, Colorado, where I had the
    honor of addressing men and women who wear the Nation's uniform. I just
    want to share with you right quick our country's foreign policy. In a
    nutshell, it's ``We'll do everything we can to keep America secure.'' I
    will not forget the lessons of September the 11th, 2001. My duty as the
    President, obviously, is to deal with domestic issues and to tackle
    tough problems. My duty as your President as well is to keep this
    country secure. And I had the honor of meeting with men and women who
    wear the Nation's uniform who are doing just that.
        We'll protect our homeland as best as we possibly can. But the best
    way to protect the homeland is to chase the killers down one at a time
    and bring them to justice, which is exactly what we intend to do.
        Freedom equals peace, as far as I'm concerned. And when you hear us
    working for freedom in troubled parts of the world, you've just got to
    know it will lead to peace. We'll deal with the short-term security
    needs by staying on the offensive. We'll help our children grow up in a
    free society by bringing freedom to parts of the world that desperately
    need freedom. Our soldiers--as we head into Thanksgiving, we need to
    give thanks to our soldiers for their sacrifice, for the honor they
    bring to our country, for the service they render by bringing freedom to
    troubled parts of the world. You see, we're bringing freedom in the
    heart of the Middle East.
        Free countries don't develop weapons of mass destruction. Free
    countries don't attack their neighbors. Free countries listen to the
    hopes and aspirations of the people who live in those countries. No,
    America also believes that freedom is not America's gift to the world;
    freedom is the Almighty's gift to every person who lives in this world.
    And this Nation will stay the course to bring democracy and freedom to
    Afghanistan and Iraq. And by doing so, we will not only help the long-
    suffering people in those countries; we will make America more secure
    and the world more peaceful.
        Thank you for letting me come today. May God bless you all, and may
    God bless America.

    Note: The President spoke at 10:32 a.m. In his remarks, he referred to
    Karla Perez, chief executive officer and managing director, and S.
    Daniel McBride, chief of staff, Spring Valley Hospital; Alan B. Miller,
    president and chief executive officer, and Michael Marquez, vice
    president of acute care, Universal Health Services; Gov. Kenny C. Guinn
    of Nevada and his wife, Dema; Josephine Franks, wife of Representative
    Trent Franks; and Darlene Ensign, wife of Senator John Ensign of Nevada.
    The Office of the Press Secretary also released a Spanish language
    transcript of these remarks.