    [Public Papers of the Presidents of the United States: George W. Bush (2003, Book II)]
    [November 25, 2003]
    [Pages 1625-1631]
    [From the U.S. Government Publishing Office www.gpo.gov]

    [[Page 1625]]

    Remarks at the Los Olivos Senior Center in Phoenix, Arizona
    November 25, 2003

        Thanks for coming. I'm thrilled to be at Los Olivos Center. You're
    kind to have me. And I'm here to talk about some issues facing our
    Nation, probably an issue you'd like to hear about, which is Medicare. I
    think you probably have heard of Medicare. [Laughter] I think you
    probably recognize that Medicare needs to be modernized and reformed so
    it works better for you.
        The United States House of Representatives, the United States Senate
    recently took historic action to modernize and to strengthen the
    Medicare system so it works for you. I'm here to tell you, I look
    forward to signing a good piece of legislation which says that our
    country will keep our commitment to today's seniors and prepare to
    receive tomorrow's seniors into Medicare--people like me--[laughter]--
    with a system that's modern and strong.
        You know, our job in Washington is to tackle problems when we see
    them, not to pass them on to future Congresses or future Presidents or
    future generations. I want to thank the Members of Congress for taking
    on this very difficult issue. I appreciate them for their hard work.
    Medicare has worked for many people. It got a little old. It got a
    little tired. It needed to be changed. We changed it, and the system is
    better for it.
        The Members of Congress who are here, I appreciate them coming.
    Senator Jon Kyl is one of the fine Members of the
    United States Senate. Congressman Rick Renzi,
    he's from the north; Trent Franks is from the
    north--Congressman Franks, and Josie, his
    wife, is with him; J.D. Hayworth--I don't know
    if you've ever heard of J.D., but--[applause]. They're fixing to call
    J.D. ``Slim,'' ``Slim'' Hayworth. [Laughter] Jeff Flake is with us. Jeff, I'm honored you're here. Congressman
    Jim Kolbe from Tucson, Arizona, is with us. I'm
    honored. These are all fine Members of the United States Congress. I've
    enjoyed working with them all. They're good, honest men who care deeply
    about the citizens of the State of Arizona.
        I appreciate Jan Brewer, who is the
    secretary of state of the great State of Arizona, with us. Your mayor is
    with us, Skip Rimsza. I'm honored, Mr. Mayor,
    that you're here. My only advice to the mayor is to make sure you fill
    the potholes. [Laughter] He's been doing a great job of filling the
    potholes for the people of Phoenix, Arizona. It's a--I know he's fixing
    to leave office, but I--the people of this city owe him a debt of
    gratitude for nearly 10 years of great service, great honest public
    service.
        I want to thank Cindy McCabe, who is the
    executive director of this fine center. I really appreciate you and your
    staff putting on this event. It's not easy to have the President come.
    You know, these entourages are quite big--[laughter]--a lot of people
    roaming around when the President is here. But the center has done a
    fabulous job of welcoming us, and I'm really glad I came.
        Mark McClellan is with me. He's a
    Texan, kind of like I am. And he's the Commissioner of the Food and Drug
    Administration, the FDA. He's got a huge responsibility, and he's doing
    a really good job. I appreciate you coming, Commissioner. I'm honored
    you're here.
        You know, a lot of times people talk about the strength of America,
    and they think in terms of the number of airplanes we might have or, you
    know, look, the number of soldiers in uniform or the size of our
    wallets, but that's really not the strength of our country. The strength
    of America is the hearts and souls of the American people. You think
    about it. That's what makes this country incredibly strong. It's the
    fact that people are willing to reach

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    out to a neighbor in need. I call them soldiers in the army of
    compassion. That's the most important army here in America, in many
    ways, when you think about it.
        I met a soldier. She's probably a general, although she would call
    herself a simple private. That would be Maybelle Harris. Maybelle, where are you? There she is, Maybelle.
    She's a Sunshine Lady for AARP. She sends cards to people who are
    celebrating and/or mourning the loss of a loved one. In other words, she
    understands that there's a special responsibility for those of us who
    are fortunate in this country to help people who might have a hurt in
    their heart.
        Maybelle is, since '82--has been a
    member of the Gold Star Wives club. This is an organization dedicated to
    assisting widows of military servicemen. Maybelle, I want to thank you
    for your compassion. I want to thank you for the example you have set.
    You make it clear that America can change, one heart, one soul, one
    conscience at a time. And you set a fine example for--particularly
    people coming up here in America--that in order to be a solid citizen,
    love your neighbor just like you'd like to be loved yourself. I
    appreciate your example, Maybelle.
        We've got the world's greatest health care system. I hope you
    understand that. I say that with certainty. We've got the best docs in
    the world. We've got fabulous nurses. We've got wonderful facilities for
    people to go to. We've got wonderful research in America. I mean, if you
    really think about the research we do in this country, the lifesaving
    research, the pharmaceutical drugs that change people's lives in a
    positive way, it is--you understand when I say we've got the best health
    care system in the world.
        And we need to keep it that way. We need to make sure it continues
    to be the best health care system in the world. A lot of that has to do
    with honoring our obligation to our seniors and to make sure the
    Medicare system works well. Some it has to do with making sure that we
    don't have too many lawsuits in our society, which runs good doctors out
    of practice and runs up the cost of medicine, that makes it hard for
    people to get good health care.
        I believe we need medical liability reform at the Federal level,
    medical liability reform which will say, ``If you get harmed by a bad
    doctor, you ought to have your day in court.'' Of course you ought to be
    able to sue. But we've got to get rid of these frivolous lawsuits that
    cause our docs to practice defensive medicine, which runs up your cost
    of medicine and runs some doctors out of practice. This country needs
    national medical liability reform.
        I want to thank Kyl and the Members of the House
    for supporting these measures. We got a good bill out of the House. It's
    stuck in the Senate. [Laughter] Some Members of the Senate must
    understand--and by the way, your Senators don't need this message, but
    some--maybe in some neighboring States they need it. No one has ever
    been healed by a frivolous lawsuit in our society. For the sake of good
    health care, for the sake of keeping our docs in practice, and for the
    sake of making sure our customers, the patients of America, have health
    care that's available and affordable, we need medical liability reform
    at the Federal level.
        We need to make sure we've got a Medicare system that works. It's
    first important to recognize that Medicare is a basic trust between our
    Federal Government and our citizens. The Federal Government said,
    starting in 1965, this is our responsibility to make sure our seniors
    get a health care system that works. And therefore, we have a Federal
    responsibility to make sure that the health care system is the best we
    can possibly come up with through law for our seniors.
        Part of making sure American health care works is to make sure
    Medicare is modern, and that's what the bill I am going to sign does. It
    changes the Medicare system,

    [[Page 1627]]

    which needed to be changed. Medicare has not kept up with the advances
    of modern medicine. That's a fact. And we have a choice in Washington to
    ignore that fact or to deal with that fact.
        When Medicare was passed in '65, health care meant house calls,
    surgery, and long hospital stays. And that's how the Medicare system was
    designed, to deal with that type of medicine. Medicine has changed.
    Modern medicine now means preventative care, which is not a part of
    Medicare, outpatient procedures, at-home care. In other words, medicine
    changed. Invasive surgeries are now unnecessary because of miraculous
    new prescription drugs that have been developed. Think about how much
    medicine changed since 1965. Medicare didn't change with it.
        You know, most Americans have coverage for new forms of health care.
    That's the fact. But seniors who rely exclusively on Medicare do not,
    and that's why we needed to change the system. Medicine changed.
    Medicare hadn't. The Congress dealt with it, and now we can say Medicare
    is modern. And that's important change for the health care and for
    quality of life for our citizens.
        I'm sure you've heard some question the need to change the system. I
    will give you an example of why we needed to change it. It's a clear
    example of why we need to change it. Medicare will pay $28,000 for a
    needed hospital stay for ulcer surgery. Yet it will not pay for the $500
    for the anti-ulcer drugs that would keep the senior out of the hospital
    in the first place. Now, that doesn't make any sense to me. See, we'll
    pay the $28,000, but we won't pay the $500 to keep from having to pay
    the $28,000 in the first place, see. We needed to change the system.
    Medicare ought to cover medications that will keep our seniors from
    getting sick in the first place. And yet it doesn't for those who rely
    exclusively on Medicare.
        Medicare was not quick to change as medicine changed. After all,
    there was a bureaucracy that had to make the decisions. Bureaucracies
    don't move very fast; they're slow. Bureaucracies are cumbersome. Many
    times, it took a law from the Congress to change what was covered under
    Medicare, and getting laws out of Congress sometimes aren't easy either.
    It's a cumbersome process. It's not a very good system. Private plans
    were able to adjust quickly. Private plans were able to meet a
    consumer's demand. Medicare was stuck, see. It just wouldn't change.
        And so one of the things we've done in this new bill and this new
    system is we recognize that seniors are plenty capable of making
    choices, that a senior is able to choose. A senior is plenty capable of
    being able to say, ``Here are the pros and cons of these very plans, and
    I want to take this plan that matches my needs.''
        One way to get Medicare to change is to give seniors choices. See,
    Congress has got choices. If you've got a health care plan for the
    Congress, you can say, ``I like this plan,'' or ``I like that plan,'' or
    ``I might want this.'' But in Medicare, the old Medicare system, you
    didn't have that choice. And therefore, the delivery of certain
    procedures and technologies were slow in coming, and that's not right.
    The system was stuck in the past, and we needed to do something about
    it.
        And our job in Washington is to solve problems, not pass them on.
    And that's what we did. This is a good piece of legislation, important
    reform. It will take about 2 years to get the reforms in place. It's a
    complex--listen, when you change something that's been in effect since
    1965 by legislation, it's--there's a lot of print, a lot of pages. It
    was a hard piece of work, don't get me wrong. And so it's going to--
    there's going to be a transition period.
        But Congress wisely said, ``We've got to do something during the
    transition period,'' and what that is, is that seniors will be given a
    health care card, a prescription drug card that you'll be able to use
    and be able to get a discount of up to 10 to

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    25 percent on the drugs you now currently take. That's a positive
    development. You will get a card within 6 months, a discount card that
    will allow you to take it to where you're buying your drugs, and you'll
    get a discount. Plus, if you're a low-income senior, you'll get $600 a
    year as a credit on that card to help you buy drugs.
        Congress was wise in helping with the transition. Congress was smart
    to enable people to better afford prescription drugs, since prescription
    drugs is the newest form of medicine relative to the past. When the full
    drug benefit arises 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 for our seniors who are relying upon prescription drugs.
    Seniors with the highest drug bills, of course, 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 medicines. Congress wisely said,
    ``We want to help the lowest-of-income seniors have a modern Medicare
    system with no premium and no copayments in certain cases.'' And I
    appreciate Congress for the compassion.
        John Bajusz is with us. He's on the stage. I
    just had a--by the way, some of these people here and I had a wonderful
    visit about their current desires and needs and frustrations and worries
    about their status, particularly with health care. John has high
    prescription drug costs. He's on a Medicare HMO that provides about $100
    in drug coverage a month. But he spends about $500 to $600 a month. That
    probably sounds familiar to some of you all. You're on a program that
    helps a little bit. Under the law that I'm going to sign, he will save
    up to about $2,000 a year in his drug costs. That helps John, at least
    that's what John told me. [Laughter] I take his word for it.
        See, we're helping John. We're helping John
    with a modern Medicare system. He's out of pocket $500 to $600 a month.
    If you say he spends 6 and nets 100, it's about $500 a month. He's going
    to save $2,000. That will come in plenty handy. There's a lot of Johns
    around America who this bill will help in a very positive way.
        Under the new reforms, as I told you, seniors will have choices.
    That's an important part of the bill. We want you to have choices.
    Earlier today I was in Las Vegas, and I met with a couple. The man said,
    ``You know, my wife and I, before we chose our Medicare+Choice plan''--
    maybe some of you are on that plan--``before we chose that plan, we
    weighed out the pros and the cons. I listed the pros and the cons for a
    variety of policies, and we picked Medicare+Choice.'' My point to you
    is, is that he spent a lot of time trying to figure out what was best
    for him and his wife. I'm sure some of you do that as well. That's what
    we want. We want people to be able to have that choice.
        Now, I fully understand some on Medicare don't want to choose at
    all. Some people that are on the current system like where they are, and
    they're frightened by change. And that's realistic. That's reasonable. I
    can understand that. And so could the Congress. And so we said that if
    you want to stay on Medicare, you can, traditional Medicare. But now
    we'll have a prescription drug benefit for the first time. And that's
    important. It's important to recognize that change sometimes isn't a
    part of somebody's future.
        But a lot of people want to choose. And choice is important. See,
    some people will want expanded coverage for hospital stays or protection
    against high out-of-pocket medical expenses. People ought to be able to
    pick a plan. And when people pick a plan and they start choice, then
    it's amazing what happens. The plans start meeting the needs of the
    consumer, not the whims of somebody in Washington, DC, who gets to

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    make the decision for you. That's an important part of this bill. This
    bill introduces choice for our seniors.
        I met with the Weavers today, Glenn and Marjorie, from Sun City. They are on
    Medicare+Choice. They like the plan. See, they picked it out. They said,
    ``This plan meets our needs.'' They want to stay on it. The Government
    was starving Medicare+Choice for awhile. One of the positive aspects
    about the bill I'm going to sign funds Medicare+Choice so people like
    the Weavers have got this plan available for them.
        I met with Dick and Willa
    Key. They were here. They are not retired. They are near retired. They
    want prescription drug coverage. They want choices. See, they like the
    way this bill is modeled, because their view is--and I share this view--
    the more choices available for our American citizens, the more likely it
    is the health care system will meet their needs, and this bill provides
    that. Make no mistake about it, it recognizes that the decisionmaker in
    this process should be you, the American consumer.
        There are other reforms I want to mention briefly. Under the new
    law, when seniors sign up for Medicare, they will get a complete health
    examination so doctors can know their health needs right from the start.
    That was very practical by Congress to do that. It seems like to make
    sense to me that it's very important to diagnose problems early so you
    can solve them. And so Medicare now, for the first time, will have a
    complete health examination available for people who sign up. There's
    obviously an emphasis on preventative care, and that's important.
        The bill provides incentives for companies to keep existing coverage
    for their retirees. I'm sure some of you have worked hard and worked for
    a private concern, and you've got a health care plan now. And the bill
    makes sure that that's a health care plan is still available for you, as
    best as we possibly can. We don't want people saying, ``Well, gosh, the
    Federal Government has now modernized Medicare; we don't have an
    obligation any more. Go to the Government.'' So Congress did a good job
    of addressing this issue, and I appreciate that.
        Every American, old and young, will be able to have what's called a
    health savings account. That makes a lot of sense. People ought to be
    able to put money aside tax-free to help their families with medical
    expenses, not only current medical expenses but future medical expenses.
    The health savings accounts will be set up to encourage people to choose
    healthy lifestyle choices. When you've got your own money out there for
    your health care that you can see on a daily basis, all of a sudden, you
    start making better choices with your life.
        And these health savings accounts are not only important for
    seniors, but they're also important for younger workers as well to be
    able to utilize. Congress wisely put these in place. Health savings
    accounts not only will encourage people to make right choices but will
    make--will help maintain the doctor-patient relationship, which is a
    vital part of a effective and excellent health care system.
        The bill helps rural hospitals. Hospitals in Phoenix don't qualify
    as rural--[laughter]--but some of these Congressmen represent rural
    hospitals. And this bill wisely helps them continue to be a vital part--
    to serve the vital part of our country, which is the good folks living
    in rural America. The bill sets up fair reimbursement rates for doctors
    serving Medicare patients. This is a good bill, is what I'm telling you.
    It's an historic achievement. It's a bipartisan achievement.
        See, year after year, the problems in the Medicare system were
    studied and debated, and then nothing ever got done. As a matter of
    fact, Medicare in the political parlance wasn't ``Medicare''; it's
    called ``Medi-scare.'' [Laughter] People were scared to talk about
    Medicare for fear of a political backlash. And so the problems just
    festered, and the system got out of date, and

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    people weren't getting the health care that they deserved. And the
    Federal Government was not fulfilling its obligation to our seniors, and
    that was wrong.
        And so we moved. We moved in spite of the fact that some up there in
    Washington said that nothing could get done, that it was impossible to
    make reforms. But we acted. And we acted on some solid principles,
    providing new treatments and choices for our seniors, provide
    prescription drug coverage, keep the commitment of Medicare to better
    the lives of America's seniors for not only this generation but
    generations to come.
        That's what we're doing in Washington, DC, and it was hard work. It
    really was. It was a lot of debate and sharp elbows and a lot of
    political dialog. But the Members focused on the most important job of
    all, and that was working for the people, working to make sure that we
    fulfilled our promise. I'm honored to sign this bill. I'm looking
    forward to it. It's a historic piece of legislation. It wasn't perfect,
    but I haven't found a piece of legislation that's perfect yet.
    [Laughter] But we're improving the system, and I can say to the Members,
    ``Job well done.''
        I also want to talk a little bit about our national defense. My job
    is to address problems at home, whether it be the economy or health
    care, whether it be medical liability reform, and to work with the
    Congress to get things done. My job as well is to protect the American
    people. It's a solemn responsibility, and I accept it. And I want to
    thank the Members of Congress for joining me in this important task.
    See, I'm not going to forget the lessons of September the 11th, 2001.
    Our life changed that day, didn't it? It really did.
        When we were growing up--when old Senator Kyl
    and I were growing up, we used to think oceans could protect us. We used
    to think America could pick or choose where we--how to deal with a
    gathering threat. You know, if we saw a threat here, we may choose to
    deal with it or ignore it, because we felt pretty safe here at home. We
    felt like the enemy could never get to us. They tried on--they hit us
    pretty hard on Pearl Harbor, but kind of--in our own mind, if the truth
    be known, we thought that it isn't going to happen again.
        And September the 11th, 2001, came, and it happened. It happened in
    one of our great cities. Thousands of people lost their life. I vowed
    that day to never forget the lessons. We will do everything we can to
    protect our people at home, but the best way to protect our people is to
    chase these killers down and to bring them to justice. The best way to
    protect our homeland is to deny them sanctuary in countries that might
    allow them to train or provide them with weapons or training. The best
    way to protect our homeland is to work with allies and friends who
    understand the call to history and to share intelligence and to find
    them.
        And that's what we're doing. Yesterday I went to Fort Carson,
    Colorado. I had the honor of addressing about 6,000 members of our
    military and their families. The military spirit is high. They
    understand their responsibilities. I had the chance to thank them for
    their service to our country, to stand in harm's way. I appreciated so
    very much their sacrifices in Afghanistan and Iraq.
        You see, the issue in Iraq is not only our own security short-term.
    By removing Saddam Hussein, America is safer.
    So is the neighborhood. But the long-term issue is to make sure, in the
    heart of the Middle East, democracy and freedom reign. And that's
    important for peace. It's essential for peace in the world. Free
    countries are peaceful countries. People who live in freedom are people
    that are peaceful people. Free countries don't develop weapons to hurt
    their neighbors. Free countries focus on the aspirations of their
    citizens, the hopes of their citizens.
        And so we've got a hard task ahead of us in Iraq. But I just want to
    assure you that we will stay the course; we will do

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    the job; we will not be intimidated by thugs and killers who will kill
    innocent Iraqis or try to kill our coalition troops to force us out,
    because I truly believe that when we succeed, we will leave behind a
    more peaceful world.
        Many of you have served our country, and you can understand what I'm
    about to tell you: Freedom is precious. Freedom is inherent in our soul.
    Freedom is not America's gift to the world; freedom is the Almighty's--
    Almighty God's gift to every person who lives in this world. We will
    work to protect ourselves, but we'll also work to free people who have
    been enslaved by tyranny, free those who live in a country where they
    get tortured if they speak out. We love freedom in America. We will
    never forget our love for freedom. Our foreign policy is based upon
    freedom and peace, and we'll succeed.
        Thank you all very much. God bless.

    Note: The President spoke at 4:33 p.m. In his remarks, he referred to
    Mayor Skip Rimsza of Phoenix, AZ; and former President Saddam Hussein of
    Iraq.