    [Public Papers of the Presidents of the United States: George W. Bush (2003, Book II)]
    [November 13, 2003]
    [Pages 1522-1527]
    [From the U.S. Government Publishing Office www.gpo.gov]

    Remarks at the Engelwood Neighborhood Center in Orlando
    November 13, 2003

        Thanks for coming. Thanks for the warm welcome. I want to thank the
    Engelwood Neighborhood Center for hosting us. [Applause] You're awfully
    kind to have us. Behave yourself. [Laughter] I wish I had time for a
    workout. I saw your facilities. [Laughter] One good way to help people
    maintain their health is to encourage people to exercise. And I want to
    thank those of you who are encouraging people of all ages to get a
    little exercise on a daily basis. The best way to make sure your health
    is strong is to prevent disease in the first place. Nothing like going
    out for a good stroll to keep yourself healthy.
        I also want to thank our friends in my administration and the
    seniors who are participating in the discussions in Denver,
    Philadelphia, Phoenix, Cleveland, and Dallas. I notice that Surgeon
    General Carmona is hosting an event on the
    SMU campus. That kind of warms my heart, because First Lady Laura
    Bush went to SMU. I don't know if they still
    remember her there--[laughter]--but I certainly remember her

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    here. [Laughter] And she sends her very best.
        I want to thank you all for being here at what I would call an
    historic time when it comes to the health of our seniors, because I
    believe, with hard work and the right focus and with your help, we can
    reform Medicare. We can reform Medicare for the benefit of people who
    are on Medicare, and we can reform Medicare for those of us who are soon
    to be on Medicare. We have an obligation in this country. After years of
    debate and deadlock and delay, both Houses of Congress are nearing final
    passage of the biggest improvements in senior health care in 40 years.
    We're on the verge of giving seniors prescription drug coverage,
    expanded coverage for preventative maintenance medicine and therapy, and
    more health care choices.
        Members of Congress say they support these Medicare reforms. Now
    it's time for a final vote. Members of Congress must resolve their
    remaining differences. The House and the Senate must resolve their
    differences and get a bill to me. For the sake of America's seniors, I
    call on the United States Congress to get the job done.
        I appreciate Josefina's service to
    our Nation. As you know, she's the Assistant Secretary for Aging, U.S.
    Department of Health. Her boss, Tommy Thompson, a former Governor of Wisconsin, Cabinet Secretary, is
    now--has been on the Hill today working out the differences between the
    House and the Senate. He is intricately involved in making sure we get
    us a good Medicare bill.
        I want to thank my brother, the Governor of
    this great State, who cares. He's got the right priorities. I know his
    priorities because we were both raised by the same mother. [Laughter] By the way, she wants there to be a modern
    Medicare system. [Laughter] But Jeb prioritizes his faith and his family
    and the people of Florida. He cares deeply about the people here. I'm
    proud of his leadership. They may say I'm not very objective, but he's a
    great Governor.
        I'm honored that five distinguished Members of the United States
    House of Representatives have joined us here for this discussion. They
    are people who are going to help make the decision. I view them as
    allies in this important issue as well as allies in helping us keep the
    peace around the world. They are Congressman Ric Keller, Congressman John Mica,
    Congressman Adam Putnam, Congressman
    Katherine Harris, and Congressman--
    Congresswoman Katherine Harris, and Congressman Tom Feeney. I'm honored you all are here.
        I appreciate so very much your interest in this issue. I want to
    thank you for working with us. It's a tough issue. It's a tough issue
    because it's a complex issue, but modernizing Medicare is the right
    thing to do. We must not miss this opportunity. I ask the Members to go
    back and take--share the passion that not only I share--have but the
    others in the audience have about those of us in Washington doing our
    duty, doing what we're called to do, and that is to tackle tough issues
    and lead.
        I want to thank Rhonda Medows, who is the
    secretary of the Agency of Health Care Administration. Rhonda, thank you
    for coming. I want to thank Terry White for
    being here. It's good to see you again, Terry. He's the secretary of the
    Florida Department of Elder Affairs. They know what I'm talking about,
    for the need for us to have a modern Medicare system. You know more than
    they know, because you live on Medicare; you understand the system needs
    to be changed and modernized.
        I want to thank the mayor of Orlando, Buddy Dyer, for coming. Mr. Mayor, I'm honored you're here. Thank
    you for taking time. I appreciate Rich Crotty, who is the chairman of Orange County, for being here as
    well. Thank you, Rich, for coming. I appreciate the interest of Federal,
    State, and local officials in this very important subject.

    [[Page 1524]]

        I want to thank--I just came from what they call a roundtable
    discussion. Generally we have roundtable discussions sitting at square
    tables. [Laughter] You know how Government works. [Laughter] Jeb and I met with Estelle Baker
    and Loretta De Maintenon; the
    MacDonalds, Marge and Mac; and Beverly and Dick
    Allred. The reason we did is because we want to
    hear firsthand their stories. I'll share some of their stories with you.
    But you know, there's nobody--the best people to share with us the need
    to modernize Medicare are those who rely on Medicare. And they're able
    to tell the good news about Medicare and the bad news about Medicare,
    what works in Medicare and what doesn't work in Medicare. Both of us
    like to listen to people who have had firsthand experiences, and I want
    to thank the meeting participants for sharing their stories with us.
        Today when I landed--at your fantastic airport, by the way--I met
    Tillie--[applause]. Crotty, that's a good
    sign when people clap when I mention the airport. [Laughter] I met a
    very interesting woman named Tillie Walther.
    Tillie is here. Tillie is a volunteer for the Retired and Senior
    Volunteer Program. It's called RSVP. She dedicates a lot of time to help
    other people.
        The reason I bring up Tillie is that
    when people focus on America, they think about our great military might,
    and I'll keep our military mighty. They think about our pocketbooks;
    we're working hard to make sure they're full. The truth of the matter
    is, the great strength of our country is the heart and souls of our
    citizens, people who are willing to take time out of their day to make
    somebody else's life better. And Tillie is such a person. She's leading
    by example. I love her spirit. I love the example she sets. My call to
    people here and around our country is to love your neighbor just like
    you'd like to be loved yourself. Find a way to help somebody in need.
    Find a way to help somebody who hurts, and the country will be better
    off. Thank you, Tillie. Thanks for coming. I'm really, really honored
    you're here.
        Many seniors depend upon Medicare. That's what we're here to talk
    about. And the Medicare program is a basic trust that must be upheld
    throughout the generations. Our Government has made a commitment to our
    seniors--the Federal Government has made a commitment to our seniors
    through the Medicare program. We made a commitment to provide good
    health care for seniors, and we must uphold that commitment.
        Each of the seniors that I talked to today understands that Medicare
    needs to be modernized. It needs to be changed. It needs to be brought
    into the 21st century. They all want the Medicare system that allows
    them to pick the health care coverage that best meets their needs. And I
    want to share with you some of the thoughts that we had.
        Marge and Mac MacDonald, they take seven different medications at a cost of about
    $300 a month, and they have no prescription drug coverage. That is not
    exactly how the planners of Medicare envisioned a senior spending their
    years of retirement. That's expensive. It's costly. Marge says she's
    frustrated that Washington has not delivered a prescription drug benefit
    under Medicare. She says, ``I'm tired of the talk.'' This is her words,
    not mine. ``I'm tired of the talk. Sooner or later, somebody needs to do
    something. What is the point of retiring at all if you're going to worry
    about whether you have the money you need to survive?'' Marge is right.
    We've had plenty of talk in Washington. We've debated this issue for a
    long time. Now is the time for action.
        Estelle Baker--I mentioned Estelle
    earlier--she, in addition to her Medicare benefits, she has drug
    coverage through a supplemental insurance policy. Perhaps some of you
    all have the same type of arrangement. She said it's time for all
    seniors to have that kind of coverage. She said, ``Seniors should have
    the same kind of safety

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    net--some kind of safety net, and it should be done as soon as
    possible.'' In other words, that--what you're hearing from people is
    that when people retire, they don't want to have to worry. They've been
    worrying, probably raising their kids and worrying about their jobs and
    worrying about this and worrying about that. We don't want our seniors
    worrying about a health care system that is not meeting their needs.
        Every senior I've talked to is grateful about the Medicare system,
    and it's done a lot. In many ways, it's fulfilled the promise, up until
    recent history, and therefore the system needs to be undated. That's
    what we're here to discuss. That's what Congress must hear. They must
    hear your voice that the system needs to be updated, that while the
    system has worked, we can do a better job.
        Remember, Medicare was created at a time when medicine consisted
    mostly of house calls and surgery and long hospital stays. That was the
    nature of medicine when Medicare was created, and therefore the Medicare
    system responded to that. Now modern medicine includes preventative
    care, outpatient procedures, at-home care, and miraculous new
    prescription drugs. Medicine has changed; Medicare hasn't.
        Three-quarters of seniors have some kind of drug coverage, and
    that's positive news. Yet seniors relying exclusively on Medicare do not
    have coverage for prescription drugs--for most prescription drugs and
    for many forms of preventative care. That needs to be fixed. This is not
    good medicine. It's not cost-effective. Medicare needs to change.
        For example, Medicare will pay--I want you to hear this example.
    Medicare will pay for extended hospital stays for ulcer surgery, at the
    cost of about $28,000 per patient. That's important coverage,
    particularly if you have an ulcer. Yet, Medicare will not pay for the
    drugs that eliminate the cause of most ulcers, drugs that cost about
    $500 a year--willing to pay the $28,000 for the hospital stay but not
    the $500 to try to keep the person out of the hospital in the first
    place. To me, that says we've got a system that needs to updated and
    modernized. It's not enough for Medicare to pay to treat our seniors
    after they get sick. Medicare should be covering the medications that
    will be keeping our seniors from getting sick in the first place.
        The best way to provide our seniors with modern medicine, including
    prescription drug coverage and better preventative care, is to give them
    better choices under Medicare. If seniors have choices, health care
    plans will compete for their business by offering better coverage at
    affordable prices. That's a fact. With greater choice, we can give
    American seniors the very best of modern medicine.
        It's very important for people on Medicare to know that one of the
    choices that I strongly support and Members of Congress support is
    allowing people to remain in traditional Medicare programs. We fully
    understand that some seniors simply do not want to change, and that's
    understandable. In any system, modernization must say to the seniors,
    ``If you're happy where you are, you stay there.'' If you're a senior
    who wants to stay in Medicare and you're concerned about prescription
    drugs, you should be able to get a Medicare-approved prescription drug
    coverage. That's what the bill says. And that's what we want to happen:
    There's no reason for you to leave Medicare and that the Medicare system
    needs to be modernized to include prescription drugs.
        If you're a senior who wants enhanced benefits, something a little
    different, something better, something that meets your particular needs,
    such as a new Medicare-approved private plan that includes a drug
    benefit along with other options, coverage for extended hospital stays
    or protection against high out-of-pocket expenses, you should have that
    choice as well. In other words, there are--a variety of choices ought

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    to be available for seniors. If you like managed care plans, if you're
    happy with that, that option ought to be available. And if you're a low-
    income senior without much savings, you will receive extra help each
    month and more generous coverage so you can afford a Medicare option
    that includes prescription drug benefits.
        That's the reform in front of Congress. It's moving forward. We've
    just got to make sure it moves forward to completion. That's what we're
    here to discuss today. In Medicare reform, we're applying this basic
    principle: Seniors should get to choose the kind of coverage that works
    best for them, instead of having that choice made solely by the
    Government. You see, every Member of Congress gets to choose a health
    care plan that makes the most sense for them, and the same for Federal
    employees. If choice is good for Members of the Congress, then choice is
    good for America's seniors.
        For seniors without any drug coverage now, the reforms will make a
    big difference in their lives. In return for a monthly premium of about
    $35, or $1 a day, most seniors now without coverage will see their drug
    bills cut roughly in half. A senior who has no drug coverage now and a
    monthly drug cost of $200 would save more than $1,700 on drug costs each
    year. A senior with monthly drug costs of $800 would save nearly $5,900
    on drug costs each year.
        Putting improvements into place are going to take some time, and so
    we need to give seniors some immediate savings. We'll provide all
    seniors with a Medicare-approved drug discount card that would save
    between 10 to 25 percent off the cost of their medicines. So in other
    words, when the bill--as the bill--when it passes, and I'm an optimist--
    particularly with your help, I will even be more optimistic--that in the
    time the bill transitions between the old system and the new system,
    there will be a Medicare-approved drug discount card for you. Low-income
    beneficiaries will receive an annual $600 subsidy, along with their
    discount card, to help them purchase their prescription medicines.
        And the legislation that Congress passes must make sure that the
    prescription drug coverage provided to many retirees by their employers
    is not undermined. We don't want the system to undermine some of the
    really good plans that you may have received as a result of your
    previous employer. Medicare legislation should encourage employers to
    continue the benefits, while also extending drug coverage to the
    millions of Medicare beneficiaries who now lack it.
        Congress should also make sure that Medicare rests on solid
    accounting. The current Medicare system accounting does not always give
    a clear indication of its long-term financial health. I support the
    Medicare system that alerts future Congresses and Presidents when
    Medicare's costs are rising faster than expected, so they can address
    the problem. The accounting safeguard that we're working on in the bill
    will help Medicare stand on a strong financial foundation. We owe that
    to the taxpayers of our country.
        The important thing we're talking about here is, not only will the
    steps we're taking strengthen Medicare for today's seniors but also for
    tomorrow's retirees. It seems to be a popular thought with the baby
    boomers. Many workers are counting on Medicare to provide good health
    care coverage in their retirement. These reforms will give our workers
    confidence that Medicare will serve them with the very best of modern
    medicine, and that's important for people to know. The budget I
    submitted earlier this year commits an additional $400 billion over 10
    years to implement this vision of a stronger Medicare system. This is
    enough to meet our commitments to the seniors today and to future
    generations of Americans.
        I urge the seniors and all Americans to speak up and to call or
    write your Representatives or Senators and urge them to get a final bill
    that meets the goal I just

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    outlined. You need to speak up for prescription drug coverage. You need
    to speak up for health care choices. You need to speak up for a modern
    Medicare system that puts patients and doctors in charge. For years, our
    seniors have been calling for a prescription drug benefit. For years,
    American seniors have been calling for more choices in their health care
    coverage, and now we'll see who is really listening in Washington, DC.
        The choice is simple: Either we will have more debate, more delay,
    and more deadlock, or we'll make real progress. I made my choice. I want
    real progress, and I urge the Congress to take the path of progress and
    give our seniors a modern Medicare system. We've come far. Let's finish
    the job.
        Thank you for coming. God bless.

    Note: The President spoke at 2:07 p.m. In his remarks, he referred to
    Surgeon General Richard Carmona; Josefina Carbonell, Assistant Secretary
    for Aging, Department of Health and Human Services; Gov. Jeb Bush of
    Florida; and Rich T. Crotty, chairman, Orange County Governing Board.
    The Office of the Press Secretary also released a Spanish language
    transcript of these remarks.