[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.