[Public Papers of the Presidents of the United States: George W. Bush (2004, Book I)]
[January 26, 2004]
[Pages 130-138]
[From the U.S. Government Publishing Office www.gpo.gov]
Remarks in Little Rock, Arkansas
January 26, 2004
The President. Thank you. Thanks for coming. Thanks for having me.
Thanks for the warm welcome. I appreciate the fact that a Texan is being
treated so well here in Arkansas. [Laughter] It's nice to be in this
part of the world again. Arkansas is full of really good people, decent,
caring people, and so is this hospital. I'm honored that you would have
allowed me and my rather significant entourage--[laughter]--to come to
Baptist Health Medical Center.
I'm here to talk about health issues. I'm here to talk about one of
the reasons why health care costs are going up. And that's the fact that
we've got too many darn lawsuits, too many frivolous and junk lawsuits
that are affecting people. I'm here to make sure that we talk in a way
that says to the people of Arkansas and America that we need medical
liability reform to make sure that medicine is affordable and available.
But I'm here, first and foremost, to thank the people of this
medical center, those here in person and those listening via cable. I
want to thank you for what you do. I want to thank you for your heart. I
want to thank you for caring about your fellow citizens. I appreciate
very much your being on the frontline of healing, healing lives in such
a compassionate way. Our health care system is the best in the world,
and we need to keep it that way.
I appreciate Russ. Thank you
for your introduction. Thanks for being the CEO of Baptist Health
System. Thank you for joining us in--we just had what they call a
roundtable. The table was square. [Laughter] But nevertheless, we had a
great discussion, and Russ was there. He
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talked about this hospital, its outreach, its not only desire to serve
people in the city of Little Rock but also its desire to serve people in
rural Arkansas.
I want to thank Doug Weeks, the senior vice
president and administrator, our host. I want to thank my friend the
Governor for coming. Governor Huckabee is a--
[applause]. Part of good health care depends on how you treat your own
body. [Laughter] No, I'm serious. I'm absolutely serious. The best way
to--one of the best ways to prevent disease is to make right choices.
One of the right choices is to watch what you eat. The Governor has
clearly done that. [Laughter] He's setting a good example.
Another right choice is to exercise frequently. Some of us like to
run--or used to like to run before we broke down. [Laughter] I try to
exercise 6 days a week. The Governor exercises. And I hope people in
Arkansas and around the country understand that the exercise is a good
way to avoid disease in the first place. Making right choices is
important. And Governor, I appreciate the
example you've set for this great State.
I want to thank the Lieutenant Governor, Win
Rockefeller, for joining us. Win, glad to
see you. He exercises too. [Laughter] I appreciate the mayor, Mayor
Dailey from Little Rock, for being here. Mr.
Mayor, thank you for coming. Mayor Hays of
North Little Rock is here as well. Thank you for coming, appreciate you.
You've got a tough job. I like to remind the mayors, just go ahead and
fill the potholes, and everything will be fine. [Laughter]
I know we've got leaders from the statehouse here, Senator
Baker and Representative Parks and others. Thank you all for coming out and giving me
a chance to share some thoughts with you.
Before I get into the issue of health, I do want to remind you that
our country still faces big challenges. And we're rising to meet the
challenges. The most important job of my administration is to protect
the American people, is to chase down those who would do us harm and
bring them to justice, is to never forget the lessons of September the
11th, is to stay on the offensive, and that's what we're doing.
We're spreading freedom, and as we do so, the world becomes more
peaceful. Freedom is not America's gift to the world; freedom is the
Almighty's gift to each man and woman in the world.
I appreciate so very much the contribution of the Arkansas Guard.
Over 4,000 troops are part of our effort to not only make America more
secure but to make the world more free. I know that the Governor
informed me that these troops are ready to go. They understand the
mission. They're proud to serve our country. I'm proud to call them--I'm
proud to be their Commander in Chief. And I want their families to know
how much we are grateful for their sacrifice as well. Arkansas ought to
be proud of the men and women who wear the uniform, and they're going to
make this Nation proud and more secure in their sacrifices.
I told everybody the other night at the State of the Union that
we're going to stay on the offensive against Al Qaida, and we're making
good progress. We're on an international manhunt. We're in a different
kind of war. It used to be in the old days, you could measure progress
based upon the number of airplanes that the enemy had or the number of
ships in a flotilla. And the big battles of the past were clashes of
equipment that were visible for people to see. And this is the kind of
war where sometimes you see action, and sometimes you don't. Sometimes
progress is being made, and it's hard to tell it, because in order to
dismantle the Al Qaida terrorists network, we've got to be on a manhunt,
and we've got a lot of people on the manhunt.
Just yesterday--not yesterday--just last week, we made further
progress in making America more secure when a fellow named Hassan
Ghul was captured in Iraq. Hassan
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Ghul was a--reported directly to Khalid Sheik Mohammed, who was the mastermind of the September the 11th
attacks. He was a killer. He was moving money and messages around South
Asia and the Middle East to other Al Qaida leaders. He was a part of
this network of haters that we're dismantling. Our intelligence officers
did a good job. He was captured in Iraq, where he was helping Al Qaida
to put pressure on our troops. There is one less enemy we have to worry
about with the capture of Hassan Ghul. Our people are doing great work.
This country's economy is getting better, and that's positive news
for the people of Arkansas and the people of America. The tax relief we
passed is working. See, I believe that when people have more money in
their pocket, they will then spend or save or invest, and that causes
the whole economy to grow, which then helps people find a job. Much of
the tax relief we passed is set to expire, and it's set to expire right
about the time the economy gets going. It makes no sense to have a tax
increase on the American people at this stage or any stage as far as I'm
concerned. And therefore, we need to make the tax relief permanent.
In order to make this tax relief permanent, let people keep more of
their own money to keep driving this economy forward. Small businesses
need to keep more money. You see, most new jobs in America are created
by small-business owners. If you're worried about job creation, we need
to continue to stimulate the small-business sector of our economy.
Congress needs to act. They need to make these tax relief packages we
passed for small business permanent so people can find work here in
America.
We also need to have an energy policy. The people of Arkansas
understand energy. We need a policy. We need a policy that encourages
conservation. We need a policy that helps modernize our electricity
systems, and we need a policy that makes us less dependent on foreign
sources of energy.
We need to open up markets for Arkansas' farmers and ranchers. When
you're good at something, we ought to encourage the sale of those
products elsewhere, outside of our markets. And we're good at things in
America. We're good at growing crops, and we're good at raising cows,
and we're good at being on the cutting edge of innovation. We need
markets for those products. We need less regulation for businesses and
small businesses.
And we've got to deal with rising health care costs. Rising health
care costs are making it difficult for some entities to hire people.
Rising health care costs affect all Americans. We want our families to
feel more secure. Rising health care costs create insecurity in our
Nation.
And so we need to continue the focus on costs. We're making some
good progress, by the way, about helping people with health care. We've
got what we call community health centers in America. I'm committed to
the expansion and the building of new community health centers. These
are places where people who don't have insurance or live in areas
without enough doctors can find health care. Community health centers
make sense. It takes the pressure off the emergency rooms of hospitals
such as this. We've opened or expanded 600 community health centers
since 2001. The budget I proposed calls for another 218 to be opened or
expanded. This is a good way to make sure that health care is available
for those who don't have insurance yet. And so I call upon Congress to
look at that part of my budget and continue working with the
administration to expand these vital centers around Arkansas and around
America.
And then we worked on Medicare. You might remember what it was like
before this year when people talked about Medicare. The political issue
was really called ``Medi-scare.'' [Laughter] If somebody would talk
about it, somebody else would
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say, ``Wait a minute. They're going to try to take away Medicare from
the seniors.'' But I felt strongly that Medicare needed to be
modernized. I felt like we needed to deal with the issue now and not
pass it on like other Congresses and administrations had done. It's time
to address the issue before it became so acute that the system didn't
work. And it was time to fulfill a promise to our seniors, and so we
acted. I was proud to sign that bill, and as I told the Congress, ``If
you try to change it and it hurts our seniors, I'll veto the bill.''
It's going to take a while to implement the Medicare bill. It's a
complex piece of legislation. After all, it's the first modernization
since Lyndon Johnson signed Medicare in the mid-sixties.
This year, seniors are going to get a drug discount card, which will
save them 10 to 25 percent off the retail price of most prescription
drugs. And the lowest income seniors will get a $600 credit. That will
help seniors with drug costs.
Secondly, next year we'll begin preventive screenings against
diabetes and heart disease for seniors just entering Medicare, plus
they'll get a wellness exam. That's important. It's the first time that
Medicare has actually been into the business of preventive screenings.
Any good doc will tell you, you need to figure out what the issue is in
order to deal with people. And a preventive screening will help the
medical profession better treat our seniors.
Finally, in year 2006, seniors will receive the prescription drug
coverage they've been promised. For about $35 a month, most seniors will
see their drug bills cut in half. That's a good deal for America's
seniors.
And finally, in the bill is an interesting innovation, one that
isn't the first time it's been tried, but it's now been expanded--
they're called health savings accounts, which will allow Americans to
save for future medical expenses, tax-free. And that's an important
innovation, an important reform.
Another way to help, by the way--or a way to help deal with rising
costs is to understand the impact rising costs have on small businesses.
A lot of big businesses are able to absorb the costs because they've got
the capacity to negotiate better. When you've got a large universe of
people that you're trying to cover, you can have more strength in
negotiations. It gives you a better hand.
The problem we have with small businesses is they don't have the
capacity to pool together, to negotiate on behalf of a lot of people.
And that's why I'm a strong supporter of what's called association
health plans that will allow small businesses to pool risk and have a
better negotiation policy with those who offer insurance. Congress needs
to pass this piece of legislation. It is good for the entrepreneurs of
Arkansas.
Lower income Americans should be helped with health care by
refundable tax credits. It's been a part of my budget. It's an important
reform. It will help with the issue of the uninsured. People with health
savings accounts, when they buy high deductible insurance policies to
protect them against catastrophic medical costs or hospitalization or
major surgery, should be allowed to deduct those premiums. See, that
will help with the rising costs of health care as well. Those are some
practical suggestions for Congress to look at, ways to strengthen the
private delivery of medicine as opposed to strengthening the Government
involvement in medicine.
There's something else we can do at the Federal level, and that is
to promote promising health information technology. The truth of the
matter is, medicine is on the leading edge of change. And some of the
new drugs are fantastic about--to help save lives. Some of the new
machinery is fantastic. The information systems of the health care
system are a little antiquated. I mean, you're still moving files by
hand, aren't you? Kind of writing it out by hand.
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Well, what we need to do is to have standards and computerized records
so that we can improve care and prevent errors, which will save money in
the system. There's tremendous savings to be had by bringing technology
into the medical field, and the Federal Government can help there as
well.
These are good steps. Yet one of the main cost-drivers, that has
nothing to do with what happens in an operating room or a waiting room,
happen in the courtroom. One of the reasons people are finding their
premiums are up and it's hard to find a doc these days is because
frivolous and junk lawsuits are threatening medicine across the country.
And there's a lot of them, people just filing these suits. I call them
junk suits because they don't have any merit. The problem is they cost
money to fight.
Every one of these junk suits that people put out there requires the
expenditure of money, which affects consumers. That's you. It affects
hospitals. That's you as well. In order to avoid protracted litigation,
those who provide insurance oftentimes just settle the case. You've got
these giant judgments looming out there, people say, ``Well, I better
just go ahead and settle this, rather than risk a bad jury verdict.''
That drives up costs too. People just filing these lawsuits right and
left, and it's running up the costs. Doctors' premiums, the cost of
doing business, they're rising. That makes it hard on the docs. It makes
it hard on docs to do what they're called to do, which is to heal lives.
Medical liability premiums for Arkansas doctors rose more than 150
percent last year. That makes it awfully hard for doctors to do
business. And what is their business? Their business is seeing patients.
Their business is helping to make somebody's life better. Yet these
lawsuits are making it hard for docs to practice their business in the
State of Arkansas and other States as well.
You see, the costs get passed on. They get passed on to patients or
their employers. One of the major cost-drivers in the delivery of health
care are these junk and frivolous lawsuits. The risk of frivolous
litigation drives doctors--and hear me out on this--they drive doctors
to prescribe drugs and procedures that may not be necessary, just to
avoid lawsuits. That's called the defensive practice of medicine.
According to a survey of the Arkansas Medical Society, 90 percent of
Arkansas doctors say the fear of lawsuits have caused them to do
unnecessary procedures.
See, lawsuits not only drive up premiums, which drives up the cost
to the patient or the employer of the patient, but lawsuits cause docs
to practice medicine in an expensive way in order to protect themselves
in the courthouse.
The defensive practice of medicine affects the Federal budget. The
direct cost of liability insurance and the indirect cost from
unnecessary medical procedures raise the Federal Government's health
care costs by at least $28 billion a year. Remember, we provide--at the
Federal level, we provide health care through Medicare and Medicaid and
veteran's health and Government employee costs. The defensive--the cost
of defensive medicine raises your bill as a taxpayer. Not only does it
make it harder to go see a doc, it also costs you more as a taxpayer.
Medical liability reform is a national issue because medical liability
lawsuits raise the Federal budget. It's a national issue that requires a
national solution.
You need to get your Governor--I know he's
strongly, and the Lieutenant Governor is
strongly in favor of liability reform--you need to work it here in
Arkansas, by the way. Just don't rely upon the Federal Government, but
get you good medical liability. It's tough, because some of these lawyer
groups are some of the politically strongest groups in the State and the
country. I understand how tough it is. But we're doing the right thing
by insisting upon medical liability reform. We're doing the right thing
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by telling people the truth, and that is the health care system looks
like a giant lottery. That's what it looks like these days because of
these lawsuits. And somehow, the trial lawyers always hold the winning
ticket. Lawyers walk away with up to 40 percent--40 percent--of every
settlement and verdict, which adds up to billions of costs, billions of
unnecessary costs.
Lawsuits don't heal patients. That's a fact. And they're driving a
wedge between the docs and their patients. One of the most vital links
of good medicine is the doctor-patient relationship. Yet many doctors
fear what they tell a patient will be used against them in a court of
law. We've got a culture of lawsuit here in America, a culture of
lawsuits, a litigation culture, which is driving a wedge between the
doctors and patients, and that's not right. When docs treat their
patients, the only thing they should worry about is the health of their
patients, not some trial lawyer breathing down their neck.
Seventy-one percent of the doctors in Arkansas say they are
considering early retirement. Let me tell you what's happening here in
Arkansas, and it's happening in other States too. You're not alone.
These frivolous and junk lawsuits are not only driving up the costs, but
a lot of docs are thinking about quitting the practice of medicine.
Remember, I talked about to make sure medicine is affordable and
available. Lawsuits drive up the affordability. Lawsuits are driving
docs out of the practice, which means there's less availability. You've
got to have doctors in your communities. In order to be a vibrant,
successful community, you need a viable health care industry with good
docs. And yet, 71 percent of the doctors in this State say they're
considering early retirement; 50 percent of the physicians say they're
having difficulty recruiting new doctors to practice in Arkansas.
This litigation culture puts a sign up there saying, ``If you come
to our State, you're likely to get sued.'' Who wants to do that? People
want to practice medicine. They don't want to spend their time defending
themselves in the courthouse because of the frivolous and junk lawsuits
that are too prevalent today in America. More than a third of the docs
are considering moving out of State. See, that says to me you got a
problem here in Arkansas. And by the way, again I repeat, you're not
alone. Trust me, you're not alone. There's a lot of States that can't
get good medical liability reform through.
Today I met with some decent docs and health administrators. Let me
tell you their stories so that we get a better feel for why we need
medical liability reform at the State and Federal level.
Sara McBee is here. There's Sara. She's from
Fayetteville, Arkansas. She practices family medicine. She was
delivering between 80 and 100 babies a year. Now, there's a soul--a good
soul who loves life to the point where she's willing to take her talents
and deliver babies. It must be an unbelievably satisfying profession to
bring life to be.
And yet, in July of 2002, her insurance
premiums more than doubled. See, the litigation culture made it nearly
impossible for her to practice her love. I say nearly impossible,
because she wouldn't break her commitments to expecting patients and
hung in there for a year. But her premiums continued to rise, and Dr.
McBee has stopped delivering babies, as a direct result of too many junk
lawsuits, and that's not right. That's not right.
Let me give you another story. Dr. John Wilson is with us. Dr. Wilson is a good soul. He's an
orthopedist from Little Rock, Arkansas. He's been practicing medicine
for--I think he said 35 years, 30 of which he wasn't hassled by
lawsuits. In other words, what we're talking about is a new phenomenon
here in society--in this society. He is a--he believes that doctors are
called to serve. Besides just healing people, they're called to serve
people. And I bet
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you when you talk to most docs, that's the way they feel as well.
So he traveled every week to the Arkansas
Delta. And for people who aren't familiar with Arkansas, that is a poor,
rural area that, frankly, does not have enough doctors. And he heard a
calling. So he would go there to help--to love, really, if you think
about it--to practice his talent and skills and to love people by
helping them, and then he got sued. And the lawsuits were dropped, but
he was unable to find insurance because he was told if he kept going
over there, the cost of his business, the cost of being a doctor, would
rise dramatically. And so he quit going. He quit going.
By the way, I went to Mississippi a while ago and talked to a doc
who was there in the Mississippi Delta. He came down from another State
to practice medicine. He understood there's a lot of poor people there;
he wanted to help them. He got sued--for helping poor people, because
he's a doctor. And guess what? He left. The Wilson story and the story I
just mentioned to you, it's just all too common. And people get
affected. These junk lawsuits not only are running up the cost of
medicine; they're making the quality of life of some of our citizens--
diminishing the quality of life.
Sully and Mary Ligon
are with us. They're from Helena--or Henrietta?
Mrs. Ligon. It's Helena.
The President. Helena, yes, Helena. How quickly we forget.
[Laughter] Anyway, see, the Ligons got help from Dr. Wilson. She
was telling me she got injured during one Christmas and tore a rotator
cuff, and Dr. Wilson being the good doc he is, fixed it. Her fastball is
back up to about 85 miles an hour now. [Laughter] But Dr. Wilson no
longer goes there. And Sully got knocked over by a cow. He said a wild
cow, not a mad cow. [Laughter] He got hurt, see. And Dr. Wilson was
their doc because he used to go there. He no longer goes there. So guess
what? The Ligons now have to drive here. And as they were quick to point
out, they can afford to do so, which is good. It's inconvenient as heck,
but they can afford to do so. There's a lot of people there that can't,
and they're missing out on a good doc. And the reason Dr. Wilson is not
there is because lawsuits are running up the cost of medicine, make it
hard for him to practice. His heart's right. Trust me. I heard him. But
he just can't go there.
There's just too many junk and frivolous lawsuits. We need to do
something about it for the sake of a lot of people. I met with Frank
Wise. He's from Fulton County Hospital.
It's a rural hospital. These junk lawsuits have raised the cost of
delivering babies such that they no longer do so in his hospital. And he
tells the story about people desperately looking for a place to--for a
bed, and babies being delivered on a bridge.
Listen, I'm going to tell you something. We can have balance in our
society when it comes to having a good legal system and a good medical
system. It's not that way today. The pendulum has swung way, way too
far.
D'Borai Lynn Cook--you might have
heard of her if you work here. She's the emergency room case manager.
She sees firsthand what it means to practice medicine defensively. She
says they over-prescribe to cover themselves to make sure that, as they
do their job, they're thinking about what would happen if they end up in
a court of law. She says that--she said then there's the negative aspect
of defensive medicine with people saying, ``I'm not going to handle that
case.''
See, too many lawsuits affect the lives of a lot of good people, and
we need to do something about it. And so I proposed to the Congress to
act. My job as the President, if I see problems, is to address them
square on, and I expect Congress to do the same thing. I expect Congress
to do the same.
First of all, we want to make sure the court system is uncluttered.
We want to
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make sure that if a person is injured, they have their day in court.
Frivolous and junk lawsuits make it hard for those who get injured to
have their day in court, for starters. And secondly, obviously, if
they've been hurt by a bad doc, there needs to be a judgment, and that
person needs to be able to recover the cost of their care, the recovery,
and the economic losses for the rest of their life. Every good doc wants
to make sure that the legal system works fairly. Good docs aren't afraid
to stand up in a court of law. They just don't want to be run out of
business because of these junk lawsuits, just filing suit after suit
after suit.
People ought to be allowed to recover economic damages. But for the
sake of a strong health care system, for the sake of making sure health
care is accessible and affordable, we need a $250,000 cap on non-
economic damages.
States that have got a hard cap have seen positive results, have
seen the judicial system work well and the medical field stay vibrant.
And if harm is caused by truly egregious behavior, patients should be
able to recover reasonable punitive damages.
What I propose is fair, see. I've laid out something that's balanced
and fair, something that addresses a critical national need, and that is
the cost of medicine. The problem is, is that some in the United States
Senate don't see it that way. That bill I put up there passed the House
of Representatives, and it's stuck in the Senate. And your Senators need
to hear from you about a balanced, fair system. For the sake of Arkansas
and States around the country, you need medical liability reform.
We need to make sure we've got joint and several liability reform as
well. See, what happens is some of these junk lawsuits, they'll just
file against everybody. Even though they may not be like 100-percent
responsible for an issue, they'll have to pay 100 percent of the cost.
That's not fair. That hurts hospitals in particular and a lot of docs as
well. There needs to be good reform. There just needs to be good, sound
national reform that's fair and balanced and full of common sense.
The House passed a bill. It's stuck in the Senate. These Senators
have got to understand no one has ever been healed by a frivolous
lawsuit. And I'm going to stay on the issue until we get it fixed. This
is a national problem.
Let me talk about one other issue, and then I'll let you get back to
work. Today I met Mary Lynn Roberson at
the airport. Mary Lynn has volunteered--she's right there. I told her I
was going to say her name. Thank you, Mary Lynn. She has volunteered
here for nearly three decades. She visits with family and friends of
surgery patients. In other words, she's spreading love, is what she's
doing. And the reason I bring that up, and her work, is because the true
strength of America is the fact that there are Mary Lynns in every
community who are willing to take time out of their personal life to
love a neighbor just like you'd like to be loved yourself.
We're a mighty nation when it comes to our military, and we'll keep
it that way. We're a mighty nation when it comes to wealth in our
economy, and it's getting better. But the most mighty aspect of our
Nation is the fact that our citizens, from all walks of life, care
deeply about a neighbor in need.
One of the most compelling things about being the President is I get
to see on a daily basis the true compassion of our fellow citizens. And
I hear just unbelievably fantastic stories about people overcoming big
odds, because a neighbor is helped. Somebody has just taken time out of
their life to make a difference.
My call to the good people of Little Rock is to work with the Boy
Scouts--and I thank you for being involved in such a values-based
program--or to start a program in your house of worship to feed the
hungry or find shelter for the homeless. If you are interested in
helping make a difference, mentor a child, teach a child how to read.
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What a fantastic gift that is to teach a child to read. After all, I
like to say reading is the new civil right. And you can help.
The strength of this country is the fact that we're a compassionate
country. And there are thousands of people who are soldiers in the army
of compassion, working hard to change lives, just like you're doing here
at this hospital.
I'm so grateful that you gave me a chance to come by and talk about
issues of national concern. I'm particularly grateful for the love you
show for people who hurt here in society. This country is a great
country because it is full of great people.
I'm honored to be here. May God bless your work, and may God
continue to bless America. Thank you.
Note: The President spoke at 11:14 a.m. at the Baptist Health Medical
Center. In his remarks, he referred to Russell D. Harrington, Jr.,
president and chief executive officer, Baptist Health System; Doug
Weeks, senior vice president and administrator, Baptist Health Medical
Center; Gov. Mike Huckabee and Lt. Gov. Win Rockefeller of Arkansas;
Mayor Jim Dailey of Little Rock, AR; Mayor Patrick Hays of North Little
Rock, AR; State Senator Gilbert Baker and State Representative Marvin
Parks of Arkansas; and Khalid Sheik Mohammed, senior Al Qaida leader
responsible for planning the September 11 attack, who was captured in
Pakistan on March 1, 2003.