    [Public Papers of the Presidents of the United States: George W. Bush (2005, Book I)]
    [January 26, 2005]
    [Pages 86-95]
    [From the U.S. Government Publishing Office www.gpo.gov]

    Remarks in a Discussion on Health Care in Bethesda, Maryland
    January 26, 2005

        The President. Thank you all for coming. Please be seated. Thanks
    for the warm welcome. Thanks for coming. I'm looking forward to having
    what I think you'll find to be a very interesting dialog about
    innovative ways to make sure that our health care system addresses the
    needs of our individual citizens.
        This is an issue that requires a lot of dialog so people understand
    the problems and a lot of innovative thinking to make sure that the
    system works. My judgment is the system won't work if medical decisions
    are made by Government. I believe the best kind of decisionmaking occurs
    when consumers make decisions and the relationship between their doctors
    and the patients are--become the cornerstone of good health care policy.
        And so we're going to have a dialog. I want to thank our fellow
    citizens for being here. We just had a little discussion about how to
    make sure this conversation goes without flaw. [Laughter] I'm confident
    it will.
        First, I want to thank the Governor of the great State of Maryland for joining us today. As
    you know, at times I take a little--a brief weekend retreat in the great
    State of Maryland at a fine facility called Camp David. And the last
    time the Governor was there, was with Laura and
    me. He and the first lady were there, and it
    happened to be the day of the blizzard. So I've invited him back in the
    summer. [Laughter]

        I want to thank my friend Elias Zerhouni, the Director of the National Institutes of Health. I
    appreciate the job you're doing, Doc; you're doing a fabulous job. I
    want to thank Les Crawford, who's
    with us today, the Acting Director of the--Acting Commissioner of the
    FDA. Thank you, Les, for being here. And I want to thank everybody else
    who has come. I'm honored that you're interested in this very important
    subject.

        Before we talk about health care, though, I do want to talk about a
    couple of other subjects. One, I am, as you could tell from the speech I
    gave last week, a firm believer in freedom and the ability of freedom to
    bring peace to our world. I am so pleased to watch liberty advance
    throughout the world in places that--where people--in places where
    people never dreamt liberty would come. I want our fellow citizens to
    see what is happening in our world in the last couple of months.

    [[Page 87]]

        I mean, in Afghanistan millions of people voted for a
    President for the first time in 5,000 years.
    It's a grand moment in history when people who had been condemned to
    tyranny--by in this case, the Taliban--have a chance to express
    themselves in the ballot box--at the ballot box, to let their opinions
    be known as to how Government ought to respond to their needs.
        As well the Palestinians elected new leadership. I am very pleased
    by the courage and leadership shown by Abu Mazen, his desire to unify security forces within the
    Palestinian territory, so as to defeat the terrorists there and allow
    for democracy to advance. I believe a Palestinian democracy will emerge
    and will grow, enabling us to achieve a goal of two states, Israel and
    Palestine, living side by side in peace.
        As well the Ukraine swore in a new President, which was a remarkable advance of democracy in that part
    of the world. And finally, this Sunday, after years of brutal tyranny,
    the long-suffering people of Iraq will go to the polls to vote for a--
    freedom is on the march. Freedom will continue on the march, and
    therefore the world will be more peaceful, and we'll be able to say we
    left behind a more steady and stable and peaceful world for our children
    and our grandchildren.
        At home, we've got to make sure freedom continues on the march as
    well. That starts with making sure every child receives a great
    education. The No Child Left Behind Act is the beginning of making sure
    high standards and accountability come to our classrooms, so that not
    one single child is left behind. We're making progress, and over the
    next 4 years, we'll continue to make progress.
        The world is watching as to whether or not we're able to manage our
    budgets. One of the things people say, ``Are you capable of dealing with
    twin deficits?'' On the one hand, we have a fiscal deficit, so I'll be
    submitting a budget to the United States Congress that sets clear
    priorities. One of the priorities of my administration was doubling the
    funding for NIH so we continue to stay on the leading edge of research
    and technological change.
        We understand how important science is. And we understand it's
    important to be the leading nation when it comes to research, and we'll
    continue to stay there. But we are funding some things that aren't
    effective as well. And so the budget I submit to the United States
    Congress will work on reducing our deficit in half by--over a 5-year
    period of time, and at the same time, funding much needed priorities.
        As terms of the current account deficit--that would be the deficit
    as far as our trade goes--the best way to deal with the current account
    deficit is to make sure America is the best place in the world to do
    business, to risk capital, so that we can continue to grow our economy.
    And the first step of doing that is for Congress to bring meaningful
    legal reform to my desk early in this legislative session, reforming the
    asbestos law, reforming class-action lawsuits, and reforming medical
    liability.
        We'll continue to work on free and fair trade. I believe we can
    compete with anybody, anywhere, so long as the rules are fair. We need
    to open up markets around the world so our farmers and entrepreneurs and
    manufacturers can sell our products around the world. We need to make
    sure that regulations are fair. We've got to make sure that taxes remain
    low so as not to snuff out the entrepreneurial spirit in America. Our
    economy is growing. Small businesses are vibrant and alive and well. New
    jobs are being created by small businesses, and we want to continue that
    momentum. People are finding work. We've recovered from recession. And
    it's important for Congress to understand that we've got to create an
    environment for continued capital expansion if we want our people to
    find jobs. And so I'm looking forward to working with them.
        We've got a lot of big challenges ahead of us. And one of the
    biggest challenges of all is Social Security. And it's a challenge

    [[Page 88]]

    because if you're a dad, for example, of a 23-, 24-year-old child, when
    that child comes time to retire, the system is broke. It's flat bust. In
    13 years, the system begins to go negative. That's more money going out
    than coming in.
        And so it seems like to me, for people like me who have gotten
    positions of responsibility, we should deal with this issue and not pass
    it on in hopes that it gets better. It's not going to get better unless
    Congress works with the administration to have a permanent, long-term
    fix for Social Security. If we do not act, the cost becomes more
    expensive in the out-years. If we do not act, there's going to be a need
    for huge payroll tax increases and/or major benefit cuts. So now is the
    time to move. And I understand there's a reluctance by some in Congress
    to take on a tough decision. But I believe we've been elected for a
    reason, and that is to confront problems and to work together in a
    bipartisan spirit.
        For those seniors who are worried about the debate on Social
    Security, you have nothing to worry about. Nothing will change. But your
    children and your grandchildren do have something to worry about. And so
    I look forward to working with the Congress to come up with a long-term
    solution to fix Social Security.
        As well we need to come up with reasonable, commonsense policies to
    address the rising costs of health care. And so today we're going to
    talk about some innovative ideas. One is health savings accounts. And
    we'll be talking to an employer and somebody--a beneficiary, like me, of
    a health savings account. A health savings account enables a person to
    be in charge of his or her own health care decisions. Health care
    savings account will cover major catastrophic problems and, at the same
    time, allow a person to save and/or a business to save tax-free for the
    everyday expenses of health care. And if in fact you have not reached
    your limit for your catastrophic care--in other words, if you have money
    left over, you can roll it over, tax-free, into a savings account that
    you call your own.
        We've got some people who can probably explain this better than me
    here, consumers of health savings accounts. But health savings accounts
    all aim at empowering people to make decisions for themselves, owning
    their own health care plan, and at the same time bringing some demand
    control into the cost of health care. Our view is, is that if you're a
    consumer of health care and you're in the marketplace making health care
    decisions, it is more likely that there be more cost control in health
    care than a system in which the consumer of health care has his or her
    health care bills paid by a third-party provider.
        Secondly, we're going to talk about association health plans, which
    will allow small businesses to pool across jurisdictional boundaries to
    be able to afford health care insurance at the same discounts that big
    companies get. The principle behind association health plans is that the
    more risk you're able to spread amongst beneficiaries, the lower your
    cost of health care. And unfortunately, too many laws restrict small
    businesses from being able to pool risk. And so we're going to talk
    about that.
        We're going to talk about an integrative way to establish a national
    marketplace for health care by allowing people to get on the Internet
    and buy a health care plan in a State other than that in which you live.
    It's kind of an interesting way to encourage more consumer activism,
    more choices for our citizens here in the country.
        And finally, we're going to talk about making sure that we expand
    our children's health savings program. And we're going to talk to a lady
    who has been very much involved in encouraging people to sign up for
    what's called SCHIP, so the youngest citizens can take care [advantage]
    * of the Government programs that are now available.
    ---------------------------------------------------------------------------
        * White House correction.

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    [[Page 89]]

        As well I want to remind you all that we will continue to promote an
    adequate safety net for our citizens, and by that, we've got community
    health centers in America today. I want to continue to expand community
    health centers. This is the place where the poor and the indigent can
    get primary care. And they're great centers. And Congress has been very
    cooperative in the past of funding our budget requests, and I hope they
    do again as we continue to expand these community health centers all
    across the United States of America.
        We will, obviously, continue to make sure Medicare fulfills its
    promise. Obviously, I felt the system needed to be reformed. It was a
    system that would pay, for example, for hospitalization of a senior
    citizen for heart surgery but not for the medicine that could prevent
    the heart surgery from being needed in the first place. It was a system
    that needed to be changed, and at the same time, it was a system that
    needed to respond to the demands of our senior citizens. And so we
    introduced market forces into the Medicare system to make it such that
    it can continue to evolve and grow and change as medicine changes and,
    therefore, meet the needs of our senior citizens.
        Tomorrow I'm going to go to Cleveland to talk about the importance
    and need of information technology in the health care field. If you
    really think about many industries in America, they've been able to
    modernize and become more productive by introducing IT, information
    technology, into their industries. It's a little difficult--a little
    more difficult task here in health care. We've got 21st century medical
    practices but a 19th century paperwork system. Doctors are still writing
    prescriptions by hand. Most doctors can't write clearly anyway, and so
    it's a--[laughter]--so there's a better way to enable our health care
    system to wring out inefficiencies and to protect our patients. So
    medical electronic records is going to be one of the great innovations
    in medicine. And I look forward to talking about ways to advance
    information technology and health care.
        Finally, a way to make sure that our citizens are able to better
    afford health care is to speed generic drugs to the market. I want to
    thank the FDA for propagating rules that prevent pharmaceuticals from
    delaying the advent and access to our consumers of generic drugs. These
    drugs do the exact same thing as brandname drugs do and yet cost a
    fraction of the cost of the brand names. And so we're doing a better job
    of speeding generics to the markets. And that's a positive development
    for our seniors and all citizens, for that matter.
        So here are some practical ways to address the cost of health care
    without allowing the Federal Government to become the health care
    decider. The federalization of health care would be bad medicine for the
    American people. And one way to prevent that from happening is to
    propose positive alternatives. And that's what we're going to discuss
    today.
        And the first person I'm going to discuss health savings accounts
    with is Pat Zakula--correct? Exactly. Pat
    Zakula. [Laughter] She called me George Brush. [Laughter]
        All right, where are you from?
        Patricia Zakula. I'm from northeast
    Indiana.
        The President. Northeast Indiana. Fabulous, yes. And so what do you
    do?

    [At this point, Ms. Zakula, executive director, Children First Center,
    Garrett, IN, made brief remarks.]

        The President. Great, thanks for doing that. You're a soldier in the
    army of compassion. So you've got employees, right? How many?
        Ms. Zakula. Yes, we have 70 employees.
    Because most of our services are home-based, it takes a lot of people to
    do what we do. Most of our staff are women, some in their twenties to in
    their fifties.
        The President. Right. And you're expected to provide health
    insurance.

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        Ms. Zakula. That's right. And we've been
    doing--providing health care--health insurance for people for many
    years, as we keep growing. But it became a real struggle, because the
    costs were just exorbitant, and they would go up, you know, in double
    digits every year, and sometimes twice a year they would go up.
        The President. Right, which is a common problem for a lot of smaller
    enterprises. So how did you deal with it?

    [Ms. Zakula made further remarks.]

        The President. This is interesting. Listen to what she's saying. First of all, they're going broke. They
    can't afford health care. Like many small businesses or small enterprise
    or small nonprofit, she's faced with a choice: ``Do I keep the doors
    open and have employees without health care''--basically, is what you're
    saying.
        The HSA comes along, and so the plan, as I understand it, has a
    deductible of 1,700--in other words, you pay for the first $1,700 of
    expenses--and then you have insurance to cover the----
        Ms. Zakula. That's correct, to cover the
    100 percent after you reach that $1,700.
        The President. Right. And the way this HSA works is you take the
    high-deductible plan, of $1,700 in your case, and contribute $1,700 into
    the plan, tax-free, so that the person has the 1,700 to cover expenses,
    up until the insurance policy kicks in. I think that's the way yours
    works.

    [Ms. Zakula made further remarks.]

        The President. If the 1,700 isn't spent, it rolls over to the next
    year tax-free and the owner of the HSA can pull the money out tax-free
    for health care. And so it's an incentive to save.
        Now, think about this, if for example, you make healthy choices in
    your life and the 1,700 could be rolled over, the healthier you are, the
    less likely you're going to spend on normal health care needs, the more
    money you have that you call your own. And secondly, the benefit is,
    your employees start making decisions. As opposed to saying, ``You've
    got to go buy X, Y, Z for this amount,'' people all of a sudden start to
    shop for that which is best for them.
        Ms. Zakula. That's true. And people
    who--when they found out that their visit to the doctor really didn't
    cost $20, which was our co-pay--[laughter]--then they're not--then they
    don't run to the doctor all the time. However, they are using--they're
    using preventative care and doing the things that they need to do, but
    they're more likely to shop around and to weigh things, whether I need
    to do this or not.
        The President. Part of the issue with health savings accounts is for
    people to even understand they exist. And so you're talking to an
    owner who is on the leading edge of change.
    These are relatively new products available. And part of the reasons why
    we're discussing this is we want small-business owners and individuals
    to realize that health savings accounts are now available. And I urge
    everybody to look into the benefits of a health savings account.
        And you need to listen to Bill Lomel, who
    is with us. You are an owner of a health savings account?
        William Lomel. Right. I'm Bill Lomel. I'm
    from Atlanta----
        The President. Exactly, Lomel, just as I
    said. [Laughter] Two for two. [Laughter]
        Mr. Lomel. I have a commercial roofing
    contracting business with 25 employees and, like Pat, was faced with
    similar decisions. I mean, the monthly premium for our family coverage 2
    years ago went from 450 to 750, and then it was going up over a
    thousand. And the group kept getting smaller because people were
    dropping out of the plan. The individuals couldn't afford their portion
    of the coverage. And it was kind of an effect going on, making it----
        The President. Catch-22.
        Mr. Lomel. Yes.

    [Mr. Lomel, owner, Titan Roofing, LLC, Suwanee, GA, made further
    remarks.]

    [[Page 91]]

        The President. You getting that? It's important for people to
    understand what he's saying. He buys the high-
    deductible policy to cover major medical expenses, and the savings on
    that policy from what he was paying otherwise more than equals the zero
    to 5,000 dollars cost up until the insurance kicks in. It's his own
    money, the 5,000. He owns it. It earns interest tax-free. In other
    words, he's able to put it in an interest-bearing account. And if he or
    his three children do not spend the 5,000, whatever the balance is, it
    rolls over to the next year. And it's--and it enables, frankly, small
    businesses to stay in business and families to be able to better afford
    health care.
        You enjoying it?
        Mr. Lomel. Yes, it's great, and it's made
    providing that benefit possible again.
        The President. Yes.
        Mr. Lomel. So we're meeting with all of
    our employees to get them signed up individually on programs that I can
    kind of help facilitate.
        The President. Absolutely. Most of the working uninsured in America
    work for small businesses. And so for small-business owners out there
    who are worried about being able to pay for insurance for your
    employees--and a lot of owners are, like you were--I mean, it must be
    nerve-wracking.
        Mr. Lomel. Well, one of the key things
    that has come out of this is that when I go to the doctor, I'm
    interested in the cost. [Laughter]
        The President. Yes.
        Mr. Lomel. And I had----
        The President. That's pretty good.
        Mr. Lomel. I had a small skin cancer
    removed this year. And just--I asked.
        The President. Yes.
        Mr. Lomel. They offered me two procedures,
    and I said, ``Well, how much does this one cost and how much does that
    one cost, and what are their effectiveness?'' And they were virtually
    the same, so----
        The President. You know, it sounds simple, but it is a dynamic that
    in many cases is absent from the health care markets because if a third
    party makes that payment, he never gets to ask
    the question. He just accepts the decision. And all of a sudden when you
    have consumers starting to ask questions about cost, it is a governor on
    cost at the very minimum. And so part of--one way to make sure that
    costs don't continue to escalate is to introduce consumer demand into
    health care decisionmaking. And since HSAs enable a consumer to own
    their own account and manage their own account and make decisions for
    their account, we've introduced demand into the marketplace.
        Thank you two for sharing this. I signed up for an HSA. I'm feeling
    pretty good these days, and--[laughter]--I think I'll have some money
    left over. But recognizing that I can prevent disease, I want to
    encourage people to exercise on a regular basis, make wise choices about
    what you put in your body, be mindful of what you eat. And if you happen
    to be an HSA owner, like the three of us, you will realize--more likely
    realize savings that you can roll over tax-free and call your own.
        Hopefully, one of these days when I get to be an old guy, my HSA
    will be bulging with money--[laughter]--and I will be comfortable in the
    security of retirement because my HSA will be a part of a--you know,
    other options to provide good health care for me and my family.
        We've got Rich Parsons with us. I
    actually got it right, two for three now. What do you do, Rich?
        Richard Parsons. I run the Montgomery
    County Chamber of Commerce, which is a small nonprofit right here in
    Montgomery County, Maryland, and we represent the employer community.
        The President. Good, thanks. Welcome. I'm glad you're here. You are
    here not only to talk about the wonderful benefits of having a business
    in Montgomery County but as well to discuss----
        Mr. Parsons. Well, what we want to
    talk about is really the same issue you just

    [[Page 92]]

    heard from a consumer standpoint; it's the lack of choice. It doesn't
    affect just consumers, but small-business owners in particular and small
    nonprofits like ours. We have a very small range of choices that we can
    select from when we go to do what we all want to do, which is provide
    our employees with good coverage at good prices. We're finding our
    choices in a State like Maryland, and even though this is one of the
    leading biotech and medical innovations centers of the world today, we
    have about four policies--four companies that will even write policies
    for small businesses in the State. And we've got to expand choices, and
    that's what I wanted to talk about today.
        The President. Well, I appreciate that. That's common sense, isn't
    it? If you want there to be reasonable price, the more consumers have to
    choose in a marketplace, the more likely it is you'll be able to find
    something at the price you want. That's how the marketplace works.
    You're telling me the marketplace is somewhat restricted here.
        Mr. Parsons. Well, because of
    regulatory factors and just the way the marketplace has turned out here
    in Maryland, we are not allowed by State law to do what some States are
    allowed to do, which is to offer association health plans, where my----
        The President. Right. Describe what an association health plan is,
    please.

    [Mr. Parsons, president and chief executive officer, Montgomery County
    Chamber of Commerce, Derwood, MD, made further remarks.]

        The President. Right. An association health plan will allow people
    to pool risk. That's what we're saying. And I happen to think that we
    ought to allow small businesses to pool risk across State boundaries. In
    other words, I think a restauranteur in Maryland ought to be able to
    combine in the same insurance plan as a restauranteur in Texas. I think
    we ought to be focusing on the social objective of making sure our
    small-business owners can find affordable health care so that fewer
    people are working uninsured, rather than jealously guarding
    jurisdictional lines for whatever reason.
        And so I look forward to working with Congress to get an association
    health plan out--bill out that will allow for pooling of risk for small-
    business owners across jurisdictional boundaries. And nonprofits, by the
    way, should be allowed to pool risk as well.
        Have you heard of health savings accounts, in the meantime? I mean,
    these are really great. [Laughter]
        Mr. Parsons. I learned about them at
    this event. I'm going to look into it.
        The President. You seriously ought to look into them. [Laughter]
        But Congress needs to understand that on the one hand, you cannot
    complain about people who don't have insurance and you work for a small
    business and then not allow small businesses to be able to have the
    opportunities in the marketplace, the same opportunities afforded
    companies with large pools, large employee bases. You've got to give
    them the opportunity to be able to shop.
        And so association health plans make a lot of sense. I want to thank
    you for sharing that with us, Rich.
        Mr. Parsons. Well, thank you. We need
    the help in Congress.
        The President. I agree. That's what we're here to do. We're here to
    remind Congress about the benefits.
        Jesse Patton.
        Jesse Patton. Correct. [Laughter]
        The President. Got that right.
        Mr. Patton. Just like the general.
        The President. Yes, sir. [Laughter] The founder and president of----
        Mr. Patton. Associations Marketing Group
    in Des Moines, Iowa. We're actually an insurance agency that specializes
    in the sale and service of both individual and group health insurance
    plans. And we do business in 42 States, so we work with individuals not
    only in Iowa but across all of the United States.

    [[Page 93]]

        The President. And Jesse wants to talk
    about an idea that I broached early on, and that is to allow consumers
    to shop.

    [Mr. Patton made further remarks, concluding as follows.]

        Mr. Patton. The nice thing about this
    proposal is that people would be able to go across State lines, but they
    would still have the safety feature of having their products still
    regulated by insurance division, insurance commissioner.
        The President. That's an important point. Sorry to interrupt you.
    You were on a roll. [Laughter]
        Mr. Patton. Go ahead, you're the
    President.
        The President. Thank you.
        Mr. Patton. I'm just the general.
    [Laughter]
        The President. So you're a--you heard Bill
    talk about--he got on the Internet. He was trying to find more
    information. He was worried about finding a product that he could use.
    Imagine someone living in Maryland getting on the Internet and being
    able to shop nationwide for an insurance plan that meets his or her
    specific needs--basically what you're saying.
        Mr. Patton. Correct. If you look at an
    example that we did for your staff of a 35-year-old individual with a
    35-year-old spouse and two children on a $500 deductible, premiums from
    the various States--my home State of Iowa, that premium actually comes
    in at $430. Other States that we looked at, those premiums are at 1,500,
    1,200, $1,609. So they're up to a thousand dollars difference in that
    individual rate for the same product, same insurance carrier, just based
    on the State that you reside in.
        The President. And so, perhaps, one way to encourage reform at the
    State level is to allow consumers to actually make choices. And the more
    consumers that buy a product in a certain State may cause other States
    to have the incentive necessary to change the regulatory burden so that
    products can be delivered at a less expensive price in their own State.
        But the real question people have is, ``Well, how do I know I'm not
    getting cheated?'' In other words, it's one thing to open up additional
    consumer price. But how do you know it's not a fly-by-night or a
    shyster? We caught a guy the other day
    flimflamming people on the tsunami relief effort. There was a lot of
    innocent folks who think they're making a contribution, in this case, to
    help somebody's life, and it turns out he was a--the FBI found out that
    he was a flimflam artist. How do we make sure that the innocent consumer
    is not buying a product from a company that doesn't have the capital
    base necessary to provide insurance, for example?
        Mr. Patton. Correct, and there's
    actually a couple safety features here. I, as an insurance agent, am
    licensed and able to do business based on a license I hold by the
    insurance division of the State that I operate in. I must also get a
    nonresident license in another State that I plan to sell business. So
    I'm actually regulated--if I would sell a product here in Maryland, I'm
    actually regulated by the insurance division in Maryland under my
    insurance license here, plus I'm also regulated by the insurance
    division in Iowa, which is my home base. And then, again, you would have
    the insurance commissioner's office also regulating the carrier and the
    product.
        The President. Right. So in other words, if you're a Texan buying
    into Iowa, and you feel like you've been cheated, there would be a
    complaint mechanism----
        Mr. Patton. Correct.
        The President. ----and the State would, therefore, make the
    decisions as to whether or not the--on the capital-worthiness of a
    particular entity offering insurance in that State.
        Mr. Patton. Correct. You would actually
    have two safety features, your home State and your State that you were
    buying your insurance from.

    [[Page 94]]

        The President. Right. I think it's an interesting idea. I think the
    more we give choice to consumers and the more consumers are allowed to
    be in the marketplace designing and shopping for product that meets
    their needs, the more likely it is we'll be able to control costs and
    make the marketplace work. It works in other industry, and I think we
    need to bring--I know we need to bring market forces into the health
    care field.
        For those of you who live in Maryland, by the way, you're fortunate
    to have a Governor who understands
    all this. I appreciate your efforts, by the way, on medical liability
    reform, addressing the cost. And we look forward to working with you,
    Governor, and other Governors as well to do the best we can to make this
    system work on behalf of consumers in the health care field.
        Finally, we've got Tammi Fleming with us,
    from the great city of New Orleans, Louisiana. Isn't that right?
        Tammi Fleming. Yes, you got that right.
    [Laughter]
        The President. Tammi runs an interesting
    program. Why don't you describe your program, Tammi.

    [Ms. Fleming, program manager, Health Care for All, New Orleans, LA,
    made brief remarks.]

        The President. The point is, is that we have programs aimed at
    helping people who need help, basically is what you're saying. And one
    such program is SCHIP--that's the Children's Health Care Insurance
    Program. And it's not fully subscribed. In other words, we had the money
    available, and States did not access the money to help children with
    good health care.

    [Ms. Fleming made further remarks.]

        The President. The reason we've asked Tammi to come is because it's very important for States to
    develop effective outreach programs. At the Federal level, we're willing
    to help fund outreach programs. We think it's important for people
    who've qualified for the SCHIP program to know that that program is
    available without stigma. And it is an effective way to provide our
    children with the insurance we want our children to have.
        And so what Tammi is saying is, she's
    pointing up the fact that we need a grassroots effort across the country
    to enable people to know what is available for the Children's Health
    Care Program.

    [Ms. Fleming made further remarks.]

        The President. Well, I appreciate what you're doing. Walkers and
    talkers. That's good. Good job.
        Well, listen, I want to thank you all for joining the discussion.
    The solution is one that--the solution to health care costs is one that
    requires a myriad of approaches, as opposed to a single Federal
    Government approach. I believe the more we empower people to make
    decisions, the better off we are in terms of achieving a national
    objective, which is affordable health care that's available. And I want
    to thank you all for sharing with people innovative ideas.
        I'm pleased to inform you that Dr. Condi Rice has just been confirmed by the United States
    Senate. She will be a great Secretary of State for the United States of
    America. I'm honored to be working with her, and I look forward to
    spreading freedom and peace.
        Thank you all for coming. May God bless you all.

    Note: The President spoke at 11:49 a.m. at the National Institutes of
    Health. In his remarks, he referred to Gov. Robert L. Ehrlich, Jr., of
    Maryland and his wife, Kendel; President Mahmoud Abbas (Abu Mazen) of
    the Palestinian Authority; and President Viktor Yushchenko of Ukraine.

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