    [Public Papers of the Presidents of the United States: George W. Bush (2005, Book I)]
    [January 27, 2005]
    [Pages 99-106]
    [From the U.S. Government Publishing Office www.gpo.gov]

    Remarks in a Discussion on Health Care Information Technology in
    Cleveland, Ohio
    January 27, 2005

        The President. Thank you, Leavitt.
    Thank you, Mike. No, thank you all. Thanks for coming. No, please be
    seated. Thank you. Thanks for the warm reception. It's great to be here
    at one of the Nation's finest medical complexes. I want to thank you for
    giving us a chance to come by and talk about how to make sure health
    care is available and affordable for our fellow citizens.
        I am honored Mike Leavitt has agreed
    to serve our country. He's been in the job 15 hours, and he hasn't made
    any mistakes yet. [Laughter] But he is going to do a great job. He was a
    former Governor from the great State of Utah. He understands the need
    for the Federal Government to relate effectively with State governments.
    The HHS is a complex organization with a lot of tasks. It requires good
    management skill in order to be an effective Secretary. I am confident
    that Mike has got the skill set and the vision necessary to do the job.
        And so, Mr. Secretary, welcome to the
    job. I'm looking forward to working with you. I know a lot of docs are
    too. And you'll do fine. Fifteen hours and no errors is a good start.
        I want to thank Toby Cosgrove, the doc, the CEO and chairman of this fantastic
    facility, for welcoming us here. I'm honored, Doc, that you put up with
    the entourage and let us come and visit with the good folks here in the
    Cleveland area.
        I appreciate the docs who showed me the fantastic technologies that
    are now in place in this hospital. That's part of what we're going to
    discuss today. As you can see, I've asked some people who know what
    they're talking about to come and share the great excitement of
    information technology and how it can help change medicine and save
    money and save lives and, most importantly, make our fellow citizens--
    make available to our fellow citizens a health care system that is
    responsive to their needs.
        And so thank you all for coming. I think you're going to find this
    pretty interesting. I know I'm going to.
        I want to thank the Governor of the great State of Ohio for joining
    us. The last time I saw Taft, he was dancing on the
    stage at an Inaugural ceremony. [Laughter] He's about a lousy a dancer
    as I am. [Laughter]

    [[Page 100]]

        I want to thank two Members of the Congress who traveled with me
    today on Air Force One, Ralph Regula, who is a fine Member of the House
    of Representatives, as well as--thank you for coming, Ralph--as well as Congressman Steve
    LaTourette. We appreciate you coming,
    Steve. You over there? Yes, he's still there. I was going to say, if he
    skipped the deal, he wasn't going to get a ride back. [Laughter]
        I want to thank all the docs who are here. I want to thank all the
    people who--nurses who are here and the staff members who are here. I
    want to thank you for your compassion, and I want to thank you for
    lending your enormous skills and talents to saving lives. It's--we've
    got the greatest medical system in the world, and the role of the
    Federal Government is to do what is necessary to keep it that way. And I
    believe that the reason why we're so good is not only because we're
    great at research, but our people are so compassionate and decent and
    care about their patients.
        I want to talk--by the way, I met a guy named T.J. Powell. Where are you, T.J.? There you go. T.J. was at Air Force
    One. The reason I like to mention somebody like T.J. is because he
    volunteers a thousand hours per year in helping people as a member of
    the Ohio Medical Reserve Corps. In other words, he lends his talent and
    time to help people have a better life. In my State of the Union, I'm
    going to talk about the strengths of our country, the economy and our
    military--and we intend to keep it strong to keep the peace. But the
    true strength is the fact that we've got citizens from all walks of life
    who are willing to volunteer a thousand hours a year to make somebody's
    life better. I thank you for the example you've set, T.J. I appreciate
    you coming.
        So the fundamental question facing the country is, can we have a
    health care system that is available and affordable without the Federal
    Government running it? I mean, it really is a philosophical challenge.
    There's good, well-meaning folks who believe that the best health care
    system is one where Washington, DC, makes the decisions. I happen to
    believe the best health care system is one where the consumers, the
    patients, make the decisions.
        And so here are some practical ways for us to deal with the rising
    costs in health care. One is to make sure that people who can't afford
    health care have got health care available to them in a commonsense way.
    And that's why I'm such a big backer of expanding community health
    centers to every poor county in America. We really want people who
    cannot afford health care, the poor and the indigent, to be able to get
    good primary care at one of these community health centers and not in
    the emergency rooms of the hospitals across the United States of
    America.
        The best way for a compassionate society to help make sure there is
    a health care safety net is to expand these community centers, which are
    working. I mean, this is something--we say, ``Are you going to fund
    programs that get results?'' And the answer is: You bet. And these
    community health centers get great results. And so I'm looking forward
    to calling upon Congress to expand them to every poor county in the
    country.
        Secondly, we have made clear our commitment to our Nation's seniors
    that we'll have a Medicare system that is modern. I can remember
    traveling the country explaining to people that Medicare would pay for
    thousands of dollars for a heart surgery--$100,000 for a heart surgery,
    say, but not one dime for the prescription drugs that would prevent the
    heart surgery from being needed in the first place. That didn't seem a
    very effective use of taxpayers' money to me, and it certainly said that
    the Medicare system wasn't modern.
        So I called upon Congress, and Congress acted, and I signed a bill
    that makes the Medicare system more modern to meet the needs of our
    seniors. Inherent in the reforms in that bill is giving seniors more

    [[Page 101]]

    options and more choices to choose from, which is a philosophy that I
    think you'll hear as we discuss what is available to help control costs.
    In other words, the more choices people have in health care, the more
    likely it is that costs will be under control.
        Let me give you an interesting idea that I think small-business
    owners need to look at, and those are called health savings accounts--or
    individuals need to look at it, or families need to look at health
    savings accounts. A health savings account is basically a plan that says
    you buy a high-deductible catastrophic plan--in other words, you cover
    your first $2,000 of medical expenses, and then the insurance kicks in
    after that--and that to cover the medical--routine medical expenses up
    to $2,000, your business contributes tax-free into the plan, which is--
    and if you don't spend the 2,000--in other words, if you make right
    choices about how you live and what you put into your body; in other
    words, if you prevent disease by exercising on a daily basis, and
    there's money not spent in the account--you can roll it over from one
    year to the next tax-free. And as you withdraw the money, you can do so
    tax-free.
        Now, the cost of the insurance for the high-deductible catastrophic
    plan is incredibly less expensive than the normal third-party payer
    system. And the savings on premiums from that plan more than covers the
    incidental costs necessary until you get up to the deductible. That's a
    complicated way of saying, this works.
        And I ask small-business owners to take a look at health savings
    accounts. Most of the working uninsured work for small-business owners,
    who are getting squeezed by the high cost of medicine. This is a way to
    be able to afford health care for your employees and, at the same time,
    put your employees in charge of the decisionmaking when it comes to
    health care.
        One of the issues, in terms of the cost of health care, is the fact
    that many people have their health care decisions made by third-party
    payers. So, in other words, they're not really involved with the
    expenses and the expenditure of money. You show up, and the insurance
    company covers your costs. But you don't know what the costs are, and
    you're not involved in the decisionmaking. Health savings accounts,
    which will make life more affordable for employer and employee, really
    puts somebody in charge of the decisionmaking, and that in itself is
    part of how you control costs. If you're out there shopping for a better
    deal, it helps bring cost efficiencies into a system that needs cost
    efficiencies.
        Another way to help people afford health care, particularly small
    businesses, is to allow small businesses to pool risk. Right now, if
    you're a restaurant in Ohio and a restaurant in Texas, you have to buy
    your insurance only within Ohio or only within Texas. I believe
    restaurants ought to be able to pool across jurisdictional boundaries so
    they can buy insurance at the same discount that big companies get to
    do. In other words, the more people you have in the--in your pool of
    people to insure, the less expensive insurance becomes. It makes sense,
    doesn't it? But the law prevents people from doing that now. So here are
    some practical ways to help with the cost of medicine.
        Another practical way--and I want to thank the FDA for having
    responded to our call--is to get generic drugs to the market faster.
    Brandname drugs are protected by patent for a period of time to allow
    pharmaceutical companies to recoup their research and development. That
    makes sense, but what doesn't make sense is the company's ability to
    delay the arrival of generic drugs. They do the exact same thing
    brandname drugs do, but they're far less expensive. And so, by speeding
    generic drugs to the market, we'll make pharmaceuticals more affordable
    to our seniors and take the pressure off our State budgets, which we are
    now in the process of doing.
        But we're here to talk about another way to save health--save costs
    in health care,

    [[Page 102]]

    and that's information technology. Now look, most industries in America
    have used information technology to make their businesses more cost-
    effective, more efficient, and more productive, and the truth of the
    matter is, health care hasn't. I mean, health care has been fantastic in
    terms of technological change. I mean, you see these machines in these
    hospitals--compared to what life was like 10 years ago, things have
    changed dramatically.
        And health care has got--we've got fantastic new pharmaceuticals
    that help save lives, but we've got docs still writing records by hand.
    And most docs can't write very well anyway, so--[laughter]. Can you?
    [Laughter]
        And so the fundamental question is, how do we encourage information
    technology in a field like health care that will save lives, make
    patients more involved in decisionmaking, and save money for American
    people. That's what we're here to talk about.
        And I've asked Dr. David Brailer to
    join us. When we started the process of encouraging information
    technology to spread throughout health care and setting the goal that
    there ought to be--every patient--every American ought to have a
    medical--electronic medical record within I think 7 years--7 years or 10
    years?
        David Brailer. Ten years.
        The President. Ten years--yes, 10. I asked David--or I didn't ask David--Secretary Tommy
    Thompson asked David and told me he asked
    David to be in charge of the Federal effort to do what is necessary to
    reduce the obstacles and roadblocks to get electronic medical records
    into the hands of every citizen.
        So I've asked David to join us to kind of help explain what I'm
    desperately trying to explain to you--[laughter]--in English--and so
    that people understand why information technology can advantage our
    society.
        Why don't you start, David?

    [At this point, Dr. Brailer, National Health Information Technology
    Coordinator, Department of Health and Human Services, made brief
    remarks.]

        The President. Yes, if you're in Florida--living in Ohio and you
    have to go down to Florida--my brother is the Governor, so I'm putting a plug there. [Laughter] But you go to
    Florida, you get in an automobile accident, an electronic medical record
    means your data to the doc in the emergency room is transmitted just
    like that, as opposed to calling somebody, getting them out of bed,
    could you please go find so-and-so's file, read somebody's file, and
    transmit the information. I mean, you can imagine, a speedy response to
    an emergency saves lives.
        Go ahead, sorry. I just wanted to put a plug in there.
        Dr. Brailer. It's okay, sir. [Laughter]

    [Dr. Brailer made further remarks.]

        The President. Well, thank you, sir. David, thanks. He's outlined kind of a national vision, a
    national strategy--which is being implemented from the ground up, by the
    way, not the top down. That's why we're here at the hospital, because
    they've implemented really interesting information technology here.
        Let me just say one thing before we get to some docs who are on the
    frontline of change. One of the things we have to do in this society is
    to have a judicial system that's fair and balanced. And I couldn't help
    but think of these good folks who are practicing medicine and realizing
    that too many of their fellow citizens are leaving the practice of
    medicine because of junk lawsuits. This society needs to have balanced
    and fair law. And it is important for Members of Congress, Members of
    the United States Senate, to know that a unbalanced legal system, a
    system where the law is like a lottery when it comes to suing people in
    medicine, is driving good people out of practice. We need medical
    liability reform--now.

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        Anyway--Martin Harris. Martin, what do
    you do? Dr. Martin Harris--excuse me.
        C. Martin Harris. I am a general
    internist, but I'm also the chief information officer for the Cleveland
    Clinic Foundation.
        The President. That's pretty good. [Laughter]
        Dr. Harris. It's a good combination;
    keeps me up.
        The President. That's strong--[laughter]--a man of many talents.

    [Dr. Harris made brief remarks.]

        The President. You're doing good. Keep going. [Laughter]
        Dr. Harris. All right. I do have one
    more. And I will point out to you that everything I'm talking about will
    be in place in Florida by July this year. [Laughter]
        The President. Let me ask you something. I know you've got one more.
    I don't want to--I'm just sitting here thinking about, I'm sure people
    are out there saying, ``I don't want my medical records floating around
    ether, so somebody can pick them up.'' I presume I'm like most
    Americans; I think my medical records should be private. I don't want
    people prying into them. I don't want people looking at them. I don't
    want people opening them up unless I say it's fine for you to do so.
    Explain how you----
        Dr. Harris. Absolutely. So that is
    true, and it's true whether it's in electronic form or whether it's a
    piece of paper. We want to know that the record is secure and that it
    remains confidential. But information technology actually works
    perfectly to document that. If you left a medical record on paper in a
    room, how will you know who saw it? You can't know. When it's in
    electronic form, when anyone logs on to the system, we know. We know who
    they are. We know where they are. We know what they were looking at. And
    we can keep logs of all that information so that we can confirm for our
    patients that their information is secure.
        The President. One more?

    [Dr. Harris made further remarks.]

        The President. See, what he's saying
    there is that these networks are beginning to grow, from the Cleveland
    Center out, and the fundamental question is, can the Cleveland Center's
    network talk to somebody else's network so that you can exchange
    information? It's one thing to have information on a regional basis; we
    need to have it on a national basis so that information flows across our
    country. And that's what the interoperability means.
        Listen, you did a fabulous job.
        Dr. Harris. Thank you.
        The President. Really good job.
        Dr. Bob Juhasz. Dr. Juhasz, thank you
    for being here. What kind of doctor are you--besides a good one?
    [Laughter]
        Robert S. Juhasz. I am a primary care/
    internal medicine physician.

    [Dr. Juhasz, internist, The Cleveland Clinic, Concord Township, OH, made
    brief remarks, concluding as follows.]

        Dr. Juhasz. And with the MyChart, it
    allows me to look at that laboratory information, be able to put a
    secure message to that patient about their laboratory data, and it sends
    them a secure message to say that you have something to look at in your
    MyChart site. They log on in a secure way to that site, and they're able
    to actually review their laboratory work, anything that they've had done
    previously, as well as my notes. They're also able, if they need to ask
    for a prescription refill or if they need to get a future appointment,
    they can do that. And for patients like Patty, that----
        The President. Is Patty your patient?
        Dr. Juhasz. Yes, she is.
        Patricia McGinley. I'm the patient.
        The President. Sometimes when we leave the doctor's office, we're
    wondering when you're going to get new magazine subscriptions.
    [Laughter] Anyway----
        Dr. Juhasz. I try to make sure those
    are updated. [Laughter]

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        The President. Patty. Bob is your doctor?
        Ms. McGinley. Yes, he is. He has been
    for 6 years.
        The President. Looks like a fine man.
        Ms. McGinley. He's a wonderful
    physician.
        The President. By the way, before we get to Patty, just think how many Bobs there are in the world who
    have--who will go from writing and wondering and picking up files to an
    efficient system. And when that's--what he
    just described, the efficiency he just described means he's saving time
    and, therefore, money for the patients. And when you multiply the
    efficiencies to be gained all across the spectrum, whether it be
    individual docs or hospitals or networks, that's why some predict that
    you can save 20 percent off the cost of health care as a result of the
    advent of information technology.
        Patty.
        Ms. McGinley. Yes, Mr. President.
        The President. Welcome. I'm glad you're here. Thank you for coming.
        Ms. McGinley. Thank you for having me.
        The President. You look healthy to me, but I'm not a doctor.
    [Laughter]

    [Ms. McGinley made further remarks.]

        The President. You did a great job. I think one of the things that's
    interesting--what struck me about Patty's conversation was--is that--how
    liberated she feels through information and that I'm sure a lot of
    patients--and you probably can testify to this--are pretty nervous about
    dealing with doctors and the words and the diseases and all that stuff.
    And all of the sudden, the more educated you become, the more
    comfortable you become, not only about figuring out what's wrong but,
    more importantly, figuring out how to cure the problem.
        And one of the--listen, information is a liberating tool. And it's
    liberating for a lot of parts of life, including health care. So thank
    you for sharing that.
        Ms. McGinley. You're welcome.
        The President. Jorge del Castillo.
    See. I'm Jorge, too. [Laughter]
        Jorge del Castillo. It's a good name.
        The President. That means George. [Laughter] He's Jorge D., I'm Jorge W. [Laughter] Anyway--so where do
    you work?

    [Dr. del Castillo, associate chief of emergency medicine, Evanston
    Northwestern Healthcare, Evanston, IL, made brief remarks.]

        The President. How long has--have these medical records been
    available in your situation?
        Dr. del Castillo. We deployed--we
    started in March of 2003. This March it will be 2 years. Interestingly
    enough, most of our physicians went into the electronic medical records
    kicking and screaming, and now they can't live without it. It is--the
    system went down the other day for about 2 hours, and there were just
    complaints and cries of help and so on because you just cannot live
    without it. It is just one of the best things that can happen to the
    medical field.
        The President. Yes, you see it's interesting, isn't it? I mean,
    they've only been in--have had this technology for 2 years. I mean,
    we're talking the beginning of, and--of a development in health care
    that is going to be lifesaving and costsaving and changing for the
    better. And that's what's so exciting about it. And I appreciate you
    sharing that with us.
        Dr. del Castillo. My pleasure, sir.
        The President. We've got one other doc here to talk to, Barth
    Doroshuk. Barth, where do you live?
        Barth Doroshuk. I'm from Bethesda,
    Maryland, Mr. President.
        The President. Right, yes, yes.
        Mr. Doroshuk. Right next door to you.
        The President. Within spitting distance of the Capital. [Laughter]
        Mr. Doroshuk. Exactly.
        The President. Give us a sense about you--actually, I'll introduce
    Barth. Barth is

    [[Page 105]]

    a--I wouldn't call you sole practitioner, but close to it.
        Mr. Doroshuk. We have a very--we have a
    small practice in Washington, DC, and in Maryland. The Washington ENT
    Group provides ear, nose, and throat medicine and head and neck surgery
    to the regional area of the metropolitan DC area.
        The President. And how many docs?
        Mr. Doroshuk. And we have six doctors.
        The President. So it's a relatively small practice.
        Mr. Doroshuk. Small compared to the
    testimonies we've heard this morning already--four audiologists and a
    radiology technician because we do some X rays. And when we went into
    electronic medical records back in 2000, we were looking at starting the
    practice up, and we had a choice: Do we do it the way we've always done
    it, or do we move ahead? Is there technology that's there? Is it
    reliable enough? And is the investment safe? And lo and behold, we
    decided to go ahead and implement a fully digital medical office, and we
    haven't looked back.
        The President. Which, by the way, has got to be a pretty serious
    decision for a very small doctors' office. In other words, there's a lot
    of doctors out there saying, ``I don't think I need this, and the cost-
    benefit ratio certainly doesn't justify me, the sole practitioner, or me
    operating with three or four other docs.''

    [Mr. Doroshuk, president and chief operating officer, Washington ENT
    Group, Bethesda, MD, made further remarks.]

        The President. Is the cost-benefit--I mean, is it clear to you now
    that----
        Mr. Doroshuk. It's very clear to us, very
    clear to us. When we opened up our second office, it was not even a
    factor.
        The President. So in other words, it kind of defies the notion that
    there has to be economies of scale in order to benefit from IT--in other
    words, big hospitals with a lot of docs will benefit, but little docs
    won't be able to afford the costs. And it's very important for docs who
    are listening to this to understand that the cost-benefit is noticeable
    and real, and not only that, you're expanding as opposed to going out of
    business.

    [Mr. Doroshuk made further remarks.]

        The President. The role of the--thank you. Good job. The role of the
    Federal Government is to not only set the strategy but to spend grant
    money to encourage the development of regional hubs and to really get
    the process started. There will be a certain momentum that will be
    achieved once the cost-benefit becomes aware to everybody that's a
    practitioner. But the Government's role is to help best practices get
    started. We've sent out two Federal grants from HHS totaling $3 million
    to Cleveland Clinic to help spur and spawn this fantastic technological
    development.
        And one of the things that I'm excited about is that we're just
    beginning to learn about the great potential of information technology.
    And I think what you're witnessing is a dialog about--on a subject that
    is going to change our lives for the better, and that's why I'm excited
    about it.
        I thank our panelists for being here, for sharing your knowledge,
    your firsthand knowledge about what is possible, what's taking place.
    Imagine what the world is going to be like 10 years from now. I mean,
    what we're hearing today is just the beginning of substantial change,
    all aimed at improving people's lives and making sure that health care
    is as affordable as it can possibly be for every citizen.
        I hope you've enjoyed this as much as I have. I have found it to be
    incredibly informative, and I want to thank our panelists once again for
    sharing their wisdom and knowledge.
        God bless.

    Note: The President spoke at 11:30 a.m. at the Cleveland Clinic
    InterContinental Suite Hotel. In his remarks, he referred to Toby

    [[Page 106]]

    Cosgrove, chairman and chief executive officer, The Cleveland Clinic;
    and Gov. Bob Taft of Ohio.