    [Public Papers of the Presidents of the United States: George W. Bush (2005, Book I)]
    [January 5, 2005]
    [Pages 8-15]
    [From the U.S. Government Publishing Office www.gpo.gov]

    Remarks Following a Discussion on Medical Liability Reform in
    Collinsville, Illinois
    January 5, 2005

        The President. Thank you all. Please be seated. Thanks for coming
    out to say hello. It's great to be in southern Illinois. I appreciate
    the chance to come to Madison County. I'm honored to be the first
    sitting President to visit the city of Collinsville. I'm sorry
    Laura is not with me.
        Audience members. Aw-w-w! [Laughter]
        The President. That is generally the reaction. [Laughter] I was
    hoping she and I could go look at the Catsup
    Bottle. [Laughter]
        Thanks for waiting on me. I had a visit with some of the--some folks
    from the area here, a neurosurgeon, a cardiologist, the administrator of
    a hospital, ob-gyn, a patient, all about the health care crisis that
    exists here in this part of the world. And that's what I'm here to talk
    about. I'm here to talk about how we need to fix a broken medical
    liability system.
        I want to thank all the good folks who provide health care for the
    folks in this part of the world, the nurses, the docs, the
    administrators. Thank you all for coming. Thanks for your compassion.
    Thanks for your care. Thanks for taking an active interest in an
    important issue that faces not only this part of the world but the
    country. But really what I'm here to do is to make--say as clearly as I
    can, the United States Congress needs to pass real medical liability
    reform this year.
        And there's no doubt in my mind we have a strong ally in this issue
    in the great Speaker of the House of Representatives from the great
    State of Illinois, Denny Hastert.
        And I want to thank Congressman John Shimkus for his leadership not only on this issue but on other
    issues. It's good to be with his wife, Karen,
    again, sons, David, Joshua, and Daniel. Nice to see you
    boys. And you brought Mom and Dad. Your mom is probably telling you what
    to do, just like mine is. [Laughter] You're probably listening about
    half the time, just like I am. [Laughter] Welcome.
        I'm also proud to be traveling today with a great Congressman from
    Peoria, Illinois, Ray LaHood. Thank you, sir.
    Appreciate you coming.
        The State Treasurer of Illinois has joined us, Judy Baar
    Topinka. Appreciate you. Tom Cross is here. He's the minority leader in the house. I'll tell
    you what he's doing in the house of representatives for the State of
    Illinois: He is leading the medical liability reform effort. And I want
    to thank you, Tom, for taking a strong role. Appreciate you coming.
        I know the mayor is here. Mr. Mayor--yes, he's here, Stan
    Schaeffer. I appreciate you coming, Mr.
    Mayor. Appreciate you being here. I usually like to give mayors
    unsolicited advice: Fill the potholes. [Laughter] You've probably got
    some advice for me: Pass the highway bill. [Laughter]
        I want to thank those of you who are working on this medical
    liability issue here in the State of Illinois. I appreciate your
    efforts. Look, it's about time the medical profession gets involved.
    It's about time you let people know what's on your mind. It's time to
    make sure that the issue comes to the forefront not only at the Federal
    level but at the local level as well.
        I want to thank Connie Bergmann. I met
    Connie. She came out to the airport--airbase, and--kind of airbase-
    airport combo, I guess it is. She is a volunteer for the American Red
    Cross. The reason I bring her up is, every stop I make in America I like
    to herald a citizen who's taken time out of his or her life to volunteer
    to make the country a better place. See, the great strength of America
    is not our military

    [[Page 9]]

    might, and it's certainly not the size of our wallets. The great
    strength of America lies in the hearts and souls of our fellow citizens,
    people who are willing to love a neighbor just like they'd like to be
    loved themselves, people who are willing to take time to volunteer to
    make America a better place. And Connie Bergmann is such a person. And I
    want to thank you for serving the Red Cross.
        And speaking about the Red Cross, the International Red Cross is
    doing heroic work in a part of the world that has suffered incredible,
    incredible death and destruction. The American people express our
    sympathy to the victims of the tsunami disasters.
        Yesterday I spoke to Secretary of State Colin Powell and Governor Jeb Bush of Florida, who
    I sent on a delegation--with a delegation to assess the relief
    operations. And they reported in that the devastation is beyond
    comprehension. They also reported in that they will come back with an
    assessment about how we can more effectively help. But they also
    reported that our military is doing heroic work in helping to save life.
    They're flying rescue missions 24 hours a day. They're making a huge
    difference in the people's lives over there by delivering supplies
    directly to those in need. Our Government has not only stepped up with
    the use of military assets, but we have pledged $350 million in disaster
    assistance to help the people over there who are suffering.
        There's huge generosity here in America as well. As you know, I
    tapped a couple of ex-Presidents--[laughter]--number 41 and number 42,
    to help out. I asked them to help, and they are. My dad and President Clinton
    have graciously given of their time to help make sure that people know
    there is a need and to make sure the
    donations are properly channeled into
    programs that work. If you want to help, get on the Internet for the
    USA--www.usafreedomcorps.gov. There's a place to help. And on that web
    page, you'll find different agencies which are doing the good work.
        What I don't want is, I don't want people to be sending money to
    places that aren't really doing the job. We don't need to support
    organizations that aren't effectively delivering compassion and help.
    And so on this web page, you'll find a way to help, if you so desire to
    do so. What they tell me is, the most important contribution a person
    can give is cash, and let the agencies on the ground be able to use that
    cash to best meet the needs of those who have suffered.
        I want to thank all the Americans who thus far have been
    participating in this urgent cause. You're showing the true strength of
    America through your good heart.
        I don't know if you know this: This is my first trip after the New
    Year. And it's good to come here to Illinois. I'm rested and ready to
    continue to serve to be your--to continue to be your President and to
    serve the people of this country. And we've got a big agenda item--a big
    agenda and a series of items that we'll be dealing with.
        First of all, we're going to win the war on terror. We've still got
    to--we will be steadfast. We will be resolved. We'll be wise. We won't
    give in to these people. We have a duty in your Government to protect
    the American people. So the second big task at hand is to make sure we
    do everything we can to protect our homeland. And I will assure you I
    will continue to work to spread freedom and democracy and, therefore,
    peace in parts of the world that are desperate for freedom, democracy,
    and peace.
        We're going to work with the Congress to be wise about how we spend
    your money. We're going to keep your taxes low so this economy continues
    to grow. We're going to continue to work with our farmers and ranchers
    to make sure they can sell the products overseas, in markets where
    people need food and beef and pork. We're going to work to pass a
    national energy

    [[Page 10]]

    plan. We're going to work to cut our deficit in half over the next 5
    years.
        And I look forward to working with members of both political parties
    to do something about our health care system. First, it is important for
    Americans to understand we have the best health care system in the
    world. And we need to keep it that way. We've got the best hospitals,
    both urban and rural. We've got the world's most talented and
    compassionate doctors and nurses. And we've got the world's--and we lead
    the world in innovative research. We're on the cutting edge of change.
    We're saving lives through our research. Americans should be proud of
    our medical system, and we all must be grateful for those who work hard
    to provide compassion and care.
        Our health care system faces serious challenges. We all know that.
    The cost of health care is rising rapidly, and that burdens our
    families. It hurts our small businesses. It makes it harder for the job
    creators to expand the job base. Too many Americans are left struggling
    to find affordable health care. And so I think we need to take practical
    steps to make sure this health care system of ours is more affordable
    and available, and we've got to take those steps this year.
        To improve health care in America, we need to expand the use of
    health savings accounts. It's a product that lets you save tax-free for
    routine medical care while keeping affordable coverage against major
    illness. Small businesses must be allowed to join together, to pool risk
    so they can buy insurance for their employees at the same discounts that
    big businesses are able to do.
        To address the cost of medical care, we need to apply 21st century
    information technology to the health care field. We need to have our
    medical records put on the IT. We need to make sure that we speed up the
    delivery and arrival of cheaper generic drugs to help control costs. We
    want to make sure our Medicare system still allows seniors to have
    choice in the system.
        There's a lot we can do. We've got to make sure we expand community
    health centers around our country to provide care for the poor and the
    indigent. And we've got to make sure low-income children are enrolled in
    government health care programs so they receive the care they need.
    These are practical steps to help people be able to find health care at
    affordable prices and, at the same time, make sure the health care
    system is not run by the Federal Government but by patients and doctors.
        To make sure our health care system works the way we want it to
    work, we've got to address the root causes of rising medical costs. Part
    of addressing those costs can be achieved by introducing information
    technology. Part of addressing those costs can be achieved by
    introducing generic drugs faster, just like I mentioned.
        Some of the cost increases in our health care system are necessary
    and worthwhile. After all, research into new treatments requires major
    investments. World-class medical technology is expensive. In other
    words, to stay on the leading edge of medicine, it costs money. And I
    suspect somebody whose life has been saved by the latest technology is
    going to say that cost increase was necessary. But some costs are not
    necessary. And that's what the American people must understand and
    Members of the United States Senate and the United States House must
    understand.
        Many of the costs that we're talking about don't start in an
    examining room or an operating room; they start in a courtroom. What's
    happening all across this country is that lawyers are filing baseless
    suits against hospitals and doctors. That's just a plain fact. And
    they're doing it for a simple reason: They know the medical liability
    system is tilted in their favor. Jury awards in medical liability cases
    have skyrocketed in recent years. That means every claim filed by a
    personal-injury lawyer

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    brings the chance of a huge payoff or a profitable settlement out of
    court. That's what that means. Doctors and hospitals realize this. They
    know it's expensive to fight a lawsuit, even if it doesn't have any
    merit. And because the system is so unpredictable, there is a constant
    risk of being hit by a massive jury award. So doctors end up paying tens
    of thousands or even hundreds of thousands of dollars to settle claims
    out of court, even when they know they have done nothing wrong.
        That's what's happening in the system today. It's a system that's
    just not fair. It's costly for the doctors. It's costly for small
    businesses. It's costly for hospitals. It is really costly for patients.
        When those providing insurance have to pay the bills for enormous
    jury verdicts or out-of-court settlements, they have to raise premiums
    on physicians they cover. Specialists in high-risk practices like ob-gyn
    or neurosurgery are particularly vulnerable to lawsuits, so their
    premiums rise the fastest. You're about to hear a couple of stories of
    folks in this area who can testify to that fact.
        Because junk lawsuits are so unpredictable, they drive up insurance
    costs for all doctors, even for those who have never been sued, even for
    those who have never had a claim against them. When insurance premiums
    rise, doctors have no choice but to pass some of the costs on to their
    patients. That means you're paying for junk lawsuits every time you go
    to see your doctor. That's the effect of all the lawsuits. It affects
    your wallet. If you're a patient, it means you're paying a higher cost
    to go see your doctor.
        If part of the national strategy has got to be to make sure health
    care is available and affordable, health care becomes less affordable
    because of junk lawsuits. And that's what the people of southern
    Illinois and the people of America must understand, that every time you
    read about big jury verdicts or out-of-court settlements or lawsuits
    being filed here or there, you're paying for it.
        For some physicians, even raising costs for patients isn't enough to
    afford the premium increases caused by these lawsuits. And so physicians
    are faced with a terrible choice: give up medicine entirely, or to move
    to another place where they can afford to practice medicine. And that
    problem affects all doctors, from family practitioners in rural towns to
    surgeons in big-city hospitals.
        In 2003, almost half of all American hospitals lost physicians or
    reduced services because of medical liability concerns. Think about
    that: One-half of all American hospitals lost physicians. Over the past
    2 years, the liability crisis has forced out about 160 physicians in
    Madison and St. Clair counties alone. When doctors move or close their
    practices, guess who suffers: the patients, the people who live in these
    good towns in this part of the world. Pregnant women have to travel
    longer distances for checkups. Accident victims lose critical minutes in
    transit to faraway emergency rooms. New residents, people you're trying
    to get to come and live in your communities, have a hard time finding
    doctors willing to accept extra patients. And that causes the quality of
    life in your community to deteriorate. It's a problem that we must
    address.
        America's health care professionals should be focused on fighting
    illnesses, not on fighting lawsuits. Junk lawsuits change the way docs
    do their job. Instead of trying to heal the patients, doctors try not to
    get sued. Makes sense, doesn't it? If you're worried about getting sued,
    you're going to do everything you can to make sure you don't get sued.
    That's why doctors practice what's called defensive medicine. That means
    they're writing prescriptions or ordering tests that really aren't
    necessary, just to reduce the potential of a future lawsuit.
        They have specialists who stop taking emergency room calls. Doctors
    turn away patients with complicated, life-threatening

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    conditions because they carry the highest risk for a lawsuit. Defensive
    medicine drives a wedge between the doctors and the patients, and
    defensive medicine is incredibly costly for our society. Altogether,
    defensive medicine drains some 60 to 100 billion dollars from the
    economy. Defensive medicine raises medical bills for patients and
    increases insurance costs for employers, and it takes money away that
    small businesses could use to invest and expand.
        This liability system of ours is, what I'm telling you, is out of
    control. And you have people in this area and the doctors in this area
    understand what I'm talking about. A recent study ranked Madison County
    the number one place in the country for trial lawyers to sue. And that's
    a ranking I'm sure you'd like to get rid of. And those of you traveling
    in from St. Clair County aren't doing much better. [Laughter] St. Clair
    is ranked the second county in America where you're likely to get sued.
    In other words, if you see a team of trial lawyers spending a lot of
    time in the Collinsville area, you can be pretty sure they're not
    looking for horseradish. [Laughter]
        Let me share some of the stories of the folks I met with today. I
    think this will help clarify what I'm trying to say to you. Dr. Chris
    Heffner is with us. He's a neurosurgeon from
    Belleville Memorial and St. Elizabeth Hospitals. Raise your hand, Doc.
    He is one of only two neurosurgeons still practicing south of
    Springfield, Illinois. You've got two people in the area. In just 2
    years, his annual premiums have more than doubled from $131,000 a year
    to $265,000 a year. And at the same time, his amount of insurance
    coverage has been cut in half.
        A few years ago, Chris decided that
    closing his head trauma part of his practice was the only way he could
    afford to stay in this area. He told me he loves living here in this
    part of the world. He likes to raise his family here. He and his wife
    made a tough decision to stay here, in spite of the fact that his
    premiums doubled and he got half the coverage. And so the only way he
    could stay here and to provide a level of care that he wants everybody
    to have was to cut out part of his practice. He still treats dozens of
    patients with spinal cord injuries, but now brain trauma victims in
    southern Illinois have to be airlifted across the river to St. Louis. He
    said, ``It's very distressing. I spent years of training to do brain
    surgery. It's a big part of my life. I made a commitment to stay here,
    but I had to make adjustments to keep the ax from falling.'' The system
    needs to be fixed.
        Dr. Greg Gabliani is with us. He's from
    Alton, and he is a cardiologist. He was raised in Quincy, and he moved
    to Madison County in 2001, even though his colleagues warned him about
    the medical liability crisis here. In 3 years, his premiums have risen
    from $12,500 to $60,000 a year--3 quick years. Last year he had to stop
    performing certain procedures to bring his costs under control. He said,
    ``You either have to change the nature of your practice, or you have to
    leave.'' He didn't want to leave, so he's having to cut back on his
    services. We've got a problem, folks.
        I met with Bob Moore. He's the CEO of Red
    Bud Regional Hospital. That's big Bob. He's a father of six, I want you
    to know. [Laughter] His hospital has a long tradition of delivering
    babies, but this past November, he made the difficult decision to close
    his ob unit. The malpractice--see, he had the--they employ the doctors
    in his hospital. They become the employer. They're going to cover the
    insurance for them, and it doubled from $150,000 to $270,000--more than
    doubled. They're paying $270,000 a year now. That's a lot for a little
    hospital in a small town. Maybe for a big hospital, it's not a lot, or
    for those of us who are used to dealing with the Federal budget, it's
    not a lot. [Laughter] It's a lot for a small town hospital.
        Red Bud used to handle 120 deliveries a year. But now a lot of the
    women have to drive an hour to get to an ob unit. He

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    said, ``You wouldn't get an ob-gyn to come here. It's affecting rural
    medicine.'' ``It'' happens to be the medical liability crisis, is
    affecting rural medicine. Lawsuits are affecting rural medicine. It's a
    societal issue that has to be dealt with. I couldn't put it any better,
    Bob. It is a societal issue that we must deal with. It is a quality of
    life issue. We don't want our little towns being--not having any health
    care. We want people who live in rural America, like Crawford, Texas--
    [laughter]--to be able to get--to have a quality of life--[applause].
        Leslie Scariano is with us. She is an
    ob-gyn from Alton. She spent her entire career as a doctor in southern
    Illinois, and she has never been sued. She is a good doc. She shut down
    her practice on December the 31st of this year because her premiums have
    skyrocketed out of control. That means she couldn't afford to stay in
    practice. She had a choice to make: quit practicing medicine, or go
    broke. She said, ``I don't want to quit practicing medicine and I'm not
    going broke, so I'm going to move to Colorado.'' You lost a good soul
    from this part of the world because the system is out of control.
    Leslie's premiums will be about 80 percent lower in Colorado than here
    in Illinois.
        I met with Kim Vogel, who is right with us--
    yes, there she is. She was one of Leslie's
    patients. She's expecting her second child early next month--like, soon.
    [Laughter] When she found out she was pregnant last year, Kim started
    seeing the ob-gyn that delivered her daughter, Katie. That ob-gyn moved to Tennessee. Then she started seeing
    Leslie. Leslie is moving to Colorado. Kim is now on her third ob-gyn,
    and she's worried about it. She said, ``I understand the doctors'
    position. I don't blame them. But as a patient, I see them leave and I
    think, what am I going to do now, and where does that leave me? I feel
    like I've lost control over how my pregnancy will go.''
        Unfortunately, this is not just a story confined to this part of the
    world. This is a story of pregnant moms all over America who are
    wondering whether or not they're going to be able to find good quality
    health care for their child and themselves. I've come to this part of
    the world because I want to assure you that, one, I understand the
    problem and I intend to work with Congress to do something about it.
        You know, when I was the Governor of Texas, I felt that we could
    solve medical liability issues at the State level. And there was two
    things wrong with that strategy. One is that a State would pass good
    medical liability reform, and all the trial lawyers would do is go to
    the State that has lousy medical liability law. So you're not solving
    the problem, you're just shifting the problem. You're making the quality
    of life issue go from one area--the deterioration of quality of life
    issue go from one area to the next. That didn't seem to make any sense.
        But the other thing I discovered is that because of medical
    liability problems and lawsuits and increasing premiums and the
    defensive practice of medicine, your Federal budget spends $28 billion a
    year, extra money. See, we have to pay for Medicaid and Medicare and
    veterans' benefits. The rising cost of health care, the number of
    lawsuits, the defensive practice of medicine is driving up the cost to
    our taxpayers. Medical liability reform is a national issue, and it
    requires a national solution.
        So I went to Congress with some proposals that I think are fair,
    proposals that will build confidence in the judicial system. Nobody
    likes to come to a part of the world that says the judicial system is
    out of control, and people lose confidence in it. We've got to have
    confidence in the fairness of our system. We want people who are harmed
    to be able to get--have their day in court and get fair treatment in the
    courts of law. But we want--we don't want a system that's so tilted the
    other way that it runs good doctors out of business and makes it hard
    for hospitals to deliver care.

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        I believe a victim of a legitimate medical error should be allowed
    to collect full economic damages, 100 percent of the cost of their
    medical care and recovery plus economic losses for the rest of their
    life. Seems to be fair, if you get hurt. And when appropriate, injured
    people should be allowed to collect reasonable noneconomic damages. And
    in the case of truly egregious wrongdoing, patients should be entitled
    to punitive damages. But there needs to be some reason when it comes to
    noneconomic damages in the system, and that's why I proposed a hard cap
    of $250,000 on noneconomic damages.
        Interestingly enough, the State of California has a cap on
    noneconomic damages that was enacted in 1975. Patients in that State see
    their claims settled a third faster than in States without those limits.
    In other words, patients are treated more fairly where there's a cap.
    And since 1975, insurance premiums for California doctors have become
    much more affordable premiums than anywhere else in the country--than in
    most States. Caps on noneconomic damages work. It's a good idea, and the
    Congress ought to adopt them.
        We have another problem with our legal system, and that is trial
    lawyers sometimes sue all the doctors involved in the patient's case
    even if most of the doctors have nothing to do with the patient's
    injuries. It's simply unfair to punish doctors who have done nothing
    wrong. And so to make sure doctors and hospitals are treated fairly,
    Congress needs to pass joint and several liability reform.
        I think the people are beginning to understand the importance of
    this issue. I know you do. I know the people of this part of the world
    understand it, because you see firsthand what happens when the system
    gets out of control: 160 docs leave 2 counties. People understand that
    no patient has ever been healed by a frivolous lawsuit; no small
    business has ever grown because of a frivolous lawsuit; the cause of
    justice is never served by frivolous lawsuit.
        I know you're serious about this liability issue here. I talked
    about it everywhere I went on the campaign--nearly everywhere I went on
    the campaign trail, and I believe the voters made their position clear
    on election day about medical liability.
        The House passed a good medical liability reform bill last year. I
    want to thank the two Members of Congress for working on it. The Senate
    failed to get the job done. Well, the new Congress is starting over, you
    know. We've got a new chance to get something done for the--on behalf of
    the American people. Both Houses will have a fresh opportunity to
    address this issue. I'm looking forward to working with the leadership
    of the House to get the bill moving. It's important for the United
    States Senators from this State and other States to recognize the
    significance of the problem and get a meaningful, real medical liability
    bill to my desk so I can sign it in the year 2005.
        Junk lawsuits affect more than just the medical field. According to
    a recent study, frivolous litigation has helped drive the total cost of
    our tort system to more than $230 billion a year. That's the equivalent
    of $3,200 for every family of four. The lawsuit burden falls especially
    hard on small businesses. And yet small businesses are the engine of
    job--are the engines of job creation in our country. Seventy percent of
    all new jobs in America are created by small businesses. The tort costs
    in America are now far higher than in any other major industrialized
    nation. Think about that. We live in a competitive world. This is a
    global economy, and so our tort system has become a needless
    disadvantage for American manufacturers and entrepreneurs.
        And so here are some actions Congress can take as well. To protect
    small businesses and workers, we need to change the way we handle class-
    action lawsuits. Interestingly enough, this is another problem you know
    well in Madison County. The

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    number of class actions filed here increased by over 5,000 percent
    between 1998 and 2003, even though the vast majority of defendants named
    in those suits are not actually from Madison County. Think about that.
    These massive interstate class actions clog your local courts. They hurt
    the honest workers and communities of the businesses targeted by the
    class-action lawyers. The proper place for large interstate class
    actions to be tried is not in a local court but rather in a Federal
    court, which are designed--[applause]. I look forward to working with
    both bodies and members of both parties to get good class-action reform
    out of the Congress this year.
        I'll also work with Congress to reform asbestos litigation. Asbestos
    lawsuits in southern Illinois and elsewhere have led to the bankruptcy
    of dozens of companies and cost tens of thousands of jobs. Many asbestos
    claims are filed on behalf of people who are not sick. The volume of
    asbestos lawsuits is beyond the capacity of our courts to handle, and it
    is growing. More than 100,000 new asbestos claims were filed last year
    alone. Congress has begun considering options to improve the current
    system for handling asbestos lawsuits. They need to act and get the job
    done. I look forward to signing an asbestos reform in 2005.
        I think we're sent to Washington to solve problems, not to pass them
    on to future Congresses. I believe we are called to do the hard work to
    make our communities and quality of life a better place. And it's hard
    work for some in Congress to stand up to the trial lawyers. I understand
    that. But all we're asking for is fairness. We want our doctors treated
    fairly. We want the hospitals treated fairly. And most of all, we want
    the patients and the American people treated fairly.
        And I appreciate you all giving me a chance to come by and talk
    about the vital issue of legal reform. I intend to go back to Washington
    here shortly, and when I see Members of the Congress as I work this
    issue, I'm going to say, ``I spoke to the good folks of southern
    Illinois. They understand the problem, and they expect you, Members of
    the United States Senate and the United States House of Representatives,
    to get the job done.''
        Thanks for coming by to say hello. I hope you and your families have
    a blessed and healthy 2005. May God bless you all.

    Note: The President spoke at 1:13 p.m. at the Gateway Center. In his
    remarks, he referred to Tom Cross, minority leader, Illinois House of
    Representatives; and Mayor Stan Schaeffer of Collinsville, IL.