[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

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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,

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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

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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

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