    [Public Papers of the Presidents of the United States: George W. Bush (2006, Book I)]
    [February 16, 2006]
    [Pages 252-261]
    [From the U.S. Government Publishing Office www.gpo.gov]

    Remarks in a Discussion on Health Care Initiatives
    February 16, 2006

        The President. Thank you all. Thanks for the warm welcome. Thanks
    for coming. We're about to have a discussion about how this country can
    make sure our health care system is available and affordable. And I want
    to thank our panelists for joining us. It's an interesting way to
    describe and discuss policy. It's a lot better than me just getting up
    there and giving a speech--you don't have to nod. [Laughter]
        Do you want to kick things off, Mark?
        Mark B. McClellan. I'd be glad to. I'd
    like to welcome all of you to the Department of Health and Human
    Services. As you know, there are many people here who are working day
    and night to protect the public health, to help our health care system
    work better.
        We have the privilege of working with the best health professionals
    in the world--

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    doctors, nurses, others who have some great ideas about delivering
    better care and about finding ways to do it with fewer complications and
    at a much lower cost. But in many ways, our health care policies haven't
    kept up with what our health care system can do, and we're going to
    spend some time talking about that today.
        So, Mr. President, we're very pleased to have you here today to lead
    this discussion of some new ideas for improving our health care.
        The President. Yes, thank you, Mark.
    Thanks. Mike Leavitt--where are you,
    Michael? Surely, he's here? [Laughter]
        Dr. McClellan. He's in Florida, Mr. President.
        The President. Oh, he's in Florida.
    Okay. Surfing. [Laughter] Actually, I saw him this morning--now don't
    make excuses for him. He's doing a heck of a job--he really is--and I
    hope you enjoy working for him.
        I am really pleased that Nancy Johnson
    is here. Madam Congresswoman, thank you for coming. If you want to meet
    somebody in Congress who knows something about health care, talk to
    Nancy; she is a tireless advocate for making sure the health care
    systems are efficient and compassionate. And I really want to thank you
    for coming. It's a joy to work with you on these big issues.
        I thank all the folks here at HHS. Thank you for working hard on
    behalf of our fellow citizens. You've got a tough and important job, and
    you're doing it well. One of the reasons why is because, you know, we've
    clearly defined roles of government--with the role of Government in
    health care. And one of the roles is to make sure our seniors have a
    modern, reformed Medicare system. And I want to thank those of you who
    are working on making sure that the Medicare system is explained to and
    available for seniors all across the country.
        We did the right thing when it came to saying that if we're going to
    have a program for seniors, let's make sure it works as good as
    possible. And part of that meant modernizing the system so it included a
    prescription drug benefit. It's not easy to sign up millions of people
    in a quick period of time to a new program, and there were some
    glitches. The good thing about this Department, and the good thing about
    Mike and Mark is that they have prioritized problems to be fixed and
    have gone around the country fixing them.
        Millions of folks--about 25 million people have signed up for the
    new Medicare benefit. I don't know if you remember when we first had the
    discussions about the Medicare benefit, people said, ``It will cost
    about $37 a month per beneficiary.'' One of the interesting reforms was
    not only making sure that medicine was modernized, but seniors actually
    were given choices to make in the program. And Mark's done a fine job of encouraging providers to be in the
    markets. And as a result of choice in the marketplace, the average per--
    anticipated cost is $27 a month.
        In other words, giving people a decision to make is an important
    part of helping to keep control of cost. We have a third-party system--
    third-party payer system. When somebody else pays the bills, rarely do
    you ask price or ask the cost of something. I mean, it seems kind of
    convenient, doesn't it? You pay your premium; you pay your copay; you
    pay your deductible; and somebody pays the bills for you.
        The problem with that is, is that there's no kind of market force.
    There's no consumer advocacy for reasonable price when somebody else
    pays the bills. And one of the reasons why we're having inflation in
    health care is because there is no sense of market. We're addressing the
    cost-drivers of health care, and this discussion today is a part of
    helping to make sure health care is affordable. And as it becomes
    affordable, it becomes more available, by the way.
        A couple of ideas, other than the subject at hand, to make sure
    health care is affordable is--and we'll talk a little bit about
    information technology. I know there's a

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    great initiative here at HHS to help bring the health care industry into
    the modern era by implementing information technology reforms. And for
    those of you working on the project, thanks, and we take it very
    seriously at the White House, and I know you take it seriously here.
        Secondly, I want to thank those of you who are working on community
    health centers. One way to help control costs is to help people who are
    poor and indigent get costs in places that are much more efficient at
    delivery of health than emergency rooms. And so we're committed to
    expansion of community health centers. Again, thanks on that,
    Nancy, for helping in Congress. They work.
    We're measuring results, and the results are good results.
        Thirdly, lawsuits are running up the cost of medicine. The practice
    of--the defensive practice of medicine or the practice of defensive
    medicine--I'm a Texan--[laughter]--it costs about 28 billion a year when
    doctors overprescribe, to make sure that they kind of inoculate
    themselves against lawsuit. It runs up Federal budgets. It costs the
    economy about 600 to 100 billion--60 to 100 billion a year.
        And so we've got to do something about these junk lawsuits. I mean,
    they're running good people out of practice. I said a statistic the
    other day in the State of the Union that's got to startle you if you're
    involved with the health care delivery in America: 1,500 counties don't
    have an ob-gyn because lawsuits have driven a lot of good docs out of
    those counties. And that's not right.
        And so we've got to get medical liability reform. The House has done
    a good job of passing it. It's stuck in the Senate. So for the sake of
    affordable and available health care and if--is to get a good, decent
    bill passed.
        One other way to help control costs is to interject market forces,
    as I mentioned. And one way to do that is through what's called health
    savings accounts. Health savings accounts are an innovative product that
    came, really, to be as a result of the Medicare bill that I was honored
    to sign. And they're an innovative account that combines savings on a
    tax-free basis with a catastrophic health care plan. We'll have some
    consumers here of health savings accounts that will describe how they
    work and whether or not they're working worth a darn.
        But the key thing in a health savings account is you actually put a
    patient in charge of his or her decisions and--which we think is a vital
    aspect of making sure the health care system is not only modern, but a
    health care system in which costs are not running out of control. And
    part of making sure consumers, if they have a decision to make, can make
    rational decisions is for there to be transparency in pricing. In other
    words, how can you make a rational decision unless you fully understand
    the pricing options or the quality options. When you go buy a car, you
    know, you're able to shop and compare. And yet in health care, that's
    just not happening in America today.
        And so one of the--this discussion is centered around encouraging
    consumer-based health care systems and strengthening private medicine
    through transparency and pricing and quality. And I hope you find this
    as interesting a discussion as I will.
        I'm going to start off with Dr. Gail Wilensky. Do you know anything about health care? No. [Laughter]
    She knows a lot about health care. You've been working the health care
    industry for, what--tell us what you do.

    [At this point, Gail Wilensky, senior fellow, Project HOPE, made brief
    remarks.]

        The President. Thank you for the lead-in. We spend a lot of money at
    the Federal level, and you would expect that if we're sitting up here
    talking about transparency then we ought to do something about it. I
    mean, the Federal Government is the

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    largest purchaser of health care--am I right--46 percent of all health
    care dollars.
        Dr. McClellan. That's right.
        The President. Okay. What are you going to do about it? [Laughter]
        Dr. McClellan. Well, Mr. President, we
    are doing a lot about this already, as you know. With--before the
    Medicare drug benefit, Medicare provided a drug discount card for
    millions of seniors to enable them to save billions of dollars. And with
    that card, we made available information on discounted drug prices for
    all the prescription drugs and all the pharmacies around the country.
    Seniors use that information to keep prices down. They shopped, and we
    saw during the course of this program, savings actually increase over
    time.
        The President. Yes.
        Dr. McClellan. G1We also saw lots of seniors switching to drugs that
    they found out about that could meet their medical needs at a much lower
    cost.
        The President. One thing a person watching out there--what we're
    talking about, for example, when it comes to putting information out on
    drugs, a brand name drug and a generic drug do the same thing, but
    there's a huge price differential. And what Mark is saying is, is that we made, as a result of our
    Government policies, the providers to provide a shopping list, a
    comparison for people to get on the Internet and find out whether they
    can buy a drug cheaper or not.
        Dr. McClellan. That's right. And many
    people are saving 70 or 80 percent or more on their drug cost by
    switching to generics. You can get this information on the Internet. You
    can also get it by calling 1-800-MEDICARE. And we're doing the same
    thing with the drug benefit. And that's one reason the drug benefit
    costs now are so much lower than people expected, as you mentioned
    earlier.
        We're trying to make more information available on hospital quality,
    on nursing home quality, on many other aspects of health care. But we
    can't do this alone; we've got a public/private health care system, so
    we need to work with health professionals, with consumer groups, with
    business purchasers, and with the health plans in this country to get
    useful information out. We started to do that through collaborative
    efforts, like the Hospital Quality Alliance and the Ambulatory Care
    Quality Alliance. These are groups that include all of the different key
    stakeholders in our health care system working together to make useful
    information available on quality and cost.
        Some of that's happened already, but I think with the leadership
    from the President and with the full backing of the Federal Government,
    we can move this effort along much more quickly and much more
    extensively to get information out about satisfaction with care, to get
    information out about outcomes of care and complications, and to get
    information out about cost. And, Mr. President, we're very pleased to be
    starting right now a new program that will be piloted in six large
    communities around the country, where all these different groups--the
    health professionals, business groups, Government organizations,
    including Medicare and the Agency for Health Care Research and Quality,
    and health plans--are going to be working together to make useful
    information available to consumers and health professionals in these
    communities about the quality and costs of their health care. And
    hopefully, we'll be able to move this project along very, very quickly.
        The President. Good.
        Dr. McClellan. We're working.
        The President. Nice going. Yes, I know you are. You're working hard.
    Mark also has been responsive to some of
    the issues of the Medicare rollout. And they've been moving hard and
    traveling around the State. And thanks for responding to what's going to
    end up being a really, really important program for our seniors--let me
    say, a revitalized, important program for

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    our seniors. It's going to make a big difference. Thanks for working so
    hard.
        Robin Downey. What do you do,
    Robin?
        Roberta ``Robin'' Downey. I'm
    head of product development for Aetna.
        The President. Yes.
        Ms. Downey. And I was
    instrumental in launching our HSA program. We've been doing consumer-
    directed plans since 2002. And so we're the first national plan to offer
    an HSA in the health plan arena.
        The President. Good move. I bet you're really selling a lot of them.
        Ms. Downey. Yes, we are. The
    adoption is higher in the HSA than it is in the HRA now. It's
    increasing, and I'm probably one of Aetna's first members in the HSA.
        The President. You and I both. We own an HSA.
        Ms. Downey. Yes, yes, both in
    it.
        The President. Let me ask you something. Aetna, obviously, is a big
    health insurance company. Do you--obviously you've got an opinion on
    transparency, otherwise you wouldn't be sitting here--but give us from
    your perspective, from the insurance company's perspective, tell us what
    transparency means to you and how best we can work together to implement
    the transparency.

    [Ms. Downey, vice president and head of product development, Aetna, made
    brief remarks.]

        The President. Good. And I presume there was resistance at first?
        Ms. Downey. Not resistance;
    they wanted to know why. I think physicians are wondering why the
    consumers need that kind of information. So they're getting used to
    that. And then they were actually pretty helpful when we were talking
    about how we were going to display it. They were saying, make it easy
    for the patients to understand, so they're helping us take the medical
    terminology, put it into layman's terms. They wanted to make sure it
    wasn't going to create more work for them; were people going to be
    calling their offices constantly. And that's what we want to do; we want
    to put it on the web site so they don't have to constantly call. So we
    want to provide easy access.
        And so they were also concerned with, if you put cost information
    there, and you don't have quality, then people will price shop on cost
    alone, and they're very afraid of that--and they should be, because
    people should understand the----
        The President. So how do you handle that?
        Ms. Downey. We're marrying that
    now. We're going to expand that pilot. It was so successful, we're going
    to expand it into more locations in the fall of 2006, and we're going to
    be marrying that information with the quality information so the
    consumer can go out and see what the unit cost is, what the efficiency
    is, what the clinical quality is. And so they can look at the overall
    value. We're pretty pumped about it.
        The President. Well, I appreciate you doing it. It must be exciting
    to be on the leading edge of an interesting innovation and to a--into
    health care.
        Ms. Downey. Very much.
        The President. It's hard to believe that ours is a market society in
    which people are able to shop based upon price and quality in almost
    every aspect of our life, with the exception of health care. And it's no
    wonder that we're dealing with what appears to be ever-increasing costs.
        You know, it's really interesting, LASIK surgery is a good example
    of a procedure that was really didn't--was not a part of a third-party
    payer, just came to be. People could choose it if they wanted to choose
    it, could pay for it if they didn't want to--would pay for it themselves
    if they chose to use it. And more doctors started offering LASIK
    surgery. There was more information about LASIK surgery, and the price
    came down dramatically over time, and the quality was increasing. And
    now LASIK surgery is eminently affordable for a lot of people, because
    the market actually

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    functioned. And I think what Robin
    is saying is that they're trying to introduce those same kind of forces
    in Cincinnati.
        Thanks for doing what you're doing. I met with your old boss today.
    Maybe he's watching out there. [Laughter]
        Ms. Downey. He talks to me just
    the way you talk to Mark--``just do it.''
    [Laughter]
        The President. A little bossy. [Laughter]
        Ms. Downey. Yes. But you get
    stuff done.
        The President. Yes, that's right.
        Dan Evans is the president and CEO
    of Clarion Health Partners in Indianapolis, Indiana. Thanks for coming.
    They're doing some interesting things. He's a hospital guy.
        Daniel F. Evans, Jr. Yes. We're--
    I'm the CEO of an academic medical center, so we have both a university
    and a hospital. We have 4,000 peer review projects ongoing right now,
    including----
        The President. Tell everybody what a peer review project is.

    [Mr. Evans, president and chief executive officer, Clarian Health
    Partners, Inc., made brief remarks.]

        The President. So how easy is it to establish a matrix, or a--
    information for consumers to be able to really accurately understand?

    [Mr. Evans made further remarks.]

        The President. The--we're really talking about making sure each
    American has an electronic medical record, over which he or she has got
    control of the privacy. An interesting--another example was what
    happened--the Veterans Administration, by the way, has implemented
    electronic medical records. In other words, they're using modern
    technology to bring this important agency into the 21st century. A lot
    of files at your hospital still--probably not your hospital but the
    typical hospital--are handwritten.
        Mr. Evans. Well, you know, what
    happens is, they may be electronic in the hospital, but handwritten in
    the doctor's office----
        The President. Yes, and the doctors can't write anyways, so--
    [laughter].
        Mr. Evans. Well, the pen is a very
    dangerous thing.
        The President. Yes, it is.
        Mr. Evans. Yes, as you well know.
    [Laughter]
        The President. And so the idea is to modernize doctors' offices and
    hospitals and providers through information technology. And so the
    Veterans Department has done this. In other words, each veteran has got
    an electronic medical record. And so when Katrina hit, a lot of veterans
    were scattered, and they were just displaced. And you can imagine the
    trauma to begin with, and the trauma is compounded if you're worried
    about your record being lost somewhere, your medical record.
        And fortunately, because the veterans at the Department had already
    acted, these medical records went with the patient, and a lot of
    veterans got instant help. And so a doc could just, you know, kind of
    download their record, take a look at what was prescribed before, take a
    look at other procedures, and boom, the medicine and the help was
    brought up to speed quickly, which is great. And I want to thank you for
    doing that.
        Information technology is going to help change medicine in a
    constructive way, and it does dovetail with price and equality.
        Yes. Getting kind of adrift of what we're talking about here? I hope
    so. If not, we'll go over to Jerry;
    she'll help--[laughter]. Jerry, welcome. Where do you live? What do you
    do?
        Jerry W. Henderson. Mr. President, I
    live in Baltimore, Maryland.
        The President. Welcome.
        Ms. Henderson. And I am a nurse, and
    I've been in health care for over 30 years. And for the last 9 years,
    I've had the responsibility of running an ambulatory surgery center in
    Baltimore.
        The President. Good. Called?

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        Ms. Henderson. The SurgiCenter of
    Baltimore.
        The President. Very good. And tell us, you know, the transparency
    issue--you--we had a little visit ahead of time, so it's not the first
    time I've seen her; she gave me a little hint about what she was going
    to talk about. Go ahead and share with people--small clinic, relatively
    small clinic, big hospital guy, small
    clinic person.

    [Ms. Henderson, executive director, SurgiCenter of Baltimore, made brief
    remarks.]

        The President. Right. And the reason why they can't yet is because
    you happen to be on the leading edge of what is an important reform.
        Ms. Henderson. I think so.
        The President. Yes, it is. Well, so do the patients, more
    importantly. And thank you for sharing that with us.
        You have--happen to have a patient here.
        Ms. Henderson. I do.
        The President. You've known Gail before?
        Ms. Henderson. Gail
    Zanelotti was a patient at our center, and I
    think she'll tell you that probably it was a more convenient and
    comfortable and patient----
        The President. You're not putting words in her mouth are you? [Laughter]
        Ms. Henderson. No, no. But I bet she
    would tell you that. [Laughter]
        Gail Zanelotti. It was more convenient
    and comfortable. [Laughter]
        The President. It was? Very good. [Laughter]
        Ms. Henderson. See? [Laughter]
        The President. You were diagnosed with what?
        Ms. Zanelotti. With bilateral breast
    cancer in October. And I had several procedures performed at the
    Surgical Center of Baltimore. And they treated me as if I were the main
    event. That's how I felt--socially, emotionally, physically. The whole
    gamut was covered. And I chose the surgeon first for quality and then
    went on to find the pricing and everything else through them----
        The President. Sure.
        Ms. Zanelotti. ----which they were very transparent about. It was a
    very positive experience. And I'm still in communication with them
    because--through the reconstructive process.
        The President. Yes.
        Ms. Zanelotti. And I would do it the same way again.
        The President. And so how does--I mean, so you're the consumer. You
    walk in, obviously, pretty well traumatized to a certain extent. You've
    got this horrible disease that's attacked you. And you come to them, and
    they--and you're asking what questions?
        Ms. Zanelotti. I saw the surgeon that
    night, and I think we were there at 10:30 p.m. at night.
        The President. Oh, great.
        Ms. Zanelotti. I mean, it's amazing how
    dedicated some of these doctors are. And then they take you through the
    process of different diagnostic steps that you have to take. And really,
    you see how curable things can be if it's caught early. And I was very
    lucky to be able to be faced with step-by-step approach to get back to
    my journey of full health.
        The President. Good job. Congratulations.
        Ms. Zanelotti. Thank you.
        The President. You've got that sparkle in your eye, you know.
    [Laughter]
        Ms. Zanelotti. Thank you. Very lucky.
        The President. And so--no, I appreciate it. It's an interesting--the
    transparency reform is going to take place in both large entities and
    smaller entities, because consumers shouldn't be restricted to shopping
    only in a large entity or a small entity. ``Shopping'' isn't the right
    word, but you know what I mean--in other words, out there looking for
    the procedure that fits their needs at the right cost and the right
    price.

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        It almost doesn't matter if we have transparency if consumers,
    however, are not in a position to make decisions. In other words, if
    somebody is making the decision for you, transparency only matters to
    the decider.
        And so Bruce is with us today--Bruce Goodwin. He's an HSA owner. Bruce, describe HSAs--well,
    first of all, tell us what you do.
        William ``Bruce'' Goodwin. My
    company manufactures computer plate technology for the graphic arts
    printing business.
        The President. How many employees?
        Mr. Goodwin. We have 20
    employees. We're a small company.
        The President. Yes. By the way, two-thirds of new jobs in America
    are created by small businesses. And if a small business can't afford
    health care, it's pretty likely they're not going to be aggressive in
    expanding. And I presume you have some health care issues.
        Mr. Goodwin. Well, I'm here as
    an employer who is concerned about health care costs for sure, and a
    strong advocate of health savings accounts. I'm a firm believer that for
    employers, health savings accounts is probably the best weapon we've got
    in the battle of these rapidly escalating health care costs. And I'm
    very much hopeful, and I appreciate very much your leadership in trying
    to help strengthen the health savings accounts.
        The President. Yes, we'll talk about it in a minute. So tell people
    what a health savings account is. This is kind of a foreign language to
    everybody but the 3 million people who own one. It's just a new product.
    And it's just beginning to happen.

    [Mr. Goodwin, president, Glunz and Jensen, Inc., made brief remarks.]

        The President. An insurance plan with a health savings account is a
    high-deductible catastrophic plan coupled with a tax-free health savings
    account to pay routine medical costs up to the deductible. That's the
    way they're structured now. Many employees--I was at Wendy's yesterday.
    Wendy's has now got 9,000 employees using health savings accounts. The
    company pays for part of the premium, as well as the contribution into
    the cash account to be paid by the customer for routine medical
    expenses.
        If you don't spend all your money in your cash account, you can save
    it tax-free and roll it over to the next year, and then you contribute
    again. Wendy's premiums rose this year, I think, at less than 2
    percent--maybe even less than 1 percent, if I'm not mistaken. And they
    were increasing at double-digit rates--I hope I'm not exaggerating--they
    were going up quite dramatically, let me put it to you that way. And now
    their premiums were significantly lower. And the savings enabled them to
    put additional money into their employees' accounts, additional
    contributions.
        It's an interesting concept, because all of a sudden, it puts an
    individual in charge of health care decisions. There's an incentive, by
    the way, for people to make rational choices about what they consume--
    like, if you don't smoke and drink, it's more likely you'll stay healthy
    and not spend money in your account. If you exercise--I'd strongly urge
    mountain biking--[laughter]--it helps you stay healthy. And by staying
    healthy, you actually save money. There's a remuneration for good
    choice.
        And what Bruce is saying is
    that it's helped his business afford health care. It's helped a lot of
    small businesses. If you're a small-business owner, please look into
    health savings accounts for the good of your employees.
        Interestingly enough, about a third of those who've purchased the
    new health savings accounts were uninsured. Many of the uninsured in
    America are young people, kind of the bulletproof syndrome--you're never
    going to get sick, so therefore, why buy insurance. Now, there's an
    incentive to buy insurance because it means you can save tax-free.

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        And so Bruce has used them,
    and it's--and he reports that he's able to better control his costs,
    which is really important for the small-business sector. And it's also
    important for the large-business sector to say to their employees,
    ``Here is something that's really beneficial for you and your families
    because when you saved the money, it's your money.'' Savings in health
    care doesn't go to a third party entity; it goes to the consumer. It's a
    new concept that's just coming in to be.
        In order for it to work, there has to be transparency. How can you
    expect somebody to make rational decisions in the marketplace if they
    don't see price and quality? It's going to be a very important--what
    we're talking here is a very important reform to really fit into a--
    making sure the private medicine aspect of our medical system remains
    the center of medicine.
        There's a debate here in Washington about who best to make
    decisions. Some up here believe the Federal Government should be making
    decisions on behalf of people. I believe that consumers should be
    encouraged to make decisions on behalf of themselves. And health savings
    accounts and transparency go hand in hand.
        There are some things we need Congress to do to make health savings
    accounts work even better than they are. One is to make sure that one's
    contributions into the health savings account is--can be--it will be
    equal to the deductible, plus any copays that may have to be made. In
    other words, we shouldn't cap the contribution, cash contribution at
    where it is; it needs to be raised.
        Secondly, we need to make sure the Tax Code treats employees in
    large companies and employees in small companies equally when it comes
    to purchasing health savings accounts. And thirdly, and a key component
    of making sure health savings accounts works, that addresses one of the
    real concerns in our society, and that is people changing jobs but
    fearful of losing health care as they do change jobs, is to make sure
    health savings accounts are portable in all aspects, a health care plan
    that encompasses health savings accounts. Today, the rules enable one to
    take with them the cash balances in their health savings accounts but
    not the insurance in their health savings accounts. In order to make
    these plans truly portable, so as to bring peace of mind to people,
    we've got to make sure that health savings accounts are genuinely
    portable accounts.
        I look forward to working with Congress to strengthen, not weaken,
    but strengthen these very important products that puts the doctor and
    the patient in the center of the health care decision. Today we've heard
    some interesting, innovative ideas that are taking place from the
    insurance industry to the providers to the Federal Government. And we
    will continue to implement transparency. And it's just the beginning.
    And I predict that when this--as this society becomes more transparent,
    as the consumers have more choice to make, you'll see better cost
    containment. And as we're able to contain costs, we achieve some great
    national objectives: One is to make sure health care is affordable, and
    two, make sure it's available.
        I want to thank you all for coming to join us. It was an interesting
    discussion. Appreciate your time. God bless.

    Note: The President spoke at 1:18 p.m. in the Great Hall at the U.S.
    Department of Health and Human Services.

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