    [Public Papers of the Presidents of the United States: George W. Bush (2006, Book I)]
    [April 5, 2006]
    [Pages 644-653]
    [From the U.S. Government Publishing Office www.gpo.gov]

    Remarks in a Discussion on Health Care Reform in Bridgeport, Connecticut
    April 5, 2006

        The President. Thank you all. Darrell,
    thanks for the invitation. I think you're going to find this an
    interesting way to discuss a vital issue for our country, and that is,
    really, how do we stay competitive? How does the United States of
    America remain the preeminent economic leader in the world?
        And one way you do so is you make sure you've got an environment
    where small businesses can thrive, where people can feel comfortable in
    having health care that's available and affordable. So thanks for coming
    and giving us a chance to discuss the issue. You notice I say ``us.''
    There's nothing worse than a guy kind of blowing away in a lecture, so
    I've invited fellow citizens to come and share their experiences about
    an interesting way to approach affordability and availability in health
    care.
        But before I do that, I want to thank you all very much for taking
    time out of your day to come and listen. I appreciate very much the
    Governor, Jodi Rell, joining us. Governor Rell
    is a--you know, I know something about Governors. I used to be one. She
    is really a dignified, classy woman who has done a fine job for the
    State of Connecticut.
        I flew down today with Congressman Chris Shays. Shays is a very thoughtful person. He is a friend. He is
    an independent fellow--[laughter]--who speaks his mind. But he does so
    in a way that gets people to listen to him. And I appreciate his
    thoughtful approach to a lot of issues. And I appreciate your friendship
    as well. I'm looking forward to hearing your lecture on the way back to
    Washington. [Laughter]
        Mr. Mayor, thank you for joining us. So
    Laura comes back and says, ``I met the mayor of
    Bridgeport. He's a good guy.'' I say, ``Well, that's great.'' I don't
    know what you did, Mayor, but you at least convinced the First Lady
    you're a good guy. [Laughter] And I appreciate your hospitality and your
    kindness to my wife who--you know, she's really not a politician. She is
    a really fine woman, great mother, great

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    wife, thoughtful person. And I appreciate your kindness to her. She's
    also, obviously, got good judgment. Her Chief of Staff, Anita
    McBride, was raised right here in Bridgeport.
        I appreciate other State and local officials who are here, thank all
    the business leaders. The challenge is whether or not this Nation is
    going to be a confident nation. Our economy is strong right now. GDP
    grew at 3.5 percent last year. We're adding jobs. The national
    unemployment rate is 4.8 percent. I think the unemployment rate here is
    something less than that, here in the State of Connecticut. People are
    working. Small businesses are flourishing. Productivity is up. And the
    fundamental question is, how do we keep it that way? What do we do? Do
    we lose our confidence and retreat, or do we create the conditions so
    that capital flows and the entrepreneurial spirit remains strong?
        My attitude is that the United States is the leader of the world,
    and by putting good policies into place, we'll remain the leader of the
    world. And that's where we should be. And so here are some ideas as to
    how to do that.
        One is to keep taxes low. I believe when people have more money in
    their pockets it helps the entrepreneurial spirit, causes the economy to
    grow. One reason we overcame the recession and the stock market collapse
    and the attacks on our country and the wars we've been through and the
    natural disasters we've been through is because people have got more
    money to save and invest and spend. And so I'm looking forward to
    working with Congress to keep the taxes low and, at the same time, be
    wise about how we spend the people's money.
        I understand we've got an issue with energy. I know it probably came
    as a shock to some of my fellow citizens here in Connecticut when I
    stood up in front of the country and said, ``We've got a problem; we're
    addicted to oil.'' And I meant it. We've got an economic problem being
    addicted to oil because when fossil fuels--demand for fossil fuels rise
    in other parts of the world, it causes our energy bills to go up. We've
    got a national security problem when it comes to oil. When you've got
    people in the world who don't like us, from which we get supplies of
    oil, it causes those problems to come into the Oval Office. And
    therefore, we have to deal with the geopolitics of oil when it comes to
    securing this country. And we've got an environmental problem relying
    upon fossil fuels. And so I think there's a better way forward, and I
    look forward to working with Congress to keep us competitive in the
    world's stage by diversifying away from the use of oil.
        And here are some ideas: Using ethanol in our automobiles is an
    idea, developing hybrid plug-in batteries so that we can drive the first
    40 miles on electricity and not using gasoline, being wise about nuclear
    power, using solar power. There's a variety of things we need to do
    together to help us diversify away from hydrocarbons, and I'm intent
    upon doing that for the sake of the competitiveness of the United States
    of America.
        Another idea I look forward to working with Congress on is to make
    sure that we are competitive when it comes to having the workforce of
    the 21st century, and we're going to make good progress on this with
    Congress. And that is to do something on the research and development
    tax credit, is double our commitment to the research in the basic
    sciences in Washington, DC, so that we're technologically competent,
    that we're on the leading edge of research when it comes to the world's
    economy, and then make sure our kids have got the skills necessary to
    fill the jobs by emphasizing math and science, particularly in junior
    high.
        In terms of competitiveness, a big issue, of course, is health care.
    And in Washington, DC, there is a philosophical debate that rages, and
    that is how best to implement a health care strategy; what should

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    it look like? And to simplify the debate, it basically says,
    ``Government ought to be the decider. Government ought to drive demand,
    and Government ought to control supply,'' versus a system in which
    individuals are in charge of their own health care decisions. I
    recognize that it may be oversimplification, but, nevertheless, that's
    the crux of the debate.
        And it's an important debate, and so I've got some ideas as to how
    this debate ought to go. And it starts with, one, a Federal commitment
    to certain people within our society, the poor and the elderly. The
    Medicare plan we passed modernized Medicare for the first time since
    Lyndon Johnson provided that--signed that bill. It is an important piece
    of legislation. It is working; 27 million Americans have signed up. If
    you have not looked at the new Medicare opportunities for you, you ought
    to do so by calling 1-800-MEDICARE.
        Interestingly enough, by providing competition into the system--in
    other words, giving our seniors choices--the estimated cost for Medicare
    is dropping significantly. I believe competition works. And I believe
    Government ought to trust people to make the right decision for their
    selves and their families. And that's what Medicare has done.
        Another important way for health care to work is to expand community
    health centers. One of the things Shays
    told me was, he said you've got a good community health center here in
    Bridgeport. Community health centers are vehicles--places of opportunity
    for low-income citizens to be able to get primary care, so as to take
    the stress off of emergency rooms of your hospitals, for example.
        We've expanded 800 of them over the years; we intend to expand or
    open 400 more over the next 2 years. These are wise use of taxpayers'
    money, to help keep a Federal commitment to helping the poor deal with
    health care.
        And same goes to Medicaid. Medicaid is a very important program. I
    look forward to working with the Governors to make sure that the
    Medicaid system works more efficiently, most importantly for those who
    are getting Medicaid help.
        Now, in terms of a lot of other folks, it seems like to me that we
    ought to be working toward the design of a system that makes health care
    available and affordable. And let me give you some ideas as to how to do
    that.
        One, many small businesses are having trouble affording health care
    insurance. One of the reasons why is, they don't have the same pooling
    opportunity--pooling of risk opportunities that larger companies get.
    And so I think it makes sense to allow small businesses to pool risk
    across jurisdictional boundaries so they can afford the same kinds of
    insurance purchases that big companies get.
        For example, a restaurant in Bridgeport ought to be allowed to pool
    risk with a restaurant in Texas so that there's economies of risk.
    Today, that can't happen. Association health plans will enable small
    businesses to better afford insurance. I'm looking forward to working
    with Congress to get that out of the Congress.
        Secondly, one of the cost-drivers for health care are these
    frivolous lawsuits that are running good doctors out of practice and
    forces doctors and hospitals to practice defensive medicine. When I
    first went to Washington I said, ``Well, this is just a State issue,''
    Governor. I thought it could be best solved at
    the State level, until I realized the defensive practice of medicine
    plus these liability increases through lawsuits costs us about $28
    billion a year to the Federal--cost the Federal budget $28 billion. I
    said, that's a national problem, and it demands a national solution.
        The House passed a bill. Of course, it's stuck in the Senate. It
    needs to get out of the Senate. In order to make health care more
    affordable and more available, we need comprehensive medical liability
    reform immediately. You know what's an amazing statistic is, there are
    1,700 counties

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    in our country that have no ob-gyn. They got run out of business. And
    that's not right, and it's not fair, and it's necessary for Congress to
    act.
        The third area we need to work on is information technologies. I
    know there is a lot of hospital people here. But we've set the goal--and
    I think you understand what I'm talking about, is to make sure that
    health care is brought into the 21st century by using information
    technology in such a way as, on the one hand, we have medical records;
    on the other hand, we protect patients' privacy. And we can do so.
        A classic example of the importance of information technology came
    down there with Katrina. A lot of veterans were displaced as a result of
    that hurricane, but they had medical electronic records because the
    Veterans Administration has begun to modernize. And therefore, they were
    able to take their medical electronics records to their destination--
    where they moved to and were able to get immediate health care. The
    records were there; they were available. The doc that they checked in
    with was able to access their records on a real-time basis and were able
    to--so there was no, kind of, loss of care; there was no confusion about
    what was necessary.
        We will save a lot of costs with information technologies, and we'll
    reduce medical errors with information technologies. And Secretary
    Leavitt, who is the head of HHS, has got
    a strong program to encourage the advance of information technology.
    Some estimate we save 30 percent in health care costs when information
    technology is spread throughout our society. And so we've got a Federal
    commitment, and we look forward to working with you to spread that
    commitment.
        And finally, we're here to talk about what's called health savings
    accounts. It's a really interesting idea that Congress passed in the new
    Medicare law. It's an idea that it's really important for people--no
    matter what side of the philosophical debate you may be on--to at least
    pay attention to what's available. A health savings account addresses
    one of the major cost-drivers in our system, and that is, is that a lot
    of people get health care, but somebody else pays the bill. It's called
    a third-party payer system.
        And when somebody else pays the bill, sometimes you don't pay
    attention to the cost. You know, when you go out and purchase an
    automobile, somebody doesn't pay the bill for you; you pay it. And you
    tend to shop and you look and you try to find out what's best for you.
    The third-party payer system, which is, you know, an integral part of
    our health care system today, essentially says, ``You sign up for a
    program, and if you get sick, somebody else will take care of it for
    you.'' And I believe that the more the consumer is involved in pricing,
    the more the consumer is involved in the decisionmaking, the more likely
    it is people will start making rational decisions for their own needs.
        And one way to do that is through the advent of health savings
    accounts, which is, in essence, health savings account coupled with a
    high-deductible, catastrophic insurance plan. That's long-word talk for,
    if you get sick, above a certain amount, your insurance pays for it. If
    not, you pay for it. But the savings, if you don't spend money, are tax-
    free. In other words, this is an interesting way of making sure the
    patient and the provider are the integral deciders in health care
    decisions. If that's not clear enough, they'll help clear it up for me.
        You know, LASIK surgery is an interesting--it's interesting to think
    about. LASIK surgery is a surgery that helps correct your eyesight. And
    I don't know how many years ago it was, but LASIK surgery was very
    expensive. But this happened to be a part of medical--medicine where
    there really was a market. More people began to provide LASIK surgery.
    People began to shop for LASIK surgery. And the

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    cost for LASIK surgery has gone down dramatically, and the quality of
    LASIK surgery has improved dramatically.
        A lot of that has to do with the fact that the consumer was the
    decider. The consumer actually began to look around and decide what was
    best for him or her in the marketplace. That stands in contrast to a
    system where somebody else pays the bills.
        Health savings accounts really mean that the individual owns and
    controls their health care. Health savings accounts enable somebody to
    say, ``Look, if I make the right decisions about smoking or drinking or
    exercising, that I'll end up saving money.'' Health savings accounts
    help small businesses more afford health care coverage. Many of the
    uninsured are people who work for small businesses. They are the working
    uninsured. And if we have product available for small businesses to
    better afford insurance, it will help this country remain competitive.
        Health savings accounts would be good for young people. A lot of
    young people feel bulletproof. They don't feel like they need insurance;
    they don't think they're ever going to get sick. But if a young person
    starts saving now for future health care costs and the interest
    compounds on a tax-free basis, it's amazing how much money a person can
    save.
        And so this is an interesting idea. It started off rather slowly. In
    the marketplace today, there are about 3 million citizens who have got
    health savings accounts. Interestingly enough, part of the debate in
    Washington is, they say, ``Sure he wants health savings accounts; only
    the rich will access them.'' That's not what happened. The uninsured are
    accessing health savings accounts. Many of the health savings accounts
    owners are folks with their high school degree. A lot of health savings
    accounts owners are people with not an extraordinary amount of income.
    You know, it kind of defies the concept that certain people can't make
    decisions on their own--you know, ``If you don't have a Ph.D., you
    shouldn't be allowed to decide things.'' People are plenty smart when it
    comes to their own lives and coming to making decisions about health
    care needs. And I believe we ought to encourage more consumer activism,
    more involvement in making health care decisions.
        So that's what we're here to talk about. And by the way, one other
    point is you can't make good health care decisions unless there's
    transparency in the marketplace. People need to see price. One of the
    things we're trying to encourage is for health care providers to post
    their prices so people can choose, so people are able to--you know,
    ``This kind of makes sense for me; this doesn't make sense for me.''
    Nontransparency in pricing makes it awfully hard to achieve savings. And
    after all, one of the national objectives has got to be to have a health
    care system that is available and affordable. Availability means
    transparency in prices; affordability means--will be enhanced by
    transparency in pricing.
        And so there's a competing vision from one that says, let's let the
    Federal Government make decisions. It's one vision I strongly support
    because I believe--I'm one of these kind of persons that believes that
    people are plenty capable of making rational decisions and choices.
        We're here to talk about this--I mentioned the panel of folks. We'll
    start with Stephen Glick.
        Stephen Glick. Yes, good morning, Mr.
    President. Welcome to Connecticut.
        The President. Yes, it's good to be back here. Was born here, good
    to be back. [Laughter] Educated here. [Laughter]
        Mr. Glick. We love that.
        The President. Yes.
        Mr. Glick. Before I make my remarks, I'd like to have my wife, Sally
    Glick, and partner in the business stand up. She's in the middle of the
    row up there. Welcome.
        The President. That's a pretty good move. Smart guy, you know?
    Welcome, Sally.

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        Mr. Glick. Next to her is my son, Aaron,
    who is finishing his second year of law school--hopefully. [Laughter]
    And next to her is my daughter, Jamie Lombardi. Jamie is part of our
    team at CIT, and we welcome her.
        The President. Why don't you tell everybody what the CIT is.

    [At this point, Mr. Glick, administrator, Chamber Insurance Trust, made
    brief remarks.]

        The President. Good job. Skip the dating service thing. Anyway--
    [laughter].
        Mr. Glick. Do you know----
        The President. No, I don't, believe me. [Laughter] Look, I'm the
    funny guy; you're the--[laughter].
        Mr. Glick. Once in my life. [Laughter]
        The President. One of the interesting things about society is
    there's--sometimes people resist change, and part of the reasons I'm
    doing forums like this and part of the reason Steve does what he does is to help educate people about
    what's available.
        I strongly urge small-business owners to find out more about health
    savings accounts. I urge young people to find out about health savings
    accounts. It doesn't hurt to learn. And I think you'll find these to be
    very interesting opportunities. And one person who knows a lot about
    them is Dr. Bill West, entrepreneur.
        William J. West, Jr. Thank you very
    much, Mr. President.
        The President. Is that a true statement, ``entrepreneur''?
        Dr. West. Yes, absolutely.
        The President. Good. Sometimes ``doctor'' and ``entrepreneur'' don't
    go hand in hand. [Laughter]
        Dr. West. ``Businessman/doctor,''
    don't go hand in hand.
        The President. What kind of doctor?
        Dr. West. I'm a board-certified
    practicing ob-gyn, located in Redding, Pennsylvania. I'm actually a
    third generation----
        The President. Have you got a health care crisis in ob-gyns in
    Redding?
        Dr. West. Yes, we do.
        The President. A leading question--I knew the answer before he said it. [Laughter]
        Dr. West. We actually just lost
    eight more people practicing obstetrics in our hospital as of January 1.
        The President. We've got a serious national problem. The Senate
    needs to get rid of all this, you know, politics and focus on solving
    this problem. Different subject--go ahead. Sorry about that.

    [Dr. West, president and founder, First HSA, LLC, made brief remarks.]

        The President. So, like, you're making the pitch. What do you tell
    people about HSAs?
        Dr. West. They are not just for the
    healthy and wealthy; they work for everyone, including the chronically
    ill. They make total sense for everyone out there. It truly is
    consumerism.
        The President. Tell people why.
        Dr. West. Well, basically, you
    know, right now in the physician marketplace, there is no consumerism.
    People don't know what the cost of services are, and I don't know what
    the cost of services are. I might prescribe a drug that I have no clue
    it costs $20 a tablet, and it's taken every 4 hours. A one-week
    prescription could cost $600. Why don't I know that? Because I'm not
    paying for it. And usually the patient is not paying for it because all
    they have is a copay.
        That's the problem with the third-party system. We have a disconnect
    between the patient, the provider, and the true cost of those health
    care services. Health savings accounts reconnect the patient and the
    provider with the true cost. And we start to make wise decisions. We
    have increased use of generic medications. We shop around for services.
    Maybe an MRI costs a little bit more at this hospital versus that
    hospital. And we start to use----

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        The President. Just to make sure everybody understands--a health
    savings account is a combination of a high-deductible catastrophic plan,
    and the deductible is a cash account that earns interest-free. And the
    cash account is--as you'll hear later on--can be contributed by the
    individual, contributed by the company, can be contributed a combination
    of the worker and the company, can be contributed all different ways.
    But the shopping around is for the cash portion of a person's account.
        Dr. West. Absolutely. At First HSA,
    we provide a checking account which allows unlimited checkbook and Visa
    debit card access to the funds. Clients get monthly statements; they get
    the IRS reporting; they have 24-hour telephone banking. And they earn
    interest on the accounts, and those unused funds rollover from year to
    year.
        So if I had $3,000 in my account and spent 1,000, 2,000 plus
    interest rolls into the next year, and I can put an additional 3,000 in
    the following year.
        The President. What is important for people to understand is that
    when you combine the cash contribution plus the premium for the high-
    deductible insurance, it's less cost than the current insurance plans.
    That's important for people to understand. That's why we keep--I urge
    people to take a look. I mean, this is a cost-savings measure that has
    the additional benefit of connecting the consumer to the provider.
        Dr. West. Absolutely. And the
    consumer benefits from healthy lifestyle choices, as you stated earlier,
    and they financially benefit from that. As a physician, many times
    patients will come to me to want to stop smoking, and I'll write a
    prescription to stop smoking. The first question they're going to ask me
    is, ``Does my health insurance plan cover that?'' If the answer is no,
    they hand the prescription back to me because they're not financially
    incentivized to do that. In a health savings account, they take that
    prescription, they go get it filled, and they stop smoking because
    they're the ones who are going to benefit from that healthy lifestyle.
        The President. And they benefit because they don't spend--ultimately
    spend money on disease that would drain their savings account. The
    important thing for people to understand when they listen to the health
    savings account discussion is that the savings account is owned by the
    individual, and if a person changed jobs, for example, the savings
    account goes with the person. It's a part of a person's asset base. It
    is an integral part of a person's--and will be an integral part of a lot
    of people's future, to have this money stored up for health care needs,
    coupled with a high-deductible catastrophic plan in case something
    disastrous happens.
        How's your business going?
        Dr. West. It's been phenomenal.
    There's been exponential growth. I also wanted to let you know that we
    actually got a union to go 100-percent HSA as one of our clients, and
    they love the plan. They're really--our clients range from professionals
    to unions to formerly unemployed, uninsured workers, sole proprietors,
    entrepreneurs. We have them all.

    [Dr. West made further remarks.]

        The President. Information keeps people involved. Information is an
    integral part of consumers making rational decisions and choices.
        Dr. West. Absolutely. We've
    developed a personal electronic health record, where they can take this
    health record with them from doctor to doctor, so they have improved
    quality.
        The President. Explain to people what a personal health record is--
    an electronic personal health record.
        Dr. West. Basically, online, what
    they have access to is, they can put in all their personal health care
    information--all their diseases, their medications, past family history,
    social history--all those things are in the health record. They then can
    print it out and take that with them, or put it onto

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    their PDA or whatever, and take that with them to the doctor's office.
    Many times, when we first come into the doctor's office, what do we do?
    We have to fill out a new form saying, here's all my medical----
        The President. Unless you're not a very good writer.

    [Dr. West made further remarks.]

        The President. Things are changing. I think if you listen carefully
    to the doc, he's describing a different
    approach to health care that is consumer-centered. Now you've got to--in
    order to accept that as a rational way of approaching health care,
    you've got to trust people to make rational decisions. And I think our
    society should. I think the Federal Government should trust people to
    make good decisions. And, amazingly, what happens when that starts to
    happen is, you start seeing the rapid increase of price in health care
    begin to decline and people watching their--how they treat their bodies
    better.
        So thanks, doc. Thanks for being----
        Dr. West. Thank you very much.
        The President. Thanks for coming.
        Greg?
        Gregory B. Gravel. Good morning, Mr.
    President. Thank you. My name is Greg Gravel. I'm the president and
    chief executive officer of the Whitney Center.

    [Mr. Gravel made brief remarks.]

        The President. The Whitney Center, like you told me earlier, Aunt
    Marge?
        Mr. Gravel. Absolutely.
        The President. My grandfather's sister was----
        Mr. Gravel. We go back a long ways, sir.

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

        Mr. Gravel. We front-ended part of the
    HSA plan for our employees and continue to do so today.
        The President. Tell everyone what that means.
        Mr. Gravel. We actually put money into
    their account. As long as the employee were to contribute a like amount,
    we put $520 a year into their health savings account.
        The President. Right. So in this case, the deductibility is 1,040--
    --
        Mr. Gravel. Correct.
        The President.  Cash into the account that will earn interest tax-
    free, be withdrawn tax-free, was 1,040, half of which you paid and half
    of which the employee paid.
        Mr. Gravel. Correct. Correct.

    [Mr. Gravel made further remarks.]

        The President. What's the premium on the high-risk deductible plan?
        Mr. Gravel. It's about $4,500 for a
    single covered employee. The difference between 2004 and 2005, we were
    able to save $78,000 in our premiums; 2005 to 2006, we saw a 1.8 percent
    increase--1.8 percent, not point--not one-eight--not 18 percent but 1.8
    percent increase in our premium. When is the last time you have heard of
    your health care premium increasing by as little as that amount?

    [Mr. Gravel made further remarks.]

        The President. Good. Lin works with you?
        Mr. Gravel. Absolutely.
        Lin Onorato. My name is Lin Onorato. I am
    the assistant director of dining services at the Whitney Center. I am an
    HSA participant. I have a family plan.

    [Mrs. Onorato made brief remarks.]

        The President. Let me ask you something. People would say, well, you
    know, you can't possibly make rational decisions. I presume that, kind
    of, entering in the marketplace as a shopper, consumer is a little
    daunting at first----
        Mrs. Onorato. Definitely.
        The President. ----but when somebody is listening out there that
    says, ``I wonder

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    if I ought to try this,'' how would you encourage--I mean, obviously
    you're confident enough to talk about it sitting up here with the
    President--[laughter]--and you've gained a certain amount of experience
    in the process. What would you recommend to somebody who says, ``Well, I
    don't think I've got the capacity to go out and find out what's
    available''?
        Mrs. Onorato. It's real easy. You get from--
    we use ConnectiCare, and they give us their provider book, and you can
    go through, and you can ask your doctor questions and, ``How much will
    this cost?'' And you can call up different people and get the best price
    for your money without compromising quality.
        The President. See, this is a--change is hard. The old system was,
    ``Well, don't worry; somebody else will take care of it.'' There is a
    new opportunity that saves people money, actually earns people money.
    And I love the idea of Lin being able to say, ``I own my account.''
    Notice she emphasized the $800 that was unspent in the cash portion of
    the account--say, ``It's my money; I get to roll it over.''
        If something terrible were to happen, there is an insurance policy
    to take care--it's called the catastrophic aspect of this plan.
    She is in charge of making the decisions for her
    family. That bothers some people in Washington, DC. They don't believe
    she's capable of doing so. I do. But the benefit for society as a
    whole--this helps control costs and makes health care more available and
    affordable.
        And so I want to thank you for having the confidence to share this
    with us.
        Mrs. Onorato. Thank you for the opportunity.
        The President. Thank you for being here. Good job.
        Verna, are you ready?
        Verna Moran. Sure am.
        The President. Tell everybody what you do.
        Ms. Moran. First of all, I'd like to thank
    you for allowing me to be here today, Mr. President. And my name is
    Verna Moran. I'm vice president of human resources for the Seitz
    Corporation.

    [Ms. Moran made brief remarks.]

        The President. Let me stop you right there, if you don't mind.
    Sorry.
        Ms. Moran. Sure.
        The President. A lot of business people, small-business owners, when
    they're confronted with a 25-percent increase on a relatively high base
    decide not to offer people insurance anymore. That's why a lot of our
    citizens who work for small businesses do not have insurance. It's the
    working uninsured--many of the working uninsured are employees of the
    small-business company.
        What's important, however, is that 70 percent of new jobs in America
    are created by small-business owners. And therefore, if our small-
    business sector is weakened because of rising health care costs, it
    makes this country less competitive.
        Sorry to interrupt.
        Ms. Moran. Not at all. And with the 25
    percent--you can interrupt any time. [Laughter]
        The President. Maybe here but not at the house. [Laughter]

    [Ms. Moran made further remarks.]

        The President. The combination of the high-risk deductible--premium
    on the high-risk deductible, relative to their cost last year, enabled
    the savings from their cost last year to be--this company to contribute
    100 percent of the cash portion of the health savings accounts for their
    employee.
        Ms. Moran. Correct.
        The President. It's a pretty strong benefit for a small company to
    be able to do.

    [Ms. Moran made further remarks, concluding as follows.]

        Ms. Moran. So a healthy employee could, in
    fact, at the end of the year, have their

    [[Page 653]]

    whole deductible be rolled over in a future year.
        The President. And it's their money.
        Ms. Moran. And it's their money.

    [Ms. Moran made further remarks.]

        The President. It's an amazing story, isn't it? One hundred seventy-
    five employees?
        Ms. Moran. One hundred fifty employees, yes.
        The President. One hundred fifty employees, I just increased it a
    little bit. [Laughter]
        Ms. Moran. Well, that's all right because we
    plan to increase, so that's okay. [Laughter]
        The President. Oh, that's good. That's interesting. I bet you're
    more confident about expanding because all of a sudden, you've got a
    better handle on your health care costs.
        Ms. Moran. Exactly.
        The President. And I really strongly urge small-business owners to
    look at these products. And I find it amazing that Verna is able to describe a plan that is very innovative,
    employee-centered, and yet at the same time, she can say that we've
    saved money for the company.
        Ms. Moran. Absolutely.
        The President. Good job.
        Ms. Moran. Thank you. Thank you very much,
    Mr. President.
        The President. We've come to describe one way to approach health
    care. And it is to take care of the elderly and the poor and to
    encourage our fellow citizens to become directly involved in making
    health care decisions.
        I urge the Congress to look at ways to strengthen health savings
    accounts by making the tax deductibility fair, by expanding the size of
    the contribution levels that people can make, by making sure that health
    savings accounts are as portable as they possibly can be so that the
    worker, if he or she chooses to change jobs, can take the full account--
    insurance plus the savings--with him or her to a new job.
        The United States of America is constantly faced with different
    choices. And there are very important philosophical debates raging. And
    today you all heard one aspect of a very important part of a
    philosophical debate taking place, and that is how best to run the
    health care system. I've made my decision. I'm looking forward to
    continuing to have a consumer-driven system to be the heart of American
    health care.
        And I appreciate you all sharing your thoughts, and thank you all
    for letting us come and visit with you.

    Note: The President spoke at 11:01 a.m. at the Playhouse on the Green.
    In his remarks, he referred to Darrell Harvey, chair, Business Council
    of Fairfield County; and Mayor John M. Fabrizi of Bridgeport, CT.