[Public Papers of the Presidents of the United States: George W. Bush (2006, Book I)]
[May 1, 2006]
[Pages 836-844]
[From the U.S. Government Publishing Office www.gpo.gov]
Remarks to the American Hospital Association
May 1, 2006
Thank you very much. It was on this stage 2 nights ago that I had
the pleasure of showing up with a George W. Bush look-alike. [Laughter]
So I walked in, and Dick said, ``Is it
really you?'' [Laughter]
Thanks for your introduction, Dick.
Thanks for the invitation to be here. I want to, first, thank all the
good people of the American Hospital Association. I appreciate the
important voice that you provided for our hospitals, but more
importantly, I appreciate the compassionate care you give to our
citizens.
I have come to talk about a comprehensive health care strategy that
will make health care more affordable and available for all our
citizens. And I appreciate you giving me a chance to use this forum as
an opportunity to discuss our vision for moving forward.
I do want to thank George Lynn, who is
the chairman of the American Hospital Association board of trustees. I
want to thank all the trustees who are here. I appreciate the leadership
of the American Hospital Association. I want to thank the
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members of the American Hospital Association.
I understand--there he is--my friend Charlie Norwood is here. Good to see you, Congressman. Thank
you so much for being here. You're looking pretty good. [Laughter]
Looking real good, as a matter of fact. [Laughter]
This economy of ours is strong, and that's important for health
care. It's important for the hospitals. And the economy is getting
stronger. We put our trust in the American people by cutting taxes, and
the tax relief we passed is saving--is helping people save and spend and
invest. And when people save, spend, and invest, it causes our economy
to grow. Thanks to tax relief and progrowth economic policies, we're now
in our fifth year of uninterrupted economic growth.
In the first quarter of this year, the economy grew at 4.8 percent.
We've had 18 straight quarters of economic expansion. Last year our
economy grew faster than any other major industrialized nation. Over the
past 2\1/2\ years, we've created 5.1 million new jobs, and that's more
than Japan and the 25 nations of the EU combined. Productivity is high;
the unemployment rate is 4.7 percent; consumer confidence is at its
highest point ever--in nearly 4 years. The new economic report out today
contains good news on income growth.
Things are looking good for this economy, but we cannot be
complacent. One of my concerns is that the United States of America
loses our nerve, fears competition, and we become an isolated and
protectionist nation. And health care plays a vital role in making sure
this nation remains competitive.
One of the best ways to make sure that we're a competitive nation is
to continue to invest in research and technology. If America wants to be
the leader of the world, we've got to remain on the leading edge of
change. As many of you know, when I came into office, I pledged to
continue the doubling of the funding for the National Institutes of
Health, and we kept that commitment. And it's one of the many reasons
why our health care system leads the world. And we need to keep--we need
to understand the importance of research at the Federal level, and
that's why I have proposed that the United States Congress double
Federal investment in basic scientific research.
In other words, for this country to be competitive, we've got to
invest in the future. See, I don't think we ought to fear the future; I
don't think we ought to become protectionists and isolationists. I think
we need to continue to lead, and one way to lead is to lead in research
and development.
To keep this economy competitive with other nations around the
world, we've got to do something about our dependence on oil. Dependency
on oil creates an economic problem for us, and it creates a national
security problem for us. So I look forward to working with Congress to
change--to help speed up research and development so we can change our
habits, so we can drive cars fueled by ethanol, or so we can have
batteries that enable cars to drive for the first 40 miles on
electricity.
To keep this country competitive, we've got to have a health care
system that provides our people with good quality care at affordable
prices. In other words, you're a part of an industry that must be
reformed in order for the United States to continue to be an economic
leader.
America has the best health care system in the world, pure and
simple. We got the best medicines; we got the best doctors; and we have
the best hospitals. And we intend to keep it that way. Yet we are
challenged by the fact that health care costs are rising sharply. In the
past 5 years, private health insurance premiums have risen 73 percent.
And as a result, some businesses have been forced to drop health care
coverage for their employees. You know that as well as anybody. Others
have been forced to raise copayments and premiums.
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Some have been paying increasing health care costs and, therefore, have
been unable to give workers the pay raises they need to cope with rising
health care costs.
With rising costs, many Americans are concerned. They're concerned
they're not going to be able to afford health care. As you well know,
millions of our fellow citizens have no health insurance at all. And as
you know, that places burdens on our Nation's hospitals. This is
unacceptable, for this country to have health care costs rising as fast
as they are. If we want to be the leader of the world, we must do
something about it. And my administration is determined to do something
about it.
To make our health care system work for all Americans, we have to
choose between two philosophies: one that trusts government to make the
best decisions for the people's health care or one that trusts the
people and their doctor to make the best decisions for their health
care.
We know from experience which of these systems works best. Other
nations that have adopted for bigger government and more centralized
control now have long waits for treatment for their people. The quality
of care is lower; there's less technological innovation. In America, as
you know, we follow a different path. We lead the world in health care
because we believe in a system of private medicine that encourages
innovation and change.
And the best way to reform this health care system is to preserve
the system of private medicine, is to strengthen the relationship
between doctors and patients and make the benefits of private medicine
more affordable and accessible for all our citizens.
Government has a role to play; don't get me wrong. We're kind of--
we're big in the health care field, as you may know. [Laughter] We have
a major role to play in strengthening and reforming this health care
system, but in a way that preserves the doctor-patient relationship.
And that's what I want to talk to you about today. The first goal of
our health care strategy is to meet the obligation the Federal
Government has made to take care of the elderly and the poor. We have
said, as a Federal Government, we will help the elderly and the poor,
and I intend to keep that obligation. We're meeting that obligation,
that responsibility through Medicare, Medicaid, and community health
centers.
More than four decades ago, the Federal Government established
Medicare to provide health coverage for older Americans. The bill was
signed by Lyndon Baines Johnson. He came from a State I know pretty
well. [Laughter] When I came into office, I found a Medicare program
that was outdated, a Medicare program that was not meeting the needs of
America's seniors. The way I tried to explain it to the American people
was this: We had a system that would pay $28,000 for an ulcer surgery
but not the $500 it would cost for prescription drugs that would prevent
the ulcer from being--with taking hold in the first place. And that
didn't make any sense--$28,000 for the surgery but not a dime of
prescription drugs to prevent the surgery from being needed. To me,
that's an outdated system. It's one that's not very cost-effective, and
it's one that does not provide quality care for our seniors.
So I decided to do something about it. And I worked with the
Congress, and we passed critical legislation that modernizes Medicare
and provides seniors with more choices through the private sector and
has given our seniors better access to the prescription drugs they need.
The benefit allows seniors to choose from a number of private
prescription drug plans to find the one that is right for them. It
encourages plan providers to compete for the seniors' business, and that
helps lower costs. The new Medicare prescription drug benefit is a good
deal for America's seniors. The typical senior will end up spending
about half of what he or she used to spend on prescription drugs each
year.
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In addition, we've provided extra help for low-income seniors. About
a third of seniors are eligible for prescription drug coverage that
includes low or no premiums, low deductibles, and no gaps in coverage.
On average, Medicare will pay for more than 95 percent of the costs of
prescription drugs for low-income seniors. I know you shared my concern
when we heard the stories of low-income seniors having to choose between
food and medicine. And because of this reform, those days are over with.
The Medicare prescription drug benefit went into effect in January.
More than 30 million people now have prescription drug coverage through
the Medicare program, and hundreds of thousands more are signing up each
week. We want every senior who needs coverage to sign up.
The May 15th deadline for seniors to sign up at the lowest cost is
approaching. Over the next 2 weeks, this administration will encourage
our Nation's pharmacies--pharmacists and doctors and hospitals and
others in the medical community to continue to get the word out to
seniors about the benefits of this important program. There are some
seniors who are risk-adverse; they don't want to change. It is really
important for those of us who are involved in health care in this
country to get the word out that, at the very minimum, seniors ought to
look and see what's available. Americans need to take advantage of this
opportunity to choose a plan.
We're also--I also recognize that we got a problem with the long-
term viability of Medicare. Today the trustees for our Medicare and
Social Security systems will release their annual report. Each year the
trustees remind us that these programs are not structured in a way that
they will be financially sound for our children and our grandchildren.
The problem is pretty basic. There's a lot of baby boomers like me
getting ready to retire--[laughter]--in my case, 2\1/2\ years.
[Laughter] And there's a lot of baby boomers who are living longer, and
there are fewer workers per beneficiary paying money in the system to
support future retirees like me. And so the systems are going broke, and
now is the time to do something about it. We've got too much politics in
Washington, DC. It's time to set aside politics and restructure Social
Security and Medicare for generations to come.
We're honoring our Nation's commitments to take care of the poor by
strengthening Medicaid. Medicaid is a program administered in
conjunction with the States that provides health care for low-income
families with children, poor seniors, and disabled Americans. To help
improve Medicaid, earlier this year, I signed legislation to restructure
Medicaid and give States more flexibility in designing better programs
to cover their citizens.
Under the reforms I signed into law, it's now easier for States to
offer alternative benefit plans, provide coverage to more people, and
design their Medicaid program to meet their State's needs and budgets.
In the coming months, my administration will be encouraging States to
adopt commonsense reforms. Our health care system must be guided by the
needs of patients, not by rules emanating out of Washington, DC.
Another way we're meeting our commitment to Americans in need is
through community health centers. These centers provide primary health
care for the poor, so they don't have to go to the emergency room of a
hospital to get routine care. This is a really good use of taxpayers'
money. It makes a lot of sense to have community health centers so that
we can cut down on unnecessary visits to the emergency rooms. Health
centers help lower the cost of health care for everyone.
Since I took office, we've funded about 800 new or expanded health
centers, bringing our total to more than 3,700 health centers serving
more than 13 million Americans a year. And over the next 2 years, we
will fund the opening and expanding of 400 more health centers. And
Congress
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needs to fully support these health centers in the budget that I have
submitted.
And so we have got a strategy to take care and help our elderly and
the poor and the disabled. The second part of our strategy is to make
care and coverage more affordable and available for Americans. And here
are five key policies to support this goal.
Our first policy is to expand health savings accounts to help
improve health care and to help lower costs. Under the current system,
as you well know, most Americans have no idea what the actual cost of
their treatment is. Third-party insurers pay their bills, so patients
have no reason to demand better prices, and the health care industry is
under little pressure to lower prices. When somebody else pays the
bills, it seems like everything is just fine. The result is that health
care costs are skyrocketing. The insurance companies pass these rising
costs on to their workers--on to workers and their employees in the form
of higher premiums.
Now, health savings accounts transform what I believe is an outdated
system by putting patients in control of how their health care dollars
are spent. And when patients and consumers see how their health care
dollars are spent, they demand more value for their money. The result is
better treatment at lower costs.
HSAs have two components: low-cost catastrophic insurance coverage
and tax-free savings accounts. The catastrophic coverage protects you
and your family in the event of a devastating medical illness. The
health savings account allows your--or your employer to contribute to a
tax-free account to pay for your routine medical needs. The money that
goes into your account is tax-free, the interest earned on your account
is tax-free, and the money withdrawn from your account is tax-free. It
means that you own your money in your account, and that you can build
your savings by rolling over contributions that you do not spend in any
given year.
HSAs can help us move toward a health care system that is no longer
dominated by third-party payers, to a system in which consumers make
their own decisions. And we see strong evidence that HSAs are making
health care more affordable and accessible. From March 2005 to January
2006, the number of HSAs tripled from 1 million to more than 3 million.
This is a new product. People are getting--taking a look at it. They're
beginning to see the merits of a tax-free savings system coupled with
catastrophic care.
Forty percent of the people who bought HSAs have family incomes
below $50,000. HSAs are making health care more accessible for those
without insurance. More than a third of those who bought HSAs on their
own had previously been uninsured. HSAs are good for small-business
owners. HSAs, in my judgment, will mean that Americans who do not have
coverage will be able to get coverage and afford coverage, which is good
for America's hospitals. You see, by making health care coverage more
affordable, more Americans can afford insurance. And with more Americans
insured, fewer people will show up at our Nation's hospitals needing
uncompensated care.
HSAs also create an incentive for patients to become more informed
about their medical options and more involved in their treatment as they
shop for the best value for their health dollar. This involvement
strengthens the doctor-patient relationship.
Equally importantly is that HSA owners can see the benefits of
changing risky behavior. They can follow doctors' preventative
recommendations. The healthier you are, the less money you're going to
spend out of your savings account. And there will be a tangible return--
more of your own money, tax-free. Some employers are even offering
employees financial incentives to get regular checkups and lose weight
and
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get fit. By encouraging preventative medicine, HSAs save lives and save
health care dollars.
HSAs will benefit hospitals, doctors, and patients, and they can
also benefit hospital workers. Today, only a handful of hospitals offer
HSAs to their employees. I encourage the members of the American
Hospital Association to consider the benefits of offering health savings
accounts to your employees. HSAs will provide your workers with better
care and lower your health care costs.
For decades, America's hospitals and health care professionals have
led the world in innovation and quality medical care. Now you have an
opportunity to help America transform our health care system by choosing
the innovation and quality of health savings accounts. As HSAs continue
to grow in popularity, my administration is working to expand them to
even more Americans.
One way to make HSAs more attractive is to make them portable so
they can meet the practical needs of today's workers. Many people are
changing jobs, and one of their greatest fears is that they will lose
their health care coverage. We believe that no American should have to
remain locked in a job to get health insurance. Today, the savings in
your health account are portable, and that means you can take your
savings accounts from job to job. However, the health insurance within
your HSA account is often not portable, and this is because of outdated
laws and practices that prevent insurers from offering portable
policies. I believe health insurers should be allowed to sell portable
HSA policies nationwide.
Another obstacle to expanding HSAs is the Federal Tax Code. Under
current law, employers and employees pay no income or payroll tax on any
health insurance provided through the workplace. If you buy your own
insurance, you do not get the same tax break. That means that the self-
employed or the unemployed or workers at companies that do not provide
health insurance are at a great disadvantage. Congress needs to end this
discrimination in the Tax Code and give Americans who buy HSA policies
on their own the same tax breaks as those who get their health insurance
from their employers.
The current Tax Code also limits the amount you contribute to your
HSA tax-free. The limit is usually tied to your deductible. Sometimes
your total out-of-pocket expenses are greater than your deductible.
Those with chronic illnesses often have expenses that go well beyond
their deductibles. So we need to fix the Tax Code by allowing Americans
to cover their out-of-pocket expenses with tax-free dollars and make
HSAs even more practical for more American families.
In addition to these efforts to fix the code, I've proposed a
refundable tax credit to help low-income Americans purchase health
coverage on the individual market. Under my proposal, low-income
families can receive up to $3,000 in a refundable tax credit to purchase
HSA-qualified insurance. By working together, we can reform our Tax Code
and make it easier for American families to get health care.
And this week, Congress takes an important step in these efforts.
Congressman Eric Cantor of Virginia will
introduce a bill that would end many of the biases in the Tax Code,
provide a tax credit of up to $3,000 for low-income families, and make
HSAs more attractive. It's a bill called the ``Tax-Free Health Savings
Act.''
I also want to thank Senators Burns and
Allen, Ensign, and
DeMint for introducing bills to improve HSA
options for all Americans and Senators Santorum and Murkowski for introducing
legislation supporting the low-income tax credit. Congress needs to pass
these reforms and make sure the doctor-patient relationship remains
central to our health care system.
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The second policy for making health care more affordable and
accessible is to increase transparency in our health care system. To be
smart consumers, we need to be informed consumers, and this is
especially true for patients with HSAs who have an incentive to spend
their HSA dollars wisely. They need to know in advance what their
medical options are, the quality and expertise of the docs and the
hospitals in the area in which they live, and what their medical
procedures will cost.
My administration is working with the AHA and other health care
associations to provide patients with reliable information about prices
and quality on the most common medical procedures. And I want to thank
the AHA board for adopting a resolution this week supporting
transparency. I appreciate your leadership on this vital issue.
We must work together to get patients the information they need so
they can get the best quality care for the best price. If you're worried
about increasing costs, it makes sense to have price options available
for patients. That's what happens in a lot of our society; it should
happen in health care as well. By increasing transparency, the idea is
to empower consumers to find value for their dollars and to help
patients find better care and to help transform this system of ours to
make sure America remains the leader in health care.
Secretary Leavitt has met with
leaders in the health care industry in 13 cities to encourage them to
work with the Department of Health and Human Services to increase
transparency in the marketplace. We're asking doctors and hospitals and
other providers to post their walk-in prices to all patients.
I directed the Department of Health and Human Services to make data
on Medicare's price and quality publicly available on the Internet. The
first data will be available to all Americans by June 1st. We're also
asking insurance companies to increase health care transparency by
providing their negotiating prices and quality information to their
enrollees. And the Federal Government will do the same. My
administration will be requiring transparency from insurance plans
participating in Federal programs. Beginning this year, the Federal
Employees Benefit Program and the military's Tricare system are asking
contractors to begin providing price and quality information.
Today I'm asking for your help. Every hospital represented here
should take action to make information on prices and quality available
to all your patients. If everyone here cooperates in this endeavor, we
can increase transparency without the need for legislation from the
United States Congress. By working together, transparency--to increase
transparency, we can help lower costs.
Third policy is to provide modern information technology to our
medical system. Too many doctors' offices and hospitals have the most
advanced technology in the 21st century but still use last century's
filing systems. Doctors are still writing out files by hand, and that's
kind of dangerous because most doctors don't write too well. [Laughter]
In hospitals, there's more risk of medical error and duplicate tests
when records are handwritten on paper instead of cross-checked on a
computer.
So in 2004, I set a goal that most Americans would have an
electronic health record within 10 years. And we're making good progress
toward that goal. The first thing is, we needed to develop a common
standard of language so that health care providers in Los Angeles and
health care providers in New York knew what the--knew what we are
talking about.
Imagine how valuable this access to information will become. If you
had someone who had an epileptic seizure outside their hometown and
ended up in a hospital in a nearby town, these electronic records would
help save lives. Information would be valid and clear. There wouldn't be
any
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confusion amongst those who are working hard to provide compassionate
care.
As we develop an information network--nationwide information
network, we will make sure that we protect the privacy of a patient's
medical record. But make no mistake about it, bringing information
technology into our health care system is going to reduce costs and
increase quality care for American people.
And I hope you're aggressive on this front. I urge you to work with
the AHA to come up with a plan to help develop a nationwide information
system that is modern and helps you do your job better.
Fourth policy is to make it easier for small businesses to obtain
the same discounts that big companies get when obtaining health care
insurance. Unlike big businesses, small companies cannot negotiate lower
health insurance rates because they can't spread their risk over a
larger pool of employees. So we proposed association health plans that
will allow small firms to band together across State lines and buy
insurance at the same discounts available to big companies. The House
has passed a bill. The Senate hasn't acted, and now it's time for the
United States Senate to do something good for the small-business
employers of this country.
Our fifth policy to confront high-cost health care and to make sure
private medicine is central in the United States is to confront the glut
of frivolous lawsuits that are driving good doctors out of practice and
driving up the cost of health care. To avoid junk lawsuits,
professionals in the health care field are forced to practice defensive
medicine. They order tests and write prescriptions that are not
necessary so they can protect themselves from trial lawyer lawsuits. One
hospital CEO in New York said, ``Fear of liability does nothing but
threaten patient safety by discouraging open discussion of medical
errors and ways to prevent them.''
The total cost of defensive medicine to our society is estimated at
60 to a 100 billion dollars a year, and that includes $28 billion billed
directly to the American taxpayers through increased costs of Medicare,
Medicaid, Veterans Affairs, and other Federal health programs. The costs
of frivolous litigation are more than financial; they hurt patients all
across America.
Most Americans are shocked when I cite the fact there are nearly
1,500 counties in the United States without an ob-gyn. We want our
doctors focused on providing compassionate care, not fighting junk
lawsuits. We want our hospitals pursuing innovative and promising ways
to heal, not battling lawyers who second-guess them in the courts. This
is a national issue that requires a national response. The House of
Representatives have passed a good bill; the Senate has done nothing on
medical liability reform. For the sake of affordable and accessible
health care, we need medical liability reform this year.
I'm looking forward to working with the Congress to enact these
reforms. This is a commonsense way of dealing with rising health care
costs. And by dealing with rising health care costs, we will strengthen
private medicine and fight off the calls of those in Washington, DC, who
want the Federal Government making all the decisions for health care.
The story of America's hospitals is a story of America's commitment
to be a nation of care and compassion. America's strength and its
goodness and prosperity is built on a trust in the extraordinary wisdom
and power of the American people. And so I believe that by giving more
Americans more control over their health care decisions, we will
strengthen the doctor-patient relationship, and we will preserve the
system of private medicine that has made our Nation's hospitals and
health care the best in the world.
People here in Washington need to trust the people. People here in
Washington need to do commonsense things to address the rising costs of
health care. And this person in Washington has come to thank
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you for your compassion and what you do for the communities all around
America. May God continue to bless your work, and may God bless our
country. Thank you.
Note: The President spoke at 1:17 p.m. at the Washington Hilton Hotel.
In his remarks, he referred to Richard J. Davidson, president, American
Hospital Association.