    [Public Papers of the Presidents of the United States: George W. Bush (2006, Book II)]
    [August 22, 2006]
    [Pages 1543-1552]
    [From the U.S. Government Publishing Office www.gpo.gov]

    Remarks in a Discussion on Health Care in Minneapolis, Minnesota
    August 22, 2006

        The President. Thank you very much. Thank you. Please be seated.
    Thank you for coming. Thanks for the warm welcome. We've got some work
    to do. [Laughter]
        Thanks for being here today. And I want to thank our panelists for
    joining Secretary Leavitt and me to talk
    about health care. And before we do, I want to say a couple of words
    about some of the guests here. First, I'm real proud to be here with
    your Governor, Tim Pawlenty. Governor, thanks
    for being here. Senator Norman Coleman is with
    us. Senator, thanks for coming. Three Members of the Congress--Jim
    Ramstad, whose district we're in; Mark
    Kennedy is with us; John Kline is with us. Thanks for coming.
        We've got members of the statehouse here. We've got local
    officials--Mayor Jan Callison, the mayor of--
    Mayor, thanks for coming. This is the 50th anniversary of Minnetonka,
    right? Yes, good. Congratulations. Wait until you turn 60. [Laughter]
    It's not as old as it sounds. [Laughter]
        We're going to have an interesting dialog today. I'm going to sign
    an Executive order after a while, but I want to explain why we're
    signing the Executive order to you.

    [[Page 1544]]

    We've got an interesting debate in health care in America. And I guess
    if I had to summarize how I view it, I would say there's a choice
    between having the government make decisions or consumers make
    decisions. I stand on the side of encouraging consumers. I think the
    most important relationship in health care is between the patient and
    their provider, the patient and the doc. [Applause] Thank you. And
    health care policy ought to be aimed at bolstering the consumer.
    Empowering individuals to be responsible for health care decisions is
    kind of the crux about what we're talking about.
        Obviously, all of us are concerned about costs. You know, I hear it
    a lot. We talk about--we'll hear from Jane Brown here, who helps those who need help here in your
    community. She says health care costs oftentimes make it hard for people
    to buy food. You talk to small-business owners and one of the big
    concerns they have is the cost of health care, that many, in order to
    stay in business, you know, have to say to their employee, ``You provide
    for yourself.'' And that's troubling. It's troubling. It doesn't matter
    what your political party is; it's an issue that needs to be addressed
        And so the fundamental question is, how do you address cost, given
    the philosophy that I've just described to you? And so here are some
    ideas I'd like to share with you.
        One way to help small businesses address the cost of rising
    insurance is to allow them to pool risk across jurisdictional
    boundaries. In other words, if you're a restaurant in Minnesota and
    you're a restaurant in Texas, you ought to be allowed to pool your
    employees into a employee risk pool so that the insurance is lower
    because of the spreading of risk. Those are called association health
    plans. One idea to--that says basically, the small-business owner will
    be in charge of the health care for his or her company--is to encourage
    association health plans.
        Another idea is to make sure that--let me take a step back. There is
    a very important role for the Federal Government in health care. And
    that is to provide for the elderly and the poor. One of the things that
    Mike and I have worked on, and I hope
    some of you have helped with, is to encourage seniors to take a look at
    the new Medicare drug benefit. I was very concerned that Medicare had
    gone stale, and it needed to be reformed. Medicare is a vital program,
    and it's an important Federal program. And it worked.
        The problem is, medicine had changed and Medicare hadn't. Medicare
    would pay, you know, $100,000 for an operation but not a dime for the
    prescription drugs that would prevent the operation from being needed in
    the first place. And it didn't make any sense. It didn't make any sense
    to the seniors, nor did it make any sense to the taxpayers. So we've
    changed Medicare. And if you're a poor senior in America, the Government
    is going to really help you with prescription drugs. And if you're not a
    poor senior, you'll save a half on your drug--prescription drugs. It's a
    good deal.
        The Federal Government has also got a role in helping the poor
    through Medicaid. And one of the tasks that I've given to Michael
    Leavitt is to say to the Governors, ``You
    should have the flexibility necessary to design a Medicaid program that
    meets the needs of your citizens.''
        Now, having said that, here's what we need to continue to do in the
    private sector. One of the problems to make sure health care is
    affordable and available is the legal system. And, look, it's out of
    kilter. We want everybody to have justice. But unfortunately,
    particularly in medicine, there are too many frivolous and junk lawsuits
    that are running good doctors out of practice and running up the cost of
    medicine. Do you realize that in order to avoid lawsuits, many doctors
    practice what's called defensive medicine? In other words, they
    prescribe medicines that may not be necessary or procedures that may not
    be necessary, just in case they get hauled into

    [[Page 1545]]

    the court of law. As a matter of fact, it's estimated that the defensive
    practice of medicine costs your Federal Government, costs you, the
    taxpayer, $28 billion a year.
        Now, when I first went to Washington, I said, ``Well, this is an
    issue that ought to be solved at the State level,'' until I realized the
    budgetary impact that these lawsuits are having on you, the taxpayer.
    And so I went to Congress and worked with the House, and we got a good
    medical liability reform law out of the House. Unfortunately, it's stuck
    in the Senate. The trial lawyers are tough in Washington, by the way.
    They really don't want to see medical liability reform. But if you're
    interested in making sure the system works, if you want people to have
    access to affordable health care and have doctors that are around to
    practice to begin with, you need to have strong medical liability reform
    in order to make the health care system work.
        Thirdly, have you ever watched how these files work in medicine?
    We're going to talk to Dr. Dean here in a minute.
    Her penmanship is probably pretty good--[laughter]--but most doctors
    don't write too well, and yet they write a lot in files. What I'm
    telling you is, medicine is really behind the times when it comes to
    information technology. And one of the things we'll talk about here is
    how to use information technology to wring the costs out of medicine and
    yet be able to deliver good quality care to our citizens.
        It's estimated that between 25--that we can reduce costs by 25 to 30
    percent with the advent of what we call medical--electric medical
    records, so each person has got their own electronic medical record that
    you've got data on. In other words, we'll be passing information from
    provider to provider via the Internet, via new technology as opposed to
    handwritten files that are carried from one office to the other. We're
    going to spend some time talking about that. It is a practical way to
    help control medical costs so people have got health care that's
    available and affordable.
        Fourthly, we've got to make sure that we have plans that encourage
    consumer saving, in other words, insurance plans, products for people to
    be able to use in order to get health care that encourages savings. One
    idea is health savings accounts. These are plans where you buy a high-
    deductible catastrophic plan. You contribute money tax-free, but you're
    the consumer, you're the decisionmaker when it comes to health care. You
    decide. You decide what doctor you see.
        Think about the system today as a third-party payer. How many of you
    have got insurance, and you never really cared about the cost because
    somebody else is paying the bill, right? You don't really care about the
    quality because some person in an office somewhere is paying the bill on
    your behalf. It's called a third-party payer system. It's the prevalent
    system today.
        One of the things we're trying to encourage is the design of new
    opportunities for citizens to be able to get quality health care where
    they're in charge of the decisionmaking, that encourages people to make
    rational savings. If we have more consumer involvement in health care,
    then it makes sense--if that's the goal--then it makes sense to make
    sure that consumers have got rational data from which to make choices.
    And that's not the case today in medicine, really, when you think about
    it.
        I don't know how many of you all have ever said, ``Gosh, I wonder
    how much this procedure is going to cost me,'' or, ``Before I go to see
    this person, I want to know how much it costs,'' or, ``Maybe I need to
    know what this hospital charges.'' I doubt many of you have done that. I
    think the new trend in medicine is going to be to encourage transparency
    in pricing as well as transparency in quality. And that's the subject of
    today's discussion. How do we encourage consumerism. What do you do?
    Well, one thing you do is you make sure people understand their options,
    how much something costs. And if they decide to make a purchase, what do
    they expect;

    [[Page 1546]]

    what are the expectations from the consumer?
        The Federal Government has got a lot to do with this because we
    spend a lot of money in health care, when you really think about
    Medicaid and Medicare, veterans' benefits, Department of Defense. And
    one of the initiatives Mike is now going
    to undertake is to say, ``In order to do business with the Federal
    Government, you've got to show us your prices and you've got to help us
    develop a qualitative standard so the people that we're trying to help
    know what they're getting.''
        And so here are some practical ways to address the rising cost of
    medicine. These are ways that basically say, we want you, the consumer,
    in charge, that there is such thing as a market, and that markets
    function. You remember Lasik surgery, eye surgery? It's a place where--
    it was a procedure that cost a lot of money when it first came on, and
    yet there was quite a bit of competition. People said, ``Look, I'm good
    at this. Why don't you come to my shop?'' Or you noticed docs were
    advertising; all of a sudden, the cost of laser surgery has dropped
    precipitously. It's now affordable procedure. Markets work when
    consumers have got options to make in the marketplace.
        And that's what this Executive order is going to do. I'm going to
    have Mike describe the Executive order to
    you here in a minute. But it's an order that basically commits the
    Federal Government to work with State and local and docs and hospitals
    to lead the way, to be a part of this new movement about transparency in
    pricing and quality.
        Have I done it all right?
        Secretary of Health and Human Services Michael O. Leavitt. You've done a good job, Mr. President. [Laughter]
        The President. That's what he's
    supposed to say.

    [At this point, Secretary Leavitt made brief remarks.]

        The President. There's a lot of savings, by the way, when you're not
    writing things down on paper. Just ask some of the more modern
    businesses here in Minnesota, where your unemployment rate is, like,
    really low because of the productivity of your companies. One reason why
    is, they use information technology.
        Sorry, Secretary.

    [Secretary Leavitt made further remarks.]

        The President. Yes. Why don't you talk to them about electronic
    medical records? I didn't do a very good job of describing it.
        Secretary Leavitt. When----
        The President. I'll give it a stab, and then you come back in.
        Secretary Leavitt. All right. Got
    you. [Laughter]
        The President. So one of these days, you're going to have all your
    medical records on a little key that you can then plug into a computer,
    and all of a sudden, information is at the provider's fingertips, which
    makes the system a lot more efficient, which means less costly, but also
    saves on medical errors. But the problem we face is that the--we've got
    to develop a standard language. Medicine is a fairly complicated--got a
    complicated dictionary, let's put it that way. So what's the procedure
    on that, Mike?

    [Secretary Leavitt made further remarks, concluding as follows.]

        Secretary Leavitt. My mother went to
    the doctor the other day. She told me that she filled out her name,
    address, insurance company name, birth date, telephone number--seven
    different times. Now, that's not necessary----
        The President. My mother wouldn't have been
    so patient as your mother. [Laughter] I hope
    she's not watching. [Laughter] Good job, Michael.
        Michael Howe is an interesting character
    here. He is an entrepreneur who's come

    [[Page 1547]]

    up with a unique idea on how to help people have affordable and
    available health care.
        Michael, did you start your deal--like, are
    you the classic entrepreneur, start in the garage?
        Michael Howe. No, actually, I have to give
    credit; there were other groups. There were physicians and entrepreneurs
    that devised the mechanism, devised the innovation that MinuteClinic
    really represents.
        The President. Okay, well, tell people what MinuteClinic is. If you
    haven't heard about it, it's worth listening.

    [Mr. Howe, chief executive officer, MinuteClinic, made brief remarks.]

        The President. What's process management? Tell people what that is.
        Mr. Howe. Well, the interesting thing is,
    you can go through, and when you do something--strep test, a strep
    throat test--if you do thousands of strep throat tests, you can----
        The President. You've got a problem, if there's thousands of strep
    tests. [Laughter]
        Mr. Howe. You do. You have a problem. But
    you also have an opportunity.
        The President. Yes, right. Okay. [Laughter] That's the spirit.
    [Laughter] Sorry. Go ahead.
        Mr. Howe. No, no, it's all right. You have
    an opportunity to measure the effectiveness of one provider versus the
    next. You have an opportunity to measure treatment protocols.

    [Mr. Howe made further remarks.]

        The President. So do you have one in a shopping mall?
        Mr. Howe. Absolutely. We have one in the
    Eden Prairie Mall right over here in Minnesota.
        The President. Really? Isn't that interesting?
        Mr. Howe. And the idea----
        The President. A person walking down there looking, and says,
    ``Here's the--if you need help, here are the costs.''
        Mr. Howe. That's right.
        The President. Posted right there for them to see on----
        Mr. Howe. Absolutely. And to compare it to
    where they go. It's also right-sized. And what I mean by that, it's a
    small facility. It's focused on a very specific scope of practice;
    common family ailments that some estimates are as high as 40 percent of
    the medical visits in today's society, are covered by these conditions.
        So this is an opportunity to provide a higher quality care,
    transparent pricing, but also much more affordable. Our prices are 40 to
    50 percent of what it would cost anywhere else.
        The President. And are people going?
        Mr. Howe. Well, in the last 6 years, we've
    completed 500,000 patient visits; we've had no malpractice claims;
    consumers tell us that their patient satisfaction runs between 97 and 98
    percent; 99.6 percent of our patients tell us they'd use the service
    again, refer it to family and friend. Clearly, the providers we selected
    do a tremendous job making the emotional connection that delivers the
    end result that we're really looking for.

    [Mr. Howe made further remarks.]

        The President. Well, in order to have electronic medical records,
    there has to be a standardization in medicine to begin with.
        You know, it's interesting, isn't it? It's an interesting idea he
    had, and it's meeting a consumer need. That stands in stark contrast to
    the government making the decisions for you, is to make different
    options available to patients. And you're providing health care at a 40
    percent or 50 percent----
        Mr. Howe. It's half the cost.
        The President. Yes, it's great. Thanks for doing what you're doing.
    And you're in other States?
        Mr. Howe. Yes, we have 86 clinics across 11
    States at this point. We anticipate some very significant growth over
    the next few years.

    [[Page 1548]]

        The President. Yes, you ought to.
        Mr. Howe. We're going to drive them very
    hard.
        The President. Nothing better than being with an entrepreneur, isn't
    it? [Laughter] Thanks, Michael.
        Marilyn, thanks for joining us.
        Marilyn Carlson Nelson. Delighted
    to be here.
        The President. We're thrilled you're here--chairman of the board,
    CEO of one of Minnesota's great companies, Carlson Companies. Thanks for
    joining us. What's on your mind?
        Ms. Carlson Nelson. Well, first
    of all, I want to say thank you. I think we've been waiting at Carlson
    and in this community for about 20 years to hear what we've just heard,
    and that is inoperability, standards, quality standards, incentives.
        At Carlson, we've worked with the Business Health Care Action Group
    for--I think we started almost 20 years ago now--to look at how to
    incentivize providers to have more transparency. We've worked on
    involving and engaging our employee base in preventative--various kinds
    of preventative activities. But recently we've put in several
    innovations--one, I have to say, a MinuteClinic in our headquarters.
        The President. You saved 50 percent, I hope? [Laughter]
        Ms. Carlson Nelson. Actually, we
    did the research. It looked as if a cost to us and our employees was
    about $40 to $50 through MinuteClinic for this certain set of services;
    it was, like, $100 in the doctor's office and dramatically more than
    that in the emergency room, where a lot of people end up going for that
    kind of care.

    [Ms. Carlson Nelson, chairman of the board, chief executive officer, and
    president, Carlson Companies, made brief remarks.]

        The President. This is an issue that we're focusing on the core
    problem, and that is, we're dealing with an industry that really is not
    modern, that needs help in the legal profession, and that needs more
    consumerism. You know, you mentioned preventative health. Nothing that
    will cause somebody to take good care of their body than a--than having
    an insurance program that encourages savings. You make rational
    decisions and you exercise and you don't smoke and watch your drinking;
    it's amazing how your health improves. If you walk 2 miles every day, it
    really makes a big difference.
        And if you have policies that say there's an incentive for you, you
    benefit from making that kind of rational decision, you monetarily
    benefit--like the health savings accounts, it helps with prevention. If
    people really watched what they ate, it's amazing how health care costs
    would also go down in America as well.
        Yes, Michael.
        Secretary Leavitt. Mr. President,
    there is--this is a good thing for our health, and it's a good thing for
    the system. It's also an economic imperative that we do it.
        The President. Yes.
        Secretary Leavitt. What Ms. Carlson
    suggested, I'm hearing from employers all over the country. Health care
    is now 16 percent of our gross domestic product, and it's headed for 20
    percent. And there's really not a place on the economic leader board for
    a country that continues to spend more and more and more in one sector.
        I was looking at the--and it's hitting consumers. I was looking in
    my home State at the teachers. They've got the largest increase----
        The President. What is your home State?
        Secretary Leavitt. That's Utah, by
    the way. [Laughter] And yet the teachers, many of them, end up having
    less take-home pay because of the cost of health care.

    [Secretary Leavitt made further remarks.]

        The President. Jim Chase. What do you do, Jim?
        Jim Chase. Well, Mr. President, I work with an
    organization here in Minnesota that's been working on many of the things
    that you and Secretary Leavitt have talked

    [[Page 1549]]

    about, and we're quite excited to have you here today.

    [Mr. Chase, executive director, MN Community Measurement made brief
    remarks.]

        The President. And so, like, what is your group--what's the name of
    your group?
        Mr. Chase. We're called Minnesota----
        The President. I know, but--[laughter].
        Mr. Chase Minnesota Community Measurement.
    We're a non-profit that's been together for about 3 years.
        The President. Really? And so the local folks came together and
    said, ``Let's give old Jim some work and figure
    out how to do--[laughter]--have a health care system that works well.''
        Mr. Chase. My work came later. [Laughter] But
    I think what's exciting is that we're actually seeing some changes now.
    Being able to measure this, we're seeing the results change. And it's
    very encouraging, I think, for the providers out there who are--that's
    what they were in this for, was to find ways to treat their patients
    better.

    [Mr. Chase made further remarks.]

        The President. So, like, how many community measurement groups are
    there in the country, do you suspect? It sounds like it's pretty unique.
        Mr. Chase. Yes. There are several that have
    started. In fact, we're pleased to be working with Secretary Leavitt in
    the Ambulatory Quality Alliance that has formed nationally, that are
    bringing together, to start with, six sites around the country that are
    in various stages of pulling together this kind of information.

    [Mr. Chase made further remarks.]

        The President. Good work. Thanks. It must be exciting to be, kind
    of, on the leading edge of substantial change.
        Mr. Chase. It keeps us busy. [Laughter]
        The President. That's good. I know the feeling. [Laughter]
        We are joined by Dr. Laura Dean, ob-gyn. I
    will start off by telling you a startling statistic: There are 1,600
    counties in the United States without an ob-gyn. I mean, we're talking
    about availability and affordability; obviously, 1,600 counties have got
    a serious problem.
        Thanks for hanging in there.
        Laura Dean. You're welcome.
        The President. A lot of ob-gyns are leaving the practice because
    they're getting sued out of existence, pure and simple. I can't put it
    any more plainly than that. If you want to have ob-gyns in America, we
    need medical liability reform to protect these good people.
        Step up, Doc. How long have you been
    practicing?
        Dr. Dean. I've been practicing obstetrics and
    gynecology for 10 years in the community of Stillwater, and I've
    delivered more than 1,500 babies.
        The President. Really?
        Dr. Dean. Yes, sir.
        The President. That's good. [Laughter] What's on your mind?
        Dr. Dean. Well, I--certainly, as a physician,
    my goal is to help my patients make good decisions about their health
    care. And I'm excited about what you're here to talk about today,
    because I've been providing them with all kinds of medical information
    to help make decisions, but the financial piece has been missing. And
    people need that piece in order to make good and whole decisions.
        The President. So, like, are you going to put on the window, you
    know, Dr. Laura Dean, 100 bucks? [Laughter] How
    does it--are you an individual practitioner?
        Dr. Dean. I'm in a group practice with family
    practice doctors, other ob-gyns, internists, pediatricians.

    [Dr. Dean, ob-gyn, Stillwater Medical Group and Lakeview Hospital, made
    brief remarks.]

        The President. See, it's interesting, isn't it--kind of a mindset
    change. It used to be you'd go in and just take whatever they gave you,
    because somebody else is paying

    [[Page 1550]]

    the bill. And if we can get a system down where people are able to have
    a good program, a good product, good insurance, but where the consumer
    has more to say with what's purchased or not, all of a sudden, the
    dynamic begins to change and costs begin to go down. You know, the good
    doc here volunteered to us all you don't need
    this procedure.
        That cost--that saves money over time. The whole system benefits if
    we have a thousand providers making that same decision on an hourly
    basis. And so what Laura is saying is, if
    consumers have more information from which to make decisions, all of a
    sudden, costs begin to become less of a burden on the system, I think is
    what you're saying.
        Dr. Dean. Absolutely.
        The President. Lawsuits bothering you? Obviously, look, I led the
    witness. [Laughter] Not even a lawyer, and I led the witness. [Laughter]
        Dr. Dean. Certainly it is something looming
    over the heads of physicians every day, the thought about lawsuits,
    really--maybe ordering tests to protect yourself and to make sure. I
    have many colleagues similar in age to me, which is not real old yet, in
    practice of medicine----
        The President. Twenty-seven. [Laughter]
        Dr. Dean.  ----who have stopped delivering
    babies, who have stopped performing surgery.
        The President. It's a problem; you've got a problem. It is a problem
    when society starts losing good souls that otherwise would be ob-gyns.
    It's a real problem, and we better do something about it. It's one thing
    to have good law; we want good law. But these frivolous lawsuits are a
    real problem for the people of Minnesota and all across the United
    States. It's serious business. These trial lawyers need to back off, and
    these politicians in the United States Senate, people like
    Coleman, need to step up. And he will.
    [Laughter] And he has.
        No, he's been strong; he's been strong on
    medical liability reform. I'm not trying to turn this thing into a
    political deal. I'm just telling you, for the sake of this country, for
    the sake of good medicine, we better get some good medical liability
    reform out of the United States Senate.
        Thanks, Dr. Dean.
        Dr. Dean. Thank you.
        The President. Thanks for practicing. One of the wonderful things
    about America is our health care providers are fantastic people. They
    really are decent, honorable people who've answered a higher calling.
    And we appreciate--[inaudible].
        Dr. Dean. Thank you. Thank you, sir.
        The President. Speaking about a higher calling, Jane Brown, executive director, Second Harvest Heartland.
    Has anybody ever heard of Second Harvest Heartland? Good. So you don't
    need to tell them what you do. Actually, you're feeding people who need
    help.
        Rachel ``Jane'' Brown. That's
    correct, sir.
        The President. Actually, if people need--I presume it's okay for me
    to say, you could use some contributions?
        Ms. Brown. Oh, my, yes. That's a
    wonderful thing for you to say. [Laughter]
        The President. Seriously. I know Marilyn will help you. [Laughter]
        Ms. Brown. Thank you for that.
        The President. She has.
        Ms. Carlson Nelson. Yes.
    [Laughter]
        The President. She has been
    helping, as has corporate Minnesota.
        Ms. Brown. Yes, corporate
    Minnesota has been very good to us. And the Carlson Companies are
    wonderful.
        Second Harvest Heartland is a food bank, and we have 800 agencies
    that get their food from us, so every little bit helps, so thank you for
    that.
        The President. Yes. Well, we were talking--actually, the reason that
    this subject came up is I was asking her whether or not she had enough product to help people who need
    help, and the answer is, never enough.
        Ms. Brown. Never enough, no,
    nowhere near enough yet.

    [[Page 1551]]

        The President. Yes. But you've done some interesting things through
    health care.
        Ms. Brown. We have. We have--
    Marilyn and I were contrasting--she has a huge company; there are 76
    employees at Second Harvest Heartland and 66 who receive their health
    insurance through our organization. And this last year, we offered an
    HSA for the first time as one of the options, and 15 percent--or 10 of
    those employees--opted to take it. And I'm one of those who opted to
    take it.
        The President. Everybody understand what that is? It's, again, a
    high-deductible catastrophic plan, and that the person and/or company
    can put money in tax-free to cover up to the deductible.
        Ms. Brown. That's great.
        The President. Which actually saves money.
        Ms. Brown. It saves money. It does
    so many things, and that's why we've chosen it.

    [Ms. Brown made brief remarks.]

        The President. And you contribute into the savings account?
        Ms. Brown. Yes. As the employer,
    yes, we do.
        The President. One hundred percent?
        Ms. Brown. No. It's a shared
    responsibility, and that's very important, that there's a shared
    responsibility in that.

    [Ms. Brown made further remarks.]

        The President. Right, right. This is a--Jane has given her employees a very interesting option,
    and that is a consumer-driven plan where there is a incentive to save,
    to be a good shopper, and to make rational choices about how you live
    your life. And if you live a healthy lifestyle, you're going to spend
    less money out of the money she has contributed into their health
    account. But the money is yours. In other words, there's a catastrophic
    plan available; you may pay the first 3,000--the $3,000 is on the
    company, and anything above $3,000 goes to the insurance company.
        So you can see, if you don't spend the $3,000, and you're able to
    roll it over, tax-free, and then there's another 3,000 contributed next
    year, and you roll over money you save, pretty soon you've got a good
    health savings account, because the Government doesn't tax any of it. It
    doesn't tax the money going in; it doesn't tax the earnings; and it
    doesn't tax the money coming out.
        And if you change jobs--by the way, which is an interesting
    statistic in our society today. Somebody told me the other day that
    people change jobs about eight times before they're 32 years old. That
    wasn't the case when we were growing up.
        Ms. Brown. No, it wasn't.
    [Laughter]
        The President. Anyway, doesn't it make sense to have a plan that you
    can carry with you? That's called portability. And so what Jane has provided her employees is something that
    encourages consumerism but also helps meet their needs, and that's what
    medicine has got to do. It's got to meet the needs of the consumer, not
    the government. And that's what we're talking about, innovative ideas,
    innovative ways to help control costs in health care.
        And I hope you've gained something from this conversation. At the
    very least, please leave with the notion that we're thinking
    differently, because you need to think differently. The system right now
    needs reform and needs to be fixed. And you're fortunate in the State of
    Minnesota that you've got leadership at the State and local and the
    corporate and individual level that is willing to think differently to
    help a new system evolve. And it's coming, and it's going to make a huge
    difference for people's lives.
        And I want to thank all our panelists for joining us today. It's
    been a fascinating conversation. God bless you all.
        Oh, wait a minute, now I'm going to sign an Executive order. And I
    think you'll find this interesting. It doesn't take very long, and we
    usually have people stand behind me when I do it. [Laughter]

    [[Page 1552]]

        You ready, Pawlenty?

    [The President signed the Executive order.]

        The President. Done.

    Note: The President spoke at 2:41 p.m. at the Minneapolis Marriott
    Southwest. In his remarks, he referred to Mayor Jan Callison of
    Minnetonka, MN. The Executive order on promoting quality and efficient
    health care in Federal Government administered or sponsored health care
    programs is listed in Appendix D at the end of this volume.