[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.