    [Public Papers of the Presidents of the United States: George W. Bush (2007, Book I)]
    [January 25, 2007]
    [Pages 57-67]
    [From the U.S. Government Publishing Office www.gpo.gov]

    Remarks in a Discussion on Health Care in Lee's Summit, Missouri
    January 25, 2007

        The President. Rich, thank you very
    much for inviting us here to Saint Luke's. We had a fascinating tour of
    your facility. It is safe to say that Saint Luke's hospital--the Saint
    Luke's Health System understands the power of technology to help
    compassionate doctors and nurses better do their job. And technology is
    a--we saw, like, unbelievably interesting medical programs, programs
    that enable doctors to better analyze disease and deal with disease
    before it becomes acute, which is important.
        The reason why I emphasize the information technology aspects of
    this hospital is that part of the role of Government is to encourage
    people to make decisions to help hold the cost of health care down. And
    when a hospital modernizes, when you go from files to electronics, it
    helps hold the cost of health care down.
        One of the interesting things about medicine is that medicine tends
    to have lagged behind the rest of our economy when it comes to
    information technology. And yet under Rich's leadership, this facility and its sister facilities
    are doing some really interesting reforms we'll talk about a little bit.
        I want to thank George Pagels, who is
    the CEO of this facility. George, thank you. He's a doctor and gave us
    the tour--met a lot of really fine nurses and docs, by the way. I
    appreciate Senator Bond joining
    us; thanks for coming. And of course, our Secretary of Health and Human
    Services, who will say something here in
    a minute.
        I want to talk a little bit about a comprehensive strategy to make
    health care available and affordable. There is no question in my mind
    that a proper role for the Federal Government is to help the poor and
    the elderly and the diseased get health care. We'll do that. And to the
    extent that these important programs need to be reformed and
    strengthened, we will do that as well. Witness what we did with
    Medicare. Medicare was old and stagnant; it needed to be reformed. We
    reformed it through a generous prescription drug benefit that has
    actually worked; it's helped our seniors. And so we will do our duty at
    the Federal level, and when we find deficiencies in Federal programs, we
    will work to correct them, for the good of the citizens and the
    taxpayers.
        The second aspect of our responsibility is to work to make health
    care available

    [[Page 58]]

    and affordable for all our citizens, and the best way to do that is
    through private health insurance. Therein lies part of the debate we
    have in Washington. We believe the private sector is the best delivery
    of health care. We know there's a role for the Federal Government, but
    it's not to dictate; it's not to be the decisionmaker. And so
    Mike and I and others in my
    administration have been strategizing on how best to make health care
    available and affordable.
        Here are some ways. One, helping spread information technology--
    we're the biggest user of health care in the United States, and
    therefore, we can help people understand the benefits of using
    information technology. Secondly, price transparency, one reason we came
    to this hospital is that under Rich's
    leadership, this hospital system has been willing to place its prices
    and its quality ratings out for consumers to see.
        I mean, health care is an interesting industry, isn't it, where a
    lot of times you have no idea about the price of the service you're
    paying for. You just assume it's okay. Somebody says, ``Here's your
    price,'' and you say, ``Okay, I'll pay it.'' We believe that with price
    transparency and quality assessments, consumers will have a better
    decisionmaking process. And we want consumers making the decision in
    health care.
        Think about a system where there's a third-party payer. So you've
    got your insurance, somebody pays your bills for you, and you're not
    involved. You just kind of assume that the third-party payer is making a
    rational decision on your behalf. And our view is, is that in order to
    have--to worry about health care costs, the more a consumer is involved,
    the more likely we'll be able to deal with the increasing cost of health
    care.
        Another reform is medical liability reform. I'm walking around the
    hospital here; a professional comes up to me and says, ``We practice too
    much medicine for fear of lawsuits,'' which raises the cost of your
    bill. See, if the medical provider is worried about getting sued, they
    will make decisions on how to stay out of the court of law more than--as
    important as decisions on how to keep you healthy. Medical liability is
    a real problem in a lot of States.
        And we are trying to get the United States Congress to hear that
    same call. And I'll keep working on medical liability reform. Why--to
    help make health care more affordable. But also, when you get a lot of
    lawsuits, it causes good docs to quit the practice of medicine. There
    are a lot of counties in the country that do not have ob-gyn because
    these lawsuits have run them out of practice. And it's not right, and
    it's not fair. And so we need to have the political will in Washington
    to take on a very powerful lobby, which is the trial lawyers, and
    prevent these frivolous lawsuits from running up the cost of your
    medicine and running good docs out of practice.
        A couple of other points I want to make before we talk to the--talk
    about this new initiative I laid out to the country. I think it's very
    important to help develop plans that make the consumer in charge of as
    much of the health care decision as possible. These are called--one idea
    is health savings accounts. This basically says that there is a product
    available for you to use where you're the decisionmaker and you're able
    to contribute tax free, earn money in your account tax free, take money
    out tax free on medicine. If you don't spend the money in your account
    one year, you can roll it over; it becomes a savings account. It's an
    incentive for you to make good decisions about your life, and it also
    provides catastrophic care in case something bad happens to you. We'll
    talk about health savings accounts here in a minute, and their effect on
    enabling people who do not have insurance to have health care available
    and affordable for them.
        Finally, small businesses need help. I mean, it's hard to be able to
    buy insurance when you're a stand-alone company. And

    [[Page 59]]

    insurance is basically a spreading of risk through pooling of risk, and
    we just need to allow small businesses to be able to buy insurance at
    the same discounts that big companies can by pooling risk.
        In other words, a restaurant in Missouri ought to be able to have
    their employees insured with a restaurant in Texas. In other words, put
    them all in the same pool so they can get the benefits of spreading
    risk. Now, these are practical things to get done. And they're hard to
    get done in Washington because people in Washington have a different
    view. They want the Government basically making the decisions for health
    care. The view of the people here is that you ought to be making those
    decisions.
        One way to encourage you to make the right decisions when it comes
    to health care is to take the inequities out of the Tax Code. If you
    work for a company, you pay--you get your health care free, in essence.
    It's part of the benefit package. If you're a stand-alone person, you
    pay your health care on an after-tax basis. In other words, there's
    discrimination in the Tax Code based upon who you work for. It makes it
    harder for people to be able to--individuals or small-company employees
    to be able to buy health care.
        And so what we've said--and Michael
    spent a little time describing this--we've said that all Americans who
    have health care ought to be allowed to have a $15,000 deduction on your
    income taxes if you're a married couple--if you're married, and if
    you're not, $7,500. In other words, the benefits you receive from your
    company become part of your taxable income, offset by a $15,000
    deduction. And so if the benefits you get from your company are $11,000,
    you'll have $4,000 deducted from your income. And that's important.
        It also will help people who are uninsured or on the verge of being
    uninsured. In other words, it encourages the development of an
    individual market. It makes it more likely an individual will be able to
    afford health care. If you've got a family of four with $60,000 income,
    you get a substantial tax savings, which will then enable your health
    insurance to be more affordable. And we'll talk about that.
        The point I'm trying to make to you is, the system is geared toward
    enabling the individual to have more control over his or her
    decisionmaking and make the Tax Code fair for the individual. And
    finally, I've instructed Michael to work
    with States. We believe that there's been some very innovative policy
    that takes place at the State level to cover the uninsured, to help the
    sick, to help those who are poor be able to get insurance. And so we're
    going to have flexibility with Federal money that goes to States, and
    all we request is the States develop a basic health insurance plan that
    becomes more affordable. Oftentimes the plan that is only available for
    the individual is priced out of their control because of mandates and
    add-ons. And Michael is going to say to Governors: Look, we're going to
    help you. You got some interesting ideas. We think it makes sense to use
    Federal money to help you with those ideas, but you need to develop a
    basic plan so that health care is affordable for more of our citizens.
        And here's a comprehensive strategy. A lot of times in Washington,
    they say: ``Well, let's just design it there in the Federal Government;
    it will all work.'' It won't, in my judgment. It will become
    bureaucratic; it will become costly; it won't empower individuals; it
    will make it harder to get affordable health care.
        And so here's a strategy, a multiple-pronged strategy, a strategy
    that says there's a lot of things we need to do to help our American
    citizens be able to buy private health insurance.
        Leavitt is in charge. Michael is the
    Secretary of Health and Human Services. He's spent a lot of time on the
    subject. You might want to add a few comments, and then we can hear from
    some of our citizens here.

    [[Page 60]]

    [At this point, Secretary of Health and Human Services Michael O.
    Leavitt made brief remarks.]

        The President. Yes, Leavitt, one
    thing before you get--I see we've got some cameramen here. Why don't you
    give them the cameraman story.
        Secretary Leavitt. I had a terrific
    conversation yesterday.
        The President. For all you cameramen out there.
        Secretary Leavitt. Someone asked me--
    actually, it was a news organization here in Missouri, anticipating our
    trip, asked me, ``What are you going to talk about?'' And I said,
    essentially, we've got this problem that we're trying to solve, with
    people who work in restaurants or in daycare centers or are self-
    employed, and it's unfair that they should be treated in a way. And I
    could see the cameraman----
        The President. He's an independent contractor; he's on his own,
    basically.
        Secretary Leavitt. But he was behind
    the camera doing this, which is unusual. [Laughter]
        The President. Because he wants to be treated just like the person
    who works for big corporate America, and he wants to be able to have
    that deduction.
        Secretary Leavitt. So before we were
    even off the satellite, he's saying--``And you should have said
    independent cameramen.'' [Laughter] He said, ``Do you know how much I
    pay for insurance?'' He says, ``It's $1,350 a month, and I have to pay
    it after I pay my taxes, and it's just not fair.''
        It isn't fair. This is the right thing to be doing.
        The President. Thank you.
        Rich, thanks for having us.
    Appreciate you inviting--letting us tour your hospital here.

    [G. Richard Hastings, president and chief executive officer, Saint
    Luke's Health System, made brief remarks.]

        The President. The other thing that's interesting about what
    Rich is doing--availability of health
    care--they've got, like, a specialist sitting in Kansas City capable of
    analyzing somebody's graphs in a remote region, which, again, remember
    it's affordability and availability for health care. And information
    technology is able to make medicine available throughout rural Missouri
    or rural Kansas, for example. And it's very exciting, and I appreciate
    what you're doing.
        Mr. Hastings. Thank you, sir.
        Secretary Leavitt. I want to make
    certain you all understand here three things that are happening that
    need to happen all over the country--here that are happening. The first
    is, you're a connected system. If a patient wants to get their medical
    records, they can do it in a convenient way. People need to have access
    to their own records in a way that will be convenient to them. And this
    idea that a patient then can have an independent assessment of the
    quality of the care that their provider is giving them is revolutionary
    and very important.
        But then you combine that with the ability for people to know what
    it costs. Once you have the cost and the quality, you're now making
    decisions based on value. And that's what we hope in the future. The
    whole system will become a connected system that has competition based
    on value, where consumers are making decisions, as opposed to someone
    other than the consumer.
        The President. Dr. Jim Kelly. Why don't
    you tell people what you do, Doctor?
        James B. Kelly. Thank you, Mr. President.
        The President. Let me guess. [Laughter]

    [Dr. Kelly, anesthesiologist, Saint Luke's Hospital of Kansas City, made
    brief remarks.]

        The President. I don't think people know what you mean by defensive
    medicine. Why don't you describe that?

    [[Page 61]]

        Dr. Kelly. Well, you're always concerned.
    One, we're here to take care of patients, and that's our primary
    objective. But if you are told that you do a poor job or go--everybody
    lives in fear of being sued, and they will go to extreme lengths to
    document that everything they're doing is the right thing. If any of us
    were so unfortunate to fall down right now and bump our head, it would
    be hard to get out of this hospital--if you tell the emergency room
    physician that you hit your head--without a CT scan, maybe even an
    overnight stay in the ICU. They want to make sure that they're okay and
    not just trust their clinical skills that it's a little bump on the
    head.
        The President. In other words, practicing maybe too much medicine--
    --
        Dr. Kelly. Too much medicine and extra
    tests.
        The President. It actually costs the Federal Government something
    like 23 billion a year.

    [Dr. Kelly made further remarks.]

        The President. Well, I appreciate you. I happen to believe this is a
    Federal issue. When I first came to Washington, I said, we ought to
    allow these--each State to determine their own medical liability reform.
    I believe it's--and I chose to make it a Washington issue because it's
    costing our taxpayers so much money. When I say ``costing,'' we're a big
    consumer of health care through Medicare, Medicaid, veterans' benefits.
    And when doctors' premiums go up, they charge more. And with doctors in
    fear of being sued, they practice more medicine than is necessary.
        And I don't know if 20 billion is the right number, but it is a lot.
    I think it is something like that. And that's extra money for the
    taxpayers. And I'd like to get it done in Washington, DC, frankly. And I
    believe medical liability is a huge--I know it's a huge issue in a lot
    of States, and we'd like to help you. Thanks for working on it.
    Appreciate you being involved.
        Jim Henderson.
        Jim Henderson. Thank you, Mr. President.
        The President. President----
        Mr. Henderson. Not like you, but thank you
    very much. [Laughter]
        The President. ----of Dynamic Sales, Inc. Where are you based, and
    what do you do?
        Mr. Henderson. St. Louis, Missouri. We're
    a construction and industrial supply company----
        The President. Great. How are you doing?
        Mr. Henderson. ----and I'm a second-
    generation owner. It's been very good. The economy has been very good to
    us, and the business has been booming. We're on our 11th record year.
        The President. Good.
        Mr. Henderson. So we're very pleased.
        The President. All because of good management.
        Mr. Henderson. From the top down.
    [Laughter]
        The President. That's right. How many employees?
        Mr. Henderson. We have seven employees;
    five full-time, two part-time.
        The President. Right, and your issue with health care?

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

        Mr. Henderson. So when they say, ``Well,
    we can keep your premiums the same,'' they're not really saving us
    anything, because we're having to pass that along to the employees, of
    which I am an employee of the corporation. So now my health insurance
    costs just went up too. And it's just a vicious cycle that we've been
    dealing with for over 17 years.
        The President. This is probably the biggest problem we hear from
    small businesses around the country. And in that small businesses create
    most new jobs in America, it makes sense to come up with plans to help
    small businesses thrive.

    [[Page 62]]

        Michael, I don't know if you want to
    comment on this----
        Secretary Leavitt. I'd be
    interested----
        The President. ----deductibility plan because I think it's going to
    save your employees a lot of money and make it easier for you to be in a
    position to do what you want to do, which is be--consider yourself a
    good employer.
        Mr. Henderson. Well, that's the hard
    thing, is when you're trying to hire more people, health insurance is
    really important. And if you're telling people: ``Well, we've got a
    $2,000 deductible and a 70/30 split, but, hey, we're a good company to
    work for''--well, you might be a nice family company to work for, but I
    can't afford to work here.
        The President. Have you looked at this deal that I proposed?
        Mr. Henderson. Yes, sir; I have. And from
    what I've looked at, off of the information you've sent to me, I think
    that it's going to be very attractive.
        The President. And how does it help you?
        Secretary Leavitt. Jim could describe
    it, or I--well, I mean, Jim is like a lot of other small businesses. If
    he and his employees had this ability to have this standard exemption--
    in Jim's case personally, he'd have the exemption; he'd get the tax
    savings. It would be--he'd have about a $2,183 increase in his take-home
    pay. The value of the actual deduction to him would be 7,200, which
    would go a long ways to helping defer some of those costs.
        When you look at that example--and take Martha, for example--Martha
    had a similar problem as Jim did and chose to go to a health savings
    account. When you combine these two, it becomes well within the grasp of
    almost any employee to have an affordable, basic health insurance.
    Martha, maybe you could----
        The President. Yes. Just one point before you go. I think it's very
    important for our citizens to know that as we level the playing field
    between employees of little companies and big companies, it makes it
    easier for small companies to stay in business. The Tax Code, it treats
    a certain group of people in the United States unfairly when it comes to
    health care. People who work for big businesses get their health care on
    a--without--with no--they pay no taxable income on it. Small companies
    who are having trouble staying in business because of the nature of
    their size of the company pass on the increased cost to their employees.
    And we've got to level the playing field from a taxes perspective. It is
    by far the most hopeful and fair option of any medical health care
    option out there today, unless, of course, you want the Federal
    Government running it all, saying, ``Okay, we'll provide you insurance,
    we'll provide everybody insurance,'' which would be a mistake.
        Anyway, listen to health savings accounts, but I don't want to be
    Mr. Lecturer. But she is--it's an interesting option for you.
        Mr. Henderson. I did look at those, but
    for our employees, they weren't as attractive, because our employees
    said: ``If I can set aside $2,000 a year or whatever to put into a
    health savings account, I'd be doing it anyway.''
        Secretary Leavitt. So they'll be able
    to--with this tax change, they'll now have the money that can go to do
    just that.
        Mr. Henderson. That's been what's so
    frustrating about this, is each year those costs go up--we want to make
    it affordable for our employees--the company's paying more for the
    insurance that they're receiving. We don't get to turn around and say to
    our customers, ``Hey, we're raising your prices''----
        The President. No, that's right.
        Mr. Henderson. ----``25 percent because
    our insurance went up.'' And when we ask the insurance: ``Why is it
    going up? We haven't had these major losses.'' Their reply is, ``Because
    we can.'' That's what I was told: ``Because we can.'' I'd like to tell
    all my customers that, hey, I'm raising your prices 25 percent because I
    can.

    [[Page 63]]

        The President. Right. It's a problem, and the reason I've come here
    to discuss this with a frustrated small-business owner like you is
    because we believe that we've designed a solution that will help a lot.
        Mr. Henderson. Yes, sir.
        The President. Martha.
        Martha Gelencher. Yes, Mr. President.
        The President. Why don't you tell everybody what you do? Are you as
    passionate about your employees as my man Jim?
        Ms. Gelencher. Yes, I am.
        The President. That's good.
        Ms. Gelencher. I've been in the
    business for 30-plus years, and having health insurance has always been
    a big issue. I think we as employee--individuals now are facing what Jim
    said is--the individual and the employer are facing the same problem
    right now.
        The President. Let me ask you something. How many employees do you
    have?
        Ms. Gelencher. Thirty, of which six are
    full-time.
        The President. Right. And so you started getting squeezed.
        Ms. Gelencher. Yes, from the very
    beginning. In fact, no one wanted--for many years, no one wanted to
    insure someone that had only 30 employees.
        The President. Yes, or six full-timers.
        Ms. Gelencher. Yes. It's like, well,
    you're just not----
        The President. It's one reason why you don't have a lot of leverage.
        Ms. Gelencher. Right.
        The President. People don't want to insure you.
        Mr. Henderson. If we drop below five,
    we've been told----
        The President. Yes. So you're at 6 full-time, 24 part-time. And you
    started looking at options, and what happens?
        Ms. Gelencher. Well, we went with the
    HSAs; we've been with them for 2\1/2\ years. We were able to give more
    full-time people insurance. We save 40 percent of what we had been
    paying.
        The President. Yes, see, that's why I think--get somebody to--HSAs
    really do hold the cost down for small businesses.
        Ms. Gelencher. They really do. They
    really do.
        The President. It's a little difficult to get the employee to sign
    on at first, right? It's a novel concept, as opposed to somebody paying
    your bills. An HSA basically says, you're in charge of your own health
    care.
        Ms. Gelencher. Right, and it gives the
    small-business person a little advantage over the larger-business
    person, because they have their own savings account----
        The President. That's right.
        Ms. Gelencher. ----and they can--it
    grows, and it's theirs, and they become more responsible for how they
    spend their health care.
        The President. A high deductible catastrophic care plan with the
    company and/or the individual contributing tax free the amount of the
    deductible into a savings account. The person owns their savings
    account. In other words, it's beneficial to small business because it's
    cheaper to buy the HSA than it is normal insurance that you're battling
    for. Have you found that to be true?
        Ms. Gelencher. I agree with you 100
    percent. Yes. And our employees are very pleased. And I mean, really, it
    was a lifesaver for us because it just became such a big problem, as we
    see all across the board now, with individuals--low-income, middle
    income--most of our people are middle income, so that's to their
    advantage.
        The President. See, the problem with small businesses and
    individuals is that there's no market relative to--like big companies;
    there just isn't. And we need to help establish a market. Demand will
    yield the supply of insurance policies, so long as States enable there
    to be the development of a basic plan without mandates and things added
    on to it. And that's really one of the benefits of HSAs, by the way.
    It's like a basic health care plan.

    [[Page 64]]

        Let me ask you something. Do your employees like the idea of being
    able to--of course they like the idea--your employees are able to take
    their health care with them from job to job--take the savings account
    aspect?
        Ms. Gelencher. Exactly.
        The President. It's theirs, not yours.
        Ms. Gelencher. Right.
        Secretary Leavitt. May I ask Martha a
    question?
        The President. Yes, sure.
        Secretary Leavitt. Martha, I have an
    HSA, so I have some experience with this, but I'm curious as to your
    experience with them. Did it cause you to be more interested in what
    things were costing than when you just had an insurance card?
        Ms. Gelencher. Exactly. Exactly.
        Secretary Leavitt. I remember the
    first time I walked into a drug store with my HSA and presented them
    with my new card. And I knew I was--that my savings--my health savings
    account would be paying part of it. And they--this prescription I had
    was going to be $379. And I'd been getting this prescription for quite
    awhile, and I had no idea what it was going to cost. And I said to the
    druggist: ``Is there a generic version of this?'' It was--it changed my
    way of thinking about this completely. Did you have that experience?
        Ms. Gelencher. Exactly the same.
        Secretary Leavitt. Have you seen any
    kind of change in the way your employees have thought about this as a
    result?

    [Ms. Gelencher, owner, Corporate Building Services, made further
    remarks.]

        Secretary Leavitt. Something that
    Rich said and that Martha has said that is important: One of the things
    they are doing here at Saint Luke's is that they are allowing people to
    know what the prices are in advance. A lot of people go to hospitals and
    they say, ``I'd like to know how much this costs.'' And the hospital
    just isn't equipped to answer that question or the doctor just doesn't
    think about what the cost is because usually it's just about processing
    the insurance.
        This very--this gets at the heart of how we keep costs down.
    Suddenly people begin to ask themselves: Is there a generic version of
    this? How much should this cost? Those are the kinds of questions that
    begin to create small businesses with a competitive product. And
    hospitals like the one we're in today have led in that transparency,
    knowing the quality, knowing the cost, being involved in the decision.
    It's a very important way to keep costs down.
        The President. Yes, that's why the best health care system is one
    that recognizes that decisions made by doctors and patients are the best
    decisions. It's best to hold down costs. It's best to enhance quality.
    It is really what happens in most other aspects of our market. It
    doesn't happen--happening in health care. And the policies that we're
    detailing are trying to encourage more consumer involvement in order to
    hold down costs. And it's a foreign concept for a lot of people because
    it hasn't been happening for years. And it's a concept that frankly some
    in Washington don't like because it runs contrary to a philosophy that
    basically says, the Federal Government is a better decisionmaker.
        Anyway, thanks for joining us. Thanks for being an innovator. The
    tax deduction is going to help your folks----
        Ms. Gelencher. Yes, very much so.
        The President. ----$15,000, 7,500 for a single person.
        Ms. Gelencher. And I can't imagine why
    someone would not----
        The President. Be for it?
        Ms. Gelencher. ----think it would.
    [Laughter]
        The President. Well, it's an interesting question, particularly
    since it's a revenue-neutral proposal, which is important. Cost money or
    lose money, it's--according to the experts, it's revenue neutral.
        Jones--Dan Jones, where do you live?
        Dan Jones. I live in St. Louis, Missouri.

    [[Page 65]]

        The President. You do--home of the mighty Cardinals.
        Mr. Jones. Yes, sir. Yes, Mr. President.
        The President. They came to the White House recently.

    [Mr. Jones, service engineer, Software To Go, made further remarks.]

        The President. Here's the classic guy--young guy in the marketplace, basically priced out of the
    individual market.
        Mr. Jones. Yes, sir.
        The President. And the plan helps him. Matter of fact, what they
    were telling me coming in that you could buy a good health care plan for
    about $1,350.
        Mr. Jones. Yes, we were looking at that. And
    within the State of Missouri, I can get about $1,300 for a really nice
    health care for the year.
        The President. Save 2,270 in taxes.
        Mr. Jones. Over the year.
        The President. So you put $929 in your pocket.
        Mr. Jones. Absolutely.
        The President. Does it make sense to do that? I think it does.
        Mr. Jones. What could you do with just a
    little over--under a thousand dollars? That's Christmas, you know.
    [Laughter]
        The President. Well, why don't you think about saving it? [Laughter]
        Mr. Jones. Yes, well, I got a gigantic family,
    and I got a godchild who: ``Buy me this, buy me that.''
        The President. Anyway, there are plenty of people who feel like
    they're doing just fine when it comes to health insurance, particularly
    those who work for big corporate America, which is fine. It's just that
    the system discriminates against the Dan Joneses
    because the Tax Code that has evolved over time has made it harder for
    him, relative to other people in our society, to purchase insurance.
        And this is exactly what this plan is designed to do. We're trying
    to move somebody like Dan from being a statistic,
    an uninsured person, into insurance. And here is a logical way for the
    Government to do so. And if people in Washington are serious about
    dealing with the uninsured, here is a serious idea for them to consider.
    Instead of just dismissing things because of pure politics, we have put
    forth ideas that are worthy of debate and we believe will work. And I
    know that our citizens, fellow citizens, regardless of their political
    party, expect there to be a serious dialog on constructive ideas that
    are put forward to make sure people like Dan Jones have got private
    insurance. And I thank you for coming and sharing. How many people work
    in your firm?
        Mr. Jones. Three full-time employees right
    now, but hopefully, more.
        The President. But you're growing.
        Mr. Jones. Absolutely.
        The President. There you are.
        Mr. Jones. Small businesses, they grow. And
    the more money you save along the way, the more you can grow.
        The President. There you go. Well, thank you for coming.
        Mr. Jones. Thank you, Mr. President.
        The President. Tom. Appreciate you
    coming, Tom.
        Thomas R. Beauregard. Sure.
        The President. Tom Beauregard. What
    do you do?
        Mr. Beauregard. I lead a business
    within United Health Care that's focused on extending access to the
    uninsured.
        The President. Oh, really?

    [Mr. Beauregard, lead strategist, Hewitt Associates LLC, made further
    remarks, concluding as follows.]

        Mr. Beauregard. And then the other
    thing we see is just changes in the labor market, where you've got
    people moving from job to job. So the average individual will have about
    10 jobs across their career now.
        The President. That's right.
        Mr. Beauregard. So there really is
    a need for----

    [[Page 66]]

        The President. That's an interesting point, excuse me. A lot of
    people in America probably know this, but just in case they don't, most
    people change jobs, like, seven or eight times before they're 35 years
    old, in America these days.
        Mr. Beauregard. And it's
    accelerating.
        The President. That means you better have a portable health care
    plan.

    [Mr. Beauregard made further remarks.]

        The President. I appreciate your studying it. You may need to come
    up to Washington to testify. [Laughter] Thank you very much.
        Why don't we end with Esmerelda.
    Esmerelda, welcome.
        Esmerelda Wergin. Thank you.
        The President. You are a--where do you work?
        Mrs. Wergin. I work at my grandmother's
    restaurant, Ninfa's Tortillas. I'm a waitress there.
        The President. Ninfa's? You recommend it?
        Mrs. Wergin. Oh, yes. [Laughter] My
    grandma----
        The President. How are your cheese enchiladas?
        Mrs. Wergin. Perfect. [Laughter] And
    she makes them herself.
        The President. Does she really?
        Mrs. Wergin. Yes, she's back there.
        The President. What's her name? Ninfa?
        Mrs. Wergin. Ninfa. Ninfa.
        The President. That's what I thought. [Laughter] Good. Married?
        Mrs. Wergin. Yes, married with two
    children.
        The President. And how old?
        Mrs. Wergin. I have a 2-year-old and a
    7-year-old; both boys.
        The President. Fabulous, fabulous. And so give us your health
    insurance story.

    [Mrs. Wergin made further remarks.]

        The President. This plan we've outlined would save Esmerelda and her family 3,500 a year. Does it make sense to
    level the playing field and have a rational Tax Code and enable her to
    be able to purchase health insurance? I think it does. Rather than
    having your family sit outside the system, grinding away on trying to
    find a health care system that they can afford, why not help them afford
    health care system through making the Tax Code fair? That's all we're
    asking.
        Isn't that right?
        Mrs. Wergin. Oh, whatever you say, Mr.
    President. [Laughter]
        The President. Esmerelda, thanks for
    coming.
        Mrs. Wergin. You're welcome.
        The President. I hope people got a flavor of what we're trying to
    get done, that this plan helps people be able to afford private health
    insurance, and that is really the crux of good health care. Good health
    care is a health care system where government helps people who need
    help, like the poor--those who are hard to insure. Part of what we
    recognize is that Mike needs to give States flexibilities to help set up
    risk pools, to be able to add selection when it comes to individualized
    markets. But ultimately, the best health care plan is one that trusts
    people like Esmerelda and her family or
    Jones--Dan Jones--to make decisions, and is one
    that enables our small-business sector to remain economically viable.
        We thought long and hard about what to propose. We proposed a bold
    initiative, an initiative that takes equities--out of the system, so
    people are treated fairly. And I know Americans expect that the United
    States Congress will take a good look at all ideas to determine how best
    to make this health care system run well.
        And I thank you all for coming and giving us a chance to talk with
    you. I appreciate your candor; appreciate what you do for the country.
    Thank you. Good job.

    Note: The President spoke at 12:08 p.m. at Saint Luke's East--Lee's
    Summit Hospital. In his remarks, he referred to George A.

    [[Page 67]]

    Pagels, chief medical officer, Saint Luke's Health System, and chief
    executive officer, Saint Luke's East--Lee's Summit Hospital.