    [Public Papers of the Presidents of the United States: George W. Bush (2007, Book I)]
    [February 21, 2007]
    [Pages 165-175]
    [From the U.S. Government Publishing Office www.gpo.gov]

    Remarks in a Discussion on Health Care in Chattanooga, Tennessee
    February 21, 2007

        The President. Thank you all very much. Please be seated. Thank you.
    Thank you very much. I'm honored to be here. Jim, thank you. We just toured a pretty fantastic hospital. He
    talked about robotics that are being used to operate on. He said that I
    was on the machine, and he's right, but there wasn't anybody at the
    other end of the machine, you'll be happy to hear. [Laughter]
        I want to talk today about health care. I see people wearing our
    uniform; I want to thank you for wearing the uniform. I am the Commander
    in Chief, and proudly so. I'm also the educator in chief. The job of the
    educator in chief is to try to educate people about different ways to
    solve major problems facing our country, and we've got a problem with
    health care. It's not affordable, and it's not accessible to too many of
    our people. And the fundamental question is how to deal with it. And so
    today we're going to have a conversation with experts. We've got people
    who call themselves experts, like me and the Secretary and the Governor. And we got
    people who are living experts because they're having to deal with the
    health care problems.
        And so I want to thank you for joining us. I particularly want to
    say thanks to Michael Leavitt, who is the
    Secretary of Health and Human Services. I asked him to join my Cabinet.
    He came from the State of Utah, where he was a Governor. I happen to
    believe Governors know how to set agendas and know how to achieve
    results. You've got you such a Governor here in the State of Tennessee
    as well. And, Mr. Governor, we appreciate you
    joining us. Mike and--[applause].
        I think you're going to find it interesting as we discuss the proper
    relationship between the Federal Government and States, as we design
    programs that help individuals be in charge of their health care
    decisions. And so we're going to have a discussion with some of your
    fellow citizens here, and I want to thank you all for joining us. It
    seemed like a pretty good idea when you accepted--[laughter]--and then
    you got out here--look at all the people and cameras. Anyway, I think
    you're going to find it interesting. I know I'm looking forward to
    hearing what you all have to say.
        I'm keeping pretty good company today, as you can see. Not only have
    we got the Governor; we've got the Lieutenant
    Governor with us today. Lieutenant Governor
    Ramsey is with us. Thanks for coming. There he is, yes, Ramsey.
        I am very proud of your--the
    Senators you've got up there--that you sent up
    to Washington. The senior Senator, Lamar Al-
    exander--appreciate you coming, Lamar. Proud to be here. He's a good,
    thoughtful guy, who, by the way, paid me and Laura a high compliment the other day in the newspapers in
    Tennessee when he noticed that we had worked hard to increase the budget
    of the National Park System, thereby directly benefiting the people who
    care about the parks in eastern Tennessee. And so thank you for not only
    helping us get that piece of legislation into the process; I'm looking
    forward to getting it passed during the appropriations process.
        The other United States Senator is a
    fellow you know pretty well, a man who made his marks in paving the
    roads and filling the potholes, former mayor Bob Corker. Thanks for
    coming.
        And finally, the United States
    Congressman--all he talks about is ``Chatt-town,'' every time I see him.
    He says, ``You remember Chattanooga, now, Mr. President, don't you?''
    [Laughter] ``You came here when you were not in public office. We expect
    you to come back in public office.'' And I'm glad, Zach, that I finally
    listened to you when it came to my travel schedule.

    [[Page 166]]

    I'm really thrilled to be here in this beautiful part of our country,
    and I'm also proud to be in the presence of your Congressman, Zach Wamp.
    Thanks for being here.
        We got the mayor with us today--the
    mayors. We got the mayor, Ron Littlefield, of
    Chattanooga. Mr. Mayor, thank you for coming; proud to have you here.
    Mayor Claude Ramsey of Hamilton County. I told the mayor, I said, ``In
    Texas, we call them county judges.'' [Laughter] So I said, ``I might
    just call you `Judge.''' And he said, ``Well, Mr. President, you can
    call me whatever you want to call me.'' [Laughter] Mayor, thanks for
    coming; appreciate you being here.
        I do want to thank the good folks who work at Erlanger. Thanks for
    putting up with me and the entourage. We really had a wonderful tour.
    And the truth of the matter is, you can put all the robotics you want in
    a hospital, or all the x rays; what really matters is the compassion and
    care given by people. And so I want to thank the docs and the nurses and
    the staff of that wonderful facility for being on the leading edge of
    compassion.
        It was really interesting, a couple of
    docs showed us some stroke recovery
    procedures, and one of the examples was a 26-year-old woman who got a
    stroke, and she couldn't talk. And then the next film they put up there
    was her talking, and how happy she was. And it had to make you feel
    great, doc, to know that you saved somebody's life. And so I thank you.
        And the mission, by the way, of government is to make sure that the
    quality of health care received by our patients around this country
    remains the best in the world. Private medicine works. And we need to
    make sure that we put good policies in place to make sure private
    medicine is the norm, quality care is given to as many Americans as
    possible. And that's what we're here to discuss.
        Now, look, we got a problem, and the problem is, health care costs
    are rising too fast for a lot of our individuals and small-business
    owners. Here's one of them right here. He's about
    to testify--[laughter]--about the rising cost of health care, see.
    Individuals are being priced out of the market. And so what is the
    proper policy to deal with it? You sent us up to Washington to identify
    problems, but you also sent us up there to identify solutions. And so I
    want to share some solutions with you today, some ideas that I hope the
    Members of Congress take seriously.
        A first philosophical note is that the best decisions are made by
    providers and patients, not by government or insurance companies. In
    other words, if you want a health care system that really works, you
    want the decisionmaker to be the individual, in consultation with
    somebody who knows what they're talking about, somebody trained to help
    that person make the proper decision; that would be your doctor.
        Secondly, that when it comes time to helping people who need help,
    it makes sense for us to make sure the Federal Government does its job
    and to work in concert with States. Now, I believe the Federal
    Government has a solemn responsibility to take care of the sick--I mean,
    the disabled, the elderly, and the poor. We have made that commitment,
    and we've got to honor that commitment.
        Recently, we took on a big issue in the Congress, and that was to
    make sure that the Medicare system provided modern medicine for our
    seniors. And we passed new legislation that said, we're going to help
    with pharmaceutical drugs, that for the poor, they'll get their
    pharmaceuticals; but for those who aren't poor, they'll have some
    choices to make about how best to suit their needs when it comes to
    medicine. See, I believe in choice. I told you: I want those patients
    making the decisions.
        And guess what? It's working. Part D reform for Medicare is working.
    I congratulate the Secretary on helping implement this piece of
    legislation.

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        My point to you is, is that we take our responsibility seriously. We
    want to make sure there's adequate funding, and we will. We want to make
    sure that funding ends up in the hands of people who need help.
        Other ways to control costs are to make sure that we introduce
    information technology into health care. If you want to be honest about
    it--I think we probably ought to be--a lot of health care is kind of
    lagging behind the rest of the country when it comes to IT. I mean,
    they're still filling out forms by hand, doctors signing things, which
    leads to, sometimes, confusion, since doctors can't write very well.
    [Laughter] Paper gets lost. Files move around, and they get reshuffled
    the wrong way. We need to help make sure that health care is as modern
    as other aspects of our society. We want people to have a medical
    identification record that you can take with you--by the way, that is
    secure from people snooping.
        I'll tell you an interesting example of that is, our Veterans
    Affairs Department has done a good job of providing individualized
    health care records on the computers. And so when Katrina hit in New
    Orleans, all the files were destroyed for a lot of the health care
    providers, but each individual vet had his own health care chip. And so
    when they went to Houston, for example, they were able to take that,
    plug it into a computer. The doctors there at the VA was able to see
    what the previous treatments were or what the person needed, and there
    was a seamless transition from care in New Orleans to care in a VA place
    somewhere else.
        And so we've got--we're working on that, and the Federal Government
    can help. After all, we're a huge provider of health care. We want there
    to be price transparency in health care. I don't know about you, but I
    don't remember ever asking how much something was going to cost when it
    came to health care. I do when it comes to a car--or I used to.
    [Laughter] I will soon. [Laughter] But there's not many consumers
    asking: ``What does it cost, doc? And what's the quality of the
    product?''
        And so there's--transparency in pricing will help control costs.
    It's amazing what happens when consumers are making decisions. And one
    way to help consumers to make decisions is to encourage systems that put
    consumers in charge of health care decisions, like health savings
    accounts. Like, if you're running a small business, you need to look at
    a health savings account. People can save money with health savings
    accounts. These are innovative products, innovative ways of providing
    insurance for yourself and your family, where you actually save money
    tax free if you don't spend money on yourself.
        We believe there needs to be association health plans. I'm very
    worried about small businesses not being able to afford insurance but
    not nearly as worried as the CEOs of small businesses. It's got to pain
    somebody running a small business to know they can't provide their
    employee with the coverage they need. And yet small businesses aren't
    able to have the same advantages that big corporations get when it comes
    time to spreading risk across a lot of people they're insuring.
        And so I believe small businesses ought to be able to pool risk
    across jurisdictional boundary. That's fancy words for, I think a
    restaurant in Chattanooga ought to be able to put their employees in the
    same risk pool as a restaurant from Houston, Texas, so you can spread
    risk. Those are called association health plans.
        Here's another innovative way to help people be able to have
    affordable insurance. I strongly believe we've got to do something about
    lawsuits. I don't want to get too--[applause]. We've got a system in
    some States where you can't find an ob-gyn in a county because the
    lawsuits are running these good people out of the county. And by the
    way, it's running up the cost of medicine. A doc, whether they'll admit
    it to you or not, can't help but think

    [[Page 168]]

    in the back of their mind: ``I might get sued; I'm going to practice a
    little extra medicine.'' That's called the defensive practice of
    medicine. But it means that you're paying more for health costs than are
    absolutely necessary. If I was a doctor and worried about a lawsuit, I'd
    be doing the same thing. I'd be protecting myself for fear of a lawsuit
    that could conceivably damage my capacity to stay in business.
        And I happen to believe lawsuit reform is a national issue. When I
    first got up to Washington, Governor, I
    thought the States ought to take care of it. And then I found out that
    we're spending about $28 billion of your money as a result of the
    defensive practice of medicine. See, we spend a lot of money on
    Medicare, Medicaid, Veterans Affairs. And so when somebody is practicing
    extra medicine to avoid the consequences of a lawsuit, it's costing our
    taxpayers money.
        And I decided it was a national issue that requires a national
    response. And we hadn't done a very good job of getting that liability
    bill passed out of the Senate, but these two Senators are with us. And
    I'm going to keep pushing, so long as I'm the President, to get good
    national liability reform so to make medicine more accessible and more
    affordable for more of our citizens.
        You probably think I'm going to do all the talking. Yes. [Laughter]
    My wife--by the way, who sends her love--would
    tend to agree with you. [Laughter] By the way, I am a lucky man that
    Laura said yes when I asked her to marry me, and I really--[applause]--I
    know this isn't very objective, but I firmly believe the country is
    lucky to have her as the First Lady, I really do.
        There are some ideas I just laid out for people to think about on
    how to deal with the rising cost of medicine. I've got an idea as to how
    to make sure people can get private insurance. We ought to be striving
    to help people buy insurance so that hospitals like Erlanger don't have
    to pick up the tab.
        So the fundamental question is, how do we help? Well, the Tax Code
    needs to be changed. If you work for a large corporation in Chattanooga,
    Tennessee, you get your health care free, basically. In other words, you
    don't have to pay any tax on the benefits. If you work for a small
    company and that small company can't afford your health care and you go
    out and buy health care on your own, you pay with after-tax dollars. In
    other words, it costs you more than the person who works for a large
    company to buy insurance, and that's unfair.
        We're worried about helping make sure people can afford health care.
    But the Tax Code is so structured that if you're an individual or
    somebody working for a company that can't afford health care, you're
    disadvantaged relative to a company that is a larger company.
        And so here's an idea that Congress needs to consider: If you're
    married, got a family, and buying health care, you get a $15,000
    deduction from your income taxes, right off the top. It doesn't matter
    whether you're working for the largest company in Chattanooga or one of
    the smallest; you get that deduction. If you're single, you get to
    deduct $7,500 from your--not only your income tax but your payroll
    taxes. And the reason you do that--and you're going to hear some
    examples of how this will help our fellow citizens--one, it helps
    somebody afford insurance; two, it will help in the development of a
    market for individuals in the insurance world.
        Right now there's a limited market for the individual. It makes it
    hard to find a product that either suits your needs or you can afford.
    The more policies written to meet the individual--in other words, the
    larger the risk pool--the more likely it is that costs will come down
    for the individualized policy. That's just the way it works. Yet the Tax
    Code discourages the individual from being in the market.
        Now, one of the concerns I have about such a plan is that some
    people can't afford

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    insurance, some people won't be able to get insurance. This plan will
    help a lot of people afford it, like the uninsured, the working
    uninsured. Now, remember, the Government is going to take care of the
    poor--that's called Medicaid--and SCHIP, plus what the innovative
    policies Phil is doing here in Tennessee. The
    Government is going to take care of the elderly; we take care of the
    disabled. And here's a way to help people who are working uninsured
    afford insurance. We'll give you some examples here in a minute.
        But I am also worried that there is--that the process will kind of
    leave out people who may have preexisting conditions. In other words,
    it's okay for the individual who's healthy to go get insurance, but how
    about the person that's not healthy? And therefore, Secretary
    Leavitt is designing a plan that says, we
    will give you flexibility with Federal money that we give you--to the
    State to help you design risk pools--like they're doing here in
    Tennessee--that will help you take care of the uninsurable, like you're
    doing here in Tennessee. In other words, it's a collaboration with the
    Federal Government and the State government to come up with innovative
    ways to deal with the issues as a result of adverse selectivity because
    of individual policies being the norm.
        And so I'm going to have Leavitt
    start us off in talking about it. And by the way, in return for
    flexibility, we expect the States to design basic health care coverage--
    coverage that doesn't have all kinds of mandates on it; coverage that
    means somebody is more likely to be able to afford health care. And
    again, that's what the Governor has done here
    in Tennessee.
        You've got yourself--you're on the leading edge of some really
    interesting ideas in your State. You really are. And I want
    Mike to kick off the discussions, and
    then we're going to bring the Governor in. And
    then--we're getting ready to talk among ourselves here. Anyway, Michael.

    [At this point, Secretary of Health and Human Services Michael O.
    Leavitt and Governor Philip N. Bredesen, Jr., of Tennessee made brief
    remarks.]

        The President. Yes, Governor, thanks. It's
    really important for me and Mike to know
    that we've got Governors on the frontlines of health care
    decisionmaking, designing programs that meet the needs of your State.
    Truth of the matter is, I'd rather, Governor, you be making these
    decisions than some of our brothers and sisters in Washington.
    [Laughter]
        Gov. Bredesen. I would agree with that,
    Mr. President.
        The President. A couple of points--he said--you know, this is an
    interesting statistic--I think it's before age 30, most youngsters will
    have had, like, eight or nine jobs. Isn't that interesting? Baby boomers
    like us, we're not used to that kind of turnover in the job market,
    which means you better have health care policies that are able to follow
    the person.
        One reason there's uncertainty in our economy is, people are worried
    about whether or not they're going to be able to have health insurance
    if they do what is the norm, which is to change jobs. And so I like the
    idea of the Governor designing a plan--health
    savings account has got the same sense of portability--you can take it
    with you. It's your--you own the deal.
        And the other thing he talked about: preventative care. I want to
    remind you; it doesn't cost any money to walk outside and walk for a
    couple of miles. Make sure when you ride your mountain bike, you don't
    crash on caliche. [Laughter]
        We've got Joe Cofer with us--mighty doctor.
        Joe Cofer. Thank you, President Bush.
        The President. What kind of doc are you?
        Dr. Cofer. Surgeon.
        The President. Oh, yes?
        Dr. Cofer. Yes, sir.
        The President. And what kind?
        Dr. Cofer. General surgeon.

    [[Page 170]]

        The President. Feeling pretty good here, by the way, thank you.
    [Laughter]
        Dr. Cofer. If you need something out, let me
    know.
        The President. Yes. You're working at Erlanger?
        Dr. Cofer. Yes, sir.
        The President. Good. Do you like working there?
        Dr. Cofer. I love it.
        The President. I guess otherwise you wouldn't be working there.
    [Laughter]
        Dr. Cofer. I'd still be working there.
    [Laughter]
        The President. Oh, that's right. Yes. That's a smart thing, the old
    boss is sitting over there--[laughter]. Give us
    your concerns. What's on your mind?
        Dr. Cofer. Well, I think that the plans you've
    set forth are very important. I think we've got to develop health care
    for those that are uninsured, and I'd like to tell you about what we've
    done with Project Access.
        The President. I'd like to hear it.
        Dr. Cofer. Okay. First, let me welcome you and
    Secretary Leavitt, from the University of Tennessee College of Medicine,
    from Erlanger Hospital, and all the physicians who practice here in
    Hamilton County. Thank you for coming to Chattanooga, the best kept
    secret in America, and thank you for coming here to talk about health
    care.
        The President. Working the chamber of commerce angle, that's good.
    [Laughter]
        Dr. Cofer. That's right.
        The President. Yes. Don't forget the Governor now; the University of Tennessee has got the budget,
    right?

    [Dr. Cofer, surgeon, Erlanger Hospital--Baroness Campus, and chairman,
    Project Access, made further remarks.]

        The President. You know, the great strength of the country is not
    our military, nor the size of our wallets; it's the size of our hearts
    and the compassion for fellow citizens. I appreciate, doc, what you're doing. We have an admonition to love our
    neighbor like we'd like to be loved ourself. A government cannot make
    people love one another. That happens when loving citizens decide: I'm
    going to help solve a problem.
        And I thank you for recognizing that the Federal Government and the
    State government can't solve all the problems. Instead of waiting around
    for them to do something they cannot possibly do, you have stood up and
    done it yourself. And for that, I congratulate you and thank you and the
    citizens.
        Our job is to keep the economy growing as best we can so people are
    able to help themselves and get out of poverty and be able to afford
    health care, and to do smart policies to be able to make sure that the
    uninsured numbers shrink. That's the objective. That's the goal. That's
    why Phil is doing what he's doing. That's why
    I'm suggesting that Congress revisit the Tax Code to make it easier for
    citizens to be able to afford insurance.
        We've got Danny Jennings with us.
    Welcome, Danny. You're married?
        Danny Jennings. Yes.
        The President. Yes, you are. And how many children?
        Mr. Jennings. Two.
        The President. Ages?
        Mr. Jennings. Eight and ten.
        The President. They're Chattanooga baseball fans?
        Mr. Jennings. Probably will be after
    this. [Laughter]
        The President. That's good. Yes. What do you do for a living?
        Mr. Jennings. I manage a nursery in
    McMinnville, Tennessee.
        The President. Really? Fantastic. Now's your chance if you want to
    put a pitch out there for some rhododendron. [Laughter]
        Mr. Jennings. Those are coming in soon,
    by the way. [Laughter]
        The President. Well, yes, see. I'm just showing off a little--flora.
    [Laughter]
        Tell me about your health care. Are you insured?

    [[Page 171]]

        Mr. Jennings. No. At the present time,
    no. I'm in between insurance companies. I've had problems in the past
    with the rising cost of health insurance and, of course, the
    deductibles. And then there's preexisting conditions, which drive the
    price up even more.
        The President. Yes. So here's a guy
    that's got two children.
        Mr. Jennings. Yes.
        The President. Eight and ten--and young family in America has got no
    health insurance. And it's got to be a little bit intimidating for you.
        Mr. Jennings. Oh, absolutely. I own my
    own home, and yes, that's very intimidating.
        The President. One of the reasons I've asked Danny to come is because I want to help you understand how
    the standard deduction, in his case, of $15,000, will help him better
    afford health insurance. As I understand it right now, that when you--it
    costs Danny about $450 a month to be able to get insurance to cover his
    family's needs.
        Mr. Jennings. Yes.
        The President. If we can get Congress to change the Tax Code--now,
    here's a fellow working for a small company
    that does not have insurance, can't afford to go in the market himself.
    But if we can get the standard deduction passed so that he's able to
    deduct $15,000 off his income tax and payroll tax, he saves about $4,500
    a year in taxes, which means that the cost per month for him and his
    family for health insurance goes down to $47 a month when you apply the
    tax savings.
        The reason I asked Danny to come is
    because I want you to understand that the standard deduction can mean a
    lot to a fellow who's working and trying to be able to afford private
    health insurance. In other words, there's more money in his pocket as a
    result of the tax standard deduction, and there's more peace of mind
    knowing that his kids and that he and his wife are covered.
        Mr. Jennings. Absolutely.
        The President. So I want you to do me a favor. You don't need to
    write Wamp; he's on board. We'll find you
    another Congressman to write. [Laughter] Sounds pretty good.
        Mr. Jennings. Absolutely.
        The President. Yes, I think it will work for you, Danny. I really do. And Danny, I'm concerned about a lot of
    our citizens, but I don't like to think about a society where the cost
    of health care has gotten such that a fellow who is trying to do the
    best he can for his family--got him a house, got him a steady job, but
    he can't afford health care. And here's one idea for the people of
    this--for the Congress to think about. Lets Danny make the decision; he
    gets to buy health insurance; but he's got 4,500 extra dollars to do so
    on an annual basis.
        Mr. Jennings. Definitely.
        The President. Thanks for coming.
        Mr. Jennings. Thank you.
        The President. Marty Ginn.
        Martha ``Marty'' Ginn. Yes, sir.
        The President. Glad you're with us.
        Ms. Ginn. I'm glad to be here.
        The President. What do you do for a living, besides being--
    she's got the toughest job in America,
    and that's being a single mom. That's the toughest job, by the way, in
    my judgment. So what do you do?
        Ms. Ginn. I'm an office manager in
    McMinnville, Tennessee. I've been working there for about 10 years.
        The President. Good.
        Ms. Ginn. And I love it.
        The President. Do you?
        Ms. Ginn. Yes, I do. I'm very good
    at it.
        The President. It's important to have high job satisfaction. Are you
    good at it?
        Ms. Ginn. Yes, sir. [Laughter]
        The President. Give the girl a
    raise, will you? [Laughter] And so do you have health insurance?
        Ms. Ginn. No, sir.

    [[Page 172]]

        The President. Yes, so you work for a company that does not offer
    health insurance?
        Ms. Ginn. Yes, sir. I have a--I
    have inquired on some insurance, but I have a preexisting condition--I
    have trouble with my left knee--and the quotes were just outrageous. So
    I'm just kind of stuck.
        The President. So you'd rather go without insurance--or not rather
    go--you just can't afford it. Let me put it that way.
        Ms. Ginn. Well, there you go.
        The President. It's not a matter of rather; it's a matter of
    necessity.
        Ms. Ginn. Can't afford it.
        The President. Yes. Since Marty is
    a single person, she gets to deduct $7,500 off of income and payroll
    taxes, which would yield her about $1,900 in savings on an annual basis,
    which could then be applied toward health insurance. In other words,
    Marty can't afford health insurance; the plan needs to--we've got to
    have something in government to help encourage people who cannot afford
    health insurance to do so. One is to help deal with the cost, and we've
    laid out some ways to do it, but another is to change the Tax Code.
        She doesn't get the same benefit
    when she buys health insurance as somebody working for a larger company.
    That's patently unfair. I know it wasn't designed that way when they did
    that in the health care system. But it's unfair for her. And all I'm
    going to ask from people in Congress is, be fair. Treat the Martys of
    the world in a fair way. And we believe in treating her fairly; she'll
    be able to better afford health care.
        Ms. Ginn. That would be great.
    [Laughter]
        The President. Yes. Good. And you've got your daughter out there.
    She's 21?
        Ms. Ginn. My son.
        The President. Your son? Yes.
        Ms. Ginn. My son.
        The President. As I said, your son. [Laughter]
        Ms. Ginn. Trust me; he's a son.
    [Laughter]
        The President. That's good. Is he listening to his mother?
        Ms. Ginn. He always does.
        The President. Yes. Mine can't say the same
    thing. [Laughter]
        Ms. Ginn. The Marines taught him
    well.
        The President. He's a marine?
        Ms. Ginn. Yes.
        The President. Yes, ma'am. I
    appreciate it. I know you're proud of him. Where is he? Is he out there?
    Yes, sir. Thanks for serving. Thank you. Yes, sir. He yelled, ``Semper
    Fi,'' at the Commander in Chief--proudly received.
        Audience member. Hooah!
        The President. There you are. [Laughter] Okay. That's enough.
    [Laughter]
        Amy Childers--isn't that right?
        Amy Childers. Yes, sir.
        The President. So are you gainfully employed?
        Ms. Childers. Yes, sir.
        The President. Like, what do you do?
        Ms. Childers. I'm an interior designer in
    Nashville, Tennessee.
        The President. Great. You came over with the Governor?
        Ms. Childers. I did.
        The President. That's good--from the same area. Nashville is an
    exciting town, isn't it?
        Ms. Childers. Yes, sir.
        The President. It really is a vibrant town; it's an exciting place.
    Thanks for coming. And so who do you work for?
        Ms. Childers. I work for Lumen Lamps.
        The President. Yes. That means you sell lamps?
        Ms. Childers. I do. [Laughter]
        The President. I'm occasionally in the market. [Laughter] And so
    what's your--give us a feel--your company--once again, she works for a company that does not provide health
    insurance.
        Ms. Childers. We are a very small company.
    I'm the only full-time employee besides my employer, and he can't afford
    for

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    us. And so I turned 35 last summer and my----
        The President. You don't look a day over 34. [Laughter]
        Ms. Childers. Most people say 22, but
    thanks. [Laughter]
        The President. Good one. Yes, I'm not running again. [Laughter]
        Ms. Childers. I'll let you slide.
    [Laughter]
        The President. Who invited Amy? Where is
    the guy? [Laughter]
        Ms. Childers. Okay. So I turned 35, and my
    cover went from $130 a month to $210. So my dad wasn't supposed to know
    this--I dropped that health insurance----
        The President. He knows it now. [Laughter]
        Ms. Childers. Yes, he does.
        The President. I hate to tell you, Amy, but
    see those cameras back there? [Laughter]
        Ms. Childers. He's over there.
        The President. Where is your dad? Is he here?
        Ms. Childers. He is.
        The President. Good. Okay, well, I'll see him afterwards.
        Ms. Childers. All right.
        The President. I'll cover for you. [Laughter] So anyway, you dropped
    your health insurance because----
        Ms. Childers. It went up to $210 a month,
    and so I got one that's $5,000 deductible at $100 a month.
        The President. Here's the thing. Amy, look,
    I can't tell you how many people there are that work for small
    businesses who cannot afford insurance. I mean, a big slug of the
    uninsured in America works for small business companies; some, by the
    way, of the uninsured are young people who never think they're going to
    get sick and don't bother to buy insurance. But a big slug work for
    people that are struggling to make ends meet.
        It's hard to be a small-business owner. It's hard to survive in a
    competitive world. And yet we've got to make sure our small businesses
    are strong; after all, they create 70 percent of the new jobs in
    America. We want the entrepreneurial spirit to be strong. One of the
    roadblocks to success is the cost of health care. And so here's a man
    who's got a small business. He has to make a difficult decision not to
    provide insurance for his employee. She has to
    decide.
        Doesn't it make sense to change the Tax Code so that Amy
    Childers can better afford insurance? And so if
    she gets the $7,500 deduction, she saves about $2,000 a year--which
    means something other than the kind of plan you have is more affordable
    to you. Isn't that right?
        Ms. Childers. Yes, sir.
        The President. Yes. See, the reason I've asked these three folks to come to talk about--first of all, I just want people
    to be able to identify with what it means to be in a society in which
    you either don't have health insurance or you don't have adequate
    coverage. And there's a lot of our citizens who are just that way, and
    we've got to do something about it. It's not right, and it's not fair.
        And there's an interesting debate going on--how best to solve the
    problem. Some say, ``Well, maybe the Federal Government ought to do it
    all.'' I don't believe that. I believe we can do a combination of good
    policy with the Tax Code, good policy to help those who we have an
    obligation to help, good policy with State, and good policy with
    charity, to make sure that we're able to provide that mosaic so that
    people can know that the society is better off as a result of accessible
    and affordable health care.
        Now, we've got a man--thank you for coming,
    by the way. You did a wonderful job.
        Will Smith, living the American Dream.
        Will Smith. Thank you, Mr. President.
        The President. Is that an accurate statement?
        Mr. Smith. Yes, it's a correct statement.
        The President. You know, I love a society where a fellow like Will
    Smith says, ``I want

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    to start my own business.'' We want people from all across the country
    saying, ``I want to take a risk and start my own business.'' It's good
    for the country. Ownership is good for the country. Creating jobs
    through the small-business sector is good for the country.
        So tell us what you're doing.
        Mr. Smith. All right. I'm a developer, sir. I
    was one of the--we're the largest real estate developer in the city
    right now.
        The President. Really? Good. Married?
        Mr. Smith. Yes, married--four kids.
        The President. That's good. And the name of your company?
        Mr. Smith. It's WAS Properties.
        The President. Put his wife's name in the
    deal. Will, and your wife's name is Andrea?
        Mr. Smith. Andrea.
        The President. See, W-A. Get it? Will and
    Andrea? [Laughter] And Smith--S. [Laughter]
        Mr. Smith. That's correct.
        The President. That is a smart move to put the wife's name in the company. [Laughter] So what are your
    problems?
        Mr. Smith. Well, I have 9 full-time
    employees, and I count my contractors, which is about 50--
    subcontractors, which is about 50 employees. And in the nine employees
    that I have full time, they're not only just my employees; they're part
    of my family, because they've been with me for about 4 or 5 years. And
    we just can't afford insurance for them.
        The President. First of all, I want you to hear the spirit that
    he just talked to me. He said, ``These are my
    close friends.'' In other words, these are more than just employees. A
    CEO of a small business views--many times--views the employees as
    family. And so he's concerned about whether or not he is providing for
    his family, which is frankly an obligation of people who run a company.
    But the problem is, insurance has gotten too expensive to be able to do
    that, I guess.
        Mr. Smith. Exactly.
        The President. Yes. So I got an idea for you--two ideas. One is to
    look at health savings accounts--high deductible plans with a cash
    contribution to take care of ongoing medical expenses. If your employee
    does not spend the money, he or she gets to keep it and earn money tax-
    free and gets to save it; that's one idea. You ought to take a look.
        The other idea is--I know I'm beating a dead horse, but sometimes
    you have to say the same thing over and over and over again, and I'm
    going to say it one more time: We need to let Will and his employees be able to deduct the cost--a standard
    deduction off their income taxes so that he's got just as good a chance
    to provide insurance for his employees that big companies do here in
    Chattanooga. That's what we need to do. It is a really important idea.
        I know that you're looking and you're scrambling, but it would be a
    lot easier if you were able to work with your employees because of the
    money that they save as a result of tax deductions.
        Mr. Smith. That's correct.
        The President. And so the whole purpose, by the way, of this
    discussion is to help the individual, but to also help the entrepreneur
    do their duty. That's why I've come. I've really come to say thanks to
    your Governor for being innovative. See, he's
    helping lay out a basic health care plan. One of the problems we have at
    State level is that over time, a lot of mandates have been added to
    insurance. You know, the hair follicle benefit, well, you don't need
    hair follicles, particularly if you have hair. [Laughter] If you're
    going bald, you might think you do, but it's probably not a necessary
    part of a health care plan.
        I'm not saying that's happening in Tennessee. [Laughter] But after a
    while--the Governor knows what I'm talking
    about, and so does this Governor--it's
    hard to resist. And so they get--these insurance plans get all kinds of
    things added on to them, which makes the expense beyond the reach.

    [[Page 175]]

    And so the Governor said: ``Look, we're going to try--well, that's fine;
    we'll have those plans; but we're going to devise another plan too, just
    to provide for basic health care.'' That will help his employees, and so
    will change in the Tax Code.
        I firmly believe we can do a better job in helping people get
    private insurance than we're doing today. Matter of fact--and we need
    to. See, the status quo is unacceptable. And so I've come to talk to you
    about some ideas, and I want to thank you for giving us the forum to do
    that. Ideas matter in the public life. And here's an idea, a series of
    ideas.
        I strongly urge both Republicans and Democrats to take a look at
    what we've announced. We want to work with people in Washington, DC. I'm
    tired of the politics, just like you're tired of the politics. We can do
    a better job of finding common ground on commonsense ideas to solve
    common problems.
        And so I thank you for giving us a chance to come today. I want to
    thank our fellow citizens--my fellow citizens for joining us in helping
    to illuminate the problem and helping me highlight the solution.
        Governor, I'm honored that you came. You
    didn't need to come. It's a great honor that you're here. In return,
    Laura and I will have you for dinner next Sunday
    night. [Laughter] Well, we were going to do it anyway but--[laughter]--
    all the Governors are coming to town. I'm looking forward to welcoming
    your Governor. [Laughter] And I thank the Secretary. Doc, thanks for coming.
        God bless you all. Thanks for your time.

    Note: The President spoke at 12:33 p.m. at the Chattanooga Convention
    Center. In his remarks, he referred to Jim Brexler, president and chief
    executive officer, Erlanger Health System; and Lt. Gov. Ron Ramsey of
    Tennessee.