[Weekly Compilation of Presidential Documents Volume 39, Number 48 (Monday, December 1, 2003)]
[Pages 1688-1694]
[Online from the Government Publishing Office, www.gpo.gov]

<R04>
Remarks at Spring Valley Hospital in Las Vegas, Nevada

November 25, 2003

    Thank you for the warm welcome. It's great to be here in Las Vegas, 
the great State of Nevada. I'm sorry I don't get to spend the night 
here. [Laughter] They say the nightlife is pretty active. [Laughter] 
It's a great part of our country. Thanks for your welcome.
    I also appreciate the Spring Valley Hospital Medical Center team for 
hosting us. It's not easy to have the President of the United States 
come. It seems like the entourages are quite large these days. 
[Laughter] So I appreciate the hard work in facilitating my visit.
    It's amazing that this facility is not only--is not yet 2 months 
old, yet it is providing a really good record of care and compassion. 
Thanks to the good docs and nurses and CEOs and aides who work here. I 
want to thank you for caring about your fellow citizens with good, 
decent health care.
    Today--speaking about good, decent health care, today we had a major 
victory to improve the health care system in America. The United States 
Senate has joined the House of Representatives in passing historic 
reform of Medicare that will strengthen the system, that will modernize 
the system, that will provide high-quality care for the seniors who live 
in America.
    I want to thank and congratulate the Members of Congress for their 
hard work. You

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see, we have a responsibility in Washington, DC, to solve problems, not 
to pass them on. And today the United States Congress met its 
responsibility. We inherited a good Medicare system. It has worked, but 
it was becoming old and needed help. Because of the actions of the 
Congress, because of the actions of members of both political parties, 
the Medicare system will be modern, and it will be strong.
    I appreciate Karla Perez for hosting us here. She had a very good 
visit about health care needs in this community and around our country. 
Karla is an impressive CEO and managing director, and I'm really glad 
she invited me here. I want to thank Alan Miller, Mike Marquez, and Dan 
McBride for their leadership as well.
    I appreciate so very much your fine Governor, Kenny Guinn, for 
showing up today. Governor, it's great to see you. He's a close friend, 
as is Dema. The Governor and I both married very well. [Laughter] Laura 
sends her love to both of you. [Laughter]
    Two Members of the United States Congress from Nevada are with us 
today, Congressman Jim Gibbons and Congressman Jon Porter. They 
supported this piece of legislation. They support a lot of good 
legislation. And I'm proud of your work, and I appreciate your courage 
in doing the right thing for America's seniors--by the way, not only the 
seniors today, but those of us who are going to be seniors.
    I also want to welcome Trent Franks from the great State of Arizona, 
friend, a man who also supported Medicare reform. He and his wife Josie 
are here to join us today, and I'm honored that you all would come over 
from Arizona to say hello. I want to thank the Nevada attorney general 
for joining us, Brian Sandoval. I appreciate members of the statehouse 
for being here. I'm glad Darlene Ensign is with us, the Senator's good 
wife--for joining us. Most of all, I'm really glad you all are here, and 
thanks for letting me come by to say hello.
    Today when I landed, I met Maria Konold-Soto. She's a--where is 
Maria? Oh, there's Maria. Yes. What Maria does is she volunteers in your 
community on the Medical Reserve Corps. Perhaps you've heard about it. 
It is a chance to help our communities prepare for a potential 
emergency. Notice I said ``volunteers.'' A lot of times people talk 
about the strength of the country in terms of our military might or the 
size of our wallets. The strength of America is the heart and souls of 
our fellow citizens who are willing to volunteer to make their 
communities a better place.
    I know a lot of the docs here provide a lot of care for people who 
hurt. That's part of making America a compassionate place. Maria is part 
of making America a compassionate place. All of you who volunteer, I 
want to thank you very much for the job you do. If you're interested in 
being a patriotic American, love a neighbor just like you'd like to be 
loved yourself, and you'll make a significant contribution to our 
country.
    This Nation's health care is great. We've got the best health care 
in the world, and we need to keep it that way. We've got a great health 
care system because of our docs--well trained, decent, caring people who 
practice medicine. We've got a great health care system because of our 
nurses who work hard to provide compassionate care. We've got the best 
research in the world. We're on the leading edge of change in America.
    But we've got to keep the system vibrant. And we must keep it the 
best in the world, which we intend to do in Washington, DC. We started 
that by making sure our seniors have got a modern system. The Medicare 
system, first of all, is an essential commitment of the Federal 
Government. Our Federal Government has made a commitment to our seniors 
that we will provide them an up-to-date, decent health care system. It's 
a basic trust that has been upheld throughout the generations.
    And we're keeping that trust by making sure the system works, by 
making sure that our seniors are well treated. In recent years, Medicare 
has not kept up with the advances of modern medicine. In other words, it 
hasn't met the trust that the Federal Government has promised to our 
seniors. Remember, when Medicare was passed in 1965, health care meant 
house calls and surgery and long hospital stays. And the system was 
designed to meet the health care delivery systems of

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the day. Modern medicine today now includes preventative care, 
outpatient procedures, and at-home care.
    Many invasive surgeries are now unnecessary because of the new 
prescription drugs which are being developed. Many Americans have 
coverage for these new forms of health care, and that's positive, and we 
need to keep it that way. Yet seniors who rely exclusively on Medicare 
do not have the coverage for many of the new treatments and do not have 
coverage for prescription drugs. In other words, medicine changed, and 
Medicare didn't. And as of today, Medicare is changing.
    Let me give you an example of the need for modernization. The health 
care providers here know these examples only too well. Medicare is 
willing to pay $28,000 for a hospital stay for ulcer surgery. But it 
won't pay the $500 for the anti-ulcer drugs that would keep the senior 
out of the hospital in the first place. Those examples--or that example, 
like many others, says to me we had a problem with the Medicare system. 
It doesn't make any sense to pay the 28,000 at the end of the process 
but not the 500 up front to keep the 28,000 from happening in the first 
place.
    Medicare should cover medications to keep our seniors out of the 
hospitals. The new bill does this. The important part of the reform is 
to recognize that medicine has changed. It will save our Government and 
the taxpayers money by providing prescription drugs early so we don't 
have to pay for it in long hospital stays or invasive surgeries.
    Most seniors have got some form of prescription drug coverage from a 
private plan, and that's important. It's a fact of life here in America. 
Those plans, however, are becoming less available. We've got to make 
sure the private sector remains vibrant. The bill I'm about to describe 
to you does that.
    Medicare was very slow to take advantage of new medical advances, 
besides prescription drugs. In other words, you had to go through a 
bureaucracy in order to get certain procedures covered. Bureaucracies 
don't move very quickly. They tend not to be very sympathetic 
organizations. They're not consumer-driven. They're process-driven. 
They're hidebound by rules and regulations. The docs here know what I'm 
talking about. You get to deal with bureaucracies. It must be a 
frustrating experience. Sometimes it's a frustrating experience to try 
to change bureaucracies.
    The Medicare plan that I'm going to sign understands that a lack of 
competition meant that there was no real need to provide innovation. And 
so we're helping to change the system by giving seniors more options and 
more choices. See, Members of Congress have got choices. They get to 
choose from a health care plan, and it works quite well. The three 
Congressmen here would tell you they're probably pretty satisfied with 
the plan, if they've chosen to be in it. In other words, you get to 
choose.
    This new Medicare bill I'm going to sign says seniors are plenty 
capable of making choices themselves. I used to say, ``If it's good 
enough for the Members of Congress to have choice, it ought to be good 
enough for the seniors in America to have choice.'' Now they're going to 
have choice, thanks to the bill I'm going to sign.
    It's going to take a while for this piece of legislation to kick in. 
It's going to take about 2 years to get all the reforms in place. But 
within 6 months of the law being signed, our seniors will start to see 
real savings in health care costs because seniors will be eligible for a 
drug discount card that will save them between 10 to 25 percent off 
their regular drug costs. And low-income seniors will receive up to $600 
a year to help them with their drug costs in addition to the card. Their 
card will serve as a transition to the reforms that are inherent in the 
Medicare legislation.
    When the full drug benefit arrives in 2006, all seniors will be 
eligible for prescription drug coverage for a monthly premium of about 
$35. The result is that for most seniors without coverage today, the 
Medicare drug plan will cut their annual drug bills roughly in half. 
That's positive news for America's seniors.
    It's positive news for Joyce and J.C. Pearson. J.C.'s from 
Tennessee, by the way, and he reminded me that without Tennessee, Texas 
wouldn't have been much. [Laughter] He reminded me more than once, I 
might add. [Laughter] The Pearsons are--live on a tight budget. They 
spend about $300 a month for prescription drugs. Under the new

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Medicare reform bill passed today, they will save $1,800 a year. Joyce 
said they can use that money. She said it's going to come in handy in 
their retirement years.
    Seniors with the highest drug bills will save the most. Seniors with 
the greatest need will get the most help. Low-income seniors will pay a 
reduced premium or no premium at all and lower or no copayments for 
their medications.
    Under the new reforms, seniors, as I mentioned, will have choices. 
You see, some seniors don't want to choose, and I can understand that. 
In other words, people who are on Medicare just don't want to be 
confronted with a choice, and the system in the bill we passed 
recognizes that. You can understand why. The person is up in years, and 
it's pretty comfortable. They don't want to have to change. Change makes 
some people nervous, and we understand that. And so should seniors want 
to stay in traditional Medicare and receive a prescription drug benefit, 
they will now be able to do so. That's one of the key reforms in the 
bill. But other seniors want to choose. They want to be able to make a 
selection based upon their own particular needs. Some might want 
protection from high out-of-pocket medical expenses. Some might want 
expanded coverage for hospital stays. Some might want to be able to pick 
a plan that better meets their own individual needs. And under this law, 
choices will be readily available for our seniors, and that's an 
important part of reform.
    Because, you see, when seniors or any citizen makes a demand, the 
system responds. If there is a demand-driven system, it means the 
doctor-patient relationship is going to be more firm, and it means 
people will have better choices to meet their own particular needs. Some 
seniors may want the coverage that comes with managed care plans, 
Medicare+Choice.
    Bob May is with us today. Bob is a World War II veteran. He is what 
I would call a solid citizen. Bob said, ``You know,'' his wife--who 
unfortunately passed away recently--and he ``sat down and analyzed, made 
a choice, and we weighed the pros and the cons about what health care 
plan would fit our needs.'' I want you to hear that carefully. Bob and 
his wife sat down and said, ``Here's the pluses and the minuses.'' In 
other words, he's plenty capable of making a choice. He didn't need the 
Government telling him how to choose what health care plan best met his 
needs. And so he chose Medicare+Choice, and it works, he said. Under the 
law, Medicare+Choice will be strengthened, not starved. It is a viable 
option for our seniors around the country. In other words, people will 
have more control over their health care options, and health care plans 
will start competing for their business. And that's positive, positive 
for the consumers, positive for the seniors of America.
    There are other important reforms in this bill. When seniors sign up 
for Medicare, they will get a complete health examination so that 
doctors can know their health needs from the start. We're finally 
beginning to focus on preventative care. It makes sense to include 
preventative care in any health care reforms. The health care providers 
here know that better than anybody.
    The bill provides incentives for companies to keep the existing 
coverage they provide for senior retirees. There was some concern in 
Washington, a legitimate concern, as far as I'm concerned, that a 
Medicare reform plan would encourage employers to not do their 
responsibility to their former retirees. This bill addresses that. Two 
out of every three seniors is now covered by some form of private 
coverage, and the bill addressed the issue and--to make sure that that 
coverage is still a viable alternative in the marketplace.
    Every American, old and young, will be able to have a health savings 
account. They will be able to put money aside tax-free to help their 
families with medical expenses. Medical savings accounts are important 
part of reform. Medical savings accounts trust the consumers, provides 
incentives for people to make wise choices, and helps to maintain the 
doctor-patient relationship.
    This bill helps rural hospitals. This would not qualify as a rural 
hospital here. [Laughter] But rural hospitals need help to continue to 
serve our country. This bill sets fair reimbursement rates for doctors 
serving Medicare patients. This is a good bill, and I'm looking forward 
to signing it.

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    Last Saturday's vote in the House and today's vote in the Senate 
marks an historic moment, a bipartisan achievement that all Americans 
can be proud of. Year after year, the problems in Medicare system were 
studied and debated, and yet nothing was done. As a matter of fact, they 
used to call Medicare ``Mediscare'' for people in the political process.
    Some said Medicare reform can never be done. For the sake of our 
seniors, we've gotten something done. We're acting. We acted on 
principle in Washington, DC. We'll provide new treatments and new 
choices. We'll get prescription drug coverage they deserve. We'll keep 
our commitment to Medicare to better the lives of the American seniors 
for generations to come.
    I appreciate the hard work of the Members of the Congress. It's a 
tough bill. People worked hard on it. A lot of people searched their 
soul on this complex and important piece of legislation, but they stayed 
after it, stayed focused on the people. A lot of Members put politics 
aside, which we need to do in Washington, DC, when we're talking about 
the people's business.
    I appreciate the seniors and the seniors' groups, such as the AARP, 
who lobbied hard on behalf of a modern Medicare system. People made 
their opinions known. They let the Members know where they stand. And it 
worked, and it helped. And I'm honored to put my signature on this 
historic piece of legislation.
    Another topic of conversation came up at our roundtable discussion, 
and that was the effect of junk lawsuits on the delivery of health care 
in America and in Nevada. You see, one of the things we must work for is 
a health care system which is affordable and available. Junk lawsuits, 
the threat of junk lawsuits, drive up the cost of health care and run 
good docs out of the system.
    It's important for our fellow citizens to understand the effect of 
junk lawsuits. You see, docs who are threatened and are constantly sued, 
even though their practice is a good, strong, excellent practice, resort 
to what's called defensive medicine. They order procedures and tests 
that may not be needed but are--provide protection in the court of law. 
You see, if you think a lawyer is simply fishing for a rich settlement, 
is constantly looking over your shoulder, you'll end up practicing 
what's called defensive medicine. Docs are afraid to give their patients 
certain advice. In other words, the doctor-patient relationship is 
disrupted for fear that that advice will be used against them in the 
court of law. This problem not only affects the doctors; it affects the 
patients as well. See, it's running up the cost of medicine. It affects 
a person's ability to deliver good, quality health care.
    Donna Miller is an OB/GYN specialist here in Vegas. Dr. Miller has 
seen her premiums go up about $28,000 last year, to about $72,000 this 
year. She thinks they're headed to about $100,000 this year. You know 
what I'm talking about, about premium increases. It's a system that 
reflects lawsuit after lawsuit after lawsuit. And Dr. Miller's patients 
pay the price. These junk lawsuits are driving up the cost of medicine.
    Here's what she says. She says, ``You got into medicine to take care 
of people and to spend time with your patients. With the premiums going 
up the way they are, you can't do that.'' She told me about the 
colleagues who have left Nevada. I remember when your trauma center shut 
down here. It made national news. It's a clear sign that you've got an 
issue here that must be dealt with, because the people who are affected 
are the people of Nevada.
    It means that women who want to have their babies delivered in 
Nevada are having a hard time finding a doc; that's what it means. And I 
met Jill Forte today, a proud mother. She found out she was pregnant 
with her second child. She called her doctor. The doctor told her that 
because of insurance costs, she could no longer deliver her baby. So she 
started calling around. She was told the same thing--I think she told 
me, about five different docs. She considered going to California. 
Fortunately, she was able to make a connection through a friend for a 
local doc to take her case.
    But you see--and let me tell you what she said. She said she was in 
total shock. She didn't know what was going on until it happened. 
Looking for a doctor, worried about finding a doctor when you're 
pregnant, is a stress that is an unnecessary stress. It's a stress 
caused by frivolous and junk lawsuits.

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It doesn't make any sense to have a society that sues so often that 
expectant mothers are worried about finding a doctor. We've got to do 
something about this in America.
    There's a cost to the Federal Government because of the frivolous 
and junk lawsuits and the defensive practice of medicine. It is 
estimated that the defensive practice of medicine raises the Federal 
budget by $28 billion a year. You see it from Medicare, Medicaid, 
veterans' health benefits, for example. The junk lawsuits affect our 
budget. Therefore, I view this as a national problem which requires a 
national solution. We need a system where patients who are harmed have 
their day in court, where they can collect damages to cover their 
injuries or recovery or rehabilitation and loss of income. If you've 
been harmed by a bad doc, you deserve your day in court. Frivolous 
lawsuits, by the way, that clog the courts make it very difficult for 
someone with a legitimate claim to get into the court. When patients can 
prove they were harmed by a doctor's egregious behavior, they should be 
able to collect reasonable punitive damages.
    There needs to be a $250,000 cap on noneconomic damages. I laid out 
this proposal to the Congress. The House of Representatives responded in 
a positive way, and I want to thank the Members here for voting the 
right way. The bill is stuck in the Senate. You need to contact a 
Senator in the State of Nevada and let them know you're interested in 
national medical liability reform. The Senators must understand that 
nobody in America has ever been healed by a frivolous lawsuit. For the 
sake of the patients in this State and for the doctors in this State and 
for the patients and docs around the country, we need medical liability 
reform now. And the Members of the Senate must understand, this is a 
compelling national issue, and I will keep it on the front burner until 
we get the problem solved.
    Finally, yesterday, I was in Fort Carson, Colorado, where I had the 
honor of addressing men and women who wear the Nation's uniform. I just 
want to share with you right quick our country's foreign policy. In a 
nutshell, it's ``we'll do everything we can to keep America secure.'' I 
will not forget the lessons of September the 11th, 2001. My duty as the 
President, obviously, is to deal with domestic issues and to tackle 
tough problems. My duty as your President as well is to keep this 
country secure. And I had the honor of meeting with men and women who 
wear the Nation's uniform who are doing just that.
    We'll protect our homeland as best as we possibly can. But the best 
way to protect the homeland is to chase the killers down one at a time 
and bring them to justice, which is exactly what we intend to do.
    Freedom equals peace, as far as I'm concerned. And when you hear us 
working for freedom in troubled parts of the world, you've just got to 
know it will lead to peace. We'll deal with the short-term security 
needs by staying on the offensive. We'll help our children grow up in a 
free society by bringing freedom to parts of the world that desperately 
need freedom. Our soldiers--as we head into Thanksgiving, we need to 
give thanks to our soldiers for their sacrifice, for the honor they 
bring to our country, for the service they render by bringing freedom to 
troubled parts of the world. You see, we're bringing freedom in the 
heart of the Middle East.
    Free countries don't develop weapons of mass destruction. Free 
countries don't attack their neighbors. Free countries listen to the 
hopes and aspirations of the people who live in those countries. No, 
America also believes that freedom is not America's gift to the world; 
freedom is the Almighty's gift to every person who lives in this world. 
And this Nation will stay the course to bring democracy and freedom to 
Afghanistan and Iraq. And by doing so, we will not only help the long-
suffering people in those countries; we will make America more secure 
and the world more peaceful.
    Thank you for letting me come today. May God bless you all, and may 
God bless America.

Note: The President spoke at 10:32 a.m. In his remarks, he referred to 
Karla Perez, chief executive officer and managing director, and S. 
Daniel McBride, chief of staff, Spring Valley Hospital; Alan B. Miller, 
president and chief executive officer, and Michael Marquez, vice 
president of acute care, Universal Health Services; Gov. Kenny C.

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Guinn of Nevada and his wife, Dema; Representative Trent Franks of 
Arizona and his wife, Josephine; and Darlene Ensign, wife of Senator 
John Ensign of Nevada. The Office of the Press Secretary also released a 
Spanish language transcript of these remarks.