[Weekly Compilation of Presidential Documents Volume 41, Number 4 (Monday, January 31, 2005)]
[Pages 106-112]
[Online from the Government Publishing Office, www.gpo.gov]

<R04>
Remarks in a Discussion on Health Care Information Technology in 
Cleveland, Ohio

January 27, 2005

    The President. Thank you, Leavitt. Thank you, Mike. No, thank you 
all. Thanks for coming. No, please be seated. Thank you. Thanks for the 
warm reception. It's great to be here at one of the Nation's finest 
medical complexes. I want to thank you for giving us a chance to come by 
and talk about how to make sure health care is available and affordable 
for our fellow citizens.
    I am honored Mike Leavitt has agreed to serve our country. He's been 
in the job 15 hours, and he hasn't made any mistakes yet. [Laughter] But 
he is going to do a great job. He was a former Governor from the great 
State of Utah. He understands the need for the Federal Government to 
relate effectively with State governments. The HHS is a complex 
organization with a lot of tasks. It requires good management skill in 
order to be an effective Secretary. I am confident that Mike has got the 
skill set and the vision necessary to do the job.

[[Page 107]]

    And so, Mr. Secretary, welcome to the job. I'm looking forward to 
working with you. I know a lot of docs are too. And you'll do fine. 
Fifteen hours and no errors is a good start.
    I want to thank Toby Cosgrove, the doc, the CEO and chairman of this 
fantastic facility, for welcoming us here. I'm honored, Doc, that you 
put up with the entourage and let us come and visit with the good folks 
here in the Cleveland area.
    I appreciate the docs who showed me the fantastic technologies that 
are now in place in this hospital. That's part of what we're going to 
discuss today. As you can see, I've asked some people who know what 
they're talking about to come and share the great excitement of 
information technology and how it can help change medicine and save 
money and save lives and, most importantly, make our fellow citizens--
make available to our fellow citizens a health care system that is 
responsive to their needs.
    And so thank you all for coming. I think you're going to find this 
pretty interesting. I know I'm going to.
    I want to thank the Governor of the great State of Ohio for joining 
us. The last time I saw Taft, he was dancing on the stage at an 
Inaugural ceremony. [Laughter] He's about a lousy a dancer as I am. 
[Laughter]
    I want to thank two Members of the Congress who traveled with me 
today on Air Force One, Ralph Regula, who is a fine Member of the House 
of Representatives, as well as--thank you for coming, Ralph--as well as 
Congressman Steve LaTourette. We appreciate you coming, Steve. You over 
there? Yes, he's still there. I was going to say, if he skipped the 
deal, he wasn't going to get a ride back. [Laughter]
    I want to thank all the docs who are here. I want to thank all the 
people who--nurses who are here and the staff members who are here. I 
want to thank you for your compassion, and I want to thank you for 
lending your enormous skills and talents to saving lives. It's--we've 
got the greatest medical system in the world, and the role of the 
Federal Government is to do what is necessary to keep it that way. And I 
believe that the reason why we're so good is not only because we're 
great at research, but our people are so compassionate and decent and 
care about their patients.
    I want to talk--by the way, I met a guy named T.J. Powell. Where are 
you, T.J.? There you go. T.J. was at Air Force One. The reason I like to 
mention somebody like T.J. is because he volunteers a thousand hours per 
year in helping people as a member of the Ohio Medical Reserve Corps. In 
other words, he lends his talent and time to help people have a better 
life. In my State of the Union, I'm going to talk about the strengths of 
our country, the economy and our military--and we intend to keep it 
strong to keep the peace. But the true strength is the fact that we've 
got citizens from all walks of life who are willing to volunteer a 
thousand hours a year to make somebody's life better. I thank you for 
the example you've set, T.J. I appreciate you coming.
    So the fundamental question facing the country is, can we have a 
health care system that is available and affordable without the Federal 
Government running it? I mean, it really is a philosophical challenge. 
There's good, well-meaning folks who believe that the best health care 
system is one where Washington, DC, makes the decisions. I happen to 
believe the best health care system is one where the consumers, the 
patients, make the decisions.
    And so here are some practical ways for us to deal with the rising 
costs in health care. One is to make sure that people who can't afford 
health care have got health care available to them in a commonsense way. 
And that's why I'm such a big backer of expanding community health 
centers to every poor county in America. We really want people who 
cannot afford health care, the poor and the indigent, to be able to get 
good primary care at one of these community health centers and not in 
the emergency rooms of the hospitals across the United States of 
America.
    The best way for a compassionate society to help make sure there is 
a health care safety net is to expand these community centers, which are 
working. I mean, this is something--we say, ``Are you going to fund 
programs that get results?'' And the answer is:

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You bet. And these community health centers get great results. And so 
I'm looking forward to calling upon Congress to expand them to every 
poor county in the country.
    Secondly, we have made clear our commitment to our Nation's seniors 
that we'll have a Medicare system that is modern. I can remember 
traveling the country explaining to people that Medicare would pay for 
thousands of dollars for a heart surgery--$100,000 for a heart surgery, 
say, but not one dime for the prescription drugs that would prevent the 
heart surgery from being needed in the first place. That didn't seem a 
very effective use of taxpayers' money to me, and it certainly said that 
the Medicare system wasn't modern.
    So I called upon Congress, and Congress acted, and I signed a bill 
that makes the Medicare system more modern to meet the needs of our 
seniors. Inherent in the reforms in that bill is giving seniors more 
options and more choices to choose from, which is a philosophy that I 
think you'll hear as we discuss what is available to help control costs. 
In other words, the more choices people have in health care, the more 
likely it is that costs will be under control.
    Let me give you an interesting idea that I think small-business 
owners need to look at, and those are called health savings accounts--or 
individuals need to look at it, or families need to look at health 
savings accounts. A health savings account is basically a plan that says 
you buy a high-deductible catastrophic plan--in other words, you cover 
your first $2,000 of medical expenses, and then the insurance kicks in 
after that--and that to cover the medical--routine medical expenses up 
to $2,000, your business contributes tax-free into the plan, which is--
and if you don't spend the 2,000--in other words, if you make right 
choices about how you live and what you put into your body; in other 
words, if you prevent disease by exercising on a daily basis, and 
there's money not spent in the account--you can roll it over from one 
year to the next tax-free. And as you withdraw the money, you can do so 
tax-free.
    Now, the cost of the insurance for the high-deductible catastrophic 
plan is incredibly less expensive than the normal third-party payer 
system. And the savings on premiums from that plan more than covers the 
incidental costs necessary until you get up to the deductible. That's a 
complicated way of saying, this works.
    And I ask small-business owners to take a look at health savings 
accounts. Most of the working uninsured work for small-business owners, 
who are getting squeezed by the high cost of medicine. This is a way to 
be able to afford health care for your employees and, at the same time, 
put your employees in charge of the decisionmaking when it comes to 
health care.
    One of the issues, in terms of the cost of health care, is the fact 
that many people have their health care decisions made by third-party 
payers. So, in other words, they're not really involved with the 
expenses and the expenditure of money. You show up, and the insurance 
company covers your costs. But you don't know what the costs are, and 
you're not involved in the decisionmaking. Health savings accounts, 
which will make life more affordable for employer and employee, really 
puts somebody in charge of the decisionmaking, and that in itself is 
part of how you control costs. If you're out there shopping for a better 
deal, it helps bring cost efficiencies into a system that needs cost 
efficiencies.
    Another way to help people afford health care, particularly small 
businesses, is to allow small businesses to pool risk. Right now, if 
you're a restaurant in Ohio and a restaurant in Texas, you have to buy 
your insurance only within Ohio or only within Texas. I believe 
restaurants ought to be able to pool across jurisdictional boundaries so 
they can buy insurance at the same discount that big companies get to 
do. In other words, the more people you have in the--in your pool of 
people to insure, the less expensive insurance becomes. It makes sense, 
doesn't it? But the law prevents people from doing that now. So here are 
some practical ways to help with the cost of medicine.
    Another practical way--and I want to thank the FDA for having 
responded to our call--is to get generic drugs to the market faster. 
Brandname drugs are protected by patent for a period of time to allow 
pharmaceutical companies to recoup their research and development. That 
makes sense, but

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what doesn't make sense is the company's ability to delay the arrival of 
generic drugs. They do the exact same thing brandname drugs do, but 
they're far less expensive. And so, by speeding generic drugs to the 
market, we'll make pharmaceuticals more affordable to our seniors and 
take the pressure off our State budgets, which we are now in the process 
of doing.
    But we're here to talk about another way to save health--save costs 
in health care, and that's information technology. Now look, most 
industries in America have used information technology to make their 
businesses more cost-effective, more efficient, and more productive, and 
the truth of the matter is, health care hasn't. I mean, health care has 
been fantastic in terms of technological change. I mean, you see these 
machines in these hospitals--compared to what life was like 10 years 
ago, things have changed dramatically.
    And health care has got--we've got fantastic new pharmaceuticals 
that help save lives, but we've got docs still writing records by hand. 
And most docs can't write very well anyway, so--[laughter]. Can you? 
[Laughter]
    And so the fundamental question is, how do we encourage information 
technology in a field like health care that will save lives, make 
patients more involved in decisionmaking, and save money for American 
people. That's what we're here to talk about.
    And I've asked Dr. David Brailer to join us. When we started the 
process of encouraging information technology to spread throughout 
health care and setting the goal that there ought to be--every patient--
every American ought to have a medical--electronic medical record within 
I think 7 years--7 years or 10 years?
    Dr. David Brailer. Ten years.
    The President. Ten years--yes, ten. I asked David--or I didn't ask 
David--Secretary Tommy Thompson asked David and told me he asked David 
to be in charge of the Federal effort to do what is necessary to reduce 
the obstacles and roadblocks to get electronic medical records into the 
hands of every citizen.
    So I've asked David to join us to kind of help explain what I'm 
desperately trying to explain to you--[laughter]--in English--and so 
that people understand why information technology can advantage our 
society.
    Why don't you start, David?

[At this point, Dr. Brailer, National Health Information Technology 
Coordinator, Department of Health and Human Services, made brief 
remarks.]

    The President. Yes, if you're in Florida--living in Ohio and you 
have to go down to Florida--my brother is the Governor, so I'm putting a 
plug there. [Laughter] But you go to Florida, you get in an automobile 
accident, an electronic medical record means your data to the doc in the 
emergency room is transmitted just like that, as opposed to calling 
somebody, getting them out of bed, could you please go find so-and-so's 
file, read somebody's file, and transmit the information. I mean, you 
can imagine, a speedy response to an emergency saves lives.
    Go ahead, sorry. I just wanted to put a plug in there.
    Dr. Brailer. It's okay, sir. [Laughter]

[Dr. Brailer made further remarks.]

    The President. Well, thank you, sir. David, thanks. He's outlined 
kind of a national vision, a national strategy--which is being 
implemented from the ground up, by the way, not the top down. That's why 
we're here at the hospital, because they've implemented really 
interesting information technology here.
    Let me just say one thing before we get to some docs who are on the 
frontline of change. One of the things we have to do in this society is 
to have a judicial system that's fair and balanced. And I couldn't help 
but think of these good folks who are practicing medicine and realizing 
that too many of their fellow citizens are leaving the practice of 
medicine because of junk lawsuits. This society needs to have balanced 
and fair law. And it is important for Members of Congress, Members of 
the United States Senate, to know that a unbalanced legal system, a 
system where the law is like a lottery when it comes to suing people in 
medicine, is driving good people out of practice. We need medical 
liability reform--now.
    Anyway--Martin Harris. Martin, what do you do? Dr. Martin Harris--
excuse me.

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    Dr. C. Martin Harris. I am a general internist, but I'm also the 
chief information officer for the Cleveland Clinic Foundation.
    The President. That's pretty good. [Laughter]
    Dr. Harris. It's a good combination; keeps me up.
    The President. That's strong--[laughter]--a man of many talents.

[Dr. Harris made brief remarks.]

    The President. You're doing good. Keep going. [Laughter]
    Dr. Harris. All right. I do have one more. And I will point out to 
you that everything I'm talking about will be in place in Florida by 
July this year. [Laughter]
    The President. Let me ask you something. I know you've got one more. 
I don't want to--I'm just sitting here thinking about, I'm sure people 
are out there saying, ``I don't want my medical records floating around 
ether, so somebody can pick them up.'' I presume I'm like most 
Americans; I think my medical records should be private. I don't want 
people prying into them. I don't want people looking at them. I don't 
want people opening them up unless I say it's fine for you to do so. 
Explain how you----
    Dr. Harris. Absolutely. So that is true, and it's true whether it's 
in electronic form or whether it's a piece of paper. We want to know 
that the record is secure and that it remains confidential. But 
information technology actually works perfectly to document that. If you 
left a medical record on paper in a room, how will you know who saw it? 
You can't know. When it's in electronic form, when anyone logs on to the 
system, we know. We know who they are. We know where they are. We know 
what they were looking at. And we can keep logs of all that information 
so that we can confirm for our patients that their information is 
secure.
    The President. One more?

[Dr. Harris made further remarks.]

    The President. See, what he's saying there is that these networks 
are beginning to grow, from the Cleveland Center out, and the 
fundamental question is, can the Cleveland Center's network talk to 
somebody else's network so that you can exchange information? It's one 
thing to have information on a regional basis; we need to have it on a 
national basis so that information flows across our country. And that's 
what the interoperability means.
    Listen, you did a fabulous job.
    Dr. Harris. Thank you.
    The President. Really good job.
    Dr. Bob Juhasz. Dr. Juhasz, thank you for being here. What kind of 
doctor are you--besides a good one? [Laughter]
    Dr. Robert Juhasz. I am a primary care/internal medicine physician.

[Dr. Juhasz, internist, The Cleveland Clinic, Concord Township, OH, made 
brief remarks, concluding as follows.]

    Dr. Juhasz. And with the MyChart, it allows me to look at that 
laboratory information, be able to put a secure message to that patient 
about their laboratory data, and it sends them a secure message to say 
that you have something to look at in your MyChart site. They log on in 
a secure way to that site, and they're able to actually review their 
laboratory work, anything that they've had done previously, as well as 
my notes. They're also able, if they need to ask for a prescription 
refill or if they need to get a future appointment, they can do that. 
And for patients like Patty, that----
    The President. Is Patty your patient?
    Dr. Juhasz. Yes, she is.
    Patricia McGinley. I'm the patient.
    The President. Sometimes when we leave the doctor's office, we're 
wondering when you're going to get new magazine subscriptions. 
[Laughter] Anyway----
    Dr. Juhasz. I try to make sure those are updated. [Laughter]
    The President. Patty. Bob is your doctor?
    Ms. McGinley. Yes, he is. He has been for 6 years.
    The President. Looks like a fine man.
    Ms. McGinley. He's a wonderful physician.
    The President. By the way, before we get to Patty, just think how 
many Bobs there are in the world who have--who will go from writing and 
wondering and picking up files to an efficient system. And when that's--
what he just described, the efficiency he just

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described means he's saving time and, therefore, money for the patients. 
And when you multiply the efficiencies to be gained all across the 
spectrum, whether it be individual docs or hospitals or networks, that's 
why some predict that you can save 20 percent off the cost of health 
care as a result of the advent of information technology.
    Patty.
    Ms. McGinley. Yes, Mr. President.
    The President. Welcome. I'm glad you're here. Thank you for coming.
    Ms. McGinley. Thank you for having me.
    The President. You look healthy to me, but I'm not a doctor. 
[Laughter]

[Ms. McGinley made further remarks.]

    The President. You did a great job. I think one of the things that's 
interesting--what struck me about Patty's conversation was--is that--how 
liberated she feels through information and that I'm sure a lot of 
patients--and you probably can testify to this--are pretty nervous about 
dealing with doctors and the words and the diseases and all that stuff. 
And all of the sudden, the more educated you become, the more 
comfortable you become, not only about figuring out what's wrong but, 
more importantly, figuring out how to cure the problem.
    And one of the--listen, information is a liberating tool. And it's 
liberating for a lot of parts of life, including health care. So thank 
you for sharing that.
    Ms. McGinley. You're welcome.
    The President. Jorge del Castillo. See. I'm Jorge, too. [Laughter]
    Dr. Jorge del Castillo. It's a good name.
    The President. That means George. [Laughter] He's Jorge D., I'm 
Jorge W. [Laughter] Anyway--so where do you work?

[Dr. del Castillo, associate chief of emergency medicine, Evanston 
Northwestern Healthcare, Wilmette, IL, made brief remarks.]

    The President. How long has--have these medical records been 
available in your situation?
    Dr. del Castillo. We deployed--we started in March of 2003. This 
March it will be 2 years. Interestingly enough, most of our physicians 
went into the electronic medical records kicking and screaming, and now 
they can't live without it. It is--the system went down the other day 
for about 2 hours, and there were just complaints and cries of help and 
so on because you just cannot live without it. It is just one of the 
best things that can happen to the medical field.
    The President. Yes, you see it's interesting, isn't it? I mean, 
they've only been in--have had this technology for 2 years. I mean, 
we're talking the beginning of, and--of a development in health care 
that is going to be lifesaving and costsaving and changing for the 
better. And that's what's so exciting about it. And I appreciate you 
sharing that with us.
    Dr. del Castillo. My pleasure, sir.
    The President. We've got one other doc here to talk to, Barth 
Doroshuk. Barth, where do you live?
    Barth Doroshuk. I'm from Bethesda, Maryland, Mr. President.

    The President. Right, yes, yes.

    Mr. Doroshuk. Right next door to you.

    The President. Within spitting distance of the Capital. [Laughter]

    Mr. Doroshuk. Exactly.

    The President. Give us a sense about you--actually, I'll introduce 
Barth. Barth is a--I wouldn't call you sole practitioner, but close to 
it.

    Mr. Doroshuk. We have a very--we have a small practice in 
Washington, DC, and in Maryland. The Washington ENT Group provides ear, 
nose, and throat medicine and head and neck surgery to the regional area 
of the metropolitan DC area.

    The President. And how many docs?

    Mr. Doroshuk. And we have six doctors.

    The President. So it's a relatively small practice.

    Mr. Doroshuk. Small compared to the testimonies we've heard this 
morning already--four audiologists and a radiology technician because we 
do some X rays. And when we went into electronic medical records back in 
2000, we were looking at starting the practice up, and we had a choice: 
Do we do it the way we've always done it, or do we move ahead? Is there 
technology that's there? Is it reliable enough? And is the

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investment safe? And lo and behold, we decided to go ahead and implement 
a fully digital medical office, and we haven't looked back.
    The President. Which, by the way, has got to be a pretty serious 
decision for a very small doctors' office. In other words, there's a lot 
of doctors out there saying, ``I don't think I need this, and the cost-
benefit ratio certainly doesn't justify me, the sole practitioner, or me 
operating with three or four other docs.''

[Mr. Doroshuk, president and chief operating officer, Washington ENT 
Group, Bethesda, MD, made further remarks.]

    The President. Is the cost-benefit--I mean, is it clear to you now 
that----
    Mr. Doroshuk. It's very clear to us, very clear to us. When we 
opened up our second office, it was not even a factor.
    The President. So in other words, it kind of defies the notion that 
there has to be economies of scale in order to benefit from IT--in other 
words, big hospitals with a lot of docs will benefit, but little docs 
won't be able to afford the costs. And it's very important for docs who 
are listening to this to understand that the cost-benefit is noticeable 
and real, and not only that, you're expanding as opposed to going out of 
business.

[Mr. Doroshuk made further remarks.]

    The President. The role of the--thank you. Good job. The role of the 
Federal Government is to not only set the strategy but to spend grant 
money to encourage the development of regional hubs and to really get 
the process started. There will be a certain momentum that will be 
achieved once the cost-benefit becomes aware to everybody that's a 
practitioner. But the Government's role is to help best practices get 
started. We've sent out two Federal grants from HHS totaling $3 million 
to Cleveland Clinic to help spur and spawn this fantastic technological 
development.
    And one of the things that I'm excited about is that we're just 
beginning to learn about the great potential of information technology. 
And I think what you're witnessing is a dialog about--on a subject that 
is going to change our lives for the better, and that's why I'm excited 
about it.
    I thank our panelists for being here, for sharing your knowledge, 
your firsthand knowledge about what is possible, what's taking place. 
Imagine what the world is going to be like 10 years from now. I mean, 
what we're hearing today is just the beginning of substantial change, 
all aimed at improving people's lives and making sure that health care 
is as affordable as it can possibly be for every citizen.
    I hope you've enjoyed this as much as I have. I have found it to be 
incredibly informative, and I want to thank our panelists once again for 
sharing their wisdom and knowledge.
    God bless.

Note: The President spoke at 11:30 a.m. at the Intercontinental 
Cleveland Clinic Suite Hotel. In his remarks, he referred to Toby 
Cosgrove, chairman and chief executive officer, The Cleveland Clinic; 
and Gov. Bob Taft of Ohio.