Outlines Health Care Agenda
Medical College of Wisconsin
February 11, 2002
2:52 P.M. CST
Well, thank you very much Tommy, I appreciate your introduction. You hear may
be in Wisconsin, but you've got to keep your address where it is right now;
I'm counting on you. He's doing a fabulous job. (Applause.) I love Wisconsin
for a lot of reasons: one, you produced Thompson. I love you so much I even
come in the winter, which is hard for Texan. (Laughter and applause.)
It is an honor to visit this distinguished place of learning, which trains so
many outstanding physicians. I happen to know something about Wisconsin doctors.
I'm pretty familiar with them, after all, the White House is Colonel Richard
Tubb, raised right here in Wisconsin. He's not only a fine doctor, he fortunately
got special instructions on pretzel-related conditions. (Laughter and applause.)
My advice is, swallow after you chew. (Laughter.)
But the Medical College of Wisconsin represents the future of health care, here
and throughout our country. It's a fitting place to address the great opportunities
and challenges that the future will bring our country. Our health care system
is in need of important reform, and on the verge of amazing discovery. We must
seize the moment for the benefit of all Americans.
And that's why I want to thank Scott McCallum for welcoming me here, and I appreciate
his leadership for the state of Wisconsin. I want to thank the members of the
congressional delegation: Barrett, Petri, Ryan, Sensenbrenner for coming, as
well. It's good to see all of you. I'm looking forward to working with you to
do what's right for the citizens in terms of health care.
I appreciate Michael, his leadership and his hospitality. I want to thank the
docs who gave me a briefing. And I want to thank all of you for your warm --
for your warm welcome.
I want to talk about two things, and they both have to do with the challenges
we face. I briefly want to talk a little bit about the challenge we face abroad.
And then I want to talk about the challenge we face at home, particularly with
First, the enemy made a bad mistake. They don't understand us. Let me rephrase
that, they didn't understand us. They do now. We are patient. We're resolved
people. But we are absolutely determined to defend freedom. (Applause.)
I'm pleased to report that out of the evil have come some good, one of which
is that in Washington, there is no difference between Republicans and Democrats
as to who is the most patriotic, or who wants to win the most. All of us want
to win the war against terror, for which I am grateful.
But I want to tell you all that we're just beginning, that I see this as a unique
moment in history. And this nation must seize the moment. And it's this: either
we defend freedom, so that our children and grandchildren can grow up in a peaceful
world, or we blink. And if we blink, the rest of the world will blink as well.
I don't believe we have that luxury. I believe we must find terror wherever
it hides, and bring it to justice. And so the Afghan theater is the first theater
in the war against terror. And we've done a lot in a quick period of time. I
laid out a doctrine that said, if you harbor a terrorist, if you feed a terrorist,
if you hide a terrorist, you're just as guilty as the terrorists. And the Taliban
found out what I meant. Not only have we thrown them out, but in doing so, we
liberated. We liberated women and children from the clutches of one of the most
barbaric regimes in the history of mankind. (Applause.)
I'm proud of our military. And for those of you who have got a relative in the
military, thank you. And I know you're proud of that relative, as well. There's
a lot of focus on one individual in this war on terror. But this is much bigger
than one person. Oh, the guy, he can hide, and he can run, but there's no cave
deep enough for the arm of justice of the American people. And it's just a matter
of time. I have no artificial date deadlines. I really don't care if it's tomorrow
or a month from now or a year or a couple of years. But Mr. bin Laden is going
to meet his fate.
And in the meantime, the United States of America will continue to rally our
coalition, to continue to cut off money from terrorist organizations, continue
to share intelligence so we can react better, continue to defend our homeland,
and continue to insist that freedom loving nations find, incarcerate and bring
to justice anybody who would harm America, our allies, and our friends. (Applause.)
There was some concern amongst some that the farther we got away from the horrible
day of September 11th, America would waver in our determination. They don't
need to be concerned. We are determined, we are patient, we are tough, we're
compassionate. We will not yield to terror. (Applause.)
There are a lot of challenges we face. We fight a recession. I'm optimistic
we'll recover. But one of the big challenges is our health care system. I like
to put it this way: we face a huge challenge of making sure that we're still
the world's greatest health care system. That's our challenge. How do we maintain
our edge? How do we make sure the American people get the best health care in
And it starts by making sure that we attract the best and brightest to the medical
profession. And that can start with the President saying, thank you for dedicating
your lives to such a great calling. America appreciates the fact that you've
chosen a profession that is so profound, and so important. It's a model of service
and excellence. And the achievements of our medical professionals set the standards
for the entire world.
Life expectancy in America today is eight years longer than it was in 1950,
and 29 years longer than it was in 1900. That's a lot of progress. And for millions,
those extra years of life are more active and more healthy than anybody could
have imagined. We're making great progress against many diseases, such as breast
cancer and colon cancer and childhood leukemia. The death rate from coronary
disease is down 40 percent since 1980. Our country leads the world in Nobel
Prizes for science and medicine, and in the invention of new drugs and medical
I truly believe that this progress is one of America's greatest contributions
to mankind. It is a tribute to the outstanding efforts of the medical profession,
and to a system of private medicine that encourages innovation and rewards hard
Yet our doctors and patients know that our system is far from perfect. Too many
patients feel trapped by the system, with decisions about their health dictated
by HMOs or government bureaucracies. Too many doctors feel buried in paperwork.
I've heard it said that some doctors feel they don't practice medicine, they
At the same time, health care costs are rising sharply, and many people worry
they won't be able to afford the treatments they need. Some procedures are overused,
often as defensive measures to avoid litigation. And about 40 million Americans
still have no health insurance at all.
We must reform health care in America. We must build a modern, innovative health
care system that gives patients more options and fewer orders, and strengthens
the doctor-patient relationship.
Government has got to take an active role in reform. Yet it's important that
government's role is not to centralize; nor is government's role to control
the delivery of medicine. (Applause.) Other nations have tried this route, and
it has led to long waits for treatment, low quality care and lagging technologies.
And for many patients, their experience with centralized government-controlled
medicine leads them somewhere else -- often right here to America, where they
can get the treatment and care they need.
The role of government in health reform is to fix the system where it's failing,
while preserving the quality and innovation of a private, patient-centered medical
system. All reform should be guided by some goals.
The first goal: all Americans should be able to choose a health care plan that
meets their needs at affordable prices. When people have good choices, when
people are given different options, health plans have to compete for business
-- which means higher quality and better coverage.
Most Americans get their health coverage at work. Yet higher costs are causing
some employers to cut back on benefits, or insist that the employee pay more
-- especially if they want to choose their own doctor or to avoid the complications
of managed care. Many families end up in a health plan whose monthly premium
puts a strain on their budget -- and when they require care, they find what
they need really isn't fully covered.
So here's what I propose. I propose we give workers more choice. I propose we
reform the system to make the system more individualized, by creating personal
health accounts. Instead of paying a large premium every month for services
you may not use, I believe we ought to have an account that allows a person
to pay a much smaller premium for major medical coverage and then put the savings
into a health account, tax free. (Applause.)
The money is your money. It's your money in the health account, not the government's
money. And you can use it for whatever health care need that arises. If you
don't use it, it's yours to keep. And the more affordable -- and for the more
affordable premium, you also get catastrophic care, protection in case of serious
The tendency for government is one-size-fits-all. If part of reform is to restore
the patient-doctor relation and to give patients more choices, we have to change
the tax system to -- and allow for patients to make decisions that is in their
best interests. (Applause.)
I also propose to help workers get better and more affordable choices in health
plans at work. Now, some large companies are -- you're okay, you've got some
choice. But many small businesses are unable to afford health insurance. And
so -- and that's because there's not much purchasing power. A stand-alone small
business does not have purchasing power in the market place. Either they can't
afford to cover or they have to allow their employees to settle on a high premium,
high-dollar single plan.
And so what I propose is that we ought to allow employers to pool together --
through an industry association or perhaps the Chamber of Commerce -- so that
they can get the best deal for their workers, just as large corporations are
allowed to do. (Applause.)
Too many workers get no coverage at all through their jobs. This is especially
true among minorities, part-time employees and seasonal workers. For those with
limited means, my budget will provide new credits to afford health coverage
-- up to a thousand dollars for an individual, or $3,000 for a family.
And they won't have to wait for tax time to get these health credits. We'll
make them immediately available for qualifying families, giving them the help
they need when they need it. (Laughter.)
And at the same time, we'll work with our nation's governors to create purchasing
groups to negotiate with insurers for the people who use these health credit.
In other words, people who don't have insurance must be given incentive to purchase
insurance; the states can help them pool, in order to get decent -- decent coverage;
but it's not a government program. In other words, we trust the people. The
government incents individuals to make decisions in the market place. If the
goal is to increase quality care by encouraging individual choice and a doctor-patient
relationship, health credits is one way to help the uninsured do so.
I also strongly believe that the legislation that I proposed to help unemployed
workers makes a lot of sense. And it's this: as soon as a person qualifies for
unemployment benefits, the government would cover 60 percent of the cost of
continuing their health care. That's a proper role for the federal government.
The role of the federal government is to help people who have been unemployed,
not only with benefits, but also with their health care costs.
And the same principle of encouraging choice and helping people help themselves
must apply as well to two government-sponsored programs, Medicaid and Medicare.
Medicaid and the S-CHIP program provide essential coverage for low income families
and seniors, and persons with disabilities. These Americans also deserve more
choices. My budget gives states more flexibility to provide better options in
Medicaid and S-CHIP, and makes additional funds available for states to improve
And the Medicare program is a source of security and dignity for tens of millions
of our seniors. It is an incredibly important commitment that our federal government
has made. I strongly support Medicare because it is so crucial in the lives
of older Americans. But I understand that Medicare is antiquated. It has not
kept pace with advances in medicine. For instance, when Medicare was established
in 1965, health care usually meant hospital care. Today we understand how important
it is to prevent people from getting sick in the first place -- yet Medicare
does not fully cover preventive medicine.
In the past 37 years, many new medicines have arrived to replace invasive treatments
and surgeries. These drugs can be more effective than surgery and are far less
expensive. A serious stomach ulcer, for instance, once required a lengthy stay
in the hospital and many thousands of dollars in medical bills. Today, the ulcer
can be cured with prescriptions costing only hundreds of dollars. Yet Medicare
would only cover the surgery, not the prescription.
We must bring Medicare into the 21st century: to expand its coverage, to improve
its services, to strengthen its financing and to give seniors more control over
the health care they receive. (Applause.) I think we're making progress in Washington;
progress toward convincing the Congress that all wisdom doesn't exist in Washington
bureaucracies when it comes to health care for the elderly. We've got Republicans
and Democrats and an independent from the United States Senate working on Medicare
Seniors who are happy with the current system should be able to keep the coverage
just the way it is. In other words, if there is a senior living in America who
says, I love Medicare just the way it is, nothing changes. And that's an important
-- it's important for a lot of Americans to hear that. But all seniors should
be offered different options, a range of options from which to choose, in both
the private sector and private markets, as well as a better government plan
with better Medigap options. And all of these choices -- all of them -- however,
must include prescription drug coverage. (Applause.)
The second goal of reform is quality -- the ability for a patient to get the
best care from the doctor of our choice.
Managed care plans have done a lot to make health care more affordable for many
people. They can also unfairly deny coverage, and step between doctor and patient.
When such basic rights are lost, they've got to be restored by law. And that's
why I urge Congress to get a patients' bill of rights to my desk. (Applause.)
We're close to an agreement on this issue. I've given a message to Congress:
please send me a bill that protects all patients, not just a fortunate few.
Send me a bill with comprehensive patient protections. No one should be charged
extra, for example, for simply visiting the nearest emergency room. No one should
have to run a bureaucratic gauntlet before he or she can see a specialist. And
if health plans deny care, every patient should have the right to a prompt review
by an impartial panel of doctors.
Finally, we should be serving the interests of the patients, not the self-interest
of trial lawyers. (Applause.) There will always be matters that can and will
be resolved in a courtroom. But with a strong review process, most disagreements
between patients and health plans will end up in medical care, not in the courtroom.
Needless litigation does not -- needless litigation does incredible harm to
our health care system. It costs everyone time and money -- especially patients
who need care quickly -- and can destroy the bond of trust between physician
and patient. Frivolous lawsuits drive up insurance premiums for everybody, and
discourage employers from offering employee coverage at all. It is really important
to remember that we want to help doctors to heal, not encourage lawyers to sue.
And the hostile legal atmosphere that doctors face is adding to costs and undermining
the quality of health care in practical ways. At some hospitals, for instance,
doctors have worked closely with one another to cut the rate of infection after
surgery by more than half. Yet when they discuss that information openly, or
put it on a paper for the benefit of others, they also put themselves at risk
of a lawsuit. We actually have a system that penalizes doctors for trying to
prevent errors and avoid complications in patient care. And that doesn't make
much sense. These good faith efforts do not deserve the punishment of a lawsuit
and Congress needs to do something about that. (Applause.)
When it helps patients, information must be broadly shared. In the Medicare
system, we're giving people more information on the quality of nursing homes
all across the country -- and we plan to do the same thing throughout the health
care system. Increased reliance on information technology will not only lower
costs, it also holds great promise for detection and treatment and the development
of new cures for disease.
Personal medical information, however, must always be strictly confidential.
A patient's right to privacy must be protected, and we will enforce those protections.
My final goal in health care reform is to make sure government acts where it
should -- providing a strong health care safety net and promoting research on
the frontiers of science. The federal government has accepted these responsibilities,
and we must fulfill them.
Many of the poor and uninsured, including legal immigrants, are outside our
system of health care entirely. Their neighborhoods often have few health care
professionals or facilities. They have little or no access to preventive care,
and most treatment takes place in an expensive emergency room.
Around the country, more than 3,000 community health centers are fighting these
problems -- by giving immunizations, providing prenatal care, and treating illness
before they become medical emergencies. I strongly support these community health
centers because they're compassionate -- (applause). They are compassionate,
they are cost effective, and America needs more of them. And so I've set this
goal: we need 1,200 more community health centers over the next five years to
make sure our government fulfills its commitment to the need. (Applause.)
The federal government has a large role in medical research, as you well know
here. And that role is now urgent. In response to the threats facing our nation,
we've committed more than $2 billion to develop new tests and new treatments
for bioterror weapons. (Applause.) This research is not only important for the
immediate, but it is likely to produce new insights into the treatment of diseases
such as tuberculosis, malaria, HIV/AIDS. Our massive effort to ensure the safety
of our people will improve the health of our people.
The National Institutes of Health is one of the most successful government undertakings
in our history. The work of the NIH has helped us defeat a long list of diseases
and dangers to public health. Now, as scientists begin to read the codes of
life itself, we are nearing incredible breakthroughs in the fight against disease.
We may, in our lifetime, lift from humanity the curse of cancer.
This is a moment of great national challenge, and the work of the NIH has become
even more urgent and promising. I'm asking Congress to give strong support to
the NIH, and my budget achieves the goal I set out when I sought the vote, and
that is we will have doubled the NIH goal at the end of the year 2003. (Applause.)
Science is -- on the very sources, is closing in on the sources of sickness
and disease. By 2010, scientists predict, genetic tests will allow individuals
to know if they are predisposed to certain conditions. Within 20 years, targeted
drug and gene therapies will be available for diabetes and hypertension and
As we pursue the promise of these projects, we must also be alert to their dangers.
Genetic information should be an opportunity to prevent and treat disease, not
an excuse for discrimination. (Applause.) Just as we addressed discrimination
based on race, we must now prevent discrimination based on genetic information.
There is another danger to guard against: the use of genetic research to threaten
the dignity of life itself. The powers of science are morally neutral -- as
easily used for bad purposes as good ones. In the excitement of discovery, we
must never forget that mankind is developed -- is defined not by intelligence
alone, but by conscience. Even the most noble ends do not justify every means.
(Applause.) Life itself is always to be valued and protected. In biomedical
research, we're dealing with the very makings of life -- and the law must be
firm and clear in restraining the reckless and protecting the voiceless. (Applause.)
These are the goals of health care reform -- principles to make a good system
even better. We'll put our trust in the choices of patients and the decisions
of doctors -- the surest way to better coverage and better care. We'll protect
patients and doctors from unfair treatment and unreasonable lawsuits. And government
will fulfill its unique responsibilities to provide a health care safety net,
and conduct the research that holds such great hope for all of us.
With these reforms, new breakthroughs in medical research will reach the patients
who need them -- quickly and at the lowest cost possible.
I believe America can achieve anything it sets its mind to. I believe -- I don't
believe, I know we're going to win the war against terror. (Applause.) And I
know if we honor our professionals and honor our patients, and recognize the
limited role of government, if we trust Americans to make the right choices
for their lives, we'll have the health care system that remains the envy of
There's no doubt in my mind that with the right reforms, the right philosophy,
a philosophy of trust -- trust in people -- that America will remain on the
cutting edge of medicine. And as America remains on the cutting edge of medicine,
America will be the promised land for all of us.
It is such an honor to be here. I want to thank the youngsters who are going
to be docs. I want to thank you for your service. (Applause.) Give them an "A"
for attending, for sitting through this lecture. (Laughter.) But I do appreciate
And I also appreciate your professors. (Applause.) And I appreciate the chance
to come and share with my fellow citizens about the future of health care in