2002.03.11: Address to National Managed Health Care Congress

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Address to National Managed Health Care Congress

Thank you, Dr. Hughes (Dr. Edward Hughes, Northwestern University), for that kind introduction. And I want to thank our wonderful Surgeon General, Dr. Richard Carmona, for speaking to you this morning.

I really enjoy working with Dr. Carmona, and he and I are blessed to have the best employees in the federal government at HHS.

Dr. Carmona and I are also very grateful that President Bush has put health care at the top of his agenda. We share a vision for American health - a vision in which Americans are well informed about health issues, lead healthy lifestyles, and have access to high quality care. Different people have different needs and desires for how to get and pay for health care and health insurance, but managed care is a popular and successful one whose beneficiaries really appreciate it, and I commend you for serving them.

Through waivers and state plan amendments, the Bush Administration has already expanded access to health coverage for more than 2.2 million people, and expanded the range of benefits offered to 6.7 million other Americans. If the President's budget is adopted, we will increase investment at HHS by 25% since 2001.

We want to help even more of the uninsured. That's why we have proposed tax-based supports to help people purchase health insurance. That's why we have expanded community health centers. That's why we support assisting states with their health programs for low-income Americans.

I want to talk with you this morning about the two biggest government health care programs, Medicare and Medicaid, and then if there's time I'd like to talk with you about some other related topics, such as medical liability and patient safety.

After years of watching Congress bemoan the state of Medicare but fail to rise above partisan bickering, I'm especially proud that President Bush has the courage to propose a bold plan to improve Medicare.

We want to improve the health of America's seniors-to make sure that every senior in the country gets meaningful new benefits, including help with prescription drugs.

The greatest health care system the world has ever known operates in the United States. And you're a critical part of it. America's doctors and hospitals offer the best care because they enjoy the freedom to compete and Americans enjoy a choice of providers.

However, our Medicare program is not structured to provide seniors access to these wondrous inventions, new technology, and the same choices and quality other Americans get from their health plans. For example, while 76% of seniors have some form of drug coverage, Medicare itself does not provide an outpatient drug benefit, so too many seniors go without the medicines they need.

As President Bush has observed, Medicare will pay a doctor to perform a heart bypass operation, but will not pay for drugs that could prevent the need for surgery. Medicare will pay for an amputation, but not for the insulin that could help diabetes patients avoid losing their limbs.

President Bush wants to remove these barriers to affordable, quality health care by modernizing Medicare, for its current beneficiaries and for the future. That's why, last week, he proposed a framework to improve Medicare by offering more choices and better benefits. In order to make these changes, the President and I need Congress's help and your help.

In addition to meeting the projected growth of Medicare, the President proposes to spend an additional $400 billion over the next ten years to pay for these improvements. Medicare beneficiaries will be offered several types of coverage, including keeping what they have now, and all of these choices will include a subsidized prescription drug benefit.

Let me outline the three options that we will offer Medicare beneficiaries: Traditional Medicare, Enhanced Medicare, and Medicare Advantage.

So those are the three options. But it's also important to keep in mind what all three options have in common. All seniors will receive prescription drug assistance. All seniors will be able to choose doctors and hospitals. And all seniors will have the choice of an individual health care plan that best meets their needs-just like Members of Congress and federal employees have.

All of us want to make sure that Medicare does the right thing for seniors. And you know that seniors want better coverage. That's why it is urgent that Congress work with the President to modernize and improve Medicare this year. If these choices are good enough for members of Congress, they are good enough for our seniors.

I should mention that our framework also provides extra help for low-income seniors to cover their prescription drugs. This is in addition to the drug discount card we will offer to all seniors.

The sooner we act, the sooner we can offer the meaningful new benefits to all our seniors, and the healthier our citizens-and our economic future-will be.

Reform of Medicare would be incomplete without reform of Medicaid. Most people don't realize that Medicaid is bigger than Medicare, and is growing more rapidly. Both are vital to making sure all Americans have access to health care. Sadly, the current Medicaid system is a bureaucratic and fiscal mess. It's not delivering consistent results for the taxpayers' dollar, and it's proving a fiscal nightmare for the states.

Most states are facing a budget crisis right now. Because Medicaid is one of the largest items in a state budget, a state government facing budget pressure may have no choice but to look at Medicaid spending. Under the current matching mechanism, if a state cuts $1 of its own spending, it may forfeit $2 in federal funds.

That's why I'm happy to tell you that the Bush Administration has proposed a plan to make Medicaid more effective, cover more people, and provide better health care delivery. If Congress adopts this plan, states will be able to improve health coverage for low-income Americans. Americans who might be cut off from coverage will be able to keep it.

We're going to begin by addressing the immediate fiscal needs of the states … meeting the 9% base growth in the program with adequate funding … and adding in another $3.25 billion in new money for 2004 and $8.9 billion in new money over five years. Our plan will be budget-neutral over ten years, but will frontload some of the money from the later years into the earlier years.

And we're going to give states the flexibility they need to spend that money. They must be able to tailor the spending to address their own areas of greatest need. I spent fourteen years as Governor of Wisconsin, and let me tell you, states and their governors absolutely must have this freedom to act. Unfortunately, the bureaucratic rules of Medicaid today are too inflexible - but we're going to change that.

Finally, Medicaid reform means holding states to performance standards. We're going to make sure this money is spent wisely - children must be covered … fair benefits must be provided … and the rolls of the uninsured must come down. That's common-sense reform and common-sense leadership. And it's yet another way we're going to extend access to health care while keeping health care costs down.

Another piece of the puzzle when it comes to reducing health care costs is controlling the crisis in medical liability lawsuits. Medical liability premiums have skyrocketed in recent years as average jury awards have doubled from $475,000 in 1996 to $1 million in 2000.

This is a national problem that requires a national solution. The Bush Administration has a comprehensive reform proposal that will serve two goals.

The President and I have urged Congress to pass a bill that would put reasonable limits on subjective non-economic damages. This would emulate what the state of California did with great success 25 years ago. We also need to limit punitive damages in medical liability cases.

Under our proposal, injured patients would collect full actual, out-of-pocket damages - medical costs, lost wages, custodial care and assistance, or replacement child care for an injured mother, for example. But they would not be able to collect unlimited amounts for "non-economic" damages.

We support legislation that would also make key procedural reforms in medical liability cases: elimination of "joint and several liability" … uniform statute of limitations … collateral source rule reform … and reasonable limits and court approval of attorney contingency fees.

The House of Representatives passed these reforms last September. We believe this was an important step in the right direction - and we call on the House to pass it again this year, and for the Senate to join us in bringing these common sense reforms to all Americans.

We need to focus on preventing errors instead of compensating for them. One of the barriers to improving care is doctors' reluctance to discuss errors because they fear that information they discuss will spawn more litigation.

We support legislation to encourage doctors and other experts to work together to improve quality by ensuring that information is kept confidential. We urge Congress to pass this bill and give the professionals the tools they need to improve quality - not to fuel more lawsuits.

Thank you for listening, and thank you for your leadership and your insights as we move forward to keep American health care the best in the world. We can't do it without you.

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