Bush Pushes Proposals in Round-Table Discussion

On the heels of his recent State of the Union address, President Bush traveled to Lee's Summit, Mo., on Jan. 25 to discuss -- and garner support for -- some of his proposals for making health care affordable and available to all Americans.

With an "Affordable Health Care" banner as a backdrop, Bush hosted a round-table discussion on health care initiatives in an intimate setting designed to personalize his proposals -- a process further bolstered by testimonials from working Americans.

Flanked by those workers, as well as by HHS Secretary Mike Leavitt and Rich Hastings, president and CEO of Saint Luke's Health System, Bush launched an informal chat that began with the benefits of health information technology; included a plug for medical liability reform; and ended with personal stories about individuals' efforts to secure health insurance for themselves, their families and their employees.

The promulgation of health IT in hospitals and physician offices continues to be a focus of the Bush administration -- a focus shared by the AAFP. Bush praised Saint Luke's efforts in that area, particularly the hospital's eICU system, described as advanced telemedicine technology. The system allows the hospital's physicians and other health care clinicians to monitor ICU patients from as far away as Hays, Kan., some 300 miles to the west.

"They've got a specialist sitting in Kansas City capable of analyzing somebody's graphs in a remote region," said Bush, emphasizing that the system delivers affordable, quality care to rural areas.

The only physician at the table, Jim Kelly, M.D., an anesthesiologist from St. Louis, told Bush about the battle for medical liability reform in Missouri. Kelly said the tort reform passed by the Missouri legislature in 2005 has helped to rein in defensive medicine.

"Everybody lives in fear of being sued, and they (physicians) will go to extreme lengths to document that everything they're doing is the right thing," including ordering extra tests, said Kelly.

"In other words, practicing maybe too much medicine," said Bush, adding that defensive medicine costs the government -- and taxpayers -- perhaps as much as $20 billion a year through Medicare, Medicaid and veterans' benefits.

Bush's bridge -- from waste incurred because of overuse of medical tests to rising health care costs -- will make sense to most physicians; but his next statement -- "When doctors' premiums go up, they charge more" -- is at odds with physician payments under the current Medicare fee schedule, which doesn't supply reasonable payment for the services family physicians provide. (See related editorial [Members Only].)

Jim Henderson, who owns a small, second-generation family business in St. Louis, told Bush that his biggest concern about health care is that the costs keep rising. "I'm glad to see everybody in the country is getting excited about (rising costs), but we've been dealing with it for over 17 years," he said.

Henderson described the "vicious cycle" of escalating insurance premiums and deductibles that his company has endured over the years. Passing those rising costs on to his employees has hindered his hiring efforts and stifled the growth of his company, he said.

"This is probably the biggest problem we hear from small businesses around the country," said Bush. Since small businesses create most of the new jobs in America, "it makes sense to come up with plans to help small businesses thrive," he said.

"As we level the playing field (by changing the tax code) between employees of little companies and big companies, it makes it easier for small companies to stay in business," he added.

Martha Gelencher, owner for more than 30 years of a janitorial service in Olathe, Kan., told Bush that providing her employees with health insurance "has always been a big issue." Gelencher switched to health savings accounts, or HSAs, more than two years ago and said her company is saving nearly 40 percent on insurance costs for her full-time staff.

Bush acknowledged that employees might not embrace HSAs at first glance. "It's a novel concept, as opposed to somebody paying your bills. An HSA basically says you're in charge of your own health care," he said.

HHS' Leavitt recently switched to an HSA plan, and he said the personal accountability the plan demands has changed his behavior. He recounted how he recently filled a long-standing prescription for the first time under his HSA plan.

"I knew that … my heath savings account would be paying part of it," said Leavitt, adding that he not only asked how much the drug would cost, but then asked about a generic alternative. "It changed my way of thinking about this completely," he said.

Bush's latest health care proposal includes tweaking the tax code to offer a standard tax deduction for health insurance to "level the playing field" between workers who receive employer-based health insurance and those who are forced to go it alone. The strategy reflects Bush's faith in private health insurance.

"We believe the private sector is the best deliverer of health care. We know there's a role for the federal government, but it's not to dictate, it's not to be the decision maker," Bush told round-table participants.

"The best health care system is one that recognizes that decisions made by doctors and patients are the best decisions," he said, picking up on phrasing he'd used in his Jan. 23 State of the Union address. "The policies that we're detailing are trying to encourage more consumer involvement in order to hold down costs."

Bush also challenged lawmakers in Washington to "take a good look at all ideas to determine how best to make this health care system run well."

"If people in Washington are serious about dealing with the uninsured, here is a serious idea for them to consider," he said.