Bush’s Prescription for Medical Reform

America’s health-care system is “in need of urgent reform,” President Bush said Monday as he laid out an array of principles that he said would provide greater patient choice, reduce costs and expand coverage.

“We must reform health care in America,” Bush said in a speech at the Medical College of Wisconsin. “We must build a modern, innovative health-care system that gives patients more options and fewer orders and strengthens the doctor-patient relationship.”

But the president offered few new specific ideas. Instead, he blamed lawyers for many of the ills in the system.

Most of the principles that he espoused here enjoy broad bipartisan support in Congress, including a patients’ bill of rights, but opinions diverge over how best to achieve those goals.

Among those who leveled a blast at Bush on Monday was Sen. Edward M. Kennedy (D-Mass.), who was the president’s key congressional ally on education reform.

“For senior citizens, the administration’s budget is just another broken promise. Its commitment to prescription drug coverage under Medicare is less than for new tax breaks, less than the Republican Congress supported last year, and far less than is needed to give the elderly the protection they need,” Kennedy said in a statement issued in Washington.

“Senior citizens deserve a real Medicare prescription drug benefit, and they deserve it now,” the senator added.

After addressing an audience of several hundred supportive physicians, Bush attended a fund-raiser for Wisconsin Gov. Scott McCallum, a fellow Republican who became governor after Tommy G. Thompson resigned to serve as Bush’s secretary of Health and Human Services.

It was the president’s fourth post-Sept. 11 fund-raiser--a reflection of his quickening pace of partisan political activities in anticipation of the November elections. Last week, Bush attended two fund-raisers in New York for Gov. George Pataki.

With the control of both the House and Senate at stake, Bush is scheduled to attend about 40 political events for Republicans around the country.

In his remarks here, the president did not immerse himself in the nitty-gritty details of health policy, but he did spend a good deal of time enunciating his broad goals.

The details are in the budget that he released last week.

Breaking Down Where the Money Will Go

Among them is $14 billion over the next decade to expand medical savings accounts--tax-exempt accounts that individuals may create and use to pay for most routine, out-of-pocket medical expenses short of catastrophic illnesses. A number of states already have such accounts.

These accounts, Bush said, would afford consumers greater control over how their health-care dollars are spent. Other proponents say such accounts can generate savings for employers, instill cost-consciousness among consumers and create unprecedented competition among providers, while granting unrestricted choice of doctors and eliminating bean-counters from the physician-patient relationship.

But opponents warn that the accounts attract mainly the young and healthy, leaving sicker people with high-cost medical needs in traditional insurance pools, causing premiums to soar and forcing some into the ranks of the estimated 40 million uninsured Americans.

Bush’s proposal would lower the deductible requirements for the medical savings accounts and allow the funds to be used for preventive care costs.

“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 encourage and allow for patients to make decisions that [are] in their best interests,” Bush said.

For those who lack employer-based coverage, Bush is seeking $89 billion in his budget for “health credits”--$1,000 for individuals and $3,000 for families--to buy insurance. Such credits would enable 6 million uninsured Americans to afford coverage, according to the White House.

Bush’s budget also seeks $15 billion to help the newly unemployed by paying 60% of the cost of their continued health coverage. This provision would help 4 million displaced workers, the White House said.

The president also called for pooling small businesses and individuals into purchasing arrangements to increase their bargaining power with insurance companies.

The budget seeks $190 billion for Medicare, the medical insurance program for older Americans, which the president called “antiquated.”

Bush complained, for example, that Medicare offers insufficient coverage for preventive medicine. He also vowed to provide seniors with coverage for prescription drugs, although he did not explain how.

“We’ve got Republicans and Democrats and an independent from the United States Senate working on Medicare reform,” he said.

Bush also called for the creation of an additional 1,200 community health-care centers in the next five years. There are already about 3,000 such clinics serving the poor.

Bush became most animated when he called on Congress to enact a patients’ bill of rights. The GOP-controlled House and the Democratic-controlled Senate have passed competing versions, with the biggest differences over consumers’ ability to sue medical providers.

Bush came down squarely Monday on the side of the providers--and the House bill, which contains far stronger limitations on the legal recourse of consumers who believe they have suffered at the hands of insurance companies or doctors or both.

Bush’s fierce anti-lawyer remarks likely set the stage for a huge tussle with Democrats, who enjoy strong financial support from trial lawyers all over the country.

“We should be serving the interests of the patients, not the self-interests of trial lawyers,” Bush said.

“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,” the president added.

“Frivolous lawsuits drive up insurance premiums for everybody, 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.”

He added: “And the hostile legal atmosphere that doctors face is adding to costs and undermining the quality of health care in practical ways.”