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By Rich McManus
Photos by Ernie Branson
On the Front Page...
Visiting NIH for the third time in 2 years, President George W. Bush dropped by Jan. 26 for a 40-minute town hall-style meeting in Masur Auditorium, Bldg. 10 during which he emceed a discussion with five citizens on the topic "Strengthening Health Care." He called it "a dialogue about innovative ways to make sure that our health care system addresses the needs of our individual citizens.
"My judgment is the system won't work if medical decisions are made by government," Bush asserted. "I believe the best kind of decision-making occurs when consumers make decisions and the relationship between their doctors and the patients [becomes] the the cornerstone of good health care policy."
He came to endorse health savings accounts (HSAs), a way to widen health care coverage for citizens by offering tax-free accounts to be used for medical care. Unlike traditional health insurance, in which deductibles are low, but premiums high (and shared by employer and employee), HSAs feature fairly high deductibles. But HSAs allow contributors to save what they put into them year after year, until the money is needed; once the deductible is exceeded by expenses, insurance kicks in for the rest of coverage. Bush's plan is intended to encourage more free-market competition among insurers, more choice among consumers, and wider coverage for the nation's huge numbers of uninsured or under-insured workers.
Masur Auditorium was packed with guests invited by the White House, along with a representation of NIH, FDA and Health Resources and Services Administration employees.
The President acknowledged a handful of audience members, including Maryland Gov. Robert L. Ehrlich, Jr. (R) and NIH director Dr. Elias Zerhouni. "I appreciate the job you're doing Doc," he said to Zerhouni. "You're doing a fabulous job."
Bush gave the audience a preview of his State of the Union speech by touching briefly on a number of international topics before addressing the issue at hand.Among his highlights: the presidential election in Afghanistan ("millions of people voted for a president for the first time in 5,000 years"); elections in Palestine ("I believe a Palestinian democracy will emerge and will grow, enabling us to achieve a goal of two states, Israel and Palestine, living side by side in peace."); and recent elections in Ukraine and Iraq. On the domestic front, he mentioned his No Child Left Behind education initiative; the budget ("The budget I submit to the United States Congress will work on reducing our deficit in half over a 5-year period of time."); economic issues such as free trade, low taxes, recovery from recession; Social Security reform ("The system is broke. It's flat bust."); and legal reform, including asbestos law, class action lawsuits and medical liabilities.
During the discussion on HSAs, the President gave his rationale for the system: "A health savings account enables a person to be in charge of his or her own health care decisions. Health care savings accounts will cover major catastrophic problems, and at the same time, allow a person to save, and/or a business to save tax-free for the everyday expenses of health care. And if, in fact, you have not reached your limit for your catastrophic care — in other words, if you have money left over, you can roll it over, tax-free, into a savings account that you call your own."
During the dialogue, Bush also touched on related topics such as expanded community health care centers, making generic drugs more widely available, and modernizing health care with strengthened IT (information technology).
He said, "I want to remind you all that we will continue to promote an adequate safety net for our citizens, and by that, we've got community health centers in America today. I want to continue to expand community health centers. This is the place where the poor and the indigent can get primary care. And they're great centers. And Congress has been very cooperative in the past of funding our budget requests, and I hope they do again as we continue to expand these community health centers all across the United States of America."
He thanked the FDA "for propagating rules that prevent pharmaceuticals from delaying the advent and access to our consumers of generic drugs. These drugs do the exact same thing as brand name drugs do and, yet, cost a fraction of the cost of the brand names. And so we're doing a better job of speeding generics to the markets. And that's a positive development for our seniors, and all citizens for that matter."
With respect to IT, he noted, "We've got 21st century medical practices, but [a] 19th century paperwork system. Doctors are still writing prescriptions by hand. Most doctors can't write clearly anyway...So there's a better way to enable our health care system to wring out inefficiencies and to protect our patients. So medical electronic records is going to be one of the great innovations in medicine."
The President introduced and interviewed his guests, eliciting details about the benefit of HSAs and good-naturedly interrupting their accounts to make certain points. The forum enabled him to display the endearing political gifts of self-deprecation (he mangled the pronunciation of several of the guests' names) and spontaneous recovery from gaffes (he is not unlike the late Johnny Carson in his comic timing).
Though NIH itself was not a topic for the discussion, Bush nonetheless left the audience with no doubt about his position on how the fruits of medical research ought to be applied: "The federalization of health care would be bad medicine for the American people."
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