Bush Addresses Health Care Policy

Christopher Lee
Washington Post Staff Writer
Thursday, July 19, 2007; 11:27 AM

Q: You mentioned your tax proposals. You mentioned the children's health insurance debate. You talked about not wanting that program to expand, not wanting to see an expansion of government. I'm told that only about 10 percent of the children on that program are above 200 percent of poverty. And I've also reviewed the CBO analysis that says it would take about $14 billion over the next five years in new money, expanded money, just to keep that program enrolling the same number of kids. You've proposed less than that [$5 billion in new money]. In essence, then, aren't you proposing a cut in that program rather than holding the line?

BUSH: Actually our budget proposal increases the amount of money from one year to the next. Secondly, as I said, I support the initial intent of the program. My concern is that when you expand eligiblity, people eligible for the program, you're really beginnign to open up an avenue for people to switch from private insurance to the government. And the point I was makign to small businesss owneres is that this is part of a national debate as to how best to make health care available for people. As I said, there are good decent people who believe the government approach is the best approach. I don't."

LEAVITT: Mr. President would you like me to reconcile those numbers for you?.........The issue you've raised is how much would it cost to reauthorize SCHIP in its originial intent. You do the math. The Urban Institute, when you ask the question, How many people are there that are uninsured? The optimum number that you come up with is 1.7 million that are uninsured at any time during a given year. And that assumes that you could find them all and insure them all on the one day and have them there the full year. That's the maximum number. The cost of SCHIP is $1,152 a year [per person]. So take 1.7 and mulitply it by 1,152 and what you end up with is less than $2 billion a year. Times that by 5 [years], you come up with about nine-point-something billion dollars over a five year period. That's what the president's budget is. Now CBO says it's [$]14 [billion]. We disagree with that number, but we're prepared to sit down with CBO and work out that difference. The president's policy very clearly is, we want to reauthorize SCHIP. We want to do it at the level that was originally intended. That's our policy and we're prepared to work with them on coming up with the right number."

BUSH: What you've just learned is how the president develops a budget. So in this particular case it's Leavitt's responsibility......His job is to make sure that the intent of the bill, which we support, is funded. And he just explained the number we put forward. I am focusing on a larger debate, and that's how best to provide private insurance to private individuals in a system that is very inefficient and costly. You heard the frustrations of the people living here in Maryland. They said, we just don't get that many products to choose from. I am deeply worried in a system in which there is limited choice, because that ends up being an inefficient system. Secondly, the way our system has evolved is it really has shut out the consumer. There is no price sensitivity because somebody else pays the bills. What we're saying is that rather than expand the role of government, let's develop policies that will encourage the development of an individual market where individuals are more directly involved. And therein lies the philosphical debate, and it's one that I will continue to press hard on, and one of the main reasons why I reject this notion of expanding SCHIP beyond it's original purpose.

Q: Sir, Senator Grassley and Senator Hatch, both Republicans and neither one fans of big government, have said that they would like to discuss your tax proposals but that the practical reality and the political reality is that in the Democratic Congress right now it's hard to get that off the ground. And they don't want to see it tied to the debate over the children's health insurance program. If they can back off of that for now and embrace the $35 billion package in the Senate Finance Committee, how come you can't?

BUSH: I disagree. I'm not going to surrender a good and important idea before the debate really gets started. And I thinik it's going to be very important for our allies on Capitol Hill to hear a strong, clear message from me that expansion of government in lieu of making the necessary changes to encourage a consumer-based system is not acceptable.

Q: You've said that one of the problems you have with the current SCHIP program and the prospective expansion of it is that you're worried that it will go to children of higher income and you're bothered that adults have been covered.

BUSH: No, no. I'm worried that there will be a strong incentive for people to switch from the private sector to the government.

Q: It was your administration that approved many of the waivers that allowed states to cover kids at higher income levels and to cover adults.

BUSH: Correct.

Q: In retrospect, were those decisions to grant those waivers a mistake?

BUSH: It was experimentation on the part of our administration. Now is the time to recognize that we - I think we have an opporutnity to fundamentally change how the system is going to evolve. And the best way to do that is through the tax code, plus a lot of other initiatives inlcuding AHP's, which we've been pushing for, HSAs, which we've been pushing for, different consumer choices in Medicare whichc we pushed for and got enacted. The idea of giving states flexibility to meet objectives is a part of kind of a federalist approach to government. That should not preclude the idea of changing the tax code so that a new and better system will evolve more quickly which will help us contain costs and improve quality.

LEAVITT: I'd just add that the basis on which the waivers were granted led to changes in the Deficit Reduction Act giving states flexibility to do that without waivers. And so states now do that in Medicaid and so therefore it isn't necessary. We've removed -- we hav transitioned -- about 700,000 adults from SCHIP to Medicaid, and we will continue to do that. Our policy is to provide a means by which families can be united, but we ought to be doing it through private insurance, having SCHIP added to private policies as opposed to the other way around.

Q: If I could switch topics to the surgeon general. The former surgeon general, Richard Carmona, testified last week with many complaints about political interference, in his view, in his role as the nation's top doctor. He talked about reports that he couldn't get out, he talked about his speeches being rewritten. You've often said that you trust your military experts on the ground in places like Iraq to give you the best advice. Yet there has been a lot of complaints that you haven't trusted your scientific and public health experts to do the job they've been trained to do. Why is that?

BUSH: I strongly reject that characterization. I can't speak to some of the complaints the surgeon general made. I was pleased that he agreed to serve my administration. I admired his background. He worked energetically in his job. And obviously at some point in time he became very disgruntled and spoke out about it. But ours is an administration that attracts very smart, capable people. I'm very interested in their points of view and I expect people to speak out. I also have my own points of view and feel very strongly about a lot of issues. But we welcome debate inside this administration."


Q: Your current nominee for surgeon general, James Holsinger, had his Senate confirmation hearing last week.

BUSH: I hope he gets confirmed.

Q: And among the things he said was that he would advocate advertising -- a ban on direct marketing of drugs to consumers, he noted that he'd been an advocate of higher tobacco taxes in Kentucky, he said that using condoms was important for preventing pregnancy and sexually transmitted disease and suggested that condoms would even be appropriate for teens as long as they were also taught about abstinence. If he were to support these positions as surgeon general, would you support that? What would you do?

BUSH: I think what he is talking about is on a wide range of subjects -- let me talk about the program that we're funding in Africa for example when it comes to condom use. We believe in a balanced approach to dealing with health, safety when it comes to HIV?AIDS. It's called ABC -- Abstinence. Be faithful. And use Condoms. And I think what he's done in this instance is mirrored that which we're promoting as we spend hopefully $30 billion additional dollars to save lives.

Q: But you would allow your surgeon general to advocate a ban on advertising -?

BUSH: He just advocated it.

Q: But if he were to do that in office, sir, you would not stand in his way?

BUSH: I'd listen to him very carefully. He's not the final decider, he is an adviser. But if you are saying, can he be allowed to express his opinion inside this administration? Absolutely.

Q: On the subject of stem cells, a colleague who knows a lot more about this than I do tells me that recently science has advanced to the point where they are able to get embryonic stem cells without destroying the embryo. Your policy, which you announced in 2001, prohibits funding of research on embryonic stem cells produced after Aug. 9 of that year. A number of scientists are now saying, the science has advanced to the point where we can do this without damaging the embryos, and perhaps it's time for the policy to change.

BUSH: You can develop stem cells without destroying life. I would strongly urge you and your colleague to go look at the public speech I gave on this very subject in the East Room of the White House earlier this year. I think you'll find that I was pleased to herald new scientific advances that will enable us to advance science without the destruction of life.

Q: Do you forsee lifting the ban on funding for research on those sorts of embryos?

BUSH: As a matter of fact, we're expanding that kind of research on stem cell lines in which the life of a person hasn't been destroyed. There is some really exciting -- as a matter of fact, I stood on stage with a person whose life had been saved as a result of these new therapies. That's what I've been saying all along. There are ways to develop stem cell lines without the destruction of human life. There are ways to use adult stems cells to save lives. There's a myriad of ways to advance good science without crossing an ethical line.

Q: Just forgive my lunk-headedness, but so ---

BUSH: You need to go ahead and read the speech Christopher, believe me. I think you'll find it to be stimulating.

Q: But one could say that you would support funding embryonic stem cell research with stem cells that have not ---

BUSH: If life had not been destroyed, yes.


Q: The Congress I believe, today, one of the committees is going to look at the bill that would allow the FDA to regulate tobacco, including new restrictions on advertising and on niccotine content. Is this somethat that you support?

BUSH: We've always said that nicotine is not a drug to be regulated under FDA.

Q: Why not sir?

LEAVITT: The big problem is that FDA's role in the world is to find that things are safe and effective. It's hard to imagine that a product like a cigarrette could ever be found to be safe. And consequently you're asking the FDA to pronounce something as safe that will never be safe. And there are a lot of concerns about the use of the FDA brand by cigarrette companies to assure people that they have been "FDA-approved." There is a lot more to it, but that's the basis of it.

BUSH: That's a much more articulate answer than mine, which short-changed it. I'm trying to get rid of you.

Q: If you want to leave, I can't stop you. But thanks for your time.

BUSH: Enjoyed it Chris.

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