WASHINGTON - President Bush, laying out his domestic priorities in the days leading up to his State of the Union address, visited the National Institutes of Health in Bethesda yesterday to promote his plan to control health care costs.
Telling an invitation-only audience that putting the federal government in charge of health care would be "bad medicine for the American people," Bush argued for private solutions instead.
He pushed his proposals - including widening the use of inexpensive, high-deductible private insurance plans for individuals - with the help of a panel of like-minded citizens from around the country, put on stage by the White House to give testimonials to his program.
"This is an issue that requires a lot of dialogue so people understand the problems, and a lot of innovative thinking to make sure that the system works," Bush told about 450 people at the Clinical Center on NIH's suburban Maryland campus.
"My judgment is the system won't work if medical decisions are made by government."
The president, who has emphasized his desire to build an "ownership society," sketched a vision for the nation's health system radically different from today's employer-based, government-supported system.
In Bush's formulation, individuals, not their employers, would pay for health care, thus giving them an incentive to keep spending low. The government would help out with tax breaks allowing people to save money for medical expenses by using tax-free Health Savings Accounts.
Private insurance would kick in to pay for only the most expensive, catastrophic health care costs, after a substantial deductible.
The ideas "all aim at empowering people to make decisions for themselves, owning their own health care plan, and at the same time, bringing some demand control into the cost of health care," Bush said.
Attending the event were Republican Gov. Robert L. Ehrlich Jr. of Maryland, NIH Director Elias A. Zerhouni and Lester M. Crawford, acting commissioner of the Food and Drug Administration, as well as NIH employees, physicians and others from the health care and insurance industries.
Bush, who lists medical malpractice reform among his top priorities, praised Ehrlich for pushing the Maryland General Assembly to address the issue recently, even though the governor has said he was "disappointed" with the resulting measure, enacted over his veto.
Nod to Ehrlich
"You're fortunate to have a governor who understands all this," Bush said. Nodding at Ehrlich, he added, "I appreciate your efforts, by the way, on medical liability reform."
Bush mostly focused on expanding HSAs, first enacted as part of the Medicare overhaul of 2003. He is proposing to sweeten the accounts by giving lower-income people and small businesses tax credits to fund them, and by making contributions tax-deductible.
Bush and his five-person panel perched on stools in front of large blue placards bearing the day's slogan, "Strengthening Health Care."
Appearing in good spirits after the first news conference of his second term earlier in the day, Bush joked with the audience, confiding that the exchange they were about to witness would not be entirely freewheeling.
"We just had a little discussion about how to make sure this conversation goes without flaw," Bush said, to chuckles from the audience. "I'm confident it will."
Bush advocated allowing small businesses and nonprofit organizations to band together to purchase group health insurance plans, known as Association Health Plans, that would pool their risk, presumably lowering premiums.
Many of the president's critics, including most Democrats, argue that Bush's health care plan amounts to shifting the burdens of an out-of-control health care system onto individuals who cannot afford them, leaving the poorest and sickest patients without care.
Some of them dismissed Bush's latest comments as hollow promises from a president who, they said, added to the rolls of the uninsured during his first term.
"Empty words from the president cannot mask a four-year record of failure," Sen. Edward M. Kennedy, a Massachusetts Democrat, said in a statement, noting that the number of people without health insurance has grown by 1 million over each of the past four years, to 45 million.
"The Republican policies of un-benign neglect are no longer sustainable. The price of continued inaction is simply too high."
Massachusetts Sen. John Kerry, Bush's Democratic rival in last year's election, criticized Bush in an e-mail to supporters, pushing instead his own plan to expand existing government health programs to cover virtually all the nation's children.
"In the midst of photo-ops and canned speeches, [Bush] is offering no genuine solution to the fact that 11 million American children have no health insurance," Kerry wrote.