Dawn, from Nashville writes:
i keep hearing a lot about schip (?). what is it? why wouldn't the president want to support it?

Michael Leavitt
In 1997, the Congress passed the State Children’s Health Insurance Program, also known as “SCHIP.” This program allowed each state to design within parameters an insurance program targeted to low-income children for which the federal government would pay roughly 70 percent and the state would pay roughly 30 percent.

It’s been a very successful program. Every state has implemented it. There are roughly 6 million children who are covered by it.

The most important point I would like to make today is that the administration supports the reauthorization of this program, which expires on Sept. 30th. We do not want to see the coverage of children in any way jeopardized.

We believe that the program is an important tool in working toward our goal of every American having access to an affordable basic insurance policy. However, it needs to be focused on low income children. It should not become the tool by which we extend insurance through the federal government to all Americans.

For that reason, we have indicated to the leadership of Congress that if they choose to make a huge expansion into populations that are not low-income, then we will object and the President will veto it. Now, let me emphasize that more than half of the children who would be covered under the proposals that the Congress is making are currently insured and they’re insured through the private marketplace. Further, under the expansion that’s been discussed, if a family of four made $81,700, they would be eligible. In other words, this would cease to be a program to cover or to help cover poor children from low income families and become a means of being able to expand those that are currently insured privately.

Tasha, from Abingdon, VA writes:
Why can the United States not have a Free Health Care system for people who cannot afford health insurance, have a low income or aren't able to receive it at all? I have been to France recently and they have a health care system where no one has to pay. Just wondering what can be done or if something is being done.

Michael Leavitt
There really is no such thing as a “free” health care system. Somebody has to pay for it. The French pay for their health care indirectly through taxes. This involves the French government in virtually every decision made about who gets what care and limits choices.

Americans pay for their health care more directly and therefore have more control over the care they get and more access to the latest treatment options. But state and federal governments also fund quite a lot of health care. One out of every two dollars spent on health care in the U.S. comes from a government agency. About 45% of all American children are enrolled in Medicaid or the State Children’s Health Insurance Program. Half of all births in the U.S. are paid for by the federal government.

For some, that’s not enough. They want the federal government to pay for everything. But that would mean higher taxes, fewer choices, less innovation, longer waits, and worse care. There are ways we can improve the programs we already have. We’re working to expand Medicare Advantage, which provides better care and more choices through private insurers than the standard Medicare benefit. We have also proposed eliminating the discrimination in tax policy against those Americans who buy health insurance on their own and not through their employers. This would mean that 20 million to 25 million more Americans could afford private insurance.

Jonathon, from Fajardo, PR writes:
Is Michael Moore accurate in his assessment of the poor quality of health care in the U.S.? Is his depiction of the U.S. health care crisis in "Sicko" on the mark or way off? Have you seen the movie yet?

Michael Leavitt
I have not seen the movie yet, but I intend to and I promised the movie’s producer that I would. I have heard and read quite a lot about it, though. My understanding is that the movie doesn’t address problems with the government-run systems of Canada, Britain, France, and Cuba. Just yesterday there was a press report about how the Americans taken to Cuba in the movie got VIP care, not the care the average Cuban gets.

By most measures, the more market-based U.S. health care sector comes out on top. The Organization for Economic Cooperation and Development found that just 5% of patients slated for elective surgery in the U.S. waited more than four months, compared with 38% in Britain and 27% in Canada. Over 150,000 Canadians come to the U.S. each year for health care. Some come for life-saving care such as cancer radiation, coronary bypass operations, and angioplasty.

The U.S. also provides the best access to new drugs. Of 360 new drugs brought to market since 1994, 86% were available in the U.S., compared with 66% in Canada and 53% in France. The U.S. also leads the world in the number of new drug launches. From 1998 to 2002, there were only 44 new drug launches in Europe, compared with 85 in the U.S.

It is true that our health care system is in serious need of reform – but not the Cuban-style socialized medicine that is advocated in “Sicko.” We need a uniquely American approach, based on a free, competitive marketplace organized to make private health insurance affordable for all Americans.

Wayne, from St. Petersburg writes:
One of the disadvantages of a private or for-profit healthcare system is that all the market incentives seem to work in favor of withholding medical care from a patient in his or her most dire time of need. How is your administration working to help create market incentives that will help Americans get needed healthcare that they've paid for, that they've been promised by their healthcare providers?

Michael Leavitt
Regulating health insurers is a state responsibility. Our focus at the federal level is on helping the states organize the health care marketplace to provide more and better choices of insurance.

One way is to eliminate the tax discrimination against people who buy private insurance on their own and not through their employer. The president has proposed a standard deduction for health insurance. Others have proposed a tax credit. Either way would make health insurance more affordable and give people more choices of insurers.

The federal government can also assist states in working together to make insurance more portable from state to state. This would also give people more choices, allowing them to keep a plan they like even if they move out of state.

My department is also very involved in encouraging implementation of a value-driven health care system. Such system would make the health care marketplace more competitive and efficient. Consumers and insurers would be better able to compare the price and the quality of the available care. The more competitive and efficient system would lower costs and raise quality, providing an overall better value for consumers. Check out our website at www.hhs.gov/valuedriven/.

Caroline, from Utica, NY writes:
Dear Secretary Leavitt, Thank you for participating in "Ask the White House."

What does the Department of Health and Human Services do to promote vibrant health so that people do not get sick? What kind of resources does HandHS devote to preventative medicine?

Michael Leavitt
I’m very glad you asked, Caroline. Prevention has never been more important than it is today. Preventable chronic diseases are prevalent in every community across the nation. Obesity, diabetes, heart disease, osteoporosis — they are all contributing to serious health problems. More than 50 percent of American adults do not get enough exercise to stay healthy. About a third of adults are now obese. Just today I saw a press report saying that obese Americans will be in the majority by 2015.

Recently, we’ve focused on reaching out to Medicare beneficiaries with important prevention messages: Be physically active each day, eat a nutritious diet, take advantage of medical screenings, and avoid risky behaviors. We have had the Medicare prevention bus touring the country this spring and summer, stopping at community events, health fairs, and roundtables on prevention. At every stop, we are encouraging people in these communities to know their health histories, to take Medicare’s prevention checklist to their doctors, and to talk to their doctors about preventive services. For more information, call 1-800-MEDICARE, or visit www.Medicare.gov.

Children are also at risk. In the last 20 years, the number of overweight adolescents tripled. Children are now being diagnosed with high blood pressure, high cholesterol, and type 2 diabetes — formerly known as “adult onset diabetes.” So earlier this year we partnered with the Ad Council and DreamWorks to create a serious of public service announcements using characters from the Shrek movies to encourage children to exercise. The message is simple: Get up and move! We’ve heard from parents who loved the PSAs because they actually got children up and moving.

We need to develop a culture of wellness in this country. But this requires change of self, not just of our health-care system. Health care begins with self care. Until we learn to approach prevention and staying healthy with the same rigor we do treatment, we’re not going to get ahead of our health-care problems.

Cathie, from Irvine, CA writes:
I realize that Pres. Bush's top priority is the war on terror, but he should not forget the American citizens and their concerns about health costs. What, if any, is being done to ensure that every United States citizen has access to health insurance? Is there any chance of socialized health in the future?

Thank you.

Michael Leavitt
There is a widely held aspiration in our nation that every American should have access to affordable health insurance.

The federal government provides assistance for the poor, the elderly, and the disabled through programs like Medicare, Medicaid, and SCHIP. These are essential tools and will continue to help those in need. However, there is a real need to create a marketplace for affordable insurance beyond that provided through federal government assistance.

Many states recognize the problem and we are working with them to support their efforts to make insurance more affordable for all Americans. This can be done without threatening protections employers have for the insurance they provide employees – protections that should be continued.

In addition, the President has a proposal to help level the playing field for Americans who purchase health insurance on their own. Federal and state policies and laws need to ensure that those who buy health insurance on their own do not face tax discrimination. Employers who buy insurance for their employees will continue to receive tax protection.

Beyond that, we need to create a health care system where there is competition based on value – the best quality at the lowest price. This type of system will reduce the costs of health care overall.

That’s not the health care system in America today. Most of us don’t know or have access to the information we need to evaluate the cost and quality of the care we receive. That is why HHS launched an initiative to change our focus to a value-driven health care system. If we give consumers more information, then consumers can be a force in driving quality up and costs down.

That is what happened when we implemented the new Medicare drug benefit. Instead of restricting choice to one government benefit, Congress allowed choices and competition. The market responded. The cost of the monthly premium dropped from an estimated $37 to $22 a month. Why the drop? Competition.

Chuck, from New Haven, CT writes:
Hi Secretary Leavitt,Avian flu has been off of the front pages for a while now. Does this mean we are out of the woods? Are there sufficient stockpiles of Tamiflu, and has the mortality of human cases been going down in recent years?

Michael Leavitt
While some of the media attention may have receded, public health officials agree that avian H5N1 influenza still poses a real threat of sparking the next pandemic. The disease is highly pathogenic, and it continues to spread. To date, over 300 people have contracted the disease, and almost 200 have died. While we cannot be certain the H5N1 strain will spark the next pandemic, we can be sure that pandemics happen and we need to prepare.

Over the last year and a half, the federal government has made great progress in building up the nation’s defenses and planning for the future. Among other things, we have licensed the first H5N1 vaccine for humans and added enough vaccine to our stockpile to treat six million people; we have committed over $1 billion to expand our nation’s influenza vaccine production capacity over the next five years; and we have held over 50 flu summits around the country.

Each step we take toward pandemic preparedness today strengthens our public health infrastructure and makes us better prepared to face the challenges of tomorrow.