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[Weekly Compilation of Presidential Documents]

[Page 1485]
Monday, November 3, 2003
Volume 39_Number 44
Pages 1469	1510
Week Ending Friday, October 31, 2003
Message to the Senate Transmitting the Protocol Amending the Sri Lanka-
United States Taxation Convention

October 28, 2003

To the Senate of the United States:

    I transmit herewith, for Senate advice and consent to ratification, 
the Protocol Amending the Convention Between the Government of the 
United States of America and the Government of the Democratic Socialist 
Republic of Sri Lanka for the Avoidance of Double Taxation and the 
Prevention of Fiscal Evasion with Respect to Taxes on Income signed at 
Colombo on March 14, 1985, together with an exchange of notes, signed at 
Washington on September 20, 2002 (the ``Protocol''). I also transmit, 
for the information of the Senate, the report of the Department of State 
concerning the Protocol.
    The Protocol would amend the Convention to make it similar to tax 
treaties between the United States and other developing nations. The 
Convention would provide maximum rates of tax to be applied to various 
types of income and protection from double taxation of income. The 
Convention, as amended by the Protocol, also provides for resolution of 
disputes and sets forth rules making its benefits unavailable to 
residents that are engaged in treaty shopping.
    I recommend that the Senate give early and favorable consideration 
to this Protocol in conjunction with the Convention, and that the Senate 
give its advice and consent to ratification.
                                                George W. Bush
 The White House,
 October 28, 2003.

[Weekly Compilation of Presidential Documents]

[Page 1485-1488]
Monday, November 3, 2003
Volume 39_Number 44
Pages 1469	1510
Week Ending Friday, October 31, 2003
Remarks on Medicare Reform Legislation

October 29, 2003

    The President. Thank you all for coming. Good morning. Welcome to 
the White House. I'm glad you're here. We're meeting at an historic 
time, and the reason why is,

[[Page 1486]]

after years of debate and deadlock, the Congress is on the verge of 
Medicare reform. And that's important. Prescription drug coverage for 
our seniors is within reach. Expanded coverage for preventive medicine 
and therapy is within our reach. More health care choices for seniors 
are within our reach.
    Though a few difficult issues remain, the Congress has made 
tremendous progress. And now is the time to finish the work. The 
Congress needs to finalize legislation that brings our seniors the best 
of modern medicine. I want to sign the legislation into law before the 
year is out.
    And the point person for this administration in working with the 
Congress to move the legislation along is Tommy Thompson, our Secretary. 
He has done a fabulous job. If he looks tired, it's because he's showing 
up early--[laughter]--and going to bed late, working for the seniors of 
    I want to thank Tom Scully, who is the Administrator--Scully is the 
Administrator of the Centers for Medicare and Medicaid Services. I 
appreciate you coming.
    We've got other members of my administration who are concerned about 
the health of all Americans, including our seniors: Rich Carmona, the 
Surgeon General--thank you, General; the head of the Centers for Disease 
Control and Prevention, Julie Gerberding. Thank you, Julie, for being 
here. It's good to see you. The Director of the National Institutes of 
Health, Elias Zerhouni--Dr. Zerhouni is with us.
    We've got a lot of other important people here, too many to name. 
But I have just come from a roundtable discussion with some seniors and 
some people involved in the process, a corporate executive who is from 
Caterpillar, who assures me that corporations have no intention of--if 
there's a Medicare reform bill signed by me, corporations have no 
intention to what they call dump retirees into a system they don't want 
to be dumped into. And I appreciate that commitment by Rich Lavin. Thank 
you for bringing that up.
    I want to thank Jim Parkel from Fairfield, Connecticut, who is the 
president of the AARP, for being here. I appreciate my friend Jim 
``Budda'' Martin for being here today. He's very much concerned about 
the health of our citizens. And thank you all for coming. This is an 
important moment, as I said.
    You see, the stories we heard remind Tommy and me that seniors 
depend upon Medicare and that the Medicare program is a basic trust that 
must be upheld throughout the generations. What we're talking about is 
trust, can people trust their Government to bring a modern system of 
health to our seniors. We made a commitment at the Federal level to 
provide good health care for seniors, and we must uphold that 
commitment. That's what we're here to discuss today, how best to do 
    Each of the seniors that we talked about--talked to understands that 
the system needs improvement, that Medicare needs to be modernized. I'm 
determined to meet this responsibility.
    And let me share some of the stories we heard right quick. Neil 
LaGrow is with us. Neil, thank you. He takes 10 medications, about $525 
a month he spends. He pays for it all. Because of these costs, he 
continues to work, although I must say he didn't complain about it. 
[Laughter] He likes to work. We need our seniors working, by the way, in 
terms of making contributions to our society. I'm not talking about 
being on the factory floor for 8 hours, but I am talking about passing 
on values from one generation to the next or helping in different 
community activities as you see fit. It's a really important 
contribution to our country. Neil does that. If he gets some help with 
his prescription drug costs, it's going to make his retirement a little 
easier. [Laughter] Isn't that right?
    Mr. LaGrow. That's very right.
    The President. Seniors should be able to plan their retirement 
better. The best way to do so is to make sure that they can afford the 
medicines necessary to keep them healthy. That's what we're talking 
about in this bill.
    Joan Fogg is with us, from Richmond. She and her husband, Walter, 
are on Medicare, and they pay a goodly portion for drugs right out of 
their own pocket. ``When we think we're getting down on money, we go 
ahead and cut the medication in half.'' That's what she said. ``That's 
not the way it should be, but we deal with it. We have to.'' Joan is 
right, that's not the way it should be. That's

[[Page 1487]]

why we want to modernize the system. That's why we want to work better 
for all seniors.
    Most American seniors and people with disabilities are grateful for 
the current Medicare system. Yet they understand the system has 
problems. Our job is to address those problems. We should carefully 
correct the problems. That's what we're elected to do. Medicare was 
created at a time when medicine consisted mostly of house calls and 
surgery and long hospital stays. Now modern medicine includes 
preventative care, outpatient procedures, and at-home care. Life is 
changing. Medicare is not.
    Many invasive surgeries are now unnecessary because of miraculous 
new prescription drugs. Most Americans have coverage for this new 
medicine. Three-quarters of seniors have some kind of drug coverage. But 
seniors relying exclusively on Medicare do not have coverage for most 
prescription drugs and many forms of preventative care. This is not 
good. It's not cost-effective medicine.
    Medicare today will pay for extended hospital stays for ulcer 
surgery, at a cost of about $28,000 per patient. And that's important 
coverage. Yet Medicare will not pay for the drugs that eliminate the 
cause of ulcers, drugs that cost about $500 a year. So we're going to be 
talking about cost savings; there's an example of cost savings.
    Medicare will pay many of the costs to treat a stroke, including 
bills from hospital and rehab center, doctors, home health aides, and 
outpatient care. Those costs can run more than $100,000. And this is 
essential coverage. Yet Medicare does not cover the blood-thinning drugs 
that could prevent strokes, drugs that cost less than $1,000 a year.
    The Medicare system has many strengths. Yet it is often slow to 
respond to dramatic changes in medicine. It took more than a decade and 
an act of Congress to get Medicare to cover preventative breast cancer 
screenings. It took 10 years and then an act of Congress to change the 
system. That's not a good system. Our seniors should not have to wait 
for an act of Congress for improvements in their health care.
    The best way to provide our seniors with modern medicine, including 
prescription drug coverage and better preventative care, is to give them 
better choices under Medicare. If seniors have choices, health plans 
will compete for their business by offering better coverage at more 
affordable prices.
    The choices we support include the choice of making no change at 
all. I understand some seniors don't want to change, and that's 
perfectly sensible. If you're a senior who wants to stay in the current 
Medicare system, you'll have that option, and you'll gain a prescription 
drug benefit. That's what the reform does.
    If you're a senior who wants enhanced benefits, such as coverage for 
extended hospital stays or protection against high out-of-pocket 
expenses, you'll have that choice. If you liked managed care plans, that 
option will be there. If you're a low-income senior, you will receive 
extra help each month and more generous coverage, so you can afford a 
Medicare option that includes prescription drug benefits.
    We're applying a basic principle: Seniors should be able to choose 
the kind of coverage that works best for them, instead of having that 
choice made by the Government. Every Member of Congress gets to choose a 
health coverage plan that makes the most sense for them. So does every 
Federal employee. If this kind of coverage is good enough for the United 
States Congress, it's good enough for America's seniors.
    For seniors without any drug coverage now, these reforms will make a 
big difference in their lives. In return for a monthly premium of about 
$35, or a dollar a day, those seniors now without coverage would see 
their drug bills cut roughly in half. A senior who has no drug coverage 
now and monthly drug costs of $200 a month would save more than $1,700 
on drug costs each year. A senior with monthly drug costs of $800 would 
save nearly $5,900 on drug costs each year. Those are important savings, 
help change people's lives in a positive way.
    I'm optimistic the House and the Senate negotiators will produce a 
bill that brings real savings to millions of seniors and real reform to 
Medicare. Once the legislation is passed, it will take some time to put 
into place. During this period, we'll provide all seniors with a 
Medicare-approved drug discount card that saves between 10 to 25 percent 
off the cost

[[Page 1488]]

of their medicines. So they'll have a start to see savings immediately.
    Low-income beneficiaries will receive a $600 subsidy along with 
their discount card to help them purchase their prescription medicines. 
The legislation Congress passes must make sure that the prescription 
drug coverage provided to many retirees by their employers is not 
undermined. That's what Rick and I just discussed. Medicare legislation 
should encourage employers to continue benefits, while also extending 
drug coverage to the millions of Medicare beneficiaries who now lack it.
    These steps will strengthen Medicare, not only for today's seniors 
but for tomorrow's retirees. Many workers are counting on Medicare to 
provide good health care coverage in their retirement. That's what 
people are counting on. These reforms will give our workers confidence 
that Medicare will serve them with the very best of modern medicine.
    The budget I submitted earlier this year commits an additional $400 
billion over 10 years to implement this vision of a stronger Medicare 
system. We're keeping our commitments to the seniors of today. We must 
pursue these reforms so that our Medicare system can serve future 
generations of Americans.
    The time to improve our Medicare system has come. Now is the time. I 
urge America's seniors to speak up, to call and write your 
representatives to urge them to work out a final bill. Speak up for 
prescription drug coverage. Speak up for health care choices. Speak up 
for a modern Medicare system that puts patients and doctors in charge.
    I urge the Congress to act quickly, to act this year, not to push 
this responsibility to the future. We have the opportunity--we have the 
obligation to give seniors more choices and better benefits. We have 
come far, and now is the time to finish the job.
    Thank you for coming. Appreciate it. Good to see you all. Thank you 

Note: The President spoke at 11:06 a.m. in Room 450 in the Dwight D. 
Eisenhower Executive Office Building. In his remarks, he referred to 
Richard P. Lavin, vice president, Human Services Division, Caterpillar 
Inc.; and Jim Martin, president, 60 Plus Association. The Office of the 
Press Secretary also released a Spanish language transcript of these 

[Weekly Compilation of Presidential Documents]

[Page 1488]
Monday, November 3, 2003
Volume 39_Number 44
Pages 1469	1510
Week Ending Friday, October 31, 2003
Notice--Continuation of the National Emergency With Respect to Sudan

October 29, 2003

    On November 3, 1997, by Executive Order 13067, the President 
declared a national emergency with respect to Sudan pursuant to the 
International Emergency Economic Powers Act (50 U.S.C. 1701-1706) to 
deal with the unusual and extraordinary threat to the national security 
and foreign policy of the United States constituted by the actions and 
policies of the Government of Sudan. Because the actions and policies of 
the Government of Sudan continue to pose an unusual and extraordinary 
threat to the national security and foreign policy of the United States, 
the national emergency declared on November 3, 1997, and the measures 
adopted on that date to deal with that emergency must continue in effect 
beyond November 3, 2003. Therefore, consistent with section 202(d) of 
the National Emergencies Act (50 U.S.C. 1622(d)), I am continuing for 1 
year the national emergency with respect to Sudan.
    This notice shall be published in the Federal Register and 
transmitted to the Congress.
                                                George W. Bush
 The White House,
 October 29, 2003.

 [Filed with the Office of the Federal Register, 9:04 a.m., October 30, 

Note: This notice was published in the Federal Register on October 31.


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