Decision Points

by George W. Bush

  The process of reconciling the House and Senate bills dragged through the summer. When Congress returned from recess in early September, I set out to reenergize the debate with two days of school visits in Florida. Laura agreed to give her first-ever testimony on Capitol Hill. As a teacher and librarian, she had great credibility on education. Her appearance was scheduled for September 11, 2001.

  By the end of that morning, it was clear I would not be the education president. I was a war president. Throughout the fall, I urged Congress to finish No Child Left Behind. Ted Kennedy gave a courageous speech defending accountability in front of the National Education Association, a teachers’ group that contributed heavily to Democrats and strongly opposed the bill. Senator Judd Gregg and Congressman Boehner, once an advocate of abolishing the Education Department, rallied Republicans who were anxious about the federal role in education. Like me, they argued that if we were going to spend money on schools, we ought to know the results it produced. A week before Christmas, Congress passed No Child Left Behind by a bipartisan landslide.

  Over the years, No Child Left Behind prompted plenty of controversy. Governors and state education officials complained that the bureaucracy was too rigid and that too many schools were labeled as failing. When Margaret Spellings became education secretary in 2005, she modified bureaucratic restrictions and increased flexibility for states. But we both made clear we would not dilute the accountability measures. The purpose of the law was to reveal the truth, even when it was unpleasant.

  Some critics said it was unfair to test students every year. I thought it was unfair not to. Measuring progress was the only way to find out which students needed help. Others complained about what they called “teaching to the test.” But if the test was well designed to measure knowledge of a subject, all the schools had to do was teach that subject.

  Another common claim was that No Child Left Behind was underfunded. That’s hard to believe, given that we raised federal education spending by 39 percent over my eight years in office, with much of the extra money going to the poorest students and schools.*

  On a more fundamental level, the critics who complained about the money missed the point of No Child Left Behind. The premise of the law is that success cannot be measured by dollars spent; it has to be judged by results achieved.

  By the time I left office, fourth- and eighth-grade math scores had reached their highest levels in history. So had fourth-grade reading scores. Hispanic and African American students set new records in multiple categories. The gap had narrowed in exactly the way we wanted: All students improved, but minority students improved the most.

  In January 2008, I visited Horace Greeley Elementary School in Chicago to mark the sixth anniversary of No Child Left Behind. The school, named for the nineteenth-century abolitionist, was 70 percent Hispanic and 92 percent poor. It had outperformed most public schools in Chicago. Student proficiency in reading had risen from 51 percent in 2003 to 76 percent in 2007. Math proficiency had improved from 59 percent to 86 percent.

  At Horace Greeley Elementary School. White House/Joyce Boghosian

  It was uplifting to see a school full of low-income minority students thrive. A sixth-grader, Yesenia Adame, said she enjoyed taking tests. “Then your teachers can know what you need help on,” she explained. At the end of my visit, I told students, parents, and the press what I had long believed: No Child Left Behind is a piece of civil rights legislation.

  I used to quip that I was a product of a faith-based program. By 1986, faith had changed my heart, and I had quit drinking. Ten years later, my eyes opened to the potential of faith-based programs to transform public policy.

  In June 1996, two African American churches in the town of Greenville, Texas, were burned. Until 1965, a sign on the town’s main street had advertised “The Blackest Land, The Whitest People.” As governor, I feared we were witnessing a surge in old-time racism.

  I traveled to Greenville to condemn the burnings. A mixed-race crowd of about four thousand people turned out in the football stadium. “From time to time, Texans boast that ours is a big state.” I said. “But as big as this state is, it has no room for cowardice and hatred and bigotry.” Then I gave the microphone to Tony Evans, a dynamic African American pastor from Oak Cliff Bible Fellowship in Dallas. He told a story about a house with a crack in the wall. The owner hired a plasterer to cover the crack. A week later, the crack reappeared. So he hired another plasterer. A week later, the crack was back again. Finally the homeowner called an old painter, who took one look and said, “Son, first fix the foundation and then you can fix the crack in the wall.”

  The crowd nodded and clapped. Then Tony turned to me. “Governor, I have something to say to you,” he said.

  Uh-oh, I thought. Where is this headed?

  “We need to fix the foundations,” he said, “and your old government programs aren’t doing the job.” He said he had a better alternative. It was the most effective welfare system in the world. It had buildings on many street corners, a list of willing workers, and regular meetings to study the perfect manual for saving lives.

  He was talking about houses of worship. And he was right. Faith-based programs had the potential to change lives in ways secular ones never could. “Government can hand out money,” I said, “but it cannot put hope in a person’s heart or a sense of purpose in a person’s life.”

  I looked for ways for Texas to partner with faith-based organizations. I met with Chuck Colson, Richard Nixon’s White House counsel, who had spent time in a federal penitentiary and found redemption. Chuck had founded an organization devoted to spreading the Gospel behind bars. We agreed to start a faith-based program in one wing of a Texas prison. Chuck’s program, the InnerChange Freedom Initiative, would provide instructors for Bible study and a life lessons course. The program would be optional and open to prisoners near the end of their sentences. Each inmate who participated would be connected with a mentor and welcomed into a church congregation upon release.

  In October 1997, I visited the Jester II prison near Sugar Land, Texas, where several dozen inmates had enrolled in InnerChange. At the end of the tour, a group of men in white jumpsuits filed into the courtyard. They formed a semicircle and struck up “Amazing Grace.” After a few stanzas, I joined the chorus.

  The next morning, Karen Hughes brought me the Houston Chronicle. There I was on the front page, shoulder to shoulder with the prison choir. The story noted that the man next to me, George Mason, had pled guilty to killing a woman twelve years earlier. That day in the prison yard, he did not seem like a murderer. He had a gentle manner and a kind smile. No question he had become a spirit-filled man.

  When I ran for president, I decided to make a nationwide faith-based initiative a central part of my campaign. In my first major policy speech, delivered in Indianapolis, I said, “In every instance where my administration sees a responsibility to help people, we will look first to faith-based organizations, to charities, and to community groups.”

  Nine days after my inauguration, I issued executive orders creating an Office of Faith-Based and Community Initiatives in the White House and in five Cabinet departments. The offices changed regulations and broke down barriers that had prevented faith-based charities from accessing the federal grant-making process. To emphasize the initiative’s nonpartisan nature, I appointed Democrats to serve as the first two directors. One was John Dilulio, an innovative professor from the University of Pennsylvania. The other was Jim Towey, a thoroughly decent man who had led Florida’s social services department and served as Mother Teresa’s lawyer. I used to tell Towey that we sure have a litigious society if Mother Teresa needed a lawyer.

  Some said the faith-based initiative blurred the line between church and state. I took that concern seriously. Government should never impose religion. Every citizen has the right to worship as he or she wishes, or not to worship at all. I was always wary of people who used faith as a political weapon, suggesting they were more righteous
than their opponents. My favorite Bible verse for politicians is Matthew 7:3—“Why do you see the speck that is in your brother’s eye, but do not notice the log that is in your own eye?”

  At the same time, government need not fear religion. If social service programs run by people of faith did not proselytize or discriminate against people receiving services, I thought they deserved a chance to compete for taxpayer dollars. The government should ask which organization would deliver the best results, not whether they had a cross, a crescent, or a Star of David on their wall.

  The initiative opened up roughly $20 billion a year in federal funding to competition from faith-based groups. Many of these organizations had no experience interfacing with government, so we held forty conferences and more than four hundred grant-writing seminars to help them apply for funding. Ultimately, more than five thousand faith-based and community organizations, mostly small grassroots charities, received federal grants.

  In January 2008, I visited the Jericho Program of East Baltimore. Operated by Episcopal Community Services of Maryland and funded by a grant from the Department of Labor, the program provided mentoring, counseling, and job training services to recently released adult male convicts. The nine men from Jericho were quiet when I walked into the room. I detected a fair amount of skepticism. “I drank too much at one point in my life,” I said to break the ice, “and I understand how a changed heart can help you deal with addiction.”

  The men opened up and told their stories. One had been convicted of selling drugs, another of cocaine possession, another of theft. Many had been in and out of prison several times and had abandoned their families. Thanks to the services they received at Jericho, they had begun to find purpose in their lives. One man emotionally explained how thrilled he was to have reunited with his three daughters. “Six months ago, I was broken down,” he said. “Now I am shaking hands with the president.” Another told me proudly that he had received two job offers. “Drugs have always been a problem in my life, up until now,” he said. “Thanks to Jericho,” he said, “I got my groove.”

  The Jericho Program’s recidivism rate was 22 percent, less than half of Baltimore’s overall rate. The men I met that day were among fifteen thousand who had benefited from the Prisoner Reentry Initiative we launched in 2004. Their recidivism rate was 15 percent, one third of the national average.

  My most extraordinary meeting on faith-based initiatives took place right across the hall from the Oval Office. In June 2003, I had convened a roundtable discussion with faith-based leaders. Chuck Colson and several members of InnerChange attended. When I stepped into the Roosevelt Room, I spotted a familiar-looking African American man. I walked over and gave him a big hug. “I’m sure glad you’re here,” I said.

  It was George Mason, the man from the prison choir in Sugar Land. Upon release, he had earned a job as a janitor at his church. He also led a Bible study and served as a mentor for others leaving prison. What a testimony to the redemptive power of Christ: George Mason and George W. Bush together in the West Wing.

  With George Mason. White House/Tina Hager

  Created by President Johnson in 1965, Medicare had helped countless seniors enjoy healthier lives. But while medicine had advanced, Medicare had not. Benefits were determined by a government bureaucracy that was wasteful and very slow to change. When private insurers added mammogram coverage to protect against breast cancer, it took Medicare ten years and an act of Congress to catch up.

  Medicare’s most antiquated feature was that it did not cover prescription drugs. The program would pay $28,000 for ulcer surgery, but not $500 a year for pills that would prevent most ulcers.

  I was struck by the stories of older Americans who had to choose between buying groceries and medicine. One sixty-nine-year-old woman I met, Mary Jane Jones of Virginia, had to work twenty hours a week just to afford her nearly $500-a-month bill for prescription drugs and insulin. She told me she sometimes used needles three or four times to save money.

  Medicare wasn’t just outdated; it was going broke. The combination of rising health costs and the upcoming retirement of the Baby Boom generation had created a $13 trillion unfunded liability. The next generation would get stuck with the bill.

  The rising costs bankrupting Medicare affected the whole health-care system. America’s health spending had doubled from about 7.5 percent of GDP in 1972 to more than 15 percent in 2002. Part of the explanation was the cost of new medical technology. Junk lawsuits also played a role. But the primary cause was a fundamental flaw in the system: Most people had no idea what their health care cost.

  Seniors and the poor had their bills paid by the government through Medicare and Medicaid. Most working Americans received coverage through their employers and relied on a third party, an insurance company, to negotiate prices and determine payments. Many self-employed Americans couldn’t afford health insurance because the tax code disadvantaged them and regulations prohibited small business owners from pooling risk across jurisdictional boundaries.

  What the system lacked was market forces. There was no sense of consumerism or ability to shop around for the best deal, no competition for customers’ business, and no transparency about quality and price. As a result, there was little incentive for doctors or patients to limit the resources they consumed, which was crucial to holding down costs.

  I saw reforming Medicare as a way to solve two problems. First, by adding a prescription drug benefit, we would modernize the program and provide seniors with the quality health care their government had promised. Second, by delivering the drug benefit through private insurance plans that compete for seniors’ business, we could inject market forces into the health care system. Reforming the program would also create an opportunity to expand Medicare Plus Choice, later renamed Medicare Advantage, which allowed seniors to obtain all their health care through flexible, affordable private insurance plans.

  I knew Medicare reform would be a tough political issue. Introducing market forces into a government health program would upset the left. Adding an expensive prescription drug benefit would be unpopular with the right. But I decided to take on the challenge.

  Under our plan, seniors who wanted the new prescription drug benefit would have to choose private plans instead of government-run Medicare. We would change Medicare’s funding formula so that the government-run program had to compete with private plans on a level playing field. Both reforms would introduce more market forces and help address the rising costs of health care.

  Before announcing my plan publicly, I previewed it with Republican leaders in the House. They told me my proposal didn’t stand a chance on Capitol Hill. Democrats would never support a bill that required seniors to give up their government-run Medicare coverage to receive a prescription drug benefit. Some Republicans wouldn’t either.

  I faced a tough decision. I could fight for a lost cause or make a compromise. I decided to propose a prescription drug benefit that would be administered by private health plans but open to all seniors, including those who wanted to keep government-run Medicare coverage.

  My Medicare team** worked closely with Senate Majority Leader Bill Frist and Finance Committee Chairman Chuck Grassley of Iowa. Chuck wisely brought two key Democratic counterparts, Senators Max Baucus of Montana and John Breaux of Louisiana, into the drafting process. They produced a solid bill that garnered support from thirty-five Democrats. The Senate passed the bill in June by a vote of 76 to 21.

  In the House, some conservatives balked at the cost of the drug benefit, which we eventually estimated at $634 billion over ten years. But Speaker Denny Hastert, Majority Leader Tom DeLay, and Ways and Means Committee Chairman Bill Thomas built a fragile coalition to pass the bill 216 to 215. Just nine House Democrats voted for a benefit they had demanded for years. The rest voted no. During the debate on the floor of Congress, not a single Democrat criticized the Medicare bill for costing too much. Most wanted to spend more money.

  The razor-thin House margin m
ade it essential that the House and Senate bills be combined in a way that retained Republican support. To address cost concerns, we included a so-called trigger provision that would take effect if Medicare spending rose faster than expected. Congress would then be required to make reforms to address the problem.***

  We also highlighted health savings accounts, an innovative new health insurance product created by the House bill. Designed to make coverage affordable for small businesses and individuals, HSAs coupled low-premium, high-deductible insurance against catastrophic illness with a tax-free savings account to pay routine medical expenses. Employers or individuals could contribute to the account, which belonged to the individual and could be taken from job to job. Because HSA owners paid their own health-care expenses and kept any money left over, they had incentives to stay healthy, shop for good deals, and negotiate better prices.

  In mid-November, AARP, the influential seniors’ advocacy group, endorsed the compromise bill. “This is not a perfect bill, but America cannot wait for the perfect,” CEO Bill Novelli said. He was then excoriated by Democratic leaders, labor unions, and liberal editorial pages. But his stand went a long way with wavering members of Congress.

  The decisive vote came on November 21, 2003. Laura and I had long been scheduled to spend that day in Great Britain, as part of the first official state visit there by an American president since Woodrow Wilson. Some suggested postponing the trip. I refused. “They have phones in London, you know,” I reminded the team.

  Laura and I enjoyed spending time with Queen Elizabeth II, a gracious, charming woman with a keen sense of humor. In 2007, Her Majesty and Prince Philip came to celebrate the four hundredth anniversary of the Jamestown settlement. In my welcoming remarks before seven thousand people on the South Lawn, I thanked the queen for her long friendship with America. “You helped our nation celebrate its bicentennial in 17 …” I caught myself before I could finish the date, 1776, a rough year in U.S.-British relations and an unflattering commentary on the queen’s longevity. The eighty-one-year-old monarch glanced at me with a wry smile. “She gave me a look that only a mother could give a child,” I said. At a dinner at the British embassy the next night, Her Majesty said, “I wondered whether I should start this toast by saying, ‘When I was here in 1776 …’ ”