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President Bush argued Thursday that the United States needs a health care system in which patients pay more directly for their care, because that will turn them into comparison shoppers whose interest in a good deal will drive costs down.

Bush said the current system, in which employers and insurance companies are the most involved in paying health care bills, makes individuals less engaged in the cost of the procedures they get.

"When somebody else pays the bills, rarely do you ask price or ask the cost of something," the president said during a panel discussion on his health care initiatives at the Department of Health and Human Services. "The problem with that is that there's no kind of market force, there's no consumer advocacy for reasonable price when somebody else pays the bills. One of the reasons why we're having inflation in health care is because there is no sense of market."

Bush is making a series of appearances this month to highlight priorities he outlined in his State of the Union address. It was the second day in a row that the president emphasized the need for changes to the nation's health care system. On Wednesday, he pushed his call for an expansion of health savings accounts at the headquarters of the Wendy's fast-food chain in Ohio.

Health savings accounts were a big theme Thursday, as well.

Bush wants to encourage more people to open health savings accounts by increasing the tax advantages.

People who open such accounts also must buy a high-deductible insurance policy for catastrophic expenses that requires an individual to pay for at least the first $1,050 in expenses and families the first $2,100. Bush wants to let people put enough money in their health savings accounts to cover all their health insurance costs, not just the deductibles as allowed now. This would allow them to set aside more money tax-free.

Democrats argue that the accounts don't help those in need. They say it takes money to pay premiums on the high-deductible insurance policies, and that the working poor do not have extra money to set aside in the accounts.

Bush also campaigned for medical records to be kept electronically, to cut down on inefficiency and cost, and for more information to be made available about the price and quality of medical procedures. All these things, he said, would encourage a "consumer-based health care system."

"When you go buy a car you're able to shop and compare," he said. "And yet in health care that's just not happening in America today."