President Bush promoted his plans for health savings accounts and other “reasonable commonsense policies” to address spiraling medical costs.

“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 a forum on health care at the National Institutes of Health on Wednesday. “My judgment is the system won’t work if medical decisions are made by government.”

Bush wants to expand tax breaks for lower-income Americans who buy their own insurance and for those who purchase high-deductible policies and have health savings accounts, which are tax-free investments that can be used for health expenses.

He also favors allowing small businesses in different states to band together to offer insurance to workers.

Bush has lumped these initiatives, along with his plan to add private investment accounts to Social Security, as part of a second-term package he calls an “ownership society.”

“We need to bring market forces into the health care field,” the president said, fielding questions from an invitation-only town-hall-style audience.

“I believe the best kind of decision-making occurs when consumers make decisions and the relationship between their doctors and the patients become the cornerstone of good health care policy,” Bush said.

Bush emphasized the need to improve information technology in the health care field.

“We have 21st century medical practices, but a 19th century paperwork system,” he said. “Doctors are still writing prescriptions by hand. Most doctors can’t write clearly anyway.”

And he gave his audience a few pointers on fitness: “I want to encourage people to exercise on a regular basis, make wise choices about what you put into your body and be mindful of what you eat.”

Bush noted that health savings accounts were already available, and that he had set one up for himself and his family.

Individuals are being asked to shoulder more financial responsibility and to rely less on government under Bush’s various “ownership society” proposals.

Supporters claim market forces will bring people more options, lower prices and higher quality health care.

Some parts of the package have generated controversy in Congress, particularly among Democrats opposed to reductions in guaranteed benefits under many existing programs.