So he is saying the incentive structure is made so that doctors go to chopping off foots, for profit. Also they are not immediately reimbursed, paper work is paper work, more then likely they are going to push through the big money items first, but they don't get immediately reimbursed.
In fact after that little gaffe he never once mentioned the mean old doctors taking away peoples feet for profit again.
We can also go into all the examples(lies) that he told about the mean old insurance companies that let people die but then where found out that those people he was referencing actually lived.
But nah, Bush messing up some words is way worse.