Expanding Access to Health Care for Millions of Americans
Remarks by the President in a Conversation on Health Care and Community Health Centers
Youngstown State University
Youngstown, Ohio
THE PRESIDENT: Thank you, Ron. Listen, thanks for coming.
(Applause.) As you can see, I'm joined by some of your fellow citizens
here, to have a dialogue about health care. And there's some really
amazing things going on in the Youngstown area, as well as across the
country, to make sure people have got a safety net. And that's what
we're going to discuss, community health centers and why they're
important for Ohio, why they're important for the country, and how they
fit into a strategy to make sure we do a better job of controlling
costs, as well as making sure people get health care. That's what
we're here to discuss.
We've got some real experts here that I'll be introducing in a
minute, people who have actually used community health -- people who
work in a community health center, people who run community health
centers, and people who oversee community health centers. We've got
the whole spectrum of the community health center world right here in
Youngstown to discuss why they're important.
Before I do, first of all, I want to thank Tony Atwater, the
Provost of this fine university. Tony, thank you very much.
(Applause.) You're a good man to host us. It's not easy to welcome
the President. (Laughter.) The entourages are quite large these days.
But I'm really proud that we could visit your beautiful campus. And
thanks a lot for the hospitality.
Tom Van Coverden is the President and CEO of the National
Association of Health Care Centers. Tom, thanks for coming, glad
you're here. (Applause.) George McKelvey is with us. Mr. Mayor, it's
good to see you. Thank you for your service. See you tomorrow.
(Applause.) Mr. Mayor and I first met on a train, didn't we, four
years ago. Thanks for coming by. You're doing a fine job here. And
the Mayor told me when I first met him, he said, my vision is a modern
Youngstown. And you're making it come true. I'm proud of your
service. Doing a great job.
And the Mayor of Alliance is with us, Toni Middleton. Where are
you, Mr. Mayor? There you go. Thanks for coming. (Applause.) The
reason Tony is here, I think a community health center is opening up in
Alliance.
MAYOR MIDDLETON: Yes, we opened up in December.
THE PRESIDENT: See, Mr. Mayor, you've got yourself a good asset in
your community, which we'll be discussing here shortly.
Listen, when I landed at the airport, I met a fellow named Sid
Harris. I'm about to introduce Sid. He has been an active volunteer
at a local hospital for 15 years, where he's performed over 4,000 hours
of volunteer help. Sid is a -- he runs fundraisers so that children
with heart problems can go to camp in Virginia. He sends nursing
students to Youngstown State University. Sid is a soldier in the army
of compassion. Sid is right here.
Sid, why don't you stand up, if you don't mind. (Applause.) Thank
you, Sid. His wife pointed out to me when I got off the plane, Sid may
not be able to see you, but he sure can hear you. (Laughter.) The
thing about Sid is, is that he is such a loving guy that he wants to
help somebody in life. That's what he wants to do. We talk about the
strength of the country being the U.S. military, and we're going to
keep it strong so the world will be more peaceful and free. We talk
about one of our strengths being the fact that we're a wealthy nation
compared to other nations, and that's the way we want it, and we've got
to make sure we remain the best place in the world to risk capital so
people can work. But the true strength of the country is in the hearts
and souls of our citizens. That's the true strength of America. The
true strength of our country is the fact that people like Sid are
willing to take time out of their lives to make somebody else's life
better.
We've got people in our country who hurt, who are lonely, who
wonder whether or not the future belongs to them, whether or not
there's any brighter day. And we've got people in our country who are
willing to surround the lonely with love and to help. See, that's the
strength of America. And the reason I like to talk about the Sid
Harrises of the world is to thank those here and those around
Youngstown, and those around the country, who are doing the same thing,
and to call upon others to love your neighbor like you'd like to be
loved yourself. We all can save America, one heart and one soul at a
time. And Sid Harris is a part. (Applause.)
I appreciate you coming, Sid.
There's an interesting debate in Washington about health care. My
view is, is that we need to empower consumers and doctors. We need to
make sure the patient-doctor relationship is the center of health care
decision-making, not Washington, D.C. (Applause.) We need to make
sure that we put good policy in place that helps patients.
One of the things that you're going to see happening here very
quickly is drug discount cards will be sent out to senior citizens.
It's a good thing. You take those drug discount cards and you'll be
able to -- (applause.) This is part of Medicare reform, making the
Medicare system better. And the drug discount cards will allow seniors
to save between 15 to 25 percent off of brand-name medicines, and more
off of generic drugs. There's a market over the Internet, kind of
that's taking place -- in other words, people are now posting price so
consumers have got the ability to choose price. And that is causing
more price efficiency in the marketplace. It's a positive thing that's
beginning to take place.
By the way, poor seniors will get a $600 credit on their card.
Many drug companies have said they're going to, once the $600 credit is
used, they'll extend to help the poorest of seniors with drug prices.
It's a positive development.
Medicare reform is going to work, and it's going to work well. It
fully kicks in in the year 2006. The first stage is the drug discount
cards that are now being sent out.
Secondly, we've passed what's called health savings accounts. I
suspect there's some small businesspeople here. These are particularly
beneficial for individuals and small businesses. This will allow you
to put money into a health savings account, tax-free; earn interest on
it, tax-free; take it out, tax-free, to pay for ordinary medical
expenses, as well as to pay for a high-deductible, low-cost medical
catastrophic policy. It's a good way to help control costs. It's a
new innovation that is beginning to get in the marketplace, all aimed
at helping to control medical costs and making sure the patient-doctor
relationship is the center of medical decision-making processes.
We need what's called association health care plans. This will
allow small businesses to pool risk so they can have the same
purchasing power as large businesses do. I believe there ought to be
tax credits for the working uninsured. And I know you need medical
liability reform here in the state of Ohio and across the United
States. (Applause.)
Here's why. Junk and frivolous lawsuits cause docs to have to
practice what's called defensive medicine. In other words, they
practice more medicine than you need in order to make sure that if and
when they get sued, they've got a good case. Secondly, junk and
frivolous lawsuits mean their premiums go up for their medical
liability insurance, which means your bills go up. Thirdly, junk and
frivolous lawsuits discourage good docs from even practicing medicine
in the first place. If you want health care to be affordable and
available, you need to have a legal system that is fair and balanced.
I believe this is a national issue because it runs up the cost of
medicine for national budgets. The Medicare budget goes up, the
Medicaid budget goes up, the veterans' health care system costs go up.
And we need a -- and we need law coming out of Washington to make
medical liability reform the law of the land. It passed the House;
it's stuck in the Senate. (Applause.)
These are practical ways to address the rising costs of health
care, the availability of health care, all aimed at making sure the
patient and the doc are the center of the health care decision-making
process.
Now, one of the problems we got here in America is that there are
some people, quite a few people who need primary care, a place where
they can go get help when they need it. The problem, oftentimes people
go to the emergency room, which is very cost-inefficient. It costs the
taxpayers money. The emergency room ought to be used for true
emergencies, not for the primary care of health care -- primary health
care for people who can't afford health care. So the government wisely
set up what's called community health centers. These are facilities
where -- that provide primary and prenatal care, checkups,
immunization, preventative treatments to anybody who needs them. In
other words, this is a part of the safety net. This is a wise
expenditure of taxpayers' money. It relieves pressure off of the
emergency rooms, and it provides a safety net for some of the citizens
in our communities.
We provide care up to about 13 million people a year, I think. I
think it's important for us to continue to either expand existing
community health centers, or build new ones. The goal I set when I
first got elected was that we would expand them by 1,200 -- expand or
build 1,200 new ones. We've accomplished half of that goal. I'm
asking for Congress to accomplish the other half of the goal over the
next couple of years. This is wise use -- (applause.)
These things make sense. It's a heck of a lot better system than
having the entire health care system federalized. This makes a lot of
sense to make sure that we recognize in our society people can't afford
health care and they need access to health care. And it's a practical
way to do so.
Today you're going to hear from people who use the community health
centers. You're also going to hear about a doc who works at the
community health center. But I first want to start off with Betty
Duke. Her job is -- well, she's got a pretty fancy title. She's the
Administrator of the Health Resources and Services Administration --
HRSA. (Laughter.) In Rockville, Maryland. She works for Tommy
Thompson, who is my Cabinet Secretary for Health and Human Services.
She's got such a complicated job, it required a Ph.D. But her job is
to oversee this health center initiative, the expansion of existing
health centers, or the building of new ones in communities where there
is a need.
Why don't you tell us, Betty, just anything you want to say, you're
welcome. It's your mike.
* * * * *
THE PRESIDENT: One of the things -- we're trying to get up to
serving 16 million people, see. There's a lot of discussion about
whether or not people have got access to health care. This is access
to health care in a practical way. a practical way -- 16 million
people -- (applause).
They treat bicycle injuries? (Laughter and applause.) I was
wearing my helmet, I want you to know. (Laughter.)
Ron, you're the CEO of the Ohio Northeast Health Systems, Inc.
That's a long title for -- (laughter.)
MR. DWINNELLS: We call it "One," as in "Number One." (Laughter.)
THE PRESIDENT: Number One? Okay. You're the health CEO of
"Number One," then. So, like, what is your -- how many of these
centers do your run? How long have you been running centers? How
often are they open?
* * * * *
THE PRESIDENT: Tell people why it's -- I think they're
cost-effective; otherwise I wouldn't be asking them to expand. Do you
think they're -- of course, you think they're cost- effective.
(Laughter.) You're not a lawyer, but it's a leading question.
(Laughter.)
MR. DWINNELLS: Yes, I definitely think it's very cost-effective.
This year, we're anticipating 60,000 visits. We have a $5 million a
year budget this year. This is compared to $600,000 in 1998. So
there's been a huge growth. I believe -- I saw figures once where to
care for a patient through community health centers, it was an ungodly
small amount, a dollar something per encounter. And it's amazing,
because it's run close to --
THE PRESIDENT: -- goes to an emergency room, or no care at all
until it's too late. Until, in other words, somebody gets so sick that
they show up requiring a much greater bill. It's going to be -- it
will cost them a lot of money if we don't take care of our problem
early.
* * * * *
THE PRESIDENT: One of the things I forgot to ask Betty about was
the National Health Service Corps.
* * * * *
THE PRESIDENT: I appreciate you doing that. In other words, what
Betty does is not only see the construction and/or oversee the
construction or expansion of these facilities, her job also is to
provide incentive to health care providers to show up and work there.
And that's good. It's a good program. And part of it is to forgive
loan.
MR. DWINNELLS: Mr. President, can I say --
THE PRESIDENT: Yes, absolutely.
MR. DWINNELLS: I'm a National Health Service Corps alumni.
THE PRESIDENT: Are you? Good.
MR. DWINNELLS: Yes, and I'm still here. (Laughter and applause.)
THE PRESIDENT: We've got somebody who works for you here.
Compton. Compton, I'm glad you're here. Comp's a doc. What kind of
doc are you?
DR. GIRDHARRY: I'm an obstetrician/gynecologist, Mr. President.
THE PRESIDENT: How long have you been practicing medicine?
DR. GIRDHARRY: I was practicing for 21 years in the city of
Alliance.
THE PRESIDENT: And?
DR. GIRDHARRY: And I was, unfortunately, forced out, to give up
that practice because of the rising cost of malpractice insurance.
THE PRESIDENT: Let me stop you there. You hear me talk about the
need for medical liability reform. You need to do it Ohio. We need to
do it in Washington. (Applause.) Listen, everybody will have their
day in court, but it's -- a reasonable person must know that the system
is totally out of whack -- totally out of whack when you start driving
people out of business, people who you need in your communities.
Fortunately -- I didn't mean to tell your story for you -- (laughter)
-- fortunately, you found a home.
* * * * *
THE PRESIDENT: Doc, I'm here thanking you. See? (Laughter.)
You're the guy who's helping make people's lives better. And I
appreciate that.
One of the interesting things is -- and so, you were worried about
medical liability reform -- I mean, liability insurance as a private
doc. What about now when you work here?
DR. GIRDHARRY: That's the great thing about it. Being in sole
practice, I actually was administrating my whole practice, and my
practice was a major headache. So now, with the federal tort, I don't
have to worry about that.
THE PRESIDENT: Yes, in other words, the government helps with the
--
DR. GIRDHARRY: That is correct.
THE PRESIDENT: Isn't that right, Betty?
DR. DUKE: That's correct. That's correct. We have a program in
which we provide insurance for the health providers who work in our
system.
THE PRESIDENT: See, I want people who might be listening out
there, who are docs out there, who are wondering whether or not it
makes sense to go and lend their services and their expertise and their
compassion to a community health center to understand that it's a good
place to show -- to do your skill, it's a good place to come.
Are you still looking for docs?
DR. DUKE: We are always looking for docs, and we make it really
good for them to come to work for us.
THE PRESIDENT: You do? Good. Well, you've got living proof of it
right here in Compton.
Anything else you want to say, Compton, now that you've got the
floor? (Laughter.)
DR. GIRDHARRY: I think also that the health clinic is a great
idea, because a lot of my patients, when I went out of business, are
traveling right now to different cities. And the problem is that a lot
of them don't seek the health care because they either can't afford it,
or they can't do the distance, and they have young kids at home. So it
is a major help for these people.
THE PRESIDENT: Well, that's good. Thanks. I appreciate you being
here. Thanks for your compassion. (Applause.) I'm glad you're here.
Cindy.
MS. SACCO: Yes.
THE PRESIDENT: Got the mike there.
MS. SACCO: Got the mike.
THE PRESIDENT: Which one is your grandson?
MS. SACCO: That handsome gentleman right there.
THE PRESIDENT: In the uniform? Thanks for your service, Sergeant,
I appreciate it. (Applause.) Your grandmother was bragging on you.
(Laughter.)
Cindy, thanks. Tell us your story.
* * * * *
THE PRESIDENT: So the center is sitting there, you go in --
MS. SACCO: No insurance.
THE PRESIDENT: Right.
MS. SACCO: Didn't matter.
THE PRESIDENT: Right. That's what they're there for.
MS. SACCO: Come on in.
THE PRESIDENT: That's exactly why we need to expand them. And,
obviously, we want people to have insurance; need to work -- encourage
people to have insurance. There's ways to do so in a cost-effective
way, as well, through tax credits. Some don't have insurance. Some
are too poor, some are sick, some have never been to a doctor in their
life. These centers are available. You not only go to the center, you
obviously find a specialist, or they find a specialist for you.
MS. SACCO: They found him for me.
THE PRESIDENT: Right, yes.
MS. SACCO: They took care of everything. They don't only take
care of you physically, the staff, from the doctors on down, take care
of your emotional needs, your well-being.
THE PRESIDENT: Kind of like a hospice.
MS. SACCO: It's wonderful. The staff there is unbelievable.
DR. DWINNELLS: We look at the total well-being of the person, not
just the disease, but the overall total. It's a holistic approach.
THE PRESIDENT: So you have volunteers there who help post-surgery
--
DR. DWINNELLS: Well, they're not volunteers, we pay them.
(Laughter.) We have some volunteers.
THE PRESIDENT: Paid volunteers. (Laughter.) That's good.
(Laughter.)
You got anything else you want to say? I'm proud of your sons.
Her other son is a Marine in Haiti, serving our country. (Applause.)
MS. SACCO: Grandson. That's their mommy, right there.
THE PRESIDENT: I mean, grandson. What am I saying? Where's mom?
Hey, mom, how are you? Are you the -- you've got the same pictures on,
that's good. I'm proud of them, that's good. Yes, tell them thanks.
Well, you already told one, thanks. Tell the other one, thanks. You
don't look old enough. (Laughter.)
MS. SACCO: Nor do I. (Laughter and applause.)
THE PRESIDENT: I was just about to say that. (Laughter.)
MS. SACCO: I'm cuing you. (Laughter.)
THE PRESIDENT: I quit. (Laughter.)
Joyce Phifer is with us, as well. Joyce, thank you for coming. A
mom of 11 children. (Applause.) Any of them here?
MS. PHIFER: Yes, my son is here.
THE PRESIDENT: Your son is here?
MS. PHIFER: He, too, was in the service, until he had to have a
kidney transplant.
THE PRESIDENT: Where is he?
MS. PHIFER: He's there.
THE PRESIDENT: There he is. Thank you, sir. (Applause.)
Welcome.
* * * * *
THE PRESIDENT: This is a fantastic story. And the operation was
in January?
MS. PHIFER: In January.
THE PRESIDENT: This year?
MS. PHIFER: This year.
THE PRESIDENT: You look great. (Laughter.) That's right.
(Applause.) I hope this helps you understand a key aspect of our
strategy, to make sure that our health care system is available to
citizens from all walks of life. And that's really important for our
society, is to have a health care system that is -- that meets the
needs of every patient and every consumer.
And one way to do it is to expand -- one part of the strategy is to
expand community health centers. It's a common-sense approach to
making sure that the health care system works. You see, it's a
common-sense approach to making sure the system meets the needs without
centralizing the decision-making process in Washington, D.C. I think
this system is -- this approach is a much better approach.
It's -- obviously, there's more that needs to be done. I mentioned
several key things: Expand health savings accounts, make sure the
Medicare reform continues forth, medical liability reform, association
health care plans, tax credits for the uninsured -- but all of it
fitting together makes sense so that the country can be proud of the
health care system, so docs can feel comfortable practicing medicine in
the health care system, so that we can remain the best place in the
world to get health care.
And one of the challenges we face is to make sure the health care
system responds to the needs of the citizens. Another challenge we
face is to make sure we secure our country. And I can assure you I
will use every asset at my disposal to make sure the American homeland
is safe and secure. (Applause.)
We have faced a lot of challenges in this nation, but our spirit is
strong, our sight and vision is clear. America understands where we
need to go. We need to be compassionate at home, and we need to be
firm and resolved abroad as we spread freedom and peace.
It is such an honor to be here. I want to thank -- thank the folks
who were willing to share their stories with you all and with me. I
hope you have a better understanding of a key component of how
America's health care system will work better as we head out into the
21st century.
May God bless the citizens of this community, and may God continue
to bless our country. Thank you for coming. (Applause.)