    [Public Papers of the Presidents of the United States: William J. Clinton (1995, Book II)]
    [August 9, 1995]
    [Pages 1228-1232]
    [From the U.S. Government Publishing Office www.gpo.gov]

    Remarks in a Roundtable Discussion at the Teen Health Connection in
    Charlotte
    August 9, 1995

        The President. I want to explain to all of you why I came here, and
    then I want you to talk to me a little bit. I spend an enormous amount
    of my time, as you might imagine, trying to do things that I believe
    will help our country meet the challenges we face today so that young
    people will have a better future. And it's obvious to me that even if I
    do the best job I could possibly do and have a good economic policy,
    even if we do everything we can at the national level with the passing
    of an anticrime bill or a welfare reform bill, even if I keep the
    country strong in terms of its national security relationship with other
    countries, unless young people have good, healthy, constructive lives at
    the grassroots level, the things that I do will not succeed in getting
    you the future you deserve.
        And I've been talking a lot in the last few weeks about how we can
    bring the American people together to get over all these partisan and
    other racial and income and regional divisions in our country and try to
    bring people together to solve problems. And every time I get a chance I
    tell people, look, there's not a problem in this country that hasn't
    been solved by somebody somewhere. And so I pledged a few weeks ago and
    I started doing this, that as I traveled around the country, in addition
    to giving speeches and talking to people--in fact, I just talked to this
    big Baptist convention--I would actually go visit places where people
    were solving problems and helping other people live their lives, to try
    to highlight it so people in other parts of the country would see it and
    say, ``Hey, I could do that, too. Hey, my kids can be better off, too.
    We can do this.'' So that's really why I'm here.
        So I want to give you the chance to educate me about what you're
    doing and what you think, maybe what else others like me could do to
    help you more. And I want, through that, to give you the chance to
    educate the country about what you're doing, so that people in other
    places that may not have a facility like this will take heart and maybe
    do the same thing. That's why I'm here. And however you all want to
    handle it, I'll be glad to--I just want to listen.

    [At this point, moderator Barbara Zeigler, founder and executive
    director of Teen Health Connection, invited participants to speak, and
    several patients shared their experiences with the center, explaining
    how it had helped them physically and emotionally.]

    [[Page 1229]]

        The President. Do most of these young people that come in here have
    no health insurance?
        Dr. John Johnston. A number has Medicaid and a number on a sliding
    pay scale, which means that there's a minimal amount that they pay.
        The President. But most of them don't have private health insurance?
        Dr. Johnston. No, it is--no, sir.
        The President. So, they're either Medicaid eligible or they just pay
    whatever they can?
        Dr. Johnston. Right.
        Q. Mr. President, I also wanted to thank you for what you did for
    the foster children and for welfare because if it wasn't for what you
    did, most of us wouldn't be able to come here, wouldn't be able to have
    Medicaid.
        The President. I'm glad you said that because that's one of the big
    issues. We're trying to save that program in this Congress. And the
    proposals for the cuts in Medicaid--most people think of Medicaid as
    just some sort of vague welfare program, so they think we can just cut
    any amount of money out of it and be all right. But two-thirds of the
    Medicaid money in our country goes to take care of older people and
    disabled people who live in nursing homes or other care facilities. And
    the other third goes to people like you, to children.
        I don't know--if we cut this Medicaid program too much it's going to
    be very hard for facilities like this to succeed. And just to point out,
    there's no telling how much money you're saving. In addition to giving
    all these kids a better life, there's no telling how much money you save
    in the health care system because, otherwise every time somebody gets
    sick, as you just said, they're going to show up at the emergency room
    whether it's an appropriate emergency room procedure or not. And if you
    have something--if you have a diabetic condition, you have no choice. I
    mean, if you don't have a regular health connection--I use your--
    [inaudible]--but if you don't have a regular health connection, you're
    in deep trouble if you get sick. You've got to show up.
        But what else? What else does this place do for all of you? Anybody
    else want to talk?

    [A participant stated that teens could depend on the Teen Health
    Connection for emotional and physical help.]

        The President. It's kind of like a community facility, though, isn't
    it?

    [The participant explained how support from the program had helped her
    adjust to her foster home.]

        The President. What about the parents? What's your experience with
    this program?

    [Parents explained how the program benefited their children by providing
    a place to talk about problems confidentially.]

        The President. How much growth have you had?
        Ms. Zeigler. More than triple since we opened.
        The President. So now how many young people are you serving?

    [Ms. Zeigler stated that there were over 3,500 patients in the program
    and they hoped to open new locations in the future.]

        The President. Especially if you're going to give them this kind of
    personal attention.
        Ms. Zeigler. Well, and that's always a problem because you're torn
    between the need to meet the needs and particularly with managed care
    coming in, you know, just get moving and get your kids in and out. But
    if you're really going to do good--[inaudible].
        The President. Do all your young people live in Charlotte?
        Ms. Zeigler. Yes. We do have a few that will come in from South
    Carolina, a few from other counties.
        The President. But by and large, they're all from here.
        Ms. Zeigler. Yes, by and large, they're all from here.
        The President. And how many uninsured young people are in this
    county?
        Ms. Zeigler. Well, 20 percent of our youth is in poverty in
    Charlotte. I'm not sure of the exact numbers that are uninsured. But I
    could----
        The President. But it's a big number? It's more than 3,500.
        Ms. Zeigler. Oh, yes. I mean, it's about 14,000. There are 14,000
    that are uninsured that are on Medicaid. But there have been many more
    others that actually have----
        The President. Who weren't on Medicaid but don't have comprehensive
    health insurance.
        Ms. Zeigler. Yes, that don't have health insurance. And there's a
    lot of people who may live in a two-parent family, but they are right
    above getting Medicaid but are not working in a situa-

    [[Page 1230]]

    tion where they're provided with comprehensive health care. So those are
    also the families that use the emergency room, which is good because the
    physicians are there--very, very costly to the community. And it doesn't
    give continuity that you see here.
        The President. One of the things I think we have to think about,
    again--that's why it's important we don't just say we're going to cut
    Medicaid a certain amount of money without knowing what we're getting in
    return. We can't just sort of jump off a big old cliff without knowing
    what the consequences are. If we're going to go to managed care, in my
    opinion, we ought to have facilities like this. There ought to be some
    sort of managed care formula so you can meet all the needs of these
    young people. You can estimate, for example, if you have a diabetic
    condition, how many times a year you might need to be in here and what
    are the kinds of things that could happen, because the idea of managed
    care is that they would get a certain amount of money, instead of being
    able to bill Medicaid every time. Let's say you sign up, and this is
    going to be your primary medical place, and they get a flat amount of
    money. But it's hard to know.
        I see your teen pregnancy prevention posters back there, you know. I
    see your AIDS posters back there. I know all of you talked about the
    kind of psychological support and emotional support; I mean, I don't
    know how you put a dollar figure on that. So I think we have to be very
    careful because what we really need is these community comprehensive
    health facilities for young people all across America. And as you point
    out, they are very cost-effective, but you've still got to be able to
    show up every morning and turn the lights on.
        Ms. Zeigler. And they're people-effective, and I think they make a
    difference.
        Dr. Johnston. I think we've been lucky that we have a community that
    is supporting us and involved in efforts. And those in the community--
    you say that is cost-effective, but is also expensive when you're
    dealing with kids that have more problems that we see than you would
    normally see. You really need to put your resources together to meet
    those problems. It pays off, but you're going to have a hard time always
    convincing people that are pulling out their checkbook that that's the
    case.
        The President. You guys want to say anything about the center?

    [A participant who recently moved to Charlotte explained how supportive
    the center was and how comfortable he felt talking to Dr. Johnston.
    Another participant explained how a sliding scale payment plan helped
    him pay his medical bills and still attend college.]

        The President. I'm glad you like to talk to him, even if he doesn't
    say what you agree with. Guys like us, you know, when we get old with
    gray hair we're supposed to say things you don't agree with. That's our
    job. [Laughter]
        But this is very encouraging. Last year when we tried to get health
    insurance for everybody and we didn't succeed--that's the system every
    other country has. If we're not going to have that system, then the only
    way we can do right by the children of this country is literally to make
    a facility like this available to every child in America. There is no
    other alternative. You either have to have everybody having a health
    insurance policy or you have to have a community comprehensive health
    facility like this where Medicaid covers the poor kids, kids with low
    enough incomes, and everybody else is on some kind of sliding scale but
    nobody gets turned away. Those are the only two ways known to humankind
    to serve all the young people. And every young person needs to be able
    to get health care.
        What about you, Anthony?

    [Anthony Lattimore described how counselors helped him confront family
    problems and encouraged him to make responsible decisions.]

        The President. That's really important. You know one of the biggest
    problems we have all over America with young people today is trying to
    make sure that all of our young people stop and think before they make
    decisions or say or do things that they'll later regret. I mean it's a
    general problem. And it's a bigger problem today than ever before, not
    only because a lot of young people have difficulties at home but also
    because we live in a world where things happen so fast. This whole--
    young people like you, many of you exposed to television where you see
    whole life stories in a 30-minute program or you see all these--there
    are a lot of things that have happened that have changed the way we
    think. And I think every young person needs somebody, to talk to
    somebody that basically gives you permission and gives you the ability
    and the strength to stop, look, and

    [[Page 1231]]

    listen before you make a decision that you may regret.
        Q. I mainly come here to talk to the counselor because I have a lot
    of friends who are--[inaudible]--and I come here to talk to the
    counselor, Melissa. And I tell her my problems because I sometimes can't
    tell them to my mom. But I tell her mostly about things going on in my
    life, and she listens. She can tell me what I should do and what she
    thinks I'm going to do.
        The President. Let me ask you something. Do you think most young
    people who come here feel more comfortable, for example, talking to the
    counselors here than they would at the school they attend?
        Q. Yes.
        The President. And why do you think that is?
        Q. Because at school they can--I wouldn't talk to the school
    counselor because they're friends with the staff and--well, over here I
    can really--I trust them over here.
        The President. So if something was bothering you that had to do with
    school, you think if you shared it with a counselor they might violate
    your confidence and make it hard for you to feel like you were making
    any progress.

    [Participants explained that information shared with employees of the
    center was kept completely confidential and parents were not informed
    without the patient's consent.]

        The President. They really treat you--you have a lot of
    responsibility and a lot of say-so.

    [A participant explained that Teen Health Connection counselors were
    more accessible than the counselors at her school.]

        The President. Robert.

    [Robert Goulding described how center employees helped him improve in
    school and find a job. Dr. Johnson, Teen Health Connection medical
    director, then explained the center's confidentiality policy.]

        The President. Do you want to tell me anything?

    [A participant explained how center employees encouraged him to do well
    in school.]

        The President. How often do you come? Are you scheduled to come on a
    regular basis, or do you kind of come when you feel the need to?
        Q. I usually come--[inaudible]--my physical's every year. Once a
    year for physicals.
        The President. And if you feel you need to come but you don't have a
    scheduled appointment, do you call in advance and tell them you want to
    come or do you just show up?
        Q. Yes, you call and make an appointment with the doctor.

    [Ms. Zeigler explained the importance of encouraging patients to be
    responsible and treating them with respect.]

        The President. When you have a council, a teen council in place,
    what do they do?

    [Ms. Zeigler discussed the many suggestions that the teen advisory board
    made to improve the center and urged parents to listen to their
    children's ideas.]

        The President. I've never learned anything when I was talking. Or
    rarely. Once in a while I get a new idea when I'm talking. It's usually
    when I'm listening, I'm learning.

    [A participant explained that Medicaid allowed her to continue receiving
    medical care.]

        The President. Let me ask you something. What are your other funding
    sources besides Medicare and the payments people make on a sliding
    scale?

    [Ms. Zeigler explained that the center obtained about 62 percent of its
    funding through grants and fundraising.]

        The President. And 38 percent in either Medicaid or copay?
        Q. Right. It's a hard show to pull off, but as you can--
    [inaudible]--and I think unless anybody else has----
        The President. It's so cost-effective. You know, it's a funny thing
    to say--you can't put a dollar value to it. You can put a dollar value
    to how much more it would cost if Prince had to go to the emergency room
    to deal with diabetes, but you can't put a dollar value to what all the
    things you really tell me you care about there, the way people make you
    feel that you can talk to somebody. But I know this, that a whole lot
    more of you will have successful lives as a result of this clinic.
        And the rest of us, you know, if you don't make it, it's not good
    for us either. That's the

    [[Page 1232]]

    point you were making. And we pay a terrible price for that. This has
    been very encouraging, and I thank you for taking time to talk to me.
        Thank you, Barbara. Thank you, Doctor.
        Ms. Zeigler. Mr. President, staff, and everyone who has made this
    possible, we have just been thrilled to have you here.
        The President. I'll be talking about this place all over the
    country. You may have to put on a show for some other people. [Laughter]
    I may run some other people down here.
        Q. I know that you have a teenage daughter, right? I just wondered
    if you could help the foster care--[inaudible]--and we do need help
    because everyone's real short on cash, everyone is, when it comes to----
        The President. What you said to me is important. I'm going to go
    back and look at this proposed budget and see how it deals with all the
    foster care issues because it is real important to me, not only because
    I have a teenage daughter whom I stayed up past midnight talking with
    last night about all the things that were on her mind but also because
    we really need to make this foster care system in our country work
    better. And as you know, most kids on foster care don't even have--a lot
    of them at least don't have the option of even maintaining contact with
    a parent, don't even know who their parents are.
        There are a lot of real problems with the way the foster care system
    works in this country. So, you made an impression. I'll go back and----
        Q. I'm a foster child myself, and I know how she feels.
    [Inaudible]--I'm in the program now 6\1/2\ years, and you know, I know
    what it is being a foster child. I know who my mother is. I know who my
    father is.
        The President. Did you ever want to be put up for adoption?
        Q. At one time I thought about it. Then I realized well--
    [inaudible]--sometimes I thought about it. I wondered how my mom would--
    [inaudible]--she was the one--I've always forgiven my mama what she did.
    I mean, but there are some children in foster care now who, you know,
    ``I'm not going to forgive my mama this because she left me out.'' It
    doesn't matter. She took you in her womb for 9\1/2\ months.
    [Inaudible]--I have never gone from the past. Yes, sure I was--I got in
    foster care when I was about 12 years old.
        The President. You're 18 now?
        Q. I'm 19 now. I think it was 12. I'm 19 now. I start college
    September 5th. I'm going to--scot-free. I don't have to pay for one
    book. And it was because I've had a lot of backup. Especially my father,
    you know. Rick Massey, he's my foster father. But he is, you know--
    diabetes. He's stuck up for me. He's helped me through a lot. And some
    of these, you know, now in foster care, they think that the foster
    parent don't care about them, but, you know----
        The President. A lot of them do.
        Q. Yeah, a lot of them do. If that child would sit down with their
    foster parents and see all the things that they have to go through--they
    don't realize, you know, he or she is trying to help them. And I've
    received a lot of help, especially in my medical condition.
        The President. Kimberly, what do you think I need to worry most
    about in terms of health of foster kids?

    [Kimberly Taylor voiced her concern about cuts in funding since many
    foster children were dependent on that funding for adequate medical
    care.]

        The President. If the foster parents are going to take the
    responsibility to try to do a good job, then at least the rest of us can
    take the responsibility for health care. That's what you're saying,
    right?
        Ms. Zeigler. That's really----
        The President. I like it.
        Q. [Inaudible]--wrap this up.
        The President. I'm having a great time. Whenever I start to have a
    good time, I'm always supposed to go somewhere.
        Ms. Zeigler. We thank you.
        Q. Thank you, sir.
        Ms. Zeigler. This has been a wonderful opportunity to showcase teen
    health care.
        The President. You guys are great. I feel better about my country.
        Ms. Zeigler. As we grow old, we're going to have good people, young
    people taking care of us. And thank you again for giving us this
    opportunity to showcase Teen Health Connection and to listen to some of
    our most important citizens.
        The President. Thank you.

    Note: The President spoke at 2:20 p.m. at the Teen Health Connection. In
    his remarks, he referred to patient Prince Wright.