    [Public Papers of the Presidents of the United States: George W. Bush (2004, Book I)]
    [May 25, 2004]
    [Pages 927-933]
    [From the U.S. Government Publishing Office www.gpo.gov]

    Remarks in a Discussion at Youngstown State University in Youngstown,
    Ohio
    May 25, 2004

        The President. Well, thank you, Ron.
    Thanks. Listen, thanks for coming. As you can see, I'm joined by some of
    your fellow citizens here to have a dialog 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 centers, 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. 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.
        George McKelvey is with us. Mr.
    Mayor, it's good to see you. Thank you for your service. See you
    tomorrow. Mr. Mayor and I first met on a train, didn't we, 4 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. The reason Toni is here, I think a community health center is
    opening up in Alliance.
        Mayor Toni E. Middleton. Yes, we
    opened up in December.
        The President. Good. 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 holds
    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. 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]
        And 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. We've got to make sure we remain the best place in the
    world to risk capital so people can

    [[Page 928]]

    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. 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
    decisionmaking, not Washington, DC. 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--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 brandname 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-business people 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 decisionmaking 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. 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

    [[Page 929]]

    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 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.
        These are practical ways to address the rising cost 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 decisionmaking 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 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've used 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, HSRA--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.

    [At this point, Elizabeth J. Duke made brief remarks.]

        The President. Yes, I appreciate--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--16 million people.
        They treat bicycle injuries? [Laughter] I was wearing my helmet, I
    want you to know. [Laughter]
        Ron, you're the CEO of the Ohio North
    East Health Systems, Inc. That's a long title for----
        Ronald Dwinnells. We call it ``ONE,''
    as in ``Number One.'' [Laughter]
        The President. ``Number One''? Okay. You're the health CEO of
    ``Number One,''

    [[Page 930]]

    then. So, like, what is your--how many of these centers do you run? How
    long have you been running centers? How often are they open?

    [Dr. Dwinnells made brief remarks.]

        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]
        Dr. 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--
    [inaudible]--I saw figures once where to care for a patient through
    community health centers, it was this ungodly small amount, a dollar-
    something per encounter. And it's amazing, because it's run close to----
        The President. As opposed 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 a problem early.

    [Dr. Dwinnells made further remarks.]

        The President. Right. One of the things I forgot to ask Betty about was the National Health Service Corps.

    [Dr. Duke made further remarks.]

        The President. I appreciate you doing that. In other words, what
    Betty does is not only see the
    construction and--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.
        Dr. Dwinnells. Mr. President, can I
    say----
        The President. Yes, absolutely.
        Dr. Dwinnells. I'm a National Health
    Service Corps alumni.
        The President. Are you? Good.
        Dr. Dwinnells. Yes, and I'm still here.
    [Laughter]
        The President. We've got somebody who works for you here.
    Compton. Compton, I'm glad you're here.
        Compton Girdharry. Thank you, Mr.
    President.
        The President. 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. Listen, everybody ought to have their day in court,
    but 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.

    [Dr. Girdharry made further remarks.]

        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

    [[Page 931]]

    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
    liability.
        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, appreciate you being here.
    Thanks for your compassion. I'm glad you're here.
        Cindy.
        Cynthia 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,
    appreciate it. Your grandmother was bragging
    on you. That's right. [Laughter]
        Cindy, thanks. Tell us your story.

    [Ms. Sacco made brief remarks.]

        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. And so do you have--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]

    [[Page 932]]

        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.
        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,
    already told one thanks. Tell the other one thanks. You don't look old
    enough. [Laughter]
        Ms. Sacco. Nor do I. [Laughter]
        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. Any of them here?
        Joyce 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. Welcome.

    [Ms. Phifer made brief remarks.]

        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. 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 commonsense approach to making
    sure that the health care system works. You see, it's a commonsense
    approach to making sure the system meets the needs without centralizing
    the decisionmaking process in Washington, DC. 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.
        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 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.

    Note: The President spoke at 1:40 p.m in Bliss Hall. In his remarks, he
    referred to Mayor George McKelvey of Youngstown, OH; and Mayor Toni E.
    Middleton of Alliance, OH.

    [[Page 933]]