Remarks in a Roundtable Discussion at the Teen Health Connection in Charlotte

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.]

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 situation 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 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 sayso.

[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 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.