Kac Para Yarismasi

Arthritis Diet and Exercises

Health Care Stakeholder Discussion: Rural Communities

(cross talk) Nancy-Ann DeParle:
I think we should go ahead and get started. I want to welcome everybody to
the White House discussion on rural health care issues. I’m Nancy-Ann DeParle, and I’m
Counsel to the President and Director of the White House
Office of Health Reform. And to my right here is my
colleague, Dr. Mary Wakefield, who is the Director of the
Health Research — I guess Administrator, Mary,
is that the title? Mary Wakefield:
That’s correct. Nancy-Ann DeParle:
— of the Health Resources and Services Administration. I’m going to let her
talk in just a second. We’re also going to be joined by
Tina Tchen, who is the head of the Office of
Public Liaison here. And Congressman Mike Ross, who
is a congressman from Arkansas. And he is en route. But as you’ve seen from our
traffic situation here, that could mean anything from
2 minutes to 20 minutes. So we’re going to go ahead and
get started, because I know everybody has a
tight schedule today. We are — we wanted to make sure
that we were focusing on some of the issues that farmers,
ranchers and fishermen and other people who work in rural America
are facing with respect to our health care system. And that’s the reason
for our discussion today. We know that throughout rural
America, there are nearly 50 million people who face
challenges in accessing health care. Not only do they experience
higher rates of poverty, but they report more health
problems, are more likely to be uninsured and have less access
to primary health care providers than do Americans
living in urban areas. And with the recent economic
downturn, we know there’s additional potential for an
increase in many of these health care disparities and concerns
that are already elevated in rural communities. President Obama is committed to
enacting health reform this year that will help rural communities
who are struggling as the cost of health care
continues to skyrocket. And today in conjunction with
our meeting, we’re issuing a report that I think each of you
has a copy of at your place there called “Access, Hard Times
in the Heartland, Health Care in Rural America,” which we hope will provide access into the current state of health care in
rural areas and the critical need for health care reform. And some of the facts in the
report are pretty staggering. They’re things that
you know firsthand. But it includes things like a
multistate survey of farm and ranch operators found that while
90 percent of farmers have insurance coverage, one-third
purchased it directly through an insurance agent, which is
compared to the national average of 8 percent. They’re less likely to have
private employer sponsored health care benefits, of course. And nearly one in five of the
uninsured, 8.5 million people, live in rural areas. The costs of health care hits
farmers particularly hard. And I imagine I’ll hear about
that from some of you today. Again, in the multistate survey
that we feature here in this report, one in five insured
farmers had medical debt. One in five. And in one state, farmers who
purchased an individual health plan spent an average of $2,117
more than their colleagues who were able to purchase
through a group plan. So we just know that these
health care — I’m seeing a lot of nodding heads — that these
health care access issues and the costs of health care that
are staggering around our country hit even
harder in rural areas. A Speaker:
We’re really a success story, I think. The downfall is, I have two
friends that serve on the hospital board, and I had called
them after I was called to come to this meeting, and I called
them and they said the biggest problem we have is we get hard
of help at the wages that the Medicare reimburses at.>>Nancy-Ann DeParle:
Help, meaning nurses and other — A Speaker:
Yeah, the doctors are there but the nurses and right now they’re looking for a
hospital administrator and we just can’t keep up with the
wages that everybody is hiring away from us for. And you know, we’re doing —
they’re doing a wonderful job, it’s all coming back to us
farmers on the property taxes to support our hospital. And [inaudible] on the school
board [inaudible] coming back to the property tax. And, you know, you can only come to that well so many times and we’re tapped that way. My daughter I have had health
insurance the whole time. We, like I say, I started with
nothing and I still have most of it. [laughter] Nancy-Ann DeParle:
So you purchased your own insurance? A Speaker:
We purchase our own health insurance. But we make it a priority
to purchase our own health insurance, you know. Our oldest daughter, the bill
was, the computer printout came out $800,000 or more,
and we [inaudible]. But our premiums just before we
left this week, you know, it’s hard, but it’s not bad. We are in a self-employed group
of Blue Cross Blue Shield of Kansas, we were $500 last year,
we just got the numbers, we’ll be 566 a month this year. Well, that’s over 12, you know,
10, 12, 11 percent increase. I don’t know. It’s hard for the
insurance part of it. But, and I do know some of my
friends and colleagues have — that don’t have insurance. And some of them
can’t afford it. Some of them choose
to not afford it. I, you know, I think that we
have a success story in our community as far as health care. But we have to do something
about the costs and the reimbursement of health care. You know, I can’t document this,
I was told the story over the tailgate of a pickup. A man whose wife was in the
hospital last six months of her life, had a blood clot, she had
132 doctors come to see her. And he felt like he — they were
just saying, well, go get your 150 bucks today, Medicare will
pay for it, do your consulting. And that’s why we can’t do that. When you only have four doctors
in the hospital, we can’t abuse the system to try
to pad our pockets. And rural people
won’t do that anyway. We’re integrity, we’re going to
do what we — we’re going to get what we pay for and we’re not
going to cheat the system. So I’m feeling like the main —
some of the problems that we have isn’t with the rural
America as much in the cost of doctors, their insurance
they have to have. And, you know, as far as one of
the things that came to my mind when you were talking about
mobile units, we have mobile specialty units come out of a,
you know, my mother had a bone scan a week ago and they have a
mobile unit come out to do that from an hour and a half
away to our hospital. And it must be the doctors try
to do the recruiting themselves, because we have lots of
[inaudible] that come to train there to do some interns there. It was a lot tougher to pay our
health insurance when we were younger, just starting out,
just starting with kids. But God has blessed us
and we’re doing well. Now we’re able to keep
up with our premiums. But I’m concerned about the
expenses more than I am in my particular situation of access. I feel like, like I said, we are
60 miles away from a fairly good hospital. Our local hospital
is 20 miles away. Our kids go to
school 30 miles away. I mean, if they have a problem,
heart attack, what have you, have to rush somebody to
Wichita, we have Flight For Life. We just paid for a
helicopter pad there. Our county just keeps up. We’re trying to stay cutting
edge so we don’t have this that we can’t recruit doctors. That’s our story. Nancy-Ann DeParle:
Sounds like you’ve been able to stave off the recruitment problems
that some other areas have had. A Speaker:
But it’s been an
investment in the community. Nancy-Ann DeParle:
Yeah. A Speaker:
By the county. Nancy-Ann DeParle:
Sounds like it is. Wayne, I want to
get you in here. You’re from Maine;
is that correct? A Speaker:
That’s right. I’m a recovering pediatrician. [laughter] I got into medicine
the same time the government got into Medicare and
I’m not [inaudible]. We farm 150 rocky old acres in
Maine, and have a diversified family farm, some hay, some
organic fruits and vegetables on a you-pick operation. I’m on Medicare. My wife’s insured. But the word’s gotten around the
neighborhood that although I no longer see patients, people come
over to talk about their health issues. [Laughter] I have an 80-year-old
neighbor who has never, man or boy, seen a doctor as a patient. He knows a lot
about health care. He lost his wife to
diabetes after all the catastrophes that happened. But sort of makes the point that
we need doctors that patients can be sure work for
them [inaudible]. They like to tell you about the
young couple down the road that, they’re struggling mightily
to get an organic fruit and vegetable operation going. The kids are on Medicaid. They’re on Dirigo, which is
a state subsidized insurance product that knocks their annual
payment from $2,500 deductible down to 6,000 a year
from 12,000 a year. But without that supplement,
they would be paying that 12,000 a year. Now, for them and for most real
people, cost is the bottom line. And it just offends me. You know, even clear out
in rural Maine, we get the electronic edition of
the New York Times. Remember the commercials were
saying, the government’s got to stay out of offering competing
policy because they can undercut us 15, 18 percent. You know, they can’t offer a
competing insurance policy. Nancy-Ann DeParle:
This is the public plan idea? A Speaker:
That’s the public plan. Well, for my neighbors, that is
2 or $3,000 a year out of their pocket to subsidize the
commercial carrier. Do you follow what I’m saying? The organization that you
ran, Nancy, in the Clinton administration can offer — Nancy-Ann DeParle:
The Medicare program, yeah. A Speaker:
The Medicare type
program can offer an excellent product for 2 or $3,000 a year
less expensively than the commercials can. Nancy-Ann DeParle:
Well, this relates to the administrative costs.>>A Speaker:
Yes. So to offer that commercial
plan, we’re talking about wealth transfer from struggling, poor,
rural families to investor owned companies. And that’s the kind of wealth
transfer that we don’t really need right now. So the challenge is if the
commercials want to offer that product, they ought to show that
they can offer a product that’s economically as the
government product. We’re always talking about the
inefficiency of the federal government. I guess I’d finish with the
product that even rural America worries about the outlier costs. You know, the federal — the
health care costs are eating us alive. It dwarfs the Social
Security issue. And we’ve got to think terribly
carefully about how we organize to manage long-term
health care costs. We don’t have time to
really get into that. But that’s a terribly
complicated long-term question. One last parting shot. In my rather too long career,
the number of docs in this country has gone from
160,000 up to 860,000. And we’re talking about
a doctor shortage. Somebody’s writing in the New
York Times can we do health care reform with our doctor shortage. Well, it’s not a
doctor shortage. It’s a maldistribution. A Speaker:
We’ve accomplished that by taking away resources or consolidating resources from the
two smallest communities that are in the county, thus making
it more difficult for those individuals to
access health care. You know, we’ve had a lot of
discussion about the issues that are out there and I
won’t reiterate those. One solution that we tried, our
state association has tried, and are still trying to do, are
group health plans, the pooling that Rob had mentioned. Now, the only problem with that
is that farmers and ranchers tend to be older and so that
pool is slightly less healthy, probably, than the just
composition of the American population. So you start getting adverse
selection for those young farmers and ranchers who are
capable of going to the private market. And so the pooling of the group
health plan thing has worked but I can’t say it’s worked as
well as probably it ought to. This report, I didn’t get a
chance to look at it in its entirety, with reference to
access project, and I’ve looked at some of that before
I came over here. Just two points, and this gets
to the real economic heart of the matter for
farmers and ranchers. The farmers and ranchers who
reported financial problems spent almost one-half of their
income on insurance premiums and out-of-pocket health costs. And a quarter of the respondents
reported that health care expenses contributed to their
overall financial problems and falls into the postpone and
delay of needed investments on the farm. Nancy-Ann DeParle:
So it’s just like small businesses, just like large businesses, really.>>A Speaker:
That’s what farms and ranching is is small business. You know, USDA makes a lot of,
you know, reference to the amount of nonfarm income now
that’s supporting farmers. I would be curious as to how
much of that nonfarm income is derived because the economic
decision by that family is to get group health coverage as
opposed to whatever dollars they maybe could contain, you know,
from the extra –>>Nancy-Ann DeParle:
I mean, nonfarm income
is just a way of saying people go off the farm to get a job in
order to get health insurance. A Speaker:
I hear that over and over again. Nancy-Ann DeParle:
You said that, too, Jody. A Speaker:
So it’s a huge
issue and we look forward to help assisting and
finding solutions. Nancy-Ann DeParle:
And we need farmers producing good food right now. A Speaker:
Absolutely. Nancy-Ann DeParle:
Healthy food. Dr. Knudson, you said you
had a comment on this? A Speaker:
Yes. I am Dr. Alana Knudson from the
National Opinion Research Center here at the
University of Chicago. It’s actually based in Bethesda. However, when this survey was
conducted, I was part of the University of North Dakota’s
Center for Rural Health and we did this survey in partnership
with the [inaudible] project. And one of the things that we
found to your point, 38 percent of the respondents said
that they worked off farms specifically, if you look
over all at their income. And a number of their spouses
also then worked off farm. And I think one of the things
that I was struck about, because I grew up on a farm in North
Dakota, was that people are making more and more decisions
based on their access to health insurance. And one of the things that was
really clear, as you mentioned, farmers and ranchers
on average are older. And I know speaking with our
friends from Montana, their sons are not going to be able to
take over the ranching business because of the concern about
the financial viability and the challenges that they see ahead
being able to maintain a farm operation or ranch operation and
also maintain health insurance. But I think one of the things
that sometimes also gets lost in this discussion is that not only
do these farm and ranch families have challenges getting health
insurance, if they decide to stay within their farm and
purchase in the individual market, any person in that
family who has a chronic disease or any kind of preexisting
condition will ratchet up their health insurance premiums. And one of the things that many
of the respondents in this survey identified doing was
taking advantage of the high risk pools that are available in
a number of states to be able to peel off that person, if you
will, with the chronic health problems. But, you know, again, it
makes it very difficult. Because one farm family said
they had one child on one health insurance product, a mother on
another, and the remainder of the family on yet another. And we know how complicated
health insurance is to begin with. And when you have a family that
is that fragmented when they’re accessing health care, it makes
it really, really difficult. But I do think there’s some real
good innovation in looking at, for example, what you folks have
done with the fishermen and there probably are some neat
lessons to be learned there. Nancy-Ann DeParle:
Agreed. Lisa, do you have any comments
from the family farmers coalition? A Speaker:
Well, thank you
for letting us come today. Some of our member groups are
here and I think they’ve spoken really well to the problems. I know in particular one of our
Wisconsin dairy farmers works 24/7 basically, as dairy farmers
do, his wife works, I believe, full time at Wal-Mart for them
to have health insurance for them and their
two-year-old daughter. And still they go without
the preventive care. And I think, as Cybil said, you
know, the farmers are trying to raise healthy food, we’re
hearing more and more of what a concern that is,
and a need here. But our farmers need to be
protected and people who work in rural communities need to be
protected so they can afford to bring us that good food as well. Nancy-Ann DeParle:
Yeah, that was ironic when you pointed out that the challenge of people who
were trying to produce healthy foods staying
healthy themselves. It really was. I want to make sure, Neil. I’m sorry, John. John Bailey:
I’m John Bailey. I’m the Director of Research and
Analysis at the Center for Rural Affairs in Lyons, Nebraska,
population 962, and it’s a no-stoplight town. [Laughter] [Inaudible]
[Laughter] Nancy-Ann DeParle: We’re going to be hearing in, you know, this is being live-streamed, so I think we’re
going to be hearing in from others who want to weigh
in on this contest with the Congressman here. [Laughter]>>John Bailey:
We’realso releasing
a report this morning, and I’d like
you to have a copy. It’s entitled “The Causes and
Consequences of Rural Uninsured and Underinsured.” And it raises up an issue that I
think several of us have alluded to this morning. And that is the connection
between affordable and meaningful health care
coverage and entrepreneurship. And as you heard from several
people here today, they’re all entrepreneurs. And the rural economy is based
so much on entrepreneurship, whether it be farming, ranching,
fishing, or small business. And your report points out
the figures on small business coverage in rural America, the
farm and ranch coverage in rural America. So how do we provide affordable
and meaningful coverage for our rural entrepreneurs which are
such a big part of our rural economy. If we don’t solve the health
care issues of small businesses and farmers and ranchers and
fishermen in rural areas, we won’t have an entrepreneurial
economy, and that means we won’t have much of an economy
in rural America. Congress has done much to
promote initiatives to promote entrepreneurship
in rural America. The president is very
supportive of those. And this is another part of
entrepreneurship, how do we allow people to follow their
dreams, as Ted talked about right from the start. These are people who have done
everything we’ve asked them to. They have an idea, they’ve saved
money, they started a business, but they can’t afford health
insurance for themselves, their families and usually for
any employees they have. And it puts their business at
risk, puts their farm at risk. So we really need to resolve
this problem if we’re going to have any kind of economy
in rural America. One other issue I want to point
out, and Lisa just talked about, is the issue of prevention. How do we have prevention
services, how do we live healthier lives
in rural America. We have higher rates of obesity,
higher rates of almost every chronic condition and disease,
most of which are preventable, in rural America. So how do we do that? Of course, the food
issue is so important. And more resources that allow
for preventative activities, both providers and community
resources that allow for that.>>Nancy-Ann DeParle:
Thanks. A Speaker:
Thank you for having me. Nancy-Ann DeParle:
Thank you for being here and thanks for the report. Charles, you wanted
to say something? A Speaker:
Two or three quick comments. First of all, we’re honored to
be here and this is tremendous community expertise
is in this room. I’d like to thank the President. I think he realizes the
interdependence of urban and rural systems. But I want to follow on
John’s point and chat about
what Terry said. We talk a lot about
rural entrepreneurship. The largest predictor of
uninsurance in nonadjacent counties is do you work
for small business. So I’m going to
make three points. Granularity is key. Systems approaches
are essential. And we have to think about
how we frame new opportunities with intermediaries. There is no rural America. Everyone here will say once
you’ve seen one rural community, well, you’ve seen
one rural community. And that’s very critical to
how you think about this. Because the micropolitan areas
in the adjacent counties are going to do quite well. But in our frontier and remote
counties and in our high poverty counties you’re going to
need very different systems. Bob made an important point
that’s very key to think about. 90 percent of farm income
right now comes off the farm. Two-thirds of farm families,
one of them works off. But the reality is, in rural
economies, 5 percent or more work in their own business. But they make $17,000 a year,
and in urban areas it’s 35. So right away, how we deal with
that is very, very huge in terms of the return for
farm family income. Two points. I think we have a wonderful
opportunity to think about the critical access hospitals
and the flex program. That was an innovation in
public-private link that built a geography around it. Going to our fishermen. Building a community
understanding around a healthy community framework, which this
wonderful office of rural health policy, and we’re still honored
Dr. Wakefield is here, because you have a rural thinker. The reality is in our remote
rural areas, if we were thinking about the fact that human
services must link to health services, and if we were
thinking about remote campuses in which initiatives that link
healthy food systems
from farmers to Medicaid and Medicare, where
seniors aging in place could link to health care for workers
and we were building new demonstrations that said here’s
a campus in a remote community. We’re going to fulfill these
functions much like the fishermen did. There’s a very unique
opportunity here. I would also say USDA could
be a huge partner in this. We have two leaders with very
wise rural understandings in those two departments that have
been governors and I would urge us to think about new
collaborations in regional campuses for these services. Nancy-Ann DeParle:
That’s a great idea. And Governor Vilsack from, you
know, day one has been very interested in working on this. As you said, with Secretary
Vilsack and Secretary Sebelius, that’s a great idea. I wanted to just recognize Neil
and then I’m going to let the Congressman defend
his stoplight. [Laughter] Oh, yeah, I’m sorry,
Roger, I didn’t call on you either but Neil, go ahead. A Speaker:
Okay. I really appreciate the
opportunity to be here. I think the Congressman
identified the struggle, you know, trying to figure out how
you’re going to contain costs. And I want to say first that I
think it’s really important now, more than ever, to be really
clear about what that means and identifying the costs of
delivery as being the challenge as opposed to the sort of
expense of the individual. Because the seniors and the
growing senior population are rightfully scared now and what
they have for, to show for their life’s work now is Medicare and
Social Security because the retirement is gone and so on. And I think it’s so important to
keep that in mind because it’s easy to say, oh, you know, we’re
going to have a problem, we’re going to have to cut it
somewhere, where are we going to cut it. And I want to come back. I’m not a health care expert,
but I think bringing the systems points home is really important. And I think about
a couple things. One is like when I grew up,
we had school lunches, right. The women worked, they cooked
out of the USDA’s flour and, you know, lots of beets got
dumped and one kid ate them. [laughter] And as those systems
change and as the industries that make prepared foods came
in, you know, I got dialysis clinics at 36 Allendale in
South Minneapolis where I work. I’ve got dialysis clinics coming
to Hayward, Wisconsin, where I recreate with my
wife occasionally. Dialysis clinics
in rural Wisconsin. There was a cancer chemo clinic
in Fond Du Lac, Wisconsin, in Foxvale, where my mom finished
her career and ultimately died of cancer. But why? Because of the stuff
that’s going on around. Having to have those
kinds of delivery systems. But the dialysis stuff bugs me
the most because it’s like a reflection of
diabetes and obesity. And the economic opportunities
that come from, and just the kind of improvement in your
quality of life that come from either growing your own little
garden or getting it at the farmers market in the summertime
or beginning to produce for the marketplace, the connections
to USDA, the opportunities for economic development that come
from producing local foods, this is not just about having a
robust and a diverse system of food production, it’s about
bringing the schools and the education system back in here. We’ve got free and
reduced lunches. Why don’t we make them something
that’s useful that provides economic benefit. I mean, the thing that the
President has done so well is connecting the dots, and there’s
a lot of dots to connect here. But we’re going to save money is
to get us down on diabetes, down on health — on heart disease,
and, you know, up on nutrition. And, you know, we don’t have
to debate about junk food, but there is no debate about it’s
good to eat fresh foods and there’s economic opportunity,
and I hope we can find ways to continue raising that and
putting it out front here. And I’ll say one last thing. One interesting thing we just
discovered is that Latino immigrants, which we’ve done
a fair amount of work with in communities, so they struggle
with jobs, they struggle with status, they struggle with
access to health care. It turns out that a lot of them,
especially those from Mexico, come from farming backgrounds. And lo and behold when you open
up a community garden or you have some opportunity that
connects to them not in the dominant sort of, here’s
[inaudible] way, they come in droves because they
want to grow vegetables. They bring their kids, the
kids keep out of trouble. Some of them actually
want to farm. So we’ve actually now started to
do some work developing small scale free-range chicken
cooperative production systems that you can actually
make a living. The capital costs aren’t that
much, the local community loves it, and you’ve taken families
that are out of, you know, it’s not like a systems
thing you have. But you take a family that
struggles and you give them the opportunity as
entrepreneurs to move up. And now, this is one small
example, but there’s, I think, a lot of others out there that are
possible if only we encourage it and don’t discourage the
opportunities around it. So thank you so much.>>Nancy-Ann DeParle:
That’s great. And I appreciate your
highlighting prevention and wellness, which is, as you say,
a big part of President Obama’s message. Roger, you’re going to have the
last word, then I’m going to let the Congressman wrap this up. A Speaker:
All right. Thank you very much
for doing this. Our national convention was held
about a month and a half ago. Nancy-Ann DeParle:
This is a farmers union? A Speaker:
National Farmers
Union national convention. And at that, we routinely adopt
a special order of business or several special
orders of business. This year, we did that again. And one of those special orders
of business was dealing with rural health care. This is a huge
issue for farmers. Has been for all of my life. I grew up on a family farm. I lived it personally. I know, as a lot of folks have
said, that it is the principal reason a lot of farm spouses
go look for work is to get the insurance coverage. But the — and all of the things
I was going to say have largely been said except for one, and
that is that we have to make sure that we don’t forget that
health care is about people. On the way over here sitting
in the cab going nowhere — [laughter] — I got an e-mail
from one of our members who heard that I was
coming to this meeting. And he had a long, long story
about what had happened in their family. And he is actually a grandpa,
but he was talking about his son and daughter and the fact that
they had his — one of his children had gotten married and
had a baby, and that first baby that they had, of course the
pregnancy wasn’t covered in the health care policy
that they had. And eight years later, they
are still paying for the costs associated with having that kid. They’re still paying, because a
lot of you said about out in the country, we’re going to make
sure we take care of our bills. Well, you know, if you end up
with several hundred thousand dollars of cost as a young
couple just starting out on the farm, to have a baby, and, you
know, every dollar is worth a whole lot, eight years later
you’re still paying for that first baby, there’s something
wrong with the system that imposes that sort of a burden
on young folks for the rest of their lives, as it may well be. So the need here
is very evident. There have been a
lot of suggestions. But there’s no question, the
problem really does need to be addressed and needs
to be addressed now. So thank you very much for
pulling this forum together.>>Nancy-Ann DeParle:
Thank you, and thanks for bringing it home, because you’re right, we do
need to keep that in mind. Congressman.>>A Speaker:
Thanks. I would like to thank Nancy-Ann
and Mary and all involved in putting this together and I want
to commend you two on bringing people in from outside of
Washington and listening to them. Because I think this is so
critical as we try to begin this health care reform thing. There’s a lot of
misinformation out there. No one knows exactly what it’s
going to look like because it hasn’t been written yet. I’m fortunate to be on one of
two committees that will do most of the writing, Energy and
Commerce, and I’m on the health subcommittee, there’s 51 of us
that are conservative Democrats and I’m probably [inaudible]
chair their task force. We’re going to be very involved
in this whole process, as well. But, you know, I can’t emphasize
enough that this is about containing the cost, it’s about
making health care affordable and accessible. It’s about forcing the private
sector to do the right thing. Because we’ve heard so many
stories about the many things we have with the system
the way it currently is. This is not about socialized
or nationalized health care. It may very well be a public
plan option that will compete with private plans to get the
private plans to start doing right. That’s one of the things
that we’re going to have to contemplate and consider. But, you know, the reality is
half the folks already have national health care. It’s called Medicare and
Medicaid and [inaudible]. And some of you in this room are
fortunate enough to participate in those plans. But, again, it’s about, you
know, if people are concerned about the debt, you know, from
1789 through 2001, this nation was 5 trillion in debt, in the
following eight years we doubled it. And if you’re concerned about
the debt, there’s no way to ever have a balanced budget again
until we get health care costs under control and
contained in this country. So those are some of the things
that we’ve got to deal with and why we’ve got to deal with them. All this is helpful to me. I can assure you that, and I’m
not impressed with how many people out-stoplighted me. [laughter] Nancy-Ann DeParle:
That won’t happen again. I can tell you that. A Speaker:
But I can tell you that I’m going to make sure that, you know, [inaudible]
health care summit, every discussion I’ve had with the
President has been rural health care, rural health
care, rural health care. I promise you that I’m going to
keep rural health care at the forefront of this debate,
because it’s wonderful if we can make health insurance
affordable for everyone. But if health care is not
accessible for everyone, then we really haven’t accomplished
anything, at least for a lot of the folks in this country. So I couldn’t be playing this
role if it wasn’t for Nancy-Ann letting me, so I want
to thank her for that. But no, seriously, I want to
— this is helpful for me. I want to thank you for coming. And I hope that you’ll continue
to write us, e-mail us, keep us informed. As things develop, keep us
informed on how you think we can, you know, if there’s
something else you think we need to know, let us know. I mean, we are listening, which
is an important part of this process, that I think quite
frankly was missed in ’94. There weren’t enough people
listening is why we didn’t get it done. This time around, I’ve been
very impressed with how many listening sessions like this
there have been and that people are listening. So thank you for hosting this. Nancy-Ann DeParle:
Thank you, Congressman. Thank you for your leadership. And he and his staff are very
open and they’re listening. And every time I see him, and I
know every time the President sees him, he’s talking
about rural health care. And we started off saying that
this is about the 50 million rural Americans who have
difficulty getting access to health insurance. And I appreciate your being
willing to come and really speak on their behalf. We have a website, health reform
dot gov where I would encourage you to tell other people to
write us and tell us about their concerns and what they’re
experiencing out there, because we want to make sure we are
listening and that we can take the message to Capitol Hill
where the Congressman is going to be involved in helping to
write the next stage of this legislation. I also want to thank Dr.
Wakefield and her staff at [inaudible] for all the
great work they’re doing. They’re going to have an
important role in this going forward, as well. So thanks very much for coming
today and keep in touch with us, please.

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