
			 THE WHITE HOUSE

		  Office of the Press Secretary
		   (Charlotte, North Carolina)
_________________________________________________________________
For Immediate Release                               April 5, 1994

	     
		     REMARKS BY THE PRESIDENT
	       IN DISCUSSION ON HEALTH CARE REFORM
	WITH HOSPITAL ADMINISTRATORS AND MEDICAL PERSONNEL
	     
		    Montgomery County Hospital
		       Troy, North Carolina



11:04 A.M. EDT
	     
	     
	     THE PRESIDENT:  We just completed kind of a brief 
tour of the hospital and talked about -- I met some of the nurses 
and patients and people who work here.  We talked a little bit 
about the physician shortage in this county; a little about the 
problems with delivery of babies and the high rate of teen 
pregnancies, low birth weight babies, relatively low number of 
prenatal visits.  We talked about some of the reimbursement 
problems of Medicare and Medicaid and the problem that this 
hospital has at the emergency room as they take everybody whether 
they have insurance or not.  And I think that's a fair summary -- 
and I met the wonderful, dedicated people.  So why don't you lead 
off.
	     
	     Q    Thank you, sir.  I want to let Mr. Bernstein 
give us an overview of Montgomery County medicine and how it 
relates to the rural problems overall.
	     
	     THE PRESIDENT:  I think it would help for the press 
that are here, just the first time you speak if you would say 
your name and why you're here.
	     
	     Q    I'm Jim Bernstein, and I'm the director of the 
State Office of Rural Health.  We've been in business for 20 
years, working to try to get better health care in the rural 
areas -- Montgomery County is a really fine rural community and 
it's very typical of, I think, a lot of rural America.  Some are 
poor, some are wealthier and they look a little different, but 
they suffer from a lot of the same problems.  And you went 
through most of them.
	     
	     But we have -- and North Carolina has lots of 
community -- we are one of the three largest rural states in the 
country right now.  Half of our county -- there are still 
professional shortage areas.  Twenty years ago we took a little 
different approach to how to deal with rural health care.  We 
decided to sort of vet the local communities with whatever 
resources we can and let them run their own show; and what we've 
created is a community corporation.  And over time -- we've got 
about 90 different communities now.  Hopefully, the 91st has put 
together a leading citizens' group to sort of take charge.  And 
they own and operate the whole system, and the state provides a 
lot of technical assistance and some funding money.  They've put 
many millions into it over the years -- into getting it going; 
recruited about 1200 physicians for these communities.  
	     
	     I think that everybody welcomes and applauds you in 
what you're going to do for us in health reform, especially our 
rural communities.  They are, of course, very concerned about how 
things are going to affect them, and really believe that this 
universal approach is mandatory for them to be successful.  If 
you do a piece-meal approach of pulling people in, we're 
concerned that the wealthier, urban areas will suck up -- because 
the demand will rise there, but it will stay the same in the 
rural areas -- all the physicians, the nurse practitioners and 
everything will be bid out -- not only -- won't go there -- but 
they'll be bid out to go to the urban areas.  So we think it's 
imperative that we don't do universal coverage in a piece-meal 
way; that we do the whole thing so that everybody's entitled.  
Otherwise, we see another urban-rural discrepancy happening.  
It's happened in the past.
	     
	     We think our approach of building up infrastructure 
in the rural areas will mesh with the managed competition, 
because then there will be somebody to deal with plans out here 
that's got it together.  Otherwise, we're a little concerned they 
might just tick off their --  So, we're happy we've taken this 
20-year approach to dealing with our rural problems that way.
	     
	     THE PRESIDENT:  Thank you very much.  I also think 
-- I was reminded on the tour that North Carolina actually has a 
program to provide subsidies for the malpractice premiums of --
practitioners who deliver babies and do things that -- in rural 
areas that they normally wouldn't do in urban areas -- is that 
right?
	     
	     Q    Yes.  We have a lot of incentives in place in 
the state; one is that one.  Another one -- state hasn't done 
which is really good -- Arkansas might do it, I understand -- is 
that we pay our residents more money if they'll go into rural 
areas and give them higher salaries.  And then we do the usual 
things, like loan repayments, things like that.  And we have, 
also, a statewide area health education center program trying to 
bring continuing education to keep people current in Troy and 
places like that.
	     
	     THE PRESIDENT:  That's very important.  In this 
plan, I just wanted to mention this, because I think it's 
important.  As the Congress debates this whole health care issue, 
the things which get the largest amount of attention as they 
would expect, are how to provide universal coverage and whether 
you can maintain choice and quality with universal coverage.  
	     
	     And a lot of these big questions -- but what a lot 
of people don't know is that in rural America, even if you cover 
everybody, a lot of folks still don't have adequate access to 
health care, and there's a real doctor shortage out there.  And 
no matter what happens, I hope the Congress will leave in the 
provisions of our plan, which have -- one, would expand the 
national health service corps by 7,000 doctors over the next 
eight years; two, would give physicians who go into underserved 
rural areas a tax credit of $1,000 a month five years to six --
and, three, would allow a much bigger, faster write-off of 
equipment -- medical equipment that doctors might bring into 
rural areas.  So I think those three things will really help to 
reinforce what you're doing.
	     
	     Q    Mr. President, Dr. McRoberts is one of our 
three practicing family physicians in the county.  Our ratio of 
family practice physicians to population is almost one to 8,000.  
	     THE PRESIDENT:  One to 8,000 -- and what's the 
recommended ratio?
	     
	     Q    Well, to qualify as a health profession 
shortage area, it would have to be about one to 3,000 -- correct?
	     
	     Q       one to 2,000.
	     
	     THE PRESIDENT:  One to 2,000 is what you should 
have, right?
	     
	     Q    Yes.
	     
	     Q    What we should have.  And I have 8,000 active 
patients in my practice right now. 
	     

	     THE PRESIDENT:  Eight thousand?
	     
	     Q    I have over 8,000. 
	     
	     THE PRESIDENT:  When was the last time you slept?
	     
	     Q    Well, actually, I did sleep last night.  
Somebody else was on -- Dr. Heinz had that pleasure last night, 
so -- anyway, but it is difficult to just get call coverage here.  
The other two physicians are just as overtaxed as I am.  I 
average -- well, in flu season, which we've just finished, I 
averaged working 100 hours to 110 hours a week, and that was from 
January through March.  And then we're kind of taking a breather 
now, and things are a little bit easier, and I work about 80 
hours a week.  And that's direct patient care.  
	     
	     I don't ever go home feeling like I've finished my 
work.  There's always something that's not done.  It's either 
records that's not done or a couple of phone calls that I haven't 
returned, or a couple of H & Ps that I've gone and seen the 
patients, but I haven't done the paperwork yet, or whatever.  And 
you always feel like you're robbing Peter to pay Paul.  And 
that's probably the most unsatisfactory part of it, is that there 
are so many people there who need you to be someplace where 
you're not.  And, yet, whatever I'm doing always seems important 
to me at the time.  It's kind of an unhappy situation.
	     
	     But I love the area.  My heart is in rural medicine, 
and I think that the physicians who go to rural areas who stay 
there do so because, probably most of them are from rural areas 
to begin with, and they used to live in small towns.  But you 
sort of get bonded with your patients here.  I know I've got 
8,000 patients, but I know who they are.  They're not just the 
lady with severe rheumatoid arthritis, or the guy with congestive 
heart failure, or the baby that was born last week that we had to 
transfer out.  We know them by name, we know their faces, we know 
their mothers, we know their grandmothers.  
	     
	     I've been through the loss of a child with one young 
mother and now she wants me to deliver her next baby.  You can't 
leave.  I mean, it's like leaving your family.  So I think that 
that's a big part of why doctors stay in rural areas when they 
come here, is because of just personal commitments and --
	     
	     THE PRESIDENT:  What's the most important thing that 
could be done to make your life easier?  More doctors?
	     
	     Q    More doctors.  I mean, definitely.  We are at 
such a critical shortage of doctors right now, with only three 
family practitioners.  And our draw area, the population that we 
draw from is about 28,000 people.  
	     
	     THE PRESIDENT:  And what would be more likely than 
anything else to generate more doctors in this area?  What could 
be done by the --
	     
	     Q    I don't know.  That's the big question mark -- 
what will it take to get doctors to come here .  I think you have 
to look for things like loan forgiveness, certainly, or low 
repayment programs for the residents that are coming out.  
Because that way you can get fresh, young blood, you know, people 
that aren't tired yet.  
	     
	     THE PRESIDENT:  It doesn't take long to get that way 
--
	     Q  This sounds a little trite, because it's a big 
question.  But for 30 years we've awarded high-tech people and 
health professional people and basically didn't pay primary care 
people.  And I know money is not the single most important thing, 
but it is important.  And so, if the reform plan could move to 
reverse that, somehow the incentives would be not only loan 

repayment and stuff like that, but somebody who worked here could 
make as much money as somebody who worked -- even if it had to be 
paid more to get to that level than in Charlotte -- he would be 
in a better position.  Because our physicians get paid a whole 
lot less out here -- a whole lot less -- than they do in 
Charlotte.
	     
	     THE PRESIDENT:  Well I think, for one thing, if you 
start in medical school, under our plan, we would shift the 
allocation of internships and slots more toward primary care 
physicians, so you'll have more people in that business and they 
don't have to go where the market is.
	     
	     Secondly, I think, we know the national health 
service -- who just got cut way back.  So if you put another 
7,000 doctors out there, it will make a difference, because 
that's a way to pay your medical school.  And then the way the 
tax credit works is that it will, in effect, increase the income 
of every doctor and the other -- by $12,000 a year.  That's what 
$1,000-a-month tax credit is.  And even though -- even if people 
just come in here in five-year cycles, that's a significant 
amount -- that's a big commitment of your professional life; you 
can keep going that way.
	     
	     Q    Mr. President, one of the things that we have 
done in Montgomery County recently is formed a group of citizens 
to put together a not-for-profit corporation, which intent and 
mission is to try to recruit physicians into our area.  And what 
we're trying to do is create an environment where we can get six, 
eight family practice doctors.  I think a lot of us lose sight 
that family practice doctors is a specialty.  And to create this 
environment so Dr. McRoberts not on call seven nights a week, 
they don't have to work every weekend.  If we can get recruited 
six, seven doctors, they can rotate call --  They can go home and 
have quality family time, which is a real major concern that we 
have for our physicians -- and I know they have for themselves -- 
because working 100 hours a week, there aren't many hours left to 
spend with your family.
	     
	     Beth Howell who is our director of nursing, faces a 
lot of the same problems that we face on the physicians' side in 
recruiting nurses into our area.  Hospitals are not run, nor will 
they operate, without well-educated, practiced nurses.  And I'll 
let Beth --
	     
	     Q    I'm Beth Howell, and I'm the director of 
nursing here at Montgomery Memorial.  My association with this 
hospital began many years ago in 1957, when I was actually born 
in this hospital.  And my mother was a nurse here for 41 years.  
I began my nursing career here as a new graduate.  I started out 
as a staff nurse, and have been involved in education for the 
staff; and am presently involved in nursing management.  And, as 
Mr. Scott alluded to, one of the primary issues that I deal with 
on a day-to-day basis is the recruitment and retention of the 
nursing staff.  It's very difficult to compete with the larger 
facilities who are able to offer more competitive salaries and 
benefits.  There's more opportunities for professional growth in 
those facilities.  And frequently, what I hear is that larger 
facilities are reluctant to hire new graduates.
	     
	     We hire new graduates.  We invest our time and our 
resources into training them.  And then, frequently, within six 
months to a year, suddenly the larger facilities want to hire 
these seasoned professionals, and so they leave our facility.  So 
we're continuously training.  
	     
	     In small hospitals, nurses have to be very 
versatile.  We have to cross-train so that they can float from 
one unit to another, and they have to have a variety of skills.  
Continuing education is very important so that they can maintain 
their competency level and their skills.  And about the closest 
resource for continuing education is 45 miles away.  These 

programs are often expensive, and it's also very difficult when 
you're already short-staffed to free them up so that they can go 
to these programs.  
	     
	     It's very important to my staff and to me personally 
to be able to provide quality patient care.  These people that we 
take care of day to day are the same people that we see in the 
grocery store; we sit beside of them in church and they're our 
friends.  They're our families, and we feel like we have a 
personal stake in their recovery.
	     
	     THE PRESIDENT:  How many more nurses do you need?  I 
mean, just for example.  
	     
	     Q    I would like to have five additional registered 
nurses.
	     
	     THE PRESIDENT:  And where are most of them trained?  
Most of the RNs you get here?
	     
	     Q    In the local community colleges.
	     
	     THE PRESIDENT:  And is there one -- where's the 
nearest one?
	     
	     Q    We have one -- we actually have two that are 
within 20 miles, and another one that's within 40 miles.
	     
	     THE PRESIDENT:  So that's not a real problem --
	     
	     Q    Right.
	     
	     Q    Retention is the problem.  The nursing staff 
turns over a lot, just like she was saying.
	     
	     THE PRESIDENT:  I'd be interested in your feedback 
on this.  The only thing that I know of that's in our bill that 
would help is there's also -- as I say, we felt that the quickest 
way we could deal with the income disparity -- I mean, we can't 
go in and sort of change the economics of every community in the 
country, but you could give a federal tax credit.  And a credit 
is not like a deduction, it's a dollar-for-dollar deal.  And so 
there's a $500-a-month tax credit for five years for nurses, too.  
And I think that will almost close most of the gaps.  I mean, 
that's $6,000 a year.  That's probably about what the gap is 
early on. 
	     
	     Q    Is that just for health profession shortage 
areas?
	     
	     THE PRESIDENT:  Yes.  For shortage areas.  But you 
could qualify.  
	     
	     Q    Thanks.  (Laughter.)
	     
	     THE PRESIDENT:  I mean, nobody can work 80 hours or 
100 hours a week forever.  You burn out.  You can't do it.
	     
	     Q    That's right.  (Laughter.)
	     
	     THE PRESIDENT:  That's what I tell all of the young 
people at the White House with their -- energy.  At some point, 
you stop working smart and you start working stupid.  When you 
work hard, you just can't -- there's a limit to how much anybody 
can do.  
	     
	     Q    Mr. President, Dr. Craft is in pediatrics.  He 
came through our facility when he was in his resident program and 
worked in our emergency room for a short period when he was doing 
his residency.  So I think that Dr. Craft probably has some 
comments that he cold address and shed some light.
	     

	     Q    I'm Hugh Craft.  I'm a pediatrician.  I 
practice now in Roanoke, Virginia, although I'm a North Carolina 
native.  And I work at a teching hospital that serves as a 
referral center for a rural community very much like Troy, facing 
really the same types of problems.  The communities are 
different, but the problems that the hospitals in the communities 
face are very similar.  I take care of -- probably a third of the 
patients I see every year are children who are referred in from 
smaller hospitals.  Many have not had adequate primary preventive 
care services, have diseases that resulted in inadequate 
immunizations.  I think the things in your plan, the focus on 
preventive care, I think, is critical, and I think it will have a 
big impact on the health of children.
	     
	     I think universal coverage will also.  We have a 
two-tiered system and we need to have a one-tiered system so that 
patients are patients and providers are reimbursed at one level 
for everybody, and that's not an issue when the patient comes 
into the provider's office. 
	     
	     One of the things that we do that I think is helping 
our smaller communities, we do a lot of outreach education in the 
hospitals.  We'll go out to the emergency room, a nurse and 
myself, and do programs in the hospital so the staff won't have 
to leave, and we can conduct the programs there at no cost.  Part 
of our mission is teaching, and that way, can raise the level of 
skills to providers who take care of children.
	     
	     Sick kids will often first show up at the door of a 
hospital like this hospital, or small hospitals in southwest 
Virginia, and how they're taking care of theirs is really 
critical to how they're going to do more things for our hospital.  
So think the new focus on preventive care, universal access and 
the rural health initiatives which I reviewed a couple of nights 
ago I think will really help in the rural areas.
	     
	     We train a lot of family physicians who go out into 
small rural communities, and they're facing the same kind of 
problems that Dr. McRoberts faces here -- long hours, isolation 
from professional colleagues and I think there are a lot of 
things in your plan that will address those problems.
	     
	     THE PRESIDENT:  One of the things -- you mentioned 
the area health education concept, which I think has really done 
wonders in rural America, all over the country.  But one of the 
things that we have tried to do in this plan which we haven't 
talked about this morning is to provide some funds for electronic 
hookups, with really great access to technology so you can have 
almost instantaneous and continuous contact with medical centers 
around the country.  I think it isn't quite like being there, but 
it will go a long way toward bridging the gap that exists now.
	     
	     Q    Yes, I think it will.  They have to put primary 
care doctors on the front line, literally, in instant contact 
with specialists when they have the patient in their office or in 
the hospital who need some help.
	     
	     Q    Well, you know, we had a sample of that here 
for a short period of time.  Remember when we had -- and we were 
hooked up with the University of North Carolina at Chapel Hill, 
and they used to give us instant consultations on fetal 
monitoring strips on pregnant women who we felt like there was 
abnormality here that might be fairly serious, and we wanted to 
have a perinatal consultation.  And they sold it to several 
different hospitals in the state, and we were one of the 
hospitals.  And we didn't use it frequently, because most of our 
mothers are stable, luckily. 
	     
	     But, anyway, when it ended up that they took it out 
because other hospitals used it even less frequently than we did, 
and we were their last customer.  So they felt like they couldn't 
justify the cost of it.  And they called us up and asked us what 

we thought about it, and we said, well, we love it.  And we 
didn't want to turn ours in or sell it back or anything.  But 
they came and took it away from us, anyway, because they 
discontinued the program.  And that was really unfortunate, 
because that provided us with a great service for -- well, about 
a year or so, wasn't it, that we had that?
	     
	     Q    There's one other issue besides just training 
with technology -- advanced technologies to get from the large 
center to the small center.  It's actually providing sites with 
physicians and nurses to be trained in rural areas, which is 
going -- something we'll have to do about -- will have to be done 
about modifying the way you reimburse those places, because 
they're not paid to train physicians.  I'm with the college of 
medicine at East Tennessee State University that's dedicated to 
turning out primary care physicians, and does a good job, and 
they brag about turning people out in small communities in 
underserved areas.
	     
	     But I also share the same -- almost 17 years of 
experience with Dr. McRoberts in a small community in southwest 
Virginia prior to doing that chore, and prior to teaching.  And 
in those long years -- when I only went for two years -- in the 
national health service corps -- and could not leave that 
community for the very same reason she described.  I never had a 
lot of help from universities that are subsidized for their 
subspecialties so well, and expect rural communities to go there 
for their care.  
	     
	     The access issue of first access, geographic 
boundaries and economic boundaries are essential problems in 
rural areas.  
	     
	     Medical schools have a lot of supply-side thinking 
to them.  They've got the technologies, they've got the 
subspecialties, they're in here for the things that rural areas 
afford the patients to use these technologies.  There must be a 
reorientation to the actual demands of those communities and what 
needs to be trained there, and how you go about training those 
with creative and innovative ways that they're doing in Roanoke, 
our own medical school has tried to put physicians in smaller 
communities for their training -- much more of their training.  I 
think it is real regional emphasis.  
	     
	     Jim Bernstein and his organization has helped many 
communities all over this state, but he's been able to work with 
each medical school regionally throughout the state, and I think 
that focal factor -- the university, in its regional mission and 
accepting that mission across state lines many times, to get 
people there to be trained, besides just emphasizing technologies 
and telephone line and access in technology, there doesn't seem 
to be -- and people must be exposed to these places.
	     
	     THE PRESIDENT:  You know, this has been a source of 
real controversy, by the way, in the medical community, as you 
know, because we are only -- of all of our graduates from medical 
school now, only about 15 percent of the family practitioners, 
and in most other major nations, about half the doctors are 
family practitioners -- maybe slightly over half.  
	     
	     So in our bill, we propose over a five-year period 
to change the mix of medical school slots that the federal 
government subsidizes -- and, as you know, they're heavily 
subsidized -- to get to a point where about 55 percent have to be 
in family and general practice.  And I met the other night with 
all the teaching hospitals in the Boston area to talk about how 
quickly that can be done, because as you pointed out, they're all 
sort of geared up and wired to their specialties and 
subspecialties and all that, and that's sort of where the money 
is.  But I just thing that we have a very compelling obligation 
to spend the taxpayers' money at the national level to try to 
remedy what is a blooming horrible crisis.

	     
	     We're here in a little rural area, but there is a 
shortage of family practice doctors in a lot of the major urban 
areas of the country.  So I think it's not just the training 
setting, you actually have to get the med students into those 
slots, and we're going to have to change the subsidy ratio.
	     
	     Now, again, this is something that almost never gets 
discussed in the larger debate about health care.  But unless 
we're prepared to do what it takes to guarantee that we educate 
our young people in sufficient numbers to be family 
practitioners, all the economic subsidies in the world won't get 
them out there because they won't be there -- people won't be 
there.  And I think that's one thing that's very important that 
the American people know that, that with all of the doctors we 
have, we actually have a shortage of family practitioners 
nationwide, and it's going to get worse unless we change the 
economic incentives for the next year.
	     
	     Q    Mr. President, this is a wonderful discussion, 
and I know that you have other commitments that you must attend 
to today, and we could sit here all day and all night --
	     
	     THE PRESIDENT:  I'm having a good time.
	     
	     Q       carrying on these discussions.  And it is 
wonderful for us to have the  opportunity to sit down and discuss 
with you.  I'd like to thank you for visiting Montgomery Memorial 
Hospital and in speaking to our patients and our citizens, and to 
let you know we think that we're doing the right things in 
Montgomery County to deliver the best medicine we can, quality 
medicine to our citizens.  But the problem is much larger than we 
are.  And we are hoping and working for a payment system that can 
allow us to operate and serve our citizens.
	     
	     I believe one of the doctors said earlier that when 
we see a patient they normally haven't been to a doctor and 
they're to a stage that if they need hospital care it's normally 
extended hospital care.  So we're working to those -- we realize 
that the problem is much larger than we are and we are working 
very hard in our community to do what we can do.  But we need the 
help from the Congress.  We need the help from --
	     
	     THE PRESIDENT:  How much uncompensated care do you 
do here every year, do you know?  Just people who show up at the 
emergency room that are uninsured.
	     
	     Q    I would say it would be about 50 percent in the 
emergency room.  Probably, what --
	     
	     Q    Uncompensated care or less than total 
compensated care is better than 50 percent in our hospital.  
	     
	     Q    That's true, our hospital, too.
	     
	     THE PRESIDENT:  So that goes back to the first point 
you made, that universal coverage is a big deal and if people 
want medical care to continue in rural America, and forget about 
the taxpayers and anything else, this hospital could pay more --
	     Q    That's right.
	     
	     THE PRESIDENT:  -- to pay the nurses more, to pay 
other people -- to offer incentives to doctors to come directly 
if you had compensated care.  And you'd have a -- if you had a 
better array of services then because it was compensated, you 
could take better care of the pregnancies and everything else.  
	     
	     It all comes back to this universal care thing.  We 
cannot be the only country in the world that can't figure out how 
to provide basic coverage to all its citizens.  We can't justify 
this any longer.  

	     
	     Q    Thank you very much, Mr. President.
	     
	     THE PRESIDENT:  Thank you all.  I'm glad to see you.  
Your father has been educating me about these things for years 
and years.
	     
	     Q    He's tried to figure it out.
	     
	     Q    Mr. President, why is it worth it for you to 
come here and talk to just such a few people when you have 
already basically done this before -- you asked a lot of these 
same questions before.
	     
	     THE PRESIDENT:  Because it's obvious to me that 
these things come in waves -- I mean, the American people are 
thinking about it again now, and it's very important that we deal 
with some of these horrible health problems.  Most people 
lobbying on Capitol Hill will be lobbying against universal 
coverage in one way or the other.  But these folks who are out 
here giving health care know we've got to have it.  
	     
	     I also think it's very important to emphasize a lot 
of the things that are in our health care program that are not 
controversial on their face, but they could get lost unless we 
emphasize them.  For example, all the incentives for people to 
come out here and become family practitioners.  
	     
	     And so the debate, in a funny way, is just 
beginning.  We're getting all this work in subcommittees; we're 
getting things going forward.  All the surveys show an 
interesting dichotomy.  They show that support for our plan goes 
up and down based on what they heard about it from interest 
groups or in paid ads; but that if you tell them what the details 
are in our plan, then more than two-thirds of the American people 
support all the specifics.
	     
	     So what I'm trying to do is to get out here and 
highlight these real-world experiences that these doctors and 
nurses and other health care providers have so that we can focus 
the attention of the American people and the Congress on solving 
the real problems, not the rhetorical problems.
	     
	     Q    And get this on local television.
	     
	     THE PRESIDENT:  Well, yes, that's the idea.
	     
	     Q    Mr. President, are you losing public relations 
battle, Mr. President?
	     
	     THE PRESIDENT:  No, I think we're winning it again 
now.  And we're getting real movement in Congress.  But I think 
we don't have the ability to raise the kind of funds or do the 
kind of nationally organized advertising that has been done by 
some against the program.  And, inevitably, a lot of the national 
organizations may get more publicity than local ones do.  But 
when you get out here and you go beyond the rhetoric and get down 
to the details and the real-life experiences of these folks that 
are out here trying to take care of America, then the compelling 
case for reform, for universal coverage, for guaranteeing health 
security for all Americans, and getting the funds in here to 
these rural hospitals and providing more family doctors is 
overwhelming.  And so I think we just have to keep hammering this 
home, not just on local television -- I'll be grateful if you put 
this story on national television tonight.  (Laughter.)
	     
	     Q    Thank you, Mr. President, we appreciate you 
being here.
	     
	     THE PRESIDENT:  Thank you.

			       END11:38 A.M. EDT

