Are you kidding me, Mr. President?

On Tuesday, July 10, President Bush addressed a crowd in Cleveland, Ohio at the Intercontinental Hotel Cleveland.

The White House website characterized the address as a call "on Congress to Act to fund Vital Priorities" (see the link to the site and the text of the entire speech–bottom of this post).

Here is what the President said, in part, about health care:

On Tuesday, July 10, President Bush addressed a crowd in Cleveland, Ohio at the Intercontinental Hotel Cleveland.

The White House website characterized the address as a call "on Congress to Act to fund Vital Priorities" (see the link to the site and the text of the entire speech–bottom of this post).

Here is what the President said, in part, about health care:

“Let me talk about health care, since it's fresh on my mind. The objective has got to be to make sure America is the best place in the world to get health care, that we're the most innovative country, that we encourage doctors to stay in practice, that we are robust in the funding of research, and that patients get good, quality care at a reasonable cost. The immediate goal is to make sure there are more people on private insurance plans. I mean, people have access to health care in America. After all, you just go to an emergency room” [emphasis mine, LJ].

In his speech, the President goes on to argue against expanding almost any version of our public health care system that might eventually lead to a comprehensive, national health coverage plan, including coverage for children just above the national poverty line. This is understandable given his political ideology.

Now, we can legitimately debate the particulars of universal coverage and how to achieve that goal. The President's comments in the speech provide several "jumping off" points for such a debate. I respect the fact that the subject is complex and that numerous special interests are involved and have combined to make the entire issue a political quagmire for everyone. Future posts here will likely get at some of those issues and points for debate, as have several of my previous posts.

For today though, my attention is riveted on the remark the President made that actually reveals his perspective on what health care actually means, what it entails.

"I mean, people have access to health care in America. After all, you just go to an emergency room.”

I expect that any physician, hospital administrator or public health official who heard that statement must have been shocked, stunned, terrified and thoroughly amazed all at once!

For the President of the United States to equate health care with a visit to an emergency room demonstrates just how serious our national public health crisis really is. No wonder we are now spending over 15% of our annual Gross Domestic Product on health care related costs, while achieving so little return on our investment in quality public health outcomes when compared to other industrialized nations.

One of the President's major concerns as expressed later in the Cleveland address is how to best use our funds to achieve the maximum in public health quality and benefit. How such a concern squares with his placing the ERs of America in the default position for the nation's uninsured escapes me. Everyone knows that the emergency department is one of the most expensive health care venues available and is designed to be a station of last resort, or the first stop in an acute emergency situation.

Scroll back on this site to just last Thursday, July 12 ("A Medical Home"). That brief essay pointed out the extremely positive impact of a reliable medical home on minority health outcomes and clearly documented racially informed disparities.

In the same speech in Cleveland, the President vowed to veto a bipartisan plan to expand the Children's Health Insurance Program to more adequately care for the health of all of America's children. Members of his own party expressed shock at his threat, given the fact that the President had not had a chance to review the legislation.

There is a lot wrong here.

But, in my view, we can trace it all back to the simple-minded misconception that everyone already has health care. I mean, after all, anyone can go to the emergency room when they need to see a doctor.