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US Conference of Mayors

June 17, 2011
Baltimore, Maryland

Remarks as prepared for delivery

Thank you, Mayor Kautz, for that kind introduction. And thank you for inviting me to be with you today.

Being a mayor isn’t easy. Your constituents expect you to do everything from creating jobs to making sure the trash gets picked up and the streets get plowed.

In the last few years, your jobs have gotten even more challenging as your budgets shrunk while demand for services grew. The good news is the economy is coming back. We’ve created two million jobs over the last 15 months. The financial system is stabilized. There’s more work to be done, but we’re moving in the right direction.

But if we want our cities to reach their full potential, we also need to address some of the underlying issues that have held back prosperity and growth. One of those issues is health.

As mayors, you understand that health affects everything that happens in your cities. It affects how well students learn in your schools. It affects whether your neighborhoods can attract new families and businesses. It affects how productive your workforce is.

It affects the happiness and well-being of your constituents more than almost any other factor.

But too many of our cities today aren’t as healthy as they should be. Too many cities have obesity and smoking rates that are well above the national average. Too many neighborhoods have high rates of chronic diseases like diabetes and heart disease. Too many people are living too sick and dying too soon.

At the same time, cities are being squeezed by the burden of rising health care costs. In some of our cities, retiree health costs alone are in the billions or tens of billions of dollars. Every day, you see resources that could have gone to repairing roads or hiring teachers diverted to paying growing health insurance bills.

So if we want cities to thrive in the decades to come, our challenge is to improve health, while also stabilizing health care costs so they don’t take away from the other investments that are essential to keeping your city strong.

And today, I want to talk about some of the ways we’re working with mayors and cities to do that.

It starts with last year’s historic health care law – the Affordable Care Act. As you know, the law will extend coverage to 34 million previously uninsured Americans – and no one will benefit more than cities. Not only will this allow many of your constituents to finally get the care they need, but it will dramatically reduce the amount of free care that city and county hospitals provide to the uninsured and underinsured.

At Metropolitan Nashville General Hospital, for example, they predict the law will cut their uncompensated care costs by two thirds.

But expanding access to health insurance is just a first step. The most effective and affordable way to keep people healthy is to keep them out of the hospital in the first place.

That’s why, through the health care law, we’re also making a historic investment in primary care. Today, too many of your constituents live in neighborhoods with a shortage of primary care providers. As a result, they don’t get a blood pressure screening and then end up in the city hospital with a heart attack. Or they don’t get the mental health counseling they need and end up homeless where they develop much more serious medical conditions.

To address this shortage, we’re expanding the National Health Service Corps, which provides scholarships to doctors and nurses who work in underserved communities. We’re providing new funds to train minority health care providers who we know are more likely to go back and practice in their own neighborhoods. And we’re also making a historic investment to help community health centers provide care for an additional two and a half million patients.

Last year, I got to visit the St. Thomas community health center in New Orleans with Mayor-Elect Landrieu. It serves tens of thousands of New Orleans residents, most of who have little or no insurance. You can get a checkup but you can also get a mammogram or counseling. They have an eye clinic. No one was surprised when St. Thomas was one of the first facilities to open its door again after Hurricane Katrina.

With the investment we made, St. Thomas can now see nearly 12,000 more patients a year, and we’re seeing the same story in neighborhoods across the country.

These investments will make it easier for people in your cities to get the care they need. But as you know, there’s more to good health than getting the right treatment or test. Increasingly, many of our nation’s health problems can be traced back to unhealthy lifestyles.

It’s not that people don’t want to be eat right or get exercise. They do. But they face obstacles from food deserts to phys ed cuts in schools. So we’ve launched a national effort to make healthy choices more affordable and convenient. And a big part of that strategy is supporting you.


Mayors have been national leaders in developing creative approaches for promoting better health. And over the last two years, I’ve gotten to see many of these efforts firsthand.

In Louisville, I visited a school with then-Mayor Abramson where they incorporated exercises into class time and were serving a new healthy menu in the cafeteria. In Boston, I toured community gardens with Mayor Menino where students grow fruits and vegetables that are sold at farmer’s markets in areas with little access to fresh produce.

We supported both of these projects with an investment from the Recovery Act. And under the health care law, we’ll be funding even more of these local efforts through what are called Community Transformation Grants, and I encourage you to apply. Our goal is to help these promising efforts scale up, and then become role models for the rest of the country. We want mayors to take these funds, demonstrate results, and then come to meetings like this one and say: here’s how we did it.

I also want to salute you for your leadership in the First Lady’s Let’s Move Campaign. Last June, I came to Oklahoma City and asked mayors to sign up. Since then, nearly 700 cities, towns, and counties have pledged their support for ending the childhood obesity epidemic within a generation.

With your help, we’re becoming a healthier country one community at a time. And my commitment to you today is that we will keep working with you to help you expand and share your best ideas.

But even if all our prevention efforts are successful – even if every single person in every single one of your cities eats a nutritious diet and gets enough exercise and gets the right checkups and screenings – people are still going to get sick. And when they do, we need to make sure that they get the best care possible.

Unfortunately, that doesn’t always happen. According to one recent study, as many as one in three Americans who end up in a hospital are harmed by their care.

It doesn’t have to be that way. For almost every kind of common harm out there, we know of hospitals around the country that have reduced or even eliminated it.

For example, earlier this month, I visited San Francisco General Hospital with Leader Pelosi. They’re a city hospital, the only level one trauma center in San Francisco, and they serve 100,000 patients a year. A few years ago, they decided to tackle the problem of bedsores, which are incredibly painful and sometimes deadly, but also preventable. So they took a series of steps from training nurses in how to prevent bedsores to introducing special rounds where they looked for early warning signs. And in just two years, they cut their rate of bed sores by nearly 55 percent.

If San Francisco General can do this, there’s no reason every hospital in America can’t do it too. That’s why we’ve joined with employers, health plans, doctors, nurses, local health agencies and more than 1,500 hospitals across the country to form the Partnership for Patients, an alliance that’s set concrete goals for reducing medical errors over the next three years. If we achieve those goals, we’ll save up to 60,000 lives in the next three years and reduce Medicare costs by up to $50 billion over the next ten, with billions more in savings across our health care system.

When you go home, I encourage all of you to visit your local hospitals and tell them to go to and sign up. There’s no reason any of your constituents should die from a preventable error, and we now have the knowledge to bring these errors to an end.

I also know that you’ll be hearing from Mayor Walkup of Tuscon tomorrow about some of the steps cities can take to address behavioral health issues in the aftermath of the tragic shooting in his city. Our department has been working closely with Mayor Walkup, and I encourage you to take advantage of the resource guides you’ll receive tomorrow at Mayor Walkup’s presentation. Becoming a healthier country means having healthier bodies and minds, and our department is committed to working with you to make that happen.

It’s not easy to improve health and lower costs. But with the support of the Affordable Care Act, communities across the country are moving in that direction.

Now, this isn’t the only health care approach out there. For example, some in Congress have proposed turning Medicaid into a block grant and cutting $770 billion from the program over ten years. It’s worth thinking about exactly what that plan would mean for cities.

With such significant cuts, states would have no choice but to reduce benefits or kick people out of the program or both. But these people will still need to get care. The only difference will be that when they show up at your hospitals and emergency rooms, you’ll be the ones paying for it.

And it’s also important to understand what that approach wouldn’t do. It wouldn’t do anything to improve health in your cities. And it wouldn’t address what’s really driving up Medicaid costs – along with health care costs for families, businesses, and cities – which is growth in the underlying cost of care.

As mayors, the buck stops with you. If we simply cut costs without doing anything to improve care, you’ll see the consequences in your schools, your workplaces, your neighborhoods, and your hospital budgets. If we let costs continue to rise unchecked, you’ll find yourselves with fewer resources for key investments. The best path forward for cities and for our country is to stabilize costs by improving care and health. That’s the path we’ve started down together. And I look forward to continuing that journey with you in the years to come.

Thank you.