Commencement address to A.T. Still University, Kirksville

May 26, 2009

Thank you.  I’m delighted to be back here in Kirksville today for this important celebration.  I am truly honored to have this opportunity to speak with you, and to receive an honorary degree from this proud and historic institution.

I’m especially proud to receive this degree from my great friend, and your university president, Dr. Jack Magruder.  Dr. Magruder’s contributions to higher education, both here in Kirksville and throughout Missouri, have been profound.  He and Sue have touched the lives of tens of thousands of students during their long careers.  And because of their tireless dedication and leadership, generations of students have received world-class educations, both at A. T. Still and at Truman State.

Thank you, Jack, for all you’ve done for Missouri, for Kirksville, and for the universities you love. 

We were all reminded earlier this week about what a special place Kirksville is.  This community is more than home to two of Missouri’s finest universities.  It’s also home to some of the hardest-working, most welcoming and most resilient people anywhere in our state.

When the tornado tore across the northern part of town earlier this week, damaging and destroying dozens of homes, folks up there didn’t wait for help to arrive.  In fact, they didn’t even blink.  Within minutes of the storm’s passing, folks were running from house to house, to check on neighbors and make sure other families were OK.  They were helping folks dig out from the debris, and they were already planning to rebuild.  That’s the Kirksville spirit.  And that’s what makes this community so strong.

The storm certainly didn’t go easy on Kirksville, as my emergency management team and I saw on Thursday when we surveyed the damage ourselves.  But I know the folks here in Kirksville.  I know you will come together, as you always have before.  And my administration will be there to support you every step of the way.  As a community, we will rebuild.  And we will come out stronger.

The founder of osteopathic medicine and of this university, Dr. Andrew Taylor Still, was a man ahead of his time.  The principles he put forward in 1874 and the years following -- ideas regarding the treatment of the mind, body and spirit; of focusing on preventive care; and of serving those populations most in need -- were revolutionary in the late 19th century. 

To advance the ideas in which he truly believed, Still faced personal ridicule and professional ostracism.  He was forced to move, and to defend his theories from attack by leaders in the medical community.  But in the face of this adversity, he held fast.  He built his reputation.  And his results – well, those spoke for themselves.

As our knowledge of anatomy, of disease, and of medicine, has grown over the past century, it has become clear what a visionary Dr. Still truly was.  Today, osteopathy is a highly regarded and growing component of the health care profession.  Its practitioners are among the most respected men and women in the medical world.  And its first medical school, right here in Kirksville, is one of the real treasures of the state of Missouri.

Members of the A. T. Still class of 2009,

As you begin your careers as osteopathic physicians, you will continue the great legacy Dr. Still began more than 130 years ago.  You will put your knowledge and your passion to work to heal the sick; to comfort those in pain; and to improve the quality of life for your patients here in Missouri, across the country and around the globe.

And, graduates, you begin this vital work at a critical time.
You see, this state, and our nation, are facing a health care crisis.  A crisis driven by two distinct, but interrelated, forces – the growing number of individuals and families living without health insurance; and the skyrocketing costs of coverage and care.

Here in Missouri, the numbers are stark.

According to data from the U.S. Census Bureau, 729,000 Missourians were uninsured in 2008.  That’s about 13 percent of the entire state population.  It’s especially disturbing that 150,000 of those uninsured Missourians are children – the weakest, and most vulnerable, among us.

The number of uninsured Missourians grew by 9 percent from 2006 to 2008 – both because of devastating cuts to the state’s health care safety net imposed by my predecessor in 2005, and because of a decline in the number of Missourians who were eligible for health care as a benefit from their employer.

Each and every day, the consequences of this lack of coverage become clearer – and more troubling.  For individuals without insurance, the personal toll is profound and life-threatening.  When compared to those with insurance, uninsured Missourians receive fewer routine screenings; they lack access to medical care generally, and especially to preventive care; and they go longer without treatment for serious illnesses and chronic conditions. 

When they finally do receive care, individuals without insurance usually enter the health care system in poorer condition, and, in the end, their treatments often aren’t as effective as they could have been. 

In the long term, this lack of access to health care can lead to the late diagnosis of disease, and ultimately, to cases of premature death.  In other words, when the uninsured do receive care, it’s often too little, too late.

While the consequences might be more readily apparent for those without insurance, those with coverage aren’t spared from this crisis.

The cost of caring for the uninsured gets passed along to those with coverage in very real, and very expensive, ways.  As we’ve seen, because the uninsured don’t have access to traditional clinics and primary care physicians, they often wait until the last possible moment to seek treatment.  And when they do, they often head straight for the most expensive, and least efficient, provider possible: the hospital emergency room.

This places an incredible burden on already over-strapped hospital emergency departments, delaying care and creating longer wait times for every patient.  In addition, it also increases the cost of service for everyone.  And the HMOs and insurance companies certainly aren’t picking up this tab.

Instead, these costs are passed directly to consumers in the form of higher premiums and copays.  Hardworking families and small-business owners.  Single parents and middle-class men and women.  During these difficult economic times, these are the folks who are paying the price of this health care crisis.

According to data from the Missouri Foundation for Health, Missourians’ health insurance premiums were increasing by between $110 and $291 per year by 2005 because of the cost of uncompensated care provided to the uninsured.  This same report predicted that those costs would rise to between $225 and $609 a year by 2010. 

But, we must keep in mind that this report was published prior to the devastating 2005 health care cuts in Missouri – which slashed coverage and benefits from 400,000 Missourians.  As a result, these actual increases are likely to be even higher by next year.

So, today, we see both of these trends continuing to rise at an alarming rate – more and more Missourians living without access to health care; and higher costs for everyone.

On top of this, we continue to face the most severe economic recession in modern history.  Here in Missouri, 260,000 people are out of work.  Small businesses are fighting just to keep their doors open.  And good-paying jobs in manufacturing and production are heading overseas.

But, as trying as times might be right now, I have every confidence that we will turn this economy around.  Missouri is home to the hardest-working, most productive people in the country.  And our higher education institutions, including A. T. Still, are educating the young people who will help transform our economy for the future.  We will embrace emerging technologies and developing industries to create the jobs of the future here in Missouri – to get our people back to work.

To move our economy forward, it’s going to take fresh ideas, and new ways of thinking.  And it’s going to require that we develop a 21st-century workforce that is educated, prepared and healthy enough to take on the challenges of tomorrow.

That’s exactly where the new physicians in this class come in.

Osteopaths have never been afraid of a challenge.  You’ve never shied back in the face of complex cases or difficult diagnoses.

No.  Yours is a discipline born of the frontier – founded by a pioneer doctor who wouldn’t give up on his beliefs.  That osteopathic legacy, which began right here in Kirksville, continues here today, with this new class of physicians.

Dr. Still once said, “An osteopath is needed wherever there is suffering.” 

That simple belief has led generations of osteopathic physicians to dedicate their careers to working as primary care providers in underserved areas – in rural clinics, far from the nearest hospital or medical center. In urban centers, where other physicians might choose not to practice.  These areas are also, not surprisingly, ground zero in our efforts to curb the growing number of uninsured.

As the Gospel of Matthew tells us that, “Whatsoever you do to the least of my people, that you do unto me.”  Generations of osteopathic physicians have put that teaching into practice in your work with underserved – and uninsured -- populations.  You’ve demonstrated humble, profound servant leadership.  And you’ll continue to do so throughout your careers.

As you bring your healing touch to your patients, you’ll be helping us turn the corner on both this health care crisis and our economic crisis.  You’ll be helping us ensure that our workforce is healthy and ready to take on the challenges of the 21st-century economy.

But you can’t do this alone.  To tackle the health care challenges we face, we must all come together – physicians and government officials, hospital officials and insurance providers alike – to put Missouri families first.

We showed what type of innovate progress is possible earlier this year when the Missouri Hospital Association and I reached an agreement that would have reduced the number of uninsured Missourians by 35,000 – at no cost to the taxpayers.  Let me repeat that – At no cost to the taxpayers.

Missouri’s hospitals agreed to pitch in an additional $52 million a year to help provide coverage to 35,000 Missouri parents.  This contribution would have drawn down an additional $93 million in federal health care matching funds to help provide this coverage.

The only legislative action necessary to implement this plan would have been to increase the eligibility level for Missouri’s Medicaid program from 20 percent of the Federal Poverty Level to 50 percent. 

At 20 percent of the Federal Poverty Level, a single parent with two children can only earn about $3,700 a year and qualify for Medicaid.  At 50 percent of the FPL, this family could make about $9,155 a year and still be eligible for health care.  This is a huge step in the right direction.

And again, this increased coverage wouldn’t have cost a single penny from the state’s coffers.  In fact, it would have helped Missourians save money by reducing the cost of medical care and driving down premiums and co-pays.

This was the type of innovative agreement that would have made a real difference for Missouri – that would have helped us turn the corner and start moving in the right direction.  So I was deeply disappointed – and frustrated – when a few members of the Missouri House of Representatives obstructed this bill in the final hours of the legislative session.

Health care coverage for 35,000 additional Missouri parents each year.  35,000 Missourians who could have seen a primary care physician, undergone regular check-ups, and received preventive care.  Zero cost to the taxpayers.  This agreement made perfect sense to me, perfect sense to Missouri’s hospitals, and perfect sense to the state’s largest business groups.  On Thursday, the bill passed by an overwhelming, bipartisan vote in the Senate – 30 to four.

But a few in the House kept us from moving forward. 

My friends, you can see the challenges we’re up against. 

As we work to reform our health care system, to make coverage more affordable, and services more accessible, we must work together.

Physicians are powerful advocates for their patients in the clinic or in the hospital.  You can skillfully interview and evaluate a patient; reach a diagnosis; and begin a treatment. 

But to solve this health care crisis, physicians must not only serve patients when they present themselves to you in the clinic.  You must become advocates for their needs and their health throughout the community – and in the statehouse.

In another of his memorable sayings, Dr. Still tells us, “An osteopath should be a clear-headed, conscientious, truth-loving man,” – today, we would say ‘person’ – “and never speak until he knows he has found and can demonstrate the truth he claims to know.” 

When it comes to the truth of the health care crisis we face, no one knows more than you.  And as you begin your practices, we need you to speak out – to add your voices to the debate over access to health care. 

We need you to shed truth and light on the communities you serve – to inform your legislators about segments of our population living without access to insurance, and, as a result, without access to preventive care.  And about the burden that places on the clinics and hospitals where you will begin your work.

We need you to advocate on behalf of your patients and your peers.  We need you to share the truth you know.  We need you to help us move our health care system forward.

Although the House refused to implement our health care agreement this year, that does not mean our fight is over.  No, indeed.  That simply means we will try again next year – with another strong proposal, and another strong fight.  And we will continue this mission until we reduce the number of uninsured Missourians, and drive down costs for everyone.

As Kirksville was the site of a transformation in health care more than 130 years ago, I believe Kirksville will play a key role in this 21st-century transformation as well.  As the class of 2009 joins the ranks of the osteopathic physicians in practice, I urge you to continue the proud tradition begun here by Dr. A. T. Still. 

In 1874, Dr. Still knew that the health care system needed reform.  And he fought to bring about much needed change.  And today, once again, we turn to the osteopathic community to help us bring about the reforms we need so desperately now.

Together, we will help physicians better serve their patients by reducing the number of individuals living without insurance and by driving down the cost of health care for those with coverage.  We will provide additional resources to help train the next generation of physicians and other medical professionals.  And we will modernize medical record-keeping and storage.

We will transform our health care system.  And we will do it together.

The A. T. Still University class of 2009 includes students from across our country, and from six nations around the globe.  You hail from diverse backgrounds, and all walks of life.

And I know that as you leave here today, you will head to residencies, internships and fellowships in many different directions.  From major hospitals to single-doctor clinics.  From urban centers to rural outposts.  You will bring high-quality care and compassionate service to patients everywhere.

But, as you move forward, I hope you’ll always remember your time here in Kirksville fondly.  And always know that Missouri is proud to claim you as one of our own.  No matter where your road might lead, we’re glad you’ve lived and worked here in the Show-Me State, and we’d love to keep you here.

Missouri is a great place to call home.  And we’re always looking for the best and brightest to help us move our state forward, and create a broader prosperity for our people.

So, although the bright lights of distant cities might lure some of you away for a while, I hope you’ll consider returning to Missouri someday.  We’d love to welcome you back.

The challenges we face are real.  But so are the opportunities for transformation, for reform and progress.  I look forward to continuing my work with the osteopathic community in the years to come to bring about the changes we need – and to move our state forward.

Again, congratulations to the class of 2009.  And best wishes to you all as you begin your careers.

Thank you.