0 nurses. michelle and i have been blessed, we haven't been sick too much, knock on wood. but every interaction we've had at the hospital, doctors are wonderful and we appreciate them, but i know when malia and sasha were being born, we spent 90% of the time with the nurses and 10% with the ob/gyn. when my grandmother got sick and was passing away at the end, it was nurses who were caring for them and incredibly compassionate but also a professional way. and you're absolutely right, that one of the keys to reducing our health care costs overall is recognizing the incredible value of advanced practice nurses and giving them more responsibilities, because there's a lot of stuff they can do in a way that, frankly, is cheaper than having a doctor do it. but the outcomes are just as good. the challenge we have is we still have a nursing shortage in too many parts of the country. my understanding, you probably know this better than i do, part of the problem is, is that too many professors of nursing or instructors in nursing are getting paid less than actual nurses. so what ends up happening is we don't have enough slots in some of the nursing schools. that may not be true here, but there are parts of the country where that's true. so we have to upgrade a little bit the schools of nursing and make sure that they're properly resourced so that we have enough instructors. and in fact as part of the affordable care act, one of the things that we thought about was how are we going to expand and improve the number of nurses and making sure that they can actually finance their educations. and so there are some special programs for nurses who are committing themselves, as well as doctors who are committing themselves to serving in underserved communities, and we will be happy to get that information to the school of nursing here. one other element to this that i think is really interesting, we've been spending a lot of time thinking about making sure that our veterans coming back from iraq and afghanistan are getting the opportunities they need. so we instituted something called the post-9/11 g.i. bill that provides the same kind of support that my grandfather got when he came back from world war ii. and the young people who have served in our armed forces just do extraordinary work. one of the problems, though, is that they don't always get credit for the skills that they already possess when they come home. so one -- and we've got a gentleman here who's a veteran. and one great example actually is in the medical profession. that they need so that if their parents aren't willing to provide them support and they're functionally independent, that they're still able to go to college and succeed. all right? right here in the obama t-shirt. you know, so if you -- here's a general rule in the presidential town hall. if you want to get called on, wear the president's face on your shirt. >> good afternoon, president obama. my name is ivana smith. i am a graduate student in the college of community and public affairs. i study eastern affairs administration w that being said, as we are all students, we know how vital it is to have a good foundation in your education. how does your administration plan to address the major budget cuts that are happening with headstart schools around the u.s.? >> well, that's a great question and this will be a major topic over the next several months. taxes for middle class families, we initiated programs to rebuild our roads and our bridges, we helped states so they won't have to layoff as many teachers and firefighters and police officers, and that's part of the reason why we avoided a depression, although we still had a terrible recession. but the combination of increased spending and less revenue meant that the deficit went up. and by the time the republicans took over the house in 2011, they had made this a major issue. and understandably a lot of families said we're having to tighten our belts, the federal government should too. although part of what you want the federal government to do when everyone else is having a hard time is to make sure that you're providing additional support. as the economy has improved, the deficit has gone down. it's dropped at the fastest rate in 60 years. i want to repeat that because a lot of people think if you ask the average person what's happening with the deficit, they'd tell you it's going up. the deficit has been cut in half since 2009 and is on a downward trajectory. and it's going down faster than any time since world war ii. so we don't have a problem in terms of spending on education. we don't have a problem when it comes to spending on research and development. we do have a long-term problem that has to do with our health care programs, medicare and medicaid. the good news is, is that in part because of the affordable care act, obama care, costs have actually gone down -- health care inflation has gone down to the slowest rate that we've seen in a long time. so we're starting to get health care costs under control. we'll still have to make some modifications when it comes to our long-term entitlement programs so they're here for young people here when they're ready for retirement, but we don't have an urgent deficit crisis. the only crisis we have is one that's manufactured in washington, and it's ideological. and the basic notion is, is that we shouldn't be helping people get health care and we shouldn't be helping kids who can't help themselves and whose parents are underresourced, we shouldn't be helping them get a leg up. and so some of the proposals we've seen now are talking about even deeper cuts in programs like headstart, even deeper cuts in education support, even deeper cuts in basic science and research. and that's like eating your corn seed. you know, it's like being penny wise and pound foolish, because if young people aren't succeeding, if we're not spending on research and maintaining our technological edge, if we're not upgrading our roads and our bridges and our transportation systems and our infrastructure, all things that we can afford to do right now and should be doing right now and would put people to work right now, if we don't do those things, then 20 years from now, 30 years from now, we will have fallen further and further behind. so when we get back to washington, when congress gets back to washington, this is going to be a major debate. it's the same debate we've been having for the last two years. the difference is now, deficits are already coming down. what we should really be thinking about is how do we grow an economy so that we're creating a growing, thriving middle class and we're creating more ladders of opportunity for people willing to work hard to get in the middle class. and my position is going to be that we can have a budget that is sensible, that doesn't spend on programs that don't work, but does spend wisely on those things that are going to help ordinary people succeed. all right. good. let's see, it is a gentleman's turn. this gentleman right here, he's had his hand up for a while. you have a little cheering section there. >> i'm a faculty member of the computer science department. i'm very excited and encouraged by your plan on the affordability. my question is related about the quality of future higher education. as you know, many are trying their best to provide the best value by doing better with less, but the challenges are real. it's getting tougher and tougher as the budget cuts are getting tougher and tougher. so my question is what your administration will do to ensure the best american universities remains to be the best in the world in the 21st century. thank you. >> well, first of all, what's really important is to make sure that we're supporting great teachers. and since you got an applause line, you must be a pretty good one. and i don't think that there is a conflict between quality and paying attention to costs as it's affecting students. now, i mentioned earlier one of the big problems that we've seen in public universities is a diminished level of support from states, state legislatures. and part of what we're going to try to do is to provide more incentives to states to boost the support that they're giving to colleges and universities. traditionally, when you think of the great state university systems, it was because those states understood if we invest in our people, we'll have a better trained workforce, which means companies will want to locate here, which creates a virtuous cycle and everybody benefits. but starting, let's say, 15 years ago, 20 years ago, you saw a trend in which state legislatures who were trying to balance their budgets kept on cutting support to state education. what happened was that -- and i don't know whether this is true, mr. president, for suny, but around the country on average what you've seen is a drop from about 46% of the revenues of a public college coming from states down to about 25%. it's almost been cut in half. and essentially the only way these schools have figured to make it up is to charge higher tuition. so states have to do their jobs. but what is true also, though, is that universities and faculty need to come up with ways to also cut costs while maintaining quality, because that's what we're having to do throughout our economy. and sometimes when i talk to college professors -- and keep in mind, i taught in a law school for ten years, so i'm very sympathetic to the spirit of inquiry and the importance of not just looking at xs and os and numbers when it comes to measuring colleges. but what i also know is, is that there are ways we can save money that would not diminish quality. this is probably controversial to say, but what the heck. i'm in my second term so i can say it. you know, i believe, for example, that law schools would probably be wise to think about being two years instead of three years, because by the third year -- in the first two years, young people are learning in the classroom. the third year they'd be better off clerking or practicing in a firm, even if they weren't getting paid that much, but that step alone would reduce the cost for the student. now, the question is can law students -- can law schools maintain quality and keep good professors and sustain themselves without that third year. my suspicion is, is that if they thought creatively about it, they probably could. now, if that's true at a graduate level, there are probably some things that we could do at the undergraduate level as well. that's not to suggest that there aren't some real problems. colleges, for example, they have got health care costs like everybody else. personnel is one of the most important -- it's the biggest cost you've got. and if health care costs to provide insurance for your employees is going up as fast as it's been going up, that affects folks. so our idea is not just to have some cookie cutter approach that doesn't take quality into account. the idea is understanding we've got to maintain high quality, are there ways that we can reorganization schools, use technology, think about what works, so that overall we're creating a better value for the student? and one of the best things that we could do for students is to make sure that they graduate in a more timely fashion. and, you know, unfortunately too many young people go to schools where they're not getting the kind of support and advice on the front end that they need and they drift and four years, five years, six years into it, they have got a bunch of credits, but it all doesn't result in actual graduation. and then they get discouraged. and that's an area where we know we can be making improvement as well. okay? and if you've got any other ideas, let me know. all right. okay. let's get a young person in here. right there. yeah. >> welcome to binghamton. >> thanks. >> president obama. i'm camison, i'm a doctoral student here as well as a writer instructor at syracuse university. i'm interested in the giving of federal funds to students who are going to for-profit colleges or colleges i might even call predatory. i'm very conflicted about this issue and so i'd like to hear your insight. thank you. >> well, you probably know more about it than i do, since you've written about it, but let me describe for the audience what the challenge is. for-profit institutions in a lot of sectors of our lives obviously is the cornerstone of our economy, and we want to encourage entrepreneurship and new ideas and new approaches and new ways of doing things. so i'm not against for-profit institutions generally, but what you're absolutely right about is, is that there have been some schools that are notorious for getting students in, getting a bunch of grant money, having those students take out a lot of loans, making big profits, but having really low graduation rates. students aren't getting what they need to be prepared for a particular field. they get out of these for-profit schools loaded down with enormous debt. they can't find a job. they default. the taxpayer ends up holding the bag. their credit is ruined. and the for-profit institution is making out like a bandit. that's a problem. i was mentioning veterans earlier. soldiers and sailors and marines and coast guardsmen, they have been preyed upon very badly by some of these for-profit institutions. and we actually created a special task force inside our consumer advocate protection organization that we set up just to look out for members of the armed forces who were being manipulated, because what happened was these for-profit schools saw this post-9/11 g.i. bill, there was a whole bunch of money that the federal government was committed to making sure that our veterans got a good education, and they started advertising to these young people, signing them up, getting them to take out a bunch of loans, but they weren't delivering a good product. this goes to then the point i made earlier about how we can rate schools. we're going to spend some time over the course of the next year talking to everybody. talking to university professors, talking to faculty members, talking to students, talking to families. but if we can define some basic parameters of what's a good value, then it will allow us more effectively to police schools, whether they're for-profit or not for profit because there's some not-for-profit schools, traditional schools, that have higher default rates among their graduates than graduation rates, and be able to say to them, look, either you guys step up and improve or you're not going to benefit from federal dollars, because there are a bunch of schools like this one that are doing a good job and we don't want money being funneled to schools that aren't doing a good job, we want to encourage students to be smart shoppers, to be good consumers. so there are probably more problems in the for-profit sector on this than there are in the traditional not-for-profit colleges, universities and technical schools, but it's a problem across the board. the way to solve it is to make sure that we're -- we've got ways to measure what's happening and we can weed out some of the folks that are engaging in bad practices. great question. all right. this corner of the room has been neglected, so the gentleman right there, right on the corner there. yeah. >> thank you for taking the time to visit binghamton university. i'm a student of binghamton university from turkey and i want to ask something about international students. most of my friends' families have been facing hardships to support them financially. for example, two turkish equals one american dollar. this situation is getting more important for us. we think that the most reason is the high level of payment. what do you think and do you have any thing to give out. thank you. >> first of all, we're glad you're here and we hope you're having a wonderful experience. one of the great things about american universities is they are magnets for talent from around the world. and that has enriched us immeasurably. it enriches us in part because students who come here and study and excel may end up staying here and working and starting businesses, and that's always been part of the american experience. smart, striving immigrants coming in here and succeeding. that makes everybody better off, which is part of the reason why we've got to get immigration reform done so that if we're taking the time to train a great computer scientist or engineer or entrepreneur, we're not then just sending them back to their country. let's invite them if they want to stay to succeed here and start jobs here and create businesses here. now, obviously when it comes to federal grants, loans, support, subsidies that we provide, those are for our citizens. you know, a lot of americans are having a tough time affording college as we talked about, so we can't spread it too thin. what we can do, though, is to make sure that if tuition is reasonable for all students who enroll, then it makes it easier for international students to come and study here as well. so all of the things that i talked about before apply to foreign students as well as american students. we need to make sure that college is affordable, that it's a good value. the good news is that there are schools out there that are doing a great job already. we just need to make sure that we're duplicating some of those best practices across the country. all right. who's next? let's see. it's a young lady's turn, isn't it? okay. go ahead, right there, in the red -- or orange. >> my name is ann bailey, and i am a faculty member in the history and african studies department here and i teach african-american history. tomorrow i'm going to the 50th anniversary of the march on washington. and i'm going, and i'm going with my son, because i'm here, as you said, because of a good education and that good education came -- became possible because of that faith-inspired movement that really reached such an important milestone 50 years ago. and i'm so grateful for the fact that i had that opportunity and that my son and that these young people will have these opportunities. but i still kind of wonder where we are now in terms of education and civil rights. have we -- where do you think we are? what do we need to do to kind of make sure that it is education for all, including underrepresented groups? that's just my question. >> you know, 50 years after the march on washington and the "i have a dream" speech, obviously we've made enormous strides. i'm a testament to it, you're a testament to it. the diversity of this room and the students who are here is a testimony to it. and that impulse towards making sure everybody gets a fair shot is one that found expression in the civil rights movement, but then spread to include latinos and immigrants and gays and lesbians and, you know, what's wonderful to watch is that the younger generation seems -- each generation seems wiser in terms of wanting to treat people fairly and do the right thing and not discriminate. and that's a great victory that we should all be very proud of. on the other hand, i think what we've also seen is that the legacy of discrimination, slavery, jim crow, has meant that some of the institutional barriers for success for a lot of groups still exist. african-american poverty in this country is still significantly higher than other groups. the same is true for latinos. the same is true for native americans. and even if there weren't active discrimination taking place right now, and, you know, obviously we know that some discrimination still exists, although nothing like what existed 50 years ago. but let's assume that we eliminated all the discrimination magically with a wand and everybody had goodness in their heart, you'd still have a situation in which there are a lot of folks who were poor and whose families have bec