As any American who is still looking for work or a way to pay their bills
will tell you, we are by no means out of the woods. A full and vibrant recovery
is many months away. And I will not let up until those Americans who seek jobs
can find them; until those businesses that seek capital and credit can thrive;
until all responsible homeowners can stay in their homes.
That is our ultimate goal. But thanks to the bold and decisive action we have
taken since January, I can stand here with confidence and say that we have
pulled this economy back from the brink.
I want to thank the members of this
body for your efforts and your support in these last several months, and
especially those who have taken the difficult votes that have put us on a path
to recovery. I also want to thank the American people for their patience and
resolve during this trying time for our nation. Our collective failure to meet this challenge – year after year, decade after
decade – has led us to a breaking point. Everyone understands the extraordinary
hardships that are placed on the uninsured, who live every day just one accident
or illness away from bankruptcy. These are not primarily people on welfare.
These are middle-class Americans. Some canft get insurance on the job.
Others are self-employed, and canft afford it, since buying insurance on your
own costs you three....
...times as much as the coverage you get from your employer. Many other
Americans who are willing and able to pay are still denied insurance due to
previous illnesses or conditions that insurance companies decide are too risky
or expensive to cover.
We are the only advanced democracy on Earth – the only
wealthy nation – that allows such hardships for millions of its people. There
are now more than thirty million American citizens who cannot get coverage. In
just a two year period, one in every three Americans goes without health care
coverage at some point. And every day, 14,000 Americans lose their
coverage. In other words, it can happen to anyone.
But the problem
that plagues the health care system is not just a problem of the uninsured.
Those who do have insurance have never had less security and stability than they
do today. More and more Americans worry that if you move, lose your job, or
change your job, youfll lose your health insurance too. More and more
Americans pay their premiums, only to discover that their insurance company has
dropped their coverage when they get sick, or wonft pay the full cost of care.
It happens every day.
One man from Illinois lost his coverage in the middle of chemotherapy because
his insurer found that he hadnft reported gallstones that he didnft even know
about. They delayed his treatment, and he died because of it. Another woman from
Texas was about to get a double mastectomy when her insurance company canceled
her policy because she forgot to declare a case of acne.
By the time she had her insurance reinstated, her breast cancer more than
doubled in size. That is heart-breaking, it is wrong, and no one should be
treated that way in the United States of America.
Then therefs the problem of rising costs. We spend one-and-a-half times more
per person on health care than any other country, but we arenft any healthier
for it. This is one of the reasons that insurance premiums have gone up three
times faster than wages. Itfs why so many employers – especially small
businesses – are forcing their employees to pay more for insurance, or are
dropping their coverage entirely.
Itfs why so many aspiring entrepreneurs cannot afford to open a business in
the first place, and why American businesses that compete internationally – like
our automakers – are at a huge disadvantage. And itfs why those of us with
health insurance are also paying a hidden and growing tax for those without it –
about $1000 per year that pays for somebody elsefs emergency room and charitable
care.
Finally, our health care system is placing an unsustainable burden on
taxpayers. When health care costs grow at the rate they have, it puts greater
pressure on programs like Medicare and Medicaid. If we do nothing to slow these
skyrocketing costs, we will eventually be spending more on Medicare and Medicaid
than every other government program combined. Put simply, our health care
problem is our deficit problem. Nothing else even comes close.
These are the facts. Nobody disputes them. We know we must reform this
system. The question is how.
There are those on the left who believe that the only way to fix the system
is through a single-payer system like Canadafs, where we would severely restrict
the private insurance market and have the government provide coverage for
everyone.
On the right, there are those who argue that we should end the employer-based
system and leave individuals to buy health insurance on their own.
I have to
say that there are arguments to be made for both approaches. But either one
would represent a radical shift that would disrupt the health care most people
currently have. Since health care represents one-sixth of our economy, I believe
it makes more sense to build on what works and fix what doesnft, rather than try
to build an entirely new system from scratch. And that is precisely what those
of you in Congress have tried to do over the past several months.
During
that time, we have seen Washington at its best and its worst.
We have seen many in this chamber work tirelessly for the better part of this
year to offer thoughtful ideas about how to achieve reform. Of the five
committees asked to develop bills, four have completed their work, and the
Senate Finance Committee announced today that it will move forward next week.
That has never happened before.
Our overall efforts have been supported by an unprecedented coalition of
doctors and nurses; hospitals, seniorsf groups and even drug companies – many of
whom opposed reform in the past. And there is agreement in this chamber on
about eighty percent of what needs to be done, putting us closer to the goal of
reform than we have ever been.
But what we have also seen in these last
months is the same partisan spectacle that only hardens the disdain many
Americans have toward their own government. Instead of honest debate, we
have seen scare tactics. Some have dug into unyielding ideological camps
that offer no hope of compromise. Too many have used this as an opportunity to
score short-term political points, even if it robs the country of our
opportunity to solve a long-term challenge. And out of this blizzard of charges
and counter-charges, confusion has reigned.
Well the time for bickering
is over. The time for games has passed. Now is the season for action. Now is
when we must bring the best ideas of both parties together, and show the
American people that we can still do what we were sent here to do. Now is the
time to deliver on health care.
The plan Ifm announcing tonight would meet three basic goals:
It will provide more security and stability to those who have health
insurance. It will provide insurance to those who donft. And it will slow the
growth of health care costs for our families, our businesses, and our
government.
Itfs a plan that asks everyone to take responsibility for meeting this
challenge – not just government and insurance companies, but employers and
individuals. And itfs a plan that incorporates ideas from Senators and
Congressmen; from Democrats and Republicans – and yes, from some of my opponents
in both the primary and general election.
Here are the details that every
American needs to know about this plan:
First, if you are among the
hundreds of millions of Americans who already have health insurance through your
job, Medicare, Medicaid, or the VA, nothing in this plan will require you or
your employer to change the coverage or the doctor you have. Let me repeat this:
nothing in our plan requires you to change what you have.
What this plan will do is to make the insurance you have work better for
you. Under this plan, it will be against the law for insurance companies
to deny you coverage because of a pre-existing condition. As soon as I
sign this bill, it will be against the law for insurance companies to drop your
coverage when you get sick or water it down when you need it most.
They will no longer be able to place some arbitrary cap on the amount of
coverage you can receive in a given year or a lifetime. We will place a
limit on how much you can be charged for out-of-pocket expenses, because in the
United States of America, no one should go broke because they get sick.
And insurance companies will be required to cover, with no extra charge, routine
checkups and preventive care, like mammograms and colonoscopies – because
therefs no reason we shouldnft be catching diseases like breast cancer and colon
cancer before they get worse. That makes sense, it saves money, and it
saves lives.
Thatfs what Americans who have health insurance can expect from
this plan – more security and stability.
Now, if youfre one of the tens of millions of Americans who donft currently
have health insurance, the second part of this plan will finally offer you
quality, affordable choices. If you lose your job or change your job, you will
be able to get coverage. If you strike out on your own and start a small
business, you will be able to get coverage. We will do this by creating a
new insurance exchange – a marketplace where individuals and small businesses
will be able to shop for health insurance at competitive prices.
Insurance companies will have an incentive to participate in this exchange
because it lets them compete for millions of new customers. As one big
group, these customers will have greater leverage to bargain with the insurance
companies for better prices and quality coverage. This is how large
companies and government employees get affordable insurance. Itfs how
everyone in this Congress gets affordable insurance. And itfs time to give
every American the same opportunity that wefve given ourselves.
For those individuals and small businesses who still cannot afford the
lower-priced insurance available in the exchange, we will provide tax credits,
the size of which will be based on your need. And all insurance companies
that want access to this new marketplace will have to abide by the consumer
protections I already mentioned.
This exchange will take effect in four years, which will give us time to do
it right. In the meantime, for those Americans who canft get insurance
today because they have pre-existing medical conditions, we will immediately
offer low-cost coverage that will protect you against financial ruin if you
become seriously ill. This was a good idea when Senator John McCain
proposed it in the campaign, itfs a good idea now, and we should embrace it.
Now, even if we provide these affordable options, there may be those –
particularly the young and healthy – who still want to take the risk and go
without coverage. There may still be companies that refuse to do right by
their workers. The problem is, such irresponsible behavior costs all the
rest of us money. If there are affordable options and people still donft
sign up for health insurance, it means we pay for those peoplefs expensive
emergency room visits.
If some businesses donft provide workers health care, it forces the rest of
us to pick up the tab when their workers get sick, and gives those businesses an
unfair advantage over their competitors. And unless everybody does their
part, many of the insurance reforms we seek – especially requiring insurance
companies to cover pre-existing conditions – just canft be achieved.
Thatfs why under my plan, individuals will be required to carry basic health
insurance – just as most states require you to carry auto insurance.
Likewise, businesses will be required to either offer their workers health care,
or chip in to help cover the cost of their workers. There will be a
hardship waiver for those individuals who still cannot afford coverage, and 95%
of all small businesses, because of their size and narrow profit margin, would
be exempt from these requirements.
But we cannot have large businesses and individuals who can afford coverage
game the system by avoiding responsibility to themselves or their
employees. Improving our health care system only works if everybody does
their part.
While there remain some significant details to be ironed out, I
believe a broad consensus exists for the aspects of the plan I just outlined:
consumer protections for those with insurance, an exchange that allows
individuals and small businesses to purchase affordable coverage, and a
requirement that people who can afford insurance get insurance.
And I have no doubt that these reforms would greatly benefit Americans
from all walks of life, as well as the economy as a whole. Still, given
all the misinformation thatfs been spread over the past few months, I realize
that many Americans have grown nervous about reform. So tonight Ifd like
to address some of the key controversies that are still out there.
Some of peoplefs concerns have grown out of bogus claims spread by those
whose only agenda is to kill reform at any cost. The best example is the
claim, made not just by radio and cable talk show hosts, but prominent
politicians, that we plan to set up panels of bureaucrats with the power to kill
off senior citizens. Such a charge would be laughable if it werenft so
cynical and irresponsible. It is a lie, plain and simple.
There
are also those who claim that our reform effort will insure illegal
immigrants. This, too, is false – the reforms Ifm proposing would not
apply to those who are here illegally. And one more misunderstanding I
want to clear up – under our plan, no federal dollars will be used to fund
abortions, and federal conscience laws will remain in place.
My
health care proposal has also been attacked by some who oppose reform as a
ggovernment takeoverh of the entire health care system. As proof, critics point
to a provision in our plan that allows the uninsured and small businesses to
choose a publicly-sponsored insurance option, administered by the government
just like Medicaid or Medicare.
So let me set the record straight. My guiding principle is, and always has
been, that consumers do better when there is choice and competition.
Unfortunately, in 34 states, 75% of the insurance market is controlled by five
or fewer companies. In Alabama, almost 90% is controlled by just one
company. Without competition, the price of insurance goes up and the
quality goes down.
And it makes it easier for insurance companies to treat their customers badly
– by cherry-picking the healthiest individuals and trying to drop the sickest;
by overcharging small businesses who have no leverage; and by jacking up
rates.
Insurance executives donft do this because they are bad people. They
do it because itfs profitable. As one former insurance executive testified
before Congress, insurance companies are not only encouraged to find reasons to
drop the seriously ill; they are rewarded for it. All of this is in
service of meeting what this former executive called gWall Streetfs relentless
profit expectations.h
Now, I have no interest in putting insurance companies out of business.
They provide a legitimate service, and employ a lot of our friends and
neighbors. I just want to hold them accountable. The insurance
reforms that Ifve already mentioned would do just that. But an additional
step we can take to keep insurance companies honest is by making a
not-for-profit public option available in the insurance exchange.
Let me be clear – it would only be an option for those who donft have
insurance. No one would be forced to choose it, and it would not impact
those of you who already have insurance. In fact, based on Congressional
Budget Office estimates, we believe that less than 5% of Americans would sign
up.
Despite all this, the insurance companies and their allies donft like this
idea. They argue that these private companies canft fairly compete with
the government. And theyfd be right if taxpayers were subsidizing this
public insurance option. But they wonft be. I have insisted that
like any private insurance company, the public insurance option would have to be
self-sufficient and rely on the premiums it collects.
But by avoiding some of the overhead that gets eaten up at private companies
by profits, excessive administrative costs and executive salaries, it could
provide a good deal for consumers. It would also keep pressure on private
insurers to keep their policies affordable and treat their customers better, the
same way public colleges and universities provide additional choice and
competition to students without in any way inhibiting a vibrant system of
private colleges and universities.
Itfs worth noting that a strong majority of Americans still favor a public
insurance option of the sort Ifve proposed tonight. But its impact
shouldnft be exaggerated – by the left, the right, or the media. It is
only one part of my plan, and should not be used as a handy excuse for the usual
Washington ideological battles.
To my progressive friends, I would remind you that for decades, the driving
idea behind reform has been to end insurance company abuses and make coverage
affordable for those without it. The public option is only a means to that
end – and we should remain open to other ideas that accomplish our ultimate
goal. And to my Republican friends, I say that rather than making wild
claims about a government takeover of health care, we should work together to
address any legitimate concerns you may have.
For example, some have suggested that that the public option go into effect
only in those markets where insurance companies are not providing affordable
policies. Others propose a co-op or another non-profit entity to
administer the plan. These are all constructive ideas worth
exploring. But I will not back down on the basic principle that if
Americans canft find affordable coverage, we will provide you with a
choice. And I will make sure that no government bureaucrat or insurance
company bureaucrat gets between you and the care that you need.
Finally, let me discuss an issue that is a great concern to me, to members
of this chamber, and to the public – and that is how we pay for this plan.
Herefs what you need to know. First, I will not sign a plan that adds
one dime to our deficits – either now or in the future. Period. And
to prove that Ifm serious, there will be a provision in this plan that requires
us to come forward with more spending cuts if the savings we promised donft
materialize.
Part of the reason I faced a trillion dollar deficit when I walked in the
door of the White House is because too many initiatives over the last decade
were not paid for – from the Iraq War to tax breaks for the wealthy. I
will not make that same mistake with health care.
Second, wefve estimated that most of this plan can be paid for by finding
savings within the existing health care system – a system that is currently full
of waste and abuse. Right now, too much of the hard-earned savings and tax
dollars we spend on health care doesnft make us healthier. Thatfs not my
judgment – itfs the judgment of medical professionals across this country. And
this is also true when it comes to Medicare and Medicaid.
In fact, I want to speak directly to Americafs seniors for a moment, because
Medicare is another issue thatfs been subjected to demagoguery and distortion
during the course of this debate.
More than four decades ago, this nation
stood up for the principle that after a lifetime of hard work, our seniors
should not be left to struggle with a pile of medical bills in their later
years. That is how Medicare was born. And it remains a sacred trust
that must be passed down from one generation to the next. That is why not
a dollar of the Medicare trust fund will be used to pay for this plan.
The only thing this plan would eliminate is the hundreds of billions of
dollars in waste and fraud, as well as unwarranted subsidies in Medicare that go
to insurance companies – subsidies that do everything to pad their profits and
nothing to improve your care. And we will also create an independent
commission of doctors and medical experts charged with identifying more waste in
the years ahead.
These steps will ensure that you – Americafs seniors – get the benefits
youfve been promised. They will ensure that Medicare is there for future
generations. And we can use some of the savings to fill the gap in
coverage that forces too many seniors to pay thousands of dollars a year out of
their own pocket for prescription drugs.
Thatfs what this plan will do for you. So donft pay attention to
those scary stories about how your benefits will be cut – especially since some
of the same folks who are spreading these tall tales have fought against
Medicare in the past, and just this year supported a budget that would have
essentially turned Medicare into a privatized voucher program. That will
never happen on my watch. I will protect Medicare.
Now, because Medicare is such a big part of the health care system, making
the program more efficient can help usher in changes in the way we deliver
health care that can reduce costs for everybody. We have long known that
some places, like the Intermountain Healthcare in Utah or the Geisinger Health
System in rural Pennsylvania, offer high-quality care at costs below
average.
The commission can help encourage the adoption of these common-sense best
practices by doctors and medical professionals throughout the system –
everything from reducing hospital infection rates to encouraging better
coordination between teams of doctors.
Reducing the waste and inefficiency in Medicare and Medicaid will pay for
most of this plan. Much of the rest would be paid for with revenues from
the very same drug and insurance companies that stand to benefit from tens of
millions of new customers.
This reform will charge insurance companies a fee for their most expensive
policies, which will encourage them to provide greater value for the money – an
idea which has the support of Democratic and Republican experts. And
according to these same experts, this modest change could help hold down the
cost of health care for all of us in the long-run.
Finally, many in this chamber – particularly on the Republican side of the
aisle – have long insisted that reforming our medical malpractice laws can help
bring down the cost of health care. I don't believe malpractice reform is
a silver bullet, but I have talked to enough doctors to know that defensive
medicine may be contributing to unnecessary costs.
So I am proposing that we move forward on a range of ideas about how to put
patient safety first and let doctors focus on practicing medicine. I know
that the Bush Administration considered authorizing demonstration projects in
individual states to test these issues. Itfs a good idea, and I am directing my
Secretary of Health and Human Services to move forward on this initiative
today.
Add it all up, and the plan Ifm proposing will cost around $900 billion over
ten years – less than we have spent on the Iraq and Afghanistan wars, and less
than the tax cuts for the wealthiest few Americans that Congress passed at the
beginning of the previous administration.
Most of these costs will be paid for with money already being spent – but
spent badly – in the existing health care system. The plan will not add to
our deficit. The middle-class will realize greater security, not higher
taxes. And if we are able to slow the growth of health care costs by just
one-tenth of one percent each year, it will actually reduce the deficit by $4
trillion over the long term.
This is the plan Ifm proposing. Itfs a plan
that incorporates ideas from many of the people in this room tonight – Democrats
and Republicans. And I will continue to seek common ground in the weeks
ahead. If you come to me with a serious set of proposals, I will be there
to listen. My door is always open.
But know this: I will not waste
time with those who have made the calculation that itfs better politics to kill
this plan than improve it. I will not stand by while the special interests use
the same old tactics to keep things exactly the way they are. If you
misrepresent whatfs in the plan, we will call you out. And I will not
accept the status quo as a solution. Not this time. Not now.
Everyone in
this room knows what will happen if we do nothing. Our deficit will grow. More
families will go bankrupt. More businesses will close. More Americans will
lose their coverage when they are sick and need it most. And more will die
as a result. We know these things to be true.
That is why we cannot
fail. Because there are too many Americans counting on us to succeed – the
ones who suffer silently, and the ones who shared their stories with us at town
hall meetings, in emails, and in letters.
I received one of those letters
a few days ago. It was from our beloved friend and colleague, Ted Kennedy.
He had written it back in May, shortly after he was told that his illness was
terminal. He asked that it be delivered upon his death.
In it, he spoke about what a happy time his last months were, thanks to the
love and support of family and friends, his wife, Vicki, and his children, who
are here tonight . And he expressed confidence that this would be the year
that health care reform – gthat great unfinished business of our society,h he
called it – would finally pass.
He repeated the truth that health care is decisive for our future prosperity,
but he also reminded me that git concerns more than material things.h
gWhat we face,h he wrote, gis above all a moral issue; at stake are not just the
details of policy, but fundamental principles of social justice and the
character of our country.h
Ifve thought about that phrase quite a bit in
recent days – the character of our country. One of the unique and wonderful
things about America has always been our self-reliance, our rugged
individualism, our fierce defense of freedom and our healthy skepticism of
government. And figuring out the appropriate size and role of government has
always been a source of rigorous and sometimes angry debate.
For some of Ted Kennedyfs critics, his brand of liberalism represented
an affront to American liberty. In their mind, his passion for universal
health care was nothing more than a passion for big government.
But
those of us who knew Teddy and worked with him here – people of both parties –
know that what drove him was something more. His friend, Orrin Hatch, knows
that. They worked together to provide children with health insurance. His
friend John McCain knows that. They worked together on a Patientfs Bill of
Rights. His friend Chuck Grassley knows that. They worked together to
provide health care to children with disabilities.
On issues like these,
Ted Kennedyfs passion was born not of some rigid ideology, but of his own
experience. It was the experience of having two children stricken with
cancer. He never forgot the sheer terror and helplessness that any parent
feels when a child is badly sick; and he was able to imagine what it must be
like for those without insurance; what it would be like to have to say to a wife
or a child or an aging parent – there is something that could make you better,
but I just canft afford it.
That large-heartedness – that concern and regard for the plight of others –
is not a partisan feeling. It is not a Republican or a Democratic
feeling. It, too, is part of the American character. Our ability to
stand in other peoplefs shoes. A recognition that we are all in this
together; that when fortune turns against one of us, others are there to lend a
helping hand.
A belief that in this country, hard work and responsibility should be
rewarded by some measure of security and fair play; and an acknowledgement that
sometimes government has to step in to help deliver on that promise.
This has always been the history of our progress. In 1933, when over
half of our seniors could not support themselves and millions had seen their
savings wiped away, there were those who argued that Social Security would lead
to socialism. But the men and women of Congress stood fast, and we are all the
better for it.
In 1965, when some argued that Medicare represented a government takeover of
health care, members of Congress, Democrats and Republicans, did not back
down. They joined together so that all of us could enter our golden years
with some basic peace of mind.
You see, our predecessors understood that government could not, and should
not, solve every problem. They understood that there are instances when
the gains in security from government action are not worth the added constraints
on our freedom.
But they also understood that the danger of too much government is matched by
the perils of too little; that without the leavening hand of wise policy,
markets can crash, monopolies can stifle competition, and the vulnerable can be
exploited.
And they knew that when any government measure, no matter how carefully
crafted or beneficial, is subject to scorn; when any efforts to help people in
need are attacked as un-American; when facts and reason are thrown overboard and
only timidity passes for wisdom, and we can no longer even engage in a civil
conversation with each other over the things that truly matter – that at that
point we donft merely lose our capacity to solve big challenges. We lose
something essential about ourselves.
What was true then remains true
today. I understand how difficult this health care debate has been.
I know that many in this country are deeply skeptical that government is looking
out for them. I understand that the politically safe move would be to kick
the can further down the road – to defer reform one more year, or one more
election, or one more term.
But thatfs not what the moment calls
for. Thatfs not what we came here to do. We did not come to fear the
future. We came here to shape it. I still believe we can act even
when itfs hard. I still believe we can replace acrimony with civility, and
gridlock with progress. I still believe we can do great things, and that
here and now we will meet historyfs test.
Because that is who we are. That is our calling. That is our
character. Thank you, God Bless You, and may God Bless the United States
of America. ###