The President:
Madam Speaker,
Vice President Biden, members of Congress, and the
American people: When I spoke here last winter, this nation
was facing the worst economic crisis since the
Great Depression. We were losing an average
of 700,000 jobs per month. Credit was frozen. And our financial system was
on the verge of collapse. 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 still many months away. And I will not let up until
those Americans who seek jobs can find them — (applause) — 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’ve taken since January, I can stand here
with confidence and say that we have pulled this economy
back from the brink. (applause) I want to thank the
members of this body for your efforts and your support in
these last several months, and especially those who’ve
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. But we did not come here
just to clean up crises. We came here to build a future. (applause) So tonight, I return
to speak to all of you about an issue that is central to that
future — and that is the issue of health care. I am not the first President
to take up this cause, but I am determined
to be the last. (applause) It has now been nearly
a century since Theodore Roosevelt first called
for health care reform. And ever since, nearly every
President and Congress, whether Democrat or Republican,
has attempted to meet this challenge in some way. A bill for comprehensive health
reform was first introduced by John Dingell Sr. in 1943. Sixty-five years later, his son
continues to introduce that same bill at the beginning
of each session. (applause) Our collective failure
to meet this challenge — year after year,
decade after decade — has led us to
the 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 can’t get
insurance on the job. Others are self-employed,
and can’t 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 too expensive to cover. We are the only democracy — the
only advanced democracy on Earth — the only wealthy nation —
that allows such hardship for millions of its people. There are now more than 30
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 for 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, you’ll 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 won’t 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 hadn’t reported gallstones that he
didn’t 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 had
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. (applause) Then there’s the
problem of rising cost. We spend one and a half times
more per person on health care than any other country, but we
aren’t any healthier for it. This is one of the reasons that
insurance premiums have gone up three times faster than wages. It’s why so many employers —
especially small businesses — are forcing their employees
to pay more for insurance, or are dropping their
coverage entirely. It’s 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 it’s why those of us with
health insurance are also paying a hidden and growing tax for
those without it — about $1,000 per year that pays for
somebody else’s 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. Nothing else. (applause) Now, 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 Canada’s — (applause) — where we would
severely restrict the private insurance market and
have the government provide coverage for everybody. On the right, there are those
who argue that we should end employer-based systems and
leave individuals to buy health insurance on their own. I’ve said — I have to say that
there are arguments to be made for both these 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 doesn’t, rather than
try to build an entirely new system from scratch. (applause) And that is precisely
what those of you in Congress have tried to do over
the past several months. During that time, we’ve
seen Washington at its best and at its worst. We’ve 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, seniors’ groups, and even drug
companies — many of whom opposed reform in the past. And there is agreement in this
chamber on about 80 percent of what needs to be done, putting
us closer to the goal of reform than we have ever been. But what we’ve also seen in
these last months is the same partisan spectacle that only
hardens the disdain many Americans have towards
their own government. Instead of honest debate,
we’ve 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. (applause) 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. Now is the time to
deliver on health care. The plan I’m announcing tonight
would meet three basic goals. It will provide more
security and stability to those who have health insurance. It will provide insurance
for those who don’t. And it will slow the growth
of health care costs for our families, our businesses,
and our government. (applause) It’s a plan that asks
everyone to take responsibility for meeting this challenge
— not just government, not just insurance companies,
but everybody including employers and individuals. And it’s 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, or Medicare, or
Medicaid, or the VA, nothing in this plan will
require you or your employer to change the coverage or
the doctor you have. (applause) Let me repeat this:
Nothing in our plan requires you to change what you have. What this plan will do
is 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 preexisting condition. (applause) 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 the most. (applause) They will no longer be
able to place some arbitrary cap on the amount of coverage
you can receive in a given year or in a lifetime. (applause) 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. (applause) And insurance companies
will be required to cover, with no extra charge,
routine checkups and preventive care, like mammograms and
colonoscopies — (applause) — because there’s no reason we
shouldn’t be catching diseases like breast cancer and colon
cancer before they get worse. That makes sense, it saves
money, and it saves lives. (applause) Now, that’s what
Americans who have health insurance can expect
from this plan — more security and more stability. Now, if you’re one of the tens
of millions of Americans who don’t currently have
health insurance, the second part of this plan
will finally offer you quality, affordable choices. (applause) If you lose your job
or you change your job, you’ll be able to get coverage. If you strike out on your own
and start a small business, you’ll be able to get coverage. We’ll 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. It’s how everyone
in this Congress gets affordable insurance. And it’s time to give every
American the same opportunity that we give ourselves. (applause) Now, for those individuals
and small businesses who still can’t afford the
lower-priced insurance available in the exchange, we’ll
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 can’t get insurance today because they
have preexisting medical conditions, we will immediately
offer low-cost coverage that will protect you
against financial ruin if you become eriously ill. (applause) This was a good idea
when Senator John McCain proposed it in the campaign,
it’s a good idea now, and we should all embrace it. (applause) Now, even if we provide these
affordable options, there may be those — especially the
young and the 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 by giving them coverage. The problem is, such
irresponsible behavior costs all the rest of us money. If there are affordable options
and people still don’t sign up for health insurance, it means
we pay for these people’s expensive emergency room visits. If some businesses don’t
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
preexisting conditions — just can’t be achieved. And that’s why under my plan,
individuals will be required to carry basic health insurance —
just as most states require you to carry auto insurance. (applause) Likewise — 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 can’t afford coverage, and 95
percent of all small businesses, because of their size
and narrow profit margin, would be exempt from
these requirements. (applause) But we can’t 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. And while there remain some
significant details to be ironed out, I believe — (laughter) — 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 that’s been spread over the past few months,
I realize – (applause) — I realize that many Americans have
grown nervous about reform. So tonight I want to address
some of the key controversies that are still out there. Some of people’s 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 by
prominent politicians, that we plan to set up panels of
bureaucrats with the power to kill off senior citizens. Now, such a charge would be
laughable if it weren’t so cynical and irresponsible. It is a lie, plain and simple. (applause) There are also those
who claim that our reform efforts would insure
illegal immigrants. This, too, is false. The reforms — the reforms I’m
proposing would not apply to those who are here illegally. Audience Member:
You lie! (Boos!) The President:
It’s not true. 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. (applause) Now, my health care
proposal has also been attacked by some who oppose reform as a
“government takeover” 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. (applause) So let me set the
record straight here. My guiding principle
is, and always has been, that consumers do better when
there is choice and competition. That’s how the market works. (applause) Unfortunately, in 34 states, 75 percent of the insurance
market is controlled by five or fewer companies. In Alabama, almost 90 percent is
controlled by just one company. And without competition,
the price of insurance goes up and 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 don’t do
this because they’re bad people; they do it because
it’s 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 “Wall Street’s
relentless profit expectations.” 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. (applause) And the insurance
reforms that I’ve 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. (applause) Now, let me be clear.
Let me be clear. It would only be an option for
those who don’t 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 percent of Americans would sign up. Despite all this, the insurance
companies and their allies don’t like this idea. They argue that these private
companies can’t fairly compete with the government. And they’d be right if taxpayers
were subsidizing this public insurance option.
But they won’t be. I’ve 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 and
excessive administrative costs and executive salaries, it
could provide a good deal for consumers, and 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. (applause) Now, it is — it’s
worth noting that a strong majority of Americans still
favor a public insurance option of the sort I’ve
proposed tonight. But its impact shouldn’t be
exaggerated — by the left or the right or the media. It is only one part of my plan,
and shouldn’t 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
available for those without it. (applause) The public option —
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. (applause) For example — for example, some have suggested that the
public option go into effect only in those markets where
insurance companies are not providing affordable policies. Others have proposed 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 can’t find
affordable coverage, we will provide
you with a choice. (applause) And I will make sure that
no government bureaucrat or insurance company bureaucrat
gets between you and the care that you need. (applause) Finally, let me discuss
an issue that is a great concern to me, to
members of this chamber, and to the public — and that’s
how we pay for this plan. And here’s 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. (applause) I will not sign it if it
adds one dime to the deficit, now or in the future, period. And to prove that I’m serious,
there will be a provision in this plan that requires us to
come forward with more spending cuts if the savings we
promised don’t materialize. (applause) Now, 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. (applause) I will not make that same
mistake with health care. Second, we’ve 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
don’t make us any healthier. That’s not my judgment —
it’s 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 seniors for a moment, because Medicare is
another issue that’s 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’s how Medicare was born. And it remains a sacred trust
that must be passed down from one generation to the next. (applause) And that is why not a
dollar of the Medicare trust fund will be used to
pay for this plan. (applause) 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 but don’t improve
the care of seniors. And we will also create an
independent commission of doctors and medical experts
charged with identifying more waste in the years ahead. (applause) Now, these steps will
ensure that you — America’s seniors — get the benefits
you’ve 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
pockets for prescription drugs. (applause) That’s what this
plan will do for you. So don’t 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 essentially have
turned Medicare into a privatized voucher program. That will not
happen on my watch. I will protect Medicare. (applause) 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. So 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. (applause) Now, 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. And 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. Now, 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. (applause) Now — there you go.
There you go. Now, I don’t believe malpractice
reform is a silver bullet, but I’ve talked to enough
doctors to know that defensive medicine may be contributing
to unnecessary costs. (applause) So I’m proposing that
we move forward on a range of ideas about how to put patient
safety first and let doctors focus on practicing medicine. (applause) I know that the Bush
administration considered authorizing demonstration
projects in individual states to test these ideas. I think it’s a good idea, and
I’m directing my Secretary of Health and Human
Services to move forward on this initiative today. (applause) Now, add it all up, and
the plan I’m proposing will cost around $900 billion over 10
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. (applause) Now, 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 1 percent each
year — one-tenth of 1 percent — it will actually reduce
the deficit by $4 trillion over the long term. Now, this is the
plan I’m proposing. It’s 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 it’s
better politics to kill this plan than to improve it. (applause) I won’t stand by while
the special interests use the same old tactics to keep
things exactly the way they are. If you misrepresent what’s in
this plan, we will call you out. (applause) And I will not — 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 the 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 halls, in e-mails, 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, his amazing children,
who are all here tonight. And he expressed confidence that
this would be the year that health care reform — “that
great unfinished business of our society,” 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 “it concerns more than material things.” “What we face,” he wrote,
“is 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.” I’ve 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, yes, sometimes angry debate.
That’s our history. For some of Ted
Kennedy’s critics, his brand of
liberalism represented an affront to American liberty. In their minds, 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
— he knows that. They worked together to provide
children with health insurance. His friend John
McCain knows that. They worked together on a
Patient’s 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
Kennedy’s 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 can’t afford it. That large-heartedness — that
concern and regard for the plight of others — is
not a partisan feeling. It’s not a Republican
or a Democratic feeling. It, too, is part of the American
character — our ability to stand in other people’s shoes; a
recognition that we are all in this together, and 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 acknowledgment that
sometimes government has to step in to help deliver
on that promise. This has always been the
history of our progress. In 1935, 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, 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 don’t merely
lose our capacity to solve big challenges. We lose something
essential about ourselves. That was true then.
It 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 that is not what
the moment calls for. That’s 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 it’s hard. (applause) I still believe — I
still believe that we can act when it’s 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 history’s test.
Because that’s 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. (applause)