The Legion Of Light

Madame Speaker, Vice President Biden, Members of Congress, and the Americanpeople:

When I spoke here last winter, this nation was facing the worst economic crisissince the Great Depression. We were losing an average of 700,000 jobs permonth. Credit was frozen. And our financial system was on the verge ofcollapse.

As any American who is still looking for work or a way to pay their bills willtell you, we are by no means out of the woods. A full and vibrant recovery ismany months away. And I will not let up until those Americans who seek jobs canfind them; until those businesses that seek capital and credit can thrive;until all responsible homeowners can stay in their homes. That is our ultimategoal. But thanks to the bold and decisive action we have taken since January, Ican stand here with confidence and say that we have pulled this economy backfrom the brink.

I want to thank the members of this body for your efforts and your support inthese last several months, and especially those who have taken the difficultvotes that have put us on a path to recovery. I also want to thank the Americanpeople for their patience and resolve during this trying time for our nation.

CBSNews.com Special Report:Health Care

But we did not come here just to clean up crises. We came to build a future. Sotonight, I return to speak to all of you about an issue that is central to thatfuture - and that is the issue of health care.

I am not the first President to take up this cause, but I am determined to bethe last. It has now been nearly a century since Theodore Roosevelt firstcalled for health care reform. And ever since, nearly every President andCongress, whether Democrat or Republican, has attempted to meet this challengein some way. A bill for comprehensive health reform was first introduced byJohn Dingell Sr. in 1943. Sixty-five years later, his son continues tointroduce that same bill at the beginning of each session.

Our collective failure to meet this challenge - year after year, decade afterdecade - has led us to a breaking point. Everyone understands the extraordinaryhardships that are placed on the uninsured, who live every day just oneaccident or illness away from bankruptcy. These are not primarily people onwelfare. 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 yourown 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 insurancedue to previous illnesses or conditions that insurance companies decide are toorisky or expensive to cover.

We are the only advanced democracy on Earth - the only wealthy nation - thatallows such hardships for millions of its people. There are now more thanthirty million American citizens who cannot get coverage. In just a two yearperiod, one in every three Americans goes without health care coverage at somepoint. And every day, 14,000 Americans lose their coverage. In other words, itcan happen to anyone.

Butthe problem that plagues the health care system is not just a problem of theuninsured. Those who do have insurance have never had less security andstability 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. Moreand more Americans pay their premiums, only to discover that their insurancecompany has dropped their coverage when they get sick, or won't pay the fullcost of care. It happens every day.

One man from Illinois lost his coverage in the middle of chemotherapy becausehis insurer found that he hadn't reported gallstones that he didn't even knowabout. They delayed his treatment, and he died because of it. Another womanfrom Texas was about to get a double mastectomy when her insurance companycanceled her policy because she forgot to declare a case of acne. By the timeshe 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 inthe United States of America.

Then there's the problem of rising costs. We spend one-and-a-half times moreper person on health care than any other country, but we aren't any healthierfor it. This is one of the reasons that insurance premiums have gone up threetimes faster than wages. It's why so many employers - especially smallbusinesses - are forcing their employees to pay more for insurance, or aredropping their coverage entirely. It's why so many aspiring entrepreneurscannot afford to open a business in the first place, and why Americanbusinesses 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 andgrowing tax for those without it - about $1000 per year that pays for somebodyelse's emergency room and charitable care.

Finally, our health care system is placing an unsustainable burden ontaxpayers. When health care costs grow at the rate they have, it puts greaterpressure on programs like Medicare and Medicaid. If we do nothing to slow theseskyrocketing costs, we will eventually be spending more on Medicare andMedicaid than every other government program combined. Put simply, our healthcare 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 isthrough a single-payer system like Canada's, where we would severely restrictthe private insurance market and have the government provide coverage foreveryone. On the right, there are those who argue that we should end theemployer-based system and leave individuals to buy health insurance on theirown.

I have to say that there are arguments to be made for both approaches. Buteither one would represent a radical shift that would disrupt the health caremost people currently have. Since health care represents one-sixth of oureconomy, I believe it makes more sense to build on what works and fix whatdoesn't, rather than try to build an entirely new system from scratch. And thatis precisely what those of you in Congress have tried to do over the pastseveral 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 thisyear to offer thoughtful ideas about how to achieve reform. Of the fivecommittees asked to develop bills, four have completed their work, and theSenate Finance Committee announced today that it will move forward next week.That has never happened before. Our overall efforts have been supported by anunprecedented coalition of doctors and nurses; hospitals, seniors' groups andeven drug companies - many of whom opposed reform in the past. And there isagreement 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 spectaclethat only hardens the disdain many Americans have toward their own government.Instead of honest debate, we have seen scare tactics. Some have dug intounyielding ideological camps that offer no hope of compromise. Too many haveused this as an opportunity to score short-term political points, even if itrobs the country of our opportunity to solve a long-term challenge. And out ofthis blizzard of charges and counter-charges, confusion has reigned.

Well the time for bickering is over. The time for games has passed. Now is theseason for action. Now is when we must bring the best ideas of both partiestogether, and show the American people that we can still do what we were senthere to do. 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 to those who don't. And it will slow the growth ofhealth care costs for our families, our businesses, and our government. It's aplan that asks everyone to take responsibility for meeting this challenge - notjust government and insurance companies, but employers and individuals. Andit's a plan that incorporates ideas from Senators and Congressmen; fromDemocrats and Republicans - and yes, from some of my opponents in both theprimary 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 havehealth insurance through your job, Medicare, Medicaid, or the VA, nothing inthis plan will require you or your employer to change the coverage or thedoctor you have. Let me repeat this: nothing in our plan requires you to changewhat 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 youcoverage because of a pre-existing condition. As soon as I sign this bill, itwill be against the law for insurance companies to drop your coverage when you

getsick or water it down when you need it most. They will no longer be able toplace some arbitrary cap on the amount of coverage you can receive in a givenyear or a lifetime. We will place a limit on how much you can be charged forout-of-pocket expenses, because in the United States of America, no one should gobroke because they get sick. And insurance companies will be required to cover,with no extra charge, routine checkups and preventive care, like mammograms andcolonoscopies - because there's no reason we shouldn't be catching diseaseslike breast cancer and colon cancer before they get worse. That makes sense, itsaves money, and it saves lives.

That's what Americans who have health insurance can expect from this plan -more security and stability.

Now, if you're one of the tens of millions of Americans who don't currentlyhave health insurance, the second part of this plan will finally offer youquality, affordable choices. If you lose your job or change your job, you willbe 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 insuranceexchange - a marketplace where individuals and small businesses will be able toshop for health insurance at competitive prices. Insurance companies will havean incentive to participate in this exchange because it lets them compete formillions of new customers. As one big group, these customers will have greaterleverage to bargain with the insurance companies for better prices and qualitycoverage. This is how large companies and government employees get affordableinsurance. It's how everyone in this Congress gets affordable insurance. Andit's time to give every American the same opportunity that we've givenourselves.

For those individuals and small businesses who still cannot afford thelower-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 thatwant access to this new marketplace will have to abide by the consumer protectionsI already mentioned. This exchange will take effect in four years, which willgive us time to do it right. In the meantime, for those Americans who can't getinsurance today because they have pre-existing medical conditions, we willimmediately offer low-cost coverage that will protect you against financialruin if you become seriously ill. This was a good idea when Senator John McCainproposed it in the campaign, it's 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 gowithout coverage. There may still be companies that refuse to do right by theirworkers. The problem is, such irresponsible behavior costs all the rest of usmoney. If there are affordable options and people still don't sign up forhealth insurance, it means we pay for those people's expensive emergency roomvisits. If some businesses don't provide workers health care, it forces therest of us to pick up the tab when their workers get sick, and gives thosebusinesses an unfair advantage over their competitors. And unless everybodydoes their part, many of the insurance reforms we seek - especially requiringinsurance companies to cover pre-existing conditions - just can't be achieved.

That's why under my plan, individuals will be required to carry basic healthinsurance - just as most states require you to carry auto insurance. Likewise,businesses will be required to either offer their workers health care, or chipin to help cover the cost of their workers. There will be a hardship waiver forthose individuals who still cannot afford coverage, and 95% of all smallbusinesses, because of their size and narrow profit margin, would be exemptfrom these requirements. But we cannot have large businesses and individualswho can afford coverage game the system by avoiding responsibility tothemselves or their employees. Improving our health care system only works ifeverybody does their part.

While there remain some significant details to be ironed out, I believe a broadconsensus exists for the aspects of the plan I just outlined: consumerprotections for those with insurance, an exchange that allows individuals andsmall businesses to purchase affordable coverage, and a requirement that peoplewho can afford insurance get insurance.

And I have no doubt that these reforms would greatly benefit Americans from allwalks of life, as well as the economy as a whole. Still, given all themisinformation that's been spread over the past few months, I realize that manyAmericans have grown nervous about reform. So tonight I'd like to address someof the key controversies that are still out there.

Some of people's concerns have grown out of bogus claims spread by those whoseonly agenda is to kill reform at any cost. The best example is the claim, madenot just by radio and cable talk show hosts, but prominent politicians, that weplan to set up panels of bureaucrats with the power to kill off seniorcitizens. Such a charge would be laughable if it weren't so cynical andirresponsible. It is a lie, plain and simple.

There are also those who claim that our reform effort will insure illegalimmigrants. This, too, is false - the reforms I'm proposing would not apply tothose 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, andfederal conscience laws will remain in place.

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 smallbusinesses to choose a publicly-sponsored insurance option, administered by thegovernment just like Medicaid or Medicare.

So let me set the record straight. My guiding principle is, and always hasbeen, that consumers do better when there is choice and competition.Unfortunately, in 34 states, 75% of the insurance market is controlled by fiveor 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; byovercharging small businesses who have no leverage; and by jacking up rates.

Insurance executives don't do this because they are bad people. They do itbecause it's profitable. As one former insurance executive testified beforeCongress, insurance companies are not only encouraged to find reasons to dropthe seriously ill; they are rewarded for it. All of this is in service ofmeeting what this former executive called "Wall Street's relentless profitexpectations."

Now, I have no interest in putting insurance companies out of business. Theyprovide a legitimate service, and employ a lot of our friends and neighbors. Ijust want to hold them accountable. The insurance reforms that I've alreadymentioned would do just that. But an additional step we can take to keepinsurance companies honest is by making a not-for-profit public optionavailable in the insurance exchange. Let me be clear - it would only be anoption 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, basedon Congressional Budget Office estimates, we believe that less than 5% ofAmericans would sign up.

Despite all this, the insurance companies and their allies don't like thisidea. They argue that these private companies can't fairly compete with thegovernment. And they'd be right if taxpayers were subsidizing this publicinsurance option. But they won't be. I have insisted that like any privateinsurance company, the public insurance option would have to be self-sufficientand rely on the premiums it collects. But by avoiding some of the overhead thatgets eaten up at private companies by profits, excessive administrative costs andexecutive salaries, it could provide a good deal for consumers. It would alsokeep pressure on private insurers to keep their policies affordable and treattheir customers better, the same way public colleges and universities provideadditional choice and competition to students without in any way inhibiting avibrant system of private colleges and universities.

It's worth noting that a strong majority of Americans still favor a publicinsurance option of the sort I've proposed tonight. But its impact shouldn't beexaggerated - by the left, the right, or the media. It is only one part of myplan, and should not be used as a handy excuse for the usual Washingtonideological battles. To my progressive friends, I would remind you that fordecades, the driving idea behind reform has been to end insurance companyabuses and make coverage affordable for those without it. The public option isonly a means to that end - and we should remain open to other ideas thataccomplish our ultimate goal. And to my Republican friends, I say that ratherthan making wild claims about a government takeover of health care, we shouldwork together to address any legitimate concerns you may have.

For example, some have suggested that that the public option go into effectonly in those markets where insurance companies are not providing affordablepolicies. Others propose a co-op or another non-profit entity to administer theplan. These are all constructive ideas worth exploring. But I will not backdown on the basic principle that if Americans can't find affordable coverage,we will provide you with a choice. And I will make sure that no governmentbureaucrat or insurance company bureaucrat gets between you and the care thatyou need.

Finally, let me discuss an issue that is a great concern to me, to members ofthis chamber, and to the public - and that is how we pay for this plan.

Here'swhat you need to know. First, I will not sign a plan that adds one dime to ourdeficits - either 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 withmore spending cuts if the savings we promised don't materialize. Part of thereason I faced a trillion dollar deficit when I walked in the door of the WhiteHouse 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 samemistake with health care.

Second, we've estimated that most of this plan can be paid for by finding savingswithin the existing health care system - a system that is currently full ofwaste and abuse. Right now, too much of the hard-earned savings and tax dollarswe spend on health care doesn't make us healthier. That's not my judgment -it's the judgment of medical professionals across this country. And this isalso true when it comes to Medicare and Medicaid.

In fact, I want to speak directly to America's seniors for a moment, becauseMedicare is another issue that's been subjected to demagoguery and distortionduring the course of this debate.

More than four decades ago, this nation stood up for the principle that after alifetime of hard work, our seniors should not be left to struggle with a pileof medical bills in their later years. That is how Medicare was born. And itremains a sacred trust that must be passed down from one generation to thenext. That is why not a dollar of the Medicare trust fund will be used to payfor this plan.

The only thing this plan would eliminate is the hundreds of billions of dollarsin waste and fraud, as well as unwarranted subsidies in Medicare that go toinsurance companies - subsidies that do everything to pad their profits andnothing to improve your care. And we will also create an independent commissionof doctors and medical experts charged with identifying more waste in the yearsahead.

These steps will ensure that you - America's seniors - get the benefits you'vebeen 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 toomany seniors to pay thousands of dollars a year out of their own pocket forprescription drugs. That's what this plan will do for you. So don't payattention to those scary stories about how your benefits will be cut -especially since some of the same folks who are spreading these tall tales havefought against Medicare in the past, and just this year supported a budget thatwould have essentially turned Medicare into a privatized voucher program. Thatwill never happen on my watch. I will protect Medicare.

Now, because Medicare is such a big part of the health care system, making theprogram more efficient can help usher in changes in the way we deliver healthcare that can reduce costs for everybody. We have long known that some places,like the Intermountain Healthcare in Utah or the Geisinger Health System inrural Pennsylvania, offer high-quality care at costs below average. Thecommission can help encourage the adoption of these common-sense best practicesby doctors and medical professionals throughout the system - everything fromreducing hospital infection rates to encouraging better coordination betweenteams of doctors.

Reducing the waste and inefficiency in Medicare and Medicaid will pay for mostof this plan. Much of the rest would be paid for with revenues from the verysame drug and insurance companies that stand to benefit from tens of millionsof new customers. This reform will charge insurance companies a fee for theirmost expensive policies, which will encourage them to provide greater value forthe money - an idea which has the support of Democratic and Republican experts.And according to these same experts, this modest change could help hold downthe cost of health care for all of us in the long-run.

Finally, many in this chamber - particularly on the Republican side of theaisle - have long insisted that reforming our medical malpractice laws can helpbring down the cost of health care. I don't believe malpractice reform is asilver bullet, but I have talked to enough doctors to know that defensivemedicine may be contributing to unnecessary costs. So I am proposing that wemove forward on a range of ideas about how to put patient safety first and letdoctors focus on practicing medicine. I know that the Bush Administrationconsidered authorizing demonstration projects in individual states to testthese issues. It's a good idea, and I am directing my Secretary of Health andHuman Services to move forward on this initiative today.

Add it all up, and the plan I'm proposing will cost around $900 billion overten years - less than we have spent on the Iraq and Afghanistan wars, and lessthan the tax cuts for the wealthiest few Americans that Congress passed at thebeginning of the previous administration. Most of these costs will be paid forwith money already being spent - but spent badly - in the existing health caresystem. The plan will not add to our deficit. The middle-class will realizegreater security, not higher taxes. And if we are able to slow the growth ofhealth care costs by just one-tenth of one percent each year, it will actuallyreduce the deficit by $4 trillion over the long term.

This is the plan I'm proposing. It's a plan that incorporates ideas from many ofthe people in this room tonight - Democrats and Republicans. And I willcontinue to seek common ground in the weeks ahead. If you come to me with aserious 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 calculationthat it's better politics to kill this plan than improve it. I will not standby while the special interests use the same old tactics to keep things exactlythe way they are. If you misrepresent what's 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 willgrow. More families will go bankrupt. More businesses will close. MoreAmericans will lose their coverage when they are sick and need it most. Andmore 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 usto succeed - the ones who suffer silently, and the ones who shared theirstories 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 friendand colleague, Ted Kennedy. He had written it back in May, shortly after he wastold that his illness was terminal. He asked that it be delivered upon hisdeath.

In it, he spoke about what a happy time his last months were, thanks to thelove and support of family and friends, his wife, Vicki, and his children, whoare here tonight . And he expressed confidence that this would be the year thathealth care reform - "that great unfinished business of our society,"he called it - would finally pass. He repeated the truth that health care isdecisive for our future prosperity, but he also reminded me that "itconcerns 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 ourcountry."

I've thought about that phrase quite a bit in recent days - the character ofour country. One of the unique and wonderful things about America has alwaysbeen our self-reliance, our rugged individualism, our fierce defense of freedomand our healthy skepticism of government. And figuring out the appropriate sizeand role of government has always been a source of rigorous and sometimes angrydebate.

For some of Ted Kennedy's critics, his brand of liberalism represented anaffront to American liberty. In their mind, his passion for universal healthcare was nothing more than a passion for big government.

But those of us who knew Teddy and worked with him here - people of bothparties - know that what drove him was something more. His friend, Orrin Hatch,knows that. They worked together to provide children with health insurance. Hisfriend John McCain knows that. They worked together on a Patient's Bill ofRights. His friend Chuck Grassley knows that. They worked together to providehealth care to children with disabilities.

On issues like these, Ted Kennedy's passion was born not of some rigidideology, but of his own experience. It was the experience of having twochildren stricken with cancer. He never forgot the sheer terror andhelplessness that any parent feels when a child is badly sick; and he was ableto imagine what it must be like for those without insurance; what it would belike to have to say to a wife or a child or an aging parent - there issomething that could make you better, but I just can't afford it.

That large-heartedness - that concern and regard for the plight of others - isnot 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 people'sshoes. A recognition that we are all in this together; that when fortune turnsagainst one of us, others are there to lend a helping hand. A belief that inthis country, hard work and responsibility should be rewarded by some measureof security and fair play; and an acknowledgement that sometimes government hasto 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 hadseen their savings wiped away, there were those who argued that Social Securitywould lead to socialism. But the men and women of Congress stood fast, and weare all the better for it. In 1965, when some argued that Medicare representeda government takeover of health care, members of Congress, Democrats andRepublicans, did not back down. They joined together so that all of us couldenter 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 insecurity from government action are not worth the added constraints on ourfreedom. But they also understood that the danger of too much government ismatched by the perils of too little; that without the leavening hand of wisepolicy, markets can crash, monopolies can stifle competition, and thevulnerable can be exploited. And they knew that when any government measure, nomatter how carefully crafted or beneficial, is subject to scorn; when anyefforts to help people in need are attacked as un-American; when facts andreason are thrown overboard and only timidity passes for wisdom, and we can nolonger even engage in a civil conversation with each other over the things thattruly matter - that at that point we don't merely lose our capacity to solvebig challenges. We lose something essential about ourselves.

What was true then remains true today. I understand how difficult this healthcare debate has been. I know that many in this country are deeply skepticalthat government is looking out for them. I understand that the politically safemove would be to kick the can further down the road - to defer reform one moreyear, or one more election, or one more term.

But that's 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 believewe can act even when it's hard. I still believe we can replace acrimony withcivility, 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 is who we are. That is our calling. That is our character. Thankyou, God Bless You, and may God Bless the United States of America.