gentleman from north carolina. mr. etheridge: i ask for the yeas and nays. the speaker pro tempore: the yeas and nays are requested. all those in favor of taking this vote by the yeas and nays will rise and remain standing until counted. a sufficient number having arisen, the yeas and nays are ordered. operate and the chair's -- pursuant to clause 8 of rule 20 and the chair's prior announcement, further proceedings on this motion will be postponed. pursuant to clause 12a of rule i, the chair declares the house in recess until

>> people like to have books. it's a very sticky medium. you've seen this medium obviously be sticky since about the 15th, 16th century. >> tonight, the co-charmse of berteltmann on how the publishing industry is changing. >> you want it to be an err loom piece for you personally. you can't be proud of a bookshelf that is a mechanicry stick. >> the future of publishing. tonight at 8:00 eastern on "the communicators," on c-span 2.

>> how is c-span fundamental? >> i have no clue. >> maybe some government grants. >> i would say donations. >> advertising for products. >> public money, i'm sure. >> my taxes? >> how is c-span funded? 30 years ago, america's cable companies created c-span as public service. a private business initiative. no government mandate. no government money. >> president obama today addressed the annual meeting of the american medical association about his plans to change the nation's health care system. he told doctors the existing system leaves too many uninsured and force doctors to practice defensive medicine out of fear of malpractice suits. his comments are about a half an hour. [applause]

>> thank you. thank you. thank you. i've watched the president. he goes thank you, thank you, and you sit down. [laughter] >> good morning, everyone. it's a great honor and privilege for us to welcome back home to chicago the president of the united states, barack obama. [cheers and applause] the president will be coming in in just a soaked. just a couple words to him. mr. president, we appreciate that you've taken the time out of a busy schedule to join us and we're grateful for your efforts to make the path toward health system reform as open and inclusive as possible and

in particular that we have been included in those efforts. you have said that a test of the american ideal is whether we allow ourselves to be shaped by events and history or whether we act to shape them. america's physicians want to help shape a better future for our patients and our country. [applause] we know firsthand that change is needed and that the status quo isn't acceptable. [applause] we appreciate the investment you've already made to help physicians in four areas.

first, the purchase of health i.t. equipment. and we looked forward to standards for intraoperablity. [applause] and we thank you for the investment in comparative effectiveness research to enhance quality medical care. [applause] in your budget, you used realistic numbers about the cost of treating medicare patients and you charted a course to replace the senseless medicare physician payment formula and you're the first president to do it and we thank you for that. [cheers and applause] you've recognized that medical

liability concerns contribute to rising health care costs and we appreciate your interest addressing this problem. it is critical to the physicians of this country. [applause] friends, i've had the opportunity to meet president obama at the white house and i can attest to his willingness to listen and to engage. his focus on heather care reform and the polite of the uninsured -- health care reform and the plight of the uninsured takes a courageous spirited and wise judgment and we're grateful for hits leadership. so please join me as the american medical association welcomes the president of the united states, barack obama.

[cheers and applause] >> thank you. thank you. [applause] >> thank you. thank you so much. good to see you. [cheers and applause] thank you. thank you so much. please, everybody, be seated. thank you very much. you're very kind. thank you. let me begin by thanking nancy for the wonderful introduction. i want to thank dr. joseph hayman, the chairman of the board of trustees, as well as dr. jeremy lazarus, speaker of the house of delegates. thanks to all of you for bringing me home, even if it's just for a day.

[applause] you know, from the moment i took office as president, the central challenge we've confronted as a nation has been the need to lift ourselves out of the worst recession since world war ii. in the recent months, we've taken a serious of extraordinary steps, not just to repair the immediate damage to our economy, but to build a new foundation for lasting and sustained growth. we're here to create new jobs, to unfreeze our credit markets. we're stemming the loss of homes and the decline of home values. all this is important. but even as we've made progress, we know that the road to prosperity remains long and it remains difficult. and we also know that one

essential step on our journey is to control the spiraling cost of health care in america. and in order to do that, we're going to need the help of the a.m.a. [applause] >> today we are spending over $2 trillion a year on health care. almost 50% more per person than the next most costly nation. and yet, as i think many of you are aware, for all of the spending, more of our citizens are uninsured, the quality of our care is often lower, and we aren't any healthier. in fact, citizens in some countries that spend substantially less than we do are actually living longer than we do. make no mistake -- the cost of our health care is a threat to

our economy. it's an escalating burden on our families and businesses. it is a ticking time bomb for the federal budget. and it is unsustainable for the united states of america. it's unsustainable for americans like lauren klitzka, a young mother i met in wisconsin just last week, who hay learned that the breast cancer she thought she had beaten had spread to her bones, but who is now being forced to spend time worrying about how to cover the $50,000 in medical debts she has already accumulated, worried about future debts that she's going to accumulate, when all she wants to do is spend time with her two children and focus on getting well. these are not the worries that a woman like laura should have to face in a nation as wealthy as ours.

[applause] the stories like laura's are being told by women and men all across the country, by families who have heen out-of-pocket costs score and premiums double at a rate three times faster than wages. this is forcing americans of all ages to go without the check-ups or the prescriptions they need, that you know they need. it's creating a situation where a single illness can wipe out a lifetime of savings. our costly health care system is unsustainable for doctors, like michael connor in new hampshire who, as he puts it, spends 20% of each day supervising a staff, explaining insurance problems to patients, completing authorization forms, writing appeal letters, a routine that he calls

disruptive and distracting, giving him less time to do what he became a doctor to do and actually care for his patients. [applause] >> small business owners like chris and becky link in nashville are also struggling. they've always wanted to do right by their workers at their family-run marketing firm. but they've resistantly had to do the unthinkable and lay off a number of employees, layoffs that could have been deferred, they say, if health care costs weren't so high. across the country, over 1/3 of small businesses have reduced benefits in recent years and 1/3 have dropped their workers' coverage altogether since the early 1990's. our largest companies are suffering as well. a big part of what led general motors and chrysler into trouble in recent decades were the huge costs they racked up providing health care for their

workers, costs that made them less profitable and less competitive with automakers around the word -- around the world. if we do not fix our health care system, america may go the way of g.m. -- paying more, getting less, and going broke. when it comes to the cost of our health care, the status quo is unsustainable. [applause] reform is not a luxury. it is a necessity. when i hear people say, well, why are you taking this on right now, you've got all these other problems, i keep on reminding people, i'd love to be able to defer these issues, but we can't. i know there's been much discussion about what reform would cost, and rightly so. this is a test of whether we, democrats and republicans alike, are serious about

holding the line on new spending and restoring fiscal discipline. but let there be no doubt -- the cost of inaction is greater . if we fail to act -- [applause] if we fail to act, and you know this, because you see it in your individual practices, if we fail to act, premiums will climb higher, benefits well erode, the rolls of the uninsured will swell to include millions more americans, all of which will affect your practices. if we fail to act, one out of every $5 we earn will be spent on health care within a decade and in 30 years it will be about one out of every three, a trend that will mean lost jobs, lower take-home pay, shuttered businesses and a lower standard of living for all americans. and if we fail to act, federal spending on medicaid and medicare will grow by an amount

almost equal to the amount our government currently spends on our nation's defense. it will, in fact, eventually grow larger than what our government spends on anything else today. it's a scenario that will swamp or federal and state budgets and impose a vicious choice of either unprecedented tax hikes or overwhelming deficits or drastic cuts in our federal and state budgets. so to say it as plainly as i can, health care is the singlemost important thing we can do for america's long-term fiscal health. that is a fact. [applause] it's a fact and the truth is most people know that it's a fact. and yet, as clear as it is that

our system badly needs reform, reform is not inevitable. there's a sense out there among some -- and perhaps some members who are gathered here today of the a.m.a. -- that as bad as our current system may be -- and it's pretty bad -- the devil we know is better than the devil we don't. there is a fear of change. there is a worry take we may lose what works about our health care system while trying to fix what doesn't. i'm here to tell you i understand that fear and i understand the sip simple -- the cynicism. there are scars left over from past efforts at reform. after all, presidents have called for health care reform for nearly a century. teddy roosevelt called for it, harry truman called for it, richard nixon called for it, jimmy carter called for it, bill clinton called for it.

but while significant individual reforms have been made, such as medicare, medicaid and the children's health insurance program, efforts at comprehensive reform that covers everyone and brings down costs, have largely failed. part of the reason is because the different groups involved, doctors, insurance companies, businesses, workers, and others, simply couldn't agree on the need for reform or what shape it would take. and, if we're honest, another part of the reason has been the fierce opposition fueled by some interest groups and lobbyists, opposition that has used fear tactics to paint any effort to achieve reform as an attempt to -- yes -- socialize medicine. despite this long history of failure, i'm standing here because i think we're in a different time. one sign that things are different is that just this past week the senate passed a

bill that will protect children from the dangers of smoking, a reform the a.m.a. has long championed. [applause] so this organization has long championed it, it went nowhere when it was proposed a decade ago. i'm going to sign this into law. now, what makes this -- [applause] what makes this moment different, for the first time, key stakeholders are aligning not against but in favor of reform. they're coming out -- they're combing together out of a recognition that, while reform will take everyone in our health care community to do their part, everybody's going to have to pitch in, ultimately everybody will benefit. and i want to commend the

a.m.a. in particular for offering to do your part to curb costs and achieve reform. just a week ago, you joined together with hospitals, labor unions, insurers, medical device manufacturers and drug companies to do something that would have been unthinkable just a few years ago. you promised to work together to cut national health care spending by $2 trillion over the next decade relative to what it would have otherwise been. that will bring down costs, that will bring down premiums. that's the kind of cooperation we need and we appreciate that very mesh. thank you. [applause] now, the question is how do we finish the job? how do we permanently bring down costs and make quality, affordable health care available to every single american? that's what i've come to talk about today. we know the moment is right for

health care reform. we know that this is a historic opportunity we've never seen before and may not see again. but we also know that there are those who will try and scuttle this opportunity no matter what, who will use the same scare tactics and fearmongering that's worked in the past, who will give warnings about socialized medicine and government takeovers, long lines, rationed care, decisions made by bureaucrats and not doctors. we have heard this all before. and because these fear tactics have worked, things have kept getting worse. so let me begin by saying this -- to you and to the american people -- i know that there are millions of americans who are content with their health care coverage. they like their plan and, most importantly, they value their relationship with their doctor. they trust you. and that means that, no matter how we reform health care, we will keep this promise.

if you like your doctor, you will be able to keep your doctor, period. [applause] if you like your health care plan, you will be able to keep your health care plan, period. [applause] no one will take it away, no matter what. my view is that health care reform should be guided by a simple principle -- fix what's broken and build on what works. that's what we intend to do. if we do that, we can build a health care system that allows you to be physicians instead of administrators and accountants, a system that gives americans -- [applause] a system that gives americans

the best care at the lowest cost, eases up the pressure on businesses and unleashes the promise of our economy, creating hundreds of thousands of jobs, making take-home wages thousands of dollars higher and growing our economy by tens of billions of dollars more every year. that's how we'll stop spending tax dollars to prop up an unstainable system and start investing those dollars in innovation and advances that will make our health care system and our economy strong. that's what we can do with this opportunity. and that's what we must do with this moment. now, the good news is that in some instances there's already widespread agreement on the steps necessary to make our health care system work better. first, we need to upgrade our medical records by switching from a paper to an electronic system of recordkeeping. we've already begun to do this with an investment we made as part of our recovery act.

it simply doesn't make sense that patients in the 21st century are still filling out forms with pens on papers that have to be stored away somewhere. as newt gingrich has rightly pointed out -- and i don't quote newt gingrich that often -- [laughter] -- we do a better job tracking a fedex panel in this country than we do tracking patients' health records. [applause] you shouldn't have to tell every new doctor you see about your medical history or what prescriptions you're taking. you shouldn't have to repeat costly tests. all that information should be stored securely in a private medical record so your medical information can be tracked, even if you change jobs, if you move, if you have to see a number of different specialists. that's just common sense.

[applause] and that will not only mean less paper-pushing and lower administrative costs, saving taxpayers billions of dollars, it will also mean all of you physicians will have an easier time doing your jobs. it will tell you, the doctors, what drugs a patient is taking, so you can avoid prescribing a medication that could cause a harmful interaction. it will prevent the prong dosages from going to a patient. it will reduce medical errors that it is estimated lead to 100,000 lives lost in our hospitals every year. so there shouldn't be any argument there. we want to make sure we're helping providers computerize so that we can get this system up and running. the second step that we can all agree on is to invest more in preventive care so that we can avoid illness and disease in the first place. [applause]

that starts with each of us taking more responsibility for our health and for the health of our children. [applause] it means quitting smoking. it means going in for that mammogram or colon cancer screening. it means going for a run or hitting the gym and raising our children to step away from the video games and spend more time playing outside. [applause] it also means cutting down on all the junk food that is fooling an epidemic of obesity -- that is fueling an epidemic of obesity. this puts far too many americans at greater risk of costly chronic conditions and that's a lesson we've tried to instill in our daughters. some of you know, we started a white house vegetable garden.

i say we generously because michelle has done most of the work. [laughter] it's a lesson that we should work with local school districts to incorporate into their school lunch programs. building a health care system that promotes prevention rather than just managing diseases will require all of us to do our parts. it will take doctors telling us what risk factors we should avoid and what preventive measures we should pursue. it will take employers following the example of places like safeway that is rewarding workers for taking better care of their health while reducing health care costs in the process. if you're one of 3/4 of safeway workers enrolled in their healthy measures program, you can get screened for problems like high cholesterol or high blood pressure, and if you score well, you can pay lower pleemyums. you get more money in your paycheck. it is a program that has helped

safeway cut health care spending by 13% and workers save over 20% on their premiums. we're hoping -- [applause] rear hoping to do more to help employers adopt and expand programs like this one. now, our federal government also has to step up its efforts to advance the cause of healthy living. five of the costliest illnesses and conditions, cancer, cardiovascular disease, diabetes, lung disease and strokes, can be prevented. yet only a friction of every health care dollar goes to prevention. that's starting to change with an investment we're making in prevention programs that can help us harm our health and the health of our commism but as important as they are, investments in electronic records and preventive care, all the things that i just

mentioned, they're just preliminary steps. they will only make a dent in the epidemic of rise costs in this country. despite what some have suggested, the reason we have these spiraling costs is not simply because we've got an aging population. demographics do account for part of rising costs because older, sicker societies pay more on health care than younger, healthier ones. there is nothing intrinsically wrong with us taking better care of ourselves. but what accounts for the bulk of our costs is the nature of our health care delivery system itself. a system where we spend vast amounts of money on things that aren't necessarily making our people any healthier. a system that automatically equates more specific care with better care. now, a recent article in the

"new yorker" showed how mcallen, texas, is spending twice as much as el paso county. twice as much. not because people in mcallen are sicker than they are in el paso. not because they're getting better care or getting better outcomes. it's simply because they're using more treatments. treatments that in some cases they don't really need. treatments that in some cases can actually do people harm by raising the risk of infection or medical error. and the problem is this pattern is repeating itself across america. one dartmouth study shows that you're less likely -- you're no less likely to die from a heart attack and other ailments in a higher spending area than in a lower spending area.