for every american. we know the moment is right for health care reform. we know this is a historic opportunity we have never seen before and may not see again. we also know that there are those who will try to stifle this opportunity no matter what. they will use the same fear tactics that have worked in the past. it will give warnings about a government takeovers, long lines, rationed care, decisions made by bureaucrats and not the doctors. we have heard all this before. things of that and worse because we have listened to it. let me begin by saying this. i know there are millions of americans who are content with their health care coverage. they like their plan and they value their relationship with their doctor. that means that no matter how we

reform health care, we will keep this promise to the american people. if you like your doctor, you will be able to keep your doctor. [applause] if you like your health care plan, you will be able to keep that plant. 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 is broken and build a mutt is working. that is what we intend to do -- build on what is working. that is what we intend to do. we want you to be physicians instead of administrators and accountant.

a system that gives american the best care at the lowest cost. it eases up the pressure on businesses and unleashes the promise of our economy saving 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 is how we will stop spending tax dollars to prop up unsustainable businesses and start investing those dollars in innovation and advances that will make our economy better. that is what we can do with this opportunity, and that is what we must do with this moment. the good news is that in some instances there is already widespread agreement on the steps necessary to make our health care system work better. we need to upgrade our medical records by switching to an electronic system.

we have began to do this with an investment as part of our recovery act. it does not make sense that patients in the 21st century are still filling out forms with pen in papers. they have to be stored away somewhere. as newt gingrich has rightly pointed out, and i do not quite -- quantum very often -- i do not quote him very often. [laughter] you should not have to tell every new dr. you see about your medical history or what prescriptions' you are taking. you should not have to repeat this. this information should be stored securely in a private medical records so your medical information can be tracked from one doctor or another, even if you change jobs or move.

[applause] that will not only mean less paper pushing and lower administrative costs, saving taxpayers billions of dollars, it will mean all of you physicians will have an easier time doing your jobs. it will tell you what drugs a patient is taking so you can avoid prescribing a medication that causes a harmful reaction. it will reduce medical errors that lead to 100,000 lives lost unnecessarily in hospitals every year. there should not be any argument there. we want to make sure we are helping providers computerized so we can get the system up and running. the second step we all can agree on is to invest more in preventive care so we can afford -- avoid illness and disease in the first place.

[applause] it means quitting smoking and going in for that mammogram or the 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. it also means cutting down on all of the junk foods that is fuelling an epidemic of obesity. [applause] we are putting many americans at greater risk for costly chronic conditions.

michele and i are starting a white house of vegetable garden. i say we generously because michelle has done most of the work. [laughter] that is a lesson that we should work with school districts to incorporate in 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. 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 are one of three- quarters of safeway workers enrolled in their healthy measures program, you can get screened for problems like high cholesterol, high blood pressure. if you score well, you can pay lower premiums. 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. [applause] we are open to doing more to help employers adopt and expand programs like this one. our federal government also has to step up its efforts to advance the cause of health care reform. five of the costliest illnesses, cancer, cardiovascular disease, diabetes, lung disease, and strokes can be prevented. only a fraction of every health care dollar goes to prevention or public health. that is starting to change with the investment we are making in wellness programs that can help us avoid diseases that harm our health and the health of our economy. investments in electronic records and prevent care --

preventive care are ordinary steps. they will only make a dent in the epidemic of rising costs in this country. despite what some have suggested, the reason we have these spiraling costs is not simply because we have an aging population. demographics do account for part of rising costs because older and sicker societies pay more on health care than younger people. there is nothing wrong in us taking better care of ourselves. what accounts for the bulk of our costs is the nature of our health care delivery system itself. a system where we spend vast amount of money on things that do not make people more healthy. a system that automatically equates more expensive care with better care.

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

this. the first is a system of incentives where more tests and services are provided and the more money we pay. a lot of people in this room know what i am talking about. it is a model that rewards the quantity of care rather than the quality of care. that pushes you, the doctor, to see more and more patients, even if you cannot spend much time with each. it gives you every incentive to order an extra mri or a cagey, even if it is not necessary. -- ekg even if it is not necessary. it changes your calling to a business. that is not why you became doctors. that is not why you put in all of those hours in the operating room. that is not what brings you back to a patient's bedside to

check in or call the loved one of a patient to say it will be fine. you did not enter this profession to be paper pushers. be healers. that is what our health-care system should let you beat. -- be. [applause] that starts with the way we do need to reform compensating our doctors and hospitals. if you have diabetes, you should be paid well by how you

treat the overall disease. we need to create incentives for physicians to team up, because we know that when that happens, it results in better results. we need to give doctors bonuses for better health outcomes for better health care. we need to rethink the cost of a medical education and do more to reward medical students who choose a career as a primary care physician who choose to work in underserved areas. [applause] that is why we are making a substantial investment in the national health service corps that will make medical training more affordable to primary care

doctors and nurse practitioners so they are not drowning in debt when they enter the workforce. [applause] in debt. [laughter] the second structural reform we need to make is to improve the quality of medical information making its way to doctors and patients. we have the best medical schools, the most sophisticated labs, the most advanced training of any nation on the globe. yet we are not doing a very good job harnessing our collective knowledge and experience on behalf of better medicine. less than 1% of our health care spending goes to examining what treatments are most effective. less than 1%. even when that information finds its way into journals, it can take up to 17 years to find its way to an exam room or an operating table.

as a result, many doctors and patients are making decisions without the benefit of the latest research. a recent study found that only half of all cardiac guidelines are based on scientific evidence. half. that means doctors may be doing a bypass operation when replacing a stint is equally effective. all of which drives up costs without improving a patient's health. one thing we need to do is figure out what works and encourage rapid implementation of what works into your practices. that is why we are making a major investment in research to identify the best treatment for a variety of conditions. [applause] let me be clear. identifying what works is not

about dictating what kind of care should be provided. [applause] it is about providing patients and doctors with the information they need to make the best medical decisions. i have the assumption that if you have good information about what makes your patients well, that is what you are going to do. [applause] i have confidence in that. do it. we need to make sure you have the best information available. even when we do know what works, we are often not making the most of it. that is why we need to build on the examples of outstanding medicine in places like the cincinnati children's hospital, where the quality of care for cystic fibrosis patients shot up after the hospital began incorporating suggestions from parents. in places like tallahassee memorial healthcare where deaths were dramatically reduced

with rapid response teams that monitor patients' conditions. physicians to pharmacists were involved. in places like one health care system in rural pennsylvania and salt lake city where high quality care is being provided at a cost well below the national average. these are all islands of excellence. we need to make a standard in our health-care system. replicating best practices, incentivizing excellence, closing cost disparities, any legislation sent to my desk that does not achieve these goals in my mind does not earn the title of reform. my signature on a bill is not enough. i need your help, doctors. to most americans, you are the

health care system. americans, and i include myself and michele and our kids in this, we do what you tell us to do. [laughter] that is all we do. we listen to you and trust you. that is why i will listen to you and work with you to pursue reform that works for you. [applause] together, we take all of these bring spending down and quality up. we can save billions of dollars

in health-care costs and make our system work better for patients and doctors alike. when we align the interests of patients and doctors, we will be in a good place. i recognize that it will be hard to make some of these changes if doctors feel like they are constantly looking over their shoulders for fear of lawsuits. [applause] i recognize that. do not get to get excited yet. -- too excited yet. [applause] now, i understand some doctors may feel the need to order more tests and treatment to avoid being legally vulnerable. that is a real issue. hold on your horses.

[laughter] i am not advocating caps on malpractice rules, which i believe can be unfair to people who have been wrongfully harmed. i think we need to explore a range of ideas about how to put patient safety first and that doctors focus on practicing medicine, how to encourage a broader use of evidence based guidelines. i want to work with the ama so we can scale back the excess of defensive medicine that reinforces our current system and shift to a system where we are providing better care simply -- rather than more treatment. this is going to be a priority for me. i know based on your responses, it is a priority for you. [laughter] i look forward to working with you. it will be difficult. all of this will be difficult.

all of it is going to be important. i know this has been a long speech, but we have more to do. the changes that i have already spoken about, that needs to go hand in hand with other reforms. our health-care system is so complex and medicine is always involved, we need a way to continually evaluate how we can eliminate waste, reduce costs, and improve quality. that is why i am open to expanding the role of the commission created by a republican congress called the medicare payment advisory commission which includes a number of positions on the commission. in recent years, it proposed to $200 billion in savings that never made it into law. it is being incorporated in a broader reform agenda. we need to fast track some of the commission's proposals in

the future so we do not miss another opportunity to save billions of dollars. as we gain more information about what works and what does not work in our health-care system and as we seek to contain the cost of health care, we have to insure that every american can get coverage they can afford. [applause] we must do so in part because in all of our economic interests, each time an uninsured american steps foot into an emergency room with no way to reimburse the hospital for care, the cost is handed over to every american family as a bill of about $1,000. it is reflected in higher taxes, higher premiums, and higher health care costs. it is a hidden tax and hidden bill that will be cut as we ensure that every american has

insurance that will reduce costs for everyone. there is another argument. it is simply this. we are not a nation that accepts nearly 46 million uninsured men, women, and children. we are not a nation that lets hard-working families go without coverage. [applause] we do not turn our back on those in need. we are a nation that cares for its citizens. we look out for one another. that what's -- that is what makes us the united states of america. we need to get this done. [applause] we need to do a few things to

provide health insurance to every american. we need to find out what is working in our system so that if you like your health care system and your doctor, the only thing that reform will mean to you is that health care will cost less. if anyone says otherwise, they are trying to mislead you or do not have their facts straight. if you do not like your health care coverage or you do not have any insurance at all, you will have a chance under what we have proposed to take part in what we are calling a health insurance exchange. this exchange will allow you to one-stop shop for a healthcare plan, compare benefits and prices, and choose a plan that is best for you and your family. the same way that federal employees can do from a postal worker to a member of congress. [applause]

you will have your choice of a number of plans that offer a fewevery plan will offer an affordable, a basic package. this is for people who are not happy with their current plan. if you like what you are getting, keep it. nobody is forcing you to shift. if you are not, this gives you some new options. and i believe one of these options needs to be a public option that will give people a broader range of choices and inject competition into the health-care market, so that we can force waste out of the system and keep the insurance companies honest. [applause]

i know there is some concern about a public option. i understand you are concerned that today's medical rates, which many of you already feel are too low, will be applied broadly. that means our cost savings are coming off of your back. these are legitimate concerns. i believe they can be overcome. the reforms we propose to reimbursement are to reward best practices focused on patient care not on the current peace work reimbursements. we seek more stability in the health-care system that is on a sounder financial footing. these reforms need to take place regardless of whether there is a public option or not.

we will ensure you are being reimbursed in a thoughtful way that is tied to patient outcomes instead of relying on its yearly negotiations about the sustainable growth rate formula that is based on politics and the immediate state of the federal budget in any given year. [applause] i want to point out the alternative to such reform is a world where health care costs grow at an unsustainable rate. if you do not think that will threaten your reimbursements and the stability of our health- care system, you have not been paying attention. the public option is not your enemy, it is your friend.

let me also say -- address an illegitimate concern that is being put forward by those who are claiming that a public option is a trojan horse for a single payer system. i will be honest. the single payer system works pretty well in one country. but i believe, and i have taken some flak from members of my party for this belief, that it is important for reform efforts to build on our traditions here in the united states. when you hear the naysayers claim that i am trying to bring about a government-run health care, know this. they are not telling the truth. what i am trying to do -- [applause] what i am trying to do and what a public option will help do is put affordable health care within reach for millions of americans and to help ensure that everyone can afford the

cost of a health care option in our exchange, we need to provide a system to families who need it. there will be no reason at all for anyone to remain uninsured. [applause] it is because i am confident in our ability to give people the ability to get insurance at an affordable rate that i am hoping that we will have a system where every american bears responsibility for owning health insurance so long as we provide for that. the same is true for employers. every business has a responsibility to provide health insurance for its workers. small businesses who cannot afford it should receive a small exemption. small-business workers and their families will be able to

seek coverage in the exchange if their employer is not able to provide for it. here is some good news. insurance companies have expressed support for covering the uninsured. they are in favor of a mandate. i welcome their willingness to engage constructively in reform debate. but what i refuse to do is create a system where insurance companies suddenly have a whole bunch of more customers on uncle sam's dime but failed to meet their responsibilities. [applause] we are not going to do that. [applause] let me give you an example of