reform even if you're a member of congress and your senator doesn't want. i think this is a speech in which he boxes out republican members of congress unless they're willing to work with what will be a democratic plan. >> we're watching nancy pelosi doing some of the bookkeeping to get this session started, rachel, the absolutists on public option, no public option, no bill, are they really willing to sacrifice the entire bill over this one provision? >> yes. i think they are. >> take your time on answering that question, rachel. think about it. >> they're not members of any organized party. they're democrats in the great words of something much smarter and wittier than i am. i don't think you can talk about them as a unified block but there are people that feel like this is a bedrock principle and

they won't vote for something that has the public option in it. axelrod saying there will be some form of public option in whatever the final bill is. it sounds like the white house received a message that liberals won't budge on this. >> thanks for joining me tonight. president obama is about to address a joint session of congress. keith olbermann is picking up our coverage starting now. >> when president obama first addressed a joint session of congress on the 24th of february, the new president on only his 35th day in office said "health care reform cannot wait. it must not wait and it will not wait another year." six months later congress itself perhaps the president's biggest obstacle to delivering on that promise or perhaps it's been the president's own focus. this is msnbc's live coverage of

president obama's second address. 46 million uninsured the state of the health care system is not strong. alongside rachel maddow and howard fineman in washington, i'm keith olbermann in new york. here's the sergeant of arms. [ applause ] the sergeant at arms of the house chamber will introduce the president who is to follow the escort committee into the house chamber. that was the diplomatic corps arriving. we're a little bit behind schedule. they hope to have the president on the way to the podium about 45 seconds ago. as we await that process, let me turn to rachel maddow. i don't want to overstate this. i think this is a pivotal moment, one of the first of this presidency. do you agree?

>> i do. this is something presidents don't do very often. you save a joint address to congress for things like the state of the union and declarations of war for major, major issues. this is a moment that the president himself has defined as a huge moment in his presidency. he's created a high bar that he now has to jump over. i expect a speech that aims very high. >> there's the first lady entering the chamber with a hug and embrace with mrs. biden -- dr. biden. we are expecting the cabinet to be introduced next after the applause settles down. there is mrs. dr. biden on the far right. let me turn to howard, we'll know from the president within five minutes what the true story is going to be on where he wound up but who can wait five minutes. what do we know or think we

know? >> i'm reading the embargo text now which i can't tell you about because it is embargoed for another few minutes. i think it is clear he'll talk about the public option and not demand it but try to explain it clearly. he'll do that. there was vicky reggie, the wife of the late senator kennedy in the box with michelle obama, which is symbolically important because of ted kennedy's commitment to health care. he'll explain the public option and not demand it. he'll say that everybody will be covered. everybody will be required to be covered. he'll say there is strict regulation of the health care industry by the federal government which to this point there is not. he'll say that this is historic. that what he wants is historic. he'll try to be clear. he'll try to regain momentum and he'll try to make the sale and not be this time, keith, not be the law professor or the

historian or the political scientists but to be the advocate. one thing we need to remember about barack obama, while he's lawyer, he's never been a courtroom lawyer. he's never been a strong advocate in the courtroom for the prosecution or the defense. now is the time for him to be the strong advocate and to make the case for his version of health care and from what i can see reading through the speech, i think he's going to do that to a greater extent than he's done before but he's waited a long time to do it. >> has he waited too long, rachel? there is secretary clinton again whose discussion of health care was generally regarded to be ahead of the man who would become president during the campaign last year. did the president wait too long to discuss this or she discusses this here with senator collins of all people. >> i think the president said he wanted this done as best he could before the august recess. when that didn't happen, this became the appropriate next time for the president to weigh in. it wouldn't have made sense for

him to barnstorm through the rece recess. it was clear that republicans would get their opposition out during that month. that's what everyone knew would happen during that month. i think timing right now reflects the white house expectation that they are putting a book end on that. that political season of craziness and wild allegations is over and the time for legislating is now. >> howard, are you -- not to dismiss rachel's analysis there, are you along with that? it seemed that one of the accepted pieces of wisdom about what happened and wisdom is the wrong term but one of the accepted understandings of what happened in the last month was that the democrats flatly, particularly the white house, got caught flat footed and they had no expectation that that delay was going to unleash this corporate driven phony astroturf protest that bordered on mass hysteria at the town halls.

>> they were caught flat footed. they neglected a lesson from the campaigns they so brilliantly ran last year and that is that politics is vacuum. if you're not moving forward, you'll be attacked. they assumed that politics would be suspended for the summer and of course it wasn't. you're right about the corporate spending and the reaction of the health care industry various parts of the health care industry. they really got moving on this thing and it is interesting that you mention it because i was over at the supreme court earlier today hearing a very historic argument about the role of corporate cash in campaigns and there's a connection there. the new supreme court headed by chief justice roberts is positioning itself, i think, to throw out a lot of the limits on corporate spending in campaigns and what we saw last summer is a tea party, pun intended,

compared to what we'll see now. >> rachel that brings back a point that i raised a few moments ago. it seems to me that american history could easily if you confine yourselves to rights between the corporations between rights of the citizens, you could run the essential elements of american domestic history and not leave a lot out. although there have been larger, grander moments facing other presidents like both roosevelts and wilson and the others, this one is the test of the modern y era. this is corporate america's big stand on whether or not they continue to run this government. >> this is the opportunity for the democrats to take a stand on that issue and for democrats to say they stand for something other than just getting george w. bush out of audience and being a democrat and being a progressive is more than not just being a republican. it's not just about foreign policy. it's not just about the way we interact with other countries around the world. it's about the way we respect our individuals and the way we

protect our individuals in this country against the fan femanif different power we afford to corporations. that's what democrats have to decide right now. i will say that i don't think the white house was caught flat footed about what happened in august nor do i think democrats were. the beltway commonism is like a goldfish going around a tiny bowl and every revolution being surprised by that little plastic castle in the same place it was the last time they came around the goldfish bowl. every august whatever is on the table gets mud thrown on it by the opposition. that's what happens every august. every knew it would happen. >> would have you been able to predict that there would have been people screaming racist anti-logic and anti-self-interest often irrelevant comments from the halls of town halls in that month of august?

what we saw if it was strategy on the part of the democrats was damn fool strategy. >> i wouldn't predict that the opposition was so bad at opposition that they would tip their crazy hand so obviously to let us see the crazy cards they were playing with and that astroturfing would be so obvious and people like betsy mccoy would get fired from the medical supply company she worked for. the conservative in the republican movement and corporate interests driving these astroturf protest so over did it and overplayed it and they looked so nuts that was the surprise of august and not that they mounted an opposition campaign. >> howard, that nuts works, doesn't it? >> yeah. >> especially in a slightly paranoid society and i don't want to get too psychological on anybody but it is -- we're only eight years removed from 9/11 and this week which was an inducement to sometimes very

justify able paranoia but it sent an entire tone for the nation that was stoked by the previous administration but there's a lot of free floating ill defined fear out there and it takes all kinds of forums and nuts works. >> nuts works is a good slogan to live by in covering american politics for sure. >> in any century. >> and i think a few things, keith. first of all, you got to see that the president's approval rating has diminished substantially. there's no doubt about that. the numbers have gone up in terms of people who question his plan. i think part of the problem is by letting congress take the lead as we said before but it's true, you allow the opposition to pick it apart and fantasize about what it was or was not so all of that happened. the other thing that happened, i think, is because of the hand that president obama was dealt as he came into office requiring

big spending and big borrowing and big deficits on other things like the stimulus and like bailouts of banks and bailouts of the auto industry and so forth, some fair minded conservatives who aren't nuts and independents who aren't nuts got worried and scared about spending. the president didn't make the case for spending control quickly enough. >> madam speaker, the president of the united states! [ applause ]

the president followed into the chamber of the house of representatives by the majority leader, mr. reid, who is somewhat obscured on the right of your picture and the minority leader, mr. mcconnell, on the left. the other senators who will follow them will be obvious to you.

they are the visiting team as you will. it will take a while for the president to get to the podium. we'll shut up at that point. i want to continue this conversation with rachel maddow and howard fineman. rachel, howard just mentioned the drop in the president's approval rating particularly on the issue of how he's handled this. there's, i think, an understandable reaction to assume this is from critics of reform and yet that's not entirely true. there has to be a significant drop-off in confidence on those who are ultra pro-reform. >> you saw the full page ad in "the new york times" for those who worked on his campaign saying we want real reform and a real public option. there has been disappointment among progressives. a shot there with barack obama and hillary clinton. >> i can't resist noting that

that was an extra long moment with hillary clinton. there have been several public pageants recently where bill clinton, has made a point of showing himself to be in deep conversation with barack obama. i know that what was going through the president's mind there is saying i better give hillary some attention right here. >> i was thinking that perhaps he said he's open to new ideas. perhaps he was asking the secretary if she had any because now would be a good time to step forward on this. rachel mentioned that ad in "the new york times." steve was in charge of field operations for the campaign and was one of the people involved with that. true ground level of what's going on out there stuff. it seems that may be where this administration if not offkey has not tuned in yet. >> my sense is, keith, the president made the decision that he can sell those people in the end on whatever he comes up with.

that's a big bet. i'm not sure he's going to make it. he's going to win it. by the way, the halanguage in t speech is stronger in tone on the public option than i thought it would be. you are where you travel. he's going to minnesota right after this which is an indication he'll speak to those people you talked about who care about the public option and really sweeping reform. >> howard and rachel and i will now step aside for the president and rejoin you afterwards. a full hour of countdown and a full hour of rachel's show and a special edition of "ed" and when the applause dies down you'll hear from the president of the united states. >> thank you.

>> members of congress, i have the high privilege and distinct honor to present to you the president of the united states. [ applause ] >> thank you. thank you. thank you. thank you so much. thank you. thank you. thank you very much. thank you very much. thank you. please -- thank you. thank you very much. please, be seated.

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. 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. 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 have 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 the last several months and especially those who have taken the difficult votes that have put us on the path to recovery. i also want to thank the american people for their patience and resolve during this trying time for our nation. we did not come here just to clean up crisis. we came here to build a feature. 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'm 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. ever since nearly every president and congress whether democrat or republican, attempted to meet a challenge in some way. a bill for comprehensive health reform was first introduced by john dingell sr. in 1943. 65 years later his son continues to introduce the 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 placed on the uninsured to live 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 cost 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're 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. every day 14,000 americans lose their coverage. in other words, it can happen to anyone. 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 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 he didn't report gallstones 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 a e acne. by the time her insurance was reinstated reinstated, her breast cancer doubled in size. that is heartbreaking and wrong and nobody should be treated that way in the united states of america. [ applause ] then there's the problem of rising cost. we spend 1.5 times 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 aspires entrepreneurs can't 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 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. 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. [ applause ] nothing else. 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 pair system like canada's 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 of these approaches. either one would represent a radical shift that would destruct 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 ] 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. 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% of what needs to be done putting us closer to the goal of reform than he 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 toward their own government. instead of honest debate, we have seen scare tactics. some have dug into unyielding ideological camps that offer no

hope of compromise. too many have used this as an opportunity to score short-term political points even if it robs the country of our opportunity to solve a long-term challenge. out of this blizzard of charges and countercharges, confusion has reigned. well, the time for bickering is over. the time for games has passed. now is the season for action. now is when we must bring the best ideas of both parties together and show the american people that we can still do what we were sent here to do. now is the time to deliver on health care. 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 cost 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. 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 of the doctor you have. [ applause ] let me -- 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 pre-existing 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.

they will no longer be able to put a cap on the amount of coverage you can receive in a given year or in a lifetime. we'll raise the limit on how much you can charged for out-of-pocket expenses. in the united states of america, no one should go broke because they get sick. insurance companies will be required to cover with no extra charge routine checkups and preventive care like mammograms because there's no reason we shouldn't catch diseases like

breast cancer and colon cancer before they get worse. that makes sense. it saves money and it saves lives. 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 will be able to get coverage. if you strikeo out on your own, you'll be able to get coverage. we'll create an insurance exchange. a marketplace where individuals and small businesses can shop for health insurance at competitive prices. insurance companies will have an

incentive to participate in this exchange because it lets them co compete for millions of new customers. as one big group, the customers will have a better chance to bargain 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. it's time to give every american the same opportunity that we give ourselves. [ applause ] 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 are based on your needs 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 pre-existing medical conditions, we'll immediately offer low cost coverage that will protect you against financial ruin if you become seriously ill. this was a good idea when senator john mccain proposed it in the campaign, 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 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 to us pick up the tab when the workers get sick and gives those businesses an unfair advantage over their competitors and unless everybody does their part, many of the insurance reforms we seek, especially requiring insurance companies to cover pre-existing conditions just can't be achieved. 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, businesses will be required to offer their workers health care or chip in to help cover the cost of their workers. there will be a hardship waiver for those who can't afford coverage and 95% of all small business because of their size and their profit margin would be exempt from these requirements. [ applause ] but we can't have large businesses and individuals who can't afford coverage game the system by avoiding responsibility to themselves or their employees. improving our health care system only works if everybody does their part. while there remains some significant details to be ironed out, i believe a broad consensus exists for the aspects of the plan i just outlined. consumer protections for those with insurance, an exchange that allows individuals and small

businesses to purchase affordable coverage, and a requirement that people who can afford insurance get insurance. 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 of the misinformation that's been spread over the past few months, i realize that many americans have grown nervous about reform. tonight i want to address some of the key controversies that are still out there. some 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 i'm proposing would not apply to those who are here illegally. 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 conscious laws will remain in place. [ applause ] now my health care proposals also been attacked by some that oppose reform as a government takeover of the entire health care system. now, 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. let me set the record straight here. my guiding principle is and always has been that consumers do better when there's choice and competition. that's how the market works. [ applause ]

unfortunately in 34 states, 75% of the insurance market is controlled by five or fewer companies. in alabama, almost 90% is controlled by just one company. without competition, the price of insurance goes up and quality goes down. 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 and 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 ] insurance reforms that i 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.

now, let me be clear. [ applause ] 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. it would not impact those of you who already have insurance. in fact, based on congressional budget office estimates we believe that less than 5% of americans would sign up. despite all this, the insurance companies and their allies don't like this idea. they argue that these private companies can't fairly compete with the government and they would be right if taxpayers were subsidizing this insurance option. they won't be. i 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 cost and executive salaries, it could provide a good deal for consumers. it would also keep pressure on private insurers to keep their policies affordable and treat their customers better the same way public colleges and universities provide additional choice and competition to students without in any way inhibiting a vibrant system of private colleges and universities. now -- [ applause ] it is worth noting that a strong majority of americans still favor a public insurance option of the sort i proposed tonight. but its impact shouldn't be exaggerated by the left or the right or the medium. it is only one part of my plan. it shouldn't be used as a handy

excuse for the usual washington ideological battles. to my progressive friends i would remind that you for decades the driving idea behind reform has been to end insurance company abuses and make insurance available to those without it. the public option is only a means to that end. 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 ] now, for example some suggested the public option go into effect

only in those markets where insurance companies are not providing affordable policies. others proposed a co-op or another nonprofit entity to administer the plan. these are all constructive ideas worth exploring. i will not back down on the basic principle that if americans can't find affordable coverage, we'll 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 of great concern to me, to members of this xchamber and to this congress. 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. 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 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 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. that's the judgment of medical professionals across this country. this is also true when it comes to medicare and medicaid.

in fact, i want to speak directly to seniors for a moment. medicare is another issue that's been subjected to 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. and that -- [ applause ] that is why not a dollar of the medicare trust fund will be used to pay for this plan. the only thing this plan would eliminate is the hundreds of billions of dollars in waste and fraud as well as unwarranted

subsidies in medicare that goes 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. now -- [ applause ] 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. 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. 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 those tall tales have fought against medicare in the past. and just this year supported a budget that would have essentially turned medicare into a privatized 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 health care in utah or the

health system in rural pennsylvania offer high quality care at cost below average. the commission can help encourage the adoption of these common sense best practices by doctors and medical professionals throughout the system. we can reduce the waste and efficiency in medicare and medicaid will pay for most of this plan. 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. this reform will charge insurance companies a fee for their most expensive policies, which will encourage them to provide greater value for the money. an idea which has the support of democratic and republican experts. and according to these same experts, this modest change could help hold down the cost of

health care for all of us in the long run. finally, many in this chamber particularly on the republican side of the aisle, long insisted that reforming our medical malpractice laws can help bring down the cost of health care. [ applause ] there you go. there you go. now, i don't believe malpractice reform is a silver bullet, but i talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs. 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. i know that the bush administration considered authorizing demonstration projects in individual states to test these ideas. i think it's a good idea. i'm directing my secretary of health and human services to move forward on this initiative today. [ applause ] add it all up and the plan i'm proposing will cost around $900 billion over ten years. less than we have spent on the iraq and afghanistan wars and less than the tax cuts for the wealthiest few americans that congress passed at the beginning of the previous administration. [ applause ]

most of these costs will be paid for by 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 and not higher taxes. if we are able to slow the growth of health care costs by just one-tenth of 1% each year, it will reduce 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 of the people in this room tonight. democrats and republicans. 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 is better politics to kill this plan than to improve it. [ applause ] i won't stand by while the special interest 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. 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're 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 share their stories with us at town halls and 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, vicky. his amazing children who are all here tonight. 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 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 details of policy but fundamental principles of social justice and the character of our country. i 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. in 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. 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 patients bill of rs.