this is an abc news special. health care sum miments at the white house, he has had news conferences on the subject. he had plenty of town hall meetings. we had a forum here on network television on abc back in june talking about health care reform. pretty much any venue you can imagine over the last three months, the president has been

there to make his pitch for health care reform, and tonight, essentially, he plays what is his trump card. he will go to a joint session of congress, there, the capitol lit up, and the members of the house and senate have gathered in the house chamber, and the sergeants at arms of the hse and the senate are about to introduce the president, and there are some of those who will escort the president in, those are members of the cabinet, i believe, coming in right now. but there are four different health care reform bills that have already been written by committees that are circulating on capitol hill. there is a fifth bill, an important one, that will come out of the senate next week. the president will say tonight that 80% of what is in these bills are in common, the same. but that belies the fact that there is considerable disagreement among democrats about that other 20%, and no agreement from republicans that there should be any kind of

health care reform, as now written. but george stephanopoulos, and there is michelle obama, coming into the gallery, overlooking the house. george stephanopoulos, the president will say tonight that he is closer to getting a health care reform bill through congress than any president, and presidents have been trying since the beginning of the 20th century. >> and that is true, charlie. but not far along as he would like. this speech, the white house had originally hoped that the president would be giving it after a single bill passed the house of representatives and passed or about to pass the senate. but it got bogged down over the summer and you have that trio of bills in the house, the senate has passed a bill out of only one committee so far, and the president's coming into this chamber tonight with the congress split along party lines, between democrats and republicans, his own party is not unified, and though the public generally supports the idea that the status quo cannot be maintained in health care, are generally for reform, a

majority now against the specifics of the plans before the congress, and for the first time, a majority of americans don't approve of how the president is handling health care. >> george, the white house -- this is the introduction of the cabinet coming in. the white house has promised greater specificity tonight. there's been a lot of criticism that the president has been too laid back, that he's let congress take the lead and congress hasn't been able to agree on much of anything. so, they promise he will be more specific about what he wants, what he needs in this bill. will that -- will that bring them closer to getting something, or will it set off new rounds of debate? >> that is very good question. i think what they first of all hope is that by being more clear, specific, on the 80% that the president says there's common ground, especially on these insurance reforms that the president is talking about, that will affect america to now have insurance, you can't be denied it if you have a preexisting

condition, you can't be dropped if you are sick, the president hopes that's going to burn through to the american public. on other issues, like the public health insurance option that's been bedevilling the president, his own party is split on it. and we expect the president to say, this is something i'm for, but he's not going to draw a line in the sand and say i absolutely need it in order to sign a bill. in fact, i wouldn't expect that you see many veto threats from the president tonight, unlike what you saw from president clinton back in 1994. instead, i think the president, if he draws one hard line, it will be on this idea that whatever he signs cannot increase the deficit. that's one of the problems the president faces right now. a majority of americans don't approve how he's handling the deficit. they are more worried about that than ever. >> you see secretary of state clinton there, you saw defense second taif gates. tim johnson, our chief medical

editor, is going to be with us tonight, and you have followed this debate since it began, tim, and you have been sending me memos all day, really, to be effective there are a number of things that have to be in a health care reform bill. >> i'm sure there will be a lot of emphasis on increasing and improving himself insurance, expanding its coverage. what i'm looking for are actual reforms to the health care delivered by insurance. things like an increase in primary care availability, electronic records, data on what really works, what's cost effective. if we don't have those kinds of reforms, we'll have increased coverage, to be sure, but we won't have real health care reform. >> and that brings up in the state in which you live, massachusetts, they passed health care reform, that has indeed gone a long way to covering almost everyone in the state of massachusetts, but it didn't bring about real cost reforms, and bring about cost savings, and that is really done -- there's hhs secretary

sebelius. that's really not brought about much savings in the state of massachusetts, and indeed has cost the state a great deal. >> well, massachusetts is a case history of what happens when you simply increase coverage, but don't reform health care. we do have more coverage, that's a good thing. morally and medically. but unless we also increase our reform of the actual health care, we'll have soaring costs nationally, as we did in massachusetts. >> george stephanopoulos, let me come back to this issue of whether they have the votes to get a health care reform bill right now. the republicans have been pretty much united in opposition. there's talk of maybe they can get one, maybe a little bit more than that in the senate, though that's doubtful. the house, the republicans seem pretty united in opposition. do they have the prospect that they can unite democrats and pass it simply with democratic support? >> i think they certainly have the prospect, charlie. and i think the white house has been consistently confident about the idea that eventually

they will get something passed this year. they've shown no give on that issue. but right now, they don't have a majority in the house and the senate for the same bill. there are big differences, for example, over the public himself insurance option. and the president is going to reach out to republicans tonight to see if he can change that dynamic. but frankly, niter the white house or congressional leaders expect that's going to bear all that much fruit, and the real goal tomorrow is to move the public and to hope that uniphipps the democratic party so they can build up that majority for a compromise bill within their own party. >> jonathan karl, who covers congress for us, jon, what are the big hangups in terms of getting the democratic support they need to pass a bill in the house and senate? >> well, the biggest hangup, george alluded to it, to create a government-run insurance program that would compete with private insurance. and you've got a situation now, charlie, where a government-run plan, a so-called public option, could not pass in the senate,

and you hear from democratic leaders in the house that a bill without a government option would not pass in the house. so, there's a real deadlock on this, but what you've got to remember is that this president will be coming into a chamber looking at the biggest democratic majority in congress in more than a generation, and underlying all the disagreement, there's a sense here among democratic leaders that with this, with some presidential leadership, they will get something passed. this is his top priority. this is their president. but they've overcome it. >> jake tapper who coverers the white house, also there at the capitol tonight, and jake, bill clinton had similar majorities in the house and senate when he was proposing health care reform in 1992, he couldn't get it through. >> no, and in fact, if you look at the problems president clinton foretold on that night 16 years ago this month, a lot of them came true in terms of one-third of small businesses no longer being able to afford to provide insurance for their employees and dropping coverage all together. some say that president obama

over-learned the lesson of bill clinton, who was criticized for writing the bill and then giving it to congressional leaders, though bill clinton said he was told he needed to do that. and they said that president obama allowed too much ambiguity. the president admitted that this morning, that he allowed that. and today he wants to provide some clarity on the outreach to republicans. he's going to talk about medical malpractice. not talking about a major reform there in medical malpractice, but he is going to make a nod to making a compromise, a deal with republicans. >> jake, how do they solve this central conundrum that jon karl talked about? that the house says it has to have a public option, government, essentially, supported insurance program in order to pass health care reform, and the senate won't pass a public option in a bill, or at least that's what max

baucus of montana says that you can't get a bill through the senate if it has the public option. how do they resolve that? >> the way is to have the house pass what it wants to pass have the senate pass what it wants to pass, and when the reconciliation committee comes together, the conference committee to decide what is going to be in the final bill, they'll see where public support is, and where the american people are. will they support a public plan, will they support a more moderate public plan, one that would be launched by a trigger mechanism if costs don't come under control. would they only support something like a co-op, that would be privately run, but individuals could buy into it. it's going to be one of those things that they hope for the best when it comes to that decision. the president is going to make a case for the public plan. but he's not going to issue a veto threat. and to democrats, that means he's conceding the point. >> george, if the president is willing to let the house pass what it wants to pass and the

senate passes what it wants to pass and hope they can resolve it when they try to reconcile it, isn't that kicking the problem down the road? >> yes, it is. i think they would have hoped by now -- >> hold on, george. here are the sergeants at arms from the house and the senate about to introduce the president, and when he makes the walk down the aisle, we'll come back. they can't get down the aisle. here we go. >> madame speaker -- >> the president of the united states. >> and the tradition of the applause, the president going down the center aisle of the house chamber, shaking hands with those members, some of which who have been waiting for hours in order to get this moment on television. i'm sorry, let me go back to george. >> i think the white house would have hoped that the house and senate democrats were unified on this approach by now, because

their fear is once house members vote on it, it's going to be hard to walk off on that, though there's no support in the senate. i think the dynamic that will take hold, this goes back to what jake was talking about, is that democrats will see what happened after 1994, when they tried and failed, under president clinton to get health care, and the consequences for their party, and i think that, what the white house believes will ultimately force compromise among democrats, once it gets to that conference committee, is their belief that this is their best chance in three generations to pass health care. that if it passes, it will take another generation to get another chance, and might cost the democrats their major tips in the house, that everybody will be willing to sacrifice a little to get something done. >> jon karl, let me come back to this point of republicans being so, almost virtually united in opposition to the kind of health care reform the president is talking about. it is interesting to watch

speeches, state of the union speeches, who applauds and who doesn't. the republicans are so opposed, are we going to see republicans sitting on their hands all night? >> well, there are some areas of agreement. pretty substantial areas of agreement. you heard dr. tim refer to some of these. one of the big ones is the issue of insurance reform. republicans are basically on board, saying insurance compa companies cannot discriminatikc. you'll see republicans applaud there. clearly, applaud on the question of malpractice reform. so, on a lot -- there is, you know, maybe not 80% that the republicans are on board here, but there may be 50% that republicans are on board here. now, ultimately, they're not going to be there in terms of the overall bill, but on some of the points, there is support for what the president is talking about. >> the president's speech scheduled to be about 45 minutes, we are told, in length. every time we've gotten a time line, it's been a little longer,

that the president will speak. one of the reasons they chose not to have an address from the oval office is because norm limb those are shorter, and the president wanted to make his case in greater length tonight, and also, because he really does have to do a persuasion job on the congress itself, and on his democratic membership in the senate and the house. he wanted to come to this joint session of congress. and as we mentioned at the top of the broadcast, there will be a republican response. that will come from representative of louisiana, he is a surgeon, who is in his third term in the house, and he will speak from the capitol after the president has completed his address. as you know, if you're a student of these speeches, the president brings a copy of the speech for the speaker of the house and for the president of the senate, who is the vice president. nancy pelosi of california, the

speaker of the house, and former senator joe biden, now vice president joe biden behind the president there, as well. and normally, after we go through this applause, with the announcement from the sergeants at arms, the senate and house, that the president is here, then we get a reintroduction of the president from the speaker of the house and there will be another round of applause and then he will begin this speech, which is really tremendously important. as we mentioned, for three months, it really has been the single subject on his domestic agenda. the one thing that he's been talking about, and so critical to his presidency, as he's campaigned around the country for health care reform. they believe, as we have said, that they are closer to it, than any president in recent years, but they are still not there, they don't have the bipartisan support they wanted, and they don't yet have united democrats behind one single form of the bill.

so, it may be controversial, but obviously, as you can hear in the applause, the president popular in this chamber. and it is traditional that democrats and republicans salute him as he comes in. >> members of congress, i have the high privilege and distinct honor to present to you, the president of the united states. >> thank you. >> you normally see the president in the house chamber for a state of the union address. this one, a joint session of congress. it is different. and there have only been 15, actually, times when the president has come to speak to a joint session of congress. only 15 times this kind of speech has occurred since 1952. >> thank you, thank you. please. >> going back more than 55 ye years, only 15 such events. president save them for when they have important issues.

>> speaker, vice president biden, members of congress and the american people. when i spoke here last winter, this nation was facing the worst economic crisis since the great depression. we were losing an average of 700,000 jobs per month. credit was frozen, and our financial system was on the verge of collapse. as any american who is still looking for work or a way to pay their bills will tell you, we are by no means out of the woods. a full and vibrant recovery is still many months away. and i will not let up until those americans who seek jobs can find them. [ applause ]

until -- until those -- until those businesses who seek capital and credit can thrive. until all responsibility homeowners can stay in their homes. that is our ultimate goal. but thanks to the bold and decisive action we've taken since january, i can stand here with confidence and say that we are pulled this economy back from the brink. [ applause ] now, i want to thank the members of this body for your efforts and your support in these 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 crises. we came here to build a future. so -- 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. and ever since, nearly every president and congress, whether democrat or republican, has attempted to meet this challenge in some way. a bill for comprehensive health reform was first introduced by john dingell sr. in 1943. 65 years later, his son continues to introduce that same bill at the beginning of each session. [ applause ] our collective failure to meet this challenge, year after year, decade after decade, has led us to the breaking point. everyone understands the extraordinary hardships that are placed on the uninsured, who live every day, just one accident or illness away from

bankruptcy. these are not primarily people on welfare, these are middle class americans, some can't get insurance on the job. others are self-employed, and can't afford it, since buying insurance on your own costs you three times as much as the coverage you get from your employer. many other americans who are willing and able to pay are still denied insurance due to previous illnesses or conditions that insurance companies decide are too risky or too expensive to cover. we are the only democracy, the only advance democracy on earth, the only wealthy nation that allows such hardship for millions of its people. there are now more than 30 million american citizens who cannot get coverage. in just a two-year period, one in every three americans goes without health care coverage at some point. and every day, 14,000 americans lose their coverage.

in other words, it can happen to anyone. but the problem that plagues the health care system is not just a problem for the uninsured. those who do have insurance have never had less security and stability than they do today. more and more americans worry that if you move, lose your job, or change your job, you'll lose your health insurance, too. more and more americans pay their premiums only to discover that their insurance company has dropped their coverage when they get sick. or won't pay the full cost of care. it happens every day. one man from illinois lost his coverage in the middle of chemothis here chemo this he therapy because he didn't report gall stones that he didn't know about. they delayed treatment and he died because of it. another woman from texas was about to get a double ma sectmy when her policy was canceled because she forget to declare a case of acne.

by the time she had her insurance reinstated, her breast cancer had more than doubled in size. that is heartbreaking, it is wrong, and no one should be treated that way in the united states of america. [ applause ] [ applause ] then there's the problem of rising cost. we spend 1 1/2 times more per person on health care than any other country. but we aren't any health care 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 enti entirely. it's why so many aspiring entrepreneurs cannot afford to open up a business in the first place, and why american businesses that compete internationally, like our automakers, are at a huge disadvantage. and it's why those of us with health insurance are also paying a hidden and growing tax for those without it. about $1,000 per year. that pays for somebody else's emergency room and charitable care. finally, our health care system is placing a burden on taxpayers. when costs grow at the rate they have, it puts greater pressure on programs like medicare and medicaid. if we do nothing to slow these skyrocketing costs, we will eventually be spending more on medicare and medicaid than every other government program combined. put simply, our health care problem is our deficit problem.

nothing else even comes close. nothing else. [ applause ] now, these are the facts. nobody disputes them. we know we must reform this system. the question is how. there are those on the left who believe that the only way to fix the system is through a single-payer system like canada's, where we would severely restrict the 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 there are arguments to be made for both these approaches.

but either one would represent a radical shift that would disrupt the health care most people currently have. since health care represents run-sixth of our compaeconomy, believe we should fix what we have, rather than build an entirely new system from scratch. [ applause ] and that is precisely what those of you in congress have tried to do over the past several months. during that time, we've seen washington at its best and at its worst. we've seen many in this chamber work tirelessly for the better part of this year to offer thoughtful ideas about how to achieve reform. of the five committees asked to

drop bills, four have completed their work, and the senate finance committee announced today that it will move forward next week. that has never happen md before. our overall efforts have been supported by an unprecedented coalition of doctors and nurses, hospital, 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 we have ever been. but what we've also seen in these last months is the same partisan spectacle that only hardens the disdain many americans have towards their own government. instead of honest debate, we've seen scare tactics. some have dug into unyield iing ideological camps that offer no chance of compromise.

many have used this to score short-term political points even if it robs the country of our opportunity to solve a long-term challenge. and out of this blizzard of charges and counter charges, confusion has reigned. well, the time for bickering is over. the time for games has passed. 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 had health insurance. it will provide insurance for those who don't. and it will slow the growth of health care costs for our

families, our businesses and our government. [ applause ] it's a plan that asks everyone to take responsibility for meeting this challenge. not just government, not just insurance companies, but everybody, including employers and individuals. and it's a plan that incorp rates 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 v.a., 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 preexisting condition. [ applause ] as soon as i sign this bill, it will be against the law for insurance companies to drop your coverage when you get sick, or water it down when you need it the most. [ applause ]

they will no longer be able to place a cap on the amount of coverage you can receive in a given year, or in a lifetime. [ applause ] we will place a limit on how much you can be charged for out of pocket expenses, because in the united states of america, no one should go broke because they get sick. [ applause ] and insurance companies will be required to cover, at any extra charge, reteen checkups and preventative care, because there's no reason we shouldn't be catches diseases like breast cancer and colon cancer before they get worse. that makes sense, it saves money

and it saves lives. [ applause ] that's what americans who have health shurms cinsurance can exm 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 -- if you lose your job, or you change your job, you'll be able to get coverage. if you strike out on your own and start a small business, you'll be able to get coverage. we'll do this by creating a new insurance exchange. a marketplace where individuals and small businesses will be able to shop for health insurance at competitive prices. insurance companies will have an incentive to participate in this exchange, because it lets them compete for millions of new

customers. as one big group, these customers will have greater leverage to bargain for better prices and quality coverage. this is how large companies and government employees get affordable insurance. it's how everyone in this congress gets affordable insurance, and it's time to give every american the same opportunity that we give ourselves. [ applause ] so, for those individuals and small businesses who still can't afford the lower priced insurance available in the exchange, we'll provide tax credits, the size of which will be based on your need. and all insurance companies that want access to this new marketplace will have to abide by the consumer protections i already mentioned. this exchange will take effect in four years, which will give

us time to do it right. in the meantime, for those americans who can't get insurance today, because they have pre-existing medical condition, we will 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 the healthy, who still want to take the risk and go without coverage. there may still be companies that refuse to do right by their workers, by giving them

coverage. the problem is, such irresponsible behavior costs all the rest of us money. if there are affordable options, and people still don't sign up for health insurance, that means we pay for these people's expensive emergency room visits. if some businesses don't provide workers health care, it worses the rest of us to pick up the tab when their workers get sick. and gives those businesses an unfair edadvantage over their competitors. 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 achieve. that's why, under my plan, individuals will be required to carry basic herlt insurance, just as most states require you to carry auto insurance. like wise, businesses will be required to either offer their

workers health care or chip in to help cover the cost of their workers. there will be a hardship waiver for those individuals who can't afford coverage, and 95% of all small businesses, because of their size, and narrow profit margin, would be exempt from these requirements. but we can't have large businesses and individuals who can afford coverage game the system by avoiding responsibility to themselves or their employees. improving our health care system only works if everybody does their part. while there remains some significant details to be ironed out, i believe -- i believe a broad consensus exists for the aspects of the plan i just outlined. consumer protections for those with insurance, an exchange that allows individuals and small businesses to purchase affordable coverage, and a requirement that people who can afford insurance get insurance.

and i have no doubt that these reforms would greatly benefit americans from all walks of life. as well as the economy as a whole. still, given all the misinformation that's been spread over the past few months, i realize -- i realize that many americans have grown nervous about reform. so, tonight i want to address some of the key controversies that are still out there. some of people's concerns have groun out grown out of bogus claims spread by those that want to kill reform at anywhere cost. the best example of a claim made by prominent politicians and radio and talk show hosts that we plan to set up panels of bureaucrats 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 ] now, there are also those who claim that our reform immigrants would insure illegal immigrants. this, too, is false. the reforms -- the reforms i'm proposing would not apply to those who are here illegally. it's not true. and one more. misunderstanding i want to clear up. under our plan, no federal dollars will be used to fund abortions, and federal conscience laws will remain in place.

now -- now my health care proposals have been attacked by those who oppose reform as a government takeover of the entire health care system. as proof, critics point to a provision in our plan that allows the uninsured and small businesses to choose a pub luckily sponsored insurance option, administered by the government, just like medicaid or medicare. so, let me set the record straight here. my guiding principle is, and also 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 raments. 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 he 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 ] in the insurance reforms that i already mentioned will do just that. but inan additional step we can take is by making a not for profit public option available in the insurance exchange. [ applause ]

now, let me be clear. let me be clear. it would only be an option for those who don't have insurance. no one would be forced to choose. and it would not impact those of you who already have insurance. in fact, based on congressional budget office estimates, we believe that less than 5% of americans would sign up. despite all this, the insurance companies and their allies don't like this idea. they argue pry haven't companies can't fairly compete with the government. and they'd be right, if taxpayers were subsidizing this public insurance option. but they won't be. i've insisted that like any private insurance company, the public insurance option would have to be self-sufficient and rely on premiums it collects. but by avoiding some of the overhead that gets eaten up at private companies by profits, excessive administrative costs

and executive salaries, it could provide a good deal for consumers. and it would keep pressure on pry haven't 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 -- it is -- [ applause ] it's -- it's 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 media. it is only one part of my plan. and shouldn't be used as a handy excuse for the usual washington ideological battles. to my progressive friends, i

would remind you for decades the driving idea behind reform has been to end insurance company abuses and make coverage available for those without it. [ applause ] the public option -- the public option is only a means to that end. and we should remain open to other ideas that accomplish our ultimate goal. and to my republican friends, i say that rather than making wild claims about a government takeover of health care, we should work together to address any legitimate concerns you may have. [ applause ] for example, some have suggested that the public option go into effect only in markets where insurance companies are not giving affordable policies.

others have proposed a co-op or a nonprofit entity to administer the plan. these are all constructive ideas, but i will not back down on the basic principle that if americans can't find affordable coverage, we will provide you with a choice. [ applause ] and -- 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 and issue that is a great concern to

me, to members of this chamber, and to the public. and that's how we pay for this plan. here's what you need to know. first, i will not sign a plan that amends one dime to our deficits. either now or in the future. [ applause ] i will not sign it if it adds one dime to the deficit now or in the future, period. and to prove that i'm serious, there will be a provision in this plan that requires us to come forward with more spending cuts if the savings we promise don't materialize. [ applause ] now, part of the reason i faced a trillion dollar deficit when i walked in the door of the white

house is because too many niche tichs over the past decade were not paid for, from the iraq war to tax breaks for the wealthy. [ applause ] i will not make that same mistake with health care. second, we've estimated that most of this plan can be paid for by finding savings within the existing health care system. a system that is currently full of waste and abuse. right now, too much of the hard-earned savings and tax dollars we spend on health care don't make us any healthier. that's not my judgment. that's the judgment of medical professionals across this country. and this is also true when it comes to medicare and medicaid. in fact, i want to speak directly to seniors for a moment.

because medicare is another issue that's been subjected to 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 will left to struggle with a pile of medical bills in their later years. that's how medicare was born. and it remains a sacred trust that must be passed down from one generation to the next. [ applause ] and that -- that is why not a dollar of the medicare trust fund will be used to pay for this plan. the only -- the only thing this plan would eliminate is the hundreds of billions of dollars in waste and fraud, as well as unwarranted subsidies in medicare that go to insurance companies.

subsidies that do everything to pad their profits but don't improve the care of seniors. and we will also create an independent commission of doctors and medical experts, charged with identifies more waste in the years ahead. [ 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. and we can use some of the savings to fill the gap in coverage that forces too many seniors to pay thousands of dollars a year out of their own pockets for prescription drugs. [ applause ] that's what this plan will do for you. so don't pay attention to those scary stories about how your

benefits will be cut. especially since some of the same folks who are spreading these tall tales have fought against medicare in the past, and just this year, supported a budget that would essentially have turned medicare into a privatized voucher program. that will not happen on my watch. i will protect medicare. [ applause ] now, because medicare is such a big part of the health care system, making the program more efficient can help us usher in changes 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 costs below average.

so, the commission can help encourage the adoption of these common sense, best practices by doctors and medical professionals throughout the system. everything from reducing hospital infection rates to encouraging better coordination between teams of doctors. reducing the waste and inefficiency in medicare and medicaid will pay for most of this plan. now much -- much of the rest would be paid for with revenues from the very same drug and insurance companies that stand to benefit from tens of millions of new customers. and this reform will charge insurance companies a fee for their most expensive policies, which will encourage them to offer greater value for money, an idea that has support of democratic and republican experts. according to these experts, this change could help hold down the cost of health care for all of us in the long run.

now finally, many in this chamber, particularly on the republican side of the aisle, have long insisted that reforming our medical malpractice laws can help bring down the costs of health care. [ applause ] there you go. there you go. now, i don't believe malpractice reform is a silver bullet, but i've talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs. so -- 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. and 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 ]

now, most of these costs will be paid for with money already being spent, but spent badly, in the existing health care system. the plan will not add to our deficit. the middle class will realize greater security, not higher taxes, and if we are able to slow the growth of health care costs by just one-tenth of one percent each year, it will actually reduce the deficit by $4 trillion over the long-term. now, this is the plan i'm proposing. it's a plan that incorp rates ideas from many of the people in this room tonight, democrats and republicans. and i will continue to seek common ground in the weeks ahead. if you come to me with a serious set of proposals, i will be there to listen. my door is always open. but know this. i will not waste time with those

who have made the calculation that it's better politics to kill this plan than to improve it. [ applause ] i won't stand by while the special interests use the same old tactics to keep things exactly the way they are. if you misrepresent what's in this plan, we will call you out. and i will not accept the status quo as a solution. not this time. not now. everyone in this room knows what will happen if we do nothing. our deficit will grow, more families will go bankrupt, more businesses will close. more americans will lose their

coverage when they are sick, and need it the most. and more will die as a result. we know these things to be true. that is why we cannot fail. because there are too many americans counting on us to succeed. the ones who suffer silently, and the ones who share their stories with us at town halls and e-mails and letters. i received one of those letters a few days ago. it was from our beloved friend and colleague ted kennedy. he had written it back in may, shortly after he was told that his illness was terminal. he asked that it be delivered upon his death. in it, he spoke about what a happy time his last months were, thanks to the love and support of family and friends, his wife

vicki, his amazing children, who are all here tonight. and he expressed confidence that this would be the year that health care reform, that great, unfinished business of our society, he called it, would finally pass. he repeated the truth that health care is decisive for our future prosperity, but he also reminded me that it concerns more than material things. what we face, he wrote, is above all, a moral issue. at stake are not just the details of policy, but fundamental principles of social justice, and the character of our country. i've thought about that phrase quite a bit in recent days. the character of our country. one of the unique and wonderful things about america has always been our self-reliance, our rugged individualism, our fierce

defense of freedom, and our healthy skepticism of government. and figuring out the appropriate size and role of government has always been a source of rigorous and, yes, sometimes angry, debate. that's our history. for some of ted kennedy's critics, his brand of liberalism represented an affront to american liberty. in their minds, his passion for universal health care was nothing more than a passion for big government. but those of us who knew teddy, and worked with him, here, people of both parties, know that what drove him was something more. his friend, orrin hatch, he knows that. they worked together to provide children with health insurance. his friend john mccain knows that. they worked together on a patient's bill of rights. chuck grassley knows. that they worked together to provide health care for children

with disabilities. on issues like these, ted kennedy's passion was born not of some ridge yid lodrye lodge,s experience. having two children stricken with cancer. he never forget the sheer terror and helplessness that any parent feels when a child is badly sick. and he was able to imagine what it must be like for those without insurance. what it would be luke to have to say to a wife or a child or an aging parent, there are something that could make you better, but i just can't afford it. that large heartedness, that concern and regard for the plight or others is not a republican or democratic feeling. it, too, is part of the american character. our ability to stand in other op