awe good evening tonight on just the 233rd day of his presidency,

barack obama hopes to use the power of the presidency and the majesty of the u.s. capitol to push a big rock up a hill one last push to try to accomplish his goal of passing health care reform. his own initiative. some say stolen out from under him briefly by an organized and revved up opposition. tonight you are going to see a high stakes speech to the chamber and beyond. with the audience of all kinds looking for style and substance at the same time. our correspondents are fanned out across washington covering this event tonight. we'll begin with our political director and chief white house correspondent chuck todd. and chuck, big venue and it is a big gamble at the same time. >> it is. this is pretty much the biggest card you can play when it is to, when you have to give a speech to fix a political problem. this is obviously a huge setting. joint session of congress. the president tonight, it is going to be a serious speech, brian. very direct. don't expect the flourishes that

some people have gotten used to when it comes to president obama. he is going to get detailed. high is going to get specific on how he believes it is best to pay for health care reform, what he believes health care reform is, and is not, and he is going to try to debunk some things he believes, they admit themselves and the president himself admits they lost control of. >> you see the chamber is getting prepared for the president's arrival. there, of course, we see the arrival of first lady michelle obama. you will see some familiar faces and there a kiss and hug for vicki kennedy, widow of senator edward m. kennedy, along with mrs. biden and others is a special guest of the first lady in her box. we roundly expect of course the president to mention the man so often called "the lion of the senate" a championf health care reform, who didn't live long enough to see that legislative goal accomplished. senator edward m. kenny. a standing ovation for the first

lady of the united states. as she waves to friends in the gallery. our own kelly o'donnell will be in the gallery until the president starts speaking and then she will have to take another position. and kelly, so much of tonight, in a divided senate, where the democrats have 60 votes is about this, this question of whether or not as we see the president's cabinet introduced and enter the chamber. question of whether or not the president can pick up any names with an "r" after it for republicans? >> brian, there is great focus on a few key members of the republican party who have put themselves on the line trying to negotiate some sort of compromise. they have become important names in this debate. chief among them, olympia snowe, a centrist republican from maine. she has a telephone relationship with the president most republicans cannot say they have. a direct line to try to bring her ideas, represent republicans to the president, and to also

have the one-on-one relationship to try to convince mr. obama that there is some way to get republicans on board. it has not been successful yet. olympia snow says she told the president she needs to put aside a government-run option for health insurance. at least at this time. and to focus on areas where there is common ground in order to change the direction. other names that are important, chuck grassley of iowa, and they are staying at the table. many thought republicans would have bailed by now, completely rejecting e ongoing nversation, the key senators are part of what we know as the gang of six say they will stay at the table and try to find some way to sort out some common ground. a pretty big divide on key issues. brian. >> the state of maine so interesting politically. the other senator there from maine shaking the hand of secretary of state clinton, the two republican senators, olympia

snowe and susan collins on the moderate side of the ledger and both seen i the parlance of politics potential pickoffs for the democrats if a bill could be tailored to gain their vote. snowe more than collins as it stands right now. as we watch, the goings-on in the chamber. we are joined by david gregory, moderator of "meet the press." david, you watch this story develop week after week on sunday mornings. as you well know having covered washington for a long time. a joint session is, is a rare gathering. it can be a tricky animal. bill clinton spoke to a joint session about health care reform. and we all know the results from that. but we usually associate these gatherings with times of great national moment. no one alive will forget george w. bush after 9/11, or lyndon johnson after the assassination of president kennedy, no one in the obama administration could have anticipated briefly losing control of the debate to this

false rumor of death panels and having to be here at this moment resorting to this. >> well, and this is an occasion that is used for a big push to try to rally the public. and this is not a speech to congress for the sake of congress. this is a president who is using this moment in primetime to speak directly to the american people. you know, brian, he does have a big hill to walk, as you suggested. he has got to reach out to the middle of the road americans, politically, who know a couple of things. they know health care is too expensive but also know the government is paying for a lot right now from bank bailouts to g.m. bailouts and now the idea of a trillion dollar price tag for health care reform. it has a lot of americans uneasy. some of the same americans who voted for this president and put him into office. that's why this is a speech, in a moment in time, when he needs to demonstrate leadership to restore that faith in his leadership and also bring people around to the idea that he can actually reform health care by

keeping costs down and by keeping control of the deficit. you are going to hear about the two points a lot tonight. >> chuck todd, knowing we may break away for the introduction of the president at any moment here. what's the stat we use, 90% of voters in the last election actually have health care. and most of them are at least content with the health care they have. americans are giving people, they do care about those among them who are going without, but all the factors david just listed, add in a recession, job trouble, and all the other issues this president has dealt with in his 233 days. there you have the backdrop for a fight. >> that's right. you know he is going to use stability and security. we heard him use it monday night. we have heard all the aides use it. i think david axlerod used it in the interview with you. earlier today. because they're trying, he is trying to talk to the people with health insurance. and trng to reassure them.

not only reassure them that nothing is going to change he is now going to try to make the case, i am actually going to make it better. frankly that is tough because you know while you'll get folks to tell you, yes, they hate dealing with insurance companies, hate this, hate that. they sure like having insurance anare afraid of what change might look like and afraid of a lot of those things. one challenge is to convince folks with insurance that not only will nothing happen to them, that it will get better. and that government is there for a safety knelt. but it is also there to basically tell the private insurance companies, look, you have got to reform your ways. if you don't, you know, we'll hammer you another way. and that other way could be the government-run public option. >> chuck, we spent hours during the campaign talking about the president's, now president's communication skills. he gives a better than average speech. to put it as an understatement. if he gives an average speech

tonight, people will correctly ask -- then why this venue? so it does put a certain all. pressure on the president, his speech writers and this address that was still in, influx as of this afternoon? >> still influx as of late this afternoon. they were still making some tweaks, making some changes. we know behind the scenes this speech has gotten longer since we first heard about drafts of the speech yesterday. so, look, another goal of this speech is he -- you know he needs to get a political bump out of this. not to turn this all into polls and politics, but he needs to create political space for congressional democrats to go behind the scenes and get the bill written. right now, it is not written. there are 4 1/2, 5 versions of it rolling around capitol hill. this speech is an attempt to sort of calm the political waters and give members of congress space to get it done, to negotiate and get this thing on the president's desk.

>> kelly o'donnell there in the chamber of the house of representatives. of the two, of course, because there are just 100 members of the senate. it is the largest chamber and obviously always houses these joint sessions. kelly, we touched on this before. but the power of a name drop, a call-out in a speech like this, is formidable while we expect a reference to senator kennedy. the president can try to cherry pick members of either body with a well-placed name, thanking them for their help along the way. >> also trying to draw distinctions, places of common ground. for example we expect the president to reference ideas that john mccain, his opponent last year, had put forth during the campaign cycle. saying, if it was a good idea then it is a good idea today. trying to look for ways where the president can reach out, try to find some ideas where there might be a willingness of

republicans who talk about how they can come together. but the power of that podium, the power of this gathering, certainly can't be overstated. and there is a certain civility and decorum of a night like this where members who might strongly disagree during the day are going to have a much more respectful tone. everyone here today from both parties that i spoke to expressed a certain amount of excitement about having the president to come to address a joint session. this doesn't happen that often. and it does carry weight. >> here is the announcement from wilson livingsgoode. madam speaker, the president of the united states. >> sergeant of arms with the

congressional leadership down the main aisle. and as we see the members of congress who make it their business to get a seat early at the end of the row so they can be seen exchanging a handshake with the president. david gregory, it is traditional, just prior to the delivery of the speech like this that the text is put out for delivery shared with the news media meaning we can report selected quotes and certainly report the spirit of the speech. i asked a white house aide earlier today, is the president going to extend a hand or clench his fist tonight? and we were assured it would be an extended hand to congress. what do you know about what is in the speech? >> it is interesting that you use that metaphor because i think there will be a little bit of both. on the one hand you are going to hear the president tonight do something that liberal allies have encouraged him to do --

that's to fight back against misinformation that has threatened to derail this effort. on the other hand, as kelly alluded to, his aides say there will be four, five specific new ideas that the president will offer tonight, new to his plan, that he will say are actually idea that republicans have proposed as recently as john mccain during the presidential race. and that republicans have championed over the years. his message will be, if you think those things are important, they can be part of this plan. but the unspoken point is, so you have got to be part of the negotiation, you have got to be part of this process, you can't stand from behind a tree as one aide suggested and throw darts. part and time to be part of this. >> the president making his way down the main aisle. so far very little difference in temperamt, level of sustained applause or enthusiasm, at least, as he shares a joke with his secretary of state.

at least as visible on television. from say a state of the union address or any other gathering like it. the president knows that network television time is a valuable commodity and he is trying to make his way down there as quickly as he can. he has chosen to request chunks of time in primetime from the networks, three, four times. and again what is just 233 days in office. chuck todd, briefly, the white house acknowledges the president, as you mentioned, acknowledges this morning they have lost some time and message. >> this is the last, best chance they have to save health care and make it happen this year. >> now as the president lingers with the speaker of the house, to begin another quick round of formalities here. as he hands envelopes containing

the speech to both the vice president and the speaker as is custom e customary. then introduction, round of applause. if we are not careful we could get under way here. >> thank you. thank you. thank you. thank you. thank you.

>> members of congress, i have the high privilege and distinct honor to present to you the president of the united states. >> 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. be seated. 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 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.

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.

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. but we did not come here just to clean up crises. we came here to build a future. so -- [ applause ] 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 am 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 has attempted to meet this challenge in some way. a bill for comprehensive health reform 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 that are placed on the uninsured who live ever 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 the 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 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. 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 theirinsurance company has dropped theiroverage when they get sick. one man lost his insurance during chemotherapy when his insurer found he didn't report gall stones. 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 becse she forgot 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 ] then there is the problem of rising cost. we spend one and a half times per person on health care than any other country. but we an'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 aspiring entrepreneurs cannot afford to open a business in the first place, and why american businesses that compete internationally like our automakers are at a huge disadvantage. 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 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 the 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 -- where we would severelyestrict 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 have 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 1/6 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 have seen washington at its best and at its worst. we have 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 develop bills, four have completed their work, and the senate finance committee announced today 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 we have ever been. but what we have 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, have seen scare tactics.

some have dug into unyielding ideological camps that offer no hopes 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. and out of this blizzard of charges and countercharges, confusion has reigned. well the time for bickering is over. the time for games has past. 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 costs for our families, our businesses, and our government. [ applause ] it is 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 is 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. 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 cull pans 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 whe you get sick or water it down when you need it the most. [ applause ] they will no longer be able to place some arbitrary cap on the all. 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. insurance companies will be required to cover, with no extra charge, routine checkups and preventative care like mammograms and colonoscopies,

because there is no reason we shouldn't catch 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 are 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 will be able to get coverage. if you strike out on your own and start a small business you will 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 because it lets them compete for millions of new customers. as one big group these customers will have greater leverage to bargain with the insurance cull paenz fcull -- companies for better prices and coverage. how large companies and employees get affordable insurance how everyone in this congress gets affordable in sure & it is time to give every american the same opportunity that we give ourselves. for those individuals and small business whose 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. all insurance companies that

want access to this new marketplace will have t 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 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 is a good idea now and we should all embrace it. 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 therere 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 us to pick up the tab when their 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 toarry auto insurance.

likewise, likewise, businesses will be required to either offer their workers health care o chip in to help cover the cost of their workers. there will be a hardship waiver for those individuals who still can't afford coverage. and 95% of all small businesses, because of their size, and their 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. ile there remains 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 has been spread over the past few months, 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 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 ] now there are also those who claim that our reform efforts 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 my health care proposal has also been attacked by some who oppose reform as a government takeover of the entire health care system. as proof critics point to a provision in our plan that allows the uninsured and small businesses to choose a publicly 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 always has been that consumers do better when there is 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. and it makes it easier for insurance companies to treat their customers badly by cherry picking the healthiest individuals and trying to drop the sickest. by overcharging small businesses who have no leverage and by jacking up rates. 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. awful this is in service of meeting what this former executive called wall street's relentless profit expectations. now i had 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 have already mentioned would do just that. but an additional step we can take to keep insurance companies honest is b making a

not-for-profit public option available in the insurance exchange. [ applause ] now let me -- let me be clear. let me be clear, it would only be an option for those who do not have insurance. no one would be forced to choose it. 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 that these private companies can't fairly compete with the government. and they would be right if taxpayers were subsidizing this public insurance option. but they won't be. i have 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 a private company, by profits and excessive administrative costs and executive salaries, it could provide a good deal for consumers. and would also keep pressure on private insurers to keep their policy as fordable 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. [ applause ] now -- it is -- it's worth noting that a strong majority of americans still favor a public insurance option of the sort i have 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. and shouldn't be used as a handy excuse for the usual washington ideological battles. to my progressive friend i would remind you that for decades the driving idea behind reform has been to end insurance company abuses and make coverage available for those without it. 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 tether to address any legitimate concerns you may have. [ applause ]

for example, for example, some have suggested the public option go into effect only in those markets where insurance companies are not providing affordable policies. others have proposed a co-op or another nonprofit entity to administer the plan. these are all constructive ideas worth exploring. 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 no government bureaucrat or insurance scin shu -- insurance company bureaucrat

gets between you and the care that you need. finally, let me discuss an issue that is a great concern to me,  toembers of this chamber, and to the public. that's how we pay for this plan. and here is what you need to know. first, 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. and to prove that i am 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.

now, 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 initiatives over the past decade were not paid for, from the iraq war to tax breaks for the wealthy. i will not make that same mistake with health care. second, we have 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 save on health care don't make us any healthier. that's not my judgment, it'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 few speak directly to seniors for a moment. because medicare is another issue that has been subjected to demagoguery and 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 ] and 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 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 d medical experts charged with identifying more waste in the years ahead. now these steps will inensure that you, america's senis, get the benefits you have 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.

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 spreang 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 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

ples like the intermountain health care in utah or the geisinger alth system in pennsylvania offer high quality care at costs, so they can accommodate the adoption. 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. 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 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. 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 ] now, there you go. there you go. now i don't believe malpractice reform is a silver bullet, but i have talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs.

so i am 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 is a good idea and i am directing my secretary of health and human services to move forward on this initiative today. now, add it all up, and the plan i am 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 preous administration.

most of these costs will be paid for with money already being spent. but spent badly in the exting 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 1/10 of 1% each year, 1/10 of 1%, it will actually reduce the deficit by $4 trillion over the long term. now this is the plan i am proposing. it is a plan that incorporates ideas from many of the people in the 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. 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 -- 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 one whose suffer silently and the ones who share their stories with us at townhalls 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 also reminded me that it concerns more than material things. what we face, he wrote, is above all a moral issue. at ske are not just the 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 be our self-reliance, our rugged individualism, our fierce defense of freedom and our healthy scepticism of government. in figuring out the appropriate size and role of government has always been a source of rigorous and yes, some times angry debate. that is our history. for some of ted kennedy's critics his brand of liberalism represented an affront to american liberty. in their mind 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 insurance. his friend john mccain knows

that. they worked together on a patients' bill of rights. his friend chuck grassley knows that. they worked together to provide health care to children with disabilities. on issues like these ted kennedy's passion was borne not of some rigid ideology but of his own experience. it was the experience of having two children stricken with cancer. he never forgot 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 lk to have to say to a wife or a child or an aging parent, there is something that could make you better but i just can't afford it. that large heartedness, that concern and regard for the plight of others is not a partisan feeling.