if we fail to act, one out of every $5 beearn will be spent on health care and in 30 years, it will be one out of every $3. a trend that will mean more lost jobs, lower take home pay and a lower standard of living for all americans and federal spending on medicaid and medicare will grow in the coming decades to the amount our nation currently spends on our nation's defense. it will, in fact, grow larger than what our government spends on anything else today. it is a scenario that will swamp our federal and state budgets and impose a vicious choice of unprecedented tax hikes or overwhelming deficits or drastic cuts in our federal and state budgets. so to say it as plainly as i can, health care is the single most important thing we can do for america's long-term fiscal health. [applause] that is a fact. [applause] that's a fact. it's fact and the truth is most people know that it is a fact. and yet, as clear as it is that our system badly needs reform, reform is not inevitable. there is a sense out there among some and perhaps some members who are gathered here today at the a.m.a. that a