i want to thank doctor joseph heyman, the chair of the board of trustees as well as doctor jeremy lazarus, speaker of house of delegates are thanks to all of you for bringing me home or even if it's just for a day. [applause] >> you know, from the moment i took office as president, the central challenge we confronted as a nation has been the need to lift ourselves out of the worst recession since world war ii. and in recent months we have taken a series of extraordinary steps, not just to repair the immediate damage to our economy but to build a new foundation for lasting and sustained growth. we are here to create new jobs. to unfreeze our credit markets. for stemming the loss of homes and the decline of home values. all this is important. but even as we've made progress, we know that the road to prosperity remains long and it remains difficult. and we also know that one essential step on our journey is to control the spiraling cost of health care in america. and in order to do that we are going to need the help of the ama. [applause] >> today we are spending over $2 trillion a year on h