Mr. Speaker, Mr. President, Members of Congress, distinguished
guests, my fellow Americans --
Tonight, we come together to write a new chapter in the
American story.
Our Forebears enshrined the American dream -- life, liberty and
the pursuit of happiness. Every generation of Americans has
worked to strengthen that legacy to make America a place of
freedom and opportunity, where people who work hard could rise
to their full potential, and where their children could live a
better life than they did.
From the settling of the frontier to the landing on the Moon,
ours has been a story of challenges defined, obstacles overcome,
new horizons secured. This is what makes America what it is and
Americans who we are.
Now we are in a time of profound change and opportunity: the
end of the Cold War, the information age, the global economy
that have brought us both opportunity and hope, and dislocation
and uncertainty. Our goal in this dynamic age is to make change
our friend and not our enemy. To achieve that goal, we must
face our challenges with confidence, faith and discipline --
whether it's reducing the deficit, increasing investment,
creating jobs and expanding trade, converting from a high-tech
defense to a high-tech peacetime economy, making our streets
safe or rewarding work over idleness. All these challenges
require change.
If Americans are to have the courage to change we must be
secure in our most basic needs. Tonight I want to talk with you
about one of the most essential things we can do to build that
security: it is time for America to fix a health care system
that is badly broken.
Despite the dedication of millions of talented health care
professionals, our health care is too uncertain and too
expensive; too bureaucratic and too wasteful. It has too much
fraud and too much greed.
At long last, after decades of false starts, we must make this
our most urgent priority: Giving every American health security
-- health care that's always there -- health care that can never
be taken away.
On this journey, as on all others of consequence, there will be
rough stretches and honest disagreements about how to reach our
destination. After all, this is a complicated issue.
But every successful journey is guided by fixed stars. And if
we can agree on some basic values and principles, we will reach
that destination together. So tonight, I want to talk with you
about the principles that must guide our reform of America's
health care system: Security, simplicity, and savings; choice,
quality and responsibility.
When I launched our nation on the journey to reform the health
care system, I knew we needed a talented navigator -- someone
with a rigorous mind, a steady compass, and a caring heart.
Luckily for me and for our nation, I didn't have to search very
far. Because I could turn to the First Lady.
I think she has done a brilliant job.
Over the past eight months, Hillary and those working with her
talked to literally thousands of Americans to understand the
strengths and frailties of our health care system.
They met with over 1,100 health care organizations. They
talked with doctors, nurses, pharmacists, hospital
administrators, insurance and drug company executives and small
and large business owners. They talked with the uninsured and
the self-insured, with union members, older Americans and
advocates for children.
The First Lady consulted extensively with government leaders of
both political parties, across the states of our country, and
especially here on Capitol Hill.
The Stories and the Letters
Hillary and the Task Force received and read 700,000 letters
from ordinary citizens. And what they wrote -- and how bravely
they spoke about their struggle -- is what calls us all to
action.
Every one of us knows someone who has worked hard and played by
the rules but has been hurt by this system that just doesn't
work. Let me tell you about just one.
Kerry Kennedy owns a small furniture franchise that employs
seven people in Titusville, Florida. Like most small business
owners, Kerry has poured his sweat and blood into that company.
But over the last few years, the cost of insuring his seven
workers has skyrocketed, as did the cost of the coverage for
himself, his wife, and his daughter. Last year, however, Kerry
could no longer afford to provide coverage for all his workers
because the insurance companies had labeled two of them high
risk simply because of their age. But, you know what? Those
two people are Kerry's Mother and Father who built the family
business and now work in the store.
That story speaks for millions of others. And from them, we
have learned a powerful truth: we have to preserve and
strengthen what is right with our health care system and fix
what is wrong with it.
This is what is right: We are blessed with the best health
care professionals, the finest health care institutions, the
most advanced research, and the most sophisticated medical
technology on the face of the earth. My mother is a Nurse, and
I grew up around hospitals. The first professional people I
ever knew and looked up to were doctors and nurses. They
represent what is right with our health care system.
But we cannot ignore what is wrong. Millions of Americans are
just a pink slip away from losing their health coverage, and one
serious illness away from losing their life savings. Millions
more are locked into the wrong jobs, because they'd lose their
coverage if they left their companies. And on any given day
over 37 million of our fellow citizens, the vast majority of
them children or hard working adults, have no health insurance
at all. And despite all of this, our medical bills are growing
at more than twice the rate of inflation.
Our health care system takes 35% more of our income than any
other country, insures fewer people, requires more Americans to
pay more and more for less and less, and gives them fewer
choices. There is no excuse for that kind of system, and it's
time to fix it.
The proposal I will describe tonight will reform the costliest
and most wasteful health care system on Earth without any new
broad-based taxes.
Many of the principles in my plan have already been embraced by
Republicans as well as Democrats. For the first time in this
century, leaders of both political parties have committed
themselves irrevocably to providing universal, comprehensive
health care for every American.
I have been deeply moved by the spirit of this debate. We now
have both Republicans and Democrats willing to say, yes, let us
listen to the people, and let us act. Both sides understand the
ethical imperative of solving this problem; both sides know it
will define who we are as a people. Let me ask all of you --
every Member of the House, every Member of the Senate, every
Democrat and every Republican -- let us keep this spirit and
keep this commitment until our work is done.
Security
The first principle of health care reform -- the most important
-- must be security. This principle speaks to the human misery
and costs that we hear about every day when Americans lack or
lose health care coverage.
Security means that those who do not have health care coverage
will have it and, for those who have coverage, it will never be
taken away. We must achieve that security as soon as possible.
Under our plan, every American will receive a health security
card that will guarantee you a comprehensive package of benefits
over the course of your lifetime that will equal benefits
provided by most Fortune 500 corporations.
This card will guarantee you a comprehensive package of
benefits that can never be taken away. And let us pledge
tonight: Before this Congress adjourns next year, you will
pass, and I will sign a new law to create health security for
every American.
With this card, if you lose your job or switch jobs, you're
covered.
If you leave your job to start a small business, you're
covered.
If you are an early retiree, you're covered.
If you or someone in your family has a preexisting medical
condition, you're covered.
If you get sick or a member of your family gets sick, even if
it's a life-threatening illness, you're covered.
And if an insurance company tries to drop you for any reason,
you'll still be covered -- because that will be illegal.
This card will give you comprehensive coverage. You will be
covered for hospital care, doctors visits, emergency and
laboratory services, diagnostic services like Pap smears and
mammograms, substance abuse and mental health treatment.
And our proposal will pay for regular check-ups, well-baby
visits and other preventive care. It's just common sense.
People will stay healthier and at affordable costs. You know
how your mother told you that an ounce of prevention is worth a
pound of cure? Well, your mother was right. And we've ignored
that lesson for too long.
Security must also apply to older Americans. This is something
I feel very strongly about: We will maintain the Medicare
program. And for the first time, Medicare will cover the cost
of prescription drugs. And over time our proposal will provide
assistance in the home for the elderly and disabled who need
long term care. As we proceed with health care, we must not
break faith with our older Americans.
Simplicity
The second principle is simplicity. Our health care system
must be simpler for the patients and simpler for those who
actually deliver health care: our physicians, our nurses, and
our other medical professionals.
Today, we have more than fifteen hundred insurers with hundreds
and hundreds of different forms. They are time consuming for
health care providers, expensive for health care consumers, and
exasperating for anyone who has ever tried to sit down at the
kitchen table and wade through the paperwork.
The medical care industry is drowning in paperwork. In recent
years, the number of administrators has grown four times as fast
as the number of doctors. A hospital should be a house of
healing, not a monument to bureaucracy.
A few days ago, the Vice President and I visited Children's
Hospital in Washington, where they do wonderful, often
miraculous things for very sick children.
Nurse Debbie Freiberg in the cancer and bone marrow unit told
us that, the other day, a little boy asked her to stay at his
side during his chemotherapy. But she had to tell him no. She
had to go to yet another meeting to learn how to fill out yet
another form. That's wrong.
Dr. Lillian Beard, a pediatrician, in that same hospital, said
she did not get into her profession to spend hours every week
filling out forms. She became a doctor to help save lives. If
we can relieve them of that burden, they believe that each
doctor in her hospital could see 500 additional children each
year.
Under our proposal, there will be one standard insurance form,
not hundreds. We will simplify government rules and regulations
so that a doctor doesn't have to check with a bureaucrat in an
office thousands of miles away before ordering a simple blood
test. And you won't have to worry about the fine print, because
there won't be any fine print.
Savings
The third principle is that reform must produce savings in our
health care system.
Today, rampant medical inflation is eating away at our wages,
our savings, our investment capital, and our public treasury.
It undermines America's economy, competitiveness, confidence,
and living standards.
Unless we curb health care inflation, American workers will
lose $655 in income each year by the end of the decade. Small
businesses will continue to face skyrocketing premiums, and a
full third say they will be forced to drop insurance. Large
employers will have to pay as much as $20,000 a year for each
employee. And health care costs will devour more and more of
the federal budget.
Every state government and every local government will continue
to cut back on everything else they must do -- from police
protection to education -- to pay more for the same health care.
These rising costs are a special nightmare for America's small
businesses -- the engine of entrepreneurship and job creation.
Health care premiums for small businesses are 35% higher than
those of large corporations, and they will keep rising at
double-digit rates unless we act.
How will we achieve savings? Rather than looking away as the
price spiral continues, and rather than using government to set
health care prices, our proposal relies on a third way. We want
to give groups of consumers and small businesses the same
bargaining clout that the biggest corporations now have. We
will force plans to compete on the basis of price and quality,
rather than making money by turning away people who are sick, or
performing unnecessary procedures. And we will back the system
up with limits on how much plans can raise their premiums. We
will create what has been missing for too long: a combination
of private market forces and sound policy to support that
competition.
Unless every one is covered, we can never put the brakes on
health care inflation. Because when people don't have
insurance, they wait to see a doctor until their illness is more
severe and more costly, and they often seek treatment in the
most expensive settings -- like emergency rooms. And when they
can't pay their bills, because they aren't insured -- who do you
think picks up the tab? -- the rest of us do: through higher
hospital bills and higher insurance premiums.
We will also save money by simplifying the system and freeing
health care providers from costly and unnecessary paperwork and
administrative overload that now costs $100 billion a year. We
will crack down on the fraud and abuse that drains billions per
year.
This system will work. You don't have to take my word for it.
Ask Dr. C. Everett Koop. He says we could spend $200 billion
less every year without sacrificing the high quality of American
medicine. Ask the public employees in California, who have held
their own premiums down by adopting this very same approach.
Ask Xerox, which saved an estimated $1,000 per worker. Ask the
staff of the Mayo Clinic, who provide some of the finest care
in the world, while holding their cost increases to less than
half the national average. Ask the people of Hawaii, the only
state that covers virtually all of their citizens, and whose
costs are well below the national average.
People may disagree over the best way to fix the system. But
no one can disagree that we can find billions of dollars of
savings in the most costly and bureaucratic system in the world,
and we ought to be doing something about it now.
Choice
The fourth principle is choice. Americans believe they should
be able to choose their own health care plans and their own
doctor. And under our plan they will have that right.
But, today, under our broken health care system, that power to
choose is slipping away. Now it is usually the employer -- and
not the employee -- who makes the choice of what health care
plan will be provided. If your employer only offers one plan,
as do nearly three-quarters of small and medium-sized
businesses, you're stuck with that plan and the doctors it
covers.
We propose to give every American a choice among high quality
plans. You can stay with your current doctor, join a network of
doctors and hospitals, or join a Health Maintenance
Organization. If you don't like your plan, every year you'll
have the chance to choose a new one.
The choice will be left to you -- not your boss -- and not some
bureaucrat.
And we also believe that doctors should have a choice as to
what plans they practice in. We want to end the discrimination
that is now growing against doctors and permit them to practice
in several different plans. Choice is important for doctors,
and critical for consumers.
Quality
The fifth principle is quality. If we reformed everything else
in health care but failed to preserve and enhance the high
quality of our medical care, we would have taken a step
backward, not forward.
Quality is something that cannot be left to chance. When you
board an airplane, you feel better knowing that plane had to
meet standards designed to protect your safety. We must ask no
less of our health care system.
We don't propose a government-run health care system. We
propose that government sets standards to ensure health care
quality. Our proposal will create report cards on health plans,
so that consumers can choose the highest quality providers, and
reward them with their business. At the same time, our plan
will track quality indicators, so that doctors can make better
and smarter choices about the kind of care they provide.
We have evidence that more efficient delivery of health care
does not decrease quality, and may even enhance it. Let me give
you an example of one commonly performed procedure, the coronary
bypass operation.
Pennsylvania discovered that patients who were charged $21,000
for this surgery received as good or better quality care as
patients who were charged up to $84,000. High prices don't
always equal good quality.
Our plan will guarantee that quality health care is available
in even the most remote areas of our nation, linking rural
doctors and hospitals with high-tech urban medical centers. And
our plan will ensure quality by speeding research on effective
prevention and treatment measures for cancer, for AIDS, for
Alzheimers, for heart disease and for other chronic diseases.
Our plan safeguards the finest medical research establishment in
the world, and makes it even better.
Responsibility
The sixth and final principle is responsibility. We need to
restore a sense that we are all in this together, and we all
have a responsibility to be a part of the solution.
Responsibility must start with those who have profited from the
current health care system. Responsibility means insurance
companies will no longer be allowed to cast people aside when
they get sick. It must also apply to laboratories that submit
fraudulent bills; to lawyers who abuse the malpractice system;
to doctors who order unnecessary procedures. It means drug
companies will no longer be allowed to charge three times more
for prescription drugs here in the United States than they
charge overseas. Responsibility must apply to anyone who abuses
our system and drives up costs for honest, hard-working citizens
and health care providers.
Responsibility also means changing the behavior in this country
that drive up our health care costs and cause untold suffering.
It's the outrageous costs of violence from far too many
handguns, especially among the young. It's high rates of AIDS,
smoking and excessive drinking; it's teenage pregnancy,
low-birth weight babies, and not enough vaccinations for the
most vulnerable.
But let me also say this. And I hope you will listen, because
it is a hard thing to hear. Responsibility in our health care
system isn't about "them". It's about you. It's about me.
It's about each of us.
Too many Americans have not taken responsibility for their
health. Too many Americans use this health care system but
don't pay a penny for their health care. I believe those who do
not have health insurance should be responsible for paying
something. There can be no more something for nothing.
Your contribution may be as small as a ten dollar co-payment
when you visit the doctor. But all of us must have insurance.
Why should the rest of us pick up the tab when a guy who doesn't
think he needs insurance gets in an accident and winds up in the
emergency room?
Reform is going to produce a better health care system for
every one of us. But no one should think it's going to be a
free ride. We have to pay for it. Tonight I want to tell you
very plainly how we plan to do that.
Most of the money will come, as it does today, from premiums
paid by employers and individuals. But under our Health
Security Plan, every employer and every individual will be asked
to contribute to health care. This concept was first conveyed
to the Congress by President Nixon. And today a lot of people
agree that the concept of shared responsibility between
employers and employees is the best way to go, from the US
Chamber of Commerce to the American Medical Association.
Some people call it an employer mandate, but I think it is the
fairest way to achieve responsibility in the health care system.
It builds on what we already have, and what already works. It
is the reform that is easiest for consumers to understand. It
includes a discount to help struggling small businesses meet the
cost of covering their employees. It requires the least
bureaucracy or disruption and creates the cooperation we need to
make the system cost-conscious even as we expand health coverage.
Every employer should provide coverage. Three-quarters do it
now. Those that pay are picking up the tab for those that do
not. And it's just not right.
To finance the rest of reform, we'll achieve new savings in
both the Federal government and the private sector through
better decision making and increased competition, and we will
impose new taxes on tobacco.
These sources will cover the costs of the proposal I have
described to you tonight. We have subjected our numbers to the
scrutiny of the major agencies in our government as well as some
of the most respected actuaries from private accounting firms
and Fortune 500 companies.
What does all this mean for you as individuals?
Some will be asked to pay more. If you are an employer, and
you are not insuring your workers, you will have to pay more.
If you are a firm that provides only limited coverage, you may
have to pay more.
If you are a young single person in your twenties and you are
already insured, your rates may go up somewhat. But some day
you will get older. And then under this proposal, you will be
guaranteed affordable coverage.
But for the vast majority of you watching tonight will pay the
same or less for your health care coverage and, at the same
time, get the same or better coverage than you have today.
If you currently get your health insurance through your job,
under our plan you still will. And, for the first time, all of
you will get to choose what plan you belong to.
If you're a small business owner who wants to provide health
insurance to your family and your employees but can't afford to
because the system is stacked against you, this plan will give
you a discount that will finally make insurance affordable. And
if you are already providing insurance, your rates will drop
because we'll help you join with thousands of other small firms
to get the same benefits big corporations get.
If you are self employed, you will pay less, and you will get
to deduct from your taxes 100% of your health care premiums.
If you are a large employer, your health care costs will stop
increasing at double digit rates, so that you will have more
money to put into higher wages and new jobs.
These are the principles on which we must base our efforts --
Security, simplicity, and savings; choice, quality and
responsibility. These are the guiding stars that we must follow
on our journey toward health care reform.
Conclusion
Over the coming months, you are going to be bombarded with
scare tactics by those who profit enormously from the current
health care system. Some of the arguments you hear will be
sincere. Others will be motivated by self-interest. And when
they tell you that we cannot afford to change the current
system, I want you to stop and think: Who are they trying to
protect. You or themselves? And can we afford to stay with the
current system.
As Representatives in Congress, you have a special duty to look
beyond such arguments. I ask you to look into the eyes of a
sick child who needs care. Look at the face of a woman who has
been told not only that it is malignant, but also that it's not
covered by her insurance. Look at the bottom lines of the
businesses driven to bankruptcy by health care costs. And at
the forest of For Sale signs in front of homes of families who
have lost their health insurance. Then look in your heart and
tell me that the greatest nation in the history of the world is
powerless to confront this crisis. Our history and our heritage
tell us we can meet this challenge and we shall meet this
challenge.
Let us write that new chapter in America's story, and guarantee
every American comprehensive health benefits that can never be
taken away.
Some people have said that it would be a miracle if we passed
health care reform. But, my fellow Americans, I believe we live
in a time of great change when miracles do happen.
Just a few days ago, we saw a simple handshake shatter decades
of deadlock in the Middle East. We have seen walls crumble from
Berlin to South Africa. Now it is our turn to strike a blow for
freedom -- the freedom for Americans to live without fear of
their own nation's health care system.
It's hard to believe that once there was a time -- even in this
century -- when retirement was nearly synonymous with poverty,
and older Americans died in our streets. That is unthinkable
today because over a half century ago Americans had the courage
to change -- to create a Social Security System that ensures
that no Americans will be forgotten in their later years.
I believe that forty years from now, our grandchildren will
also find it unthinkable that there was a time in our country
when hardworking families lost their homes and savings simply
because their child fell ill, or lost their health coverage when
they changed jobs. Yet, our grandchildren will only find such
things unthinkable tomorrow, if we have the courage to change
today.
This is our chance. This is our journey. And, when our work
is done, we will know that we have answered the call of history
and met the challenge of our times.
