“I am not the first president to take up this cause, but I am determined to be the last,” President Obama

“I am not the first president to take up this cause, but I am determined to be the last,” President Obama told a joint session of Congress in his speech on health care.

Ed. --

I just finished laying out my plan for health reform at a joint session of Congress. Now, I'm writing directly to you because what happens next is critical -- and I need your help.

Change this big will not happen because I ask for it. It can only come when the nation demands it. Congress knows where I stand. Now they need to hear from you.

Add your voice: Ask your representatives to support my plan for real health reform in 2009.

The heart of my plan is simple: bring stability and security to Americans who already have health insurance, guarantee affordable coverage for those who don't, and rein in the cost of health care.

Tonight, I offered a specific plan for how to make it happen. I incorporated the best ideas from Democrats and Republicans to create a plan that's bold, practical, and represents the broad consensus of the American people.

We've come closer to real health reform in the last few months than we have in the last 60 years. But those who profit from the status quo -- and those who put partisan advantage above all else -- will fight us every inch of the way.

We do not seek that fight, but we will not shrink from it. The stakes are too high to let scare tactics cloud the debate, or to allow partisan bickering to block the path. Your voice, right now, is essential.

See my full plan and call on your representatives to support it:

http://my.barackobama.com/SupportReform

Ours is not the first generation to understand the dire need for health reform. And I am not the first president to take up this cause, but I am determined to be the last.

Thank you,

President Barack Obama

(RESUME)

By SHERYL GAY STOLBERG and JEFF ZELENY

Published: September 9, 2009

WASHINGTON — President Obama sought to reframe the contentious debate over health care on Wednesday, asking a critical Congress and a skeptical nation to reach consensus on legislation to expand coverage to millions of Americans and lower costs through a sweeping overhaul that has eluded lawmakers for generations.

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A blog from The New York Times that tracks the health care debate as it unfolds.

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Text: Obama’s Health Care Speech to Congress (September 10, 2009)

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Prescriptions: Live Blogging the Health Care Speech (September 9, 2009)

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“I am not the first president to take up this cause, but I am determined to be the last,” Mr. Obama told a joint session of Congress, adding, “Our collective failure to meet this challenge — year after year, decade after decade — has led us to a breaking point.”

The speech was an effort by Mr. Obama to regain his political footing on health care, the centerpiece of his domestic agenda. After months of insisting he would leave the details to lawmakers, he presented his most detailed outline yet of a plan he said would provide “security and stability” to those who have insurance and cover those who do not, all without adding to the federal deficit.

The president placed a price tag on the plan of about $900 billion over 10 years, which he said was “less than we have spent on the Iraq and Afghanistan wars.” But he devoted much of his address to making the case for why such a plan is necessary, and he sought to reassure the elderly and Americans who already have insurance that it would not take something from them.

The magnitude of his challenge quickly became clear. While Mr. Obama had been greeted by booming applause from Democrats and polite handshakes from Republicans when he entered the House chamber shortly after 8 p.m., heckling soon erupted from Republican lawmakers. A chorus of “boos” arose as the president dismissed so-called death panels as “a lie — plain and simple.”

“Lie!” one Republican lawmaker yelled back at the president, after he asserted that no illegal immigrants would receive benefits under his plan.

In forceful, direct language, often punctuated by applause, Mr. Obama decried his opponents’ “scare tactics” and appealed to the conscience of the nation. With the widow of Senator Edward M. Kennedy sitting in the House gallery, he read a letter Mr. Kennedy had written him, in which he said that health care 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.”

Many of the ideas Mr. Obama outlined were not new. He reiterated his support for a “public option,” a government-backed insurance plan to compete with the private sector, while saying he would consider alternatives. He said his plan would make it illegal for insurance companies to deny coverage to people with pre-existing conditions or drop people who are sick. He proposed that all Americans be required to carry health insurance, in much the same way drivers are required to carry auto insurance.

But Mr. Obama did embrace some fresh proposals.

He announced a new initiative to create pilot projects aimed at curbing medical malpractice lawsuits, a cause that is important to physicians and Republicans. He adopted an idea put forth by Senator John McCain, his Republican rival in the 2008 presidential race, for high-risk insurance pools to cover those with pre-existing conditions — and praised Mr. McCain by name in the speech.

The president also endorsed a plan, contained in a draft proposal being circulated by Senator Max Baucus, the Montana Democrat who is chairman of the Senate Finance Committee, to help pay for expanding coverage by taxing insurance companies that offer expensive, so-called gold-plated insurance plans.

And, to reassure those who do not believe the plan will not run up the deficit, he promised to include a provision that “requires us to come forward with more spending cuts” if the savings he envisions do not materialize.

In embracing Mr. McCain and the malpractice projects, the White House appeared to be seeking to lay the groundwork for an argument that the final bill will be bipartisan — not because it garners Republican votes, but because it contains Republican ideas. That is the same argument the Obama administration used early this year, when the president’s economic recovery package passed with just three Republican votes.

Republicans seemed primed for a fight; many, like Senator Charles E. Grassley, the Iowa Republican who has been deeply involved in health negotiations, released statements about the speech even before it began. Mr. Grassley called on Mr. Obama to “start building the kind of legislation that could win the support of 70 to 80 senators” — a goal Mr. Grassley said could not be achieved if the bill contained a new government plan.

The speech was the president’s second address before a joint session of Congress. But the political backdrop on Wednesday was far different from Mr. Obama’s appearance in the House chamber on the 36th day of his term, when an optimistic wave of momentum was at his back and his Republican rivals were dispirited and in disarray.

“What we have also seen in these last months is the same partisan spectacle that only hardens the disdain many Americans have toward their own government. Instead of honest debate, we have seen scare tactics,” Mr. Obama said. “Some have dug into unyielding ideological camps that offer no hope 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.”

He added, “And out of this blizzard of charges and counter-charges, confusion has reigned.”

While Mr. Obama was addressing lawmakers inside the ornate House chamber, the much more important audience was outside Washington: the 180 million Americans who already have health insurance and who remain skeptical that Mr. Obama’s plan will change things for the better. Inside the chamber, the president drew laughter when he said, “there remain some significant details to be ironed out.”

Mr. Obama made clear in his speech that he would have little tolerance for Republicans who were determined to defeat him. “I will not waste time,” he said, “with those who have made the calculation that it’s better politics to kill this plan than improve it.”

After the speech, Rahm Emanuel, the White House chief of staff, approached lawmakers on the floor to ask who had accused Mr. Obama of lying. Mr. Emanuel was told it was Representative Joe Wilson, Republican of South Carolina.

“No president ever has been treated like that, ever,” Mr. Emanuel told reporters.

For Mr. Obama, the speech was a go-for-broke moment; there is no more dramatic venue for a president than an address to a joint session to Congress. For many Democrats, the speech evoked memories of a similar health care address by President Bill Clinton, 16 years ago this month. Mr. Clinton called for “security, simplicity, savings, choice, quality and responsibility” — the same broad themes Mr. Obama evoked Wednesday night.

THE OBAMA PLAN: STABILITY & SECURITY FOR ALL AMERICANS

THE OBAMA PLAN: STABILITY & SECURITY FOR ALL AMERICANS

http://www.whitehouse.gov/issues/health_care/plan/

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"It will provide more security and stability to those who have health insurance. It will provide insurance to those who don’t. And it will lower the cost of health care for our families, our businesses, and our government."

– President Barack Obama

If You Have Health Insurance

More Stability and Security

• Ends discrimination against people with pre-existing conditions. Over the last three years, 12 million people were denied coverage directly or indirectly through high premiums due to a pre-existing condition. Under the President’s plan, it will be against the law for insurance companies to deny coverage for health reasons or risks.

• Limits premium discrimination based on gender and age. The President’s plan will end insurers’ practice of charging different premiums or denying coverage based on gender, and will limit premium variation based on age.

• Prevents insurance companies from dropping coverage when people are sick and need it most. The President’s plan prohibits insurance companies from rescinding coverage that has already been purchased except in cases of fraud. In most states, insurance companies can cancel a policy if any medical condition was not listed on the application – even one not related to a current illness or one the patient didn’t even know about. A recent Congressional investigation found that over five years, three large insurance companies cancelled coverage for 20,000 people, saving them from paying $300 million in medical claims - $300 million that became either an obligation for the patient’s family or bad debt for doctors and hospitals.

• Caps out-of pocket expenses so people don’t go broke when they get sick. The President’s plan will cap out-of-pocket expenses and will prohibit insurance companies from imposing annual or lifetime caps on benefit payments. A middle-class family purchasing health insurance directly from the individual insurance market today could spend up to 50 percent of household income on health care costs because there is no limit on out-of-pocket expenses.

• Eliminates extra charges for preventive care like mammograms, flu shots and diabetes tests to improve health and save money. The President’s plan ensures that all Americans have access to free preventive services under their health insurance plans. Too many Americans forgo needed preventive care, in part because of the cost of check-ups and screenings that can identify health problems early when they can be most effectively treated. For example, 24 percent of women age 40 and over have not received a mammogram in the past two years, and 38 percent of adults age 50 and over have never had a colon cancer screening.

• Protects Medicare for seniors. The President’s plan will extend new protections for Medicare beneficiaries that improve quality, coordinate care and reduce beneficiary and program costs. These protections will extend the life of the Medicare Trust Fund to pay for care for future generations.

• Eliminates the "donut-hole" gap in coverage for prescription drugs. The President’s plan begins immediately to close the Medicare "donut hole" - a current gap in its drug benefit - by providing a 50 percent discount on brand-name prescription drugs for seniors who fall into it. In 2007, over 8 million seniors hit this coverage gap in the standard Medicare drug benefit. By 2019, the President’s plan will completely close the "donut hole". The average out-of-pocket spending for such beneficiaries who lack another source of insurance is $4,080.

If You Don't Have Insurance

Quality, Affordable Choices for All Americans

• Creates a new insurance marketplace – the Exchange – that allows people without insurance and small businesses to compare plans and buy insurance at competitive prices. The President’s plan allows Americans who have health insurance and like it to keep it. But for those who lose their jobs, change jobs or move, new high quality, affordable options will be available in the exchange. Beginning in 2013, the Exchange will give Americans without access to affordable insurance on the job, and small businesses one-stop shopping for insurance where they can easily compare options based on price, benefits, and quality.

• Provides new tax credits to help people buy insurance. The President’s plan will provide new tax credits on a sliding scale to individuals and families that will limit how much of their income can be spent on premiums. There will also be greater protection for cost-sharing for out-of-pocket expenses.

• Provides small businesses tax credits and affordable options for covering employees. The President’s plan will also provide small businesses with tax credits to offset costs of providing coverage for their workers. Small businesses who for too long have faced higher prices than larger businesses, will now be eligible to enter the exchange so that they have lower costs and more choices for covering their workers.

• Offers a public health insurance option to provide the uninsured and those who can’t find affordable coverage with a real choice. The President believes this option will promote competition, hold insurance companies accountable and assure affordable choices. It is completely voluntary. The President believes the public option must operate like any private insurance company – it must be self-sufficient and rely on the premiums it collects.

• Immediately offers new, low-cost coverage through a national "high risk" pool to protect people with preexisting conditions from financial ruin until the new Exchange is created. For those Americans who cannot get insurance coverage today because of a pre-existing condition, the President’s plan will immediately make available coverage without a mark-up due to their health condition. This policy will offer protection against financial ruin until a wider array of choices become available in the new exchange in 2013.

For All Americans

Reins In the Cost of Health Care for Our Families, Our Businesses, and Our Government

• Won’t add a dime to the deficit and is paid for upfront. The President’s plan will not add one dime to the deficit today or in the future and is paid for in a fiscally responsible way. It begins the process of reforming the health care system so that we can further curb health care cost growth over the long term, and invests in quality improvements, consumer protections, prevention, and premium assistance. The plan fully pays for this investment through health system savings and new revenue including a fee on insurance companies that sell very expensive plans.

• Requires additional cuts if savings are not realized. Under the plan, if the savings promised at the time of enactment don’t materialize, the President will be required to put forth additional savings to ensure that the plan does not add to the deficit.

• Implements a number of delivery system reforms that begin to rein in health care costs and align incentives for hospitals, physicians, and others to improve quality. The President’s plan includes proposals that will improve the way care is delivered to emphasize quality over quantity, including: incentives for hospitals to prevent avoidable readmissions, pilots for new "bundled" payments in Medicare, and support for new models of delivering care through medical homes and accountable care organizations that focus on a coordinated approach to care and outcomes.

• Creates an independent commission of doctors and medical experts to identify waste, fraud and abuse in the health care system. The President’s plan will create an independent Commission, made up of doctors and medical experts, to make recommendations to Congress each year on how to promote greater efficiency and higher quality in Medicare. The Commission will not be authorized to propose or implement Medicare changes that ration care or affect benefits, eligibility or beneficiary access to care. It will ensure that your tax dollars go directly to caring for seniors.

• Orders immediate medical malpractice reform projects that could help doctors focus on putting their patients first, not on practicing defensive medicine. The President’s plan instructs the Secretary of Health and Human Services to move forward on awarding medical malpractice demonstration grants to states funded by the Agency for Healthcare Research and Quality as soon as possible.

• Requires large employers to cover their employees and individuals who can afford it to buy insurance so everyone shares in the responsibility of reform. Under the President’s plan, large businesses – those with more than 50 workers – will be required to offer their workers coverage or pay a fee to help cover the cost of making coverage affordable in the exchange. This will ensure that workers in firms not offering coverage will have affordable coverage options for themselves and their families. Individuals who can afford it will have a responsibility to purchase coverage – but there will be a "hardship exemption" for those who cannot.

Tune Into The Whitehouse Live!

Tune Into The Whitehouse Live!

http://www.whitehouse.gov/live/

Go To: http://www.whitehouse.gov/?e=13&ref=text

By Dennis Kucinich
A New Movement: Health Care as a Civil Right
The hour has arrived to begin anew the Civil Rights Movement, this time for Health Care for All.

Columnist Claims There's No Health Care Crisis; Obama Is Making It Up

Washington Post columnist Michael Gerson says there's no health care crisis and President Obama is acting "very Carter-like" by creating one where none exists. His evidence? Most people are satisfied with their health plans. Never mind that it's already been repeated ad nauseam that the reason for this statistic is that people don't use them or simply don't understand what they have. It's sort of like hearing that most people are satisfied with their new car before they drive it off the dealer's lot. My guess is that this is how some Republicans will respond to tonight's address. Watch for people to start saying that Obama is too busy presenting "a political priority as a national crisis" when "the economy, Afghanistan and Iran may be crises enough for anyone." And watch for people to start saying that the real crisis might just be the rising costs of health care reform and that Obama has no plans to deal with that.

So what should be done? Gerson says "nothing."

I have a couple of question for Mr. Gerson. Health insurance rates have doubled in the last 10 years. They're on track to double again within the decade.

Does he expect his employer to continue to foot the bill for these ever escalating expenses? Or is it possible that at some point his employer is going to send him a note saying: We've eliminated employer coverage; you're now on your own. Think that can't happen? It's already happening. It's been happening.

Does he think that one possible reason wages for middle class Americans haven't gone up (adjusted for inflation) in the last eight years is because our employers can't afford the ever increasing cost of health insurance?

I'd ask Mr. Gerson to ask one of the millions of families who have faced bankruptcy just because they got sick. Medical bills are involved in more than 60 percent of all personal bankruptcies in the U-S, an increase of 50 percent in just six years. A person whose spouse dies from cancer is not only left a widow and cost them everything they owned, but resulted in a bankruptcy that remains attached to a credit report for seven years though no financial recklessness took place.

Under today's laws, this could happen to any American family, and in less than six degrees of separation, you probably know someone who's been through it. If you don't, just wait, and hope it doesn't happen to you. Until it does.

My neighbor makes big money, easily 6-figures plus, and yet he has difficulty insuring his 21-year old son, who has a pre-existing condition requiring expensive monthly meds --and is therefore virtually uninsurable under present industry rules. If my neighbor dies --and with it, the death of his income stream-- his son is flat out of luck. Shall we just let him die, too?

If a relative fat-cat white guy like him is struggling to insure his family, what in the world is joe-average American doing?

Funny that so many of those who don't believe in survival of the fittest --Darwin, and his evil scientific ilk-- are so insistent on applying its precepts when it concerns health insurance.

MoveOn.org made this video. I don't care for MoveOn.org and yes, the video is designed to advance their agenda, but the people in it? They're real. The health care issue is certainly a crisis for them.

What if one of the people in this video was you? Maybe it is. But if you prefer, try this story in Arizona where 10,000 working parents will lose health insurance. This month.

Nope, no reform needed to help these people.
In the Washington Post, the same paper in which this column appears:

"They said I never mentioned I had a back problem," said Marrari, 52, whose coverage with Blue Cross was abruptly canceled in 2006 after a thyroid disorder, fluid in the heart and lupus were diagnosed. That left the Los Angeles woman with $25,000 in medical bills and the stigma of the company's claim that she had committed fraud by not listing on a health questionnaire "preexisting conditions" Marrari said she did not know she had.

Nope, no need for reform there.

If "the only problem with healthcare is cost," as Mr. Gerson says, explain why we pay so much when we rank 37th in the world in health care and our mortality and health rates pale in comparison to other nations? Never mind the cost for moment; why aren't we getting enough bang for our buck?

How come in the countries where government is much more involved in health care the cost of it is lower and quality of it is higher?

Gerson says the cost of health care is "artificially high because of decades of government manipulation. Compare the falling costs of toothpaste, computers or plastic surgery with the rising costs of college tuitions, houses and healthcare."

I was unaware that toothpaste costs had dropped. Not for me. As for computers and plastic surgery, those have dropped because of technical advances and proliferation. Try comparing the rising costs of food and you get a very different story, one that shows Americans do not have the money they had forty years ago (prior to Reagan anyway).
"The rising costs of college tuitions, houses and healthcare," he declares "have had government manipulation of their respective markets," which explains why they've gone up in price?

Really? Wanna explain how "government intervention" has actually made college education cheaper in state schools than private universities? How did government make housing more expensive when market forces dictated prices, as they have now, when housing prices are as much as 50 percent lower than they were?
Gerson writes that "all 'public options,' whether in airlines (80s) or higher education or housing has only raised prices." Really? There was a free college and airline paid for by tax dollars? When did that happen?

Gerson also writes that:

…encouraging a sense of crisis is a traditional tool of executive leadership. And using a joint session of Congress to address a single domestic issue is the most dramatic expression of this approach.
Carter did it effectively in April 1977. He spoke of the energy crisis as "the moral equivalent of war." Energy resources were "simply running out." (Carter's CIA predicted worldwide oil shortages by the mid-1980s.) America needed to "cope with a crisis that otherwise would overwhelm us."
The speech had immediate influence. The share of Americans who viewed the energy crisis as a serious problem jumped nine points, to 54 percent. One congressional staffer enthused: "It's damn near unpatriotic to oppose the president right now."

Encouraging a sense of crisis is a traditional tool of leadership? And who would know this better than members of the media? Do they not encourage a sense of crisis and controversy last week in playing up the faux outrage over a president's speech to school children? Did they bother to cover any town hall meetings, the majority of which were conducted in a civilized, orderly fashion? No, they showed angry people, shouting people, people finger-pointing at other people, because that sells better than civil discourse.

When Gerson writes that "encouraging a sense of crisis is a traditional tool of executive leadership," he knows of what he speaks:

Gerson proposed the use of a "smoking gun/mushroom cloud" metaphor during a September 5, 2002 meeting of the White House Iraq Group, in an effort to sell the American public on the nuclear dangers posed by Saddam Hussein. According to Newsweek columnist Michael Isikoff, "The original plan had been to place it in an upcoming presidential speech, but WHIG members fancied it so much that when the Times reporters contacted the White House to talk about their upcoming piece [about aluminum tubes], one of them leaked Gerson's phrase — and the administration would soon make maximum use of it.

The title of Gerson's op-ed? "Obama Crisis: Credibility." Why do I get the feeling that Karl Rove was whispering in his ear to drop the name "Carter," into the health care debate, knowing how well that incites the base?

Incidentally, Mr. Gerson might do well to check his history. Obama's approach to health care reform is diametrically opposed to Carter's. Ted Kennedy broke with Carter precisely because of Carter's take it slow approach. Since I assume that Mr. Gerson is an expert on politics, I have to conclude that he is being entirely dishonest when he equates Obama with Carter.

Unfortunately, if we had taken stock of the energy crisis in the 1970's, we wouldn't be beholden to Middle East oil barons today. And what is it they say about an ounce of prevention?

Or perhaps we should argue that this debate is about government spending? Let's check:

--Almost $700 billion spent so that Saddam Hussein couldn't give weapons he didn't have to terrorist groups he didn't have ties with. (And that doesn't include the future cost of the Iraq war, the wounded vets, the lost lives, the lost productivity).
--$2.5 trillion for Bush's tax cuts (for 2001-2010), with 52.5% of the benefits to the top 5% of taxpayers in 2010, and the greatest economic calamity since the Great Depression.
--$1.2 trillion over 10 years for the prescription drug care benefit, driven higher because the Congress didn't want the government to be able to bargain for the drugs (which equals a direct subsidy from taxpayers to big pharma).
Is this debate about money or priorities? If you think that spending a trillion dollars to ensure health care for all of your fellow citizens is worse than spending it on a pointless war, tax cuts for the extremely rich, and handouts to big pharma then maybe you need to reassess your priorities.

To my conservative friends here today: would you explain to me how Gerson's saying that, to a very well-off man like him, there doesn't appear to be a crisis in health care access is anything other than the most revolting, embarrassing elitism?

I wonder where he gets his health care? And I wonder what he'd do if they stopped providing it? And what he would do if he could no longer afford it out of pocket?

Annual compensation of health insurance company executives (2006 and 2007 figures):
• Ronald A. Williams, Chair/ CEO, Aetna Inc., $23,045,834
• H. Edward Hanway, Chair/ CEO, Cigna Corp, $30.16 million
• David B. Snow, Jr, Chair/ CEO, Medco Health, $21.76 million
• Michael B. MCallister, CEO, Humana Inc, $20.06 million
• Stephen J. Hemsley, CEO, UnitedHealth Group, $13,164,529
• Angela F. Braly, President/ CEO, Wellpoint, $9,094,771
• Dale B. Wolf, CEO, Coventry Health Care, $20.86 million
• Jay M. Gellert, President/ CEO, Health Net, $16.65 million
• William C. Van Faasen, Chairman, Blue Cross Blue Shield of Massachusetts, $3 million plus $16.4 million in retirement benefits
• Charlie Baker, President/ CEO, Harvard Pilgrim Health Care, $1.5 million
• James Roosevelt, Jr., CEO, Tufts Associated Health Plans, $1.3 million
• Cleve L. Killingsworth, President/CEO Blue Cross Blue Shield of Massachusetts, $3.6 million
• Raymond McCaskey, CEO, Health Care Service Corp (Blue Cross Blue Shield), $10.3 million
• Daniel P. McCartney, CEO, Healthcare Services Group, Inc, $ 1,061,513
• Daniel Loepp, CEO, Blue Cross Blue Shield of Michigan, $1,657,555
• Todd S. Farha, CEO, WellCare Health Plans, $5,270,825
• Michael F. Neidorff, CEO, Centene Corp, $8,750,751
• Daniel Loepp, CEO, Blue Cross Blue Shield of Michigan, $1,657,555
• Todd S. Farha, CEO, WellCare Health Plans, $5,270,825
• Michael F. Neidorff, CEO, Centene Corp, $8,750,751

That's over $220 million for 20 people. This is where some of your health insurance money goes. CEOs are paid based on their ability to keep costs low and profits high. Who do you suppose is on the short end of that stick in this particular equation?

EXCERPTS OF THE PRESIDENT'S ADDRESS TO A JOINT SESSION OF CONGRESS TONIGHT:

EXCERPTS OF THE PRESIDENT'S ADDRESS TO A JOINT SESSION OF CONGRESS TONIGHT:

THE BRIEFING ROOM

THE WHITE HOUSE

Office of the Press Secretary

For Immediate Release

September 9, 2009

EXCERPTS OF THE PRESIDENT'S ADDRESS TO A JOINT SESSION OF CONGRESS TONIGHT:

I am not the first President to take up this cause, but I am determined to be the last. 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. Sixty-five years later, his son continues to introduce that same bill at the beginning of each session.

Our collective failure to meet this challenge – year after year, decade after decade – has led us to a 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 expensive to cover.

***

During that time, we have seen Washington at its best and 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 that 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 eighty percent 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 toward their own government. Instead of honest debate, we have seen scare tactics. Some have dug into unyielding ideological camps that offer no hope 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 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.

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 to those who don’t. And it will slow the growth of health care costs for our families, our businesses, and our government. It’s a plan that asks everyone to take responsibility for meeting this challenge – not just government and insurance companies, but employers and individuals. And it’s 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, Medicare, Medicaid, or the VA, nothing in this plan will require you or your employer to change the coverage or the doctor you have. Let me repeat this: nothing in our plan requires you to change what you have.

What this plan will do is to 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 pre-existing condition. 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 most. They will no longer be able to place some arbitrary cap on the amount of coverage you can receive in a given year or a lifetime. 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. And insurance companies will be required to cover, with no extra charge, routine checkups and preventive care, like mammograms and colonoscopies – because there’s no reason we shouldn’t be catching diseases like 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 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. If you lose your job or 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 will 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 with the insurance companies 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’ve given ourselves.

***

This is the plan I’m proposing. It’s a plan that incorporates 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 improve it. I will not 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 the 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 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 shared their stories with us at town hall meetings, in emails, and in letters.