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President's Speech as Delivered


                           THE WHITE HOUSE

                    Office of the Press Secretary
_________________________________________________________________
For Immediate Release                         September 22, 1993


                      ADDRESS OF THE PRESIDENT
                  TO THE JOINT SESSION OF CONGRESS

                            U.S. Capitol
                          Washington, D.C.


9:10 P.M. EDT


     THE PRESIDENT:  Mr. Speaker, Mr. President, members of Congress,
distinguished guests, my fellow Americans.  Before I begin my words
tonight I would like to ask that we all bow in a moment of silent
prayer for the memory of those who were killed and those who have
been injured in the tragic train accident in Alabama today.  (A
moment of silence is observed.)  Amen.

     My fellow Americans, tonight we come together to write a new
chapter in the American story.  Our forebears enshrined the American
Dream -- life, liberty, the pursuit of happiness.  Every generation
of Americans has worked to strengthen that legacy, to make our
country a place of freedom and opportunity, a place where people who
work hard can rise to their full potential, a place where their
children can have a better future.

     From the settling of the frontier to the landing on the moon,
ours has been a continuous story of challenges defined, obstacles
overcome, new horizons secured.  That is what makes America what it
is and Americans what 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 have brought us both opportunity and hope and
strife and uncertainty.  Our purpose in this dynamic age must be to
change -- to make change our friend and not our enemy.

     To achieve that goal, we must face all our challenges with
confidence, with faith, and with discipline -- whether we're reducing
the deficit, creating tomorrow's jobs and training our people to fill
them, converting from a high-tech defense to a high-tech domestic
economy, expanding trade, reinventing government, making our streets
safer, or rewarding work over idleness.  All these challenges require
us to change.

     If Americans are to have the courage to change in a difficult
time, we must first be secure in our most basic needs.  Tonight I
want to talk to you about the most critical thing we can do to build
that security.  This health care system of ours is badly broken and
it is time to fix it.  (Applause.)

     Despite the dedication of literally 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 can never be taken away; health care that is always
there.  That is what we must do tonight.  (Applause).

     On this journey, as on all others of true consequence, there
will be rough spots in the road and honest disagreements about how we
should proceed.  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 this destination, and
we will reach it together.

     So tonight I want to talk to you about the principles that I
believe must embody our efforts to reform America's health care
system -- security, simplicity, savings, choice, quality, and
responsibility.

     When I launched our nation on this journey to reform the health
care system I knew we needed a talented navigator, someone with a
rigorous mind, a steady compass, a caring heart.  Luckily for me and
for our nation, I didn't have to look very far.  (Applause.)

     Over the last eight months, Hillary and those working with her
have talked to literally thousands of Americans to understand the
strengths and the frailties of this system of ours.  They met with
over 1,100 health care organizations.  They talked with doctors and
nurses, pharmacists and drug company representatives, hospital
administrators, insurance company executives and small and large
businesses.  They spoke with self-employed people.  They talked with
people who had insurance and people who didn't.  They talked with
union members and older Americans and advocates for our children.
The First Lady also consulted, as all of you know, extensively with
governmental leaders in both parties in the states of our nation, and
especially here on Capitol Hill.

     Hillary and the Task Force received and read over 700,000
letters from ordinary citizens.  What they wrote and the bravery with
which they told their stories is really what calls us all here
tonight.

     Every one of us knows someone who's worked hard and played by
the rules and still been hurt by this system that just doesn't work
for too many people.  But I'd like to tell you about just one.

     Kerry Kennedy owns a small furniture store that employs seven
people in Titusville, Florida.  Like most small business owners, he's
poured his heart and soul, his sweat and blood into that business for
years.  But over the last several years, again like most small
business owners, he's seen his health care premiums skyrocket, even
in years when no claims were made.  And last year, he painfully
discovered he could no longer afford to provide coverage for all his
workers because his insurance company told him that two of his
workers had become high risks because of their advanced age.  The
problem was that those two people were his mother and father, the
people who founded the business and still worked in the store.

     This 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 the health care system, but we have got to fix what is
wrong with it.  (Applause.)

     Now, we all know what's right.  We're blessed with the best
health care professionals on Earth, the finest health care
institutions, the best medical research, the most sophisticated
technology.  My mother is a nurse.  I grew up around hospitals.
Doctors and nurses were the first professional people I ever knew or
learned to look up to.  They are what is right with this health care
system.  But we also know that we can no longer afford to continue to
ignore what is wrong.

     Millions of Americans are just a pink slip away from losing
their health insurance, and one serious illness away from losing all
their savings.  Millions more are locked into the jobs they have now
just because they or someone in their family has once been sick and
they have what is called the preexisting condition.  And on any given
day, over 37 million Americans -- most of them working people and
their little children -- have no health insurance at all.

     And in spite of all this, our medical bills are growing at over
twice the rate of inflation, and the United States spends over a
third more of its income on health care than any other nation on
Earth.  And the gap is growing, causing many of our companies in
global competition severe disadvantage.  There is no excuse for this
kind of system.  We know other people have done better.  We know
people in our own country are doing better.  We have no excuse.  My
fellow Americans, we must fix this system and it has to begin with
congressional action.  (Applause.)

     I believe as strongly as I can say that we can reform the
costliest and most wasteful system on the face of the Earth without
enacting new broad-based taxes.  (Applause.)  I believe it because of
the conversations I have had with thousands of health care
professionals around the country; with people who are outside this
city, but are inside experts on the way this system works and wastes
money.

     The proposal that I describe tonight borrows many of the
principles and ideas that have been embraced in plans introduced by
both Republicans and Democrats in this Congress.  For the first time
in this century, leaders of both political parties have joined
together around the principle of providing universal, comprehensive
health care.  It is a magic moment and we must seize it.  (Applause.)

     I want to say to all of you I have been deeply moved by the
spirit of this debate, by the openness of all people to new ideas and
argument and information.  The American people would be proud to know
that earlier this week when a health care university was held for
members of Congress just to try to give everybody the same amount of
information, over 320 Republicans and Democrats signed up and showed
up for two days just to learn the basic facts of the complicated
problem before us.

     Both sides are willing to say we have listened to the people.
We know the cost of going forward with this system is far greater
than the cost of change.  Both sides, I think, understand the literal
ethical imperative of doing something about the system we have now.
Rising above these difficulties and our past differences to solve
this problem will go a long way toward defining who we are and who we
intend to be as a people in this difficult and challenging era.  I
believe we all understand that.

     And so tonight, let me ask all of you -- every member of the
House, every member of the Senate, each Republican and each
Democrat -- let us keep this spirit and let us keep this commitment
until this job is done.  We owe it to the American people.
(Applause.)

     Now, if I might, I would like to review the six principles I
mentioned earlier and describe how we think we can best fulfill those
principles.

     First and most important, security.  This principle speaks to
the human misery, to the costs, to the anxiety we hear about every
day -- all of us -- when people talk about their problems with the
present system.  Security means that those who do not now have health
care coverage will have it; and for those who have it, it will never
be taken away.  We must achieve that security as soon as possible.

     Under our plan, every American would receive a health care
security card that will guarantee a comprehensive package of benefits
over the course of an entire lifetime, roughly comparable to the
benefit package offered by most Fortune 500 companies.  This health
care security card will offer this package of benefits in a way that
can never be taken away.

     So let us agree on this:  whatever else we disagree on, before
this Congress finishes its work next year, you will pass and I will
sign legislation to guarantee this security to every citizen of this
country.  (Applause.)

     With this card, if you lose your job or you switch jobs, you're
covered.  If you leave your job to start a small business, you're
covered.  If you're an early retiree, you're covered.  If someone in
your family has, unfortunately, had an illness that qualifies as a
preexisting condition, you're still 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 will still be covered, because that will be
illegal.  This card will give comprehensive coverage.  It will cover
people for hospital care, doctor visits, emergency and lab services,
diagnostic services like Pap smears and mammograms and cholesterol
tests, substance abuse and mental health treatment. (Applause.)

     And equally important, for both health care and economic
reasons, this program for the first time would provide a broad range
of preventive services including regular checkups and well-baby
visits.  (Applause.)

     Now, it's just common sense.  We know -- any family doctor will
tell you that people will stay healthier and long-term costs of the
health system will be lower if we have comprehensive preventive
services.  You know how all of our mothers told us that an ounce of
prevention was worth a pound of cure?  Our mothers were right.
(Applause.)  And it's a lesson, like so many lessons from our
mothers, that we have waited too long to live by.  It is time to
start doing it.  (Applause.)

     Health care security must also apply to older Americans.  This
is something I imagine all of us in this room feel very deeply about.
The first thing I want to say about that is that we must maintain the
Medicare program.  It works to provide that kind of security.
(Applause.)  But this time and for the first time, I believe Medicare
should provide coverage for the cost of prescription drugs.
(Applause.)

     Yes, it will cost some more in the beginning.  But, again, any
physician who deals with the elderly will tell you that there are
thousands of elderly people in every state who are not poor enough to
be on Medicaid, but just above that line and on Medicare, who
desperately need medicine, who makes decisions every week between
medicine and food.  Any doctor who deals with the elderly will tell
you that there are many elderly people who don't get medicine, who
get sicker and sicker and eventually go to the doctor and wind up
spending more money and draining more money from the health care
system than they would if they had regular treatment in the way that
only adequate medicine can provide.

     I also believe that over time, we should phase in long-term care
for the disabled and the elderly on a comprehensive basis.
(Applause.)

     As we proceed with this health care reform, we cannot forget
that the most rapidly growing percentage of Americans are those over
80.  We cannot break faith with them.  We have to do better by them.

     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 doctors, our nurses, our other medical
professionals.  Today we have more than 1,500 insurers, with hundreds
and hundreds of different forms.  No other nation has a system like
this.  These forms are time consuming for health care providers,
they're expensive for health care consumers, they're exasperating for
anyone who's ever tried to sit down around a table and wade through
them and figure them out.

     The medical care industry is literally drowning in paperwork.
In recent years, the number of administrators in our hospitals has
grown by four times the rate that the number of doctors has grown.  A
hospital ought to be a house of healing, not a monument to paperwork
and bureaucracy.  (Applause.)

     Just a few days ago, the Vice President and I had the honor of
visiting the Children's Hospital here in Washington where they do
wonderful, often miraculous things for very sick children.  A nurse
named Debbie Freiberg told us that she was in the cancer and bone
marrow unit.  The other day a little boy asked her just to stay at
his side during his chemotherapy.  And she had to walk away from that
child because she had been instructed to go to yet another class to
learn how to fill out another form for something that didn't have a
lick to do with the health care of the children she was helping.
That is wrong, and we can stop it, and we ought to do it.
(Applause.)

     We met a very compelling doctor named Lillian Beard, a
pediatrician, who said that she didn't get into her profession to
spend hours and hours -- some doctors up to 25 hours a week just
filling out forms.  She told us she became a doctor to keep children
well and to help save those who got sick.  We can relieve people like
her of this burden.  We learned -- the Vice President and I did --
that in the Washington Children's Hospital alone, the administrators
told us they spend $2 million a year in one hospital filling out
forms that have nothing whatever to do with keeping up with the
treatment of the patients.

     And the doctors there applauded when I was told and I related to
them that they spend so much time filling out paperwork, that if they
only had to fill out those paperwork requirements necessary to
monitor the health of the children, each doctor on that one hospital
staff -- 200 of them -- could see another 500 children a year.  That
is 10,000 children a year.  I think we can save money in this system
if we simplify it.  And we can make the doctors and the nurses and
the people that are giving their lives to help us all be healthier a
whole lot happier, too,  on their jobs.  (Applause.)

     Under our proposal there would be one standard insurance form --
not hundreds of them.  We will simplify also -- and we must -- the
government's rules and regulations, because they are a big part of
this problem.  (Applause.)  This is one of those cases where the
physician should heal thyself.  We have to reinvent the way we relate
to the health care system, along with reinventing government.  A
doctor should not have to check with a bureaucrat in an office
thousands of miles away before ordering a simple blood test.  That's
not right, and we can change it.  (Applause.)  And doctors, nurses
and consumers shouldn't have to worry about the fine print.  If we
have this one simple form, there won't be any fine print.  People
will know what it means.

     The third principle is savings.  Reform must produce savings in
this health care system.  It has to.  We're spending over 14 percent
of our income on health care -- Canada's at 10; nobody else is over
nine.  We're competing with all these people for the future.  And the
other major countries, they cover everybody and they cover them with
services as generous as the best company policies here in this
country.

     Rampant medical inflation is eating away at our wages, our
savings, our investment capital, our ability to create new jobs in
the private sector and this public Treasury.  You know the budget we
just adopted had steep cuts in defense, a five-year freeze on the
discretionary spending, so critical to reeducating America and
investing in jobs and helping us to convert from a defense to a
domestic economy.  But we passed a budget which has Medicaid
increases of between 16 and 11 percent a year over the next five
years, and Medicare increases of between 11 and 9 percent in an
environment where we assume inflation will be at 4 percent or less.

     We cannot continue to do this.  Our competitiveness, our whole
economy, the integrity of the way the government works and,
ultimately, our living standards depend upon our ability to achieve
savings without harming the quality of health care.

     Unless we do this, our 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 of small businesses now
covering their employees say they will be forced to drop their
insurance.  Large corporations will bear vivid disadvantages in
global competition.  And health care costs will devour more and more
and more of our budget.  Pretty soon all of you or the people who
succeed you will be showing up here, and writing out checks for
health care and interest on the debt and worrying about whether we've
got enough defense, and that will be it, unless we have the courage
to achieve the saving that are plainly there before us.  Every state
and local government will continue to cut back on everything from
education to law enforcement to pay more and more for the same health
care.

     These rising costs are a special nightmare for our small
businesses -- the engine of our entrepreneurship and our job creation
in America today.  Health care premiums for small businesses are 35
percent higher than those of large corporations today.  And they will
keep rising at double-digit rates unless we act.

     So how will we achieve these savings?  Rather than looking at
price control, or looking away as the price spiral continues; rather
than using the heavy hand of government to try to control what's
happening, or continuing to ignore what's happening, we believe there
is a third way to achieve these savings.  First, to give groups of
consumers and small businesses the same market bargaining power that
large corporations and large groups of public employees now have.  We
want to let market forces enable plans to compete.  We want to force
these plans to compete on the basis of price and quality, not simply
to allow them to continue making money by turning people away who are
sick or old or performing mountains of unnecessary procedures.  But
we also believe we should back this system up with limits on how much
plans can raise their premiums year in and year out, forcing people,
again, to continue to pay more for the same health care, without
regard to inflation or the rising population needs.

     We want to create what has been missing in this system for too
long, and what every successful nation who has dealt with this
problem has already had to do:  to have a combination of private
market forces and a sound public policy that will support that
competition, but limit the rate at which prices can exceed the rate
of inflation and population growth, if the competition doesn't work,
especially in the early going.

     The second thing I want to say is that unless everybody is
covered -- and this is a very important thing -- unless everybody is
covered, we will never be able to fully put the breaks on health care
inflation.  Why is that?  Because when people don't have any health
insurance, they still get health care, but they get it when it's too
late, when it's too expensive, often from the most expensive place of
all, the emergency room.  Usually by the time they show up, their
illnesses are more severe and their mortality rates are much higher
in our hospitals than those who have insurance.  So they cost us
more.

     And what else happens?  Since they get the care but they don't
pay, who does pay?  All the rest of us.  We pay in higher hospital
bills and higher insurance premiums.  This cost shifting is a major
problem.

     The third thing we can do to save money is simply by simplifying
the system  -- what we've already discussed.  Freeing the health care
providers from these costly and unnecessary paperwork and
administrative decisions will save tens of billions of dollars.  We
spend twice as much as any other major country does on paperwork.  We
spend at least a dime on the dollar more than any other major
country.  That is a stunning statistic.  It is something that every
Republican and every Democrat ought to be able to say, we agree that
we're going to squeeze this out.  We cannot tolerate this.  This has
nothing to do with keeping people well or helping them when they're
sick.  We should invest the money in something else.

     We also have to crack down on fraud and abuse in the system.
That drains billions of dollars a year.  It is a very large figure,
according to every health care expert I've ever spoken with.  So I
believe we can achieve large savings.  And that large savings can be
used to cover the unemployed uninsured, and will be used for people
who realize those savings in the private sector to increase their
ability to invest and grow, to hire new workers or to give their
workers pay raises, many of them for the first time in years.

     Now, nobody has to take my word for this.  You can ask Dr. Koop.
He's up here with us tonight, and I thank him for being here.
(Applause.)  Since he left his distinguished tenure as our Surgeon
General, he has spent an enormous amount of time studying our health
care system, how it operates, what's right and wrong with it.  He
says we could spend $200 billion every year, more than 20 percent of
the total budget, without sacrificing the high quality of American
medicine.

     Ask the public employees in California, who have held their own
premiums down by adopting the same strategy that I want every
American to be able to adopt -- bargaining within the limits of a
strict budget.  Ask Xerox, which saved an estimated $1,000 per worker
on their health insurance premium.  Ask the staff of the Mayo Clinic,
who we all agree provides some of the finest health care in the
world.  They are 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 has still been able to
keep costs below the national average.

     People may disagree over the best way to fix this system.  We
may all disagree about how quickly we can do what -- the thing that
we have to do.  But we cannot disagree that we can find tens of
billions of dollars in savings in what is clearly the most costly and
the most bureaucratic system in the entire world.  And we have to do
something about that, and we have to do it now.  (Applause.)

     The fo  urth principle is choice.  Americans believe they ought
to be able to choose their own health care plan and keep their own
doctors.  And I think all of us agree.  Under any plan we pass, they
ought to have that right.  But today, under our broken health care
system, in spite of the rhetoric of choice, the fact is that that
power is slipping away for more and more Americans.

     Of course, it is usually the employer, not the employee, who
makes the initial choice of what health care plan the employee will
be in.  And if your employer offers only one plan, as nearly three-
quarters of small or medium-sized firms do today, you're stuck with
that plan, and the doctors that 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 the American citizen, the
worker -- not the boss, and certainly not some government bureaucrat.

     We also believe that doctors should have a choice as to what
plans they practice in.  Otherwise, citizens may have their own
choices limited.  We want to end the discrimination that is now
growing against doctors, and to permit them to practice in several
different plans.  Choice is important for doctors, and it is
absolutely critical for our consumers.  We've got to have it in
whatever plan we pass.  (Applause.)

     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 will have taken a step backward, not forward.
Quality is something that we simply can't leave to chance.  When you
board an airplane, you feel better knowing that the plane had to meet
standards designed to protect your safety.  And we can't ask any less
of our health care system.

     Our proposal will create report cards on health plans, so that
consumers can choose the highest quality health care 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 of the kind of care they provide.  We have evidence that more
efficient delivery of health care doesn't decrease quality.  In fact,
it may enhance it.

     Let me just give you one 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 care as patients who were charged $84,000 for the same
procedure in the same state.  High prices simply don't always equal
good quality.  Our plan will guarantee that high quality information
is available is available in even the most remote areas of this
country so that we can have high-quality service, linking rural
doctors, for example, with hospitals with high-tech urban medical
centers.  And our plan will ensure the quality of continuing progress
on a whole range of issues by speeding the search on effective
prevention and treatment measures for cancer, for AIDS, for
Alzheimer's, for heart disease, and for other chronic diseases.  We
have to safeguard the finest medical research establishment in the
entire world.  And we will do that with this plan.  Indeed, we will
even make it better.  (Applause.)

     The sixth and final principle is responsibility.  We need to
restore a sense that we're all in this together and that we all have
a responsibility to be a part of the solution.  Responsibility has to
start with those who profit from the current system.  Responsibility
means insurance companies should no longer be allowed to cast people
aside when they get sick.  It should apply to laboratories that
submit fraudulent bills, to lawyers who abuse malpractice claims, to
doctors who order unnecessary procedures.  It means drug companies
should no longer charge three times more per prescription drugs made
in America here in the United States than they charge for the same
drugs overseas.  (Applause.)

     In short, responsibility should apply to anybody to abuses this
system and drives up the cost for honest, hard-working citizens and
undermines confidence in the honest, gifted health care providers we
have.

     Responsibility also means changing some behaviors in this
country that drive up our costs like crazy.  And without changing it
we'll never have the system we ought to have.  We will never.

     Let me just mention a few and start with the most important --
the outrageous cost of violence in this country stem in large measure
from the fact that this is the only country in the world where
teenagers can rout the streets at random with semi-automatic weapons
and be better armed than the police.  (Applause.)

     But let's not kid ourselves, it's not that simple.  We also have
higher rates of AIDS, of smoking and excessive drinking, of teen
pregnancy, of low birth weight babies.  And we have the third worst
immunization rate of any nation in the western hemisphere.  We have
to change our ways if we ever really want to be healthy as a people
and have an affordable health care system.  And no one can deny that.
(Applause.)

     But let me say this -- and I hope every American will listen,
because this is not an easy thing to hear -- responsibility in our
health care system isn't just about them, it's about you, it's about
me, it's about each of us.  Too many of us have not taken
responsibility for our own health care and for our own relations to
the health care system.  Many of us who have had fully paid health
care plans have used the system whether we needed it or not without
thinking what the costs were.  Many people who use this system don't
pay a
whether we needed it or not without thinking what the costs were.
Many people who use this system don't pay a penny for their care even
though they can afford to.  I think those who don't have any health
insurance should be responsible for paying a portion of their new
coverage.  There can't be any something for nothing, and we have to
demonstrate that to people.  This is not a free system.  (Applause.)
Even small contributions, as small as the $10-copayment when you
visit a doctor, illustrates that this is something of value.  There
is a cost to it.  It is not free.

     And I want to tell you that I believe that all of us should have
insurance.  Why should the rest of us pick up the tab when a guy who
doesn't think he needs insurance or says he can't afford it gets in
an accident, winds up in an emergency room, gets good care, and
everybody else pays?  Why should the small businesspeople who are
struggling to keep afloat and take care of their employees have to
pay to maintain this wonderful health care infrastructure for those
who refuse to do anything?

     If we're going to produce a better health care system for every
one of us, every one of us is going to have to do our part.  There
cannot be any such thing as a free ride.  We have to pay for it.  We
have to pay for it.

     Tonight I want to say plainly how I think we should do that.
Most of the money we will -- will come under my way of thinking, as
it does today, from premiums paid by employers and individuals.
That's the way it happens today.  But under this health care security
plan, every employer and every individual will be asked to contribute
something to health care.

     This concept was first conveyed to the Congress about 20 years
ago by President Nixon.  And today, a lot of people agree with the
concept of shared responsibility between employers and employees, and
that the best thing to do is to ask every employer and every employee
to share that.  The Chamber of Commerce has said that, and they're
not in the business of hurting small business.  The American Medical
Association has said that.

     Some call it an employer mandate, but I think it's the fairest
way to achieve responsibility in the health care system.  And it's
the easiest for ordinary Americans to understand, because it builds
on what we already have and what already works for so many Americans.
It is the reform that is not only easiest to understand, but easiest
to implement in a way that is fair to small business, because we can
give a discount to help struggling small businesses meet the cost of
covering their employees.  We should require the least bureaucracy or
disruption, and create the cooperation we need to make the system
cost-conscious, even as we expand coverage.  And we should do it in a
way that does not cripple small businesses and low-wage workers.

     Every employer should provide coverage, just as three-quarters
do now.  Those that pay are picking up the tab for those who don't
today.  I don't think that's right.  To finance the rest of reform,
we can achieve new savings, as I have outlined, in both the federal
government and the private sector, through better decision-making and
increased competition.  And we will impose new taxes on tobacco.
(Applause.)

     I don't think that should be the only source of revenues.  I
believe we should also ask for a modest contribution from big
employers who opt out of the system to make up for what those who are
in the system pay for medical research, for health education center,
for all the subsidies to small business, for all the things that
everyone else is contributing to.  But between those two things, we
believe we can pay for this package of benefits and universal
coverage and a subsidy program that will help small business.

     These sources can cover the cost of the proposal that I have
described tonight.  We subjected the numbers in our proposal to the
scrutiny of not only all the major agencies in government -- I know a
lot of people don't trust them, but it would be interesting for the
American people to know that this was the first time that the
financial experts on health care in all of the different government
agencies have ever been required to sit in the room together and
agree on numbers.  It had never happened before.

     But, obviously, that's not enough.  So then we gave these
numbers to actuaries from major accounting firms and major Fortune
500 companies who have no stake in this other than to see that our
efforts succeed.  So I believe our numbers are good and achievable.

     Now, what does this mean to an individual American citizen?
Some will be asked to pay more.  If you're an employer and you aren't
insuring your workers at all, you'll have to pay more.  But if you're
a small business with fewer than 50 employees, you'll get a subsidy.
If you're a firm that provides only very limited coverage, you may
have to pay more.  But some firms will pay the same or less for more
coverage.

     If you're a young, single person in your 20s and you're already
insured, your rates may go up somewhat because you're going to go
into a big pool with middle-aged people and older people, and we want
to enable people to keep their insurance even when someone in their
family gets sick.  But I think that's fair because when the young get
older, they will benefit from it, first, and secondly, even those who
pay a little more today will benefit four, five, six, seven years
from now by our bringing health care costs closer to inflation.
     Over the long run, we can all win.  But some will have to pay
more in the short run.  Nevertheless, the vast majority of the
Americans watching this tonight will pay the same or less for health
care coverage that will be the same or better than the coverage they
have tonight.  That is the central reality.  (Applause.)

     If you currently get your health insurance through your job,
under our plan you still will.  And for the first time, everybody
will get to choose from among at least three plans to belong to.  If
you're a small business owner who wants to provide health insurance
to you family and your employees, but you can't afford it because the
system is stacked against you, this plan will give you a discount
that will finally make insurance affordable.  If you're already
providing insurance, your rates may well drop because we'll help you
as a small business person join thousands of others to get the same
benefits big corporations get at the same price they get those
benefits.  If you're self-employed, you'll pay less; and you will get
to deduct from your taxes 100 percent of your health care premiums.
(Applause.)

     If you're a large employer, your health care costs won't go up
as fast, so that you will have more money to put into higher wages
and new jobs and to put into the work of being competitive in this
tough global economy.

     Now, these, my fellow Americans, are the principles on which I
think we should base our efforts:  security, simplicity, savings,
choice, quality and responsibility.  These are the guiding stars that
we should follow on our journey toward health care reform.

     Over the coming months, you'll be bombarded with information
from all kinds of sources.  There will be some who will stoutly
disagree with what I have proposed -- and with all other plans in the
Congress, for that matter.  And some of the arguments will be
genuinely sincere and enlightening.  Others may simply be scare
tactics by those who are motivated by the self-interest they have in
the waste the system now generates, because that waste is providing
jobs, incomes and money for some people.

     I ask you only to think of this when you hear all of these
arguments:  Ask yourself whether the cost of staying on this same
course isn't greater than the cost of change.  And ask yourself when
you hear the arguments whether the arguments are in your interest or
someone else's.  This is something we have got to try to do together.

     I want also to say to the representatives in Congress, you have
a special duty to look beyond these arguments.  I ask you instead to
look into the eyes of the sick child who needs care; to think of the
face of the woman who's been told not only that her condition is
malignant, but not covered by her  insurance.  To look at the bottom
lines of the businesses driven to bankruptcy by health care costs.
To look at the "for sale" signs in front of the homes of families who
have lost everything because of their health care costs.

     I ask you to remember the kind of people I met over the last
year and a half -- the elderly couple in New Hampshire that broke
down and cried because of their shame at having an empty refrigerator
to pay for their drugs; a woman who lost a $50,000-job that she used
to support her six children because her youngest child was so ill
that she couldn't keep health insurance, and the only way to get care
for the child was to get public assistance; a young couple that had a
sick child and could only get insurance from one of the parents'
employers that was a nonprofit corporation with 20 employees, and so
they had to face the question of whether to let this poor person with
a sick child go or raise the premiums of every employee in the firm
by $200.  And on and on and on.

     I know we have differences of opinion, but we are here tonight
in a spirit that is animated by the problems of those people, and by
the sheer knowledge that if we can look into our heart, we will not
be able to say that the greatest nation in the history of the world
is powerless to confront this crisis.  (Applause.)

     Our history and our heritage  tell us that we can meet this
challenge.  Everything about America's past tells us we will do it.
So I say to you, let us write that new chapter in the American story.
Let us guarantee every American comprehensive health benefits that
can never be taken away.  (Applause.)

     In spite of all the work we've done together and all the
progress we've made, there's still a lot of people who say it would
be an outright miracle if we passed health care reform.  But my
fellow Americans, in a time of change, you have to have miracles.
And miracles do happen.  I mean, just a few days ago we saw a simple
handshake shatter decades of deadlock in the Middle East.  We've seen
the walls crumble in Berlin and South Africa.  We see the ongoing
brave struggle of the people of Russia to seize freedom and
democracy.

     And now, it is our turn to strike a blow for freedom in this
country.  The freedom of Americans to live without fear that their
own nation's health care system won't be there for them when they
need it.  It's hard to believe that there was once a time in this
century when that kind of fear gripped old age.  When retirement was
nearly synonymous with poverty, and older Americans died in the
street.  That's unthinkable today, because over a half a 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.

     Forty years from now, our grandchildren will also find it
unthinkable that there was a time in this country when hardworking
families lost their homes, their savings, their businesses, lost
everything simply because their children got sick or because they had
to change jobs.  Our grandchildren will 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 time.

     Thank you very much.  And God bless America. (Applause.)

                          END10:02 P.M. EDT