[House Document 111-62]
[From the U.S. Government Publishing Office]
111th Congress, 1st Session - - - - - - - - - - - - - House Document 111-62
THE PRESIDENT'S ADDRESS BEFORE A JOINT SESSION OF CONGRESS
__________
MESSAGE
from
THE PRESIDENT OF THE UNITED STATES
transmitting
THE PRESIDENT'S ADDRESS BEFORE A JOINT SESSION OF CONGRESS
September 10, 2009.--Message and accompanying papers referred to the
Committee on the Whole House on the State of the Union and ordered to
be printed
To the Congress of the United States:
When I spoke here last winter, this Nation was facing the
worst economic crisis since the Great Depression. We were
losing an average of 700,000 jobs per month. Credit was frozen.
And our financial system was on the verge of collapse.
As any American who is still looking for work or a way to
pay their bills will tell you, we are by no means out of the
woods. A full and vibrant recovery is many months away. And I
will not let up until those Americans who seek jobs can find
them; until those businesses that seek capital and credit can
thrive; until all responsible homeowners can stay in their
homes. That is our ultimate goal. But thanks to the bold and
decisive action we have taken since January, I can stand here
with confidence and say that we have pulled this economy back
from the brink.
I want to thank the members of this body for your efforts
and your support in these last several months, and especially
those who have taken the difficult votes that have put us on a
path to recovery. I also want to thank the American people for
their patience and resolve during this trying time for our
Nation.
But we did not come here just to clean up crises. We came
to build a future. So tonight, I return to speak to all of you
about an issue that is central to that future--and that is the
issue of health care.
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.
We are the only advanced democracy on Earth--the only
wealthy nation--that allows such hardships for millions of its
people. There are now more than 30 million American citizens
who cannot get coverage. In just a 2-year period, one in every
three Americans goes without health care coverage at some
point. And every day, 14,000 Americans lose their coverage. In
other words, it can happen to anyone.
But the problem that plagues the health care system is not
just a problem of the uninsured. Those who do have insurance
have never had less security and stability than they do today.
More and more Americans worry that if you move, lose your job,
or change your job, you'll lose your health insurance too. More
and more Americans pay their premiums, only to discover that
their insurance company has dropped their coverage when they
get sick, or won't pay the full cost of care. It happens every
day.
One man from Illinois lost his coverage in the middle of
chemotherapy because his insurer found that he hadn't reported
gallstones that he didn't even know about. They delayed his
treatment, and he died because of it. Another woman from Texas
was about to get a double mastectomy when her insurance company
canceled her policy because she forgot to declare a case of
acne. By the time she had her insurance reinstated, her breast
cancer more than doubled in size. That is heart-breaking, it is
wrong, and no one should be treated that way in the United
States of America.
Then there's the problem of rising costs. We spend one-and-
a-half times more per person on health care than any other
country, but we aren't any healthier for it. This is one of the
reasons that insurance premiums have gone up three times faster
than wages. It's why so many employers--especially small
businesses--are forcing their employees to pay more for
insurance, or are dropping their coverage entirely. It's why so
many aspiring entrepreneurs cannot afford to open a business in
the first place, and why American businesses that compete
internationally--like our automakers--are at a huge
disadvantage. And it's why those of us with health insurance
are also paying a hidden and growing tax for those without it--
about $1000 per year that pays for somebody else's emergency
room and charitable care.
Finally, our health care system is placing an unsustainable
burden on taxpayers. When health care costs grow at the rate
they have, it puts greater pressure on programs like Medicare
and Medicaid. If we do nothing to slow these skyrocketing
costs, we will eventually be spending more on Medicare and
Medicaid than every other government program combined. Put
simply, our health care problem is our deficit problem. Nothing
else even comes close.
These are the facts. Nobody disputes them. We know we must
reform this system. The question is how.
There are those on the left who believe that the only way
to fix the system is through a single-payer system like
Canada's, where we would severely restrict the private
insurance market and have the government provide coverage for
everyone. On the right, there are those who argue that we
should end the employer-based system and leave individuals to
buy health insurance on their own.
I have to say that there are arguments to be made for both
approaches. But either one would represent a radical shift that
would disrupt the health care most people currently have. Since
health care represents one-sixth of our economy, I believe it
makes more sense to build on what works and fix what doesn't,
rather than try to build an entirely new system from scratch.
And that is precisely what those of you in Congress have tried
to do over the past several months.
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 80 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.
For those individuals and small businesses who still cannot
afford the lower-priced insurance available in the exchange, we
will provide tax credits, the size of which will be based on
your need. And all insurance companies that want access to this
new marketplace will have to abide by the consumer protections
I already mentioned. This exchange will take effect in 4 years,
which will give us time to do it right. In the meantime, for
those Americans who can't get insurance today because they have
pre-existing medical conditions, we will immediately offer low-
cost coverage that will protect you against financial ruin if
you become seriously ill. This was a good idea when Senator
John McCain proposed it in the campaign, it's a good idea now,
and we should embrace it.
Now, even if we provide these affordable options, there may
be those--particularly the young and healthy--who still want to
take the risk and go without coverage. There may still be
companies that refuse to do right by their workers. The problem
is, such irresponsible behavior costs all the rest of us money.
If there are affordable options and people still don't sign up
for health insurance, it means we pay for those people's
expensive emergency room visits. If some businesses don't
provide workers health care, it forces the rest of us to pick
up the tab when their workers get sick, and gives those
businesses an unfair advantage over their competitors. And
unless everybody does their part, many of the insurance reforms
we seek--especially requiring insurance companies to cover pre-
existing conditions--just can't be achieved.
That's why under my plan, individuals will be required to
carry basic health insurance--just as most States require you
to carry auto insurance. Likewise, businesses will be required
to either offer their workers health care, or chip in to help
cover the cost of their workers. There will be a hardship
waiver for those individuals who still cannot afford coverage,
and 95% of all small businesses, because of their size and
narrow profit margin, would be exempt from these requirements.
But we cannot have large businesses and individuals who can
afford coverage game the system by avoiding responsibility to
themselves or their employees. Improving our health care system
only works if everybody does their part.
While there remain some significant details to be ironed
out, I believe a broad consensus exists for the aspects of the
plan I just outlined: consumer protections for those with
insurance, an exchange that allows individuals and small
businesses to purchase affordable coverage, and a requirement
that people who can afford insurance get insurance.
And I have no doubt that these reforms would greatly
benefit Americans from all walks of life, as well as the
economy as a whole. Still, given all the misinformation that's
been spread over the past few months, I realize that many
Americans have grown nervous about reform. So tonight I'd like
to address some of the key controversies that are still out
there.
Some of people's concerns have grown out of bogus claims
spread by those whose only agenda is to kill reform at any
cost. The best example is the claim, made not just by radio and
cable talk show hosts, but prominent politicians, that we plan
to set up panels of bureaucrats with the power to kill off
senior citizens. Such a charge would be laughable if it weren't
so cynical and irresponsible. It is a lie, plain and simple.
There are also those who claim that our reform effort will
insure illegal immigrants. This, too, is false--the reforms I'm
proposing would not apply to those who are here illegally. And
one more misunderstanding I want to clear up--under our plan,
no Federal dollars will be used to fund abortions, and Federal
conscience laws will remain in place.
My health care proposal has also been attacked by some who
oppose reform as a ``government takeover'' of the entire health
care system. As proof, critics point to a provision in our plan
that allows the uninsured and small businesses to choose a
publicly-sponsored insurance option, administered by the
government just like Medicaid or Medicare.
So let me set the record straight. My guiding principle is,
and always has been, that consumers do better when there is
choice and competition. Unfortunately, in 34 States, 75% of the
insurance market is controlled by five or fewer companies. In
Alabama, almost 90% is controlled by just one company. Without
competition, the price of insurance goes up and the quality
goes down. And it makes it easier for insurance companies to
treat their customers badly--by cherry-picking the healthiest
individuals and trying to drop the sickest; by overcharging
small businesses who have no leverage; and by jacking up rates.
Insurance executives don't do this because they are bad
people. They do it because it's profitable. As one former
insurance executive testified before Congress, insurance
companies are not only encouraged to find reasons to drop the
seriously ill; they are rewarded for it. All of this is in
service of meeting what this former executive called ``Wall
Street's relentless profit expectations.''
Now, I have no interest in putting insurance companies out
of business. They provide a legitimate service, and employ a
lot of our friends and neighbors. I just want to hold them
accountable. The insurance reforms that I've already mentioned
would do just that. But an additional step we can take to keep
insurance companies honest is by making a not-for-profit public
option available in the insurance exchange. Let me be clear--it
would only be an option for those who don't have insurance. No
one would be forced to choose it, and it would not impact those
of you who already have insurance. In fact, based on
Congressional Budget Office estimates, we believe that less
than 5% of Americans would sign up.
Despite all this, the insurance companies and their allies
don't like this idea. They argue that these private companies
can't fairly compete with the government. And they'd be right
if taxpayers were subsidizing this public insurance option. But
they won't be. I have insisted that like any private insurance
company, the public insurance option would have to be self-
sufficient and rely on the premiums it collects. But by
avoiding some of the overhead that gets eaten up at private
companies by profits, excessive administrative costs, and
executive salaries, it could provide a good deal for consumers.
It would also keep pressure on private insurers to keep their
policies affordable and treat their customers better, the same
way public colleges and universities provide additional choice
and competition to students without in any way inhibiting a
vibrant system of private colleges and universities.
It's worth noting that a strong majority of Americans still
favor a public insurance option of the sort I've proposed
tonight. But its impact shouldn't be exaggerated--by the left,
the right, or the media. It is only one part of my plan, and
should not be used as a handy excuse for the usual Washington
ideological battles. To my progressive friends, I would remind
you that for decades, the driving idea behind reform has been
to end insurance company abuses and make coverage affordable
for those without it. The public option is only a means to that
end--and we should remain open to other ideas that accomplish
our ultimate goal. And to my Republican friends, I say that
rather than making wild claims about a government takeover of
health care, we should work together to address any legitimate
concerns you may have.
For example, some have suggested that that the public
option go into effect only in those markets where insurance
companies are not providing affordable policies. Others propose
a co-op or another non-profit entity to administer the plan.
These are all constructive ideas worth exploring. But I will
not back down on the basic principle that if Americans can't
find affordable coverage, we will provide you with a choice.
And I will make sure that no government bureaucrat or insurance
company bureaucrat gets between you and the care that you need.
Finally, let me discuss an issue that is a great concern to
me, to members of this chamber, and to the public--and that is
how we pay for this plan.
Here's what you need to know. First, I will not sign a plan
that adds one dime to our deficits--either now or in the
future. Period. And to prove that I'm serious, there will be a
provision in this plan that requires us to come forward with
more spending cuts if the savings we promised don't
materialize. Part of the reason I faced a trillion dollar
deficit when I walked in the door of the White House is because
too many initiatives over the last decade were not paid for--
from the Iraq War to tax breaks for the wealthy. I will not
make that same mistake with health care.
Second, we've estimated that most of this plan can be paid
for by finding savings within the existing health care system--
a system that is currently full of waste and abuse. Right now,
too much of the hard-earned savings and tax dollars we spend on
health care doesn't make us healthier. That's not my judgment--
it's the judgment of medical professionals across this country.
And this is also true when it comes to Medicare and Medicaid.
In fact, I want to speak directly to America's seniors for
a moment, because Medicare is another issue that's been
subjected to demagoguery and distortion during the course of
this debate.
More than 4 decades ago, this Nation stood up for the
principle that after a lifetime of hard work, our seniors
should not be left to struggle with a pile of medical bills in
their later years. That is how Medicare was born. And it
remains a sacred trust that must be passed down from one
generation to the next. That is why not a dollar of the
Medicare trust fund will be used to pay for this plan.
The only thing this plan would eliminate is the hundreds of
billions of dollars in waste and fraud, as well as unwarranted
subsidies in Medicare that go to insurance companies--subsidies
that do everything to pad their profits and nothing to improve
your care. And we will also create an independent commission of
doctors and medical experts charged with identifying more waste
in the years ahead.
These steps will ensure that you--America's seniors--get
the benefits you've been promised. They will ensure that
Medicare is there for future generations. And we can use some
of the savings to fill the gap in coverage that forces too many
seniors to pay thousands of dollars a year out of their own
pocket for prescription drugs. That's what this plan will do
for you. So don't pay attention to those scary stories about
how your benefits will be cut--especially since some of the
same folks who are spreading these tall tales have fought
against Medicare in the past, and just this year supported a
budget that would have essentially turned Medicare into a
privatized voucher program. That will never happen on my watch.
I will protect Medicare.
Now, because Medicare is such a big part of the health care
system, making the program more efficient can help usher in
changes in the way we deliver health care that can reduce costs
for everybody. We have long known that some places, like the
Intermountain Healthcare in Utah or the Geisinger Health System
in rural Pennsylvania, offer high-quality care at costs below
average. The commission can help encourage the adoption of
these common-sense best practices by doctors and medical
professionals throughout the system--everything from reducing
hospital infection rates to encouraging better coordination
between teams of doctors.
Reducing the waste and inefficiency in Medicare and
Medicaid will pay for most of this plan. Much of the rest would
be paid for with revenues from the very same drug and insurance
companies that stand to benefit from tens of millions of new
customers. This reform will charge insurance companies a fee
for their most expensive policies, which will encourage them to
provide greater value for the money--an idea which has the
support of Democratic and Republican experts. And according to
these same experts, this modest change could help hold down the
cost of health care for all of us in the long-run.
Finally, many in this chamber--particularly on the
Republican side of the aisle--have long insisted that reforming
our medical malpractice laws can help bring down the cost of
health care. I don't believe malpractice reform is a silver
bullet, but I have talked to enough doctors to know that
defensive medicine may be contributing to unnecessary costs. So
I am proposing that we move forward on a range of ideas about
how to put patient safety first and let doctors focus on
practicing medicine. I know that the Bush Administration
considered authorizing demonstration projects in individual
States to test these issues. It's a good idea, and I am
directing my Secretary of Health and Human Services to move
forward on this initiative today.
Add it all up, and the plan I'm proposing will cost around
$900 billion over 10 years--less than we have spent on the Iraq
and Afghanistan wars, and less than the tax cuts for the
wealthiest few Americans that Congress passed at the beginning
of the previous administration. Most of these costs will be
paid for with money already being spent--but spent badly--in
the existing health care system. The plan will not add to our
deficit. The middle-class will realize greater security, not
higher taxes. And if we are able to slow the growth of health
care costs by just one-tenth of one percent each year, it will
actually reduce the deficit by $4 trillion over the long term.
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.
I received one of those letters a few days ago. It was from
our beloved friend and colleague, Ted Kennedy. He had written
it back in May, shortly after he was told that his illness was
terminal. He asked that it be delivered upon his death.
In it, he spoke about what a happy time his last months
were, thanks to the love and support of family and friends, his
wife, Vicki, and his children, who are here tonight . And he
expressed confidence that this would be the year that health
care reform--``that great unfinished business of our society,''
he called it--would finally pass. He repeated the truth that
health care is decisive for our future prosperity, but he also
reminded me that ``it concerns more than material things.''
``What we face,'' he wrote, ``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.''
I've thought about that phrase quite a bit in recent days--
the character of our country. One of the unique and wonderful
things about America has always been our self-reliance, our
rugged individualism, our fierce defense of freedom, and our
healthy skepticism of government. And figuring out the
appropriate size and role of government has always been a
source of rigorous and sometimes angry debate.
For some of Ted Kennedy's critics, his brand of liberalism
represented an affront to American liberty. In their mind, his
passion for universal health care was nothing more than a
passion for big government.
But those of us who knew Teddy and worked with him here--
people of both parties--know that what drove him was something
more. His friend, Orrin Hatch, knows that. They worked together
to provide children with health insurance. His friend John
McCain knows that. They worked together on a Patient's Bill of
Rights. His friend Chuck Grassley knows that. They worked
together to provide health care to children with disabilities.
On issues like these, Ted Kennedy's passion was born not of
some rigid ideology, but of his own experience. It was the
experience of having two children stricken with cancer. He
never forgot the sheer terror and helplessness that any parent
feels when a child is badly sick; and he was able to imagine
what it must be like for those without insurance; what it would
be like to have to say to a wife or a child or an aging
parent--there is something that could make you better, but I
just can't afford it.
That large-heartedness--that concern and regard for the
plight of others--is not a partisan feeling. It is not a
Republican or a Democratic feeling. It, too, is part of the
American character. Our ability to stand in other people's
shoes. A recognition that we are all in this together; that
when fortune turns against one of us, others are there to lend
a helping hand. A belief that in this country, hard work and
responsibility should be rewarded by some measure of security
and fair play; and an acknowledgement that sometimes government
has to step in to help deliver on that promise.
This has always been the history of our progress. In 1935,
when over half of our seniors could not support themselves and
millions had seen their savings wiped away, there were those
who argued that Social Security would lead to socialism. But
the men and women of Congress stood fast, and we are all the
better for it. In 1965, when some argued that Medicare
represented a government takeover of health care, members of
Congress, Democrats and Republicans, did not back down. They
joined together so that all of us could enter our golden years
with some basic peace of mind.
You see, our predecessors understood that government could
not, and should not, solve every problem. They understood that
there are instances when the gains in security from government
action are not worth the added constraints on our freedom. But
they also understood that the danger of too much government is
matched by the perils of too little; that without the leavening
hand of wise policy, markets can crash, monopolies can stifle
competition, and the vulnerable can be exploited. And they knew
that when any government measure, no matter how carefully
crafted or beneficial, is subject to scorn; when any efforts to
help people in need are attacked as un-American; when facts and
reason are thrown overboard and only timidity passes for
wisdom, and we can no longer even engage in a civil
conversation with each other over the things that truly
matter--that at that point we don't merely lose our capacity to
solve big challenges. We lose something essential about
ourselves.
What was true then remains true today. I understand how
difficult this health care debate has been. I know that many in
this country are deeply skeptical that government is looking
out for them. I understand that the politically safe move would
be to kick the can further down the road--to defer reform one
more year, or one more election, or one more term.
But that's not what the moment calls for. That's not what
we came here to do. We did not come to fear the future. We came
here to shape it. I still believe we can act even when it's
hard. I still believe we can replace acrimony with civility,
and gridlock with progress. I still believe we can do great
things, and that here and now we will meet history's test.
Because that is who we are. That is our calling. That is
our character. Thank you, God Bless You, and may God Bless the
United States of America.
Barack Obama.
The White House, September 9, 2009.