[Congressional Record (Bound Edition), Volume 155 (2009), Part 16]
[Senate]
[Pages 21203-21207]
[From the U.S. Government Publishing Office, www.gpo.gov]




    PRESIDENT'S ADDRESS DELIVERED TO A JOINT SESSION OF CONGRESS ON 
      SEPTEMBER 9, 2009 RELATIVE TO HEALTH CARE LEGISLATION--PM29

  The PRESIDING OFFICER laid before the Senate the following message 
from the President of the United States which was which was ordered to 
lie on the table:

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

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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

[[Page 21205]]

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 preexisting 
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

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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 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

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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 know 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.

                          ____________________