The Urgency of Health Insurance Reform

The Urgency of Health Insurance Reform


President Obama:
It is good to see you. I know you guys have
been a little bit here; it’s a little bit warm in
here — you’re all fanning yourself off, whoo! It is good to see
everybody here today. How’s everybody doing? (applause) I’ve got a couple of
acknowledgments I want to make. First of all, Mayor of St. Charles,
Patti York — where’s Patti? (applause) Thank you, Madam Mayor.
Thanks for the great weather. We also have the St. Charles
School District Superintendent, Randy Charles, is
here. Where’s Randy? I just saw him —
there he is back there. (applause) It is great to be here, great
to be back in the Show Me State, great to be back in St. Charles. Some of you may remember that it
was from this town that Lewis and Clark began their journey into
a harsh and unforgiving landscape. I can relate — (laughter) —
because the first time I came here, I was trying to
get to Washington, D.C., a harsh and
unforgiving landscape. (laughter) A big part of our campaign
was about changing the way Washington works. It was about transforming a
politics that’s driven by cynicism and a 24-hour news
cycle, and the cable chatter, and always focused on the next election
instead of the next generation. Our campaign was about meeting
the looming challenges — in education and in energy,
in our health care system, in our financial system — that
helped bring about the worst economic crisis since
the Great Depression. And it still threatens
our prosperity. It was about making our
government actually work for you, the people: a
government that lives up to its responsibilities,
including the responsibility to live within its means. Now, there’s been a lot of
discussion about government over the last several months
— and let’s face it, people have lost
faith in government. They had lost faith in
government before I ran and it’s been getting worse. You know, President Lincoln said
that “the legitimate object of government is to do for the
people what needs to be done, but which they can not … do at all, or do so
well, by themselves.” That pretty much
sums up my attitude. You let people do for themselves
what they can do for themselves; and then if there are some
things that we do better together, we should
do them together. And I believe that in
everything government does, we’ve got a special
responsibility to be wise stewards about how Americans’
hard-earned tax dollars are spent. And I know you agree
with that, too. Doesn’t matter whether you’re
a Democrat or a Republican, you don’t like seeing your money
wasted — or an independent, don’t like seeing
your money wasted. That’s a responsibility my
administration is seeking to fulfill every single day. Over the last year, we’ve gone
through the budget line by line looking for places to trim
the fat out of government. And we’ve found a lot of
fat to trim. I got to admit. Last year, we pushed Congress
to cut nearly $20 billion by streamlining or eliminating more
than 120 government programs. This year, we put another $20
billion in cuts on the table, targeting dozens of additional
programs that were wasteful or duplicative or in some cases
just plain ridiculous. For example, we decided not to
fund an office maintained by the Department of Education
— in Paris, France. (laughter) Now, I’m sure that was nice
work if you could get it. (laughter) But I didn’t think that was a
real good use of our money. We eliminated a decades-old
radio navigation system which cost $35 million a year. And some people might say,
well, why did you do that? We need that navigation system. Well, the thing is,
we got this thing call GPS now, and satellites. (laughter) So the whole radio navigation
thing wasn’t working so well. So we’ve been pushing for cuts
on things that we don’t need, that government
doesn’t do so well. And we’re also reforming the
way government contracts are awarded. Think about this,
between 2002 and 2008, the amount spent annually on
government contracts more than doubled to half a
trillion dollars. Those are contracts with
private contractors. And the amount spent on no-bid
contracts jumped by 129 percent — no-bid contracts. That’s an inexcusable
waste of your money. So last March, I ordered federal
departments to come up with plans to save as much as $40
billion a year in contracting. Now, this brings me to the
person standing right over here, the lady in pink. (applause) You know before Claire
was your senator, she was your state auditor. She just pinches pennies. I mean, she’s just — (laughter)
— you think I’m — I don’t like waste, but Claire, she just —
every dime, she’s — (laughter) So thanks to Claire, we’re
going to have a new tool to help us meet this goal of eliminating
some of these wasteful contracts and no-bid contracts. In the coming weeks we’re going
to be rolling out a new online database, which Claire McCaskill
proposed and helped pass into law. (applause) And we’ll be able to see, before
any new contract is awarded, whether a company plays by
the rules, how well they’ve performed in the past: Did
they finish the job on time? Did the company
provide good value? Did the company
blow their budget? It’s your money, so you deserve
to know how it’s spent and who these contracts are going to. And that’s an example of the
kind of service that Claire McCaskill is providing, not
just to the people of Missouri, but people all
across the country. And in every way but one, Claire
McCaskill is the new Harry Truman — (laughter) — in
the United States Senate. (applause) The one difference
is she’s a she. (laughter) But just as the Truman
Commission prevented billions of dollars of wasteful spending
during the war and saved lives in the process, through tough
and fair-minded oversight of contracting during World War II,
Claire has been a relentless force for rooting out scams and
making government more efficient. Harry Truman also said in the
commission’s final report that in completing the mission,
“[w]here necessary, heads must be knocked together.” And let me tell you, Claire loves
knocking some heads together. (laughter) She’s never been
afraid to do that. (applause) As we were driving
in, I was saying, boy, it’s just good to be
back in the Midwest, this is about as close as
I’ve been to home in a while. And part of the reason it’s
just good to be back is because Washington is a place where tax
dollars are often treated like Monopoly money — they’re
bartered and traded, and they’re divvied up among
lobbyists and special interests, and where waste — even billions
of dollars of waste — is accepted as the price
of doing business. When we proposed, by the way,
those $20 billion in cuts last year, we were ridiculed
by the press, said, “Ah, that’s just
a spit in the bucket.” Now, I don’t know about here
in St. Charles, $20 billion, that’s real money, isn’t it? Audience:
Yes. President Obama:
That’s real money. But Claire doesn’t accept
business as usual. I don’t accept
business as usual. You don’t accept
business as usual. The American people don’t
accept business as usual, especially when we’re facing
these enormous long-term deficits that threaten to leave
our children a mountain of debt. Now, this brings me to
the primary topic I want to talk about today. Nowhere is reform more needed
than when it comes to our health care system — nowhere. (applause) Nowhere. (applause) The health care system has
billions of dollars that should go to patient care and they’re
lost each and every year to fraud, to abuse, to massive
subsidies that line the pockets of the insurance industry. Let me just give you one example
— this is a long recognized but long tolerated problem
called “improper payments.” That’s what they call them. Washington always has a
name for these things. “Improper payments.” And as is often the
case in Washington, the more innocuous the name,
the more worried you should be. So these are payments mostly
made through Medicare and Medicaid that are sent
to the wrong person, sent for the wrong reason,
sent in the wrong amount. Sometimes they’re
innocent errors. Sometimes they’re because nobody
is bothering to check to see where the money is going and
they’re abused by scam artists and fly-by-night operations. (The President coughs)
Look, health care. (laughter) This health care debate
has been hard on my health, I got to tell you. (laughter) It’s estimated that improper
payments cost taxpayers almost $100 billion last year alone. Think about that. That, by the way, just that
abuse in improper payments is more than we spend on the
Department of Education and the Small Business
Administration combined. If we created a “Department of
Improper Payments” it would be one of the largest
agencies in our government. Now, for the past few years,
there has actually been a pilot program that uses a system of
tough audits to recover some of this lost money. And even though these audits,
they were just operating mainly in three states, they already
found a billion dollars in improper payments. So these results were both
disturbing and encouraging. They’re disturbing because it
shows you how much waste there is out there in the
health care system. But it’s encouraging because
we can do something about it. So earlier today, with Claire
looking over my shoulder — one of our auditors-in-chief — I
signed an order calling on all federal agencies to launch these
kinds of audits all across the country. All across the country. (applause) So agencies would hire
auditors to scour the books, go through things line by line. Auditors are paid based on how
many abuses or errors they uncover. So it’s a win-win. The auditor, if they do a
good job they get a small percentage as a reward. And the taxpayer wins by getting
huge sums of money that would otherwise be lost that we can
then spend to provide care to people who really need it, or we
can use to reduce the deficit. Now, through this effort, we
expect to more than double the amounts we would’ve otherwise
recovered — a couple of billion dollars over the next few years. And I’m announcing my support
for the Improper Payments Elimination and Recovery Act —
that’s a mouthful — but this is a bipartisan bill — (applause)
— is a bipartisan bill to expand our ability
to do these audits, so we can prevent even more
fraud and abuse and waste. Now, the reason I’m bringing all
this stuff up is because there’s been a lot of talk about
health care lately. And look, I’ll be honest, a lot
of people, they’re confused, they’re saying, well, how can
you help people get insurance who don’t have it without
it adding to our deficit? It’s a legitimate question. Well, the reason is, is because
so much of the money currently in our health care
system is being misspent. (applause) Look, if you’ve got — if you’ve
got a house and the roof is leaking and the windows are all
letting through a bunch of draft and you get that cold winter
and all the heat seeping out, and if you decide to spend on
some new windows and fix your roof, that’s going to
spend a little money, but you’d save money in the
long run because you don’t have heating expenses, and those
leaks aren’t ruining your furniture. The same thing is true with
our health care system. We’ve got leaks everywhere
— that you pay for, directly or indirectly. And if we can have a smarter
health care system, then yes, we can provide help to
middle-class folks who need it, and at the same time actually
reduce the burden on taxpayers. Now, I know that during the
health care debate opponents have tried to scare people,
especially our seniors, into thinking that we are
going after seniors’ Medicare benefits; that’s how Obama is
going to pay for his plan. When you look at the facts,
that’s just plain wrong. In fact, by saving billions of
dollars of the sort we just talked about — waste
and abuse — in Medicare, reining in waste
and inefficiencies, we’re going to be able to help
ensure Medicare’s solvency for an additional decade. (applause) This is just one example that
speaks to how we’re going to stop wasting money through the
health care system on things that don’t make people
healthy — in fact, often take away from
the care we receive, and take that money and make it
work for the American people. So Medicare will work
better, provide better care because of these reforms. Senior citizens who are dealing
with the doughnut hole in the prescription drug plan — that
plan will be filled in part because we’re not wasting money
on stuff that doesn’t work. (applause) That’s common sense. You know, I get a lot of
letters from constituents. I get about 40,000 every day,
and I don’t read all 40,000 — somebody does — but what
I’ve done is I’ve asked my staff to collect a sampling of 10
letters that I read every night. And I will tell you that my
staff is very evenhanded, because about half of these
letters call me an idiot. (laughter) And at least half of them
talk about health care. And when the health care reform
debate was really heating up, one of the things that I heard
from a lot of seniors was, “Keep your government
hands out of my Medicare.” (laughter) I heard this from
a bunch of seniors. They say, “I don’t want your
government-run health care plan, and don’t touch my Medicare.” And so I’d have to write back
and I’d say, “Ma’am,” or “Sir, Medicare is a government program.” (laughter) “But we’re not
going go weaken it. We’re going to make it stronger.” But I think those letters
tell you something about what sometimes happened in
this health care debate, because people have been hit
with a lot of bad information. And health care is
really important. And so people get worried
and they get nervous. But when you get past the
divisive and the deceptive rhetoric, it turns out that most
Americans are happy that two generations ago we made the
decision that seniors and the poor should not be saddled with
unaffordable health care costs or forced to go
without needed care. That was a decision that
we made decades ago. And it was the right
decision to make. (applause) And by the way, when we
made those decisions, folks were saying the exact
same thing about Medicare: “That’s socialized medicine,
this is government-run care,” blah, blah. blah, blah. Now, today we face
a different choice, but it’s a similar choice to the
one that previous generations faced, and that is whether
we should help middle-class families and business owners
that are being pummeled by the rising costs of health care. See, back when the Medicare
debate was taking place, seniors were having problems
because they were no longer working, and people were getting
their health care through their jobs. And so it made
sense to help them. It made sense to help the poor
who might not be employed. But back then, middle-class
folks, they were pretty secure. If you were working, you had
health care that was affordable. But you know what’s happened
over the last several decades. What’s happened is, is that more
and more businesses are saying, we can’t afford to provide
health care to our workers because the costs
are skyrocketing. So they just drop
health care altogether. A lot of small businesses, they
don’t provide health care to their employees anymore. And large businesses,
what are they doing? They’re saying to you, we’re
going to jack up your premiums, we got to increase
your deductibles. If you’re self-employed, you
are completely out of luck. If you’ve got a
preexisting condition, you are completely out of luck. And by the way, those of us who
are lucky enough to have health care today, we don’t know if
we’re the ones who are going to lose our job tomorrow,
or suddenly it turns out that our child has a
preexisting condition. And we’ll be stuck in
the exact same situation, even if we’ve got
good health insurance. (applause) Now, everything I just said, if you
talk to my opponents, they’ll agree. They’ll say, you’re right, the
health care system is broken. For too many people
it’s getting worse. They will acknowledge that the
status quo is unsustainable. But you know what they tell me? We had that big
health care summit. I know you guys watched
all seven hours of it. (laughter) Yes, absolutely.
It was scintillating. (laughter) But you heard what they said. They said, well, we agree with
you that the current system is unsustainable, but this is just
not the right time to do it. They said, let’s start over,
that’s what they said. We just got to
start from scratch. Audience:
No! President Obama:
Well, let me tell you something. The insurance industry
is not starting over. They just announced a 39 percent
rate increase in California and a rate increase of up to 60
percent right across the border in my home state of Illinois
— 60 percent in one year. That’s the future. That’s the future
if we fail to act. And by the way, I don’t recall
any of these Republicans trying to do anything about insurance
companies’ abuses during all the years they were in charge. (applause) Do you, Claire?
I don’t remember. I don’t remember them doing
anything about folks who needed some help when the government
was running surpluses. So I get a sense with
some of these folks, it’s just never going
to be the right time. But the truth is, we have
debated health care in Washington not just
this past year, we’ve been debating
it for 70 years. You know who was pushing
health care reform? Harry Truman. (applause) Harry Truman was pushing
health care reform. And by the way, you
know what they said? They said, he’s pushing
socialized medicine. Harry Truman. And over this past year
we’ve been talking about it, every proposal has
been put on the table. Every argument has been made
and everybody has made it. And I know that people view
this as a partisan issue, but the truth is, is that if you
set aside the politics of it, and what was good
for Election Day, it turns out that parties have
plenty of areas where they agree. And the plan that I’ve put
forward is a proposal that’s basically somewhere in the
middle — one that incorporates the best ideas of
Democrats and Republicans, even though the Republicans have
a hard time acknowledging it. Now, there are some folks who
wanted to scrap the system of private insurance and replace
it with a government-run health care program, like they have
in some other countries. (applause) We’ve got a couple —
some applause here. And look, it works well
for those countries. But I’ll just be honest with
you: It was not practical or realistic to do here, to
completely uproot and change a system where the vast majority
of people still get their health care from employer-based plans. And on the other side of the
spectrum there are those who believe that the answer is to
simply unleash the insurance industry, and provide less
oversight and fewer rules. Audience:
Boo! President Obama:
And that somehow
that’s going to drive down prices for everybody. This is called the “putting
the foxes in charge of the hen house” approach to
health care reform. (applause) So whatever state
regulations were in place, we’d get rid of those and so
insurance companies could basically find a state that had
the worst regulations and then from there sell
insurance everywhere. And that somehow that was
going to be helpful to you. All this would do would give
insurance companies more leeway to raise premiums and deny care. So I don’t believe we should
give either the government or the insurance companies more
control over health care in America. I want to give you more control
over health care in America. (applause) So my proposal builds on the
current system where most Americans get their health
care from their employers. If you like your plan,
you can keep your plan. If you like your doctor,
you can keep your doctor. But my proposal would change
three important things about the current health care system. Now I want everybody to pay
attention — I know it’s a little warm in here, but I
want you to pay attention, so that when you are talking to
your friends and your neighbors and folks at work and they’re
wondering what’s going on, I want you to be
able to just say, here are the three things
Obama is trying to do. First, it would end the worst
practices of insurance companies — and it would begin to
do so this year. This year. (applause) Thousands of uninsured Americans
with preexisting conditions will be able to purchase health
insurance for the very first time in their lives or
since they got sick. (applause) This year. Insurance companies
would be banned from denying coverage to children with
preexisting conditions this year. (applause) Insurance companies would be
banned from dropping your coverage when you get sick. (applause) Insurance companies would no
longer be able to arbitrarily and massively raise premiums. They would be subject to review. Those practices will end as a
consequence of health care reform. (applause) All new insurance plans would
be required to offer free preventive care to
their customers. And if you buy a new plan, there
will be no more lifetime limits on the amount of care you
receive from your insurance company — (applause) — all
that fine print that ends up getting folks into trouble. If you’re a uninsured
young adult, you’ll be able to stay on your
parents’ insurance policy until you’re 26 years old. (applause) So a lot of folks, as they’re
transitioning into the workplace, will have insurance. (applause) All right, so that’s part one
of the plan: insurance reform. Part two. For the first time, uninsured
individuals and small businesses will have the same kind of
choice of private health insurance that members
of Congress get. (applause) If it’s good enough for
members of Congress, it’s good enough for the
people who pay their salaries. (applause) This should not be a
controversial idea. The reason that federal
employees usually have pretty good insurance is because
they’re part of a pool of millions of people. So what happens is they can
negotiate for really good rates because the insurance companies
really want those millions of customers. So what we’re talking about is
setting up a pool for people who don’t work for the federal
government — you, individuals, small businesses; they
can be part of this pool. And this is an idea that a lot
of Republicans embraced in the past until I said
it was a good idea. (laughter) So all this would drive down
rates for those individuals and small businesses who aren’t part of
a big company that get good rates. And my proposal says if
you still can’t afford it, even though now the premiums are
lower than you can buy on your own, then we’ll offer you some
tax credits to make it affordable. And those tax credits would add
up to the largest middle class tax cut for health
care in history. (applause) So it’s estimated that this
would drive down the costs for folks who don’t work for big
companies — so they don’t get as good of a deal —
by 14, 20 percent. This is before the subsidies,
before the tax credits. Now, it’s true that this
will cost some money. It’s going to cost about a
hundred billion dollars per year. That’s real money,
that’s a lot of money. But most of that money
comes from the nearly $2.5 trillion a year that America
already spends on health care that we’re not spending well; that
we’re spending badly right now. So we pay for this proposal by
getting at the abuse that we just talked about. We eliminate wasteful taxpayer
subsidies that go to the insurance companies. Do you know that through
the Medicare program, we are giving insurance
companies close to $20 billion a year, about $18 billion every
year of taxpayer money through the Medicare system. And we’re saying, well,
why do we do that? They’re making a
profit on their own. And while some of what we save
goes to helping the uninsured, most of it goes back to small
businesses and the middle class who right now just aren’t
getting a good deal. It doesn’t make sense to me that
people who are really poor are able to get Medicaid, but people
who are working really hard and just not quite as poor, they
don’t get a decent deal. That doesn’t make sense to me. (applause) All right. That’s the second part. First part: insurance reform. Second part: creating this
marketplace where small businesses and individuals
can get a good deal. Third part: bringing down the
cost of health care for families and businesses and for
the federal government. Cost control. Now, when you listen to the
other side, they’ll tell you, we want to do more about cost,
we want to do more about cost. Well, let me tell you, we’ve
incorporated almost every serious idea from across the
political spectrum about how to contain rising
health care costs. There’s not an idea out there
that we have not worked on, that we have not included
in this proposal. And according to the
Congressional Budget Office — this is the office that is
supposed to be the independent referee for how things cost,
it’s not supposed to be Democrat or Republican — according to
the Congressional Budget Office, people buying health plans in
the individual market right now, they’d see their premiums
go down 14 to 20 percent. (applause) I already mentioned that.
Now, here’s another thing. A recent study by the Business
Roundtable — that’s made up of all these big
companies out there, they don’t —
they’re nonpartisan, but it’s not like they’re
just dyed-in-the-wool liberal Democrats, let’s
put it that way; these are company CEOs — they
commissioned a study and said the reforms could reduce premiums
by as much as $3,000 per employee. That’s their study, not mine. Then the Congressional Budget
Office said that the government would save a trillion dollars,
reduce the deficit by a trillion dollars. So think about it:
You’re saving money, employers are saving money, the
federal government is saving money — not according to me,
but according to these studies that were done by
independent analysts. So here’s the bottom line, St. Charles. There’s no government takeover,
unless you consider reining in insurance companies a government
takeover — and I think that’s the right thing to do. (applause) There’s no cutting
of Medicare benefits. There’s just cutting out fraud and
waste in Medicare to make it stronger. (applause) What we’re proposing is a
common-sense approach to protecting you from insurance
company abuses and saving you money. That’s the proposal,
and it is paid for. And I believe that Congress owes
the American people a final up or down vote on
health care reform. (applause) The time for talk is
over; it’s time to vote. (applause) It’s time to vote.
Tired of talking about it. (applause) Now, of course, folks in
Washington, they like to talk. And so Washington is doing
right now what Washington does. They’re speculating
breathlessly, day or night, every columnist, every pundit,
every talking head: “Is this proposal going to help the
Republicans or is this proposal going to help the Democrats?” “What’s going to happen to the
President’s poll numbers if the vote doesn’t go forward?” “If it does go forward?”
“What will it mean for November? “What will it mean for 2012?” “How’s the politics
going to play?” I heard the Republican Leader
of the Senate the other day — he’s warning Democrats, you
better be careful about voting for this; it could hurt you. I don’t know how sincere the
Republican Leader is about the best interests of Democrats. (laughter) He’s been very
generous with advice. (laughter) You know what, here’s the
bottom line, St. Charles. I don’t know how
the politics play. I don’t know. This is a hard
issue. It’s a complicated issue. There is a lot of information
floating around out there. A lot of it is inaccurate. The opponents have spent
millions of dollars fighting it. And people during
recessionary times, they’re anxious and
sort of thinking, gosh, can we really afford to
change things right now? Maybe we should just kind of
stick with the status quo, even though we know
it’s not working for us. So I don’t know how
the politics plays. But here’s what I do know: The
American people will be more secure with this reform. Our country will be stronger
because of this reform. (applause) I don’t know about the politics. But I know it is the
right thing to do, and that’s why I’m fighting
so hard to get it done. (applause) We’ve seen years — decades —
where Washington just puts off dealing with our toughest
challenges because it’s too hard, because we don’t know
how the politics works. And the will and
the capacity to act, to do serious things
in this country, starts just getting sucked away. Just gets sacked by partisanship
and political gamesmanship and debates about who’s
up and who’s down, and how does this play
politically — instead of asking what’s right
and what’s wrong. And we’ve seen terrible
consequences — not just these last two years of turmoil,
but a decade of struggle for middle class families. (applause) We can’t accept the status quo. We can’t accept the
same old/same old. I won’t accept it. Claire McCaskill
won’t accept it. Not when it comes to how we
manage taxpayer dollars. Not when it comes to how our
health care system works. Not when it comes to meeting the
difficult challenges that we face. And that’s why Claire and I are
fighting to stop waste and abuse in our government. That’s why Claire and I
are fighting to pass these health insurance reforms. (applause) Now is the time.
Now is the moment. Now is the time for us to leave
for the next generation and generations to come a stronger
and more prosperous country. We are not backing down. We are not quitting, St. Charles. And we are going
to get this done. (applause) Thank you. God bless you. And God bless the United
States of America. (applause)

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