More on Health Care Reform.

Here are some words straight from the President of the United States when he talked to people in Montana. This is what we should be listening to, and this is what we should be striving for. Health care, and the ability should be a right for all Americans, not just the rich, not just those who are already healthy, but for all Americans! Oh and remember, the government runs health care for our solders, veterans, Medicare, and Medicaid. I think that they have a bit of experience with this.

And the fact is, health care touches all of our lives in a profound way. Now, that also makes this debate an emotional one. I know there's been a lot of attention paid to some of the town hall meetings that are going on around the country, especially when tempers flare -- TV loves a ruckus.

What you haven't seen on TV -- and what makes me proud -- are the many constructive meetings going on all over the country. Everywhere -- everywhere across the country, you're seeing people who are coming together and having a civil, honest -- often difficult -- conversation about how we can improve the system. That's how democracy is supposed to work.

Earlier this week, I held a town hall in New Hampshire. A few thousand people showed up. Some were big supporters of health insurance reform, some had concerns and questions, some were downright skeptical -- didn't believe it could be done. But I was glad to see that people were there not to shout, they were there to listen and ask questions. That reflects America a lot more than what we've seen covered on television for the last few days -- and I want to thank you for coming here today in that spirit. (Applause.)


First, health insurance reform will mean a set of common-sense consumer protections for folks with health insurance. So those of you who have health insurance, this is what it will mean. Insurance companies will no longer be able to cancel your coverage because you get sick. (Applause.) That's what happened to Katie. It can't happen anymore.

If you do the responsible thing, if you pay your premiums each month so that you are covered in case of a crisis, when that crisis comes -- if you have a heart attack or your husband finds out he has cancer or your son or daughter is rushed to the hospital -- at the time when you're most vulnerable and most frightened, you can't be getting a phone call from your insurance company saying that your insurance is revoked. It turns out, once you got sick, they scoured your records looking for reasons to cancel your policy. They'd find a minor mistake on your insurance form that you submitted years ago. That can't be allowed to happen. (Applause.)

One report -- one report found that three insurance companies alone had canceled 20,000 policies in this way over the past few years. One man from Illinois lost his coverage in the middle of chemotherapy because his insurer discovered he hadn't reported gall stones he didn't know about. True story. Because his treatment was delayed, he died. A woman from Texas was diagnosed with an aggressive form of breast cancer, was scheduled for a double mastectomy. Three days before surgery, the insurance company canceled the policy, in part because she forgot to declare a case of acne. True story. By the time she had her insurance reinstated, the cancer had more than doubled in size.

And this is personal for me. I'll never forget my own mother, as she fought cancer in her final months, having to worry about whether the insurance company would refuse to pay for her treatment. The insurance company was arguing that she should have known that she had cancer when she took her new job -- even though it hadn't been diagnosed yet. If it could happen to her, it could happen to any one of us. It's wrong. And when we pass health insurance reform, we're going to put a stop to it once and for all. That is what Max Baucus is working on. (Applause.)

If this isn't enough to convince you that we should follow the Presidents health care reform plan, then read on, there is more.

Now, if you are one of nearly 46 million people who don't have health insurance, you'll finally have quality affordable options. And if you do have health insurance, we'll help make sure that your insurance is more affordable and more secure. If you like your health care plan, you can keep your health care plan. This is not some government takeover. If you like your doctor, you can keep seeing your doctor. This is important. I don't want government bureaucrats meddling in your health care, but I also don't want insurance company bureaucrats meddling in your health care either. (Applause.) That's what reform is about. (Applause.)

Now, let me say this: Under the proposals that Max is working on, more than 100,000 middle-class Montanans will get a health care tax credit. More than 200,000 Montanans will have access to a new marketplace where you can easily compare health insurance options. Nearly 30,000 small businesses in Montana will be helped by new tax benefits, as well. (Applause.) And we will do all this without adding to our deficit over the next decade, largely by cutting waste and ending sweetheart deals for insurance companies that don't make anybody any healthier. (Applause.)

If you want to think of people rationing health care, as the insurance companies do today, and doctors have to do every day as well (where would you land on a transplant list?), I would much rather have the government who works for me, whom I can vote in or out whom I like, who has an inherent interest in me and my well being helping me with my medical care then a company who has no reason to care about me except to try to get as much money out of me before I get sick, then canceling my service or trying to find ways to make me pay for the service that I had been guaranteed. The government can not discriminate against anyone, it's against the constitution, but a private company can. I do not want to free market to decided that me, or any one in my family is not a good deal, and deny them health care (which they have already done). How can you put a price on life, who would want to put a price on life, so why would any one want their lives in the hands of a market that does just that?


And now for some questions and answers.

Q I was laid off in January. I am currently uninsured. My two children have Medicaid right now. And my question is, without going into too much detail, can you tell us what you -- if you have kind of looked at Canada, England's system, and sort of -- can you pick and choose from those systems that work, that we see there's some success rate and apply that to what you're trying to push through right now?


THE PRESIDENT: Well, let me tell you what happens in other industrialized countries. First of all, I think it's important for everybody to understand that Americans spend $5,000 to $6,000 per person more than any other advanced nation on earth -- $5,000 or $6,000 more than any other person -- any other country on earth.

Now, if you think that -- how can that be? Well, you probably don't notice it, because what's happening is if you've got health insurance through your job, more and more of what would be your salary and wages is going to health insurance. But you don't notice it; you just notice that you're not getting a raise. But a bigger and bigger portion of compensation is going to health care here in the United States. Now that's point number one.

So clearly we've got a system that isn't as efficient as it should be because we're not healthier than these people in these other countries.

Having said that, most other countries have some form of single-payer system. There are differences -- Canada and England have more of what's called -- what people I guess would call a socialized system, in the sense that government owns the hospitals, directly hires doctors -- but there are a whole bunch of countries like the Netherlands where what they do is, it's a single-payer system only in the sense that government pays the bill, but it's all private folks out there -- private doctors, private facilities. So there are a bunch of different ways of doing it.

Now, what we need to do is come up with a uniquely American way of providing care. (Applause.) So I'm not in favor of a Canadian system, I'm not in favor of a British system, I'm not in a favor of a French system. That's not what Max is working on. Every one of us, what we've said is, let's find a uniquely American solution because historically here in the United States the majority of people get their health insurance on the job. So let's build on that system that already exists -- because for us to completely change that, it would be too disruptive. That's where suddenly people would lose what they have and they'd have to adjust to an entirely new system. And Max and I agree that's not the right way to go.

So all we've said is, in building a better system, what are the elements? Well, number one, for people like you, you should be able to get some help going into the private insurance marketplace and buying health insurance. So we would give you a tax credit, a subsidy of some sort, to help you obtain insurance.

Now, the problem is, if you're going out there on your own, then it's much more expensive than if you go in a big group. So we would allow you to buy into a health care exchange that would give you some power to negotiate for a better rate, because you're now part of a big pool. We would also make sure that if you do have health insurance that you are protected from some of the policies that we've already talked about that have not been very good for consumers. So you wouldn't be able to be banned for preexisting conditions. There would be caps on the amount of out-of-pocket expenses you would have to spend. So we would reform the insurance market for people who already have health insurance.

And if we do those things -- making it better for folks who already have insurance, making it easier for you to buy insurance, and helping small businesses who want to do the right thing by their employees but just can't afford it because they're charged very high rates, they can't get a good deal from the insurance companies -- if we do those things, then we can preserve the best of what our system offers -- the innovation, the dynamism -- but also make sure that people aren't as vulnerable. Now, that's essentially what we're talking about with health care reform.

And so when you start hearing people saying, you know, we're trying to get socialized medicine and we're trying to have government bureaucrats meddle in your decision-making between you and your doctor, that's just not true.

Q I think most of us know that Medicare is one of the best social programs this nation has ever put together. (Applause.) It works extremely well and helps the people who need it the most. But money doesn't grow on trees. How can we be assured that increasing coverage to others is not going to make Medicare more expensive or less effective?

THE PRESIDENT: Well, I think this is a good point, and I appreciate the question, because a lot of seniors are concerned about this. First of all, it is important to know that Medicare is a government program. So when you hear people saying, "I hate government programs, but keep your hands off my Medicare" -- (laughter) -- then there's a little bit of a contradiction there. And I have been hearing that quite a bit, all right, so I just want to -- (applause) -- I want to be clear about that.

Medicare is a terrific program and it gives our seniors security. And I want Medicare to be there for the next generation, not just for this generation. But if we don't make some changes in how the delivery system works, if we don't eliminate some of the waste and inefficiencies in the system, then seniors are really going to be vulnerable. So what we've proposed is not to reduce benefits -- benefits on Medicare would stay the same -- it's not to ration. What we are asking is that we eliminate some of the practices that aren't making people healthier.

Example number one: Subsidies to insurance companies under Medicare amount to about $177 billion over 10 years. That's how much we think we could save by eliminating subsidies to insurance companies that are offering what's called Medicare Advantage. It doesn't help seniors any more than regular Medicare does. (Applause.)

And so if we took that $177 billion, we're not making seniors worse off, but we've got that money now not only to strengthen the health care system overall, but potentially to cover more people. Now, the insurance companies don't like it, but it's the right thing to do.

Let me give you another example of changes that we should make. Right now when you go into the hospital, you get a procedure under Medicare, if you end up having to come back to that hospital a week later because something went wrong, they didn't do it right, the hospital doesn't pay any penalty for that; they just get reimbursed for a second time or a third time -- same fee, same service.

Now, think about that if car -- auto repair shops operated the same way. You take your car in and you get it fixed, and a week later the thing is broken again. You go in. The guy says, well, let me charge you all over again, and I'll do just the same thing. That doesn't make sense. So what we've said is, let's give hospitals an incentive. Let's say to the hospitals, we're going to charge you for overall treatment of whatever the problem is. And if you get it right the first time, you get to keep a little extra money. But if you keep on having the person coming back again and again, then there's a disincentive.

Those are the examples of the kinds of changes that can be made that aren't reductions in benefits, but they save the system money overall, and by the way, will actually increase the life expectancy of the Medicare Trust Fund, which is in deep trouble if we don't do something, because as you said, money doesn't grow on trees. So we're actually trying to help preserve Medicare and make people healthier in the process.

Q Thank you. I'm a single mother of two children. I'm an MSU student. I have a son that suffers from many disabilities. He's disabled for the rest of his life. He's 11 years old. He suffers from autism. He's non-verbal. He suffers from extremely hard to control epilepsy, and he's Type I diabetic. He has been sick with these ailments ever since he was nine months old. My question to you is, I rely heavily on his Medicaid to support good health care for him. What, with this reform, would happen with his Medicaid -- Medicare coverage -- or Medicaid coverage, sorry.

THE PRESIDENT: First of all, thank you for sharing your story. You are a heroic mom, so we are grateful to you and your son is lucky. (Applause.)

If you currently qualify for Medicaid -- your son currently qualifies for Medicaid, he would continue to qualify for Medicaid. So it would not have an impact on his benefit levels and his ability to get the care that he needs.

Some of the reforms that we're talking about, though -- what I just referred to as delivery system reforms, where we help, for example, encourage doctors when they are seeing a patient, instead of having five tests, do one test and then e-mail all the tests to five specialists. Those kinds of changes can save money in the Medicaid and the Medicare systems overall, and that will actually help Governor Schweitzer, who has to come up with half of Medicaid in his state budget every year, it will actually help him then be able to pay for it.

So we're not changing the benefit levels or who qualifies for Medicaid -- we might see some expansion of Medicaid, in fact, under the reforms that have been proposed in some of the legislation -- but we do have to make the whole system overall just a little bit smarter, make sure we're getting a better bang for the buck, so that the money is there for the services that your son needs. Okay.

This also includes, by the way, preventive care, wellness care, because our system really is not a health care system, it's more like a disease care system, right? We wait until people get sick and then we provide them care. Now, think about it -- are we better off waiting until somebody gets diabetes and then paying a surgeon for a foot amputation, or are we better off having somebody explain to a person who's obese and at risk of diabetes to change their diet, and if they contract diabetes to stay on their medications? Obviously the second is more cost-efficient, but right now the health care system is perverse. It does not incentivize those things that actually make people better or keeps them out of hospitals in the first place, and that's what we have to change overall to make sure that the resources are there for your son. Okay? (Applause.)

This is an important one for all of you out there listening to just the cable networks (Fox News) and if you believe what they say about health care (remember most of those commentators make much more then $250,000 a year)

Q Max Baucus, our senator, has been locked up in a dark room there for months now trying to come up with some money to pay for these programs. And we keep getting the bull. That's all we get, is bull. You can't tell us how you're going to pay for this. You're saving here, you're saving over there, you're going to take a little money here, you're going to take a little money there. But you have no money. The only way you're going to get that money is to raise our taxes. You said you wouldn't. (Applause.) Max Baucus says he doesn't want to put a bill out that will. But that's the only way you can do that.

THE PRESIDENT: Well, let -- I'm happy to answer the question.

Q Thank you.

THE PRESIDENT: Look, you are absolutely right that I can't cover another 46 million people for free. You're right. I can't do that. So we're going to have to find some resources. If people who don't have health insurance are going to get some help, then we're going to have to find money from somewhere.

Now, what I've identified, and most of the committees have identified and agreed to, including Max Baucus's committee, is that there -- overall this bill will cost -- let's say it costs $800 billion to $900 billion. That's a lot of money. That's a lot of money. That's over 10 years, though, all right? So that's about $90 billion -- $80 billion to $90 billion a year.

About two-thirds of it -- two-thirds -- can be obtained by doing some of the things I already mentioned, like eliminating subsidies to insurance companies. So you're right, that's real money. I just think I would rather be giving that money to the young lady here who doesn't have health insurance and giving her some help, than giving it to insurance companies that are making record profits. (Applause.) Now, you may disagree. I just think that's a good way to spend our money.

But your point is well taken, because even after we spend -- even after we eliminate some of the waste and we've gotten those savings from within the health care system, that's only two-thirds. That still means we've got to come up with one-third. And that's about $30 billion a year that we've got to come up with. Now, keep in mind the numbers change, partly because there are five different bills right now. This is all going to get merged in September. But let's assume it costs about $30 billion a year over 10 years. We do have to come up with that money.

When I was campaigning, I made a promise that I would not raise your taxes if you made $250,000 a year or less. That's what I said. But I said that for people like myself, who make more than that, there's nothing wrong with me paying a little bit more in order to help people who've got a little bit less. That was my commitment. (Applause.)

So what I've said is -- so what I've said is let's, for example, just -- this is the solution that I originally proposed; some members in Congress disagree, but we're still working it through -- what I've said is we could lower the itemized deductions that I can take on my income tax returns every year so that instead of me getting 36 percent, 35 percent deductions, I'll just get 28 percent, like people who make less money than me.

If I'm writing a check to my local church, I don't know why Uncle Sam should be giving me a bigger tax break than the person who makes less money than me, because that donation means just as much. (Applause.) If we just did that alone -- just that change alone, for people making more than $250,000, that alone would pay for the health care we're talking about. (Applause.)

So my point is -- my point is, number one, two-thirds of the money we can obtain just from eliminating waste and inefficiencies. And the Congressional Budget Office has agreed with that; this is not something I'm just making up; Republicans don't dispute it. And then the other third we would have to find additional revenue, but it wouldn't come on the backs of the middle class.

Now, let me just make one final point. I know that there are some people who say, I don't care how much money somebody makes; they shouldn't have to pay higher taxes. And I respect that opinion. I respect that view. But the truth of the matter is, is that we've got to get over this notion that somehow we can have something for nothing, because that's part of how we got into the deficits and the debt that we're in, in the first place. (Applause.)

When the previous administration passed the prescription drug bill, that was something that a lot of seniors needed, right? They needed prescription drug help. The price tag on that was hundreds of billions of dollars. You know how we paid for it? We didn't. It just got added on to the deficit and the debt.

So it amuses me sometimes when I hear some of the opponents of health care reform on the other side of the aisle or on these cable shows yelling about how we can't afford this, when Max and I are actually proposing to pay for it, and they passed something that they didn't pay for at all and left for future generations to have to pay in terms of debt. That doesn't make sense to me. (Applause.)

All right, can I say this, though? Randy, I appreciate your question, the respectful way you asked it, and by the way, I believe in the Constitution, too. So thank you very much. Appreciate it. (Applause.)

There is a lot more to the speach and the questions, and you can find it all on the white house web site.