i want to thank the univers of iowa for have us here __PUNCT__ and i want to give a special thank to ami and lane for join me todai to tell their stori __PUNCT__
a few hour north of here __PUNCT__ ami and lane run a small busi that offer internet servic to their commun __PUNCT__
thei were the veri first compani to provid broadband access in their remot corner of northeastern iowa __PUNCT__ and everi dai __PUNCT__ hundr of peopl count on the servic thei provid to do their job and live their live __PUNCT__
but todai thei ar on the brink of bankruptci __PUNCT__ a bankruptci that ha noth to do with ani poor busi decis thei made or slump in the economi thei weren't prepar for __PUNCT__
lane wa diagnos with cancer when he wa twenti __PUNCT__ on year old __PUNCT__
he lost a lung __PUNCT__ a leg bone and part of a hip __PUNCT__
seventeen year later __PUNCT__ he is cancer __PUNCT__ free __PUNCT__ but the cost of health insur for him __PUNCT__ hi wife and hi three kid is now over __MONEY__ per month __PUNCT__
their famili premium keep rise hundr of dollar everi year __PUNCT__ and as hard as thei look __PUNCT__ thei simpli cannot find anoth provid that will insur them __PUNCT__
ami and lane ar now pai forti percent of their annual incom in health care premium __PUNCT__
thei have no retir plan and noth save __PUNCT__
thei can no longer afford to bui new cloth or fill up their car with ga __PUNCT__ thei have rack up more credit card debt then thei know what to do with __PUNCT__ and ami wrote to us and said that the dai she heard the loan offic sai the word __PUNCT__ bankruptci __PUNCT__ wa on of the worst in her life __PUNCT__
__PUNCT__ my heart wa in pain __PUNCT__ she said __PUNCT__
__PUNCT__ thi is not who we ar __PUNCT__
we have done everyth right __PUNCT__
we have done everyth we were suppos to do __PUNCT__
thi is not who we ar __PUNCT__
ami is right __PUNCT__
thi is not who we ar __PUNCT__
we ar not a countri that reward hard work and persever with bankruptci and foreclosur __PUNCT__
we ar not a countri that allow major challeng to go unsolv and unaddress while our peopl suffer needlessli __PUNCT__
in the richest nation on earth __PUNCT__ it is simpli not right that the skyrocket profit of the drug and insur industri ar paid for by the skyrocket premium that come from the pocket of the american peopl __PUNCT__
thi is not who we ar __PUNCT__
and thi is not who we have to be __PUNCT__
in the past few month __PUNCT__ i heard stori like ami at town hall we held in new hampshir __PUNCT__ and here in iowa __PUNCT__ and all across the countri __PUNCT__
stori from peopl who ar hang on by a thread becaus of the stack of medic bill thei can't pai __PUNCT__
peopl who don't know where els to turn for help __PUNCT__ but who do know that when it come to health care __PUNCT__ we have talk __PUNCT__ tinker __PUNCT__ and let thi crisi fester for decad __PUNCT__
peopl who watch as everi year __PUNCT__ candid offer up detail health care plan with great fanfar and promis __PUNCT__ onli to see them crush under the weight of washington polit and drug and insur industri lobbi onc the campaign is over __PUNCT__
well thi cannot be on of those year __PUNCT__
we have reach a point in thi countri where the rise cost of health care ha put too mani famili and busi on a collis cours with financi ruin and left too mani without coverag at all __PUNCT__ a cours that democrat and republican __PUNCT__ small busi owner and ceo have all come to agre is not sustain or accept ani longer __PUNCT__
we often hear the statist that there ar __NUM__ million uninsur american __PUNCT__
but the biggest reason why thei don't have insur is the same reason why those who do have it ar struggl to pai their medic bill __PUNCT__ it just too expens __PUNCT__
health care premium have risen nearli __NUM__ __PUNCT__ in the past six year __PUNCT__
that four time faster than wage have gone up __PUNCT__
like ami and lane famili __PUNCT__ nearli half of all iowan have said that thei had to cut back on food and heat expens becaus of high health care cost __PUNCT__
__NUM__ million insur american spent more than a quarter of their salari on health care last year __PUNCT__
and over half of all person bankruptci ar now caus by medic bill __PUNCT__
busi aren't fare much better __PUNCT__
over half of all small busi can no longer afford to insur their worker __PUNCT__ and so mani other have respond to rise cost by lai off worker or shut their door for good __PUNCT__
some of the biggest corpor in america __PUNCT__ giant of industri like gm and ford __PUNCT__ ar watch foreign competitor base in countri with univers health care run circl around them __PUNCT__ with a gm car contain seven time as much health care cost as a japanes car __PUNCT__
thi cost crisi is trap us in a viciou cycl __PUNCT__
as premium rise __PUNCT__ more employ drop coverag __PUNCT__ and more american becom uninsur __PUNCT__
everi time those uninsur walk into an emerg room and receiv care that more expens becaus thei have nowher els to turn __PUNCT__ there is a hidden tax for the rest of us as premium go up by an extra __MONEY__ per famili __PUNCT__
and as premium keep rise __PUNCT__ more famili and busi drop their coverag and becom uninsur __PUNCT__
it would be on thing if all thi monei we spend on premium and co __PUNCT__ payment and deduct went directli toward make us healthier and improv the qualiti of our care __PUNCT__
but it doesn't __PUNCT__
on out of everi four dollar we spend on health care is swallow up by administr cost __PUNCT__ on needless paperwork and antiqu record __PUNCT__ keep that belong in the last centuri __PUNCT__
thi failur to updat the wai our doctor and hospit store and share inform also lead to costli error __PUNCT__
each year __PUNCT__ __NUM__ american die due to medic error and we lose __MONEY__ billion becaus of prescript drug error alon __PUNCT__
we also spend far more on treat ill and condit that could been prevent or manag for far less __PUNCT__
our health care system is turn into a diseas care system __PUNCT__ where too mani plan and provid don't offer or encourag check __PUNCT__ up and test and screen that could save thousand of live and billion of dollar down the road __PUNCT__
of cours __PUNCT__ the biggest obstacl in the wai of reform thi skew system of needless wast and spiral cost ar those who profit most from the statu quo __PUNCT__ the drug and insur compani who pocket a grow chunk of the medic bill that peopl like ami and lane ar go bankrupt try to pai __PUNCT__
sinc presid bush took offic __PUNCT__ the singl fastest grow compon of health care spend ha been administr cost and profit for insur compani __PUNCT__
come in a close second is the amount we spend on prescript drug __PUNCT__
in __NUM__ five of the biggest drug and insur compani were among the fifti most profit busi in the nation __PUNCT__
on insur compani ceo receiv a __MONEY__ million salari that same year __PUNCT__ and ha been given stock option worth over __MONEY__ billion __PUNCT__
as an ad perk __PUNCT__ he and hi wife get free privat health care for as long as thei live __PUNCT__
now __PUNCT__ make thi kind of monei cost monei __PUNCT__ which is why the drug and insur industri have also spent more than __MONEY__ billion on lobbi and campaign contribut over the last ten year to block the kind of reform we need __PUNCT__
thei been pretti good at it too __PUNCT__ prevent the sale of cheaper prescript drug and defeat attempt to make it harder for insur compani to deni coverag on the basi of a preexist condit __PUNCT__
look __PUNCT__ it perfectli understand for a busi to try and make a profit __PUNCT__ and everi american ha the right to make their case to the peopl who repres us in washington __PUNCT__
but i also believ that everi american ha the right to afford health care __PUNCT__
i believ that the million of american who can't take their children to a doctor when thei get sick have that right __PUNCT__
i believ that peopl like ami and lane who ar on the brink of lose everyth thei own have that right __PUNCT__
and i believ that no amount of industri profit and lobbi should stand in the wai of that right ani longer __PUNCT__
that not who we ar __PUNCT__
we now face an opportun __PUNCT__ and an oblig __PUNCT__ to turn the page on the fail polit of yesterdai health care debat __PUNCT__
it time to bring togeth busi __PUNCT__ the medic commun __PUNCT__ and member of both parti around a comprehens solut to thi crisi __PUNCT__ and it time to let the drug and insur industri know that while thei get a seat at the tabl __PUNCT__ thei don't get to bui everi chair __PUNCT__
we can do thi __PUNCT__
the climat is far differ than it wa the last time we tri thi in the earli nineti __PUNCT__
sinc then __PUNCT__ rise cost have caus mani more busi to back reform __PUNCT__ and in state from massachusett to california __PUNCT__ democrat and republican governor and legislatur have been wai ahead of washington in pass increasingli bolder initi to cover the uninsur and cut cost __PUNCT__
we had some success in illinoi as well __PUNCT__
as a state senat __PUNCT__ i brought republican and democrat togeth to pass legisl insur __NUM__ more children and __NUM__ more parent __PUNCT__
i author and pass a bill crack down on hospit price goug of uninsur patient __PUNCT__ and help expand coverag for routin mammogram for women on medicaid __PUNCT__
we creat hospit report card __PUNCT__ so that everi consum could see thing like the ratio of nurs to patient __PUNCT__ the number of annual medic error __PUNCT__ and the qualiti of care thei could expect at each hospit __PUNCT__
and i pass a law that put illinoi on a path to univers coverag __PUNCT__
it a goal i believ we can achiev on a nation level with the health care plan i outlin todai __PUNCT__
the veri first promis i made on thi campaign wa that as presid __PUNCT__ i will sign a univers health care plan into law by the end of my first term in offic __PUNCT__
todai i want to lai out the detail of that plan __PUNCT__ a plan that not onli guarante coverag for everi american __PUNCT__ but also bring down the cost of health care and reduc everi famili premium by as much as __MONEY__
thi second part is import becaus __PUNCT__ in the end __PUNCT__ coverag without cost contain will onli shift our burden __PUNCT__ not reliev them __PUNCT__
so we will take step to remov the wast and ineffici from the system so we can bring down cost and improv the qualiti of our care while we at it __PUNCT__
my plan begin by cover everi american __PUNCT__
if you alreadi have health insur __PUNCT__ the onli thing that will chang for you under thi plan is the amount of monei you will spend on premium __PUNCT__
that will be less __PUNCT__
if you ar on of the __NUM__ million american who don't have health insur __PUNCT__ you will have it after thi plan becom law __PUNCT__
no on will be turn awai becaus of a preexist condit or ill __PUNCT__
everyon will be abl bui into a new health insur plan that similar to the on that everi feder employe __PUNCT__ from a postal worker in iowa to a congressman in washington __PUNCT__ current ha for themselv __PUNCT__
it will cover all essenti medic servic __PUNCT__ includ prevent __PUNCT__ matern __PUNCT__ diseas manag __PUNCT__ and mental health care __PUNCT__
and it will also includ high standard for qualiti and effici __PUNCT__
if you cannot afford thi insur __PUNCT__ you will receiv a subsidi to pai for it __PUNCT__
if you have children __PUNCT__ thei will be cover __PUNCT__
if you chang job __PUNCT__ your insur will go with you __PUNCT__
if you need to see a doctor __PUNCT__ you will not have to wait in long line for on __PUNCT__
if you want more choic __PUNCT__ you will also have the option of purchas a number of afford privat plan that have similar benefit and standard for qualiti and effici __PUNCT__
to help pai for thi __PUNCT__ we will ask all but the smallest busi who don't make a meaning contribut todai to the health coverag of their employe to do so by support thi new plan __PUNCT__
and we will allow the temporari bush tax cut for the wealthiest american to expir __PUNCT__
but we also have to demand greater effici from our health care system __PUNCT__
todai __PUNCT__ we pai almost twice as much for health care per person than other industri nation __PUNCT__ and too much of it ha noth to do with patient care __PUNCT__
that why the second part of my health care plan includ five __PUNCT__ long __PUNCT__ overdu step we will take to bring down cost and bring our health care system into the __NUM__ centuri __PUNCT__ step that will save each american famili up to __MONEY__ on their premium __PUNCT__
first __PUNCT__ we will reduc cost for busi and their worker by pick up the tab for some of the most expens ill and condit __PUNCT__
right now __PUNCT__ two out of everi ten patient account for more than eighti percent of all health care cost __PUNCT__
these ar patient with seriou ill like cancer or heart diseas who requir the most expens surgeri and treatment __PUNCT__
insur compani end up spend a lion share of their expens on these patient __PUNCT__ and not surprisingli __PUNCT__ thei pass those expens on to the rest of us in the form of higher premium __PUNCT__
under my propos __PUNCT__ the feder govern will pai for part of these catastroph case __PUNCT__ which mean that your premium will go down __PUNCT__
second __PUNCT__ we will final begin focus our health care system on prevent costli __PUNCT__ debilit condit in the first place __PUNCT__
we all know the sai that an ounc of prevent is worth a pound of cure __PUNCT__
but todai we nowher close to that ounc __PUNCT__
we spend less than four cent of everi health care dollar on prevent and public health even though eighti percent of the risk factor involv in the lead caus of death ar behavior __PUNCT__ relat and thu prevent __PUNCT__
the problem is __PUNCT__ there current no financi incent for health care provid to offer servic that will encourag patient to eat right or exercis or go for annual check __PUNCT__ up and screen that can help detect diseas earli __PUNCT__
the real profit todai is made in treat diseas __PUNCT__ not prevent them __PUNCT__
that wrong __PUNCT__ which is why in our new nation health care plan and other particip plan __PUNCT__ we will requir coverag of evid __PUNCT__ base __PUNCT__ prevent care servic __PUNCT__ and make sure thei ar paid for __PUNCT__
but in the end __PUNCT__ prevent onli work if we take respons for our own health and make the right decis in our own live __PUNCT__ if we eat the right food __PUNCT__ and stai activ __PUNCT__ and listen to our wive when thei tell us to stop smoke __PUNCT__
third __PUNCT__ we will reduc the cost of our health care by improv the qualiti of our health care __PUNCT__
it estim that poor qualiti care current cost us up to __MONEY__ billion a year __PUNCT__
on studi found that in pennsylvania __PUNCT__ medicar spent __MONEY__ billion a year just on treat infect that patient contract while at the hospit __PUNCT__ infect that could have easili been prevent by hospit __PUNCT__
thi studi led hospit across the state to take action __PUNCT__ and todai some have complet elimin infect that us to take hundr of live and cost hundr of thousand of dollar everi year __PUNCT__
much like the hospit report card we pass in illinoi __PUNCT__ my health care propos will ask hospit and provid to collect __PUNCT__ track __PUNCT__ and publicli report measur of health care qualiti __PUNCT__
we provid the public with inform about prevent medic error __PUNCT__ nurs __PUNCT__ to __PUNCT__ patient ratio __PUNCT__ and hospit __PUNCT__ acquir infect __PUNCT__
we also start measur what effect and what not when it come to differ drug and procedur __PUNCT__ so that patient can final start make inform choic about the care that best for them __PUNCT__
and instead of reward provid and physician onli by the sheer quantiti of servic and procedur thei prescrib __PUNCT__ we start reward them for the qualiti of the outcom for their patient __PUNCT__
fourth __PUNCT__ we will reduc wast and ineffici by move from a __NUM__ centuri health care industri base on pen and paper to a __NUM__ centuri industri base on the latest inform technolog __PUNCT__
almost everi other industri in the world ha save billion on administr cost by computer all of their record and inform __PUNCT__
everi transact you make at a bank now cost less than a dollar __PUNCT__
even at the veteran administr __PUNCT__ where it us to cost nine dollar to pull up your medic record __PUNCT__ new technolog mean you can call up the same record on the internet for next to noth __PUNCT__
but becaus we haven't updat technolog in the rest of the health care industri __PUNCT__ a singl transact still cost up to twenti __PUNCT__ five dollar __PUNCT__
thi reform is long overdu __PUNCT__
by move to electron medic record __PUNCT__ we can give doctor and nurs easi access to all the necessari inform about their patient __PUNCT__ so if thei type __PUNCT__ in a certain prescript __PUNCT__ a patient allergi will pop right up on the screen __PUNCT__
thi will reduc deadli medic error __PUNCT__ and it will also shorten the length of hospit stai __PUNCT__ ensur that nurs can spend less time on paperwork and more time with patient __PUNCT__ and save billion and billion of dollar in the process __PUNCT__
final __PUNCT__ we will break the stranglehold that a few big drug and insur compani have on the health care market __PUNCT__
we all valu the medic cure and innov that the pharmaceut industri ha develop over the year __PUNCT__ but it becom clear that some of these compani ar dramat overcharg american for what thei offer __PUNCT__
thei sell the same exact drug here in america for doubl the price of what thei charg in europ and canada __PUNCT__
thei push expens product on doctor by shower them with gift __PUNCT__ spend more to market and advertis their drug than to research and develop them __PUNCT__ and when a gener drug maker come along and want to sell the same product for cheaper __PUNCT__ the brand __PUNCT__ name manufactur will actual payoff the gener on so thei can preserv their monopoli and keep charg the rest of us high price __PUNCT__
we don't have to stand for that anymor __PUNCT__
under my plan __PUNCT__ we will make gener drug more avail to consum and we will tell the drug compani that their dai of forc afford prescript drug out of the market ar over __PUNCT__
and it not just the drug industri that manipul the market __PUNCT__
in the last ten year __PUNCT__ there have been over four hundr health insur merger __PUNCT__
right here in iowa __PUNCT__ just three compani control more than three __PUNCT__ quarter of the health insur market __PUNCT__
these chang were suppos to increas effici in the industri __PUNCT__
but what realli increas is the amount of monei we pai them __PUNCT__
thi is wrong __PUNCT__ and when i presid __PUNCT__ we go to make drug and insur compani compet for their custom just like everi other busi in america __PUNCT__
we investig and prosecut the monopol of the insur industri __PUNCT__
and where we do find place where insur compani aren't competit __PUNCT__ we will make them pai a reason share of their profit on the patient thei should be care for in the first place __PUNCT__
becaus that what right __PUNCT__
we ar a countri that look at the thousand of stori just like ami and lane __PUNCT__ stori we have heard and told for decad __PUNCT__ and realiz that our american stori call on us to write them a hope __PUNCT__ happier end __PUNCT__
after all __PUNCT__ that what we done befor __PUNCT__
half a centuri ago __PUNCT__ america found itself in the midst of anoth health care crisi __PUNCT__
for million of elderli american __PUNCT__ the singl greatest caus of poverti and hardship wa the crippl cost of their health care __PUNCT__
a third of all elderli american live in poverti __PUNCT__ and nearli half had no health insur __PUNCT__
as health care and hospit cost continu to rise __PUNCT__ more and more privat insur simpli refus to insur our elderli __PUNCT__ believ thei were too great of a risk to care for __PUNCT__
the resist to action wa fierc __PUNCT__
propon of health care reform were oppos by well __PUNCT__ financ __PUNCT__ well __PUNCT__ connect interest group who spare no expens in tell the american peopl that these effort were __PUNCT__ danger __PUNCT__ and __PUNCT__ un __PUNCT__ american __PUNCT__ revolutionari __PUNCT__ and even __PUNCT__ deadli __PUNCT__
and yet the reform march on __PUNCT__
thei testifi befor congress and thei took their case to the countri and thei introduc dozen of differ propos but alwai __PUNCT__ alwai thei stood firm on their goal to provid afford health care for everi american senior __PUNCT__
and final __PUNCT__ after year of advocaci and negoti and plenti of setback __PUNCT__ presid lyndon johnson sign the medicar bill into law on __DATE__ of __NUM__ __PUNCT__
the sign ceremoni wa held in missouri __PUNCT__ in a town call independ __PUNCT__ with the man who issu the call for univers health care dure hi own presid __PUNCT__ harri truman __PUNCT__
and as he stood with truman by hi side and sign what would becom on of the most success govern program in histori __PUNCT__ a program that had seem imposs for so long __PUNCT__ presid johnson look out at the crowd and said __PUNCT__ histori shape men __PUNCT__ but it is a necessari faith of leadership that men can help shape histori __PUNCT__
never forget that we have it within our power to shape histori in thi countri __PUNCT__
it is not in our charact to sit idli by as victim of fate or circumst __PUNCT__ for we ar a peopl of action and innov __PUNCT__ forev push the boundari of what possibl __PUNCT__
now is the time to push those boundari onc more __PUNCT__
we have come so far in the debat on health care in thi countri __PUNCT__ but now we must final answer the call issu by truman __PUNCT__ advanc by johnson __PUNCT__ and push along by the simpl power of stori like the on told by ami and lane __PUNCT__
the time ha come for afford __PUNCT__ univers health care in america __PUNCT__
and i look forward to work with all of you to meet thi challeng in the week and month to come __PUNCT__
thank you __PUNCT__
