Barack Obama

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 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 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 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 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__ __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__