“This is the contradiction of American healthcare: That we have the best hospitals, the most highly-trained doctors, the latest technology—and a system in which millions find it impossible to go in for a regular checkup. A system that bankrupts families every day. A system that costs twice as much as any other in the developed world—and, for too many of us, doesn’t result in better health outcomes. Here, in the only developed nation without universal health coverage, we have a system in which millions receive world-class coverage, and millions receive practically nothing.

 

“Our challenge in the months to come is changing the second half of the equation, while leaving the first in place: preserving outstanding quality, but delivering it to millions more Americans at a lower cost. I know how difficult it sounds when stated as baldly as that, but I believe that it is eminently doable—and it must be done.

 

“Frankly, it’s not going to take much persuading to convince Americans about the need for reform—because they’re there already. And while the crisis in our economy is, rightfully, taking the bulk of public attention, that doesn’t mean that the healthcare issue is going away. Today, a majority of Americans see the cost of healthcare as their Number One personal economic concern, a perception that only gets stronger as the economic news gets worse. In fact, more than seven in ten Americans remain committed to creating a system of universal, affordable care.

 

“Americans are so passionate about healthcare reform because, for millions of us, it’s something more than an abstract issue. Millions of Americans see the effects of our failing system every day, in their own lives. There are far too many uninsured people—at least 45 million of them, and more every day—for Americans to pretend that the flaws of our healthcare harm someone else, someone invisible or far away. The uninsured are just like the rest of us; they are our friends and relatives and neighbors.

 

“And even if we are fortunate enough to have health insurance ourselves, its cost is still eating deeper and deeper into our family budgets. During the eight years of the Bush Administration, insurance premiums tripled—while wages stayed almost stagnant and the average family’s purchasing power actually declined. One big reason is that those of us with insurance are subsidizing those of us without it. Every year, uninsured Americans receive $56 billion of uncompensated care. And that care costs much more per patient, because the uninsured so often have to skip the preventive care that can nip sickness in the bud. Day after day, children are ending up in the ER because their mothers can’t afford a checkup. And if you have health insurance, your premiums are helping to cover the ER bill.

 

“We hear all the time about the 45 million uninsured—but we need to hear more about the 72 million non-elderly Americans who are deep in medical debt. Their struggles are linked. Like it or not, every one of us is linked to the healthcare crisis: Think of the small businesses struggling to keep their doors open in this recession, dropping health coverage to stay afloat. Think of the $1,500 the Big Three automakers add to the cost of every car that rolls off of their factory floors, just to pay for their workers’ health insurance and legacy costs. Think of the more than $200 billion in productivity our economy lost last year because the uninsured live sicker and die sooner. Healthcare reform is going to happen because more and more Americans are waking up to the fact that this is everyone’s problem.

 

“That’s why I am committed to helping bring comprehensive reform to the floor of the 111th Congress. So what is reform going to look like? The answer to that question is still taking shape; but as House Majority Leader, I promise that I will help Members with a wide variety of proposals to sort out their differences and settle on a common course. There are some major questions that remain to be answered—questions about mandates, changes to the tax code, and insurance reform. But whatever issues arise, the process must take in ideas from both sides of the aisle, and must occur in the open. As history has demonstrated, there’s no surer way to lose public support than working through this process in the dark.

 

“When it comes time to negotiate on reform, I will insist on two further things. First, economic conditions do not mean that we can’t be bold—in fact, they make our work more urgent. Jacob S. Hacker of Yale University argues that healthcare reform can be a robust antidote to the recession: Expanded access could be ‘an immediate economic lifeline for working families.’ So I will argue vigorously against those who would use the economy as an excuse to put this off.

 

“Second, I will insist that, even as we respond to an immediate crisis, we build a wise foundation for the future. We can’t afford to ignore entitlement reform. And we can no longer think of entitlement reform and health reform as two separate issues.

 

“We will never be able to cut the cost of Medicare and Medicaid as long as they are the first consistent source of insurance for tens of millions of Americans—as long as they are serving patients who have rarely seen a doctor before.

 

“We can’t afford to ignore the issue of long-term care, especially as the 77 million baby boomers retire and begin to flood our nursing homes. With that in mind, the federal government needs to think long and hard about the role it might have to play in the delivery of long-term care.

 

“And we can’t afford to ignore the investments that will bring down the cost of healthcare in the long run. Advanced health information technology will let doctors store and access patient records at any hospital in America—and that will help hospitals save money and lives. Funding long-term research on health outcomes can help doctors ground their treatment choices in the best empirical data and take much of the guesswork out of medicine. I think we’ve taken an important start by including both of those investments in the economic recovery plan.

 

“As Majority Leader, I will work to ensure that all of these issues get their fair hearing. Trying to reform healthcare without controlling costs and paying attention to fiscal responsibility would be like slapping a band-aid on a patient that demands major surgery. I will do everything I can to prevent that from happening.

 

“Hard experience shows us that we only have a once-in-a-decade chance, if that, to get this right. And if we fail, if we have to revisit this issue in ten or 15 more years, I don’t even want to think about how bleak the picture will be then.

 

“But we won’t fail. We have the support of the public, we have bold ideas in Congress, and we have a new President who has made healthcare reform a central plank in his platform for change. Barack Obama made that absolutely clear when he was running for President: ‘I’m tired of talking about the outrage of 47 million people without health insurance. I want to start doing something about it. I know what it’s like to see a loved one suffer not just because they’re sick, but because of a broken healthcare system.’

 

“So many Americans share stories like that. But with their support, with your help and hard work, we, together, are going to make those stories a thing of the past. We are going to get this right. We are going to build the healthcare system that America deserves.”