And mourn the end of an era.

This is information that came out in an email from the The White House regarding the myths circulating about health care reform. I'll let them speak for themselves.

Dear Friend,

This is probably one of the longest emails I’ve ever sent, but it could be the most important.

Across the country we are seeing vigorous debate about health insurance reform. Unfortunately, some of the old tactics we know so well are back — even the viral emails that fly unchecked and under the radar, spreading all sorts of lies and distortions.

As President Obama said at the town hall in New Hampshire, “where we do disagree, let's disagree over things that are real, not these wild misrepresentations that bear no resemblance to anything that's actually been proposed.”

So let’s start a chain email of our own. At the end of my email, you’ll find a lot of information about health insurance reform, distilled into 8 ways reform provides security and stability to those with or without coverage, 8 common myths about reform and 8 reasons we need health insurance reform now.

Right now, someone you know probably has a question about reform that could be answered by what’s below. So what are you waiting for? Forward this email.

Thanks,
David

David Axelrod
Senior Adviser to the President

P.S. We launched www.WhiteHouse.gov/realitycheck this week to knock down the rumors and lies that are floating around the internet. You can find the information below, and much more, there. For example, we've just added a video of Nancy-Ann DeParle from our Health Reform Office tackling a viral email head on. Check it out:

Health Insurance Reform Reality Check

8 ways reform provides security and stability to those with or without coverage

1. Ends Discrimination for Pre-Existing Conditions: Insurance companies will be prohibited from refusing you coverage because of your medical history.

2. Ends Exorbitant Out-of-Pocket Expenses, Deductibles or Co-Pays: Insurance companies will have to abide by yearly caps on how much they can charge for out-of-pocket expenses.

3. Ends Cost-Sharing for Preventive Care: Insurance companies must fully cover, without charge, regular checkups and tests that help you prevent illness, such as mammograms or eye and foot exams for diabetics.

4. Ends Dropping of Coverage for Seriously Ill: Insurance companies will be prohibited from dropping or watering down insurance coverage for those who become seriously ill.

5. Ends Gender Discrimination: Insurance companies will be prohibited from charging you more because of your gender.

6. Ends Annual or Lifetime Caps on Coverage: Insurance companies will be prevented from placing annual or lifetime caps on the coverage you receive.

7. Extends Coverage for Young Adults: Children would continue to be eligible for family coverage through the age of 26.

8. Guarantees Insurance Renewal: Insurance companies will be required to renew any policy as long as the policyholder pays their premium in full. Insurance companies won't be allowed to refuse renewal because someone became sick.

Learn more and get details: http://www.WhiteHouse.gov/health-insurance-consumer-protections/

8 common myths about health insurance reform

1. Reform will stop "rationing" - not increase it: It’s a myth that reform will mean a "government takeover" of health care or lead to "rationing." To the contrary, reform will forbid many forms of rationing that are currently being used by insurance companies.

2. We can’t afford reform: It's the status quo we can't afford. It’s a myth that reform will bust the budget. To the contrary, the President has identified ways to pay for the vast majority of the up-front costs by cutting waste, fraud, and abuse within existing government health programs; ending big subsidies to insurance companies; and increasing efficiency with such steps as coordinating care and streamlining paperwork. In the long term, reform can help bring down costs that will otherwise lead to a fiscal crisis.

3. Reform would encourage "euthanasia": It does not. It’s a malicious myth that reform would encourage or even require euthanasia for seniors. For seniors who want to consult with their family and physicians about end-of life decisions, reform will help to cover these voluntary, private consultations for those who want help with these personal and difficult family decisions.

4. Vets' health care is safe and sound: It’s a myth that health insurance reform will affect veterans' access to the care they get now. To the contrary, the President's budget significantly expands coverage under the VA, extending care to 500,000 more veterans who were previously excluded. The VA Healthcare system will continue to be available for all eligible veterans.

5. Reform will benefit small business - not burden it: It’s a myth that health insurance reform will hurt small businesses. To the contrary, reform will ease the burdens on small businesses, provide tax credits to help them pay for employee coverage and help level the playing field with big firms who pay much less to cover their employees on average.

6. Your Medicare is safe, and stronger with reform: It’s myth that Health Insurance Reform would be financed by cutting Medicare benefits. To the contrary, reform will improve the long-term financial health of Medicare, ensure better coordination, eliminate waste and unnecessary subsidies to insurance companies, and help to close the Medicare "doughnut" hole to make prescription drugs more affordable for seniors.

7. You can keep your own insurance: It’s myth that reform will force you out of your current insurance plan or force you to change doctors. To the contrary, reform will expand your choices, not eliminate them.

8. No, government will not do anything with your bank account: It is an absurd myth that government will be in charge of your bank accounts. Health insurance reform will simplify administration, making it easier and more convenient for you to pay bills in a method that you choose. Just like paying a phone bill or a utility bill, you can pay by traditional check, or by a direct electronic payment. And forms will be standardized so they will be easier to understand. The choice is up to you – and the same rules of privacy will apply as they do for all other electronic payments that people make.

Learn more and get details:
http://www.WhiteHouse.gov/realitycheck
http://www.WhiteHouse.gov/realitycheck/faq

8 Reasons We Need Health Insurance Reform Now

1. Coverage Denied to Millions: A recent national survey estimated that 12.6 million non-elderly adults – 36 percent of those who tried to purchase health insurance directly from an insurance company in the individual insurance market – were in fact discriminated against because of a pre-existing condition in the previous three years or dropped from coverage when they became seriously ill.
Learn more:http://www.healthreform.gov/reports/denied_coverage/index.html

2. Less Care for More Costs: With each passing year, Americans are paying more for health care coverage. Employer-sponsored health insurance premiums have nearly doubled since 2000, a rate three times faster than wages. In 2008, the average premium for a family plan purchased through an employer was $12,680, nearly the annual earnings of a full-time minimum wage job. Americans pay more than ever for health insurance, but get less coverage.
Learn more: http://www.healthreform.gov/reports/hiddencosts/index.html

3. Roadblocks to Care for Women: Women’s reproductive health requires more regular contact with health care providers, including yearly pap smears, mammograms, and obstetric care. Women are also more likely to report fair or poor health than men (9.5% versus 9.0%). While rates of chronic conditions such as diabetes and high blood pressure are similar to men, women are twice as likely to suffer from headaches and are more likely to experience joint, back or neck pain. These chronic conditions often require regular and frequent treatment and follow-up care.
Learn more:http://www.healthreform.gov/reports/women/index.html

4. Hard Times in the Heartland: Throughout rural America, there are nearly 50 million people who face challenges in accessing health care. The past several decades have consistently shown higher rates of poverty, mortality, uninsurance, and limited access to a primary health care provider in rural areas. With the recent economic downturn, there is potential for an increase in many of the health disparities and access concerns that are already elevated in rural communities.
Learn more: http://www.healthreform.gov/reports/hardtimes

5. Small Businesses Struggle to Provide Health Coverage: Nearly one-third of the uninsured – 13 million people – are employees of firms with less than 100 workers. From 2000 to 2007, the proportion of non-elderly Americans covered by employer-based health insurance fell from 66% to 61%. Much of this decline stems from small business. The percentage of small businesses offering coverage dropped from 68% to 59%, while large firms held stable at 99%. About a third of such workers in firms with fewer than 50 employees obtain insurance through a spouse.
Learn more:http://www.healthreform.gov/reports/helpbottomline

6. The Tragedies are Personal: Half of all personal bankruptcies are at least partly the result of medical expenses. The typical elderly couple may have to save nearly $300,000 to pay for health costs not covered by Medicare alone.
Learn more:http://www.healthreform.gov/reports/inaction

7. Diminishing Access to Care: From 2000 to 2007, the proportion of non-elderly Americans covered by employer-based health insurance fell from 66% to 61%. An estimated 87 million people - one in every three Americans under the age of 65 - were uninsured at some point in 2007 and 2008. More than 80% of the uninsured are in working families.
Learn more:http://www.healthreform.gov/reports/inaction/diminishing/index.html

8. The Trends are Troubling: Without reform, health care costs will continue to skyrocket unabated, putting unbearable strain on families, businesses, and state and federal government budgets. Perhaps the most visible sign of the need for health care reform is the 46 million Americans currently without health insurance - projections suggest that this number will rise to about 72 million in 2040 in the absence of reform.
Learn more:http://www.WhiteHouse.gov/assets/documents/CEA_Health_Care_Report.pdf

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Contact the White House

The White House • 1600 Pennsylvania Ave NW • Washington, DC 20500 • 202-456-1111

Don't miss it!

PRESS RELEASE: Tuesday, June 30, 2009
CONTACT: Joshua Welter, Washington CAN!, 206-383-1857

Health Care Advocates to Cantwell:

“Choice of Public Health Insurance Plan is a Bottom Line for Real Health Care Reform”

Private Health Co-Ops are not a Substitute for a Strong Public Option

SEATTLE—While Senator Cantwell hosts panel discussions in Seattle and Vancouver on national health care reform this week, the Health Care for America Now campaign is urging her to commit to the choice of a public health insurance plan as a “bottom line” for successful reform.

A popular cornerstone of President Obama’s health care plan would allow businesses and families the choice of keeping the insurance that they have or buying into a quality public health insurance plan. Supporters say a public option would compete with private insurers to lower costs and keep the insurance industry honest.

Senator Cantwell has come under fire for promoting an alternative proposal in the US Senate to replace a public option with small regional private insurance cooperatives that critics say would lack the national bargaining power or public accountability to be successful.

“Private co-ops are not a substitute for a strong public option that can compete to drive down costs, make health care more affordable, and keep the private insurers honest,” said Deana Knutsen, board chair for the Washington CAN!, the state’s largest grassroots community organization.

Last week, while nearly 10,000 grassroots Health Care for America Now campaign participants converged on Washington, DC for the biggest health care lobbying effort in the nation’s history, Cantwell offered cautious support for the public option. “I think there can be a bill with a public option that can pass," she told The Columbian.

This week, advocates urged her to strengthen her support. “With only private insurance industry choices, we’re stuck every year paying more and getting less, without any guarantees that we won’t be denied coverage due to a pre-existing condition,” said Knutsen. “The choice of a quality public health insurance plan should be a bottom line for successful reform.”

There is strong support for the choice of a public health insurance plan. A June 20th New York Times/CBS poll showed 72 percent support for the choice a public health insurance plan, including 57 percent of Republicans. The Seattle Times has endorsed a public option.

# # #

Health Care for America Now (HCAN) is a national grassroots campaign of more than 1000 organizations representing more than 33 million people dedicated to winning quality, affordable health care we all can count on in 2009. Health Care for America Now and its principles for reform are supported by President Obama and more than 190 Members of Congress.

Washington Community Action Network (Washington CAN!) is a statewide, grassroots lobbying organization. With over 35,000 members across the state we are the largest community organization in the state. We work on a range of issues with the broad aim of bringing about greater racial and economic justice in our state and the country.

For more information click here to go to the Washington CAN website.

www.washingtoncan.org

Thanks to our Washington citizens who stepped up to make this day one of the largest health care lobby days in history! On the video, you'll see testimony from Susie Taylor, a small business owner from Vancouver who is a member of the WA Small Business for Secure Health Care Coalition (0:15), and Maribel Peralez, a member of Washington CAN! from Lynnwood (0:42).

We just shouldn’t be in this situation: pitting the needs of kids in special education against those of kids in the mainstream.

Yet, this week it was announced that special education programs and those for low-income students in Washington schools will get an huge federal windfall over the next two years even as school administrators and teachers in overseeing general education are forced to severely cut back from the very little they have or be laid off altogether.

Don’t get me wrong. I have a kid in special education and I am thrilled to know that his school will receive part of the $400 million in federal stimulus funds allotted to our state.

But I have two children in the general education population as well and I have to say it feels mighty awkward knowing that the state’s budget crisis has forced her school to cut training and class offerings and lay off several teachers my daughters' love while their brother’s class is bolstered.

All of my kids – like every other child in Washington – deserve full funding. The Legislature’s slashing of $600 million from Initiative 728 funding, approved by the voters in 2000 to hire teachers and reduce class sizes was an unmitigated catastrophe.

The stimulus money, while sorely needed by special education teachers and their students, feels a little like salt rubbed in that wound. While districts get to improve services for some kids, they’ll be forced to hack services for others.

The answer, of course, is NOT to say no to stimulus funds as renegade leaders in Texas, South Carolina and Minnesota have done.

The answer is for Washington State to raise the revenue.needed to fund our schools fully and equitably – a task our lawmakers in 2009 failed at.

Read Andrew Garber’s Seattle Times article on the stimulus conumdrum here.

1. My kids like to play outside.

2. I like to play outside.

3. I have a child with autism and no one can tell me it was not caused by environmental factors or degradation.

4. Several studies tell me it might have been.

5. Our family has lost a child to a mysterious illness that no one can tell me was not caused by environmental factors and degradation.

6. The CDC has told me it might have been.

I have a parade of reasons why I need Congress to pass the strongest legislation possible to stop global warming, clean up the environment, conserve energy and create clean green jobs.

The last four listed here are obviously the hardest. I will never know if fewer chemicals in the air that I and my children breath and less toxins in the environment where we live would have saved a baby's life or spared another from a lifetime of challenge. The evidence is unclear, but it is mounting. It is possible that pollution, plastics, ozone eating gases and chemicals in what I eat and drink caused harm to my kids. According to some studies it is “highly” possible.

Our nation has seen an 80 percent increase in the number of children with autism or similar neurological disorders in the past decade. Asthma rates have skyrocketed. In this same decade the measures of global warming and the level of toxins and pollutants in our environment have continued to go up.

And yet despite mounting evidence of harm to the planet and possible human health impacts caused by pollutants, oil companies, dirty chemical plants and other industries spewing toxic waste have spent 16 times more money than conservation groups lobbying lawmakers just since April to take the teeth out of the American Clean Energy and Security Actthat is a foundational element of President Obama’s agenda for change for America. In fact, Exxon-Mobil alone has spent more than twice as much as the entire conservation community combined in the last three months. As President Obama and his team work to move a future-saving clean energy and green jobs bill through Congress, America’s most prolific polluters are revving their engines and trying to run progress over.

We must stop them.

Thousands of people have signed letters calling for Congress to pass a strong global warming bill. But with just one week left before the floor debate begins, we have to step up the pressure to approve a strong bill. Already the opposition’s well-monied lobby team has pushed to weaken or strike critical elements of the bill. We need Congressmen McDermott, Reichert, Larsen, Baird, Inslee and Smith to put their muscle behind this bill and strengthen it on the House Floor when it comes up for debate in just a few weeks. We need them to know this a strong act is crucial for a million reasons.

NOW is time to give Congress a parade of reasons why it must adopt a strong clean energy and green jobs bill. Please, join me in this effort: write or email your member of Congress today and give them your reasons to pass the act with all its teeth. Speak out today:

Give Your Congressperson Your Parade of Reasons to Pass a Strong Clean Energy Act

This bill is incredibly important. It’s the key to attacking global warming and jumpstarting a green economy. It’s key to our health and the health of our children.

Polluting industries will do anything to water this legislation down or keep it from winning congressional approval. Why? Because, they don’t want to change their ways. And they don’t care if padding their pockets costs a life.

Transcript of June 11 speech by President Obama to American Medical Association:

From the moment I took office as President, the central challenge we have confronted as a nation has been the need to lift ourselves out of the worst recession since World War II. In recent months, we have taken a series of extraordinary steps, not just to repair the immediate damage to our economy, but to build a new foundation for lasting and sustained growth. We are creating new jobs. We are unfreezing our credit markets. And we are stemming the loss of homes and the decline of home values.

But even as we have made progress, we know that the road to prosperity remains long and difficult. We also know that one essential step on our journey is to control the spiraling cost of health care in America.

Today, we are spending over $2 trillion a year on health care - almost 50 percent more per person than the next most costly nation. And yet, for all this spending, more of our citizens are uninsured; the quality of our care is often lower; and we aren't any healthier. In fact, citizens in some countries that spend less than we do are actually living longer than we do.

Make no mistake: the cost of our health care is a threat to our economy. It is an escalating burden on our families and businesses. It is a ticking time-bomb for the federal budget. And it is unsustainable for the United States of America.

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It is unsustainable for Americans like Laura Klitzka, a young mother I met in Wisconsin last week, who has learned that the breast cancer she thought she'd beaten had spread to her bones; who is now being forced to spend time worrying about how to cover the $50,000 in medical debts she has already accumulated, when all she wants to do is spend time with her two children and focus on getting well. These are not worries a woman like Laura should have to face in a nation as wealthy as ours.

Stories like Laura's are being told by women and men all across this country - by families who have seen out-of-pocket costs soar, and premiums double over the last decade at a rate three times faster than wages. This is forcing Americans of all ages to go without the checkups or prescriptions they need. It's creating a situation where a single illness can wipe out a lifetime of savings.

Our costly health care system is unsustainable for doctors like Michael Kahn in New Hampshire, who, as he puts it, spends 20 percent of each day supervising a staff explaining insurance problems to patients, completing authorization forms, and writing appeal letters; a routine that he calls disruptive and distracting, giving him less time to do what he became a doctor to do and actually care for his patients.

Small business owners like Chris and Becky Link in Nashville are also struggling. They've always wanted to do right by the workers at their family-run marketing firm, but have recently had to do the unthinkable and lay off a number of employees - layoffs that could have been deferred, they say, if health care costs weren't so high. Across the country, over one third of small businesses have reduced benefits in recent years and one third have dropped their workers' coverage altogether since the early 90's.

Our largest companies are suffering as well. A big part of what led General Motors and Chrysler into trouble in recent decades were the huge costs they racked up providing health care for their workers; costs that made them less profitable, and less competitive with automakers around the world. If we do not fix our health care system, America may go the way of GM; paying more, getting less, and going broke.

When it comes to the cost of our health care, then, the status quo is unsustainable. Reform is not a luxury, but a necessity. I know there has been much discussion about what reform would cost, and rightly so. This is a test of whether we - Democrats and Republicans alike - are serious about holding the line on new spending and restoring fiscal discipline.

But let there be no doubt - the cost of inaction is greater. If we fail to act, premiums will climb higher, benefits will erode further, and the rolls of uninsured will swell to include millions more Americans.

If we fail to act, one out of every five dollars we earn will be spent on health care within a decade. In thirty years, it will be about one out of every three - a trend that will mean lost jobs, lower take-home pay, shuttered businesses, and a lower standard of living for all Americans.

And if we fail to act, federal spending on Medicaid and Medicare will grow over the coming decades by an amount almost equal to the amount our government currently spends on our nation's defense. In fact, it will eventually grow larger than what our government spends on anything else today. It's a scenario that will swamp our federal and state budgets, and impose a vicious choice of either unprecedented tax hikes, overwhelming deficits, or drastic cuts in our federal and state budgets.

To say it as plainly as I can, health care reform is the single most important thing we can do for America's long-term fiscal health. That is a fact.

And yet, as clear as it is that our system badly needs reform, reform is not inevitable. There's a sense out there among some that, as bad as our current system may be, the devil we know is better than the devil we don't. There is a fear of change - a worry that we may lose what works about our health care system while trying to fix what doesn't.

I understand that fear. I understand that cynicism. They are scars left over from past efforts at reform. Presidents have called for health care reform for nearly a century. Teddy Roosevelt called for it. Harry Truman called for it. Richard Nixon called for it. Jimmy Carter called for it. Bill Clinton called for it. But while significant individual reforms have been made - such as Medicare, Medicaid, and the children's health insurance program - efforts at comprehensive reform that covers everyone and brings down costs have largely failed.

Part of the reason is because the different groups involved - physicians, insurance companies, businesses, workers, and others - simply couldn't agree on the need for reform or what shape it would take. And another part of the reason has been the fierce opposition fueled by some interest groups and lobbyists - opposition that has used fear tactics to paint any effort to achieve reform as an attempt to socialize medicine.

Despite this long history of failure, I am standing here today because I think we are in a different time. One sign that things are different is that just this past week, the Senate passed a bill that will protect children from the dangers of smoking - a reform the AMA has long championed - and one that went nowhere when it was proposed a decade ago. What makes this moment different is that this time - for the first time - key stakeholders are aligning not against, but in favor of reform. They are coming together out of a recognition that while reform will take everyone in our health care community doing their part, ultimately, everyone will benefit.

And I want to commend the AMA, in particular, for offering to do your part to curb costs and achieve reform. A few weeks ago, you joined together with hospitals, labor unions, insurers, medical device manufacturers and drug companies to do something that would've been unthinkable just a few years ago - you promised to work together to cut national health care spending by two trillion dollars over the next decade, relative to what it would otherwise have been. That will bring down costs, that will bring down premiums, and that's exactly the kind of cooperation we need.

The question now is, how do we finish the job? How do we permanently bring down costs and make quality, affordable health care available to every American?

That's what I've come to talk about today. We know the moment is right for health care reform. We know this is an historic opportunity we've never seen before and may not see again. But we also know that there are those who will try and scuttle this opportunity no matter what - who will use the same scare tactics and fear-mongering that's worked in the past. They'll give dire warnings about socialized medicine and government takeovers; long lines and rationed care; decisions made by bureaucrats and not doctors. We've heard it all before - and because these fear tactics have worked, things have kept getting worse.

So let me begin by saying this: I know that there are millions of Americans who are content with their health care coverage - they like their plan and they value their relationship with their doctor. And that means that no matter how we reform health care, we will keep this promise: If you like your doctor, you will be able to keep your doctor. Period. If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away. No matter what. My view is that health care reform should be guided by a simple principle: fix what's broken and build on what works.

If we do that, we can build a health care system that allows you to be physicians instead of administrators and accountants; a system that gives Americans the best care at the lowest cost; a system that eases up the pressure on businesses and unleashes the promise of our economy, creating hundreds of thousands of jobs, making take-home wages thousands of dollars higher, and growing our economy by tens of billions more every year. That's how we will stop spending tax dollars to prop up an unsustainable system, and start investing those dollars in innovations and advances that will make our health care system and our economy stronger.

That's what we can do with this opportunity. That's what we must do with this moment.

Now, the good news is that in some instances, there is already widespread agreement on the steps necessary to make our health care system work better.

First, we need to upgrade our medical records by switching from a paper to an electronic system of record keeping. And we have already begun to do this with an investment we made as part of our Recovery Act.

It simply doesn't make sense that patients in the 21st century are still filling out forms with pens on papers that have to be stored away somewhere. As Newt Gingrich has rightly pointed out, we do a better job tracking a FedEx package in this country than we do tracking a patient's health records. You shouldn't have to tell every new doctor you see about your medical history, or what prescriptions you're taking. You should not have to repeat costly tests. All of that information should be stored securely in a private medical record so that your information can be tracked from one doctor to another - even if you change jobs, even if you move, and even if you have to see a number of different specialists.

That will not only mean less paper pushing and lower administrative costs, saving taxpayers billions of dollars. It will also make it easier for physicians to do their jobs. It will tell you, the doctors, what drugs a patient is taking so you can avoid prescribing a medication that could cause a harmful interaction. It will help prevent the wrong dosages from going to a patient. And it will reduce medical errors that lead to 100,000 lives lost unnecessarily in our hospitals every year.

The second step that we can all agree on is to invest more in preventive care so that we can avoid illness and disease in the first place. That starts with each of us taking more responsibility for our health and the health of our children. It means quitting smoking, going in for that mammogram or colon cancer screening. It means going for a run or hitting the gym, and raising our children to step away from the video games and spend more time playing outside.

It also means cutting down on all the junk food that is fueling an epidemic of obesity, putting far too many Americans, young and old, at greater risk of costly, chronic conditions. That's a lesson Michelle and I have tried to instill in our daughters with the White House vegetable garden that Michelle planted. And that's a lesson that we should work with local school districts to incorporate into their school lunch programs.

Building a health care system that promotes prevention rather than just managing diseases will require all of us to do our part. It will take doctors telling us what risk factors we should avoid and what preventive measures we should pursue. And it will take employers following the example of places like Safeway that is rewarding workers for taking better care of their health while reducing health care costs in the process. If you're one of the three quarters of Safeway workers enrolled in their "Healthy Measures" program, you can get screened for problems like high cholesterol or high blood pressure. And if you score well, you can pay lower premiums. It's a program that has helped Safeway cut health care spending by 13 percent and workers save over 20 percent on their premiums. And we are open to doing more to help employers adopt and expand programs like this one.

Our federal government also has to step up its efforts to advance the cause of healthy living. Five of the costliest illnesses and conditions - cancer, cardiovascular disease, diabetes, lung disease, and strokes - can be prevented. And yet only a fraction of every health care dollar goes to prevention or public health. That is starting to change with an investment we are making in prevention and wellness programs that can help us avoid diseases that harm our health and the health of our economy.

But as important as they are, investments in electronic records and preventive care are just preliminary steps. They will only make a dent in the epidemic of rising costs in this country.

Despite what some have suggested, the reason we have these costs is not simply because we have an aging population. Demographics do account for part of rising costs because older, sicker societies pay more on health care than younger, healthier ones. But what accounts for the bulk of our costs is the nature of our health care system itself - a system where we spend vast amounts of money on things that aren't making our people any healthier; a system that automatically equates more expensive care with better care.

A recent article in the New Yorker, for example, showed how McAllen, Texas is spending twice as much as El Paso County - not because people in McAllen are sicker and not because they are getting better care. They are simply using more treatments - treatments they don't really need; treatments that, in some cases, can actually do people harm by raising the risk of infection or medical error. And the problem is, this pattern is repeating itself across America. One Dartmouth study showed that you're no less likely to die from a heart attack and other ailments in a higher spending area than in a lower spending one.

There are two main reasons for this. The first is a system of incentives where the more tests and services are provided, the more money we pay. And a lot of people in this room know what I'm talking about. It is a model that rewards the quantity of care rather than the quality of care; that pushes you, the doctor, to see more and more patients even if you can't spend much time with each; and gives you every incentive to order that extra MRI or EKG, even if it's not truly necessary. It is a model that has taken the pursuit of medicine from a profession - a calling - to a business.

That is not why you became doctors. That is not why you put in all those hours in the Anatomy Suite or the O.R. That is not what brings you back to a patient's bedside to check in or makes you call a loved one to say it'll be fine. You did not enter this profession to be bean-counters and paper-pushers. You entered this profession to be healers - and that's what our health care system should let you be.

That starts with reforming the way we compensate our doctors and hospitals. We need to bundle payments so you aren't paid for every single treatment you offer a patient with a chronic condition like diabetes, but instead are paid for how you treat the overall disease. We need to create incentives for physicians to team up - because we know that when that happens, it results in a healthier patient. We need to give doctors bonuses for good health outcomes - so that we are not promoting just more treatment, but better care.

And we need to rethink the cost of a medical education, and do more to reward medical students who choose a career as a primary care physicians and who choose to work in underserved areas instead of a more lucrative path. That's why we are making a substantial investment in the National Health Service Corps that will make medical training more affordable for primary care doctors and nurse practitioners so they aren't drowning in debt when they enter the workforce.

The second structural reform we need to make is to improve the quality of medical information making its way to doctors and patients. We have the best medical schools, the most sophisticated labs, and the most advanced training of any nation on the globe. Yet we are not doing a very good job harnessing our collective knowledge and experience on behalf of better medicine. Less than one percent of our health care spending goes to examining what treatments are most effective. And even when that information finds its way into journals, it can take up to 17 years to find its way to an exam room or operating table.

As a result, too many doctors and patients are making decisions without the benefit of the latest research. A recent study, for example, found that only half of all cardiac guidelines are based on scientific evidence. Half. That means doctors may be doing a bypass operation when placing a stent is equally effective, or placing a stent when adjusting a patient's drugs and medical management is equally effective - driving up costs without improving a patient's health.

So, one thing we need to do is figure out what works, and encourage rapid implementation of what works into your practices. That's why we are making a major investment in research to identify the best treatments for a variety of ailments and conditions.

Let me be clear: identifying what works is not about dictating what kind of care should be provided. It's about providing patients and doctors with the information they need to make the best medical decisions.

Still, even when we do know what works, we are often not making the most of it. That's why we need to build on the examples of outstanding medicine at places like the Cincinnati Children's Hospital, where the quality of care for cystic fibrosis patients shot up after the hospital began incorporating suggestions from parents. And places like Tallahassee Memorial Health Care, where deaths were dramatically reduced with rapid response teams that monitored patients' conditions and "multidisciplinary rounds" with everyone from physicians to pharmacists. And places like the Geisinger Health system in rural Pennsylvania and the Intermountain Health in Salt Lake City, where high-quality care is being provided at a cost well below average. These are islands of excellence that we need to make the standard in our health care system.

Replicating best practices. Incentivizing excellence. Closing cost disparities. Any legislation sent to my desk that does not achieve these goals does not earn the title of reform. But my signature on a bill is not enough. I need your help, doctors. To most Americans, you are the health care system. Americans - me included - just do what you recommend. That is why I will listen to you and work with you to pursue reform that works for you. And together, if we take all these steps, we can bring spending down, bring quality up, and save hundreds of billions of dollars on health care costs while making our health care system work better for patients and doctors alike.

Now, I recognize that it will be hard to make some of these changes if doctors feel like they are constantly looking over their shoulder for fear of lawsuits. Some doctors may feel the need to order more tests and treatments to avoid being legally vulnerable. That's a real issue. And while I'm not advocating caps on malpractice awards which I believe can be unfair to people who've been wrongfully harmed, I do think we need to explore a range of ideas about how to put patient safety first, let doctors focus on practicing medicine, and encourage broader use of evidence-based guidelines. That's how we can scale back the excessive defensive medicine reinforcing our current system of more treatment rather than better care.

These changes need to go hand-in-hand with other reforms. Because our health care system is so complex and medicine is always evolving, we need a way to continually evaluate how we can eliminate waste, reduce costs, and improve quality. That is why I am open to expanding the role of a commission created by a Republican Congress called the Medicare Payment Advisory Commission - which happens to include a number of physicians. In recent years, this commission proposed roughly $200 billion in savings that never made it into law. These recommendations have now been incorporated into our broader reform agenda, but we need to fast-track their proposals in the future so that we don't miss another opportunity to save billions of dollars, as we gain more information about what works and what doesn't in our health care system.

As we seek to contain the cost of health care, we must also ensure that every American can get coverage they can afford. We must do so in part because it is in all of our economic interests. Each time an uninsured American steps foot into an emergency room with no way to reimburse the hospital for care, the cost is handed over to every American family as a bill of about $1,000 that is reflected in higher taxes, higher premiums, and higher health care costs; a hidden tax that will be cut as we insure all Americans. And as we insure every young and healthy American, it will spread out risk for insurance companies, further reducing costs for everyone.

But alongside these economic arguments, there is another, more powerful one. It is simply this: We are not a nation that accepts nearly 46 million uninsured men, women, and children. We are not a nation that lets hardworking families go without the coverage they deserve; or turns its back on those in need. We are a nation that cares for its citizens. We are a people who look out for one another. That is what makes this the United States of America.

So, we need to do a few things to provide affordable health insurance to every single American. The first thing we need to do is protect what's working in our health care system. Let me repeat - if you like your health care, the only thing reform will mean is your health care will cost less. If anyone says otherwise, they are either trying to mislead you or don't have their facts straight.

If you don't like your health coverage or don't have any insurance, you will have a chance to take part in what we're calling a Health Insurance Exchange. This Exchange will allow you to one-stop shop for a health care plan, compare benefits and prices, and choose a plan that's best for you and your family - just as federal employees can do, from a postal worker to a Member of Congress. You will have your choice of a number of plans that offer a few different packages, but every plan would offer an affordable, basic package. And one of these options needs to be a public option that will give people a broader range of choices and inject competition into the health care market so that force waste out of the system and keep the insurance companies honest.

Now, I know there's some concern about a public option. In particular, I understand that you are concerned that today's Medicare rates will be applied broadly in a way that means our cost savings are coming off your backs. These are legitimate concerns, but ones, I believe, that can be overcome. As I stated earlier, the reforms we propose are to reward best practices, focus on patient care, not the current piece-work reimbursement. What we seek is more stability and a health care system on a sound financial footing. And these reforms need to take place regardless of what happens with a public option. With reform, we will ensure that you are being reimbursed in a thoughtful way tied to patient outcomes instead of relying on yearly negotiations about the Sustainable Growth Rate formula that's based on politics and the state of the federal budget in any given year. The alternative is a world where health care costs grow at an unsustainable rate, threatening your reimbursements and the stability of our health care system.

What are not legitimate concerns are those being put forward claiming a public option is somehow a Trojan horse for a single-payer system. I'll be honest. There are countries where a single-payer system may be working. But I believe - and I've even taken some flak from members of my own party for this belief - that it is important for us to build on our traditions here in the United States. So, when you hear the naysayers claim that I'm trying to bring about government-run health care, know this - they are not telling the truth.

What I am trying to do - and what a public option will help do - is put affordable health care within reach for millions of Americans. And to help ensure that everyone can afford the cost of a health care option in our Exchange, we need to provide assistance to families who need it. That way, there will be no reason at all for anyone to remain uninsured.

Indeed, it is because I am confident in our ability to give people the ability to get insurance that I am open to a system where every American bears responsibility for owning health insurance, so long as we provide a hardship waiver for those who still can't afford it. The same is true for employers. While I believe every business has a responsibility to provide health insurance for its workers, small businesses that cannot afford it should receive an exemption. And small business workers and their families will be able to seek coverage in the Exchange if their employer is not able to provide it.

Insurance companies have expressed support for the idea of covering the uninsured - and I welcome their willingness to engage constructively in the reform debate. But what I refuse to do is simply create a system where insurance companies have more customers on Uncle Sam's dime, but still fail to meet their responsibilities. That is why we need to end the practice of denying coverage on the basis of preexisting conditions. The days of cherry-picking who to cover and who to deny - those days are over.

This is personal for me. I will never forget watching my own mother, as she fought cancer in her final days, worrying about whether her insurer would claim her illness was a preexisting condition so it could get out of providing coverage. Changing the current approach to preexisting conditions is the least we can do - for my mother and every other mother, father, son, and daughter, who has suffered under this practice. And it will put health care within reach for millions of Americans.

Now, even if we accept all of the economic and moral reasons for providing affordable coverage to all Americans, there is no denying that it will come at a cost - at least in the short run. But it is a cost that will not - I repeat, not - add to our deficits. Health care reform must be and will be deficit neutral in the next decade.

There are already voices saying the numbers don't add up. They are wrong. Here's why. Making health care affordable for all Americans will cost somewhere on the order of one trillion dollars over the next ten years. That sounds like a lot of money - and it is. But remember: it is less than we are projected to spend on the war in Iraq. And also remember: failing to reform our health care system in a way that genuinely reduces cost growth will cost us trillions of dollars more in lost economic growth and lower wages.

That said, let me explain how we will cover the price tag. First, as part of the budget that was passed a few months ago, we've put aside $635 billion over ten years in what we are calling a Health Reserve Fund. Over half of that amount - more than $300 billion - will come from raising revenue by doing things like modestly limiting the tax deductions the wealthiest Americans can take to the same level it was at the end of the Reagan years. Some are concerned this will dramatically reduce charitable giving, but statistics show that's not true, and the best thing for our charities is the stronger economy that we will build with health care reform.

But we cannot just raise revenues. We also have to make spending cuts in part by examining inefficiencies in the Medicare program. There will be a robust debate about where these cuts should be made, and I welcome that debate. But here's where I think these cuts should be made. First, we should end overpayments to Medicare Advantage. Today, we are paying Medicare Advantage plans much more than we pay for traditional Medicare services. That's a good deal for insurance companies, but not the American people. That's why we need to introduce competitive bidding into the Medicare Advantage program, a program under which private insurance companies offer Medicare coverage. That will save $177 billion over the next decade.

Second, we need to use Medicare reimbursements to reduce preventable hospital readmissions. Right now, almost 20 percent of Medicare patients discharged from hospitals are readmitted within a month, often because they are not getting the comprehensive care they need. This puts people at risk and drives up costs. By changing how Medicare reimburses hospitals, we can discourage them from acting in a way that boosts profits, but drives up costs for everyone else. That will save us $25 billion over the next decade.

Third, we need to introduce generic biologic drugs into the marketplace. These are drugs used to treat illnesses like anemia. But right now, there is no pathway at the FDA for approving generic versions of these drugs. Creating such a pathway will save us billions of dollars. And we can save another roughly $30 billion by getting a better deal for our poorer seniors while asking our well-off seniors to pay a little more for their drugs.

So, that's the bulk of what's in the Health Reserve Fund. I have also proposed saving another $313 billion in Medicare and Medicaid spending in several other ways. One way is by adjusting Medicare payments to reflect new advances and productivity gains in our economy. Right now, Medicare payments are rising each year by more than they should. These adjustments will create incentives for providers to deliver care more effectively, and save us roughly $109 billion in the process.

Another way we can achieve savings is by reducing payments to hospitals for treating uninsured people. I know hospitals rely on these payments now because of the large number of uninsured patients they treat. But as the number of uninsured people goes down with our reforms, the amount we pay hospitals to treat uninsured people should go down, as well. Reducing these payments gradually as more and more people have coverage will save us over $106 billion, and we'll make sure the difference goes to the hospitals that most need it.

We can also save about $75 billion through more efficient purchasing of prescription drugs. And we can save about one billion more by rooting out waste, abuse, and fraud throughout our health care system so that no one is charging more for a service than it's worth or charging a dime for a service they did not provide.

But let me be clear: I am committed to making these cuts in a way that protects our senior citizens. In fact, these proposals will actually extend the life of the Medicare Trust Fund by 7 years and reduce premiums for Medicare beneficiaries by roughly $43 billion over 10 years. And I'm working with AARP to uphold that commitment.

Altogether, these savings mean that we have put about $950 billion on the table - not counting some of the longer-term savings that will come about from reform - taking us almost all the way to covering the full cost of health care reform. In the weeks and months ahead, I look forward to working with Congress to make up the difference so that health care reform is fully paid for - in a real, accountable way. And let me add that this does not count some of the longer-term savings that will come about from health care reform. By insisting that reform be deficit neutral over the next decade and by making the reforms that will help slow the growth rate of health care costs over coming decades, we can look forward to faster economic growth, higher living standards, and falling, not rising, budget deficits.

I know people are cynical we can do this. I know there will be disagreements about how to proceed in the days ahead. But I also know that we cannot let this moment pass us by.

The other day, my friend, Congressman Earl Blumenauer, handed me a magazine with a special issue titled, "The Crisis in American Medicine." One article notes "soaring charges." Another warns about the "volume of utilization of services." And another asks if we can find a "better way [than fee-for-service] for paying for medical care." It speaks to many of the challenges we face today. The thing is, this special issue was published by Harper's Magazine in October of 1960.

Members of the American Medical Association - my fellow Americans - I am here today because I do not want our children and their children to still be speaking of a crisis in American medicine fifty years from now. I do not want them to still be suffering from spiraling costs we did not stem, or sicknesses we did not cure. I do not want them to be burdened with massive deficits we did not curb or a worsening economy we did not rebuild.

I want them to benefit from a health care system that works for all of us; where families can open a doctor's bill without dreading what's inside; where parents are taking their kids to get regular checkups and testing themselves for preventable ailments; where parents are feeding their kids healthier food and kids are exercising more; where patients are spending more time with doctors and doctors can pull up on a computer all the medical information and latest research they'd ever want to meet that patient's needs; where orthopedists and nephrologists and oncologists are all working together to treat a single human being; where what's best about America's health care system has become the hallmark of America's health care system.

That is the health care system we can build. That is the future within our reach. And if we are willing to come together and bring about that future, then we will not only make Americans healthier and not only unleash America's economic potential, but we will reaffirm the ideals that led you into this noble profession, and build a health care system that lets all Americans heal. Thank you.

President Barack Obama's campaign to push a comprehensive health care reform package forward in 2009 has recently picked up speed.

According to today's New York Times, the new momentum has been spurred by an article in the June 1 edition of The New Yorker magazine, read by Mr. Obama. Apparently the story so moved him, he's been liberally distributing it among his staff and allies working for reform.

Read the article that has fueled the President's fire for health reform here:

The Cost Conundrum: What a Texas town can teach us about health care.

And there is one more reason to pick up the June issue of the magazine. This month's cover was designed using only an iPhone. Check it out:

Behold the power of technology. Let's harness more of that for PROGRESS!

The president is starting his push for fundemental health care reform in America. Check out this week's Weekly Address and get behind Obama's effort to ensure that before 10 year's time we are not spending one of every five dollars we earn on health care.

Other not-to-miss Obama speeches of the week: A Word to the Muslim World

I have come here to see what war leaves behind and to give some foundation to my protests against it. I am here also to define this word Progress for myself and determine what I am willing to give, or give up, to achieve it. It's a word and a vision I face daily in my work and I need to give it meaning.

And so I've come to the capitol under the auspices of a retreat for progressive movement leaders, but really I am looking for something more intimate. A connection to this work, a connection to those who first made progress a utopian ideal --- then made it a political priority.

It is hot and humid as I approach the Mall. We've just come from the White House where scores of black children line up against the tall black wrought iron fence to collect their snapshot and insert this president into their own personal history. Like my grandmother remembering the day Roosevelt was first elected and the photo at this very same fence that followed.

"I visited President Obama" - I can almost hear them thinking. They are excited, proud, and too young to understand the stormy sea change that brought them here. A black man in the white house. Oxymoron, miracle, historic, needed moment all.

We walk toward the World War II Memorial. It is a sprawling, marble fortress that beckons to passersby like an oasis in the sand. I can hear the water from its fountains a full block away. I am so hot and I am thirsty and while neither of these circumstances changes when I arrive, I find myself quenched when I step into the circle of nations and states and face the first remembered fallen. The men of Vermont. Thousands of dead remembered by each weathered copper wreath.

This is a place to remember death's triumph over tyranny. But really, really, all I feel are ghosts and the rushing of monument waterfalls sounds to me like the endless white noise heard by those left behind. Have you ever lost someone? Do you know the whirr of which I speak? While honoring the dead, its constant shush-shushing sound resembles the low, endless moan heard only by those who know loss. It is the sound of sorrow living on. As I stand here in a sea of tourists and veterans, I wonder how many here can truly hear the longing sound of remembrance.

We walk on, the humid morning rising fog-like off the reflecting pool. Again and again, these words fill my head: "Democracy and dead begin with D." Do they have to go hand in hand? I have no answers.

Where I want resolution and understanding I see only ducks, floating in the pool. Not Canada geese, thank God, for where is the patriotism in that? Just lowly mallard's paddling in a pond. I watch them as they bob and dive in this algae-filled place and think to myself, clean inaugural water comes only every four years. They must be patient. And I realize so must we. We must be patient for peace. Patient for progress. Patient for change.

Yes, we can. Be patient. Make change.

The hike up to the Lincoln Memorial is a sweaty endeavor. It is thick and hot, the mind is fast but the body slow. We climb the marble steps and in the place where I expect a certain disgust at wasted space and resource, I am instead awed. Awed to see this giant ebony carving of a great, great man. Annoyed that none of the school children are abiding by the entry plea "Quiet please, show respect."

On the wall, Lincoln's second inaugural address speaks as clearly today as it did upon delivery. God, deliver us from this terrible war we force ourselves to fight without reason - the war of greed, and oil, and a way of life that is not sustainable, that is not reasonable in the face of such world need.

"With malice toward none; with charity for all; with firmness in the right, as God gives us to see the right, let us strive on to finish the work we are in; to bind up the nation's wounds; to care for him who shall have borne the battle, and for his widow, and his orphan--to do all which may achieve and cherish a just and lasting peace, among ourselves, and with all nations."

We go on then to Vietnam, 58,195 names on a long and anguished wall. As we walk we see ourselves, our free selves, reflected in every name. Freedom is not free, these names shout to anyone one who will listen. I refuse to listen to them because in my heart, in my core, I want to believe that it is not true. That freedom is, indeed, free. I don't want to believe in terrorists and tyrants and dictators - I don't want to believe my country capable of a George Bush. I don't want to see him memorialized here.

And then to Korea. There are no words. The kids run and point and laugh at the marching figures, guttural and surreal, marching through the jungle.

We make our way to FDR:

"The test of our progress is not whether we add more to the abundance of those who have much; it is whether we provide enough for those who have too little."

I linger at these words. I take in, with shock, the understanding that they guide my life and always have. They have cost me a marriage, perhaps a soul companionship. And I never knew they'd been spoken before and certainly not by this great leader. I am proud as I read them and sorrowful and I know I have found my definition, my foundation. Progress can only be defined as those who have much sharing with those who have little. I understand that community is another form of communing. We must commune together. Shared resource, equal voice.

This, of course, comes in a flash, a fleeting enlightenment above the clamoring of voices and children running to and fro, and colleagues rushing me: "Let's go, let's go."

Still, more than ghosts speak to me here. We pass a wishing pool at the end of the FDR Memorial. On the edge, a tiny House Wren baths herself liberally, sensually, without embarrassment, clearly reveling in her union with the luxurious, clean pool. She puffs herself up and somersaults in the water. She looks me in the eye as if to dare me to feel insult in the extravagance of this memorial. I watch her a very long time and then I return to the reflecting pool just a short distance away where I see those same ducks floating along the brackish edge.

I had missed him at first, the little duckling tucked behind his mother's wing.

He shyly avoids my gaze. And there, in that hidden face, I get it. Freedom isn't free.
Progress forward from the moment of terror we now live in isn't free.

What we memorialize in this place, on the Mall,is a faith in democracy and freedom and progress that would not stand down.

We may not agree, we may be sad. But what we remember here is the ghost of progress evolving. The ones who died believing, no matter how real or propagandized, their sacrifice secured freedom for these little ones, these birds, these children who stroll the mall in their bright yellow school T-shirts, laughing, wrestling, teasing - barely understanding the signs:

"Quiet please, show respect."

The Fuse staff is in Washington DC this week, some of us for a first time. I am not one for monuments (always aware of the many other things that millions of dollars it takes could be spent on so many critical causes to move progress forward), but I have to admit I have been moved and grounded by our tour through the memorials our nation's war dead, to FDR, Jefferson and Lincoln.

These words on the Jefferson Memorial speak so clearly to our work at Fuse and to the desire of our 100,000 members.

"I am not an advocate for frequent changes in laws and constitutions. But laws and institutions must go hand in hand with the progress of the human mind. As that becomes more developed, more enlightened, as new discoveries are made, new truths discovered and manners and opinions change, with the change of circumstances, institutions must advance also to keep pace with the times. We might as well require a man to wear still the coat which fitted him when a boy as civilized society to remain ever under the regimen of their barbarous ancestors."

Click here for Jefferson's other inspirational, foundational calls for progress:

About the Lincoln Memorial

It's hard to go to the theater in Seattle this month and NOT know that the Seattle International Film Festival is in full throttle. 400 movies, too little time.

As always, this year's fest includes some brave documentaries focused on the progressive issues of our day, including:

The Cove, a fast-paced exposé of Japan's dolphin trade;

The Garden, where an immigrant movement rises out of the ashes of the devastating riots of 1992 and creates a community garden in South Central Los Angeles that becomes a testament to the neighborhood's resilience;

And Food,Inc.in which filmmaker Robert Kenner lifts the veil on the nation's food industry, exposing practices that wreak havoc on our environment and heath. Truly this is a call to dining-table activism.

But nothing speaks to our future as much as the film We Live in Public, which shows the impacts of a country turning itself, including its progressive advocacy efforts, over to social networking and new media.

What does this world look like played out to it's extremes? It ain't pretty folks.

Check it out:

SIFF goes on for another two weeks. Don't miss this opportunity to see some great docs about some of the critical causes of our time.

Seattle International Film Festival Schedule

Thank you John Broder.

Finally, a story that spells out exactly what "Cap and Trade" means, how it works and the changes in political will that have made it a chief part of President Obama's plan to tackle global warming:

This from Broder's New York Times article of May 17 discussing how Cap and Trade pushed taxing down the list of solutions for climate control.

Write Broder:
"As Congress weighs imposing a mandatory limit on climate-altering gases -- an outcome still far from certain -- it is likely to turn to a system that sets a government ceiling on total emissions and allows polluting industries to buy and sell permits to meet it.

That approach, known as cap and trade, has been embraced by President Obama, Democratic leaders in Congress, mainstream environmental groups and a growing number of business interests, including energy-consuming industries like autos, steel and aluminum.

But not long ago, many of today's supporters dismissed the idea of tradable emissions permits as an industry-inspired Republican scheme to avoid the real costs of cutting air pollution. The right answer, they said, was strict government regulation, state-of-the-art technology and a federal tax on every ton of harmful emissions.

How did cap and trade, hatched as an academic theory in obscure economic journals half a century ago, become the policy of choice in the debate over how to slow the heating of the planet? And how did it come to eclipse the idea of simply slapping a tax on energy consumption that befouls the public square or leaves the nation hostage to foreign oil producers? As Congress weighs imposing a mandatory limit on climate-altering gases -- an outcome still far from certain -- it is likely to turn to a system that sets a government ceiling on total emissions and allows polluting industries to buy and sell permits to meet it.

Educate yourself on Cap and Trade. Read the whole story:
From a Theory to a Concensus on Emissions by John M. Broder