A Time for Choosing - Ronald Reagan Oct 1964

A TIME FOR CHOOSING (The Speech – October 27, 1964)
(Video at Further Adventures of Indigo Red)

Thank you. Thank you very much. Thank you and good evening. The sponsor has been identified, but unlike most television programs, the performer hasn't been provided with a script. As a matter of fact, I have been permitted to choose my own words and discuss my own ideas regarding the choice that we face in the next few weeks.

I have spent most of my life as a Democrat. I recently have seen fit to follow another course. I believe that the issues confronting us cross party lines. Now, one side in this campaign has been telling us that the issues of this election are the maintenance of peace and prosperity. The line has been used, "We've never had it so good."

But I have an uncomfortable feeling that this prosperity isn't something on which we can base our hopes for the future. No nation in history has ever survived a tax burden that reached a third of its national income. Today, 37 cents out of every dollar earned in this country is the tax collector's share, and yet our government continues to spend 17 million dollars a day more than the government takes in. We haven't balanced our budget 28 out of the last 34 years. We've raised our debt limit three times in the last twelve months, and now our national debt is one and a half times bigger than all the combined debts of all the nations of the world. We have 15 billion dollars in gold in our treasury; we don't own an ounce. Foreign dollar claims are 27.3 billion dollars. And we've just had announced that the dollar of 1939 will now purchase 45 cents in its total value.

As for the peace that we would preserve, I wonder who among us would like to approach the wife or mother whose husband or son has died in South Vietnam and ask them if they think this is a peace that should be maintained indefinitely. Do they mean peace, or do they mean we just want to be left in peace? There can be no real peace while one American is dying some place in the world for the rest of us. We're at war with the most dangerous enemy that has ever faced mankind in his long climb from the swamp to the stars, and it's been said if we lose that war, and in so doing lose this way of freedom of ours, history will record with the greatest astonishment that those who had the most to lose did the least to prevent its happening. Well I think it's time we ask ourselves if we still know the freedoms that were intended for us by the Founding Fathers.

Not too long ago, two friends of mine were talking to a Cuban refugee, a businessman who had escaped from Castro, and in the midst of his story one of my friends turned to the other and said, "We don't know how lucky we are." And the Cuban stopped and said, "How lucky you are? I had someplace to escape to." And in that sentence he told us the entire story. If we lose freedom here, there's no place to escape to. This is the last stand on earth.

And this idea that government is beholden to the people, that it has no other source of power except the sovereign people, is still the newest and the most unique idea in all the long history of man's relation to man.

This is the issue of this election: Whether we believe in our capacity for self-government or whether we abandon the American revolution and confess that a little intellectual elite in a far-distant capitol can plan our lives for us better than we can plan them ourselves.

You and I are told increasingly we have to choose between a left or right. Well I'd like to suggest there is no such thing as a left or right. There's only an up or down—[up] man's old—old-aged dream, the ultimate in individual freedom consistent with law and order, or down to the ant heap of totalitarianism. And regardless of their sincerity, their humanitarian motives, those who would trade our freedom for security have embarked on this downward course.

In this vote-harvesting time, they use terms like the "Great Society," or as we were told a few days ago by the President, we must accept a greater government activity in the affairs of the people. But they've been a little more explicit in the past and among themselves; and all of the things I now will quote have appeared in print. These are not Republican accusations. For example, they have voices that say, "The cold war will end through our acceptance of a not undemocratic socialism." Another voice says, "The profit motive has become outmoded. It must be replaced by the incentives of the welfare state." Or, "Our traditional system of individual freedom is incapable of solving the complex problems of the 20th century." Senator Fullbright has said at Stanford University that the Constitution is outmoded. He referred to the President as "our moral teacher and our leader," and he says he is "hobbled in his task by the restrictions of power imposed on him by this antiquated document." He must "be freed," so that he "can do for us" what he knows "is best." And Senator Clark of Pennsylvania, another articulate spokesman, defines liberalism as "meeting the material needs of the masses through the full power of centralized government."

Well, I, for one, resent it when a representative of the people refers to you and me, the free men and women of this country, as "the masses." This is a term we haven't applied to ourselves in America. But beyond that, "the full power of centralized government"—this was the very thing the Founding Fathers sought to minimize. They knew that governments don't control things. A government can't control the economy without controlling people. And they know when a government sets out to do that, it must use force and coercion to achieve its purpose. They also knew, those Founding Fathers, that outside of its legitimate functions, government does nothing as well or as economically as the private sector of the economy.

Now, we have no better example of this than government's involvement in the farm economy over the last 30 years. Since 1955, the cost of this program has nearly doubled. One-fourth of farming in America is responsible for 85 percent of the farm surplus. Three-fourths of farming is out on the free market and has known a 21 percent increase in the per capita consumption of all its produce. You see, that one-fourth of farming—that's regulated and controlled by the federal government. In the last three years we've spent 43 dollars in the feed grain program for every dollar bushel of corn we don't grow.

Senator Humphrey last week charged that Barry Goldwater, as President, would seek to eliminate farmers. He should do his homework a little better, because he'll find out that we've had a decline of 5 million in the farm population under these government programs. He'll also find that the Democratic administration has sought to get from Congress [an] extension of the farm program to include that three-fourths that is now free. He'll find that they've also asked for the right to imprison farmers who wouldn't keep books as prescribed by the federal government. The Secretary of Agriculture asked for the right to seize farms through condemnation and resell them to other individuals. And contained in that same program was a provision that would have allowed the federal government to remove 2 million farmers from the soil.

At the same time, there's been an increase in the Department of Agriculture employees. There's now one for every 30 farms in the United States, and still they can't tell us how 66 shiploads of grain headed for Austria disappeared without a trace and Billie Sol Estes never left shore.

Every responsible farmer and farm organization has repeatedly asked the government to free the farm economy, but how—who are farmers to know what's best for them? The wheat farmers voted against a wheat program. The government passed it anyway. Now the price of bread goes up; the price of wheat to the farmer goes down.

Meanwhile, back in the city, under urban renewal the assault on freedom carries on. Private property rights [are] so diluted that public interest is almost anything a few government planners decide it should be. In a program that takes from the needy and gives to the greedy, we see such spectacles as in Cleveland, Ohio, a million-and-a-half-dollar building completed only three years ago must be destroyed to make way for what government officials call a "more compatible use of the land." The President tells us he's now going to start building public housing units in the thousands, where heretofore we've only built them in the hundreds. But FHA [Federal Housing Authority] and the Veterans Administration tell us they have 120,000 housing units they've taken back through mortgage foreclosure. For three decades, we've sought to solve the problems of unemployment through government planning, and the more the plans fail, the more the planners plan. The latest is the Area Redevelopment Agency.

They've just declared Rice County, Kansas, a depressed area. Rice County, Kansas, has two hundred oil wells, and the 14,000 people there have over 30 million dollars on deposit in personal savings in their banks. And when the government tells you you're depressed, lie down and be depressed.

We have so many people who can't see a fat man standing beside a thin one without coming to the conclusion the fat man got that way by taking advantage of the thin one. So they're going to solve all the problems of human misery through government and government planning. Well, now, if government planning and welfare had the answer—and they've had almost 30 years of it—shouldn't we expect government to read the score to us once in a while? Shouldn't they be telling us about the decline each year in the number of people needing help? The reduction in the need for public housing?

But the reverse is true. Each year the need grows greater; the program grows greater. We were told four years ago that 17 million people went to bed hungry each night. Well that was probably true. They were all on a diet. But now we're told that 9.3 million families in this country are poverty-stricken on the basis of earning less than 3,000 dollars a year. Welfare spending [is] 10 times greater than in the dark depths of the Depression. We're spending 45 billion dollars on welfare. Now do a little arithmetic, and you'll find that if we divided the 45 billion dollars up equally among those 9 million poor families, we'd be able to give each family 4,600 dollars a year. And this added to their present income should eliminate poverty. Direct aid to the poor, however, is only running only about 600 dollars per family. It would seem that someplace there must be some overhead.

Now—so now we declare "war on poverty," or "You, too, can be a Bobby Baker." Now do they honestly expect us to believe that if we add 1 billion dollars to the 45 billion we're spending, one more program to the 30-odd we have—and remember, this new program doesn't replace any, it just duplicates existing programs—do they believe that poverty is suddenly going to disappear by magic? Well, in all fairness I should explain there is one part of the new program that isn't duplicated. This is the youth feature. We're now going to solve the dropout problem, juvenile delinquency, by reinstituting something like the old CCC camps [Civilian Conservation Corps], and we're going to put our young people in these camps. But again we do some arithmetic, and we find that we're going to spend each year just on room and board for each young person we help 4,700 dollars a year. We can send them to Harvard for 2,700! Course, don't get me wrong. I'm not suggesting Harvard is the answer to juvenile delinquency.

But seriously, what are we doing to those we seek to help? Not too long ago, a judge called me here in Los Angeles. He told me of a young woman who'd come before him for a divorce. She had six children, was pregnant with her seventh. Under his questioning, she revealed her husband was a laborer earning 250 dollars a month. She wanted a divorce to get an 80 dollar raise. She's eligible for 330 dollars a month in the Aid to Dependent Children Program. She got the idea from two women in her neighborhood who'd already done that very thing.

Yet anytime you and I question the schemes of the do-gooders, we're denounced as being against their humanitarian goals. They say we're always "against" things—we're never "for" anything.

Well, the trouble with our liberal friends is not that they're ignorant; it's just that they know so much that isn't so.

Now—we're for a provision that destitution should not follow unemployment by reason of old age, and to that end we've accepted Social Security as a step toward meeting the problem.

But we're against those entrusted with this program when they practice deception regarding its fiscal shortcomings, when they charge that any criticism of the program means that we want to end payments to those people who depend on them for a livelihood. They've called it "insurance" to us in a hundred million pieces of literature. But then they appeared before the Supreme Court and they testified it was a welfare program. They only use the term "insurance" to sell it to the people. And they said Social Security dues are a tax for the general use of the government, and the government has used that tax. There is no fund, because Robert Byers, the actuarial head, appeared before a congressional committee and admitted that Social Security as of this moment is 298 billion dollars in the hole. But he said there should be no cause for worry because as long as they have the power to tax, they could always take away from the people whatever they needed to bail them out of trouble. And they're doing just that.

A young man, 21 years of age, working at an average salary—his Social Security contribution would, in the open market, buy him an insurance policy that would guarantee 220 dollars a month at age 65. The government promises 127. He could live it up until he's 31 and then take out a policy that would pay more than Social Security. Now are we so lacking in business sense that we can't put this program on a sound basis, so that people who do require those payments will find they can get them when they're due—that the cupboard isn't bare?

Barry Goldwater thinks we can.

At the same time, can't we introduce voluntary features that would permit a citizen who can do better on his own to be excused upon presentation of evidence that he had made provision for the non-earning years? Should we not allow a widow with children to work, and not lose the benefits supposedly paid for by her deceased husband? Shouldn't you and I be allowed to declare who our beneficiaries will be under this program, which we cannot do? I think we're for telling our senior citizens that no one in this country should be denied medical care because of a lack of funds. But I think we're against forcing all citizens, regardless of need, into a compulsory government program, especially when we have such examples, as was announced last week, when France admitted that their Medicare program is now bankrupt. They've come to the end of the road.

In addition, was Barry Goldwater so irresponsible when he suggested that our government give up its program of deliberate, planned inflation, so that when you do get your Social Security pension, a dollar will buy a dollar's worth, and not 45 cents worth?

I think we're for an international organization, where the nations of the world can seek peace. But I think we're against subordinating American interests to an organization that has become so structurally unsound that today you can muster a two-thirds vote on the floor of the General Assembly among nations that represent less than 10 percent of the world's population. I think we're against the hypocrisy of assailing our allies because here and there they cling to a colony, while we engage in a conspiracy of silence and never open our mouths about the millions of people enslaved in the Soviet colonies in the satellite nations.

I think we're for aiding our allies by sharing of our material blessings with those nations which share in our fundamental beliefs, but we're against doling out money government to government, creating bureaucracy, if not socialism, all over the world. We set out to help 19 countries. We're helping 107. We've spent 146 billion dollars. With that money, we bought a 2 million dollar yacht for Haile Selassie. We bought dress suits for Greek undertakers, extra wives for Kenya[n] government officials. We bought a thousand TV sets for a place where they have no electricity. In the last six years, 52 nations have bought 7 billion dollars worth of our gold, and all 52 are receiving foreign aid from this country.

No government ever voluntarily reduces itself in size. So governments' programs, once launched, never disappear.

Actually, a government bureau is the nearest thing to eternal life we'll ever see on this earth.

Federal employees—federal employees number two and a half million; and federal, state, and local, one out of six of the nation's work force employed by government. These proliferating bureaus with their thousands of regulations have cost us many of our constitutional safeguards. How many of us realize that today federal agents can invade a man's property without a warrant? They can impose a fine without a formal hearing, let alone a trial by jury? And they can seize and sell his property at auction to enforce the payment of that fine. In Chico County, Arkansas, James Wier over-planted his rice allotment. The government obtained a 17,000 dollar judgment. And a U.S. marshal sold his 960-acre farm at auction. The government said it was necessary as a warning to others to make the system work.

Last February 19th at the University of Minnesota, Norman Thomas, six-times candidate for President on the Socialist Party ticket, said, "If Barry Goldwater became President, he would stop the advance of socialism in the United States." I think that's exactly what he will do.

But as a former Democrat, I can tell you Norman Thomas isn't the only man who has drawn this parallel to socialism with the present administration, because back in 1936, Mr. Democrat himself, Al Smith, the great American, came before the American people and charged that the leadership of his Party was taking the Party of Jefferson, Jackson, and Cleveland down the road under the banners of Marx, Lenin, and Stalin. And he walked away from his Party, and he never returned til the day he died—because to this day, the leadership of that Party has been taking that Party, that honorable Party, down the road in the image of the labor Socialist Party of England.

Now it doesn't require expropriation or confiscation of private property or business to impose socialism on a people. What does it mean whether you hold the deed to the—or the title to your business or property if the government holds the power of life and death over that business or property? And such machinery already exists. The government can find some charge to bring against any concern it chooses to prosecute. Every businessman has his own tale of harassment. Somewhere a perversion has taken place. Our natural, unalienable rights are now considered to be a dispensation of government, and freedom has never been so fragile, so close to slipping from our grasp as it is at this moment.

Our Democratic opponents seem unwilling to debate these issues. They want to make you and I believe that this is a contest between two men—that we're to choose just between two personalities.

Well what of this man that they would destroy—and in destroying, they would destroy that which he represents, the ideas that you and I hold dear? Is he the brash and shallow and trigger-happy man they say he is? Well I've been privileged to know him "when." I knew him long before he ever dreamed of trying for high office, and I can tell you personally I've never known a man in my life I believed so incapable of doing a dishonest or dishonorable thing.

This is a man who, in his own business before he entered politics, instituted a profit-sharing plan before unions had ever thought of it. He put in health and medical insurance for all his employees. He took 50 percent of the profits before taxes and set up a retirement program, a pension plan for all his employees. He sent monthly checks for life to an employee who was ill and couldn't work. He provides nursing care for the children of mothers who work in the stores. When Mexico was ravaged by the floods in the Rio Grande, he climbed in his airplane and flew medicine and supplies down there.

An ex-GI told me how he met him. It was the week before Christmas during the Korean War, and he was at the Los Angeles airport trying to get a ride home to Arizona for Christmas. And he said that [there were] a lot of servicemen there and no seats available on the planes. And then a voice came over the loudspeaker and said, "Any men in uniform wanting a ride to Arizona, go to runway such-and-such," and they went down there, and there was a fellow named Barry Goldwater sitting in his plane. Every day in those weeks before Christmas, all day long, he'd load up the plane, fly it to Arizona, fly them to their homes, fly back over to get another load.

During the hectic split-second timing of a campaign, this is a man who took time out to sit beside an old friend who was dying of cancer. His campaign managers were understandably impatient, but he said, "There aren't many left who care what happens to her. I'd like her to know I care." This is a man who said to his 19-year-old son, "There is no foundation like the rock of honesty and fairness, and when you begin to build your life on that rock, with the cement of the faith in God that you have, then you have a real start." This is not a man who could carelessly send other people's sons to war. And that is the issue of this campaign that makes all the other problems I've discussed academic, unless we realize we're in a war that must be won.

Those who would trade our freedom for the soup kitchen of the welfare state have told us they have a utopian solution of peace without victory. They call their policy "accommodation." And they say if we'll only avoid any direct confrontation with the enemy, he'll forget his evil ways and learn to love us. All who oppose them are indicted as warmongers. They say we offer simple answers to complex problems. Well, perhaps there is a simple answer—not an easy answer—but simple: If you and I have the courage to tell our elected officials that we want our national policy based on what we know in our hearts is morally right.

We cannot buy our security, our freedom from the threat of the bomb by committing an immorality so great as saying to a billion human beings now enslaved behind the Iron Curtain, "Give up your dreams of freedom because to save our own skins, we're willing to make a deal with your slave masters." Alexander Hamilton said, "A nation which can prefer disgrace to danger is prepared for a master, and deserves one." Now let's set the record straight. There's no argument over the choice between peace and war, but there's only one guaranteed way you can have peace—and you can have it in the next second—surrender.

Admittedly, there's a risk in any course we follow other than this, but every lesson of history tells us that the greater risk lies in appeasement, and this is the specter our well-meaning liberal friends refuse to face—that their policy of accommodation is appeasement, and it gives no choice between peace and war, only between fight or surrender. If we continue to accommodate, continue to back and retreat, eventually we have to face the final demand—the ultimatum. And what then—when Nikita Khrushchev has told his people he knows what our answer will be? He has told them that we're retreating under the pressure of the Cold War, and someday when the time comes to deliver the final ultimatum, our surrender will be voluntary, because by that time we will have been weakened from within spiritually, morally, and economically. He believes this because from our side he's heard voices pleading for "peace at any price" or "better Red than dead," or as one commentator put it, he'd rather "live on his knees than die on his feet." And therein lies the road to war, because those voices don't speak for the rest of us.

You and I know and do not believe that life is so dear and peace so sweet as to be purchased at the price of chains and slavery. If nothing in life is worth dying for, when did this begin—just in the face of this enemy? Or should Moses have told the children of Israel to live in slavery under the pharaohs? Should Christ have refused the cross? Should the patriots at Concord Bridge have thrown down their guns and refused to fire the shot heard 'round the world? The martyrs of history were not fools, and our honored dead who gave their lives to stop the advance of the Nazis didn't die in vain. Where, then, is the road to peace? Well it's a simple answer after all.

You and I have the courage to say to our enemies, "There is a price we will not pay." "There is a point beyond which they must not advance." And this—this is the meaning in the phrase of Barry Goldwater's "peace through strength." Winston Churchill said, "The destiny of man is not measured by material computations. When great forces are on the move in the world, we learn we're spirits—not animals." And he said, "There's something going on in time and space, and beyond time and space, which, whether we like it or not, spells duty."

You and I have a rendezvous with destiny.

We'll preserve for our children this, the last best hope of man on earth, or we'll sentence them to take the last step into a thousand years of darkness.

We will keep in mind and remember that Barry Goldwater has faith in us. He has faith that you and I have the ability and the dignity and the right to make our own decisions and determine our own destiny.

Thank you very much.

Text of Obama in Portsmouth, NH Aug 11, 2009

Full text of Obama's Town Hall meeting provide by the White House. The full video (1hr, 19 mins) is linked to C-Span.
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THE BRIEFING ROOM


THE WHITE HOUSE

Office of the Press Secretary
___________________________________________________________________________
For Immediate Release August 11, 2009

REMARKS BY THE PRESIDENT
IN HEALTH INSURANCE REFORM TOWN HALL

Portsmouth High School
Portsmouth, New Hampshire

1:05 P.M. EDT

THE PRESIDENT: Hello, Portsmouth! Thank you. (Applause.) Thank you so much. Everybody have a seat. Oh, thank you so --

AUDIENCE MEMBER: We love you!

THE PRESIDENT: I love you back. Thank you. (Laughter.) It is great to be back in Portsmouth. (Applause.) It's great to be back in New Hampshire. I have to say, though, that most of my memories of this state are cold. (Laughter.) So it's good to be here in August.

There are a couple of people that I want to acknowledge who are here today, some special guests. First of all, I want to thank principal Jeffrey Collins, and the Portsmouth students and faculty and staff. (Applause.) Thank you -- our host for today. Your own outstanding governor, John Lynch is here. (Applause.) And his wonderful wife, Dr. Susan Lynch is here, the First Lady of New Hampshire. (Applause.) Your United States senator, doing a great job, Jeanne Shaheen is here. (Applause.) The governor of the great state of Maine, and we are glad he's here in New Hampshire today, John Baldacci is here. (Applause.)

Two of my favorite people, they are just taking Congress by storm, outstanding work -- Paul Hodes, Carol Shea-Porter -- give them a big round of applause. (Applause.) And we've got your own mayor, Tom Ferrini is here. Where's Tom? There he is. (Applause.)

Now, I want to thank more than anybody, Lori, for that introduction, and for sharing her story with the rest of us. (Applause.) Thank you, Lori. Lori's story is the same kind of story that I've read in letters, that I've heard in town hall meetings just like this one for the past five years. In fact, some of you were in that town hall -- those town hall meetings, as I was traveling all throughout New Hampshire. It's the story of hardworking Americans who are held hostage by health insurance companies that deny them coverage, or drop their coverage, or charge fees that they can't afford for care that they desperately need.

I believe it is wrong. It is bankrupting families and businesses, and that's why we are going to pass health insurance reform in 2009. (Applause.)

Now, this is obviously a tough time for families here in New Hampshire and all across America. Six months ago, we were in the middle of the worst recession of our lifetimes. I want you to remember what things were like in January and February. We were losing about 700,000 jobs per month. And economists of all stripes feared a second-coming of the Great Depression. That was only six months ago.

That's why we acted as fast as we could to pass a Recovery Act that would stop the freefall. And I want to make sure everybody understands what we did. One-third of the money in the Recovery Act went to tax cuts that have already started showing up in the paychecks of about 500,000 working families in New Hampshire -- (applause) -- 500,000 families in New Hampshire. We also cut taxes for small businesses on the investments that they make, and over 300 New Hampshire small businesses have qualified for new loans backed by the Recovery Act.

Now, that was a third -- that was a third of the Recovery Act. Another third of the money in the Recovery Act is for emergency relief for folks who've borne the brunt of this recession. So we've extended unemployment benefits for 20,000 New Hampshire residents. (Applause.) We've made health insurance 65 percent cheaper for families who rely on COBRA while they're looking for work. (Applause.) And for states that were facing historic budget shortfalls, we provided assistance that has saved the jobs of tens of thousands of workers who provided essential services -- like teachers and police officers. (Applause.) So it's prevented a lot of painful cuts in the state, but also a lot of painful state and local tax increases.

Now, the last third of the Recovery Act is for investments that are already putting people back to work. These are jobs refurbishing bridges and pavement on I-95; or jobs at the community health centers here in Portsmouth that will be able to add nurses, and extend hours, and serve up to 500 new patients. These are good jobs doing the work America needs done. And, by the way, most of the work is being done by private, local businesses, because that's how we're going to grow this economy again.

So there is no doubt that the Recovery Act has helped put the brakes on this recession. We just saw last Friday the job picture is beginning to turn. We're starting to see signs that business investment is coming back.

But, New Hampshire, that doesn't mean we're out of the woods, and you know that. It doesn't mean we can just sit back and do nothing while so many families are still struggling, because even before this recession hit we had an economy that was working pretty well for the wealthiest Americans, it was working pretty well for Wall Street bankers, it was working pretty well for big corporations, but it wasn't working so well for everybody else. It was an economy of bubbles and busts. And we can't go back to that kind of economy.

If we want this country to succeed in the 21st century -- and if we want our children to succeed in the 21st century -- then we're going to have to take the steps necessary to lay a new foundation for economic growth. We need to build an economy that works for everybody, and not just some people. (Applause.)

Now, health insurance reform is one of those pillars that we need to build up that new foundation. I don't have to explain to you that nearly 46 million Americans don't have health insurance coverage today. In the wealthiest nation on Earth, 46 million of our fellow citizens have no coverage. They are just vulnerable. If something happens, they go bankrupt, or they don't get the care they need.

But it's just as important that we accomplish health insurance reform for the Americans who do have health insurance -- (applause) -- because right now we have a health care system that too often works better for the insurance industry than it does for the American people. And we've got to change that. (Applause.)

Now, let me just start by setting the record straight on a few things I've been hearing out here -- (laughter) -- about reform. Under the reform we're proposing, if you like your doctor, you can keep your doctor. If you like your health care plan, you can keep your health care plan.

You will not be waiting in any lines. This is not about putting the government in charge of your health insurance. I don't believe anyone should be in charge of your health insurance decisions but you and your doctor. (Applause.) I don't think government bureaucrats should be meddling, but I also don't think insurance company bureaucrats should be meddling. That's the health care system I believe in. (Applause.)

Now, we just heard from Lori about how she can't find an insurance company that will cover her because of her medical condition. She's not alone. A recent report actually shows that in the past three years, over 12 million Americans were discriminated against by insurance companies because of a preexisting condition. Either the insurance company refused to cover the person, or they dropped their coverage when they got sick and they needed it most, or they refused to cover a specific illness or condition, or they charged higher premiums and out-of-pocket costs. No one holds these companies accountable for these practices.

And I have to say, this is personal for Lori but it's also personal for me. I talked about this when I was campaigning up here in New Hampshire. I will never forget my own mother, as she fought cancer in her final months, having to worry about whether her insurance would refuse to pay for her treatment. And by the way, this was because the insurance company was arguing that somehow she should have known that she had cancer when she took her new job -- even though it hadn't been diagnosed yet. So if it could happen to her, it could happen to any one of us.

And I've heard from so many Americans who have the same worries. One woman testified that an insurance company would not cover her internal organs because of an accident she had when she was five years old. Think about that -- that covers a lot of stuff. (Laughter.) They're only going to cover your skin. (Laughter.) Dermatology, that's covered; nothing else. (Laughter.)

Another lost his coverage in the middle of chemotherapy because the insurance company discovered he had gall stones that he hadn't known about when he applied for insurance. Now, that is wrong, and that will change when we pass health care reform. That is going to be a priority. (Applause.)

Under the reform we're proposing, insurance companies will be prohibited from denying coverage because of a person's medical history. Period. (Applause.) They will not be able to drop your coverage if you get sick. (Applause.) They will not be able to water down your coverage when you need it. (Applause.) Your health insurance should be there for you when it counts -- not just when you're paying premiums, but when you actually get sick. And it will be when we pass this plan. (Applause.)

Now, when we pass health insurance reform, insurance companies will no longer be able to place some arbitrary cap on the amount of coverage you can receive in a given year or a lifetime. And we will place a limit on how much you can be charged for out-of-pocket expenses, because no one in America should go broke because they get sick. (Applause.)

And finally -- this is important -- we will require insurance companies to cover routine checkups and preventive care, like mammograms and colonoscopies -- (applause) -- because there's no reason we shouldn't be catching diseases like breast cancer and prostate cancer on the front end. That makes sense, it saves lives; it also saves money -- and we need to save money in this health care system.

So this is what reform is about. For all the chatter and the yelling and the shouting and the noise, what you need to know is this: If you don't have health insurance, you will finally have quality, affordable options once we pass reform. (Applause.) If you do have health insurance, we will make sure that no insurance company or government bureaucrat gets between you and the care that you need. And we will do this without adding to our deficit over the next decade, largely by cutting out the waste and insurance company giveaways in Medicare that aren't making any of our seniors healthier. (Applause.) Right. (Laughter.)

Now, before I start taking questions, let me just say there's been a long and vigorous debate about this, and that's how it should be. That's what America is about, is we have a vigorous debate. That's why we have a democracy. But I do hope that we will talk with each other and not over each other -- (applause) -- because one of the objectives of democracy and debate is, is that we start refining our own views because maybe other people have different perspectives, things we didn't think of.

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. (Applause.) Because the way politics works sometimes is that people who want to keep things the way they are will try to scare the heck out of folks and they'll create boogeymen out there that just aren't real. (Applause.)

So this is an important and complicated issue that deserves serious debate. And we have months to go before we're done, and years after that to phase in all these reforms and get them right. And I know this: Despite all the hand-wringing pundits and the best efforts of those who are profiting from the status quo, we are closer to achieving health insurance reform than we have ever been. We have the American Nurses Association supporting us. (Applause.) We have the American Medical Association on board. (Applause.)

America's doctors and nurses know firsthand how badly we need reform. We have broad agreement in Congress on about 80 percent of what we're trying to do. We have an agreement from the drug companies to make prescription drugs more affordable for seniors. We can cut the doughnut hole in half if we pass reform. (Applause.) We have the AARP on board because they know this is a good deal for our seniors. (Applause.)

But let's face it, now is the hard part -- because the history is clear -- every time we come close to passing health insurance reform, the special interests fight back with everything they've got. They use their influence. They use their political allies to scare and mislead the American people. They start running ads. This is what they always do.

We can't let them do it again. Not this time. Not now. (Applause.) Because for all the scare tactics out there, what is truly scary -- what is truly risky -- is if we do nothing. If we let this moment pass -- if we keep the system the way it is right now -- we will continue to see 14,000 Americans lose their health insurance every day. Your premiums will continue to skyrocket. They have gone up three times faster than your wages and they will keep on going up.

Our deficit will continue to grow because Medicare and Medicaid are on an unsustainable path. Medicare is slated to go into the red in about eight to 10 years. I don't know if people are aware of that. If I was a senior citizen, the thing I'd be worried about right now is Medicare starts running out of money because we haven't done anything to make sure that we're getting a good bang for our buck when it comes to health care. And insurance companies will continue to profit by discriminating against people for the simple crime of being sick. Now, that's not a future I want for my children. It's not a future that I want for the United States of America.

New Hampshire, I was up here campaigning a long time. (Laughter.) A lot of you guys came to my town hall events. Some of you voted for me, some of you didn't. But here's one thing I've got to say: I never said this was going to be easy. I never said change would be easy. If it were easy, it would have already been done. Change is hard. And it doesn't start in Washington. It begins in places like Portsmouth, with people like Lori, who have the courage to share their stories and fight for something better. (Applause.)

That's what we need to do right now. And I need your help. If you want a health care system that works for the American people -- (applause) -- as well as it works for the insurance companies, I need your help -- knocking on doors, talking to your neighbors. Spread the facts. Let's get this done. (Applause.)

Thank you. Thank you. (Applause.)

AUDIENCE: Yes we can! Yes we can! Yes we can!

THE PRESIDENT: Thank you. I remember that.

Everybody have a seat. All right, this is the fun part. (Laughter.) Now, first of all, by the way, let's thank the band -- I didn't see the band over here. Thank you, band. (Applause.) Great job.

All right, here's how we're going to do this. We do a lot of town hall meetings in New Hampshire, so everybody knows the basic outlines of this thing. If you have a question just raise your hand. There are people with microphones in the audience. I am going to try to go girl-boy-girl-boy, to make sure it's fair. (Laughter.) If I hear only from people who agree with me I'm going to actively ask some folks who are concerned about health care, give them a chance to ask their questions, because I think we've got to make sure that we get out -- surface some of the debates and concerns that people have. Some of them are legitimate. I'm going to try to get through as many questions as I can. But if you can keep your question or comment relatively brief, then I will try to keep my answers relatively brief, okay? (Laughter.)

All right, so we're just going to go around the room and I'm going to start with this gentleman right here, this gentleman right here. Please introduce yourself, if you don't mind.

Q Thank you, Mr. President. Welcome to Portsmouth and New Hampshire. My name is Peter Schmidt. I'm a state representative from Dover. I'm a senior citizen. I have a wonderful government-run health care plan called Medicare. I like it. It's affordable, it's reasonable, nobody tells me what I need to do. I just go to my doctor at the hospital, I get care.

Now, one of the things you've been doing in your campaign to change the situation is you've been striving for bipartisanship. I think it's a wonderful idea, but my question is, if the Republicans actively refuse to participate in a reasonable way with reasonable proposals, isn't it time to just say we're going to pass what the American people need and what they want, without the Republicans? (Applause.)

THE PRESIDENT: Well, let me make a couple of points. First of all, you make a point about Medicare that's very important. I've been getting a lot of letters, pro and con, for health care reform, and one of the letters I received recently, a woman was very exercised about what she had heard about my plan. She says, "I don't want government-run health care. I don't want you meddling in the private marketplace. And keep your hands off my Medicare." (Laughter.) True story.

And so I do think it's important for particularly seniors who currently receive Medicare to understand that if we're able to get something right like Medicare, then there should be a little more confidence that maybe the government can have a role -- not the dominant role, but a role -- in making sure the people are treated fairly when it comes to insurance. (Applause.)

Under our proposal, the majority of Americans will still be getting their health care from private insurers. All we want to do is just make sure that private insurers are treating you fairly so that you are not buying something where if you failed to read the fine print, next thing you know, when you actually get sick, you have no coverage.

We also want to make sure that everybody has some options. So there's been talk about this public option. This is where a lot of the idea of government takeover of health care comes from. All we want to do is set up a set of options so that if you don't have health insurance or you're underinsured you can have the same deal that members of Congress have, which is they can look at a menu of options -- we're calling it an exchange, but it’s basically just a menu of different health care plans -- and you will be able to select the one that suits your family best.

And I do think that having a public option as part of that would keep the insurance companies honest, because if they've got a public plan out there that they've got to compete against, as long as it's not being subsidized by taxpayers, then that will give you some sense of what -- sort of a good bargain for what basic health care would be. (Applause.)

Now, I think that there are some of my Republican friends on Capitol Hill who are sincerely trying to figure out if they can find a health care bill that works -- Chuck Grassley of Iowa, Mike Enzi of Wyoming, Olympia Snowe from Maine have been -- (applause) -- yes, I got to admit I like Olympia, too. (Laughter.) They are diligently working to see if they can come up with a plan that could get both Republican and Democratic support.

But I have to tell you, when I listen to folks like Lori and families all across America who are just getting pounded by the current health care system, and when I look at the federal budget and realize that if we don't control costs on health care, there is no way for us to close the budget deficit -- it will just keep on skyrocketing -- when I look at those two things, I say we have to get it done. And my hope is we can do it in a bipartisan fashion, but the most important thing is getting it done for the American people. (Applause.)

All right. Let's -- this young lady right here. All right, this young lady right here. She's still enjoying her summer. When do you go back to school?

Q I go back to school September 3rd.

THE PRESIDENT: September 3rd, okay. What's your name?

Q Julia Hall from Malden, Massachusetts.

THE PRESIDENT: Nice to meet you, Julia. (Applause.)

Q I saw -- as I was walking in, I saw a lot of signs outside saying mean things about reforming health care. How do kids know what is true, and why do people want a new system that can -- that help more of us?

THE PRESIDENT: Well, the -- I've seen some of those signs. (Laughter.) Let me just be specific about some things that I've been hearing lately that we just need to dispose of here. The rumor that's been circulating a lot lately is this idea that somehow the House of Representatives voted for "death panels" that will basically pull the plug on grandma because we've decided that we don't -- it's too expensive to let her live anymore. (Laughter.) And there are various -- there are some variations on this theme.

It turns out that I guess this arose out of a provision in one of the House bills that allowed Medicare to reimburse people for consultations about end-of-life care, setting up living wills, the availability of hospice, et cetera. So the intention of the members of Congress was to give people more information so that they could handle issues of end-of-life care when they're ready, on their own terms. It wasn't forcing anybody to do anything. This is I guess where the rumor came from.

The irony is that actually one of the chief sponsors of this bill originally was a Republican -- then House member, now senator, named Johnny Isakson from Georgia -- who very sensibly thought this is something that would expand people's options. And somehow it's gotten spun into this idea of "death panels." I am not in favor of that. So just I want to -- (applause.) I want to clear the air here.

Now, in fairness, the underlying argument I think has to be addressed, and that is people's concern that if we are reforming the health care system to make it more efficient, which I think we have to do, the concern is that somehow that will mean rationing of care, right? -- that somehow some government bureaucrat out there will be saying, well, you can't have this test or you can't have this procedure because some bean-counter decides that this is not a good way to use our health care dollars. And this is a legitimate concern, so I just want to address this.

We do think that systems like Medicare are very inefficient right now, but it has nothing to do at the moment with issues of benefits. The inefficiencies all come from things like paying $177 billion to insurance companies in subsidies for something called Medicare Advantage that is not competitively bid, so insurance companies basically get a $177 billion of taxpayer money to provide services that Medicare already provides. And it's no better -- it doesn't result in better health care for seniors. It is a giveaway of $177 billion.

Now, think about what we could do with $177 billion over 10 years. I don't think that's a good use of money. I would rather spend that money on making sure that Lori can have coverage, making sure that people who don't have health insurance get some subsidies, than I would want to be subsidizing insurance companies. (Applause.)

Another way of putting this is right now insurance companies are rationing care. They are basically telling you what's covered and what's not. They're telling you: We'll cover this drug, but we won't cover that drug; you can have this procedure, or, you can't have that procedure. So why is it that people would prefer having insurance companies make those decisions, rather than medical experts and doctors figuring out what are good deals for care and providing that information to you as a consumer and your doctor so you can make the decisions?

So I just want to be very clear about this. I recognize there is an underlying fear here that people somehow won't get the care they need. You will have not only the care you need, but also the care that right now is being denied to you -- only if we get health care reform. That's what we're fighting for. (Applause.)

All right. Gentleman back here, with the baseball cap. Right there.

Q Good afternoon, Mr. President. Bill Anderson from New Hampshire. In reference to what you just said -- I'm presently under the New Hampshire Medicaid system and I have to take a drug called Lipitor. When I got onto this program they said, no, we're not going to cover Lipitor -- even though I'd been on that pill for probably 10 years, based on the information my doctor feels is right for me. And I had to go through two different trials of other kinds of drugs before it was finally deemed that I was able to go back on the Lipitor through the New Hampshire Medicaid system. So here it is, the Medicaid that you guys are administering and you're telling me that it's good -- but in essence, I'm dealing with the same thing, and you're telling me the insurance companies are doing. Thank you.

THE PRESIDENT: Well, I think that's a legitimate point. I don't know all the details, but it sounds to me like they were probably trying to have you take a generic as opposed to a brand name. Is that right? And it turned out that you did not have as good of a reaction under the generic as the brand name, and then they put you back on the brand name. Is that what happened?

Q Correct, to save money.

THE PRESIDENT: Well -- right. Look, there may be -- in nine out of 10 cases, the generic might work as well or better than the brand name. And we don't want to just subsidize the drug companies if you've got one that works just as well as another.

The important thing about the story that you just told me was -- is that once it was determined that, in fact, you needed the brand name, you were able to get the brand name. Now, I want to be absolutely clear here: There are going to be instances where if there is really strong scientific evidence that the generic and the brand name work just as well, and the brand name costs twice as much, that the taxpayer should try to get the best deal possible, as long as if it turns out that the generic doesn't work as well, you're able to get the brand name.

So the basic principle that we want to set up here is that -- if you're in private insurance, first of all, your private insurance can do whatever you want. If you're under a government program, then it makes sense for us to make sure that we're getting the best deal possible and not just giving drug makers or insurers more money than they should be getting. But ultimately, you've got to be able to get the best care based on what the doctor says.

And it sounds like that is eventually what happened. It may be that it wasn't as efficient -- it wasn't as smooth as it should have been, but that result is actually a good one. And you think about all the situations where a generic actually would have worked -- in fact, one of the things I want to do is to speed up generics getting introduced to the marketplace, because right now drug companies -- (applause) -- right now drug companies are fighting so that they can keep essentially their patents on their brand-name drugs a lot longer. And if we can make those patents a little bit shorter, generics get on the market sooner, ultimately you as consumers will save money. All right? But it was an excellent question, so thank you.

All right, it's a young woman's turn -- or a lady's turn. Right here. Yes, you.

Q Good afternoon, Mr. President. I'm Jackie Millet (phonetic) and I'm from Wells, Maine, and my question is, I am presently on Medicare and I do have a supplement. But if something happens to my husband, I lose the supplement. And what will happen? I take a lot of medications. I need a lot -- I've had a lot of procedures. And how will Medicare under the new proposal help people who are going to need things like this?

THE PRESIDENT: Well, first of all, another myth that we've been hearing about is this notion that somehow we're going to be cutting your Medicare benefits. We are not. AARP would not be endorsing a bill if it was undermining Medicare, okay? So I just want seniors to be clear about this, because if you look at the polling, it turns out seniors are the ones who are most worried about health care reform. And that's understandable, because they use a lot of care, they've got Medicare, and it's already hard for a lot of people even on Medicare because of the supplements and all the other costs out of pocket that they're still paying.

So I just want to assure we're not talking about cutting Medicare benefits. We are talking about making Medicare more efficient, eliminating the insurance subsidies, working with hospitals so that they are changing some of the reimbursement practices.

Right now hospitals, they are not penalized if there are constant readmission rates from patients that have gone through the hospital. If you go to a -- if you go to a car company or a auto shop, if you say, "Can I have my car repaired?", you get your car repaired -- if two weeks later it's broken down again, if you take it back, hopefully they're not going to charge you again for repairing the car. You want them to do it right the first time. And too often we're not seeing the best practices in some of these hospitals to prevent people from being readmitted. That costs a lot of money. So those are the kinds of changes we're talking about.

Now, in terms of savings for you as a Medicare recipient, the biggest one is on prescription drugs, because the prescription drug companies have already said that they would be willing to put up $80 billion in rebates for prescription drugs as part of a health care reform package.

Now, we may be able to get even more than that. But think about it. When the prescription drug plan was passed, Medicare Part D, they decided they weren't going to negotiate with the drug companies for the cheapest available price on drugs. And as a consequence, seniors are way over-paying -- there's that big doughnut hole that forces them to go out of pocket. You say you take a lot of medications; that means that doughnut hole is always something that's looming out there for you. If we can cut that doughnut hole in half, that's money directly out of your pocket. And that's one of the reasons that AARP is so supportive, because they see this as a way of potentially saving seniors a lot of money on prescription drugs. Okay?

All right. The gentleman right here in the white shirt.

Q Good afternoon, Mr. President. My name is Ben Hershinson (ph). I'm from Ogunquit, Maine, and also Florida. And I'm a Republican -- I don't know what I'm doing here, but I'm here. (Laughter.)

THE PRESIDENT: We're happy to have you. We're happy to have you. (Applause.)

Q Mr. President, you've been quoted over the years -- when you were a senator and perhaps even before then -- that you were essentially a supporter of a universal plan. I'm beginning to see that you're changing that. Do you honestly believe that? Because that is my concern. I'm on Medicare, but I still worry that if we go to a public option, period, that the private companies, the insurance companies, rather than competing -- because who can compete with the government; the answer is nobody. So my question is do you still -- as yourself, now -- support a universal plan? Or are you open to the private industry still being maintained?

THE PRESIDENT: Well, I think it's an excellent question, so I appreciate the chance to respond. First of all, I want to make a distinction between a universal plan versus a single-payer plan, because those are two different things.

A single-payer plan would be a plan like Medicare for all, or the kind of plan that they have in Canada, where basically government is the only person -- is the only entity that pays for all health care. Everybody has a government-paid-for plan, even though in, depending on which country, the doctors are still private or the hospitals might still be private. In some countries, the doctors work for the government and the hospitals are owned by the government. But the point is, is that government pays for everything, like Medicare for all. That is a single-payer plan.

I have not said that I was a single-payer supporter because, frankly, we historically have had a employer-based system in this country with private insurers, and for us to transition to a system like that I believe would be too disruptive. So what would end up happening would be, a lot of people who currently have employer-based health care would suddenly find themselves dropped, and they would have to go into an entirely new system that had not been fully set up yet. And I would be concerned about the potential destructiveness of that kind of transition. All right? So I'm not promoting a single-payer plan.

I am promoting a plan that will assure that every single person is able to get health insurance at an affordable price, and that if they have health insurance they are getting a good deal from the insurance companies. That's what I'm fighting for. (Applause.)

Now, the way we have approached it, is that if you've got health care under a private plan, if your employer provides you health care or you buy your own health care and you're happy with it, you won't have to change.

What we're saying is, if you don't have health care, then you will be able to go to an exchange similar to the menu of options that I used to have as a member of Congress, and I can look and see what are these various private health care plans offering, what's a good deal, and I'll be able to buy insurance from that exchange. And because it's a big pool, I'll be able to drive down costs, I'll get a better deal than if I was trying to get health insurance on my own.

This is true, by the way, for small businesses, as well. A lot of small businesses, they end up paying a lot more than large businesses per person for health care, because they've got no bargaining power, they've got no leverage. So we wanted small businesses to be able to buy into this big pool, okay?

Now, the only thing that I have said is that having a public option in that menu would provide competition for insurance companies to keep them honest.

Now, I recognize, though, you make a legitimate -- you raise a legitimate concern. People say, well, how can a private company compete against the government? And my answer is that if the private insurance companies are providing a good bargain, and if the public option has to be self-sustaining -- meaning taxpayers aren't subsidizing it, but it has to run on charging premiums and providing good services and a good network of doctors, just like any other private insurer would do -- then I think private insurers should be able to compete. They do it all the time. (Applause.)

I mean, if you think about -- if you think about it, UPS and FedEx are doing just fine, right? No, they are. It's the Post Office that's always having problems. (Laughter.)

So right now you've got private insurers who are out there competing effectively, even though a lot of people get their care through Medicare or Medicaid or VA. So there's nothing inevitable about this somehow destroying the private marketplace, as long as -- and this is a legitimate point that you're raising -- that it's not set up where the government is basically being subsidized by the taxpayers, so that even if they're not providing a good deal, we keep on having to pony out more and more money. And I've already said that can't be the way the public option is set up. It has to be self-sustaining.

Does that answer your question? Okay, thank you. (Applause.)

All right, right there. Go ahead.

Q Hello, Mr. President. My name is Linda Becher (ph). I'm from Portsmouth and I have proudly taught at this high school for 37 years.

THE PRESIDENT: Well, congratulations.

Q Thank you. (Applause.)

THE PRESIDENT: What do you teach?

Q I teach English and Journalism.

THE PRESIDENT: Excellent.

Q Yes, thank you.

THE PRESIDENT: Sure.

Q And in those 37 years, I've been lucky enough to have very good health care coverage and my concerns currently are for those who do not. And I guess my question is if every American who needed it has access to good mental health care, what do you think the impact would be on our society?

THE PRESIDENT: Well, you raise the -- (applause) -- you know, mental health has always been undervalued in the health insurance market. And what we now know is, is that somebody who has severe depression has a more debilitating and dangerous illness than somebody who's got a broken leg. But a broken leg, nobody argues that's covered. Severe depression, unfortunately, oftentimes isn't even under existing insurance policies.

So I think -- I've been a strong believer in mental health parity, recognizing that those are serious illnesses. (Applause.) And I would like to see a mental health component as part of a package that people are covered under, under our plan. Okay? (Applause.)

All right. This gentleman right here.

Q Hello, Mr. President. I'm Justin Higgins from Stratham, New Hampshire.

THE PRESIDENT: How are you, Justin?

Q Fine, thank you. There's a lot of misinformation about how we're going to pay for this health care plan. And I'm wondering how we're going to do this without raising the taxes on the middle class, because I don't want the burden to fall on my parents, and also I'm a college student so --

THE PRESIDENT: They've already got enough problems paying your college tuition. (Laughter.)

Q Exactly. Exactly.

THE PRESIDENT: I hear you.

Q Also I'm looking towards my future with career options and opportunities and I don't want inflation to skyrocket by just adding this to the national debt. So I'm wondering how we can avoid both of those scenarios. (Applause.)

THE PRESIDENT: Right, it's a great question. First of all, I said I won't sign a bill that adds to the deficit or the national debt. Okay? So this will have to be paid for. That, by the way, is in contrast to the prescription drug bill that was passed that cost hundreds of billions of dollars, by the previous administration and previous Congress, that was not paid for at all, and that was a major contributor to our current national debt.

That's why you will forgive me if sometimes I chuckle a little bit when I hear all these folks saying, "oh, big-spending Obama" -- when I'm proposing something that will be paid for and they signed into law something that wasn't, and they had no problem with it. Same people, same folks. And they say with a straight face how we've got to be fiscally responsible. (Applause.)

Now, having said that, paying for it is not simple. I don't want to pretend that it is. By definition, if we're helping people who currently don't have health insurance, that's going to cost some money. It's been estimated to cost somewhere between, let's say, $800 billion and a trillion dollars over 10 years. Now, it's important that we're talking about over 10 years because sometimes the number "trillion" gets thrown out there and everybody think it's a trillion dollars a year -- gosh, that -- how are we going to do that? So it's about a hundred billion dollars a year to cover everybody and to implement some of the insurance reforms that we're talking about.

About two-thirds of those costs we can cover by eliminating the inefficiencies that I already mentioned. So I already talked about $177 billion worth of subsidies to the insurance companies. Let's take that money, let's put it in the kitty. There's about $500 billion to $600 billion over 10 years that can be saved without cutting benefits for people who are currently receiving Medicare, actually making the system more efficient over time.

That does still leave, though, anywhere from $300 billion to $400 billion over 10 years, or $30 billion to $40 billion a year. That does have to be paid for, and we will need new sources of revenue to pay for it. And I've made a proposal that would -- I want to just be very clear -- the proposal, my preferred approach to this would have been to take people like myself who make more than $250,000 a year, and limit the itemized deductions that we can take to the same level as middle-class folks can take them. (Applause.)

Right now, the average person -- the average middle-class family, they're in the 28-percent tax bracket, and so they basically can itemize, take a deduction that is about 28 percent. I can take -- since I'm in a much higher tax bracket, I can take a much bigger deduction. And so as a consequence, if I give a charitable gift, I get a bigger break from Uncle Sam than you do.

So what I've said is let's just even it out. That would actually raise sufficient money. Now, that was my preferred way of paying for it. Members of Congress have had different ideas. And we are still exploring these ideas.

By the time that we actually have a bill that is set, that is reconciled between House and Senate and is voted on, it will be very clear what those ideas are. My belief is, is that it should not burden people who make $250,000 a year or less.

And I think that's the commitment that I made, the pledge that I made when I was up here running in New Hampshire, folks. So I don't want anybody saying somehow that I'm pulling the bait- and-switch here. I said very specifically I thought we should roll back Bush tax cuts and use them to pay for health insurance. That's what I'm intending to do. All right? (Applause.)

Okay, I've only got time for a couple more questions. Somebody here who has a concern about health care that has not been raised, or is skeptical and suspicious and wants to make sure that -- because I don't want people thinking I just have a bunch of plants in here. All right, so I've got one right here -- and then I'll ask the guy with two hands up because he must really have a burning question. (Laughter.)

All right, go ahead.

Q Thank you, Mr. President. I've worked in the medical field for about 18 years and seen a lot of changes over those 18 years. I currently work here at the high school as a paraprofessional. I have a little, you know, couple questions about the universal insurance program, which, if I understand you correctly, President Obama, you seek to cover 50 million new people over and above the amount of people that are currently getting health care at this moment.

THE PRESIDENT: It will probably -- I just want to be honest here. There are about 46 million people who are uninsured. And under the proposals that we have, even if you have an individual mandate, probably only about 37-38 million, so somewhere in that ballpark.

Q Okay, I'm off a little bit. (Laughter.)

THE PRESIDENT: No, no, I just wanted to make sure I wasn't over-selling my plan here.

Q That's okay, Mr. President. (Laughter.)

THE PRESIDENT: She's okay --

Q He winked at me. (Laughter.) My concern is for where are we going to get the doctors and nurses to cover these? Right now I know that there's a really -- people are not going to school to become teachers to teach the nursing staffs. Doctors have huge capacities; some of them are leaving private to go to administrative positions because of the caseload that they're being made to hold. I really do feel that there will be more demand with this universal health care and no added supply. I also understand that it was to be taken from Medicare, about $500 billion -- correct me if I'm wrong on that.

THE PRESIDENT: I just said that.

Q Okay. Also, you know, I'm very, very concerned about the elderly. I don't know if this is also correct, but I understand that a federal health board will sit in judgment of medical procedures and protocols to impose guidelines on all providers -- when to withhold certain types of care -- like, what is the point you get to when we say, I'm sorry that this cannot happen. Thank you very much for letting me ask those questions, Mr. President.

THE PRESIDENT: Of course. Well, first of all, I already mentioned that we would be taking savings out of Medicare that are currently going to insurance subsidies, for example. So that is absolutely true.

I just want to be clear, again: Seniors who are listening here, this does not affect your benefits. This is not money going to you to pay for your benefits; this is money that is subsidizing folks who don't need it. So that's point number one.

Point number two: In terms of these expert health panels -- well, this goes to the point about "death panels" -- that's what folks are calling them. The idea is actually pretty straightforward, which is if we've got a panel of experts, health experts, doctors, who can provide guidelines to doctors and patients about what procedures work best in what situations, and find ways to reduce, for example, the number of tests that people take -- these aren't going to be forced on people, but they will help guide how the delivery system works so that you are getting higher-quality care. And it turns out that oftentimes higher-quality care actually costs less.

So let me just take the example of testing. Right now, a lot of Medicare patients -- you have something wrong with you, you go to your doctor, doctor checks up on you, maybe he takes -- has a test, he administers a test. You go back home, you get the results, the doctor calls you and says, okay, now you got to go to this specialist. Then you have to take another trip to the specialist. The specialist doesn't have the first test, so he does his own test. Then maybe you've got to, when you go to the hospital, you've got to take a third test.

Now, each time taxpayers, under Medicare, are paying for that test. So for a panel of experts to say, why don't we have all the specialists and the doctors communicating after the first test and let's have electronic medical records so that we can forward the results of that first test to the others -- (applause) -- that's a sensible thing to do. That is a sensible thing to do.

So we want -- if I'm a customer, if I'm a consumer and I know that I'm overpaying $6,000 for anything else, I would immediately want the best deal. But for some reason, in health care, we continue to put up with getting a bad deal. We’re paying $6,000 more than any other advanced country and we're not healthier for it -- $6,000 per person more, per year. That doesn’t make any sense. So there's got to be a lot of waste in the system. And the idea is to have doctors, nurses, medical experts look for it.

Now, the last question that you asked is very important and I don't have a simple solution to this. If you look at the makeup of the medical profession right now, we have constant nurses shortages and we have severe shortages of primary care physicians. Primary care physicians, ideally family physicians, they should be the front lines of the medical profession in encouraging prevention and wellness. (Applause.) But the problem is, is that primary care physicians, they make a lot less money than specialists --

AUDIENCE MEMBER: And nurse practitioners.

THE PRESIDENT: And nurse practitioners, too. (Applause.) And nurses, you've got a whole other issue which you already raised, which is the fact that not only are nurses not paid as well as they should, but you also have -- nursing professors are paid even worse than nurses. So as a consequence, you don't have enough professors to teach nursing, which means that's part of the reason why you've got such a shortage of nurses.

So we are going to be taking steps, as part of reform, to deal with expanding primary care physicians and our nursing corps. On the doctors' front, one of the things we can do is to reimburse doctors who are providing preventive care and not just the surgeon who provides care after somebody is sick. (Applause.) Nothing against surgeons. I want surgeons -- I don't want to be getting a bunch of letters from surgeons now. I'm not dissing surgeons here. (Laughter.)

All I'm saying is let's take the example of something like diabetes, one of --- a disease that's skyrocketing, partly because of obesity, partly because it's not treated as effectively as it could be. Right now if we paid a family -- if a family care physician works with his or her patient to help them lose weight, modify diet, monitors whether they're taking their medications in a timely fashion, they might get reimbursed a pittance. But if that same diabetic ends up getting their foot amputated, that's $30,000, $40,000, $50,000 -- immediately the surgeon is reimbursed. Well, why not make sure that we're also reimbursing the care that prevents the amputation, right? That will save us money. (Applause.)

So changing reimbursement rates will help. The other thing that will really help both nurses and doctors, helping pay for medical education for those who are willing to go into primary care. And that's something that we already started to do under the Recovery Act, and we want to do more of that under health care reform. (Applause.)

All right, last question, last question right here. This is a skeptic, right?

Q I am a skeptic.

THE PRESIDENT: Good.

Q Thank you, Mr. President, for coming to Portsmouth. My name is Michael Layon (ph). I'm from Derry, New Hampshire, District 1 in the congressional district. I'm one of the people that turned myself in on the White House Web page the other day for being a skeptic of this bill. I'm proud to have done so.

THE PRESIDENT: Before you ask this question, just because you referred to it, can I just say this is another example of how the media ends up just completing distorting what's taken place. What we've said is that if somebody has -- if you get an e-mail from somebody that says, for example, "Obamacare is creating a death panel," forward us the e-mail and we will answer the question that's raised in the e-mail. Suddenly, on some of these news outlets, this is being portrayed as "Obama collecting an enemies list." (Laughter.)

Now, come on, guys. You know, here I am trying to be responsive to questions that are being raised out there --

Q And appreciate it. (Applause.)

THE PRESIDENT: And I just want to be clear that all we're trying to do is answer questions.

All right, go ahead.

Q So my question is for you, and I know in the White House the stand which you're on has often been referred to as the bully pulpit. Why have you not used the bully pulpit to chastise Congress for having two systems of health care -- one for all of us, and one for them? (Applause.)

THE PRESIDENT: Well, look, first of all, if we don't have health care reform, the gap between what Congress gets and what ordinary Americans get will continue to be as wide as it is right now. And you are absolutely right -- I don't think Carol or Paul would deny they've got a pretty good deal. They've got a pretty good deal. I mean, the fact is, is that they are part -- by the way, I want you to know, though, their deal is no better than the janitor who cleans their offices; because they are part of a federal health care employee plan, it is a huge pool. So you've got millions of people who are part of the pool, which means they've got enormous leverage with the insurance companies, right? So they can negotiate the same way that a big Fortune 500 company can negotiate, and that drives down their costs -- they get a better deal.

Now, what happens is, those members of Congress -- and when I was a senator, same situation -- I could, at the beginning of the year, look at a menu of a variety of different health care options, most of them -- these are all private plans or they could be non-for-profit, Blue Cross Blue Shield, or Aetna, or what have you -- they would have these plans that were offered. And then we would then select what plan worked best for us.

But there were certain requirements -- if you wanted to sell insurance to federal employees there were certain things you had to do. You had to cover certain illnesses. You couldn't exclude for preexisting conditions. I mean, there were a lot of rules that had been negotiated by the federal government for those workers.

Now, guess what. That's exactly what we want to do with health care reform. (Applause.) We want to make sure that you are getting that same kind of option. That's what the health exchange is all about, is that you -- just like a member of Congress -- can go and choose the plan that's right for you. You don't have to. If you've got health care that you like, you don't have to use it.

So for example, for a while, Michelle, my wife, worked at the University of Chicago Hospital. She really liked her coverage that she was getting through the University of Chicago Hospital, so I did not have to use the federal employee plan. But I had that option available.

The same is true for you. Nobody is going to force you to be part of that plan. But if you look at it and you say, you know what, this is a good deal and I've got more leverage because maybe I'm a small business or maybe I'm self-employed, or maybe I'm like Lori and nobody will take me because of a preexisting condition, and now suddenly got these rules set up -- why wouldn't I want to take advantage of that?

Now, there are legitimate concerns about the cost of the program, so I understand if you just think no matter what, no matter how good the program is, you don't think that we should be paying at all for additional people to be covered, then you're probably going to be against health care reform and I can't persuade you. There are legitimate concerns about the public option -- the gentleman who raised his hand. I think it's a good idea, but I understand some people just philosophically think that if you set up a public option, that that will drive public insurance out -- or private insurers out. I think that's a legitimate concern. I disagree with it, but that's a legitimate debate to have.

But I want everybody to understand, though, the status quo is not working for you. (Applause.) The status quo is not working for you. And if we can set up a system, which I believe we can, that gives you options, just like members of Congress has options; that gives a little bit of help to people who currently are working hard every day but they don't have health care insurance on the job; and most importantly, if we can make sure that you, all of you who have insurance, which is probably 80 or 90 percent of you, that you are not going to be dropped because of a preexisting condition, or because you lose your job, or because you change your job -- that you're actually going to get what you paid for, that you're not going to find out when you're sick that you got cheated, that you're not going to hit a lifetime cap where you thought you were paying for insurance but after a certain amount suddenly you're paying out of pocket and bankrupting yourself and your family -- if we can set up a system that gives you some security, that's worth a lot.

And this is the best chance we've ever had to do that. But we're all going to have to come together, we're going to have to make it happen. I am confident we can do so, but I'm going to need your help, New Hampshire.

Thank you very much, everybody. God bless you. (Applause.)

END
2:15 P.M. EDT