I applaud your principles of health care reform, Mr. President. I know you're aware that the average American is under an unsustainable burden. I know you've read the letters and emails and heard the accounts told in the town halls of the horrible things our current system imposes on our citizens.

With this I agree:

Finally, our health care system is placing an unsustainable burden on taxpayers. When health care costs grow at the rate they have, it puts greater pressure on programs like Medicare and Medicaid. If we do nothing to slow these skyrocketing costs, we will eventually be spending more on Medicare and Medicaid than every other government program combined. Put simply, our health care problem is our deficit problem. Nothing else even comes close. Nothing else. (Applause.)

I don't even have a quarrel with this:

Then there's the problem of rising cost. We spend one and a half times more per person on health care than any other country, but we aren't any healthier for it. This is one of the reasons that insurance premiums have gone up three times faster than wages. It's why so many employers -- especially small businesses -- are forcing their employees to pay more for insurance, or are dropping their coverage entirely. It's why so many aspiring entrepreneurs cannot afford to open a business in the first place, and why American businesses that compete internationally -- like our automakers -- are at a huge disadvantage. And it's why those of us with health insurance are also paying a hidden and growing tax for those without it -- about $1,000 per year that pays for somebody else's emergency room and charitable care.

But I want proof of this claim, and I want it documented.

Second, we've estimated that most of this plan can be paid for by finding savings within the existing health care system, a system that is currently full of waste and abuse. Right now, too much of the hard-earned savings and tax dollars we spend on health care don't make us any healthier. That's not my judgment -- it's the judgment of medical professionals across this country. And this is also true when it comes to Medicare and Medicaid.

There is much in this speech that indicts Medicare in its present form as unsustainable, and since this President has said elsewhere that Medicare and Social Security reform are tasks he feels he must undertake, and since we know the Republican party remains dedicated, despite its mouthings to the contrary, to the destruction of those programs because they are the working example of the US safety net (aka the hated "entitlements" and "liberal giveaways") I want to be assured, sir, that you are not stealthily helping that indefatigable Republican policy, that you will not fall victim to that cause nor let those in their golden years, to borrow your phrase, or looking forward to them, be bereft of that inestimable gift of security arising out of the work of such laudable presidents as had your bully pulpit in the past.

The only thing this plan would eliminate is the hundreds of billions of dollars in waste and fraud, as well as unwarranted subsidies in Medicare that go to insurance companies -- subsidies that do everything to pad their profits but don't improve the care of seniors. And we will also create an independent commission of doctors and medical experts charged with identifying more waste in the years ahead

Show me the money, Mister President.

Hundreds of billions of dollars in waste and fraud in Medicare? What waste? What fraud? Which experts? Experts like these?

Or perhaps esteemed colleagues of yours such as these?

Somebody like the Republican rebuttal speaker last night, the Louisiana heart surgeon who's been sued three times for malpractice? If he were a competent surgeon, even in Louisiana he could make more money than the salary of a Congressmember. Is he then one of those friends among the Republicans on whose judgment about waste and fraud you will depend? I hope not, Mr. President. Because if he is, or if his cohorts among the Republicans furnish you with those experts, then this statement

Now, these steps will ensure that you -- America's seniors -- get the benefits you've been promised. They will ensure that Medicare is there for future generations. And we can use some of the savings to fill the gap in coverage that forces too many seniors to pay thousands of dollars a year out of their own pockets for prescription drugs. (Applause.) That's what this plan will do for you. So don't pay attention to those scary stories about how your benefits will be cut, especially since some of the same folks who are spreading these tall tales have fought against Medicare in the past and just this year supported a budget that would essentially have turned Medicare into a privatized voucher program. That will not happen on my watch. I will protect Medicare.

Last night you delivered that line to a standing ovation in the Joint Session of Congress convened to hear you speak.

I am sure I am not the only American prepared to hold you accountable for that promise.

is so many pretty and meaningless words. In light of what came after it, in light of what you provided as context for it, Mr. President, I want to know why, if your administration is aware of hundreds of billions of dollars in waste and fraud in Medicare as it currently stands, you are not prosecuting the fraudulent claimants.

I want to know why your administration has not undertaken anti-trust prosecutions against monopolies -- you said last night yourself that in many states these monopolies exist.

Your Republican friends contend that if you opened interstate commerce to health insurance companies, as was done with banks and with savings-and-loans and investment banking institutions thanks to the work of such outstanding deregulation champions as Jim Leach, Phil Gramm, and Thomas Bliley, we would all be better off. Insurance companies, such as those U.S. Representative the Honorable Dennis Kucinich last night told us will receive the gift of a bailout under your plan, could then behave just like the banks: they could be "too big to fail" and expect direct gifts of taxpayer dollars to reward their failed business models and improper practices.

Now, because Medicare is such a big part of the health care system, making the program more efficient can help usher in changes in the way we deliver health care that can reduce costs for everybody. We have long known that some places -- like the Intermountain Healthcare in Utah or the Geisinger Health System in rural Pennsylvania -- offer high-quality care at costs below average. So the commission can help encourage the adoption of these common-sense best practices by doctors and medical professionals throughout the system -- everything from reducing hospital infection rates to encouraging better coordination between teams of doctors.

Reducing the waste and inefficiency in Medicare and Medicaid will pay for most of this plan. (Applause.) Now, much of the rest would be paid for with revenues from the very same drug and insurance companies that stand to benefit from tens of millions of new customers. And this reform will charge insurance companies a fee for their most expensive policies, which will encourage them to provide greater value for the money -- an idea which has the support of Democratic and Republican experts. And according to these same experts, this modest change could help hold down the cost of health care for all of us in the long run.

I want to know how Americans will be better served, Mr. President, by a plan built on ephemera.