Remarks in Asheville, North Carolina

With just a month to go until election day, I know you've all been hearing a lot about politics out here in North Carolina. I know you've been seeing a lot of ads, and getting a lot of calls, and reading a lot about this election in the newspaper.

But none of you need the papers, or ads on TV, or folks like me to tell you what this election is all about. You know what's at stake. You're living it.

Here in Asheville, and across America, you've seen your incomes go down as the price of just about everything has gone way up. It's harder to pay the bills. Harder to send your kids to college. Harder to save enough to retire.

And on Friday, we learned that we'd lost another 159,000 American jobs in September. It was the ninth straight month of job losses - more than three quarters of a million this year, including 24,000 here in North Carolina. And it came just as we finished a week in which our financial markets teetered on the brink of disaster.

Yet instead of addressing these crises, Senator McCain's campaign has announced that they plan to turn the page on the discussion about our economy and spend the final weeks of this campaign launching Swiftboat-style attacks on me.

Think about that for a second. Turn the page on the economy? We're facing the worst economic crisis since the Great Depression, and John McCain wants us to "turn the page?" Well, I know the policies he's supported these past eight years and wants to continue are pretty hard to defend. I can understand why Senator McCain would want to "turn the page" and ignore this economy.

But I also know this:

You're trying to pay your bills every week and stay above the water - you can't ignore it.

You're worrying about whether your job will be there a month from now - you can't ignore it.

You're worrying about whether you can pay your mortgage and stay in your house - you can't turn the page.

In 30 days you are going to elect the next president, and you need and deserve a president who is going to wake up every day and fight for you, and fight for the middle class, and fight to create jobs and grow our economy again -- not another president who doesn't get it. Not another President who ignores our problems. Not more of the same.

Senator McCain and his operatives are gambling that he can distract you with smears rather than talk to you about substance. They'd rather try to tear our campaign down than lift this country up. It's what you do when you're out of touch, out of ideas, and running out of time.

I want you to know that I'm going to keep on talking about the issues that matter - about the economy and health care and education and energy. I'm going to keep on standing up for hard working families. We're not going to let John McCain distract us from what we need to do to move this country forward.

Because November 4th, you and I are going to turn the page on the disastrous economic policies of George W. Bush and John McCain.

And one of the issues we must face and can't ignore is the explosion of health care costs that is crushing families and businesses across our country.

Understand, this is very personal to me.

I'm thinking today about my mother. She died of ovarian cancer at the age of 53. She fought valiantly, and endured the pain and chemotherapy with grace and good humor. But I'll never forget how she spent the final months of her life. At a time when she should have been focused on getting well, at a time when she should have been taking stock of her life and taking comfort in her family, she was lying in a hospital bed, fighting with her insurance company because they didn't want to cover her treatment. They claimed that her cancer was a pre-existing condition.

So I know something about the heartbreak caused by our health care system.

I know something about the anxiety of families hanging on by a thread as premiums have doubled, and debt piles up, and more than half - half - of all personal bankruptcies are caused in part by medical bills.

I know about the frustration of the nearly 40 percent of small business owners who can no longer afford to insure their employees - folks who work day and night, but have to lay people off, or shut their doors for good, because of rising health care costs.

I know the outrage we all feel about the 45 million Americans who don't have health insurance - kids who can't see a doctor when they're sick; parents cutting their pills in half and praying for the best; folks who wind up in the emergency room in the middle of the night because they've got nowhere else to turn.

But I also know that this is not who we are.

We are not a country where a young woman I met should have to work the night shift after a full day of college and still not be able to pay the medical bills for her sister who's ill. That's not right - and it's not who we are.

We are not a country where a man I met should have to file for bankruptcy after he had a stroke, because he faced nearly $200,000 in medical costs that he couldn't afford and his insurance company didn't cover. That's not right - and it's not who we are.

That is not who we are, and that is not who we have to be. Enough is enough - it's time for change.

Now I know that at this moment, when we stand in the midst of a serious economic crisis, some might ask how we can afford to focus on health care. Major financial institutions have collapsed. Families across America are struggling. And it's clear that the rescue package we just passed in Congress isn't the end of what we need to do to fix our economy - it's just the beginning. Because contrary to what Senator McCain says, the fundamentals of our economy are still not strong. And we've got to address those fundamentals right now.

In other words, the question isn't how we can afford to focus on health care - but how we can afford not to. Because in order to fix our economic crisis, we need to fix our health care system too. Let's not forget, it's not just small businesses and families who are suffering. Some of the largest corporations in America - including major American car makers - are fighting to compete because of high health care costs. They're watching their foreign competitors prosper - unburdened by these costs - as they struggle to create the good jobs we need to get our economy back on track.

So it's clear that the time has come - right now - to solve this problem: to cut health care costs for families and businesses, and provide affordable, accessible health insurance for every American.

And you'd think that anyone running for president would understand this. You'd think any candidate for the highest office in the land would have a plan to achieve these critically important goals. Well, if you think that, you haven't met my opponent, Senator John McCain.

Now, it's not that he doesn't care about what people are going through. I just think he doesn't know. That's the only reason I can think of that he'd propose a health care plan that is so radical, so out of touch with what you're facing, and so out of line with our basic values.

It starts with his proposal to deregulate our insurance industry and leave families across America without the basic protections they rely on. You may have heard about how, in the current issue of a magazine, Senator McCain wrote that we need to open up health care to - and I quote - "more vigorous nationwide competition as we have done over the last decade in banking." That's right, he wants to deregulate the insurance industry just like he fought to deregulate the banking industry. And we've all seen how well that worked out.

It would be equally catastrophic for your health care. Right now, different states have different rules about what insurance companies have to cover. Senator McCain will let companies avoid these rules. He'll let them cherry pick the state where they're based - and sell plans anywhere in America.

It's the starting gun for a race to the bottom. Insurance companies will rush to set up shop in states with the fewest protections for patients - states where they don't have to cover things like mammograms, vaccinations and maternity care.

Now what does this mean for folks here in North Carolina? Well, this state requires insurance companies to cover mental health care, cancer screening, contraception, treatment for alcoholism and more. And here in North Carolina, you have the right to appeal when your HMO refuses to cover the treatment you need.

Under John McCain's plan, insurance companies wouldn't have to follow any of these rules. These are commonsense protections to make sure that you and your doctor - not insurance company bureaucrats - are making decisions about your health. And John McCain wants to let insurance companies go around them.

So while Senator McCain talks a lot about preserving states' rights - when it comes down to it, his plan is all about protecting insurance companies' rights. Well, I think it's time we started putting the health of our families before the profits of our insurance companies - and that's what I'm going to do as President.

I also want to talk a little about how exactly Senator McCain would pay for his plan. He's been eager to share some details about that - but not all.

He tells you that he'll give you a tax credit of $2,500 per person - $5,000 per family - to help you pay for your insurance and health care costs. But like those ads for prescription drugs, you have to read the fine print to learn the rest of the story.

You see, Senator McCain would pay for his plan, in part, by taxing your health care benefits for the first time in history. And this tax would come out of your paycheck. But the new tax credit he's proposing? That wouldn't go to you. It would go directly to your insurance company.

It's an old Washington bait and switch. It's a shell game. Senator McCain gives you a tax credit with one hand - but raises your taxes with the other. He's hoping we won't notice.

Well, I've got news for John McCain: we notice, we know better, and we're not going to let him get away with that.

Because here's what happens when Senator McCain taxes your benefits: a lot of younger, healthier workers will opt out of the insurance they get at work - and go out into the individual market, where they can buy a cheaper plan. That leaves employers with older, sicker workers who are more expensive to cover - so many employers will drop their health care plans altogether.

It's the same approach President Bush floated a few years ago. And it could be the beginning of the end of our employer-based health care system. In fact, studies show that under the McCain plan, at least 20 million Americans will lose the insurance you rely on from your workplace. Your families will have to go out into the marketplace with that $5,000 tax credit and buy insurance on your own.

But what Senator McCain doesn't tell you is that the average cost of a family health care plan is more than twice that much - $12,680. So where would that leave you?

Senator McCain also doesn't tell you that insurance in the individual market is more expensive and includes fewer benefits. Many of these plans don't cover things like prescription drugs or pre-natal care.

And Senator McCain's health care plan won't do a thing to stop insurance companies from discriminating against you if you have a pre-existing condition like hypertension, asthma, diabetes or cancer. Employers don't charge you higher premiums for these conditions, but insurers do - much higher. So the sicker you've been, the harder it'll be to get the care you need.

So here's John McCain's radical plan in a nutshell: he taxes health care benefits for the first time in history; millions lose the health care they have; millions pay more for the health care they get; drug and insurance companies continue to profit; and middle class families watch the system they rely on begin to unravel before their eyes. Well, I don't think that's the change we need. I think we can do better than that.

In the end, my opponent's plan reflects the same bankrupt philosophy he's subscribed to for three decades in Washington: take care of the healthy and wealthy, and good luck to everyone else. They call this the Ownership Society, but what it really means is - you're on your own. Your job doesn't give you health care? The market will fix it. Pre-existing condition? Tough luck. Insurance company won't pay for your treatment? Too bad, you're on your own.

This approach hasn't worked these past eight years, it won't work now, and it's time for change.

Let me be clear - I don't think government can solve all our problems. But I reject the radical idea that government has no role to play in protecting ordinary Americans. I reject the thinking that says preserving our free market means letting corporations and special interests do as they please, and everyone else has to fend for themselves. I believe that if you work hard and do everything right, you shouldn't live in fear of losing everything because of a fluke of genetics, or a bad diagnosis, or a stroke of bad luck.

That is why, if I'm elected President, we're going to fix our health care system. We're going to take on the drug and insurance companies; reduce costs for families and businesses; and finally provide affordable, accessible health care for every American.

We'll start by lowering premiums by as much as $2,500 per family - and we'll do it by taking the following five steps to lower costs throughout our health care system.

First, we'll take on the drug companies, tell them thanks but no thanks for the overpriced drugs, and take steps to lower prices so people can afford them. And we'll tell the insurance companies: no more discrimination against people with pre-existing conditions. It's not right, and we won't stand for it.

Second, we'll focus on prevention. We'll make sure insurance companies cover services like weight loss programs and smoking-cessation programs to help people avoid costly, debilitating health problems in the first place.

Third, we'll reduce waste and inefficiency by using the latest technologies to move our health care system into the 21st century. This will save tens of billions a year, reduce medical errors, and let doctors and nurses spend less time with paperwork and more time with patients.

Fourth, we'll reduce the cost of our care by improving the quality of our care. We'll track which drugs and procedures work best and reward providers not just for the quantity of care they provide - but for the quality of outcomes for their patients.

Fifth, we'll help businesses and workers by picking up the tab for some of the most expensive illnesses. Under my plan, the federal government will pay for part of these catastrophic cases, which means lower premiums for you - and less money out of your pocket.

But cost-cutting isn't enough. Because today, in the year 2008, 45 million Americans still don't have any health insurance at all. This is one of the great moral crises of our time. It's not who we are - and it's not who we have to be.

That's why my plan will cover all Americans. And unlike Senator McCain, I'll do it by building on - rather than dismantling - our current, workplace-based system. So if you have insurance you like, you keep that insurance. If you have a doctor you like, you keep that doctor. The only thing that changes for you is that your health care costs will go down.

But if you don't have insurance, or don't like your insurance, you'll be able to choose from the same type of quality private plans as every federal employee - from a postal worker here in North Carolina to a Congressman in Washington. No one will be turned away because of a pre-existing condition. If you change jobs, this insurance will go with you. And if you can't afford this insurance, you'll receive a tax credit to help pay for it.

We'll also provide substantial help for small businesses in the form of tax credits that will cover up to 50 percent of the cost of insuring their employees. This will help them create not just new jobs, but good jobs - jobs with health care that stay right here in America.

And here's how I'll pay for my plan. First, I will aggressively cut health care costs by reducing waste, greed and paperwork; lowering the cost of prescription drugs; and eliminating wasteful subsidies to private plans in Medicare. That will save a lot, but will still leave a cost of about $65 billion a year.

I'll cover that remaining cost with a portion of the money I'll save by ending George Bush's tax breaks for people making more than $250,000 a year. They'll go back to paying the kind of rates they paid when Bill Clinton was President. So we'll get this done responsibly without blowing a hole in our deficit.

In the end, none of this will be easy. We're up against a powerful, entrenched status quo in Washington that will say anything and do anything and fight with everything they've got to keep things the way they are.

But I know that if we come together, and work together, we can do this. So many people are counting on us.

A woman named Robyn who I met in Florida, is one of those people. Back in May, her 16 year old son Devon [DEH-vinn] came to one of our events, and I got to meet him at the airport in Fort Lauderdale. Later that day, Devon became seriously ill. His heart started racing, and his lips turned white. He was rushed to the hospital and almost went into cardiac arrest. He was later diagnosed with a heart condition and told he needed a procedure that would cost tens of thousands of dollars. Robyn's insurance company refused to pay -- they said it was a pre-existing condition - and Robyn's family doesn't have that kind of money.

But until Devon has that procedure, he has to take medication and stop all physical activity. No more gym classes. No more football at school. No more basketball at the park with his friends.

After we met, Robyn sent me an email in which she wrote, "I can't help but feel as if somehow we failed Devon. Why couldn't we be the rich family that has the great insurance or could whip out 50 grand like it is nothing?"

She ended her email with these words, "I ask only this of you - on the days where you feel so tired you can't think of uttering another word to the people, think of us. On the days when you are playing basketball, think of Devon, who can't. When those who oppose you have you down, reach deep and fight back harder."

Today, I want to say to Robyn and Devon and everyone like them across America, you have my word that I will never back down, I will never give up, I will never stop fighting until we have fixed our health care system and no family ever has to go through what you're going through, and my mother went through, and so many people go through every day in this country. That is my promise to you.

And if all of you here today will stand with me in this work - if you'll talk to your friends and neighbors, get people to the polls, and give me your vote, then together, we won't just win this election, we will transform this nation. Thank you, God bless you, and may God bless America.