Now, despite all that we agree on and all the Republican ideas we've incorporated, many -- probably most -- Republicans in Congress just have a fundamental disagreement over whether we should have more or less oversight of insurance companies.  And if they truly believe that less regulation would lead to higher quality, more affordable health insurance, then they should vote against the proposal I've put forward.

Now, some also believe that we should, instead of doing what I'm proposing, pursue a piecemeal（零碎的，逐渐的） approach to health insurance reform, where we tinker（修补） around the edges of this challenge for the next few years.  Even those who acknowledge the problem of the uninsured say we just can't afford to help them right now --- which is why the Republican proposal only covers 3 million uninsured Americans while we cover over 31 million.

The problem with that approach is that unless everyone has access to affordable coverage, you can't prevent insurance companies from denying coverage based on preexisting conditions; you can't limit the amount families are forced to pay out of their own pockets.  The insurance reforms rest on everybody having access to coverage.  And you also don't do anything about the fact that taxpayers currently end up subsidizing the uninsured when they're forced to go to the emergency room for care, to the tune of about a thousand bucks per family.  You can't get those savings if those people are still going to the emergency room.  So the fact is, health reform only works if you take care of all of these problems at once.

Now, both during and after last week's summit, Republicans in Congress insisted that the only acceptable course on health care reform is to start over.  But given these honest and substantial differences between the parties about the need to regulate the insurance industry and the need to help millions of middle-class families get insurance, I don't see how another year of negotiations would help.

Moreover, the insurance companies aren't starting over.  They're continuing to raise premiums and deny coverage as we speak.  For us to start over now could simply lead to delay that could last for another decade, or even more.  The American people, and the U.S. economy, just can't wait that long.  So, no matter which approach you favor, I believe the United States Congress owes the American people a final vote on health care reform.  (Applause.)

We have debated this issue thoroughly, not just for the past year but for decades.  Reform has already passed the House with a majority.  It has already passed the Senate with a supermajority（绝对多数制） of 60 votes.  And now it deserves the same kind of up or down vote that was cast on welfare reform, that was cast on the Children's Health Insurance Program, that was used for COBRA health coverage for the unemployed, and, by the way, for both Bush tax cuts --- all of which had to pass Congress with nothing more than a simple majority.  

I, therefore, ask leaders in both houses of Congress to finish their work and schedule a vote in the next few weeks.  From now until then, I will do everything in my power to make the case for reform.  (Applause.)  And I urge every American who wants this reform to make their voice heard as well --- every family, every business, every patient, every doctor, every nurse, every physician’s assistant.  Make your voice heard.

This has been a long and wrenching debate.  It has stoked great passions among the American people and their representatives.  And that's because health care is a difficult issue.  It is a complicated issue.  If it was easy, it would have been solved long ago.  As all of you know from experience, health care can literally be an issue of life or death.  And as a result, it easily lends itself to demagoguery（煽动行为） and political gamesmanship（扰乱战术，制胜绝招） , and misrepresentation（误传，歪曲） and misunderstanding.

But that’s not an excuse for those of us who were sent here to lead.  That's not an excuse for us to walk away.  We can’t just give up because the politics are hard.  I know there’s been a fascination, bordering on obsession（困扰，痴迷） , in this media town about what passing health insurance reform would mean for the next election and the one after that.  How will this play?  What will happen with the polls?  I will leave it to others to sift through the politics, because that’s not what this is about.  That’s not why we’re here.

This is about what reform would mean for the mother with breast cancer whose insurance company will finally have to pay for her chemotherapy.  This is about what reform would mean for the small business owner who will no longer have to choose between hiring more workers or offering coverage to the employees she has.  This is about what reform would mean for middle-class families who will be able to afford health insurance for the very first time in their lives and get a regular checkup once in a while, and have some security about their children if they get sick.

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