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And the final point is that the costs of health care -- setting aside anything we did in reform, I mean, if we just allowed the current trajectory to go on -- is out of control.  I haven’t talked to Bob about what his costs are looking like for Celgard employees, but I can tell you that health care costs have gone up, the price of health care has gone up three times faster than wages.  So either the company is having to swallow those costs, which means that’s less money that they could use for hiring new workers or investing in new plants and equipment, or they’re passing on those costs to their employees in the form of higher premiums, higher deductibles, higher co-payments.

And what’s happening federally is, because the costs are so out of control, all the programs that we already have -- Medicare, Medicaid, the Children’s Health Insurance Program -- all those things are completely out of control.  So if you’re concerned about the deficit, what you’re really concerned about is the cost of Medicare, Medicaid, and all the other programs that are already in place.

So here’s what we did.  What we said is, number one, we’ll have the basic principle that everybody gets coverage.  And the way we’re going to do that is to say that most people individually shouldn’t buy health insurance on their own because they have no leverage and the insurance companies take advantage of it.  Instead what we’re going to do is we’re going to set up a big pool, a marketplace, that allows everybody to buy into this pool -- that members of Congress, by the way, will be a part of so you know it’s going to be a good deal -- because members of Congress, they’ve got to look out for their own families; they wouldn’t vote for it if it wasn’t going to be a good deal.  And just like Walmart is able to leverage a really good price from its suppliers for everything because they’re such a big purchaser, well, this pool will be a big purchaser and it will be able to get a better deal from insurance companies.

So that’s point number one.  That will drive down the prices for people who are participating and it will allow everybody to get a decent deal on insurance.  And what we do is we provide tax credits to people who still can’t afford it so that they can afford it.  That’s point number one.

Point number two is we’ve got the strongest insurance reforms in history.  So all those things I told you about -- you not being able to get insurance because of a preexisting condition; you finding yourself getting dropped even though you’ve been paying premiums for 15 years and suddenly they just decide, sorry, we don’t want you because you’re getting sick -- those policies will be over.  And so you will be protected as a consumer to make sure you’ve got security and protection if you’ve got insurance already.  That’s the second thing we do.

The third thing we do is we actually put in place a whole bunch of mechanisms to start reducing the actual cost of health care.  So, for example, one of the things that we do is to say we’re going to start encouraging paying doctors not based on how many tests they take, but based on the quality of the outcome -- does somebody end up healthy.

And it turns out that a lot of times if you go to the doctor you get one test.  Then you go -- referred to a specialist, you get another test.  Then maybe you go to a third person, the surgeon, you get a third test -- it’s all the same test but you’re paying three times.

So what we’re trying to say is, we’ll pay you for the first test and then e-mail the test to everybody.  Right?  (Applause.)  Or have all three doctors in the room when the test is being taken.

But that’s an example of the kinds of things that save money and will start reducing costs over the long term.  So what we’ve done is we’ve embedded in how Medicare reimburses, how Medicaid reimburses, all these ideas to actually reduce the costs of care.

So our hope is that over time, over the next three, four, five, six years, because of all these changes, that we’ve actually saved money from this, even though more people are covered. 

And so now you’ll hear the critics and the Republicans say, now, that just defies common sense.  If you’re adding 30 million more people, then it’s got to cost more money.  And you can’t pretend like somehow that’s going to help us on the deficit.  I’ve heard this criticism, I understand it. 

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