Madam Speaker, Vice President Biden, members of Congress, and the American people: 议长女士、拜登副总统、各位国会议员、美国人民：
When I spoke here last winter, this nation was facing the worst economic crisis since the Great Depression. We were losing an average of 700,000 jobs per month. Credit was frozen. And our financial system was on the verge of collapse. 去年冬天我在此发言时，这个国家正面临大萧条以来最严重的经济危机。我们当时平均每月失去七十万个就业岗位。信贷冻结。我们的金融体系处于崩溃的边缘。
As any American who is still looking for work or a way to pay their bills will tell you, we are by no means out of the woods. A full and vibrant recovery is still many months away. And I will not let up until those Americans who seek jobs can find them -- until those businesses that seek capital and credit can thrive; until all responsible homeowners can stay in their homes. That is our ultimate goal. But thanks to the bold and decisive action we've taken since January, I can stand here with confidence and say that we have pulled this economy back from the brink. 任何仍在寻找工作或想办法付账单的美国人都会告诉你，我们远未走出困境。全面而充满活力的复苏仍需数月之遥。在求职的美国人找到工作之前，在寻求资本和信贷的企业能够蓬勃发展之前，在所有负责任的房主能够保住自己的住房之前，我都不会松懈。那是我们的最终目标。但得益于我们自一月份以来采取的果敢行动，我可以满怀信心地站在这里说，我们已经把经济从悬崖边拉了回来。
I want to thank the members of this body for your efforts and your support in these last several months, and especially those who've taken the difficult votes that have put us on a path to recovery. I also want to thank the American people for their patience and resolve during this trying time for our nation. 我要感谢在座各位在过去几个月中的努力和支持，尤其是那些投下了艰难的赞成票、把我们带上复苏之路的人。我也要感谢美国人民在我国这段艰难时期所表现出的耐心与决心。
But we did not come here just to clean up crises. We came here to build a future. So tonight, I return to speak to all of you about an issue that is central to that future -- and that is the issue of health care. 但我们来到这里不仅仅是为了收拾危机。我们来这里是为了建设未来。因此今晚，我再次向各位谈论一个对未来至关重要的议题——这就是医疗改革议题。
I am not the first President to take up this cause, but I am determined to be the last. It has now been nearly a century since Theodore Roosevelt first called for health care reform. And ever since, nearly every President and Congress, whether Democrat or Republican, has attempted to meet this challenge in some way. A bill for comprehensive health reform was first introduced by John Dingell Sr. in 1943. Sixty-five years later, his son continues to introduce that same bill at the beginning of each session. 我不是第一位承担这一事业的总统，但我决心成为最后一位。自西奥多·罗斯福首次呼吁医疗改革以来，已经过去了将近一个世纪。此后，几乎每一位总统和国会，无论民主党还是共和党，都曾以某种方式试图应对这一挑战。一项全面医疗改革法案最早由老约翰·丁格尔于一九四三年提出。六十五年过去了，他的儿子每次开会仍继续提出同一项法案。
Our collective failure to meet this challenge -- year after year, decade after decade -- has led us to the breaking point. Everyone understands the extraordinary hardships that are placed on the uninsured, who live every day just one accident or illness away from bankruptcy. These are not primarily people on welfare. These are middle-class Americans. 我们年复一年、十年又十年地未能应对这一挑战，已经把我们推到了临界点。每个人都能理解无保险者所承受的巨大苦难，他们每一天都活在距离破产只差一次意外或疾病的边缘。他们主要不是靠福利生活的人。他们是美国的中产阶级。
Some can't get insurance on the job. Others are self-employed, and can't afford it, since buying insurance on your own costs you three times as much as the coverage you get from your employer. Many other Americans who are willing and able to pay are still denied insurance due to previous illnesses or conditions that insurance companies decide are too risky or too expensive to cover. 有些人在工作岗位上无法获得保险。另一些人自雇经营，无力负担，因为自行购买保险的费用是雇主提供保险的三倍。还有许多愿意也有能力付费的美国人，仍因既往病史或健康状况被拒之门外，保险公司认定这些情况风险太大或费用太高而不予承保。
We are the only democracy -- the only advanced democracy on Earth -- the only wealthy nation -- that allows such hardship for millions of its people. There are now more than 30 million American citizens who cannot get coverage. In just a two-year period, one in every three Americans goes without health care coverage at some point. And every day, 14,000 Americans lose their coverage. In other words, it can happen to anyone. 我们是唯一一个——地球上唯一一个发达民主国家——唯一一个富裕国家——任由数百万国民承受如此苦难。目前有超过三千万美国公民无法获得保险。短短两年间，每三个美国人中就有一人在某段时间没有医疗保险。每一天，有一万四千名美国人失去保险。换言之，这种事可能发生在任何人身上。
But the problem that plagues the health care system is not just a problem for the uninsured. Those who do have insurance have never had less security and stability than they do today. More and more Americans worry that if you move, lose your job, or change your job, you'll lose your health insurance too. More and more Americans pay their premiums, only to discover that their insurance company has dropped their coverage when they get sick, or won't pay the full cost of care. It happens every day. 但困扰医疗系统的问题不仅仅是无保险者的问题。那些拥有保险的人，其保障与稳定性也降至前所未有的低点。越来越多的美国人担心，一旦搬迁、失业或换工作，就会连带失去医疗保险。越来越多的美国人缴纳了保费，却在生病时发现保险公司取消其保障，或拒绝支付全部医疗费用。这样的事每天都在发生。
One man from Illinois lost his coverage in the middle of chemotherapy because his insurer found that he hadn't reported gallstones that he didn't even know about. They delayed his treatment, and he died because of it. Another woman from Texas was about to get a double mastectomy when her insurance company canceled her policy because she forgot to declare a case of acne. By the time she had her insurance reinstated, her breast cancer had more than doubled in size. That is heart-breaking, it is wrong, and no one should be treated that way in the United States of America. 伊利诺伊州的一位男士在化疗期间失去了保险，因为保险公司发现他没有申报自己甚至毫不知情的胆结石。他们延误了他的治疗，他因此去世。得克萨斯州的一位女士即将接受双侧乳腺切除手术时，保险公司却因为她忘记申报一次痤疮而取消了她的保单。等到她的保险恢复时，她的乳腺癌已经增大了一倍多。这令人心碎，这是错误的，在美利坚合众国，任何人不该遭受这样的对待。
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. 其次是成本不断攀升的问题。我们在人均医疗上的支出是其他任何国家的一点五倍，但我们的健康水平并未因此更好。这是保险费上涨速度达到工资涨幅三倍的原因之一。正因如此，许多雇主——尤其是小企业——被迫让员工承担更多保险费用，或干脆停止提供保险。
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. 正因如此，许多有抱负的创业者一开始就无力开业，也正因如此，像我国汽车制造商这样在国际上竞争的美国企业处于巨大的劣势。
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. 也正因如此，我们这些拥有医疗保险的人，也在为那些没有保险的人支付一项隐性的、不断增长的税负——每年大约一千美元，用于支付别人的急诊费用和慈善医疗。
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. 最后，我们的医疗系统正给纳税人带来不可承受的负担。当医疗成本以现有速度增长，就会给联邦医疗保险和医疗补助等计划带来更大压力。如果我们不采取行动减缓这些飞涨的成本，我们最终在联邦医疗保险和医疗补助上的支出将超过其他所有政府项目的总和。
Put simply, our health care problem is our deficit problem. Nothing else even comes close. Nothing else. 简而言之，我们的医疗问题就是我们的赤字问题。其他任何问题都无法与之相比。其他任何问题。
Now, these are the facts. Nobody disputes them. We know we must reform this system. The question is how. 以上都是事实。没有人对此有异议。我们知道必须改革这一系统。问题在于如何改革。
There are those on the left who believe that the only way to fix the system is through a single-payer system like Canada's -- where we would severely restrict the private insurance market and have the government provide coverage for everybody. On the right, there are those who argue that we should end employer-based systems and leave individuals to buy health insurance on their own. 左翼有些人认为，修复系统的唯一途径是采用类似加拿大的单一支付者制度——我们将严格限制商业保险市场，由政府为所有人提供保障。右翼则有人主张，我们应结束基于雇主的保险体系，让个人自行购买医疗保险。
I've said -- I have to say that there are arguments to be made for both these approaches. But either one would represent a radical shift that would disrupt the health care most people currently have. Since health care represents one-sixth of our economy, I believe it makes more sense to build on what works and fix what doesn't, rather than try to build an entirely new system from scratch. And that is precisely what those of you in Congress have tried to do over the past several months. 我必须说，这两种主张都有其道理。但任何一种都意味着激进转变，会打乱多数人目前享有的医疗保障。既然医疗保健占我国经济的六分之一，我认为更合理的做法是在行之有效的部分上继续建设、修正不足之处，而不是试图从零开始建立一套全新的体系。而这正是国会各位在过去几个月里所努力做的。
During that time, we've seen Washington at its best and at its worst. 在这段时间里，我们既看到了华盛顿最好的一面，也看到了最差的一面。
We've seen many in this chamber work tirelessly for the better part of this year to offer thoughtful ideas about how to achieve reform. Of the five committees asked to develop bills, four have completed their work, and the Senate Finance Committee announced today that it will move forward next week. That has never happened before. 我们看到在座许多人在今年大部分时间里不辞辛劳，为推进改革提出了深思熟虑的想法。受命起草法案的五个委员会中，已有四个完成工作，参议院财政委员会今天宣布将于下周继续推进。这是前所未有的。
Our overall efforts have been supported by an unprecedented coalition of doctors and nurses; hospitals, seniors' groups, and even drug companies -- many of whom opposed reform in the past. And there is agreement in this chamber on about 80 percent of what needs to be done, putting us closer to the goal of reform than we have ever been. 我们的整体努力得到了一个前所未有的联盟的支持，其中包括医生和护士、医院、老年人团体，甚至制药公司——他们中有许多过去曾反对改革。如今在这个大厅里，人们对于约百分之八十的待办事项已达成共识，使我们比以往任何时候都更接近改革的目标。
But what we've also seen in these last months is the same partisan spectacle that only hardens the disdain many Americans have towards their own government. Instead of honest debate, we've seen scare tactics. Some have dug into unyielding ideological camps that offer no hope of compromise. Too many have used this as an opportunity to score short-term political points, even if it robs the country of our opportunity to solve a long-term challenge. And out of this blizzard of charges and counter-charges, confusion has reigned. 但近几个月来，我们也看到了同样的党派戏码，这只让许多美国人对本国政府更加鄙夷。我们没有看到坦诚的辩论，看到的是恐吓战术。有些人固守毫不妥协的意识形态阵营，不留任何达成妥协的希望。太多的人把这当作捞取短期政治资本的机会，哪怕这会剥夺国家解决长期挑战的机遇。在指责与反指责的暴风雪中，混乱大行其道。
Well, the time for bickering is over. The time for games has passed. Now is the season for action. Now is when we must bring the best ideas of both parties together, and show the American people that we can still do what we were sent here to do. Now is the time to deliver on health care. Now is the time to deliver on health care. 好了，争吵的时候已经过去。游戏的时间结束了。现在是行动的季节。现在是我们必须把两党最好的主张汇聚在一起、向美国人民证明我们仍能完成被派来这里所做之事的时候。现在是兑现医疗改革承诺的时候。现在是兑现医疗改革承诺的时候。
The plan I'm announcing tonight would meet three basic goals. It will provide more security and stability to those who have health insurance. It will provide insurance for those who don't. And it will slow the growth of health care costs for our families, our businesses, and our government. 我今晚宣布的计划将实现三个基本目标。它将为已拥有医疗保险的人提供更多保障与稳定。它将为没有保险的人提供保险。它还将减缓家庭、企业和政府在医疗费用上的增长。
It's a plan that asks everyone to take responsibility for meeting this challenge -- not just government, not just insurance companies, but everybody including employers and individuals. And it's a plan that incorporates ideas from senators and congressmen, from Democrats and Republicans -- and yes, from some of my opponents in both the primary and general election. 这份计划要求每个人都为应对这一挑战承担责任——不仅是政府，不仅是保险公司，而是包括雇主和个人在内的所有人。这份计划也吸纳了参议员和众议员、民主党人和共和党人的想法——是的，甚至包括我在初选和大选中的一些对手的主张。
Here are the details that every American needs to know about this plan. First, if you are among the hundreds of millions of Americans who already have health insurance through your job, or Medicare, or Medicaid, or the VA, nothing in this plan will require you or your employer to change the coverage or the doctor you have. Let me repeat this: Nothing in our plan requires you to change what you have. 以下是每位美国人都需要了解的有关这份计划的细节。首先，如果你已是数以亿计通过工作、联邦医疗保险、医疗补助或退伍军人事务部获得医疗保险的美国人之一，本计划不会要求你或你的雇主改变你现有的保障或医生。让我重申一遍：我们的计划不会要求你改变已有的保障。
What this plan will do is make the insurance you have work better for you. Under this plan, it will be against the law for insurance companies to deny you coverage because of a preexisting condition. As soon as I sign this bill, it will be against the law for insurance companies to drop your coverage when you get sick or water it down when you need it the most. 这份计划要做的，是让你已有的保险更好地为你服务。根据本计划，保险公司因既往病史拒绝为你承保将是违法行为。一旦我签署这项法案，保险公司不得在你生病时取消你的保障，也不得在你最需要时削减保障范围，否则即属违法。
They will no longer be able to place some arbitrary cap on the amount of coverage you can receive in a given year or in a lifetime. We will place a limit on how much you can be charged for out-of-pocket expenses, because in the United States of America, no one should go broke because they get sick. 保险公司再也不能对你一年内或一生中所能获得的保障额度设定任意上限。我们将对你需自付的医疗费用设定上限，因为在美利坚合众国，任何人都不应因为生病而破产。
And insurance companies will be required to cover, with no extra charge, routine checkups and preventive care, like mammograms and colonoscopies -- because there's no reason we shouldn't be catching diseases like breast cancer and colon cancer before they get worse. That makes sense, it saves money, and it saves lives. 保险公司还必须免费覆盖常规体检和预防性检查，如乳腺钼靶和肠镜——因为我们没有理由不在乳腺癌和结肠癌恶化前就发现它们。这合情合理，既省钱，又救命。
Now, that's what Americans who have health insurance can expect from this plan -- more security and more stability. 以上是已拥有医疗保险的美国人能从这份计划中期待的内容——更多保障，更多稳定。
Now, if you're one of the tens of millions of Americans who don't currently have health insurance, the second part of this plan will finally offer you quality, affordable choices. If you lose your job or you change your job, you'll be able to get coverage. If you strike out on your own and start a small business, you'll be able to get coverage. 如果你是目前没有医疗保险的数千万美国人之一，本计划的第二部分将最终为你提供优质且负担得起的选择。如果你失去工作或更换工作，你都能获得保险。如果你自立门户、创办小企业，你也能获得保险。
We'll do this by creating a new insurance exchange -- a marketplace where individuals and small businesses will be able to shop for health insurance at competitive prices. Insurance companies will have an incentive to participate in this exchange because it lets them compete for millions of new customers. As one big group, these customers will have greater leverage to bargain with the insurance companies for better prices and quality coverage. 我们将通过建立一个全新的保险交易所来实现这一点——这是一个供个人和小企业以有竞争力的价格选购医疗保险的市场。保险公司将有动力参与这一交易所，因为这能让它们争夺数百万新客户。作为一个大群体，这些客户将拥有更大的议价能力，与保险公司争取更优惠的价格和更高质量的保障。
This is how large companies and government employees get affordable insurance. It's how everyone in this Congress gets affordable insurance. And it's time to give every American the same opportunity that we give ourselves. 大企业和政府雇员正是这样获得负担得起的保险。在座的每位国会议员也是如此。现在该让每一个美国人都享有我们给自己提供的同样机会了。
Now, for those individuals and small businesses who still can't afford the lower-priced insurance available in the exchange, we'll provide tax credits, the size of which will be based on your need. And all insurance companies that want access to this new marketplace will have to abide by the consumer protections I already mentioned. This exchange will take effect in four years, which will give us time to do it right. 对于那些仍负担不起交易所内较低价格保险的个人和小企业，我们将提供税收抵免，额度根据需要而定。所有希望进入这个新市场的保险公司都必须遵守我已提到的消费者保护条款。该交易所将在四年后生效，这给了我们把它做对的时间。
In the meantime, for those Americans who can't get insurance today because they have preexisting medical conditions, we will immediately offer low-cost coverage that will protect you against financial ruin if you become seriously ill. This was a good idea when Senator John McCain proposed it in the campaign, it's a good idea now, and we should all embrace it. 与此同时，对于那些因既往病史今天无法获得保险的美国人，我们将立即提供低成本保障，在你患上重病时保护你免于财务破产。参议员约翰·麦凯恩在竞选中提出这一主张时是个好主意，现在仍是好主意，我们应当共同采纳。
Now, even if we provide these affordable options, there may be those -- especially the young and the healthy -- who still want to take the risk and go without coverage. There may still be companies that refuse to do right by their workers by giving them coverage. The problem is, such irresponsible behavior costs all the rest of us money. 即便我们提供了这些负担得起的选择，仍会有人——尤其是年轻和健康的人——想冒风险不买保险。也仍会有公司拒绝为员工提供保障，对员工不负责任。问题是，这种不负责任的行为让其他人都要为之付出代价。
If there are affordable options and people still don't sign up for health insurance, it means we pay for these people's expensive emergency room visits. If some businesses don't provide workers health care, it forces the rest of us to pick up the tab when their workers get sick, and gives those businesses an unfair advantage over their competitors. And unless everybody does their part, many of the insurance reforms we seek -- especially requiring insurance companies to cover preexisting conditions -- just can't be achieved. 如果存在负担得起的选择而人们仍不参保，那意味着我们要为这些人昂贵的急诊费用买单。如果一些企业不为员工提供医疗保障，那当他们的员工生病时，就迫使其他人替他们埋单，并让这些企业对竞争对手获得不公平的优势。除非人人都尽到自己的责任，否则我们所追求的许多保险改革——尤其是要求保险公司覆盖既往病史——根本无法实现。
And that's why under my plan, individuals will be required to carry basic health insurance -- just as most states require you to carry auto insurance. Likewise -- likewise, businesses will be required to either offer their workers health care, or chip in to help cover the cost of their workers. 正因如此，根据我的计划，个人将被要求持有基本医疗保险——就像大多数州要求你购买车险一样。同样——同样，企业将被要求要么为员工提供医疗保障，要么出资帮助支付员工的保险费用。
There will be a hardship waiver for those individuals who still can't afford coverage, and 95 percent of all small businesses, because of their size and narrow profit margin, would be exempt from these requirements. But we can't have large businesses and individuals who can afford coverage game the system by avoiding responsibility to themselves or their employees. Improving our health care system only works if everybody does their part. 对于仍负担不起保险的个人将设有困难豁免，而所有小企业中百分之九十五因规模小、利润薄将不受这些要求约束。但我们不能让负担得起保险的大企业和个人通过逃避对自己或员工的责任来钻制度的空子。改善我们的医疗系统只有人人都尽一份力才行得通。
And while there remain some significant details to be ironed out, I believe -- I believe a broad consensus exists for the aspects of the plan I just outlined: consumer protections for those with insurance, an exchange that allows individuals and small businesses to purchase affordable coverage, and a requirement that people who can afford insurance get insurance. 尽管仍有一些重要细节需要敲定，我相信——我相信对于我刚刚概述的计划的几个方面已存在广泛共识：为已投保者提供消费者保护、建立让个人和小企业购买负担得起保障的交易所，以及要求负担得起保险的人购买保险。
And I have no doubt that these reforms would greatly benefit Americans from all walks of life, as well as the economy as a whole. Still, given all the misinformation that's been spread over the past few months, I realize --I realize that many Americans have grown nervous about reform. So tonight I want to address some of the key controversies that are still out there. 我毫不怀疑这些改革将极大惠及各行各业的美国人以及整体经济。然而，鉴于过去几个月流传的各种不实信息，我意识到——我意识到许多美国人对改革产生了忧虑。因此今晚我想回应一些仍存在的关键争议。
Some of people's concerns have grown out of bogus claims spread by those whose only agenda is to kill reform at any cost. The best example is the claim made not just by radio and cable talk show hosts, but by prominent politicians, that we plan to set up panels of bureaucrats with the power to kill off senior citizens. Now, such a charge would be laughable if it weren't so cynical and irresponsible. It is a lie, plain and simple. 人们的一些担忧源于那些以不惜一切代价扼杀改革为唯一目的之人散布的虚假说法。最好的例子是这种说法——不仅广播和有线电视脱口秀主持人这么说，连一些知名政客也这么说——我们计划设立官僚小组，有权处死老年人。这样的指控若非如此愤世嫉俗和不负责任，简直会令人发笑。这就是一个谎言，赤裸裸的谎言。
There are also those who claim that our reform efforts would insure illegal immigrants. This, too, is false. The reforms -- the reforms I'm proposing would not apply to those who are here illegally. 也有人声称我们的改革举措将为非法移民提供保险。这同样是假的。我所提出的改革——我所提出的改革不适用于非法居留的人。
Rep. Joe Wilson, R-South Carolina: You lie! 南卡罗来纳州共和党众议员乔·威尔逊：你撒谎！
President Obama: It's not true. And one more misunderstanding I want to clear up -- under our plan, no federal dollars will be used to fund abortions, and federal conscience laws will remain in place. 奥巴马总统：这不是真的。我还想澄清另一个误解——根据我们的计划，不会有任何联邦资金用于资助堕胎，联邦良知法也将继续有效。
Now, my health care proposal has also been attacked by some who oppose reform as a "government takeover" of the entire health care system. As proof, critics point to a provision in our plan that allows the uninsured and small businesses to choose a publicly sponsored insurance option, administered by the government just like Medicaid or Medicare. 此外，我的医改提案也遭到一些反对改革者攻击，称其为对整个医疗系统的“政府接管”。作为证据，批评者指出我们计划中的一项条款，该条款允许无保险者和小企业选择由政府主办、如同医疗补助和联邦医疗保险一样由政府管理的保险选项。
So let me set the record straight here. My guiding principle is, and always has been, that consumers do better when there is choice and competition. That's how the market works. Unfortunately, in 34 states, 75 percent of the insurance market is controlled by five or fewer companies. In Alabama, almost 90 percent is controlled by just one company. 让我在此澄清事实。我的一贯指导原则是：有选择、有竞争，消费者才会获益。市场就是这样运作的。遗憾的是，在三十四个州，百分之七十五的保险市场由五家或更少的公司控制。在阿拉巴马州，近百分之九十的市场仅由一家公司掌控。
And without competition, the price of insurance goes up and quality goes down. And it makes it easier for insurance companies to treat their customers badly -- by cherry-picking the healthiest individuals and trying to drop the sickest, by overcharging small businesses who have no leverage, and by jacking up rates. 没有了竞争，保险价格上涨，质量下降。这也让保险公司更容易恶劣地对待客户——专挑最健康的人承保、试图甩掉病情最重的人，对毫无议价能力的小企业漫天要价，并不断抬高费率。
Insurance executives don't do this because they're bad people; they do it because it's profitable. As one former insurance executive testified before Congress, insurance companies are not only encouraged to find reasons to drop the seriously ill, they are rewarded for it. All of this is in service of meeting what this former executive called "Wall Street's relentless profit expectations." 保险业高管这样做并非因为他们是坏人；他们这样做是因为有利可图。正如一位保险业前高管在国会作证时所说，保险公司不仅被鼓励寻找理由取消重病者的保障，还因此受到奖励。这一切都是为了满足这位前高管所说的“华尔街无情的盈利期望”。
Now, I have no interest in putting insurance companies out of business. They provide a legitimate service, and employ a lot of our friends and neighbors. I just want to hold them accountable. And the insurance reforms that I've already mentioned would do just that. But an additional step we can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchange. 我无意让保险公司倒闭。它们提供正当服务，雇用了许多我们的朋友和邻居。我只是想让它们承担责任。我已提到的保险改革恰恰能做到这一点。而为了让保险公司保持诚实，我们可以采取的另一项举措是在保险交易所中提供一个非营利的公共选项。
Now, let me be clear. Let me be clear. It would only be an option for those who don't have insurance. No one would be forced to choose it, and it would not impact those of you who already have insurance. In fact, based on Congressional Budget Office estimates, we believe that less than 5 percent of Americans would sign up. 现在，让我把话说清楚。让我把话说清楚。它只是给那些没有保险的人的一个选项。没有人会被强迫选择它，它也不会影响你们中已经拥有保险的人。事实上，根据国会预算办公室的估算，我们相信只有不到百分之五的美国人会参保。
Despite all this, the insurance companies and their allies don't like this idea. They argue that these private companies can't fairly compete with the government. And they'd be right if taxpayers were subsidizing this public insurance option. But they won't be. I've insisted that like any private insurance company, the public insurance option would have to be self-sufficient and rely on the premiums it collects. 尽管如此，保险公司及其盟友并不喜欢这个主意。他们辩称，这些私营公司无法与政府公平竞争。如果纳税人补贴这一公共保险选项，那他们是对的。但不会有人补贴。我已坚持，与任何私营保险公司一样，公共保险选项必须自给自足，依靠其收取的保费维持运营。
But by avoiding some of the overhead that gets eaten up at private companies by profits and excessive administrative costs and executive salaries, it could provide a good deal for consumers, and would also keep pressure on private insurers to keep their policies affordable and treat their customers better, the same way public colleges and universities provide additional choice and competition to students without in any way inhibiting a vibrant system of private colleges and universities. 但通过避免私营公司因利润、过高的管理成本和高管薪酬所吞噬的那部分间接成本，它可以为消费者提供更划算的选择，同时也能对私营保险公司形成压力，迫使其保持保单价格可负担、改善客户服务，就像公立学院和大学为学生提供额外选择和竞争，却丝毫不妨碍充满活力的私立学院和大学体系一样。
Now, it is -- it's worth noting that a strong majority of Americans still favor a public insurance option of the sort I've proposed tonight. But its impact shouldn't be exaggerated -- by the left or the right or the media. It is only one part of my plan, and shouldn't be used as a handy excuse for the usual Washington ideological battles. 值得一提的是，绝大多数美国人仍支持我今晚所提议的那种公共保险选项。但它的影响不应被夸大——无论是左派、右派还是媒体都不应如此。它只是我计划的一部分，不应被当作华盛顿惯常意识形态之争的现成借口。
To my progressive friends, I would remind you that for decades, the driving idea behind reform has been to end insurance company abuses and make coverage available for those without it. The public option -- the public option is only a means to that end -- and we should remain open to other ideas that accomplish our ultimate goal. And to my Republican friends, I say that rather than making wild claims about a government takeover of health care, we should work together to address any legitimate concerns you may have. 我想提醒我的进步派朋友，几十年来推动改革的核心思路一直是终结保险公司的滥用行为，并为无保险者提供保障。公共选项——公共选项只是达到这一目的的手段——我们应当对其他能实现我们最终目标的想法保持开放。我也想对我的共和党朋友说，与其散布医疗系统被政府接管的荒唐说法，我们更应携手解决你们可能有的合理关切。
For example -- For example, some have suggested that the public option go into effect only in those markets where insurance companies are not providing affordable policies. Others have proposed a co-op or another non-profit entity to administer the plan. These are all constructive ideas worth exploring. But I will not back down on the basic principle that if Americans can't find affordable coverage, we will provide you with a choice. And I will make sure that no government bureaucrat or insurance company bureaucrat gets between you and the care that you need. 例如——例如，有人建议公共选项只在保险公司不提供可负担保单的市场中生效。还有人提出由合作社或另一个非营利实体来管理该计划。这些都是值得探讨的建设性意见。但我不会在这样一个基本原则后退：如果美国人找不到可负担的保障，我们将为你提供选择。我也会确保没有任何政府官僚或保险公司官僚阻挡在你和你所需的医疗之间。
Finally, let me discuss an issue that is a great concern to me, to members of this chamber, and to the public -- and that's how we pay for this plan. 最后，让我谈一个我本人、在座各位以及公众都极为关心的问题——我们如何为这份计划买单。
And here's what you need to know. First, I will not sign a plan that adds one dime to our deficits -- either now or in the future. I will not sign it if it adds one dime to the deficit, now or in the future, period. And to prove that I'm serious, there will be a provision in this plan that requires us to come forward with more spending cuts if the savings we promised don't materialize. 下面是你们需要了解的内容。首先，我不会签署任何一份增加我们赤字的计划——无论是现在还是未来。如果它现在或将来会增加一分钱赤字，我都不会签署，绝不。为了证明我是认真的，这份计划将包含一项条款：如果我们承诺的节约未能兑现，就要求我们提出更多削减开支的措施。
Now, part of the reason I faced a trillion-dollar deficit when I walked in the door of the White House is because too many initiatives over the last decade were not paid for -- from the Iraq war to tax breaks for the wealthy. I will not make that same mistake with health care. 我走进白宫大门时之所以面对万亿美元赤字，部分原因在于过去十年太多举措都没有落实资金来源——从伊拉克战争到给富人的税收优惠。我不会在医疗改革上重蹈覆辙。
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. 其次，我们估算这份计划的大部分费用可以通过在现有医疗系统中挖掘节约来支付，而这个系统目前充斥着浪费和滥用。如今，我们花在医疗上的辛苦积蓄和税款中，有太多并没有让我们更健康。这不是我的判断——这是全国医疗专业人士的判断。这一点在联邦医疗保险和医疗补助上也同样成立。
In fact, I want to speak directly to seniors for a moment, because Medicare is another issue that's been subjected to demagoguery and distortion during the course of this debate. 事实上，我想借此机会直接向老年人讲几句，因为联邦医疗保险是本次辩论中另一个被煽动和歪曲的议题。
More than four decades ago, this nation stood up for the principle that after a lifetime of hard work, our seniors should not be left to struggle with a pile of medical bills in their later years. That's how Medicare was born. And it remains a sacred trust that must be passed down from one generation to the next. And that is why not a dollar of the Medicare trust fund will be used to pay for this plan. 四十多年前，这个国家确立了一项原则：在辛苦劳作一生之后，我们的老年人不应在晚年还要为一堆医疗账单挣扎。联邦医疗保险由此诞生。它至今仍是一项必须代代相传的神圣信托。正因如此，联邦医疗保险信托基金中的一分钱都不会被用来为这份计划买单。
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. 本计划唯一要消除的，是联邦医疗保险中数千亿美元的浪费与欺诈，以及流向保险公司的不当补贴——这些补贴只顾增加保险公司的利润，却不能改善老年人的医疗。我们还将成立一个由医生和医学专家组成的独立委员会，负责在未来几年内识别更多浪费。
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. That's what this plan will do for you. 这些举措将确保你们——美国的老年人——获得承诺给你们的福利。它们将确保联邦医疗保险能为子孙后代延续。我们还可以用部分节约来填补保障缺口，正是这一缺口迫使太多老年人每年自掏腰包支付数千美元的处方药费用。这就是这份计划能为你们做的。
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. 所以别听信那些说你们的福利将被削减的吓人故事，尤其是一些散布这些荒诞说法的人，过去曾反对联邦医疗保险，而就在今年还支持了一份本质上会把联邦医疗保险变成私有化优惠券计划的预算。这在我的任内绝不会发生。我会保护联邦医疗保险。
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. 由于联邦医疗保险在医疗系统中占据如此大的比重，让该计划更高效有助于推动医疗服务方式的变革，从而降低所有人的成本。我们早就知道，有些机构——如犹他州的山间医疗保健或宾夕法尼亚州乡村的盖辛格医疗系统——以低于平均水平的成本提供高质量的医疗服务。
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. 因此，该委员会可以帮助鼓励全系统的医生和医疗专业人员采纳这些合乎常理的最佳做法——从降低医院感染率到促进医生团队之间更好的协作。
Reducing the waste and inefficiency in Medicare and Medicaid will pay for most of this plan. 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. 减少联邦医疗保险和医疗补助中的浪费与低效将为这份计划的大部分费用买单。剩余的大部分费用将来自制药公司和保险公司提供的收入，而它们恰恰将从数千万新客户中获益。
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. 这项改革还将对保险公司最昂贵的保单收费，从而鼓励它们提供更高的性价比——这一想法得到了民主党和共和党专家的支持。据这些专家所言，这一温和的举措从长远来看有助于为我们所有人压低医疗费用。
Now, finally, many in this chamber -- particularly on the Republican side of the aisle -- have long insisted that reforming our medical malpractice laws can help bring down the cost of health care. Now -- there you go. There you go. Now, I don't believe malpractice reform is a silver bullet, but I've talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs. 最后，本厅中许多人——尤其是共和党一侧——长期以来坚持认为，改革我们的医疗事故法有助于降低医疗费用。好了——你们说得对。你们说得对。我并不认为医疗事故改革是万能灵药，但我与足够多的医生交谈过，知道防御性医疗可能在推高不必要的成本。
So I'm proposing that we move forward on a range of ideas about how to put patient safety first and let doctors focus on practicing medicine. I know that the Bush administration considered authorizing demonstration projects in individual states to test these ideas. I think it's a good idea, and I'm directing my Secretary of Health and Human Services to move forward on this initiative today. 因此我提议，我们就一系列想法向前推进，研究如何把患者安全放在首位，让医生专注于行医。我知道布什政府曾考虑授权在个别州开展示范项目来检验这些想法。我认为这是个好主意，今天我就指示卫生与公众服务部部长推进这项举措。
Now, add it all up, and the plan I'm proposing will cost around $900 billion over 10 years -- less than we have spent on the Iraq and Afghanistan wars, and less than the tax cuts for the wealthiest few Americans that Congress passed at the beginning of the previous administration. Now, most of these costs will be paid for with money already being spent -- but spent badly -- in the existing health care system. The plan will not add to our deficit. The middle class will realize greater security, not higher taxes. 把这些加在一起，我所提议的计划十年内将耗资约九千亿美元——少于我们在伊拉克和阿富汗战争上的支出，也少于上一届政府初期国会通过的针对最富少数美国人的减税规模。其中大部分费用将用现有医疗系统中已经在花——但花得很糟——的钱来支付。这份计划不会增加我们的赤字。中产阶级将获得更大的保障，而非更高的税收。
And if we are able to slow the growth of health care costs by just one-tenth of 1 percent each year -- one-tenth of 1 percent -- it will actually reduce the deficit by $4 trillion over the long term. 如果我们能每年把医疗费用的增长放慢仅仅千分之一——千分之一——长期来看实际上将减少四万亿美元的赤字。
Now, this is the plan I'm proposing. It's a plan that incorporates ideas from many of the people in this room tonight -- Democrats and Republicans. And I will continue to seek common ground in the weeks ahead. If you come to me with a serious set of proposals, I will be there to listen. My door is always open. 这就是我所提议的计划。这份计划吸纳了今晚在座许多人——民主党人和共和党人——的想法。在接下来的几周里，我将继续寻求共识。如果你带着一套认真的提案来找我，我会倾听。我的门始终是敞开的。
But know this: I will not waste time with those who have made the calculation that it's better politics to kill this plan than to improve it. I won't stand by while the special interests use the same old tactics to keep things exactly the way they are. If you misrepresent what's in this plan, we will call you out. And I will not -- and I will not accept the status quo as a solution. Not this time. Not now. 但请明白：我不会把时间浪费在那些盘算着扼杀这份计划比改进它更有政治利益的人身上。当特殊利益集团用老一套手段让一切照旧时，我不会袖手旁观。如果你歪曲这份计划的内容，我们会当众指出来。我也不会——我也不会接受以现状作为解决方案。这一次不行。现在不行。
Everyone in this room knows what will happen if we do nothing. Our deficit will grow. More families will go bankrupt. More businesses will close. More Americans will lose their coverage when they are sick and need it the most. And more will die as a result. We know these things to be true. 在座各位都知道，如果我们无所作为，会发生什么。我们的赤字会增长。更多家庭会破产。更多企业会倒闭。更多美国人会在最需要保险的生病时刻失去保障。更多人因此死亡。我们深知这些是事实。
That is why we cannot fail. Because there are too many Americans counting on us to succeed -- the ones who suffer silently, and the ones who shared their stories with us at town halls, in e-mails, and in letters. 正因如此，我们不能失败。因为有太多美国人指望我们成功——那些默默承受痛苦的人，那些在市政厅会议、电子邮件和信件中与我们分享自身故事的人。
I received one of those letters a few days ago. It was from our beloved friend and colleague, Ted Kennedy. He had written it back in May, shortly after he was told that his illness was terminal. He asked that it be delivered upon his death. 几天前我收到了其中一封信。它来自我们挚爱的朋友和同事泰德·肯尼迪。他早在五月就写下了这封信，当时他刚被告知病情已到晚期。他请求在他去世后送达。
In it, he spoke about what a happy time his last months were, thanks to the love and support of family and friends, his wife, Vicki, his amazing children, who are all here tonight. And he expressed confidence that this would be the year that health care reform -- "that great unfinished business of our society," he called it -- would finally pass. He repeated the truth that health care is decisive for our future prosperity, but he also reminded me that "it concerns more than material things." 信中，他谈到自己最后几个月是多么幸福的时光，这得益于家人和朋友的爱与支持，他的妻子维基，他那出色的孩子们——他们今晚都来到现场。他表达了对今年将是医疗改革——他称之为“我们社会那项伟大的未竟事业”——最终得以通过的信心。他重申了医疗改革对我们未来繁荣具有决定性作用的真理，但也提醒我“它关乎的远不止物质层面”。
"What we face," he wrote, "is above all a moral issue; at stake are not just the details of policy, but fundamental principles of social justice and the character of our country." “我们所面对的，”他写道，“首先是一个道德问题；利害攸关的不仅是政策细节，更是社会公平的根本原则和我们国家的品格。”
I've thought about that phrase quite a bit in recent days -- the character of our country. One of the unique and wonderful things about America has always been our self-reliance, our rugged individualism, our fierce defense of freedom and our healthy skepticism of government. And figuring out the appropriate size and role of government has always been a source of rigorous and, yes, sometimes angry debate. That's our history. 近几天我反复思索这一表述——我们国家的品格。美国独特而可贵的品质之一，一向是我们的自力更生、粗犷的个人主义、对自由的坚决捍卫，以及对政府适度的警惕。探讨政府的适当规模和角色，历来是激烈乃至有时愤怒的辩论之源。这就是我们的历史。
For some of Ted Kennedy's critics, his brand of liberalism represented an affront to American liberty. In their minds, his passion for universal health care was nothing more than a passion for big government. 在泰德·肯尼迪的一些批评者看来，他那种自由主义是对美国自由的冒犯。在他们心中，他对全民医保的热忱无非是对大政府的迷恋。
But those of us who knew Teddy and worked with him here -- people of both parties -- know that what drove him was something more. His friend Orrin Hatch -- he knows that. They worked together to provide children with health insurance. His friend John McCain knows that. They worked together on a Patient's Bill of Rights. His friend Chuck Grassley knows that. They worked together to provide health care to children with disabilities. 但我们这些认识泰迪并在此与他共事的人——两党人士都有——知道驱动他的是更深层的东西。他的朋友奥林·哈奇——他知道这一点。他们曾合作推动为儿童提供医疗保险。他的朋友约翰·麦凯恩知道这一点。他们曾共同推动《患者权利法案》。他的朋友查克·格拉斯利知道这一点。他们曾合作为残疾儿童提供医疗保障。
On issues like these, Ted Kennedy's passion was born not of some rigid ideology, but of his own experience. It was the experience of having two children stricken with cancer. He never forgot the sheer terror and helplessness that any parent feels when a child is badly sick. And he was able to imagine what it must be like for those without insurance, what it would be like to have to say to a wife or a child or an aging parent, there is something that could make you better, but I just can't afford it. 在这些议题上，泰德·肯尼迪的热忱并非源于某种僵化的意识形态，而是源自他的亲身经历。那是两个孩子罹患癌症的经历。他从未忘记任何一个父母在孩子重病时感到的那种纯粹的恐惧与无助。他也能想象那些没有保险的人会是怎样的处境——不得不对妻子、孩子或年迈的父母说，有办法可以治好你，但我就是负担不起。
That large-heartedness -- that concern and regard for the plight of others -- is not a partisan feeling. It's not a Republican or a Democratic feeling. It, too, is part of the American character -- our ability to stand in other people's shoes; a recognition that we are all in this together, and when fortune turns against one of us, others are there to lend a helping hand; a belief that in this country, hard work and responsibility should be rewarded by some measure of security and fair play; and an acknowledgment that sometimes government has to step in to help deliver on that promise. 那种宽宏的胸怀——对他人困境的关切与体恤——并非党派之情。它不是共和党的或民主党的情感。它同样也是美国品格的一部分——我们设身处地为他人着想的能力；一种我们命运与共的认同，当厄运降临到其中一人身上时，其他人会伸出援手；一种信念：在这个国家，辛勤工作和承担责任应得到一定程度的保障和公平对待；一种承认：有时候政府必须出手帮助兑现这一承诺。
This has always been the history of our progress. In 1935, when over half of our seniors could not support themselves and millions had seen their savings wiped away, there were those who argued that Social Security would lead to socialism, but the men and women of Congress stood fast, and we are all the better for it. In 1965, when some argued that Medicare represented a government takeover of health care, members of Congress -- Democrats and Republicans -- did not back down. They joined together so that all of us could enter our golden years with some basic peace of mind. 这历来是我们进步的历史。一九三五年，当超过半数的老年人无法自给自足、数百万人眼睁睁看着积蓄化为乌有时，有人争辩说社会保障会导致社会主义，但国会中的男男女女立场坚定，我们今日皆因此受益。一九六五年，当有人争辩说联邦医疗保险意味着政府对医疗的接管时，国会议员们——民主党人和共和党人——没有退缩。他们携手合作，让我们所有人都能带着些许基本的心安步入晚年。
You see, our predecessors understood that government could not, and should not, solve every problem. They understood that there are instances when the gains in security from government action are not worth the added constraints on our freedom. But they also understood that the danger of too much government is matched by the perils of too little; that without the leavening hand of wise policy, markets can crash, monopolies can stifle competition, the vulnerable can be exploited. 你看，我们的前辈明白，政府不能也不应该解决所有问题。他们明白，有时政府行动带来的安全保障并不值得以额外的自由受限为代价。但他们也明白，政府过度的危险与政府不足的危险相当；没有明智政策的调节之手，市场可能崩溃，垄断可能扼杀竞争，弱势群体可能被剥削。
And they knew that when any government measure, no matter how carefully crafted or beneficial, is subject to scorn; when any efforts to help people in need are attacked as un-American; when facts and reason are thrown overboard and only timidity passes for wisdom, and we can no longer even engage in a civil conversation with each other over the things that truly matter -- that at that point we don't merely lose our capacity to solve big challenges. We lose something essential about ourselves. 他们也知道，当任何一项政府举措——无论多么精心设计或多么有益——都遭到鄙夷；当任何帮助困难之人的努力都被攻击为非美国式；当事实与理性被抛诸脑后，只有怯懦被当作智慧，我们甚至无法再就真正重要的事情进行文明的对话——到那时，我们失去的不仅仅是应对重大挑战的能力。我们失去的是我们自身某些本质的东西。
That was true then. It remains true today. I understand how difficult this health care debate has been. I know that many in this country are deeply skeptical that government is looking out for them. I understand that the politically safe move would be to kick the can further down the road -- to defer reform one more year, or one more election, or one more term. 那时如此。今天依然如此。我理解这场医疗改革辩论有多么艰难。我知道我国许多人深为怀疑政府是否在为他们着想。我明白，政治上稳妥的做法是把难题继续往后推——把改革再推迟一年、再推迟一次选举、再推迟一届任期。
But that is not what the moment calls for. That's not what we came here to do. We did not come to fear the future. We came here to shape it. I still believe we can act even when it's hard. I still believe -- I still believe that we can act when it's hard. I still believe we can replace acrimony with civility, and gridlock with progress. I still believe we can do great things, and that here and now we will meet history's test. 但这并非当下所要求的。这不是我们来这里要做的。我们来到这里不是为了惧怕未来。我们来这里是为了塑造未来。我依然相信，即便困难重重我们也能行动。我依然相信——我依然相信，即便困难重重我们也能行动。我依然相信我们能用文明取代尖刻，用进步取代僵局。我依然相信我们能成就伟业，此时此地，我们将通过历史的考验。
Because that's who we are. That is our calling. That is our character. Thank you, God bless you, and may God bless the United States of America. 因为这便是我们之所以为我们。这是我们的使命。这是我们的品格。谢谢各位，愿上帝保佑你们，愿上帝保佑美利坚合众国。
