Transcript of Obama’s Health Care Speech (and the GOP response)

Transcript of the GOP Response to Obama’s Speech

The full text of President Obama’s address on health care to the Joint Session of Congress:


Madame Speaker, Vice President Biden, Members of Congress, and the American people:

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.

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 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 have taken since January, I can stand here with
confidence and say that we have pulled this economy back from the

I want to thank the members of this body for your efforts and your
support in these last several months, and especially those who have
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.

But we did not come here just to clean up crises. We came 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.

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.

Our collective failure to meet this challenge – year after year,
decade after decade – has led us to a 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. 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 expensive to cover.

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We are the only advanced democracy on Earth – the only wealthy
nation – that allows such hardships for millions of its people. There
are now more than thirty 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.

But the problem that plagues the health care system is not just a
problem of 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.

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 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.

Then there’s the problem of rising costs. 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 $1000 per year that pays for
somebody else’s emergency room and charitable care.

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.

These are the facts. Nobody disputes them. We know we must reform this system. The question is how.

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 everyone. On the right, there are those who argue
that we should end the employer-based system and leave individuals to
buy health insurance on their own.

I have to say that there are arguments to be made for both
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.

During that time, we have seen Washington at its best and its worst.

We have 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.
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 eighty percent of what needs to be
done, putting us closer to the goal of reform than we have ever been.

But what we have also seen in these last months is the same partisan
spectacle that only hardens the disdain many Americans have toward
their own government. Instead of honest debate, we have 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.

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.

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 to those who don’t. And it will
slow the growth of health care costs for our families, our businesses,
and our government. It’s a plan that asks everyone to take
responsibility for meeting this challenge – not just government and
insurance companies, but 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.

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, Medicare, 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.

What this plan will do is to 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 pre-existing 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 most. They will no longer be able to place some arbitrary
cap on the amount of coverage you can receive in a given year or 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. 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.

That’s what Americans who have health insurance can expect from this plan – more security and stability.

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
change your job, you will be able to get coverage. If you strike out on
your own and start a small business, you will be able to get coverage.
We will 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. 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’ve given ourselves.

For those individuals and small businesses who still cannot afford
the lower-priced insurance available in the exchange, we will 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.
In the meantime, for those Americans who can’t get insurance today
because they have pre-existing 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
embrace it.

Now, even if we provide these affordable options, there may be those
– particularly the young and 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. The problem is, such irresponsible behavior
costs all the rest of us money. If there are affordable options and
people still don’t sign up for health insurance, it means we pay for
those 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 pre-existing conditions – just
can’t be achieved.

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, businesses will be required to either offer their
workers health care, or chip in to help cover the cost of their
workers. There will be a hardship waiver for those individuals who
still cannot afford coverage, and 95% of all small businesses, because
of their size and narrow profit margin, would be exempt from these
requirements. But we cannot 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.

While there remain some significant details to be ironed out, 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

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 that many Americans have grown nervous about
reform. So tonight I’d like to address some of the key controversies
that are still out there.

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
prominent politicians, that we plan to set up panels of bureaucrats
with the power to kill off senior citizens. Such a charge would be
laughable if it weren’t so cynical and irresponsible. It is a lie,
plain and simple.

There are also those who claim that our reform effort will insure
illegal immigrants. This, too, is false – the reforms I’m proposing
would not apply to those who are here illegally. 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.

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.

So let me set the record straight. My guiding principle is, and
always has been, that consumers do better when there is choice and
competition. Unfortunately, in 34 states, 75% of the insurance market
is controlled by five or fewer companies. In Alabama, almost 90% is
controlled by just one company. Without competition, the price of
insurance goes up and the 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

Insurance executives don’t do this because they are 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.”

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. 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. 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% of
Americans would sign up.

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 have
insisted that like any private insurance company, the public insurance
option would have to be self-sufficient and rely on the premiums it
collects. But by avoiding some of the overhead that gets eaten up at
private companies by profits, excessive administrative costs and
executive salaries, it could provide a good deal for consumers. It
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.

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, the right, or the media.
It is only one part of my plan, and should not be used as a handy
excuse for the usual Washington ideological battles. 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
affordable for those without it. 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.

For example, some have suggested that that the public option go into
effect only in those markets where insurance companies are not
providing affordable policies. Others propose 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

Finally, let me discuss an issue that is a great concern to me, to
members of this chamber, and to the public – and that is how we pay for
this plan.

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. 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. 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.

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 doesn’t
make us 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.

In fact, I want to speak directly to America’s seniors for a moment,
because Medicare is another issue that’s been subjected to demagoguery
and distortion during the course of this debate.

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 is how
Medicare was born. And it remains a sacred trust that must be passed
down from one generation to the next. That is why not a dollar of the
Medicare trust fund will be used to pay for this plan.

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 and nothing to improve your care. And we will also
create an independent commission of doctors and medical experts charged
with identifying more waste in the years ahead.

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 pocket for prescription drugs. 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
have essentially turned Medicare into a privatized voucher program.
That will never happen on my watch. I will protect Medicare.

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. 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. 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. 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.

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. I don’t
believe malpractice reform is a silver bullet, but I have talked to
enough doctors to know that defensive medicine may be contributing to
unnecessary costs. So I am 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
issues. It’s a good idea, and I am directing my Secretary of Health and
Human Services to move forward on this initiative today.

Add it all up, and the plan I’m proposing will cost around $900
billion over ten 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. 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. And if we are able to slow the growth of
health care costs by just one-tenth of one percent each year, it will
actually reduce the deficit by $4 trillion over the long term.

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.

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 improve
it. I will not 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 the plan, we will call you out. And I will not accept the
status quo as a solution. Not this time. Not now.

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 most. And more will die as a result. We know these things to be

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 hall meetings, in emails, and
in letters.

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.

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, and his
children, who are 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.” “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.”

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 sometimes angry debate.

For some of Ted Kennedy’s critics, his brand of liberalism
represented an affront to American liberty. In their mind, his passion
for universal health care was nothing more than a passion for big

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, 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

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.

That large-heartedness – that concern and regard for the plight of
others – is not a partisan feeling. It is 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; that 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 acknowledgement that sometimes government has to step
in to help deliver on that promise.

This has always been the history of our progress. In 1933, 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.

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, and the vulnerable can be
exploited. 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.

What was true then 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.

But that’s 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 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.

Because that is 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.

3 replies »

  1. President Obama has presented good solutions to long-standing healthcare coverage. He has placed accountability where it belongs–on the individual, on business, and on government. It is a shared responsibility. I’m glad he addressed the so-called “death panel” scare tactic. Advance directives addressing end-of-life issues are not just for the elderly and ill, it’s for all adults. Age 18 is not too soon to have advance directives. Think of those who go to war and of the high rate of death and severe injury from accidents and other causes in the 18-25 year age group. As a hospice nurse, I meet with patients and families who have made no plans. It’s often difficult for them to make those plans when trying to cope with a life-threatening illness. The kindest thing we can do for ourselves and our families is to have advance directives in place before they are needed.

  2. Stop Obama? He is trying to help all Americans live healthier lives. Maybe you are one out of the few that have health care so you have nothing to worry about.

  3. We need to stop Obama and especially anyone calling for a truer capitalist system using the idea of single payer option.
    We need to make sure the corporate health insurance companies stay in control, and continue denying people access if they need to….all for the sake of making lucrative profits for their share holders, through devious manipulations of the system using teams of lawyers and immoral actions.
    Let’s make sure corporate powers retain their might and control, with patents and greed. Profit before health and sanity of people – this is the American way we must retain for our children and grandchildren, isn’t it?
    Oh wait…..we cannot eat money and use cash to treat our wounds when it’s all said and done…..maybe I (America) will re-think such a system.
    “The profit motive, when it is the sole basis of an economic system, encourages a cutthroat competition and selfish ambition that inspires men to be more concerned about making a living than making a life.”
    – MLK, Jr.

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