The demand of our people in 1980 is not for smaller government or bigger government but for better government. Some say that government is always bad… - Ted Kennedy

I've heard the critics complain about the costs of change. I'm confident that at the end of the process, the change will be paid for—fairly, responsibly, and without adding to the federal deficit. It doesn't make sense to negotiate in the pages of NEWSWEEK, but I will say that I'm open to many options, including a surtax on the wealthy, as long as it meets the principle laid down by President Obama: that there will be no tax increases on anyone making less than $250,000 a year. What I haven't heard the critics discuss is the cost of inaction. If we don't reform the system, if we leave things as they are, health-care inflation will cost far more over the next decade than health-care reform. We will pay far more for far less—with millions more Americans uninsured or underinsured.

We had conversations with Mel Laird about how we were going to proceed. He had basically the concept of pay-or-play, which we would grab today if we had that opportunity, which meant that you either have an insurance program for your people or you pay into a fund. That concept is used in Europe in their industry, not only for health but also for training programs. They have training programs with the requirement that you either have to train a certain percentage of your workers in a continuing training program, or you have to pay into a fund that will continue to train them, and so you have an ongoing and continuing training program. That was what we called the school-to-work program, which we actually implemented here during the [William] Clinton Administration. But the only way we could get it passed was if we sunsetted it, and we sunsetted it, and the Republicans wouldn’t vote to continue it, which was a good program. Now we’re into the ’70s, where Nixon gets impeached, and so that whole effort collapses.

To help finance a bill, the pharmaceutical industry has agreed to lower prices for seniors, not only saving them money for prescriptions but also saving the government tens of billions in Medicare payments over the next decade. Senator Baucus has agreed with hospitals on more than $100 billion in savings. We're working with Republicans to make this a bipartisan effort. Everyone won't be satisfied—and no one will get everything they want. But we need to come together, just as we've done in other great struggles—in World War II and the Cold War, in passing the great civil-rights laws of the 1960s, and in daring to send a man to the moon. If we don't get every provision right, we can adjust and improve the program next year or in the years to come. What we can't afford is to wait another generation.