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    美国新医改法案签署仪式在白宫东厅举行，这标志着美国民主党酝酿百年的医改方案获得历史性的突破。

    美国总统奥巴马、副总统拜登以及国会众议院议长佩洛西等民主党人出席仪式。拜登首先发表讲话，感谢民主党同仁为医改议案投下赞成票。“这是历史性的一天，”拜登说，“你们负起责任，改写历史……你们是领导者。”在场者随即热烈鼓掌。掌声中，拜登侧身对站在身旁的奥巴马说：“这是你应得的……你是令医改成为现实的那个人。”掌声过后，拜登继续说：“健康是最大的财富，如今，美国人更加富有，因为他们更加健康。”现场再次响起掌声。２００８年，全美３亿人口中约有４６３０万人没有医保。根据奥氏医改法案，美国政府今后１０年将投入９４００亿美元，把３２００万人纳入医保体系，将覆盖率从８５％提升至９５％，接近全民医保.

　  奥巴马说：“在春天到来的时刻，众议院通过了这项历史性的法案，这也将标志着美国进入一个新的时期。”他说：“在长达一个世纪的尝试，长达一年的辩论，以及所有的投票统计环节后，医疗保险改革终于在今天正式成为美国法律的一部分。”

    值得一提的是奥巴马签名时，总共换了22支笔才完成。事实上，奥巴马频繁换笔只是在遵循华盛顿一项鲜为人知的传统。用好几支笔签署重要法案的做法，至少是从罗斯福时代就已开始，现在则成了美国政府的小怪癖之一。道理十分简单，用来签署历史性法案的笔，本身会变成具有历史意义的物品。总统用的笔越多，就会有越多的礼物，可以送给在这个立法过程中有贡献的人物。白宫通常会在这些笔上刻字，送给新法的主要提倡者和支持者。

      众议院通过“参议院”的版本，意味着国会已经可以将这个法案提交奥巴马签署完成正式立法。“预算协调”修改法案反映的主要是众议院的民主党人对“参议院”版本不满的地方，包括了各种修改意见。如果“预算协调”的修改法案几天后在参议院获得通过，则两份议案将合为一个，成为奥巴马签署的最终议案，即使“预算修改”法案没有获得通过，奥巴马也将签署已经获得参众两院通过的“参议院版本”使其成为正式法律。这样对奥巴马实现美国历史上最大规模的医疗改革并没有太大的影响。

　　奥巴马还特意提到自己的母亲，表示他的母亲即使在身患癌症，即将去逝时，也一直在向保险公司要求改革。他说：“我也代表我的母亲，将医疗改革签署立法。”

　　由于参议院将在本周讨论医改修正案，共和党议员说，他们将尽力阻止修正案通过。他们甚至恫言，如果在11月的中期选举后重夺国会控制权，就要废除医改法案。

　　共和党人说，对该法案获得通过的愤慨使得他们很难在未来就其他提案与民主党保持合作，包括了气候改变立法以及移民法改革。他们将通过国会议事程序，挑战医改修正案；如果成功，修正案可能送回众议院表决。

奥巴马和拜登在签署仪式上讲话

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THE VICE PRESIDENT:  Thank you. 

Mr. President, I think we got a happy room here.  (Laughter.)  It seems ridiculous to say thank you all for being here.  (Laughter.)  Ladies and gentlemen, to state the obvious, this is a historic day.  (Applause.) 

In our business you use that phrase a lot, but I can't think of a day in the 37 years that I've been a United States senator and the short time I've been Vice President that it is more appropriately stated.  This is a historic day. 

And history -- history is not merely what is printed in textbooks.  It doesn’t begin or end with the stroke of a pen.  History is made.  History is made when men and women decide that there is a greater risk in accepting a situation that we cannot bear than in steeling our spine and embracing the promise of change.  That's when history is made.  (Applause.) 

History is made when you all assembled here today, members of Congress, take charge to change the lives of tens of millions of Americans.  Through the efforts of those of us lucky enough to serve here in this town, that's exactly what you’ve done.  You’ve made history.

History is made when a leader steps up, stays true to his values, and charts a fundamentally different course for the country.  History is made when a leader’s passion -- passion -- is matched with principle to set a new course.  Well, ladies and gentlemen, Mr. President, you are that leader.  (Applause.)

Mr. President, your fierce advocacy, the clarity of purpose that you showed, your perseverance -- these are in fact -- it is not hyperbole to say -- these are the reasons why we're assembled in this room together, today.  But for those attributes we would not be here.  Many, many men and women are going to feel the pride that I feel in watching you shortly, watching you sign this bill, knowing that their work -- their work has helped make this day possible.  But, Mr. President, you’re the guy that made it happen.  (Applause.)

And so, Mr. President, all of us, press and elected officials, assembled in this town over the years, we’ve seen some incredible things happen.  But you know, Mr. President, you’ve done what generations of not just ordinary, but great men and women, have attempted to do.  Republicans as well as Democrats, they’ve tried before.  Everybody knows the story, starting with Teddy Roosevelt.  They’ve tried.  They were real bold leaders. 
But, Mr. President, they fell short.  You have turned, Mr. President, the right of every American to have access to decent health care into reality for the first time in American history. (Applause.)

Mr. President, I’ve gotten to know you well enough.  You want me to stop because I’m embarrassing you.  (Laughter.)  But I’m not going to stop for another minute, Mr. President, because you delivered on a promise -- a promise you made to all Americans when we moved into this building. 

Mr. President, you are -- to repeat myself -- literally about to make history.  Our children and our grandchildren, they’re going to grow up knowing that a man named Barack Obama put the final girder in the framework for a social network in this country to provide the single most important element of what people need -- and that is access to good health -- (applause) -- and that every American from this day forward will be treated with simple fairness and basic justice.

Look, the classic poet, Virgil, once said that “The greatest wealth is health.”  The greatest wealth is health.  Well, today, America becomes a whole lot wealthier because tens of millions of Americans will be a whole lot healthier from this moment on.

Ladies and gentlemen, the President of the United States of America, Barack Obama.  (Applause.)

THE PRESIDENT:  Thank you, everybody.  Thank you.  (Applause.)  Thank you.  Thank you, everybody.  Thank you.  Thank you everybody.  Thank you so much.  Thank you.  Thank you.  (Applause.)  Thank you, everybody.  Please, have a seat.

Thank you, Joe.  (Laughter.)

THE VICE PRESIDENT:  Good to be with you, Mr. President.  (Laughter.)

THE PRESIDENT:  Today, after almost a century of trying; today, after over a year of debate; today, after all the votes have been tallied –- health insurance reform becomes law in the United States of America.  (Applause.)  Today.

It is fitting that Congress passed this historic legislation this week.  For as we mark the turning of spring, we also mark a new season in America.  In a few moments, when I sign this bill, all of the overheated rhetoric over reform will finally confront the reality of reform.  (Applause.)

And while the Senate still has a last round of improvements to make on this historic legislation -- and these are improvements I’m confident they will make swiftly -- (applause)  -- the bill I’m signing will set in motion reforms that generations of Americans have fought for, and marched for, and hungered to see.

It will take four years to implement fully many of these reforms, because we need to implement them responsibly.  We need to get this right.  But a host of desperately needed reforms will take effect right away.  (Applause.)

This year, we’ll start offering tax credits to about 4 million small businessmen and women to help them cover the cost of insurance for their employees.  (Applause.)  That happens this year.

This year, tens of thousands of uninsured Americans with preexisting conditions, the parents of children who have a preexisting condition, will finally be able to purchase the coverage they need.  That happens this year.  (Applause.)

This year, insurance companies will no longer be able to drop people’s coverage when they get sick.  (Applause.)  They won’t be able to place lifetime limits or restrictive annual limits on the amount of care they can receive.  (Applause.)

This year, all new insurance plans will be required to offer free preventive care.  And this year, young adults will be able to stay on their parents’ policies until they’re 26 years old.  That happens this year.  (Applause.)

And this year, seniors who fall in the coverage gap known as the doughnut hole will start getting some help.  They’ll receive $250 to help pay for prescriptions, and that will, over time, fill in the doughnut hole.  And I want seniors to know, despite what some have said, these reforms will not cut your guaranteed benefits.  (Applause.)  In fact, under this law, Americans on Medicare will receive free preventive care without co-payments or deductibles.  That begins this year.  (Applause.)

Once this reform is implemented, health insurance exchanges will be created, a competitive marketplace where uninsured people and small businesses will finally be able to purchase affordable, quality insurance.  They will be able to be part of a big pool and get the same good deal that members of Congress get.  That’s what’s going to happen under this reform.  (Applause.)  And when this exchange is up and running, millions of people will get tax breaks to help them afford coverage, which represents the largest middle-class tax cut for health care in history.   That's what this reform is about.  (Applause.)  

This legislation will also lower costs for families and for businesses and for the federal government, reducing our deficit by over $1 trillion in the next two decades.  It is paid for.  It is fiscally responsible.  And it will help lift a decades-long drag on our economy.  That's part of what all of you together worked on and made happen.  (Applause.) 

That our generation is able to succeed in passing this reform is a testament to the persistence –- and the character -– of the American people, who championed this cause; who mobilized; who organized; who believed that people who love this country can change it.

It’s also a testament to the historic leadership -– and uncommon courage –- of the men and women of the United States Congress, who’ve taken their lumps during this difficult debate. (Laughter.) 

AUDIENCE MEMBER:  Yes, we did.  (Laughter.)

THE PRESIDENT:  You know, there are few tougher jobs in politics or government than leading one of our legislative chambers.  In each chamber, there are men and women who come from different places and face different pressures, who reach different conclusions about the same things and feel deeply concerned about different things.

By necessity, leaders have to speak to those different concerns.  It isn’t always tidy; it is almost never easy.  But perhaps the greatest –- and most difficult –- challenge is to cobble together out of those differences the sense of common interest and common purpose that’s required to advance the dreams of all people -- especially in a country as large and diverse as ours.

And we are blessed by leaders in each chamber who not only do their jobs very well but who never lost sight of that larger mission.  They didn’t play for the short term; they didn’t play to the polls or to politics:  One of the best speakers the House of Representatives has ever had, Speaker Nancy Pelosi.  (Applause.)

AUDIENCE:  Nancy!  Nancy!  Nancy!  Nancy!

THE PRESIDENT:  One of the best majority leaders the Senate has ever had, Mr. Harry Reid.  (Applause.) 

To all of the terrific committee chairs, all the members of Congress who did what was difficult, but did what was right, and passed health care reform -- not just this generation of Americans will thank you, but the next generation of Americans will thank you. 

And of course, this victory was also made possible by the painstaking work of members of this administration, including our outstanding Secretary of Health and Human Services, Kathleen Sebelius -- (applause) -- and one of the unsung heroes of this effort, an extraordinary woman who led the reform effort from the White House, Nancy-Ann DeParle.  Where’s Nancy?  (Applause.)

Today, I’m signing this reform bill into law on behalf of my mother, who argued with insurance companies even as she battled cancer in her final days.

I’m signing it for Ryan Smith, who’s here today.  He runs a small business with five employees.  He’s trying to do the right thing, paying half the cost of coverage for his workers.  This bill will help him afford that coverage.

I’m signing it for 11-year-old Marcelas Owens, who’s also here.  (Applause.)  Marcelas lost his mom to an illness.  And she didn’t have insurance and couldn’t afford the care that she needed.  So in her memory he has told her story across America so that no other children have to go through what his family has experienced.  (Applause.)

I’m signing it for Natoma Canfield.  Natoma had to give up her health coverage after her rates were jacked up by more than 40 percent.  She was terrified that an illness would mean she’d lose the house that her parents built, so she gave up her insurance.  Now she’s lying in a hospital bed, as we speak, faced with just such an illness, praying that she can somehow afford to get well without insurance.  Natoma’s family is here today because Natoma can’t be.  And her sister Connie is here.  Connie, stand up.  (Applause.)

I’m signing this bill for all the leaders who took up this cause through the generations -- from Teddy Roosevelt to Franklin Roosevelt, from Harry Truman, to Lyndon Johnson, from Bill and Hillary Clinton, to one of the deans who’s been fighting this so long, John Dingell.  (Applause.)  To Senator Ted Kennedy.  (Applause.)  And it’s fitting that Ted’s widow, Vicki, is here -- it’s fitting that Teddy’s widow, Vicki, is here; and his niece Caroline; his son Patrick, whose vote helped make this reform a reality.  (Applause.)

I remember seeing Ted walk through that door in a summit in this room a year ago -- one of his last public appearances.  And it was hard for him to make it.  But he was confident that we would do the right thing.

Our presence here today is remarkable and improbable.  With all the punditry, all of the lobbying, all of the game-playing that passes for governing in Washington, it’s been easy at times to doubt our ability to do such a big thing, such a complicated thing; to wonder if there are limits to what we, as a people, can still achieve.  It’s easy to succumb to the sense of cynicism about what’s possible in this country.

But today, we are affirming that essential truth -– a truth every generation is called to rediscover for itself –- that we are not a nation that scales back its aspirations.  (Applause.)  We are not a nation that falls prey to doubt or mistrust.  We don't fall prey to fear.  We are not a nation that does what’s easy.  That’s not who we are.  That’s not how we got here.

We are a nation that faces its challenges and accepts its responsibilities.  We are a nation that does what is hard.  What is necessary.  What is right.  Here, in this country, we shape our own destiny.  That is what we do.  That is who we are.  That is what makes us the United States of America. 

And we have now just enshrined, as soon as I sign this bill, the core principle that everybody should have some basic security when it comes to their health care.  (Applause.)  And it is an extraordinary achievement that has happened because of all of you and all the advocates all across the country.

So, thank you.  Thank you.  God bless you, and may God bless the United States.  (Applause.)  Thank you.  Thank you.

All right, I would now like to call up to stage some of the members of Congress who helped make this day possible, and some of the Americans who will benefit from these reforms.  And we’re going to sign this bill.

This is going to take a little while.  I’ve got to use every pen, so it’s going to take a really long time.  (Laughter.)  I didn’t practice.  (Laughter.)

(The bill is signed.) 

We are done.  (Applause.)