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Last night, President Obama spoke to the NAACP centennial convention. (Watch the video here.)

THE PRESIDENT: Thank you. What an extraordinary night, capping off an extraordinary week, capping off an extraordinary 100 years at the NAACP. (Applause.)



So Chairman Bond, Brother Justice, I am so grateful to all of you for being here. It's just good to be among friends. (Applause.)



It is an extraordinary honor to be here, in the city where the NAACP was formed, to mark its centennial. What we celebrate tonight is not simply the journey the NAACP has traveled, but the journey that we, as Americans, have traveled over the past 100 years. (Applause.)



It's a journey that takes us back to a time before most of us were born, long before the Voting Rights Act, and the Civil Rights Act, Brown v. Board of Education; back to an America just a generation past slavery. It was a time when Jim Crow was a way of life; when lynchings were all too common; when race riots were shaking cities across a segregated land.



It was in this America where an Atlanta scholar named W.E.B. Du Bois -- (applause) -- a man of towering intellect and a fierce passion for justice, sparked what became known as the Niagara movement; where reformers united, not by color, but by cause; where an association was born that would, as its charter says, promote equality and eradicate prejudice among citizens of the United States.



From the beginning, these founders understood how change would come -- just as King and all the civil rights giants did later. They understood that unjust laws needed to be overturned; that legislation needed to be passed; and that Presidents needed to be pressured into action. They knew that the stain of slavery and the sin of segregation had to be lifted in the courtroom, and in the legislature, and in the hearts and the minds of Americans.



They also knew that here, in America, change would have to come from the people. It would come from people protesting lynchings, rallying against violence, all those women who decided to walk instead of taking the bus, even though they were tired after a long day of doing somebody else's laundry, looking after somebody else's children. (Applause.) It would come from men and women of every age and faith, and every race and region -- taking Greyhounds on Freedom Rides; sitting down at Greensboro lunch counters; registering voters in rural Mississippi, knowing they would be harassed, knowing they would be beaten, knowing that some of them might never return.



Because of what they did, we are a more perfect union. Because Jim Crow laws were overturned, black CEOs today run Fortune 500 companies. (Applause.) Because civil rights laws were passed, black mayors, black governors, and members of Congress served in places where they might once have been able [sic] not just to vote but even take a sip of water. And because ordinary people did such extraordinary things, because they made the civil rights movement their own, even though there may not be a plaque or their names might not be in the history books -- because of their efforts I made a little trip to Springfield, Illinois, a couple years ago -- (applause) -- where Lincoln once lived, and race riots once raged -- and began the journey that has led me to be here tonight as the 44th President of the United States of America. (Applause.)



Because of them I stand here tonight, on the shoulders of giants. And I'm here to say thank you to those pioneers and thank you to the NAACP. (Applause.)



And yet, even as we celebrate the remarkable achievements of the past 100 years; even as we inherit extraordinary progress that cannot be denied; even as we marvel at the courage and determination of so many plain folk -- we know that too many barriers still remain.



We know that even as our economic crisis batters Americans of all races, African Americans are out of work more than just about anybody else -- a gap that's widening here in New York City, as a detailed report this week by Comptroller Bill Thompson laid out. (Applause.)



We know that even as spiraling health care costs crush families of all races, African Americans are more likely to suffer from a host of diseases but less likely to own health insurance than just about anybody else.



We know that even as we imprison more people of all races than any nation in the world, an African American child is roughly five times as likely as a white child to see the inside of a prison.



We know that even as the scourge of HIV/AIDS devastates nations abroad, particularly in Africa, it is devastating the African American community here at home with disproportionate force. We know these things. (Applause.)



These are some of the barriers of our time. They're very different from the barriers faced by earlier generations. They're very different from the ones faced when fire hoses and dogs were being turned on young marchers; when Charles Hamilton Houston and a group of young Howard lawyers were dismantling segregation case by case across the land.



But what's required today -- what's required to overcome today's barriers is the same as what was needed then. The same commitment. The same sense of urgency. The same sense of sacrifice. The same sense of community. The same willingness to do our part for ourselves and one another that has always defined America at its best and the African American experience at its best. (Applause.)



And so the question is, where do we direct our efforts? What steps do we take to overcome these barriers? How do we move forward in the next 100 years?



The first thing we need to do is make real the words of the NAACP charter and eradicate prejudice, bigotry, and discrimination among citizens of the United States. (Applause.) I understand there may be a temptation among some to think that discrimination is no longer a problem in 2009. And I believe that overall, there probably has never been less discrimination in America than there is today. I think we can say that.



But make no mistake: The pain of discrimination is still felt in America. (Applause.) By African American women paid less for doing the same work as colleagues of a different color and a different gender. (Laughter.) By Latinos made to feel unwelcome in their own country. (Applause.) By Muslim Americans viewed with suspicion simply because they kneel down to pray to their God. (Applause.) By our gay brothers and sisters, still taunted, still attacked, still denied their rights. (Applause.)



On the 45th anniversary of the Civil Rights Act, discrimination cannot stand -- not on account of color or gender; how you worship or who you love. Prejudice has no place in the United States of America. That's what the NAACP stands for. That's what the NAACP will continue to fight for as long as it takes. (Applause.)



But we also know that prejudice and discrimination -- at least the most blatant types of prejudice and discrimination -- are not even the steepest barriers to opportunity today. The most difficult barriers include structural inequalities that our nation's legacy of discrimination has left behind; inequalities still plaguing too many communities and too often the object of national neglect.



These are barriers we are beginning to tear down one by one -- by rewarding work with an expanded tax credit; by making housing more affordable; by giving ex-offenders a second chance. (Applause.) These are barriers we're targeting through our White House Office on Urban Affairs, through programs like Promise Neighborhoods that builds on Geoffrey Canada's success with the Harlem Children's Zone -- (applause) -- that foster a comprehensive approach to ending poverty by putting all children on a pathway to college, and giving them the schooling and after-school support that they need to get there. (Applause.)



I think all of us understand that our task of reducing these structural inequalities has been made more difficult by the state and structure of our broader economy; an economy that for the last decade has been fueled by a cycle of boom and bust; an economy where the rich got really, really rich, but ordinary folks didn't see their incomes or their wages go up; an economy built on credit cards, shady mortgage loans; an economy built not on a rock, but on sand.



That's why my administration is working so hard not only to create and save jobs in the short-term, not only to extend unemployment insurance and help for people who have lost their health care in this crisis, not just to stem the immediate economic wreckage, but to lay a new foundation for growth and prosperity that will put opportunity within the reach of not just African Americans, but all Americans. All Americans. (Applause.) Of every race. Of every creed. From every region of the country. (Applause.) We want everybody to participate in the American Dream. That's what the NAACP is all about. (Applause.)



Now, one pillar of this new foundation is health insurance for everybody. (Applause.) Health insurance reform that cuts costs and makes quality health coverage affordable for all, and it closes health care disparities in the process. Another pillar is energy reform that makes clean energy profitable, freeing America from the grip of foreign oil; putting young people to work upgrading low-income homes, weatherizing, and creating jobs that can't be outsourced. Another pillar is financial reform with consumer protections to crackdown on mortgage fraud and stop predatory lenders from targeting black and Latino communities all across the country. (Applause.)



All these things will make America stronger and more competitive. They will drive innovation, they will create jobs, they will provide families with more security. And yet, even if we do all that, the African American community will still fall behind in the United States and the United States will fall behind in the world unless we do a far better job than we have been doing of educating our sons and daughters. (Applause.)



I hope you don't mind -- I want to go into a little detail here about education. (Applause.) In the 21st century -- when so many jobs will require a bachelor's degree or more, when countries that out-educate us today will out-compete us tomorrow -- a world-class education is a prerequisite for success.



There's no two ways about it. There's no way to avoid it. You know what I'm talking about. There's a reason the story of the civil rights movement was written in our schools. There's a reason Thurgood Marshall took up the cause of Linda Brown. There's a reason why the Little Rock Nine defied a governor and a mob. It's because there is no stronger weapon against inequality and no better path to opportunity than an education that can unlock a child's God-given potential. (Applause.)



And yet, more than half a century after Brown v. Board, the dream of a world-class education is still being deferred all across the country. African American students are lagging behind white classmates in reading and math -- an achievement gap that is growing in states that once led the way in the civil rights movement. Over half of all African American students are dropping out of school in some places. There are overcrowded classrooms, and crumbling schools, and corridors of shame in America filled with poor children -- not just black children, brown and white children as well.



The state of our schools is not an African American problem; it is an American problem. (Applause.) Because if black and brown children cannot compete, then America cannot compete. (Applause.) And let me say this, if Al Sharpton, Mike Bloomberg, and Newt Gingrich can agree that we need to solve the education problem, then that's something all of America can agree we can solve. (Applause.) Those guys came into my office. (Laughter.) Just sitting in the Oval Office -- I kept on doing a double-take. (Laughter and applause.) So that's a sign of progress and it is a sign of the urgency of the education problem. (Applause.) All of us can agree that we need to offer every child in this country -- every child --



AUDIENCE: Amen!



THE PRESIDENT: Got an "Amen corner" back there -- (applause) -- every child -- every child in this country the best education the world has to offer from cradle through a career.



That's our responsibility as leaders. That's the responsibility of the United States of America. And we, all of us in government, have to work to do our part by not only offering more resources, but also demanding more reform. Because when it comes to education, we got to get past this whole paradigm, this outdated notion that somehow it's just money; or somehow it's just reform, but no money -- and embrace what Dr. King called the "both-and" philosophy. We need more money and we need more reform. (Applause.)



When it comes to higher education we're making college and advanced training more affordable, and strengthening community colleges that are the gateway to so many with an initiative -- (applause) -- that will prepare students not only to earn a degree, but to find a job when they graduate; an initiative that will help us meet the goal I have set of leading the world in college degrees by 2020. We used to rank number one in college graduates. Now we are in the middle of the pack. And since we are seeing more and more African American and Latino youth in our population, if we are leaving them behind we cannot achieve our goal, and America will fall further behind -- and that is not a future that I accept and that is not a future that the NAACP is willing to accept. (Applause.)



We're creating a Race to the Top fund that will reward states and public school districts that adopt 21st century standards and assessments. We're creating incentives for states to promote excellent teachers and replace bad ones -- (applause) -- because the job of a teacher is too important for us to accept anything less than the best. (Applause.)



We also have to explore innovative approaches such as those being pursued here in New York City; innovations like Bard High School Early College and Medgar Evers College Preparatory School that are challenging students to complete high school and earn a free associate's degree or college credit in just four years. (Applause.)



And we should raise the bar when it comes to early learning programs. It's not enough just to have a babysitter. We need our young people stimulated and engaged and involved. (Applause.) We need our -- our folks involved in child development to understand the latest science. Today, some early learning programs are excellent. Some are mediocre. And some are wasting what studies show are by far a child's most formative years.



That's why I've issued a challenge to America's governors: If you match the success of states like Pennsylvania and develop an effective model for early learning; if you focus reform on standards and results in early learning programs; if you demonstrate how you will prepare the lowest income children to meet the highest standards of success -- then you can compete for an Early Learning Challenge Grant that will help prepare all our children to enter kindergarten all ready to learn. (Applause.)



So these are some of the laws we're passing. These are some of the policies we are enacting. We are busy in Washington. Folks in Congress are getting a little tuckered out. (Laughter.) But I'm telling them -- I'm telling them we can't rest, we've got a lot of work to do. The American people are counting on us. (Applause.) These are some of the ways we're doing our part in government to overcome the inequities, the injustices, the barriers that still exist in our country.



But all these innovative programs and expanded opportunities will not, in and of themselves, make a difference if each of us, as parents and as community leaders, fail to do our part by encouraging excellence in our children. (Applause.) Government programs alone won't get our children to the Promised Land. We need a new mind set, a new set of attitudes -- because one of the most durable and destructive legacies of discrimination is the way we've internalized a sense of limitation; how so many in our community have come to expect so little from the world and from themselves.



We've got to say to our children, yes, if you're African American, the odds of growing up amid crime and gangs are higher. Yes, if you live in a poor neighborhood, you will face challenges that somebody in a wealthy suburb does not have to face. But that's not a reason to get bad grades -- (applause) -- that's not a reason to cut class -- (applause) -- that's not a reason to give up on your education and drop out of school. (Applause.) No one has written your destiny for you. Your destiny is in your hands -- you cannot forget that. That's what we have to teach all of our children. No excuses. (Applause.) No excuses.



You get that education, all those hardships will just make you stronger, better able to compete. Yes we can. (Applause.)



To parents -- to parents, we can't tell our kids to do well in school and then fail to support them when they get home. (Applause.) You can't just contract out parenting. For our kids to excel, we have to accept our responsibility to help them learn. That means putting away the Xbox -- (applause) -- putting our kids to bed at a reasonable hour. (Applause.) It means attending those parent-teacher conferences and reading to our children and helping them with their homework. (Applause.)



And by the way, it means we need to be there for our neighbor's sons and daughters. (Applause.) We need to go back to the time, back to the day when we parents saw somebody, saw some kid fooling around and -- it wasn't your child, but they'll whup you anyway. (Laughter and applause.) Or at least they'll tell your parents -- the parents will. You know. (Laughter.) That's the meaning of community. That's how we can reclaim the strength and the determination and the hopefulness that helped us come so far; helped us make a way out of no way.



It also means pushing our children to set their sights a little bit higher. They might think they've got a pretty good jump shot or a pretty good flow, but our kids can't all aspire to be LeBron or Lil Wayne. (Applause.) I want them aspiring to be scientists and engineers -- (applause) -- doctors and teachers -- (applause) -- not just ballers and rappers. I want them aspiring to be a Supreme Court Justice. (Applause.) I want them aspiring to be the President of the United States of America. (Applause.)



I want their horizons to be limitless. I don't -- don't tell them they can't do something. Don't feed our children with a sense of -- that somehow because of their race that they cannot achieve.



Yes, government must be a force for opportunity. Yes, government must be a force for equality. But ultimately, if we are to be true to our past, then we also have to seize our own future, each and every day.



And that's what the NAACP is all about. The NAACP was not founded in search of a handout. The NAACP was not founded in search of favors. The NAACP was founded on a firm notion of justice; to cash the promissory note of America that says all of our children, all God's children, deserve a fair chance in the race of life. (Applause.)



It's a simple dream, and yet one that all too often has been denied -- and is still being denied to so many Americans. It's a painful thing, seeing that dream denied. I remember visiting a Chicago school in a rough neighborhood when I was a community organizer, and some of the children gathered 'round me. And I remember thinking how remarkable it was that all of these children seemed so full of hope, despite being born into poverty, despite being delivered, in some cases, into addiction, despite all the obstacles they were already facing -- you could see that spark in their eyes. They were the equal of children anywhere.



And I remember the principal of the school telling me that soon that sparkle would begin to dim, that things would begin to change; that soon, the laughter in their eyes would begin to fade; that soon, something would shut off inside, as it sunk in -- because kids are smarter than we give them credit for -- as it sunk in that their hopes would not come to pass -- not because they weren't smart enough, not because they weren't talented enough, not because of anything about them inherently, but because, by accident of birth, they had not received a fair chance in life.



I know what can happen to a child who doesn't have that chance. But I also know what can happen to a child that does. I was raised by a single mom. I didn't come from a lot of wealth. I got into my share of trouble as a child. My life could have easily taken a turn for the worse. When I drive through Harlem or I drive through the South Side of Chicago and I see young men on the corners, I say, there but for the grace of God go I. (Applause.) They're no less gifted than me. They're no less talented than me.



But I had some brakes. That mother of mine, she gave me love; she pushed me, she cared about my education; she took no lip; she taught me right from wrong. Because of her, I had a chance to make the most of my abilities. I had the chance to make the most of my opportunities. I had the chance to make the most of life.



The same story holds true for Michelle. The same story holds true for so many of you. And I want all the other Barack Obamas out there, and all the other Michelle Obamas out there -- (applause) -- to have the same chance -- the chance that my mother gave me; that my education gave me; that the United States of America has given me. That's how our union will be perfected and our economy rebuilt. That is how America will move forward in the next 100 years.



And we will move forward. This I know -- for I know how far we have come. Some, you saw, last week in Ghana, Michelle and I took Malia and Sasha and my mother-in-law to Cape Coast Castle, in Ghana. Some of you may have been there. This is where captives were once imprisoned before being auctioned; where, across an ocean, so much of the African American experience began.



We went down into the dungeons where the captives were held. There was a church above one of the dungeons -- which tells you something about saying one thing and doing another. (Applause.) I was -- we walked through the "Door Of No Return." I was reminded of all the pain and all the hardships, all the injustices and all the indignities on the voyage from slavery to freedom.



But I was reminded of something else. I was reminded that no matter how bitter the rod, how stony the road, we have always persevered. (Applause.) We have not faltered, nor have we grown weary. As Americans, we have demanded, and strived for, and shaped a better destiny. And that is what we are called on to do once more. NAACP, it will not be easy. It will take time. Doubts may rise and hopes may recede.



But if John Lewis could brave Billy clubs to cross a bridge -- (applause) -- then I know young people today can do their part and lift up our community. (Applause.)



If Emmet Till's uncle, Mose Wright, could summon the courage to testify against the men who killed his nephew, I know we can be better fathers and better brothers and better mothers and sisters in our own families. (Applause.)



If three civil rights workers in Mississippi -- black, white, Christian and Jew, city-born and country-bred -- could lay down their lives in freedom's cause, I know we can come together to face down the challenges of our own time. (Applause.) We can fix our schools -- (applause) -- we can heal our sick, we can rescue our youth from violence and despair. (Applause.)



And 100 years from now, on the 200th anniversary of the NAACP -- (applause) -- let it be said that this generation did its part; that we too ran the race; that full of faith that our dark past has taught us, full of the hope that the present has brought us -- (applause) -- we faced, in our lives and all across this nation, the rising sun of a new day begun. (Applause.)



Thank you, God bless you. God bless the United States of America. (Applause.)

Andy Stern, president of the Service Employees International Union, weighs in more fully on a report that Democrats have agreed to jettison a key provision of the Employee Free Choice Act: "As we have said from day one, majority signup is the best way for workers to have the right to choose a voice at their workplace," Stern says. "The Employee Free Choice Act is going through the usual legislative process, and we expect a vote on a majority signup provision in the final bill or by amendment in both houses of Congress."

AFL-CIO spokesman Eddie Vale sought to downplay the news a bit, characterizing the compromise as a routine part of the legislative process. But the original Times report says that Democrats have "abandoned" the provision--commonly known as Card Check--altogether. Stern's statement suggests that a compromise on the provision itself might assuage him, calling for "a majority signup provision," but that dropping it completely won't fly.

The New York Times reports that several labor friendly Democrats, including Sens. Tom Harkin (D-IA) and Sherrod Brown (D-OH) have embraced an Employee Free Choice Act compromise to win the support of conservative Democrats. That compromise? Eliminating Card Check--the majority sign-up provision that would end the secret ballot process, and, labor leaders say, curb employer intimidation.

AFL-CIO spokesman Eddie Vale tells Ben Smith: "[T]his is the normal process of how a bill becomes a law."

We are very optimistic about passing the strongest labor law reform since the Wagner Act -- one that lets workers choose to join a union without intimidation or harassment, ensures that workers who join a union get a first contract, and has meaningful penalties for violations.


But Andy Stern seems less than pleased, tweeting, "we expect a vote in the bill or by amendment on majority sign-up in both houses of Congress."

I'm told a fuller statement is on its way, but clearly this compromise won't go down without several spoons full of sugar.

Earlier this week, we told you over at TPMDC about the newly named members of what's being called the Pecora II commission, which has been given the crucial task of getting to the bottom of the financial crisis.

The stakes are high here. If we're ever to come to a full understanding of the causes of an episode that has created enormous pain, dislocation, and anxiety for a large number of Americans -- allowing us to craft policies to ensure it doesn't recur -- we need an effective commission. In other words, one that's capable of conducting an aggressive investigation that goes after the truth and lets the chips fall where they may, even if that means publicly calling out powerful Wall Street interests and lax Washington regulators. And not one that settles for making a few polite recommendations while protecting its political overseers -- as too many Washington commissions have done in the past.

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The House Ways and Means Committee voted landmark health care legislation out of committee this morning on a 23-18 vote. Three Democrats--Reps. Ron Kind (D-WI), Earl Pomeroy (D-ND) and John Tanner (D-TN)--joined Republicans in opposing the bill.

Ways and Means has jurisdiction over taxation, and approved a financing measure that would impose a surtax on wealthy Americans. That provision, though, may be a non-starter in the Senate.

The Education and Labor, and Energy and Commerce Committees are still at marking up the same bill. Energy and Commerce is expected to round out work on the bill next week, although due in part to the political make-up of the panel, that will be a harder climb.

A Thursday New York Post piece made a number of startling claims about Democratic health care reform proposals, which, the authors claim, will devastate the wealthy. Take a look at the associated chart, which was fronted on Drudge.



Notice a problem? Take the single gentleman on the top left, who earns $285,000. House Democrats would charge a surtax of one percent on every dollar he makes over $280,000. That means one percent of $5,000 or $50. But according to the Post he'll be on the line for one percent of his entire salary--an extra $2,850. Can you say "marginal taxation?" Apparently they can't at the post.

A Democratic aide sends over the following corrective:



One should note that a major source for the post article was the Tax Foundation, which releases an annual anti-tax "report" that the non-partisan Center for Budget and Policy Priorities blasts year in and year out for its numerous inaccuracies. Looks like they did no better on this project.

Former Rep. Chip Pickering (R-MS) and erstwhile C Street resident turned down Trent Lott's old Senate seat so he could be with his mistress, according to the lawsuit filed by his estranged wife this week.

The suit alleges that when Trent Lott resigned in 2007, Gov. Haley Barbour offered Rep. Pickering the seat. But the congressman turned it down after his girlfriend, Elizabeth Creekmore-Byrd, "insisted" that their relationship could not continue if he accepted the seat, as he would have to stay married for public appearances. She allegedly gave him an ultimatum, and he chose her.

A spokesman for Barbour told Muckraker that he never offered Pickering the seat.

Shortly afterward, the suit says, Pickering moved out of his home. He filed for divorce in 2008, but that case is sealed.

Other gems from the suit, which Leisha Pickering filed against Creekmore-Byrd for alienation of affection:

Creekmore-Byrd is allegedly on the board of Telepak, her family's Internet company, which employs the lobbyist organization Capitol Resources. Pickering claims the mistress got her husband a job with the lobbyists. (A visit to the company's web site shows he does work in their Mississippi office.)

The suit alleges that Creekmore-Byrd aimed "to entice and tortuously interfere" with the Pickerings' marriage, with the help of seven unnamed defendants. It also says the alleged mistress's actions would "evoke outrage and disgust in civilized society."

Pickering alleges that Creekmore-Byrd showed up at a family ski vacation intending to cause a marriage-ending rift.

Leisha Pickering apparently gleaned this information from her husband's journals and other documents, which a judge ordered returned to Rep. Pickering. The judge also apparently forbade Mrs. Pickering and her lawyers from discussing what was in the documents.

You can take a look at the lawsuit here.

TPMDC's roundup of the biggest initiatives on Capitol Hill.

  • Health Care: Three House committees are now holding mark-up hearings on health care legislation. At the Energy and Commerce hearing, seven Blue Dogs gave identical opening statements--which I've placed below the fold--restating their desire for a health care bill that cuts costs, but eschews cost cutting measures. They're countered by House progressives, dozens of whom have silently committed to oppose any health care bill without a public option. And in the Senate, things still just don't seem to be coming together.


  • Nominations: Fire fighter Frank Ricci--better known as the thorn in Sonia Sotomayor's side--finally had his moment in the sun. But even Sen. Jeff Sessions is saying she won't be filibustered.

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If you have about a half hour to kill tonight or tomorrow or over the weekend, take a look at this video, produced by Senate Republicans:



Sens. Tom Coburn (R-OK) and John Barrasso (R-WY) are among the Senate's more conservative members. But they're also M.D.s! (You may remember Coburn from TPMMuckraker's reporting on the John Ensign scandal as the conspirator who has pre-emptively refused to testify citing patient-doctor confidentiality.)

Now he's back, with his colleague from Wyoming, using his professional degree to give questionable cover to his political aims. This isn't new to the Republican party. Recall that in 2005, then-Senate Majority Leader Bill Frist (R-TN) said he disagreed with physicians' diagnosis of a vegitative Terri Schiavo, based on videotaped footage he'd viewed in his office. Frist is a heart surgeon.

A couple more data points for you. The LA Times Johanna Neuman describes House health care legislation as "a bill that could end up costing taxpayers $1.5 trillion over the next 10 years." And the New York Daily News calls it as a "massive $1.5 trillion measure" that will "hit the rich hardest."

Even if the Associated Press was correct about the cost of the bill, that wouldn't reflect the cost to taxpayers, which will be much, much lower. A large percentage of the outlays are expected to be financed by savings wrung from within the health care system itself

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