“Health insurance premiums in states have gone up between 90 and 150 percent in the last decade, far faster than wages and inflation,” said Biden.

He cited a White House report from the National Economic Council showing premiums across states have been rising at a higher pace than wages over the last decade. Biden said state health commissioners’ work to protect consumers, but too often they lack the authority or face other limitations to do more.

If there’s not a fundamental change to the system, healthcare costs will overwhelm Americans and the federal budget, he said. “If we do nothing, in 10 years, one in every $5 Americans earn will be spent on healthcare,” Biden said.

“Spending by the federal government on Medicaid and Medicare alone will be 15 percent of GDP [gross domestic product] by 2040.” The speech came the same day the Senate Finance Committee began taking up Sen. Max Baucus’ legislation on healthcare reform.

Biden stressed that insurance companies should make a profit, but they also must be held accountable.

He outlined ground rules for companies, including no discrimination for pre-existing conditions. “This is not going to spell the end of private insurance,” he said. Biden said if everyone is expected to have health insurance, companies will gain tens of millions of new customers.

The commissioners association said it favors such a mandate and prefers federal rules with state-level regulation, among other things.

Officials with the association said they haven’t endorsed any legislation, but members of Congress have consulted them along the way, and Baucus’ bill keeps a place for them.

Biden said that despite the heated debate, he’s convinced there’s broad agreement. “I know this has been a loud and contentious debate; just look at some of the town meetings,” Biden said, “but the truth is we have never been this close to real reform - ever.”