WASHINGTON - Shaking off a summer of setbacks, President Barack Obama summoned Congress to enact sweeping health care legislation Wednesday night, declaring the "time for bickering is over" and the moment has arrived to protect millions who have unreliable insurance or no coverage at all.
Obama said the changes he wants would cost about $900billion over a decade, "less than we have spent on the Iraq and Afghanistan wars, and less than the tax cuts for the wealthiest few Americans" passed during the Bush administration.
He asked a critical Congress and a skeptical nation to reach consensus on a sweeping overhaul that has eluded lawmakers for generations.
"I am not the first president to take up this cause, but I am determined to be the last," Obama said, adding, "Our collective failure to meet this challenge - year after year, decade after decade - has led us to a breaking point."
After months of insisting he would leave the details to lawmakers, he presented his most detailed outline yet of a plan he said would provide "security and stability" to those who have insurance and cover those who do not, all without adding to the federal deficit.
The president devoted much of his address to making the case for why such a plan is necessary and sought to reassure the elderly and those who already have insurance that it would not take something from them.
In forceful, direct language, often punctuated by applause, Obama decried his opponents' "scare tactics" and appealed to the conscience of the nation. With the widow of Sen. Edward M. Kennedy sitting in the House gallery, he read a letter Kennedy had written him, in which he said that health care 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."
Many of the ideas Obama outlined were not new. He reiterated his support for a "public option," a government-backed insurance plan to compete with the private sector, while saying he would consider alternatives. He said his plan would make it illegal for insurance companies to deny coverage to people with pre-existing conditions or to drop people who are sick. He proposed that all Americans be required to carry health insurance, in much the same way drivers are required to carry auto insurance.
But Obama did embrace some fresh proposals.
He announced a new initiative to create pilot projects aimed at curbing medical malpractice lawsuits - a cause that is important to physicians and Republicans. He adopted an idea put forth by Sen. John McCain, his Republican presidential rival, for high-risk insurance pools to cover those with pre-existing conditions - and praised McCain by name in the speech.
Yet, moments later, in a line apparently aimed at McCain's former running mate, Sarah Palin, Obama accused Republicans of spreading the "cynical and irresponsible" charge that the legislation would include "death panels" with the power to hasten the deaths of senior citizens.
Republicans seemed primed for a fight. Many, like Sen. Charles E. Grassley, R-Iowa, who has been deeply involved in health negotiations, released statements about the speech even before it began. Grassley called on Obama to "start building the kind of legislation that could win the support of 70 to 80 senators" - a goal that Grassley said could not be achieved if the bill contained a new government plan.
While Obama was addressing lawmakers, the much more important audience was outside Washington: the 180 million Americans who already have health insurance and who remain skeptical that Obama's plan will change things for the better. Inside the chamber, the president drew laughter when he said, "there remain some significant details to be ironed out."
Obama's challenge quickly became clear as heckling erupted from Republican lawmakers, several of whom waved signs.
In an unusual outburst from the Republican side of the House chamber, Rep. Joe Wilson, R-S.C., shouted out "You lie!" when the president said illegal immigrants would not benefit from his proposals. The president paused briefly and smiled, but from her seat in the visitor's gallery, first lady Michelle Obama shook her head from side to side.
In a statement, Wilson said later that he regretted the incident. "While I disagree with the president's statement, my comments were inappropriate and regrettable. I extend sincere apologies to the president for this lack of civility."
Obama made clear in his speech that he would have little tolerance for Republicans who were determined to defeat him. "I will not waste time," he said, "with those who have made the calculation that it's better politics to kill this plan than improve it."
Reaction from Florida lawmakers reflected the partisan divide that has made compromise so difficult.
Democratic Sen. Bill Nelson praised the inclusion of insurance exchanges "that will help the nearly one-in-four Floridians who don't have or cannot get affordable health insurance."
Rep. Vern Buchanan, R-Sarasota, said the focus needs to be on "common-sense reforms such as eliminating waste, fraud, and abuse, reducing frivolous lawsuits, coverage of pre-existing conditions, ensuring portability and preserving the doctor-patient relationship."
For Obama, the speech was a go-for-broke moment; there is no more dramatic venue for a president than an address to a joint session to Congress.
Despite deep-seated differences among lawmakers, Obama drew a standing ovation when he recounted stories of Americans whose coverage was denied or delayed by their insurers with catastrophic results.
"That is heartbreaking, it is wrong, and no one should be treated that way in the United States of America."
Times staff writer Alex Leary contributed to this report. Information from the New York Times and Associated Press was also used.
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The key points of the health care plan President Barack Obama outlined in his speech Wednesday night:
-Current coverage:Those who are getting employer-provided coverage or are insured through Medicare, Medicaid or the Veterans Administration would not be required to change plans or physicians.
-Cost:About $900 billion over 10 years.
-How it would be paid for:By finding "savings within the existing health care system" by trimming waste and rooting out fraud. Also, insurers would be charged a fee for the most expensive policies.
-Health insurance exchanges:Consumers and small businesses without coverage could comparison shop at these marketplaces among private and perhaps also public plans.
-Pre-existing conditions:Insurers would not be permitted to deny coverage because of pre-existing medical conditions.
-Public option: People without coverage may be able to choose a not-for-profit government-run insurance plan with the same rules and protections that private insurers have.