Obama Vows to Deliver on Health Care

WASHINGTON (By Sheryl Gay Stolberg and Jeff Zeleny, NYT) September 10, 2009 – President Obama sought to reframe the contentious debate over health care on Wednesday, asking a critical Congress and a skeptical nation to reach consensus on legislation to expand coverage to millions of Americans and lower costs through 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,” Mr. Obama told a joint session of Congress, adding, “Our collective failure to meet this challenge — year after year, decade after decade — has led us to a breaking point.”

The speech was an effort by Mr. Obama to regain his political footing on health care, the centerpiece of his domestic agenda. 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 placed a price tag on the plan of about $900 billion over 10 years, which he said was “less than we have spent on the Iraq and Afghanistan wars.” But he devoted much of his address to making the case for why such a plan is necessary, and he sought to reassure the elderly and Americans who already have insurance that it would not take something from them.

The magnitude of his challenge quickly became clear. While Mr. Obama had been greeted by booming applause from Democrats and polite handshakes from Republicans when he entered the House chamber shortly after 8 p.m., heckling soon erupted from Republican lawmakers. A chorus of “boos” arose as the president dismissed so-called death panels as “a lie — plain and simple.”

“You lie!” Representative Joe Wilson, Republican of South Carolina, yelled back at the president, after he asserted that no illegal immigrants would receive benefits under his plan. Mr. Wilson later issued an apology to the president for what he called “this lack of civility.”

In forceful, direct language, often punctuated by applause, Mr. Obama decried his opponents’ “scare tactics” and appealed to the conscience of the nation. With the widow of Senator Edward M. Kennedy sitting in the House gallery, he read a letter Mr. 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 Mr. 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 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 Mr. 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 Senator John McCain, his Republican rival in the 2008 presidential race, for high-risk insurance pools to cover those with pre-existing conditions — and praised Mr. McCain by name in the speech.

The president also endorsed a plan, contained in a draft proposal being circulated by Senator Max Baucus, the Montana Democrat who is chairman of the Senate Finance Committee, to help pay for expanding coverage by taxing insurance companies that offer expensive, so-called gold-plated insurance plans.

And, to reassure those who do not believe the plan will not run up the deficit, he promised to include a provision that “requires us to come forward with more spending cuts” if the savings he envisions do not materialize.

In embracing Mr. McCain and the malpractice projects, the White House appeared to be seeking to lay the groundwork for an argument that the final bill will be bipartisan — not because it garners Republican votes, but because it contains Republican ideas. That is the same argument the Obama administration used early this year, when the president’s economic recovery package passed with just three Republican votes.

Republicans seemed primed for a fight; many, like Senator Charles E. Grassley, the Iowa Republican who has been deeply involved in health negotiations, released statements about the speech even before it began. Mr. Grassley called on Mr. Obama to “start building the kind of legislation that could win the support of 70 to 80 senators” — a goal Mr. Grassley said could not be achieved if the bill contained a new government plan.

The speech was the president’s second address before a joint session of Congress. But the political backdrop on Wednesday was far different from Mr. Obama’s appearance in the House chamber on the 36th day of his term, when an optimistic wave of momentum was at his back and his Republican rivals were dispirited and in disarray.

“What we have also seen in these last months is the same partisan spectacle that only hardens the disdain many Americans have toward their own government. Instead of honest debate, we have seen scare tactics,” Mr. Obama said. “Some have dug into unyielding ideological camps that offer no hope of compromise. Too many have used this as an opportunity to score short-term political points, even if it robs the country of our opportunity to solve a long-term challenge.”

He added, “And out of this blizzard of charges and counter-charges, confusion has reigned.”

While Mr. Obama was addressing lawmakers inside the ornate House chamber, the much more important audience was outside Washington: the 180 million Americans who already have health insurance and who remain skeptical that Mr. 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.”

Mr. 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.”

After the speech, Rahm Emanuel, the White House chief of staff, approached lawmakers on the floor to ask who had accused Mr. Obama of lying. Mr. Emanuel was told it was Representative Joe Wilson, Republican of South Carolina.

“No president ever has been treated like that, ever,” Mr. Emanuel told reporters.

For Mr. 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. For many Democrats, the speech evoked memories of a similar health care address by President Bill Clinton, 16 years ago this month. Mr. Clinton called for “security, simplicity, savings, choice, quality and responsibility” — the same broad themes Mr. Obama evoked Wednesday night.