WASHINGTON—Aiming to move the healthcare debate beyond its current state of acrimony, President Obama on Wednesday stood before Congress and outlined a plan that he said would improve medical insurance for Americans who have it and make it affordable for those who don't.
The president put a specific price tag on his ideas for the first time, saying the bill would cost $900 billion over 10 years. That is tens of billions of dollars less than legislation now moving through the House.
After a summer marked by partisan fighting, Obama cast himself as a voice of reason, urging lawmakers to set aside their differences.
"The time for bickering is over," he said. "The time for games has passed. Now is the season for action."
But while the president said that he wanted to "bring the best ideas of both parties together," the healthcare debate increasingly has become a discussion among Democrats -- with all but a few moderate Republicans removing themselves from the central negotiations.
Tensions between the parties were on display as Obama spoke: Republicans booed when the president challenged the idea that the legislation would set up panels of bureaucrats to ration healthcare and "kill off senior citizens," calling that claim "a lie, plain and simple."
Rep. Louie Gohmert (R- Texas) took the unusual step of holding up a placard during the speech that said: "What Bill? What Plan?" And another Republican lawmaker, Rep. Joe Wilson of South Carolina, shouted: "You lie!" as Obama said that his healthcare overhaul would not cover illegal immigrants. Wilson later called the White House to apologize.
In laying out his preferences for the healthcare legislation, much of what the president said was familiar: The bill should require almost all individuals to carry basic insurance, and the government should provide subsidies to many people who cannot afford to buy coverage. The government also should start an "exchange," or marketplace, to help bring insurers and people who lack coverage together. Large businesses should be required to provide coverage.
But Obama offered some new endorsements of ways to finance the effort to expand health insurance to more people and improve care.
He backed the idea of taxing insurance companies in a way that targets the so-called Cadillac plans that offer the most generous benefits, which some critics have said encourage wasteful healthcare spending.
In an attempt to ease concerns among lawmakers about the costs of the plan, Obama proposed a new idea: a provision that would require spending cuts if expenses grew too large.
He also backed proposals to create a temporary program to insure people who cannot obtain coverage due to preexisting health problems. The program would end in four years, once the insurance exchange was in place to match consumers with insurance companies, and after the new law would bar insurers from refusing coverage based on preexisting medical conditions.
Obama also addressed the question of medical malpractice suits, an issue he had mentioned rarely. The president said he believed that fear of malpractice lawsuits may be driving some doctors to practice "defensive medicine" -- ordering unnecessary tests and procedures that drive up health costs. While giving no details, he proposed allowing states to test alternative ways to resolve malpractice lawsuits.
Early reaction to the speech included some encouraging signs for the president: While Republicans said that Obama's plan would raise health costs and add to the federal bureaucracy, some industry groups that in the past have blocked health legislation continued to praise the president.
"We commend the president for his vision. . . . We will continue to be a constructive partner to help meet this goal," said Billy Tauzin, who leads the drug industry's trade group, the Pharmaceutical Research and Manufacturers of America, which opposed healthcare overhaul efforts by Democrats in the past.
Sen. Ben Nelson (D-Neb.), a moderate whose support for health legislation was not assured, was effusive in praising the speech. "This was a game-changer," he said. The president "regained control of the message for the 200 million people who have insurance, about what's in it for them. That message had gotten lost."
Rep. Earl Pomeroy (D-N.D.), a member of the fiscally conservative Blue Dogs, said after the speech that he welcomed Obama's efforts to control the costs of any reform.
"I think he showed flexibility that we have not seen from some within the House majority on the public option," Pomeroy said. "I come away from that with new hope that maybe we can reach agreement."
The family of the late Sen. Edward M. Kennedy (D-Mass.) watched the proceedings from the balcony. His widow, Victoria, visibly fought back tears as the president recounted Kennedy's long-running fight to overhaul healthcare.
Obama acknowledged Republican senators who had worked with Kennedy over the years, among them Orrin G. Hatch of Utah, who joined with Kennedy to expand health insurance for children; John McCain of Arizona, who collaborated with him on a Patient's Bill of Rights; and Charles E. Grassley of Iowa, a Kennedy ally in the effort to ensure care for disabled children.
More than a tribute to Kennedy, the moment was an open appeal to Republican viewers to press moderate GOP senators who could make the difference in passing a final bill.
As in the past, the president argued for a government-run health plan to compete with private insurance companies and encourage them to cut the cost of their policies. But in another gesture to moderates and Republicans, he said that he did not view that as a must-have provision.
At the same time, Obama hinted that he might support proposals to allow a government-run insurance plan to start if Congress did not find other ways to provide Americans with affordable coverage.
"I will not back down on the basic principle that if Americans can't find affordable coverage, we will provide you with a choice," Obama said.
The address ended on a solemn note. As First Lady Michelle Obama clutched Victoria Kennedy's hand in the balcony, the president asked lawmakers to remember the senator's dying wish.
Ted Kennedy's passion was not born of rigid ideology, Obama said, but of his own experience as a father who saw two of his children fight cancer.
"That large-heartedness, that concern and regard for the plight of others, is not a partisan feeling," he said. "It's not a Republican or a Democratic feeling. It too is . . . a recognition that we are all in this together, and when fortune turns against one of us, others are there to lend a helping hand."