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 has in mind would cost about $900 billion 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.
In a televised speech to a joint session of Congress, Obama spoke in favor of an option
for the federal government to sell insurance in competition with private industry. But he said he was open to alternatives that create choices for consumers -- a declaration sure to displease its liberal supporters.
Obama's speech came as the president and his allies in Congress readied an autumn campaign to enact his top domestic priority. While Democrats command strong majorities in the House and Senate, neither chamber has acted on the issue, missing numerous deadlines leaders had set for themselves.
In a fresh sign of urgency, Sen. Max Baucus, D-Mont., announced that his Senate Finance Committee would meet in two weeks to begin drafting legislation, whether or not a handful of Democrats and Republicans have come to an agreement. The panel is the last of five to act in Congress, and while the outcome is uncertain, it is the only one where bipartisanship has been given a chance to flourish.
Obama said there is widespread agreement on about 80 percent of what must be included in legislation. And yet, criticizing Republicans without saying so, he added: "Instead of honest debate, we have seen scare tactics" and ideological warfare that offers no hope for compromise.
"Well, the time for bickering is over," he said. "The time for games has passed. Now is the season for action."
"I am not the first president to take up this cause, but I am determined to be the last," he added.
The president was alternately bipartisan and tough on his Republican critics. He singled out Sen. John McCain, R-Ariz., for praise at one point. Yet moments later he accused Republicans of spreading the "cynical and irresponsible" charge that the legislation would include "death panels" with the power to hasten the death of senior citizens.
In a reflection of the stakes, White House aides mustered all the traditional pomp they could for a president who took office vowing to change Washington. The setting was a State of the Union-like joint session of Congress, attended by lawmakers, members of the Cabinet and diplomats.
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 me treated that way in the United States of America."
The president sought to cast his own plan as being in the comfortable political middle, rejecting both the government-run system that some liberals favor and the Republican-backed approach under which all consumers buy health insurance on their own.
Obama said the legislation he seeks would guarantee insurance to consumers, regardless of pre-existing medical conditions, as well as other protections. "As soon as I sign this bill, it will be against the law for insurance companies to drop your coverage when you get sick or water it down when you need it most," he added.
The president assured those with insurance that "nothing in this plan will require you or your employer to change the coverage or the doctor you have."
Responding on behalf of Republicans, Rep. Charles Boustany, R-La., said in excerpts released in advance that the country wants Obama to instruct Democratic congressional leaders that "it's time to start over on a common-sense, bipartisan plan focused on lowering the cost of health care while improving quality."
"Replacing your family's current health care with government-run health care is not the answer," said Boustany, a former cardiac surgeon.
Republicans greeted Obama's appearance politely but coolly.
"When it comes to health care, Americans don't want government to tear down the house we have," said Senate GOP leader Mitch McConnell of Kentucky.
CURRENT COVERAGE: Those who now are getting employer-provided coverage or are insured through Medicare, Medicaid or the Veterans Administration would not be required to change their plans or their physicians. Cost: About $900 billion over 10 years. How it would be paid for: By finding "savings within the existing health care system," mostly by trimming waste and rooting out fraud. Also, insurers would be charged a fee for their 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. The competition is supposed to help lower prices. The exchanges would take effect in four years.
PRE-EXISTING CONDITIONS: Insurers would not be permitted to deny coverage because of pre-existing medical conditions. Nor could they cancel or dilute coverage when people get very sick.
AFFORDABILITY: No limits on how much coverage a consumer could get in a year or a lifetime -- but limits on out-of-pocket health care expenses. Tax credits would be available for those needing aid.
PREVENTIVE MEDICINE: Insurers must cover, at no extra charge, regular preventive care and check-ups, such as mammograms, colonoscopies and routine check-ups.
PUBLIC OPTION: People without coverage would be able to choose a not-for-profit government-run insurance plan that would have the same rules and protections that private insurers do. A government-option plan might be available only if private insurers fail to meet coverage benchmarks in designated markets. Alternatively, a nonprofit co-op might administer a competitive insurance plan.
CATASTROPHIC INSURANCE: Low-cost coverage would be available in the years before the exchanges are created to protect against financial ruin in case of a serious illness.
INDIVIDUAL INSURANCE MANDATES: Everyone would have to have basic insurance. Most businesses would be required to offer insurance or "chip in" to help cover workers. Only hardship cases and some small businesses would be exempt.
MEDICAL MALPRACTICE LAWSUITS: The administration will seek experimental "demonstration projects" in different states aimed at helping to revamp the tort system.
— SOURCE: McClatchy Newspapers