President prods Congress on health-care legislation

WASHINGTON — A forceful President Obama on Wednesday laid out a series of compromises he's willing to make to get a health-care overhaul through a nervous Congress this year, including diluting his vision for a new public-insurance program and embracing ideas floated by Republicans.

In a rare evening address to a joint session of Congress, Obama decried his opponents' "scare tactics" and appealed to the conscience of the nation.

After months of leaving the bill-writing to Congress, Obama for the first time spoke of "my plan" to meet the twin goals of controlling medical costs and providing affordable care to every American.

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."

Obama said he'd require all individuals to have health insurance and would provide tax credits to people and small businesses that couldn't afford it.

Obama also asked Republicans to work with him "rather than making wild claims about a government takeover."

Obama fought back against what he called "bogus claims," calling the talk of "death panels" "laughable if it weren't so cynical and irresponsible. It is a lie, plain and simple." He also rejected claims that his proposals would increase federal funding for abortion or provide coverage to illegal immigrants.

On perhaps the most controversial single plank in his program, Obama endorsed creating a "public-option" government program to compete against private insurers, but he didn't insist that it be included.

Instead, he left room for alternatives that liberal Democrats in Congress are resisting. Those include creating nonprofit health-care cooperatives; a "trigger" mechanism for a public option to kick in later if private insurers fail to meet bench marks of coverage; or perhaps simply tightening regulations on private insurers.

He pledged that any "public option" wouldn't weaken coverage for those on Medicare or insured through their employers. He promised them "more security and stability."

In turn, Obama made it clear he intends to work with congressional Democrats to push some health-care plan through Congress this year, on a bare partisan majority if necessary.

"I am not the first president to take up this cause, but I am determined to be the last," Obama said in remarks that he hoped would breathe new life into Democrats' push to expand coverage to many of the roughly 46 million in the United States who lack health insurance.

"We are the only advanced democracy on earth, the only nation, that allows such hardships for millions of people," he said. "Now is the season for action."

Obama said his plan could be paid for mostly by eliminating "waste and abuse" from the existing health-care system, but he wasn't specific. In addition, he'd charge insurance companies "a fee for their most expensive policies" to fund his plan. Beyond that, he failed to specify how his plan would slow rising health costs.

Three House panels have written legislation that would create a public option, raise taxes on the wealthy to help pay for the plan and mandate coverage for most people. The House is expected to combine three pending Democratic bills into one and attempt to pass it this month.

The Senate outlook is cloudier and likely to take longer. Even if both chambers pass versions of the legislation, they're all but certain to differ, requiring a House-Senate conference to draft a compromise version that each house must pass.

While Obama reached out to Republicans to work with Democrats, he made it clear that he no longer will wait for them before pushing forward.

"I will not waste time with those who have made the calculation that it's better politics to kill this plan than improve it," he said.

He asked progressives to remember that before debate over the public option erupted, their central goals had been to make coverage more affordable and to better regulate insurers. "The public option is only a means to that end and we should remain open to other ideas that accomplish our ultimate goal," he said.

Hours before the address, Senate Finance Chairman Max Baucus, D-Mont., said he intends to push forward on a measure next week, regardless of whether he has GOP support.

Obama said his plan broadly includes one of the key ideas included in the Baucus blueprint, a proposal to tax insurance companies on plans worth more than $8,000 for an individual and $21,000 for families.

Obama also called for new regulations on private insurers to protect patients. He called for creating a government health-insurance exchange, or marketplace, to take effect by 2013.

Through it, many Americans could obtain lower-cost private coverage — or possibly coverage through some variation of a public plan if Congress creates one.

Until the exchange would take effect, Obama would borrow from a plan that his 2008 Republican rival, Arizona Sen. John McCain, proposed last year — to provide catastrophic coverage for those with pre-existing conditions.

In another olive branch to Republicans, Obama indicated he'd support some "demonstration projects" to try setting experimental limits on medical-malpractice lawsuits, long a Republican goal.

To deliver their rebuttal, Republicans tapped Louisiana Rep. Charles Boustany, a physician who once questioned the legitimacy of the Hawaii-born Obama's birth certificate.

Boustany said GOP lawmakers were ready to work with the president on "common sense" reforms but that "it's time to start over on a common-sense, bipartisan plan."

Compiled from McClatchy Newspapers, The Washington Post and The New York Times