President Obama on Wednesday night sought to restart the nation's debate on health care reform with a passionate call for many key Democratic proposals and a careful endorsement of a key Republican goal: medical malpractice reform.
Seeking to regain control of a debate that deteriorated over the summer into a shouting match of untruths and unabashed partisanship, Obama endorsed the most controversial Democratic idea -- a "government option" for health insurance -- while stopping short of saying that it must be included.
Meanwhile, he reached out to Republicans concerned that doctors say they often order expensive tests only out of the fear of getting sued.
"I don't believe malpractice reform is a silver bullet, but I have talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs," Obama told a joint session of Congress. "So I am proposing that we move forward on a range of ideas about how to put patient safety first and let doctors focus on practicing medicine."
In addition, the president reversed course and endorsed funding health care reform in part through new taxes on the most expensive insurance policies -- just as Sen. John McCain, Obama's GOP opponent in the 2008 election, had
But Obama held out those olive branches only in passing, instead focusing much of his speech on the need for health care reform -- and the need to move past the angry debates and distortions of the summer.
He asked Congress to work seriously to forge a plan to offer insurance coverage to the 46 million people in America who are uninsured, while protecting people who already have insurance and reining in costs.
"Everyone in this room knows what will happen if we do nothing," Obama told a joint session of Congress. "Our deficit will grow. More families will go bankrupt. More businesses will close. More Americans will lose their coverage when they are sick and need it most. And more will die as a result.
"We know these things to be true," he added. "That is why we cannot fail."
Before an audience that included Victoria Reggie Kennedy, widow of Sen. Edward M. Kennedy, D-Mass., Obama quoted a letter he received from the senator.
"We will -- yes, we will -- fulfill the promise of health care in America as a right and not a privilege," Kennedy wrote.
In the speech, Obama endorsed many of the ideas in bills that four congressional committees have already approved. Under his proposal, every American would have to have health insurance or pay a penalty, and the government would subsidize lower-income Americans to help them pay for insurance.
Insurers could no longer deny people coverage because of pre-existing medical conditions. And a series of health insurance "exchanges" would be set up nationwide to ensure competition in areas where only a small number of insurance companies dominate the market.
While the president said he backed creation of a government insurance program to boost competition, he also indicated that it is not essential.
"To my progressive friends, I would remind you that for decades, the driving idea behind reform has been to end insurance company abuses and make coverage affordable for those without it," Obama said. "The public option is only a means to that end -- and we should remain open to other ideas that accomplish our ultimate goal."
Meanwhile, Obama told Republicans: "I say that rather than making wild claims about a government takeover of health care, we should work together to address any legitimate concerns you may have."
Obama spent a significant portion of the speech addressing the fears expressed at town hall-style meetings across the country in August.
"If you are among the hundreds of millions of Americans who already have health insurance through your job, Medicare, Medicaid or the VA, nothing in this plan will require you or your employer to change the coverage or the doctor you have," the president said.
Polls have shown that senior citizens, in particular, have grown concerned that the plan could hurt Medicare. And Obama confronted that worry.
"The only thing this plan would eliminate is the hundreds of billions of dollars in waste and fraud, as well as unwarranted subsidies in Medicare that go to insurance companies -- subsidies that do everything to pad their profits and nothing to improve your care," he said.
The president also debunked several of the other claims that opponents of the plan have made. The legislation will not force taxpayers to pay for abortion, he said, and would not offer insurance to illegal immigrants.
That statement drew an angry shout -- "You lie!" -- from Rep. Joe Wilson, R-S.C. Wilson said later he regretted the incident and extended "sincere apologies" to the president.
Obama insisted that many inaccurate claims are being spread by "those whose only agenda is to kill reform at any cost."
Most notably, he cited the claim of former Alaska Gov. Sarah Palin, the 2008 Republican vice presidential nominee, that the legislation includes "death panels" that could end the lives of the nation's senior citizens.
"Such a charge would be laughable if it weren't so cynical and irresponsible," Obama said. "It is a lie, plain and simple."
Obama also addressed a widespread and legitimate concern: that health care reform could place a burden of trillions of dollars on future generations.
Not so, the president said. He said his plan will cost about $900 billion over 10 years and be paid for by cutting waste and abuse in the system -- and by new fees on pharmaceutical and insurance companies.
"I will not sign a plan that adds one dime to our deficits -- either now or in the future -- period," he said.
Perhaps more surprisingly, Obama shifted tactics on how to raise additional funds to pay for health care. Previously a proponent of new taxes on the wealthy, Obama changed course and endorsed new "fees" on health insurers.
Such bipartisan maneuvers did not appear to have a deep impact on the bill's critics.
Rep. Chris Lee, R-Clarence, said that while he was glad Obama mentioned malpractice reform, he was disappointed that the president did not spell out in detail the savings that would help pay for reform.
"The first five points he made would all add costs to the system," Lee noted.
Meanwhile, Dr. Mark J. Lema, vice president of the Medical Society of Erie County, said he was concerned that Obama did not back away from the public option, which the doctor likened to "a cure that may be worse than the disease" because of the damage that it could do to private insurers.
Yet the speech also drew words of praise from Democrats and some other key players in the health debate.
Dr. Michael C. Cropp, president of Independent Health, lauded the Obama proposal for going beyond insurance reform and tackling the very structure of the medical system.
Rep. Brian Higgins, D-Buffalo, said the speech's "constructive" tone could refocus the debate on the issues.
"He basically said: We can do this," Higgins said.
"Tonight he set the record straight," said Rep. Louise M. Slaughter, D-Fairport.
Barry Rand, chief executive officer of AARP, agreed.
"It's time to get back to the goal of fixing our system," Rand said. ". . . We are optimistic that tonight's address will help move us toward an agreement."
Highlights of Obama's speech
*Americans would be able to keep their existing coverage and doctors if they are satisfied.
*Reform of medical malpractice system.
*Public option - a government health insurance plan - is preferred but not required.
*Highest-cost policies would be taxed.
*Strict cost control.
*Mandatory coverage for all, with fines for the uninsured.
*Cancellation of insurance due to pre-existing conditions would be prohibited.