President Barack Obama pulled together the Senate and the House, Republicans and Democrats and proponents and opponents in what he called “a season of change” to reform the nation’s health care system, outlining bipartisan ideas that he envisions making a difference.

Barack Obama

In a nearly hour-long speech before the two houses of Congress Sept. 9, Obama called for an end to denying coverage based on pre-existing conditions, called a government-run insurance plan “an additional step” to hold private insurers accountable and said one key to paying for reform is to have insurers pay a fee for those accessing their top-of-the-line health plans.

With the Senate Finance Committee announcing they are expected to conclude their reform bill next week, the full Senate and Congress are soon expected to debate a bill to reach the president’s desk by the end of the year.

Following bipartisan disagreement and public divide at health care forums nationwide, Obama sought common ground in the now months-long effort to achieve reform, telling anyone in the chamber that if they have a “serious set of proposals …my door is always open,” and in the next breath indicating that he “will not waste time with those who have made the calculation that it’s better politics to kill this plan than improve it.”

“I am not the first president to take up this cause, but I am determined to be the last,” the president announced early in his address.

The president’s plan

For the first time Obama outlined what he envisions as a plan to fix the American health care system beyond his pledge for citizens to keep the plan they are happy with and provide affordable, comprehensive care to all in the United States.

Among the details of the president’s plan were making it illegal for any private insurer to exclude a person based on a pre-existing condition or drop a policyholder or “water it down” the moment someone gets sick and needs insurance the most.

To meet the goal of increasing “quality, affordable choices,” Obama called for a health insurance exchange, allowing individuals and small businesses to shop for coverage at competitive prices. In the interim to creating that marketplace – which Obama estimated could take four years to achieve – he pledged that those who cannot attain coverage due to pre-existing conditions, the government will offer low-cost coverage protecting against “financial ruin.”

That idea was proposed by Obama’s Republican challenger for the office of president, Sen. John McCain of Arizona.

“This was a good idea when Senator John McCain proposed it in the campaign, it is a good idea now, and we should embrace it,” the president said.

Obama also outlined an individual mandate to obtain coverage, and an employer mandate to provide or assist payment for coverage, offering assistance to those facing hardship. The president estimated that 95% of all small businesses would meet exemption requirements.

The president also dispelled rumors of health reform efforts, notably the creation of “death panels” providing coverage to illegal immigrants and providing federal funding for abortions.

‘An additional step’

On the topic of creating a public health insurance plan to compete with private insurers, an idea that has divided both houses of Congress as well as Republicans and Democrats, Obama said, “Without competition, the price of insurance goes up and the quality goes down.”

Vowing to not want to put insurance companies out of business, Obama said “I just want to hold them accountable.”

“An additional step we can take to keep insurance companies is by making a not-for-profit public option available in the insurance exchange,” the president said. “Let me be clear – it would only be an option for those who don’t have insurance. No one would be forced to choose it and it would not impact those of you who already have insurance.”

Obama said the Congressional Budget Office, the nonpartisan accounting office, estimated that less than 5% of Americans would sign up for such a public option.

In his rebuttal to the president’s speech, Rep. Charles Boustany (R-La.), a heart surgeon, said there was some disappointment Obama did not take the public option “off the table,” and there are other ways to provide quality care.

One idea he said has Republican support was allowing families and businesses to buy insurance across state lines, a proposal Boustany said would provide “real choice and competition to lower costs.”

The president did not shun suggestions of creating a public option only in markets where insurers are not providing affordable policies or co-ops where groups band together for greater purchasing powers, calling them “all constructive ideas,” but added “I will not back down on the basic principle that if Americans can’t find affordable coverage, we will provide you with a choice.”

Paying for change

As controversial as the public option has been, paying for massive health reform has also caused riffs on Capitol Hill. Obama said his plan would cost “around” $900 billion over the next decade.

Obama said twice he would not sign a bill that “adds one dime to the deficit now or in the future,” calling for reforms of Medicare to reduce “waste and abuse” and streamlining the current system to cover the cost of proposed change.

Obama also echoed a proposal expected to be in the Senate Finance Committee’s bill when they finalize their debate next week of a fee on insurers on their most expensive policies, an idea the president said had bi-partisan support.

The president also said while he did not see it as a “silver bullet,” he has ordered the U.S. Department of Health and Human Services to authorize demonstration projects in states regarding medical malpractice reform on “how to put patient safety first and let doctors focus on practicing medicine.”

Invoking the memory of Massachusetts Senator Ted Kennedy, who died last month as a result of brain cancer, Obama closed his speech by reminding those assembled of what the senior Democrat called “the character of our country” to come together to overcome obstacles, something needed now more than ever.

Saying he understood how difficult debate has been and the skepticism of the public on government’s role, Obama said he knows there are some who feel delaying action is “politically safe.”

“But that’s not what the moment calls for,” Obama said. “That’s not what we came here to do. We did not come to fear the future. We came here to shape it. I still believe we can act even when it’s hard. I still believe we can replace acrimony with civility, and gridlock with progress. I still believe we can do great things, and that here and now we will meet history’s test. Because that is who we are. That is our calling. That is our character.”