Obama aims to take control of health care debate

WASHINGTON (AP) — Hoping to salvage his politically endangered health care overhaul, President Barack Obama will give a State of the Union-style address featuring fresh and more detailed arguments for revamping the system.

Scheduling of the speech for Wednesday, just a day after lawmakers return from their August recess, underscores the determination of the White House to confront critics of Obama's overhaul proposals and to buck up supporters who have been thrown on the defensive. Allies have been urging the president to be more specific about his plans and to take a greater role in the debate, and aides have signaled he will do that in the address to a joint session of Congress in the House chamber.

The speech's timing also suggests that top Democrats have all but given up hope for a bipartisan breakthrough by Senate Finance Committee negotiators. The White House had given those six lawmakers until Sept. 15 to draft a plan, but next week's speech comes well ahead of that deadline.

It follows an August recess in which critics of Obama's health proposals dominated many public forums. Approval ratings for Obama, and for his health care proposals, dropped during the month.

Obama must choose between accepting a somewhat modest bill, probably focused on broader insurance coverage and capable of winning widespread support in Congress, and a more ambitious and expensive bill that could displease crucial moderate Democrats in the House and Senate.

Vice President Joe Biden suggested Thursday that Obama will not be timid.

"We're going to get something substantial," he told a gathering at the Brookings Institution. "It's going to be an awful lot of screaming and hollering before we get there. But I believe we're going to get there."

Biden said Obama will lay out the main options for a health care overhaul and "what he thinks those pieces have to be and will be."

White House senior adviser David Axelrod told reporters Wednesday, "We believe this is the best way to kick off the final discussions, the final debate, and bring this thing to a close in a way that is meaningful."

Axelrod said earlier that all the key ideas for revising health care are "on the table," suggesting Obama will not offer major new proposals.

But he may talk more specifically about his top priorities, and perhaps add details to pending plans, to save a high-profile initiative whose defeat would deliver a huge blow to his young presidency. Obama has spoken forcefully for rules that would prevent health insurance companies from denying coverage based on an individual's health history and providing subsidies to low- and middle-income Americans to obtain health insurance.

Administration officials also have said a provision on end-of-life counseling sessions, part of a House Democratic bill, would likely be dropped from any final legislation. This summer, critics labeled the sessions "death panels," and while the notion was widely debunked, it still remained contentious and scared seniors.

Many advocates of sweeping health care changes — which would include health coverage for virtually every American, greater competition among insurers and incentives to increase the quality of care instead of the number of medical procedures performed — welcomed the president's more direct role. Obama and congressional Democrats clearly lost momentum during the August recess, they say, and the president's high profile and still-considerable personal popularity are needed to change the dynamic.

"He's got to get into the nitty-gritty and embrace very concrete proposals," said Ralph Neas, head of the National Coalition on Health Care.

It's far from clear that Obama's speech will satisfy grumbling liberals. For instance, he consistently has refused to insist on a government-run program to compete with private health insurers, a top goal of liberals, even though he says he prefers such an option.

Axelrod called the public option important, but stopped short of saying it was essential to a final bill.

Republicans fiercely oppose creation of a government-run plan, and the White House has little hope of getting GOP votes in the House and perhaps the support of only one or two moderate Republicans in the Senate. Obama and White House aides have been talking directly with Sen. Olympia Snowe, R-Maine, who has proposed an alternative to the public plan.

Snowe's idea is to use the threat of a government plan to force private insurers to become more competitive and cost conscious. She has been advocating the approach for months in closed-door negotiations with fellow senators and in talks with White House aides and the president.

The precise details have yet to be worked out, but the general idea is to give the insurance industry a fixed time to show that it can stem rising medical costs. If the private carriers fail, the government-run plan would be created. The approach could be tailored so that the government plan is used only in areas of the country where one or two private insurers control the market and have failed to bring down costs.

But the government plan wouldn't have to be used in regions where consumers have a choice of insurance companies and competition has kept prices low.

However, liberals are wary of Snowe's plan, favoring a robust government-run plan.

Several lawmakers say Obama must convincingly show that he can reduce the cost of pending health care plans. Nonpartisan budget officials have said Obama's proposals could increase the federal deficit by about $1 trillion over the next decade.

In one measure of the intense opposition Obama and his allies faced this summer, opponents of the Democratic effort outspent supporters on television commercials in August for the first time this year, according to a company that monitors political advertising.

Foes of the Democratic drive spent $12.1 million last month, compared with $9.1 million for backers of the effort, according to Evan Tracey, president of the Campaign Media Analysis Group in Arlington, Va. The U.S. Chamber of Commerce and several conservative groups were the biggest advertisers against the health care overhaul, while the drug industry, labor and AARP spent the most on the effort's behalf.

Associated Press writers Ricardo Alonso-Zaldivar, Alan Fram and Ben Feller in Washington, Mike Glover in Iowa, and Mead Gruver in Wyoming contributed to this report.

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