Doug Mills/The New York Times

David M. Herszenhorn, on Capitol Hill, and Katharine Q. Seelye, in New York, live blogged the president’s speech and reaction tonight. President Obama laid out themes of “security and stability” in an effort to reassure Americans about his health care plans. Advance text of the speech.

Katharine Q. Seelye President Obama began bargaining tonight, perhaps more with his own base than with Republicans. He paved the way for some compromises, especially on the public option. That may satisfy some Blue Dogs but may cost him some liberals. On the other hand, where are those liberals going to go?

Probably not to the Republicans, whose reactions during the speech — with Representative Joe Wilson yelling out “You Lie!” and another checking his BlackBerry — only highlighted the anger that has swept portions of the Capitol. So did the cynical laughter that greeted his remark that some “significant details” still need to be “ironed out.”

Of course, many details remain to be ironed out. And many questions persist: Did he reassure those who are happy with their insurance that an overhaul is worth the effort? Did he convince seniors that Medicare will not be cut or that care will not be rationed? What effect will the speech have, if any, on the Senate Finance Committee?

For Mr. Obama, the campaign continues, with remarks on Thursday and a rally in Minneapolis on Saturday.

But the speech also had its distracting moments, especially Mr. Wilson’s outburst and the poignant mentions of Senator Kennedy and his family, including the mention of the letter Mr. Obama received from the senator.

From Jeff Zeleny: Mr. Wilson issued these comments afterward: “This evening I let my emotions get the best of me. While I disagree with the president’s statement, my comments were inappropriate and regrettable. I extend sincere apologies to the president for this lack of civility.”

Mr. Wilson’s outburst caused Obama to pause briefly and say, “That’s not true.”

Behind him House Speaker Nancy Pelosi could be seen glaring in Wilson’s direction, but there was no move by Democratic leaders to censure Mr. Wilson. First lady Michelle Obama, in the visitors’ gallery, shook her head from side to side disapprovingly. Neither the House nor the Senate health care overhaul bills would provide coverage for illegal immigrants, the mention by the president that prompted Mr. Wilson’s comment.

Related articles — an overview by Jeff Zeleny and Sheryl Stolberg; details of the plan by Jackie Calmes and Robert Pear.

David Kirkpatrick Chip Kahn, top lobbyist for the for-profit hospitals’ Federation of

American Hospitals, watched the president’s speech tonight. A Republican, Mr. Kahn stressed how Mr. Obama carefully parsed his support still for a public insurance option. Doctors and hospitals strongly

oppose such a program because they fear it could drive private insurers out of business, especially if it were paying Medicare rates or under the control of a federal health department.

Mr. Obama’s call for a public plan, however, omitted any discussion of what rates it might pay or who might control it, and at one point he referred to it only as a “not for profit” as opposed to government

plan. “It is the payment of Medicare rates that is the issue for us, the control by government fiat!,” Mr. Kahn said.

“He worded it really carefully, because he said ‘not for profit’ and he didn’t say it had

to be controlled by the government,” Mr. Kahn added. “The way he described it, we could support that!”

Doug Mills/The New York Times

An outburst by one of the House members during Mr. Obama’s speech has caused a little bit of a flap, and we’re still trying to sort out the details. But The Times’s Carl Hulse reported that Representative Joe Wilson, Republican of South Carolina, shouted out that the president lied as Mr. Obama asserted that his health care plan would not cover illegal immigrants. From Mr. Hulse:

Following the speech, Rahm Emanuel, the White House chief of staff, approached lawmakers on the floor to ask who had accused Mr. Obama of lying. Mr. Emanuel was told it was Representative Wilson. “No president ever has been treated like that, ever,” Mr. Emanuel told reporters.

Later on CNN television interviews, Senator John McCain, Republican of Arizona, called for Mr. Wilson to apologize, saying it would be disrespectul in any forum.

Jackie Calmes points to the biography of Mr. Wilson in CQ’s “Politics in America,” which includes this line: “Wilson’s sharp and careless remarks sometimes land him in hot water.” One example listed was Mr. Wilson’s constant criticisms of Senator John Kerry during the Democrat’s presidential campaign, and even includes a reference to Mr. Wilson’s characterization of the news that Strom Thurmond had fathered a daughter with a black woman. Even after the longtime Republican senator’s family acknowledged the paternity, Mr. Wilson called the notion a “smear on the image” of Mr. Thurmond.

Mr. Wilson, 62, whose district runs from the coastal border of Georgia into central South Carolina, from Hilton Head to Columbia, was first elected to the House in 2001.



Katharine Q. Seelye On CNN, Senator John McCain basks in the re-run of Mr. Obama’s shout-out to him, and he says soothingly that “there are a lot of things we can agree on.”

But Mr. Obama’s proposal for pilot projects on altering the malpractice system is not one of them. A pilot project, Mr. McCain said, “doesn’t get it,” in terms of limiting suits and costs.

He also said that Mr. Obama’s allusion to Mrs. Palin, his former running mate, was unnecessary “and did nothing to contribute to bipartisan dialogue.” But he went mavericky on her charge that the Democrats would create “death panels.” Asked if he believed there would be such panels, Mr. McCain said no.

Katharine Q. Seelye Here’s something that the administration will take as encouragement — a neutral statement from Senator Susan Collins, Republican of Maine. In other words, unlike many other Republicans, she didn’t trash Mr. Obama’s speech.

She, of course, is one of the very few (perhaps two or three) Republicans who may be in the persuadable camp (the other being her Maine colleague, Olympia Snowe). Ms. Collins said in her statement that she was deeply concerned about the price tag of any overhaul, but concluded on this non-committal note: “The Senate Finance Committee continues to work to come up with bipartisan legislation that addresses these concerns. I look forward to seeing what its negotiations produce.” In this debate, non-committal might be considered a win.

Katharine Q. Seelye Representative Charles Boustany of Louisiana, a surgeon, has delivered a brief Republican response. He has the same problem typical of those who deliver such responses (and not, in his case, just relative anonymity) — he is standing by himself somewhere, without the animation that comes from interacting with a live audience. At the same time, Michael Steele, chairman of the Republican National Committee, put out a statement summing up the Republican view: “The president has proven his ability again to speak very well and say very little. He continued to try and sell his government-run health care experiment even though it will increase costs, increase taxes and increase the deficit.”

From Bernie Becker “Republicans are ready – and we’ve been ready – to work with the president for common-sense reforms that our nation can afford,” said Dr. Boustany, now in his third term representing a district in southwestern Louisiana, adding “it’s clear the American people want health care reform, but they want their elected leaders to get it right.”

Dr. Boustany talked of four areas where he thought there was an opportunity for consensus, including ensuring everyone has access to coverage and allowing insurers to offer wellness incentives. But as his Republican colleagues have been doing for weeks, Dr. Boustany also stood firm against increased government involvement in the health care system. “Replacing your family’s current health care with government-run health care is not the answer,” he said. “In fact, it’ll make health care much more expensive.”

David M. Herszenhorn Lawmakers are still milling about the House chamber, but the Republican Senate leader, Mitch McConnell, has already issued a statement trashing the president’s proposals and urging him to take up Republican ideas instead. “The false choice between a massive government takeover, or no reform at all, is one that has been soundly rejected across the country,” Mr. McConnell said in the statement. For the moment, it seems, Mr. Obama’s belief that partisan acrimony can be surmounted will have to wait for another day.

The president’s speech lasted 47 minutes. He closes on a strong note:

What was true then remains true today. I understand how difficult this health care debate has been. I know that many in this country are deeply skeptical that government is looking out for them. I understand that the politically safe move would be to kick the can further down the road – to defer reform one more year, or one more election, or one more term. But that’s not what the moment calls for. 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.

Doug Mills/The New York Times

David M. Herszenhorn Mr. Obama is speaking emotionally now about the late Senator Edward M. Kennedy and his passion for providing universal health insurance to Americans. And the president just gave an important shout-out to Senator Charles E. Grassley of Iowa, the senior Republican on the Finance Committee and a lead negotiator in the effort to broker a compromise health care bill.

The TV cameras are showing Mr. Kennedy’s widow, Victoria, tearing up as she listens while sitting with the first lady, Michelle Obama. Mr. Kennedy’s children are also in attendance.

Stephen Crowley/The New York Times

Katharine Q. Seelye Perhaps surprisingly, Mr. Obama makes a nod to the clamor for changing the malpractice system (a k a tort reform). This is one way of showing he is open to Republicans. He says that changing malpractice will not be a silver bullet, but he knows that doctors practice defensive medicine, which helps drive up costs. So, he said, he would support a Bush idea of demonstration projects in individual states to test some ideas about “how to put patient safety first and let doctors focus on practicing medicine.”

Just recently, Howard Dean, the former chairman of the Democratic National Committee, noted that members of his party don’t want to tackle this issue because of the powerful trial lawyers lobby.

David M. Herszenhorn Mr. Obama was just trying to make one of the toughest arguments in the health care debate but perhaps one of the most important: that better medical care is often cheaper medical care and that government spending on Medicare can be reduced substantially not by limiting treatment and care for Americans over 65, but by providing more effective and better coordinated care. Many Americans over 65 are worried that proposed Medicare cuts would limit their access to care.

The president tries to reassure them: “So don’t pay attention to those scary stories about how your benefits will be cut – especially since some of the same folks who are spreading these tall tales have fought against Medicare in the past, and just this year supported a budget that would have essentially turned Medicare into a privatized voucher program. That will never happen on my watch. I will protect Medicare.”

Carl Hulse, the Times’s chief Congressional correspondent, is in the House chamber and says the mood is extremely tense, with very sparse Republican applause.

Katharine Q. Seelye He may be walking the wire, but he just dumped his “progressive friends.” The public option, he said, is “only a means” to the long-sought end of ending insurance company abuses. “And we should remain open to other ideas that accomplish our ultimate goal.”

Fiscal conservatives join with Democrats in jumping to their feet and applauding when Mr. Obama promises his plan won’t add a dime to the deficit. The camera focuses in closely on Senator Olympia Snowe, Republican from Maine, who is considered a critical vote for Democrats on this issue but also often raises the financial ledger in discussing how to pay for initiatives.

David Herszenhorn “It is a lie, plain and simple,” Mr. Obama says about the charge that health care legislation would create “death panels” to counsel the elderly to forgo care near the end of their lives. But almost as shocking as that false allegation is that Mr. Obama is still fighting it weeks after major media outlets reported that it had no basis.

Mr. Obama says he doesn’t want to put private insurance companies out of business. “I just want to hold them accountable,” he said, as be begins a careful tight-rope on the issue of creating a government-run health care plan, a so-called public option. What’s clear from the speech is that Mr. Obama is willing to settle for a public option on a so-called “trigger” that is, a public plan would kick in only if the health care legislation fails to provide affordable insurance for a sufficient number of Americans. Liberals will likely be disappointed. Republicans will probably not be appeased. It’s a walk on a wire, but he seems to be keeping his balance.

David M. Herszenhorn A seemingly genuine smile and applause from his old opponent, John McCain, as Mr. Obama says low-cost insurance should quickly be made available to hose who need it, even before the major provisions of any overhaul take effect in four to five years.

Katharine Q. Seelye Republicans may be applauding, some, at the big clarion calls. But elsewhere, they are more critical. The Republican National Committee, for example, notes that Mr. Obama has said that “the health care problem is the deficit problem,” and adds: “Too bad his government-run health care experiment will just make it worse.”

Light chuckles erupt in the audience as the president suggests, grinning, that there are just a few details left to be ironed out in his plan.

David Herszenhorn “That’s what Americans can expect from this plan, more security and more stability.” Security and stability seem to be a refrain in this speech, reflecting a keen awareness on the part of the White House that Americans feel deeply uncertain about the prospects of sweeping health care legislation. But Mr. Obama still faces the challenge of presenting enough detail to reassure folks who already have insurance and worry they have more to lose than to gain from any changes.

David Herszenhorn “The time for bickering is over,” Mr. Obama declared. And there was notable applause from Senator Susan Collins, Republican of Maine, and Judd Gregg, Republican of New Hampshire, two of the most earnest members of the Senate who disdain bickering but neither has expressed support for the Democratic proposals on health care.

David Herszenhorn But now the Repblicans are standing, even John Boehner, the House Republican leader, applauding Mr. Obama’s assertion that it’s better to build on the existing system than start from scratch.

Katharine Q. Seelye Who needs Pilates if you’re a Democrat and in the House tonight? The members of President Obama’s party are getting plenty of exercise, standing up and applauding at numerous lines of his speech. Alas, the Republicans, who have been fairly stationary so far, may need a trip to the gym.

David Herszenhorn Mr. Obama is making his initial pitch to the 180 million Americans who currently have health insurance — stressing the risks to every American that they could lose their coverage if they lose or change their jobs, or for any number of technical reasons. Many of these Americans are among those showing up in polls who don’t really understand what’s in the bill for them, or “what’s in this for me?” as Mr. Obama asked in an earlier speech.

And now we are starting to hear the bitter pill: Americans pay more for health care than people in any other country but get worse results. Those facts are indisputable. But another problem is that even if health care legislation is adopted, Americans will still likely pay for more health care than people in any other developed country.

The president has just given the requisite nod to Representative John Dingell of Michigan, the most senior member of the House, and a champion of a health care overhaul. His father began introducing bills for overarching health care decades ago, and Mr. Dingell continues to do so, the president notes.

David Herszenhorn Mr. Obama’s opening comments, about the improvements in the economy — “we have pulled this economy back from the brink” — are not just a bit of self-praise for his administration and Congressional Democrats but rather a pointed reminder that not a single House Republican voted for his economic stimulus package. And so his opening would seem to be a warning to Republicans who so far have opposed his health care proposals.

Doug Mills/The New York Times

Here is a transcript of the president’s advance text, released by the White House. Related article by our colleague Jeff Zeleny.



Katharine Q. Seelye The sergeant-at-arms announces his arrival into the House chamber: “The president of the United States.” Mr. Obama enters the chamber at 8:11, along with Senator Mitch McConnell, the Republican leader, grinning rather uncomfortably behind him. And not quite glad-handing his colleagues the way Mr. Obama is. Senator Harry Reid, the Democratic leader, also looks rather unanimated. Mr. Obama has an embrace — and kiss — for Mrs. Clinton. He whispers in her ear and they share a laugh.

His introductory applause as he walked the aisle and reached the podium lasted a full five minutes.

Katharine Q. Seelye Members of the Cabinet, including Secretary of State Hillary Rodham Clinton, have arrived and are making their way down the aisle. It is interesting to see Secretary of State Hillary Clinton, in a fire-engine red suit. She was so associated with health care for so long — not exactly to her advantage — but has been totally absent from the current debate. Is anyone else wondering whether she has talked with President Obama about health care? Lately? It was one of the few policy areas that the two disagreed on during the Democratic primaries.

And speaking of her husband, former President Bill Clinton, he too gave a joint speech to Congress about health care in 1993. At our sib-blog, Economix, Catherine Rampell looked at sections of Mr. Clinton’s address that might serve Mr. Obama well 16 years later.

Katharine Q. Seelye The level of rebuttal and pre-buttal flying around the Web is rather dizzying tonight. It reflects how high the stakes are. And it reflects just how many moving parts there are to a big national debate. And, of course, it reflects the sophistication on both sides of the spin machines, honed during recent presidential campaigns.

But here is an “oh, really?” moment. On MSNBC, Senator Dick Durbin, Democrat of Illinois, was asked if he explained to his junior colleague, Barack Obama, that “the politics of governing are about a thousand times more complicated than the politics of campaigning?”

Mr. Durbin replied: “Well, we did sit down and talk. And believe me, his experience in the Illinois State Senate prepared him for the rough and tumble of Congress on Capitol Hill.”

Really?

David Herszenhorn The president’s speech hasn’t even started but a sub-theme of his talk is already clear: do it for Teddy. Senator Edward M. Kennedy, the Massachusetts Democrat who died of brain cancer last month, was a strong advocate for overhauling the health care system.

And Mr. Kennedy’s family will be at the Capitol tonight in a strong showing of support for Mr. Obama. Mr. Kennedy’s widow, Victoria Reggie Kennedy will be sitting with the first lady, Michelle Obama. And Mr. Kennedy’s children will be special guests of the House speaker, Nancy Pelosi. One son, Representative Patrick Kennedy, a Rhode Island Democrat, would be in the chamber anyway.

Ted Kennedy, Jr. will be in the speaker’s box along with his sister, Kara Kennedy, and two

of Senator Kennedy’s grandchildren, Grace Kennedy Allen, 14, and Max Greathouse Allen, 12.

Mr. Obama is almost certain to pay tribute to Senator Kennedy in his speech. And with so many family members in the audience the message is clear: health care is a legacy issue for

Mr. Kennedy, the former chairman of the Senate health committee.

David Herszenhorn The Senate, led by Vice President Joseph R. Biden Jr. is arriving now in the House chamber. Mitch McConnell, the Republican leader, seems unusually chipper. Max Baucus, the chairman of the Finance Committee and a leading architect of the health care legislation is smiling tightly and shaking hands. (Here’s what Mr. Baucus had to say earlier today.)

Katharine Q. Seelye We asked our readers yesterday to tell us what they would like to hear President Obama say tonight.

The main thing is, they want him to be very specific about what he wants. In that, they are no different from members of Congress, especially Democrats who are trying to defend his goals. From the excerpts of Mr. Obama’s speech released so far, he is offering some specifics but they are not markedly different from what he has said before.

Here’s what one reader wrote: “It’s not good enough to say that there will be no rationing when funding is getting cut by hundreds of billions. It’s not believable if he says that we will pay for the healthcare for 47 million people (at $10k/person, i/e. $470 billion/year x 10 years =$4.7 trillion) – and that this will be paid for by finding ‘efficiency’. Bah.”

At the same time, some readers are fed up with numbers: “Keep it simple,” one advised. “If he starts pulling all kinds of numbers out of the air I’m going to be pulling my hair out.”

Clearly, President Obama is facing a tough audience tonight.

There are a couple of other common threads running through the comments. Many readers want to hear him support a public option, which seems unlikely. Some think he should extend Medicare, which also seems unlikely.

“President Obama should adhere to his moral pronouncements and do the right thing: a public option for competition and universal coverage as a RIGHT, not a privilege, for those who can’t afford the premiums that insurers impose,” another reader wrote.

Readers also like the idea of overhauling the malpractice insurance situation, an issue that has been raised repeatedly at the town-hall-style meetings.

“Wherever I go, even avowed Democrats do not favor the current reform package,” wrote one reader. “They want to see tort reform, more competition from the insurers themselves and less government.”

In a preview from the Capitol, David Herszenhorn offers us the leadup to tonight’s speech on health care reform:

Even before a few snippets of President Obama’s big speech on health care were released by the White House on Wednesday evening, many lawmakers and staff members on Capitol Hill were in full battle mode.

Senator Charles E. Grassley of Iowa, the senior Republican on the Finance Committee and a lead negotiator on the health care legislation, issued a statement urging Mr. Obama to use his speech to promise that he will not pursue a government-run health insurance plan.

“To start building the kind of legislation that could win the support of 70 to 80 senators, the President needs to demonstrate that he’ll fight, through the end, for a proposal that reaches common goals without creating government health care.”

Mr. Grassley also used his pre-speech statement to level blistering criticism at the versions of health care legislation approved by the Senate health committee, and by three committees in the House of Representatives.

Democrats, meanwhile, sharpened their daggers and took aim at Representative Charles Boustany of Louisiana, a former cardiac surgeon who was tapped to give the Republican response to Mr. Obama’s speech. The Democrats circulated copies of a video in which Mr. Boustany seemed to support the so-called “birthers,” whose claims about the legitimacy of Mr. Obama’s Hawaiian birth certificate have been largely discredited.

Democrats also pointed to malpractice suits brought against Mr. Boustany during his medical career (few doctors are not sued), and distributed excerpts of interviews in which he seemed to make comments critical of Republicans on the health care issue.

In terms of defining the camps, some Congressional Democrats and White House officials have expressed hope that retiring Republican lawmakers might be more likely to sign on to compromise health care legislation. But one of those departing Republicans, Senator George V. Voinovich of Ohio, lashed out even before Mr. Obama had said a word:

“To date, many of his ideas have lacked vital details and have left me with more questions than answers. I am pleased that he has pledged to clear up the ‘ambiguity’ tonight, and I hope my questions will finally be addressed.”

Mr. Voinovich also complained that Mr. Obama, in his public remarks on health care, rarely if ever mentions medical malpractice lawsuits as a factor in the nation’s high health care costs – a criticism echoed by many other Republicans. Details of the president’s plans were not revealed in early excerpts released by the White House, but the advanced text indicates that he will try to appeal to those who have differed — sometimes vehemently — with him:

“Well, the time for bickering is over. The time for games has passed. Now is the season for action. Now is when we must bring the best ideas of both parties together, and show the American people that we can still do what we were sent here to do. Now is the time to deliver on health care.

The excerpts also included a warning to some of the president’s opponents: “Know this. I will not waste time with those who have made the calculation that it’s better politics to kill this plan than improve it. I will not stand by while the special interests use the same old tactics to keep things exactly the way they are. If you misrepresent what’s in the plan, we will call you out. And I will not accept the status quo as a solution. Not this time. Not now.”



Many Congressional Democrats are extremely eager for Mr. Obama to express more specific preferences about the health care legislation, which they believe may help to resolve some outstanding internal disagreements among Democrats on many different issues. The excerpts suggest that Mr. Obama will deliver at least some specifics as he outlines his plan for overhauling the health care system. But of course there is peril in getting too specific, especially as negotiators in the Senate continue to work on a bipartisan compromise.

In the Capitol, the House chamber is ready. Security has been extra tight all day. And there will be special guests, including Victoria Reggie Kennedy, the widow of Senator Edward M. Kennedy, sitting in the box with the first lady, Michelle Obama. One of our White House correspondents, Sheryl Stolberg, listed others — some of whom are ordinary citizens with health stories to tell — who will be seated with her tonight.

Mr. Obama has declared health care to be his top domestic priority, which arguably makes this the most important speech since his inaugural address. Colleague Katharine Q. Seelye looked at other presidents and how they’ve used joint addresses during times of crises, and some not.

In this speech, every phrase will be analyzed, every word scrutinized and the tenor of every rhetorical point weighed carefully. (Minute by minute actually, with not only journalists but even the Cato Institute and the Republican National Committee live blogging the speech, and with Democrats offering rapid response.)

The question, of course, is can Mr. Obama make the big sell, not just to Congress but to the American public. Stay tuned.